Ketamine therapy is going in the mainstream. Are we ready?

But she was ready to come back in a few weeks. On her second session, she received a lower dose, and the effects of the drug were much milder. She saw a sea of ​​Japanese waving maneki nico And the statues of cats tried to find her mother’s face among them. After a day or two, she started to feel a recurring feeling that seemed new. “It was this new feeling, what if it worked out?” she told me. It was a broad and upbeat sentiment. Then one day, it was gone. “I think it’s worn out or something?” She said. “It’s funny how something you can’t talk about how you feel.”

For the counterculture therapists who have been giving ketamine to their patients for years, the current boom is seen with bewilderment rather than a modicum of concern. Phil Wolfson, co-editor of The Ketamine Papers, first took ketamine in 1990, and began giving it to select patients twenty years later. (Before that, he had used MDMA in therapy, but it was discontinued when the drug became a Schedule I substance, in 1985.) Now in his 70s, he has trained several psychotherapists in the use of ketamine, including Several psychotherapists at Field Trip Health. In his private practice, he offers psychotherapy with lozenges and more intense guided tours with intramuscular injections. He’s good at neuroscience theories about how ketamine works but considers them reductive. “Everything causes neuroplasticity,” he told me. “Having great love, or climbing a mountain, or having horrific tragedy — it all creates the movement of dendrites” — the branching ends where neurons form pathways — “because the movement of dendrites is a fundamental adaptive function. We change because of experience.” We were speaking the day after the anniversary of the death of Wolfson’s son, more than thirty years ago, of leukemia, at the age of sixteen, who each year honors Wolfson with a memorial.

Wolfson, who has a silver-haired wreath whose New York accent has resisted decades of living in California, isn’t keen on classifying ketamine as an antidepressant. He tells me that change isn’t just a chemical byproduct, and diagnostic categories only help up to a point. He believes that ketamine’s special strength lies in the way it offers a “self-timeout.” Unlike ayahuasca or mushrooms, which often produce visions that combine into narratives, ketamine usually offers a brief experience of emptiness. “Ketamine doesn’t really make sense,” he said. “It’s not related to subjective experiences—the topics don’t happen, and if it does, it might not be particularly psychological in nature. I don’t reform through neuroplasticity. I’m reformed by a break from my mental obsessions.”

The most striking results from ketamine therapy include not people like my director friend, who suffers from manageable anxiety, but those with chronic, treatment-resistant depression. Zachary Rice, a 28-year-old television writer, has met a therapist since he was 10. At the age of 16, he was diagnosed with clinical depression, and in his early twenties he was diagnosed with acute post-traumatic stress disorder and obsessive-compulsive disorder. He started taking antidepressants at the age of eighteen. Since then, he has been prescribed thirteen different medications and has attempted suicide. In March 2020, when the epidemic began to spread, he returned to suicide. Talk to his therapist and psychiatrist over the phone. Fearing that more medication wouldn’t help him fast enough, they gave him two options: hospitalization or ketamine. “Basically I knew it was a gay drug or a tranquilizer for horses,” he said.

That call was on Friday. The following Monday, Rice went to a clinic in Brooklyn Heights called Ember Health. Ember was started by an emergency medicine physician named Nico Grundman and his wife, Tiffany Frank, a strategy consultant, in 2018. Ember does not refer to narcotic experiences in his marketing materials, and in the conversation, Grundman seemed wary of the term “anaesthetic,” saying it can intimidate some patients. But he said the altered state of mind that ketamine produces is a key aspect of the company’s approach to treatment. The corporate office has rugs, sofas, and herbal tea — “like a well-stocked house,” he told me. He said Ember is trying the most evidence-based approach, which is to give ketamine by intravenous infusion, not intramuscular injection, at a dose of 0.5 to 1 milligram per kilogram of patient weight. Ember does not offer in-house psychotherapy, but the company only accepts clients who are actively treated by mental health professionals.

Rice had never taken narcotic drugs before – he had always been concerned about how they might interact with his medications. On the admissions questionnaire, he was given a full score: Severe Depression. He remembers thinking, “If this doesn’t work, at least I’ll try a great drug knowing I’m not going to die, because I’m in the doctor’s office.”

Rice put on an eye mask and a pair of headphones and was connected to an intravenous drip and a heart monitor. He was encouraged to think of a happy moment, so he considered standing at the outer edge of Yosemite Valley and watching the sunset with his friends. “Then it was as if the lights were dim in the cinema and reality was gone,” he recalls. “I flew through the valley at five thousand miles per hour and crashed into Half Dome, then Half Dome exploded into the universe and I was flying into space.” The narrator is defiant, a kind of entity or guide, with an commanding yet comforting voice. (He looked like Danny Glover, Rice said.) He asked Rice if he wanted a brain tour. Rice proceeded to salute all the people working on his brain, and then the tour moved on to the formative experiences of his life, including the deeply traumatic experiences he considers the root of his mental illness. He saw a mosaic for everyone he loved and it was important to him. “You don’t have to scare them anymore,” said the narrator. “You can be alive and that’s good and that’s good.” Rice said it was the first time in twenty years that he had had anything like a positive inner monologue. The tour concluded with a “multi-dimensional safari” where he watched the elephants spin until the safari car flexes on itself and his brain merges with the driver. When Rice regained normal consciousness, he was laughing and crying.

