Depression hurts. I know because I have it. It’s not the immediate sharp pain of a bee sting, although you wish it would be, as that would be over more quickly. Depression is usually a heavy, dull ache that feels like it will last forever. You’re numb. Why get out of bed when nothing matters? According to the Anxiety and Depression Association of America, major depressive disorder affects more than 16.1 million American adults. The World Health Organization reports that by 2020 depression will be the second-leading cause of disability in the world, second to cardiovascular disease.
Well, we’re in the middle of 2020, and every single one of our lives has changed in a way we never thought possible. As of April 20, the usually joyful stoner holiday, there were at least 2,470,410 confirmed cases of COVID-19, while 169,794 people had lost their lives to the virus. The threat of coronavirus is genuine, especially for older adults and those with compromised immune systems. To protect ourselves and others, we’re “social distancing,” isolating, staying inside, and watching our paychecks vanish as the national economy enters an unprecedented depression of its own.
“As the COVID-19 pandemic escalates in the U.S., the conditions for anxiety and depression have never been higher,” says Dr. Casey Paleos, medical director at Mindbloom, self-described mental health and well-being platform. “We’re hearing from people with pre-existing mental health conditions who are experiencing an escalation of symptoms, as well as new patients who are experiencing clinical anxiety and depression for the first time in light of COVD-19 fears and the social isolation that accompanies it.”
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Depression is not just a bad mood; it’s living in such deep emotional pain that normal functioning feels impossible. Johns Hopkins Medicine lists “stressful life events” as a leading depression trigger, which applies to literally everyone right now. I can’t tell myself that my dark thoughts are just in my head, the symptom of a treatable disease. People are dying. Businesses are closing, and expired dreams have succumbed to the new world order. Access to food is difficult in certain areas. To put it bluntly, shit has officially hit the fan.
As if the world was not cruel enough, many people are not only depressed, but have treatment-resistant depression, or TRD. For a lot of people, SSRIs (Zoloft, Paxil, Lexapro, etc.) don’t work. One 2015 study found that about 40 to 60 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks. So what about everyone else with depression?
That’s not where research ends for TRD. A plethora of research shows that ketamine, a dissociative anesthetic used in human anesthesia, veterinary medicine, and, recreationally, treats the seemingly impossible—treatment-resistant depression. “Ketamine’s antidepressant effects appear to be mediated, at least in part, by restoring the ability of brain cells to form new connections with one another, a capacity that can be impaired when the brain is subjected to chronic states of stress,” says Dr. Paleos. “When this capacity is impaired, the end result manifests itself as anxiety and depression.”
Most studies suggest that intravenous administration works effectively, leading to the rise of IV ketamine clinics across the country. Additionally, in March of 2019, the FDA approved the ketamine-derived nasal spray Esketamine.
About two years ago, I personally began using ketamine IV for treatment-resistant depression and PTSD, another disorder which studies show that K helps. Long story short, there was a Category 5 hurricane, a shooting, and some severe depression and PTSD that I wanted to address immediately. While drugs such as SSRIs take weeks to build up in your system, ketamine gets to work within days, even hours, of your treatment. I have tried just about every antidepressant on the market, and nothing has worked as well as my IV ketamine treatment.
I go to N.Y. Ketamine Infusions, run by Glen Z. Brooks, MD, and I can’t recommend it enough. I was elated to receive an email that they were still open as an essential service since COVID hit. As a life-long Democrat, it’s tempting to join in on the mantra that everyone must stay home at all costs. However, I’m aware that suicide is also a risk, and worry about quarantine exacerbating a death count from depression. Is there a way to combat depression while stuck at home?
But then I heard about Mindbloom. “Even before coronavirus, clinicians on MindBloom’s platform have already facilitated hundreds of at-home sessions very successfully with incredible outcomes and zero adverse effects,” says Dylan Beynon, founder & CEO at Mindbloom. “Because of coronavirus, the team has decided that it’s in the client’s best interest to temporarily shut down the space and enable people to start their journey with MindBloom virtual sessions.” Mindbloom is not the only psychedelic at-home service. Field Trip, based out of Toronto, is offering “COVID Coping Therapy” using meditation techniques and breathwork to recreate a psychedelic experience.
Remember, ketamine is legal. It’s used off-label for PTSD, TRD, and other mental health conditions. While it’s suggested to administer ketamine intravenously, that requires going in person to a clinic. So in the midst of the COVID-19 shutdown, Mindbloom mailed me ketamine tablets after I completed client onboarding, a video consultation, and medical history paperwork.
First, you need a guardian; for me, that’s been my boyfriend/quarantine partner. Then, you begin your session with a virtual meeting with a therapist to go over any questions and concerns. I was given 300 mg to take; however, since my IV dose is 30 mg, and oral and IV have different bioavailability, due to my protective boyfriend’s insistence on going slow, I only took 150 mg this time. After the check-in with the clinician, I got comfy in bed and placed the tablet between my gum and the bottom of my lip. I put on Mindbloom’s pre-provided playlist, which included words from Sam Harris and calming ambient music. I closed my eyes, let the ketamine calmingly wash over me, and enjoyed it. My experience was mild. I felt settled into a relaxing mental and emotional get-a-way, while the K worked behind the scenes repairing neural pathways, the benefits of which I would notice within the next 36 hours or so. While the trippy part can bring about realizations, such as the need to release toxic people in your life and better appreciate the good ones, and a sense of calm, ketamine’s real work takes place after the fact.
The last time I got a ketamine IV session was about three months ago, far before quarantine was a concern. When I first began in 2018 I did the initial six sessions in two weeks, and then began coming back roughly once every six weeks for booster sessions. Now, living under COVID, I will do at-home sessions with much more frequency. Once I was out of bed, I journaled my experience as an act of integration for half an hour, and then my partner and I chatted again with the clinician. I relayed my journaling insights, which included the realization to appreciate my partner more. I was a bit loopy, which is normal, and at least for me personally, not really a big deal. I felt calm and settled and returned to a baseline of emotional stability despite living in a collective nightmare. The effects were not as pronounced as an IV treatment, but as my experience was relatively mild, next time, I will take the full 300 mg.
There are still some barriers to entry for ketamine therapy. MindBloom charges $250 a session, which, let me tell you, is a bargain. Insurance won’t cover it. Depending on who you are quarantined with, they might be judgmental of you spending all that money for a few-hour experience. Despite the heaps of scientific evidence proving that ketamine treats depression, it’s hard to de-program some people who dismiss it as an irresponsible club drug (ketamine is quite safe when taken as instructed). Overdose is rare but taking too much can lead to fear and confusion, increased heart rate and blood pressure, and urinary tract infections. Those with existing cardiac conditions are especially at risk, and most overdoses occur when people mix ketamine with other drugs.
Based on my very limited experience, which must be expanded with a second session and a higher dose, it’s harder to feel better using ketamine during a pandemic than it is in everyday life. It’s not that ketamine is less effective, it’s just that we’re in more mentally taxing times than we’re used to. We can still care for one another, we can still create, we can still hope and dream and dance, but this is likely the worst time of many of our lives. There’s no pretty way to say it. But, there is a pretty way to say that ketamine is legitimate medicine, and depression is a formidable and even deadly side effect to COVID. Ketamine offers hope in a previously hopeless area: treatment-resistant depression. And right now, we’ll take all the hope that we can get.