Ketamine is emerging as a breakthrough treatment for mental health disorders, even ones that did not respond to other forms of treatment. However, many are still hesitant to try ketamine-assisted therapy options.
One of the reasons for that is the fear of the unknown–no one knows what it is like to undergo a ketamine treatment until they’ve experienced it. Many describe ketamine experiences as “an intense, dream-like state” that allows patients to process complex emotions, resolve past trauma, and work towards inner healing. But just like with normal dreams during sleep, memories from ketamine “dreams” often dissipate soon after waking up, making it difficult to describe what the experience was like.
However, a case report written by a team at Denovo Therapy in Lubbock, Texas, provided a unique window into ketamine experiences. The report, published in Frontiers in Psychiatry, recounts the unique actions of a patient who chose to attempt to document his thoughts, feelings, and visualizations during ketamine infusions–in real time.
The Ketamine Experience
At first, the patient asked his provider to tape a pen to his hand and hold a sheet of paper for him. The patient was able to write throughout a ketamine infusion in this way, but the notes were extremely messy and limited to a few key phrases. After that, the patient tried typing. To the surprise of all, the patient was able to type almost non-stop during multiple hour-long ketamine infusions. Full transcripts can be found here.
“I feel like I’m dreaming
The stars are so beautiful at night, they cover they sky, I wish I could see them all, just as much as I love everyone. It is so good to be here. so good to be here on earth with everyone. Everyone, I love all of you. I love you all so so so so so much!!!!!
I am experiencing beauty.
In small things
In small details and places
I want everyone to be ok
I want everyone to be ok”
I feel calm, relaxed, I can breathe
Calm, calm, peace, peace, peaceful
It’s going to be ok
I’m going to be ok
I’m going to be ok
I am excited to explore
Beauty, green, a ship, falling, a road, beautiful music, I feel at home, green, a smile, happiness, warmth, it is covering me I feel like a large warm blanket. A big blanket! Safe! I feel so safe. And happy. and calm. Thank you.”
These journals provide one of the first real-time windows into what it is like to experience a ketamine transfusion. Not only that, the report confirms the treatment benefits of ketamine–after the treatment regiment, the patient was no longer depressed or suicidal. The patient also stated that the treatments helped him process traumatic events from his past that contributed to his mental health disorders.
“We are operating a psychedelic model of care, trying to get to the transcendent experience,” McCauley explained via teleconference to me on a late-December morning. In the field of mental health treatment, the clock never stops – even during days when much of the rest of the world is enjoying time at home with their families.”
Even their name, Denovo, speaks to their “out of the box” nature – translated from Latin, Denovo means “of new.” Providers at Denovo believe strongly in this ability to create something new from both existing methods of therapy and new treatment options, a true synthesis for patients.
It’s this drive to break new ground that has led the group to its latest achievement: a new academic paper published in Frontiers in Psychiatry. This paper chronicles the treatment of a medical student with suicidal ideation, treatment-resistant depression, and post-traumatic stress disorder through ketamine infusion therapy at Denovo. Previous treatments for these conditions did little to help their symptoms, but ketamine and its associated treatments at Denovo were able to provide remarkable relief.
The Ketamine Journal
Starting with a series of ketamine infusions, the patient soon found themselves open to the possibility of more therapy, or even ketamine-assisted psychotherapy (KAP). Providers at Denovo found that it was a combination of all three that created sustained results in the patient. Once the patient saw the benefit, they elected – completely of their own volition – to journal their experience and capture their mental health journey in real-time.
Providers like the ones at Denovo aim to address a critical but often overlooked aspect of healthcare: the mental health crisis in general medical education. New treatments are paving the way for an exciting next chapter in mental health treatment, but clinical studies and research still remain few and far between compared to more traditional options.
“I have wanted to do publications since the clinic opened. Case studies are a great way to get into that world,” Ben explained. “This got started, in a sense, because of our deep desire to publish and also a deep desire to create validity for the work that we’re doing.
What I figured out in writing this one is because they’re a community-accessible clinic, they have a unique perspective on delivering real care in a community. Community care is different than research.
Much of the research available currently is in clinical trials. Applying research to a community setting is challenging because people don’t fit into the clean boxes the same way they do in the study.
I have learned that, at least for me, you can read the studies, but that doesn’t really tell you how to do the care in real life. Our case study is unique because it shows how to apply what you read to an actual patient and what it means to work within the parameters of their life.
In our case, one of those was schedule constraints. The client, in this case, study couldn’t fit into the recommended six treatment sessions. Additionally, the client had budget constraints. Ultimately, we made decisions to change these parameters to optimize the treatment.”
One crucial aspect of this case study was its nature as an N of 1 trial. N of 1 trial are a type of case study that focuses on a single patient to test a specific treatment. Through this, the researchers can learn more about how this treatment works for an individual patient and can make more accurate and personalized recommendations for treatment.
Ben explained to me how this allowed them to be flexible with some of these constraints, and instead used them as opportunities to break new ground in testing. “We went with a higher dose and a different schedule. We made changes based on how the client responded to the ketamine.”
What This Case Study Means for the Future
“I hope that this study shows that not only is there more potential for dosing but also that higher doses are already known to be safe and effective to give ketamine at these doses.”
In this particular case, the client was initially unwilling to participate in outside therapy or KAP [ketamine-assisted psychotherapy]. A lot of patients come in with that: a stigma against therapy. The IVs we did created enough healing and flexibility that, eventually, the client was willing to try some therapy sessions and KAP. It was this combination of all three that created the sustained results.”
One hotly debated topic within the greater field of ketamine infusion therapy is whether or not to embrace the psychedelic nature this treatment can have. Ben explained to me the benefit it was able to provide to this particular patient.
“The ketamine therapy created enough symptom relief and neuroplasticity, and we were able to form a rapport with the client. From there, we were able to recommend regular therapy and KAP to work on specific psychological needs.
Once the client saw the benefit after the first ketamine treatment, they elected – on their own – to try to capture the ketamine experience in real-time, live. They’re a skilled typist, so they opted to do this with a computer keyboard. Again, this was all their idea.
Initially, we were a little reluctant about this, but the client pulled it off. We started to realize there was really interesting information here. One of these things is that he was typing ketamine journals at much higher than the typical dosage – showing you that the client is having transcendental experiences. And all of this content was captured and has real value.”
Reading through the typed transcript is a unique peak into the mind of a patient in the midst of the dissociative effects of ketamine infusion therapy. At one point, it’s noted the patient asked the providers to smell cinnamon again (calming scents are common in the ‘set and setting’ mentality of ketamine infusion clinics like Denovo) and thanked the provider, but appeared to have fixated on the sounds of the keyboard clicking as they were typing.
Here is the unedited excerpt of the patient’s perspective of this sequence of events:
“This gives me perspective
Can I try cinnomin?
So happy lkjdflskdjflsdkjfsl
Cacklack, calc, lacc, lack”
So what’s next for Denovo after this paper?
“We are working on another paper but are at least a few months away currently.”
True to their character, Ben and the providers at Denovo was pleased to see something special in the results from this study: something new.
“The whole thing was surprising, honestly. From my perspective, we’re just out in the desert trying to do good psychedelic work. It wasn’t until writing the paper that I realized there’s a disconnect between community-delivered care and the research that’s out there, and we have a chance to bridge that.
It wasn’t until publication that I started to understand the potential impact this paper could have. There just aren’t studies on the dose ranges people are delivering care at out in the real world. I hope this paper helps fund some of those studies so that it becomes the standard of care for ketamine.”
Learn More About Denovo Therapy
To read this exciting new academic paper, visit Frontiers in Psychiatry.