He was given tea and wrote what he saw. Then he took the elevator back to the streets of Brooklyn. Outside, everyone was wearing masks, and a dove emerged on him. He entered a garden and looked at the birds, crying over their beauty. He came home and did the chores he’d been putting off for years. “It was like stepping into life for the first time,” he told me, comparing it to the process of color correction when making a movie. “Ketamine is a color corrector for my existence. I saw the world as it was, without that heavy gray mass.”

Rice had four sessions over ten days, and he’s done monthly sessions ever since. Every session is special: Sometimes, he doesn’t get any visions at all, and sometimes he feels like he’s in a Windows 95 screensaver. “She died in the ketamine sessions,” he said. “I met what I was supposed to understand was God.” Sessions is five hundred dollars each, but sixty percent of the cost is covered by his insurance. He can tell that the effect of the session wears off when everyday tasks begin to feel insurmountable, he said. “It is not an exaggeration to say that ketamine saved my life,” he said. “This hourly session was more transformative for my mental health than anything I’ve done in over twenty years of therapy and medication.”

Field Trip, unlike Ember Health and New York Ketamine Infusions, appears to be interested in a broader client base than those resistant to treatment. Ben Medrano, MD, medical director of the New York Clinic, told me that he first tried ketamine and other psychedelic drugs as a warrior in the ’90s, and that the spiritual benefits of such experiences should extend to people who aren’t comfortable getting illegal drugs but can use a break from their regular mind. Lee said these benefits would not be easily verified in a laboratory or in a double-blind study. “These are therapeutic tools that reach the potential of consciousness,” he said. “And at the end of the day, we, as scientists, can’t talk about it much, because what do we say? We don’t even know where consciousness lies.”

If going to the doctor on a guided trip becomes routine, for some, like getting Botox, there will definitely be a bifurcated clinical scene: one for people who like hippie stuff and one for people who don’t want to do anything with it. In late June, I drove to the Catskills to watch a group of people undergo ketamine-assisted psychotherapy training at the Minla Institute, a Buddhist recreation center. There were a number of psychotherapists, but the group also included an emergency room physician, a military veteran working to provide narcotic-assisted therapy to fellow veterans suffering from PTSD, and an executive at a Miami-based startup called Nue Life.

Also in attendance was psychiatrist Bisel van der Kolk, whose book “The Body Keeps the Score” was first published in 2014, and frequently ranks among the top ten bestsellers on Amazon. Van der Kolk told me of his experience working on the first studies of Prozac and Zoloft as treatments for PTSD, “They weren’t bad,” he said, but they didn’t treat anyone, adding, “All you get now are the drugs that don’t It works pretty much.” Van der Kolk received an injection of ketamine from Wolfson a few years ago. “I exploded into the universe,” he told me. “I had no mental experience – I lost my body, I lost my mind.” He came off his trip doubting that ketamine could do anything, but his wife and collaborator, Licia Sky, noticed his changes afterward. Skye, who was also in training, told me, “Before, there was such a subtle current of impatience, such a willingness to get excited.” “That emotion prevailed, but your strength remained,” she continued, turning toward her husband. “It doesn’t mean we don’t disagree about things. It just means that a level of urgency is gone.”

It was a wonderful day in County Ulster. The sky was a bright blue and the mountains were bright green. The cultivators gathered in a large wooden-beamed room, in the forefront of which was a shimmering thunderbolt surrounded by three Tibetan frescoes. Wolfson had erected a small altar on one side, with a framed picture of his son. It was the fourth day of training. Half of the workshop participants will receive the injections, and the other half will monitor them. On the walls, large pieces of paper bear descriptions of the previous day’s journeys. Among the phrases people wrote were “a breath from God” and “they saw things inherited from the ancestors.” In a corner of the room, a woman prepares for her flight with some yoga poses. Others entered from a vegetarian breakfast in the dining hall of the retreat center and settled on the mats and pillows laid on the floor.

The session began with a prayer and recitation of a poem by Rumi. One of the assistants brought paper coffee cups with the names of the participants on them: each contained a syringe with a dose of ketamine. For the next hour, I watched the therapists undergo their training. The flight attendants watched them closely, sometimes taking notes or mirroring their movements. A type of drums and didgeridoo song played over loudspeakers, followed by a song prominently marked by a hammer. The woman who was practicing yoga raised her arms wide and moved her body in ecstasy. At the back of the room, a man began to cry, and an assistant came to Wolfson to ask for advice. “We need to help him listen to music,” whispered Wolfson.