| HN Mirror

> Is the dose administered during these sessions high enough to cause hallucinogenic effects?

Yes. It isn't effective unless you get well into a hallucinogenic state. The antidepressant effect seems to be maximized by setting the dose such that you are fairly "out there", but not so far out there that you get scared, or pass out. (Ketamine is used all the time as anesthesia for surgery, and they give you a much larger dose than is used in depression treatment, because past a certain dose, you just immediately zonk out 100%. Good ketamine therapy for depression is achieved by feathering the dose between the two extremes of zero effect and passing out.)

Hallucination means a lot of different things, but with ketamine it's pretty specific. It's not the kind of hallucination where you're looking around the room you're in and see things that don't exist. With ketamine you basically disconnect from the world you're in at the moment and go somewhere else entirely, in your own head. You will often not ingest input from your eyes, even if they're open. What goes on inside someone's head at this point varies wildly, I could tell you what it's like for me but not sure how much interest there is in that. I will say though that music has a profound impact on what goes on in my head during an infusion, and is a fun way of customizing the ketamine experience. I particularly love using my AirPods for this, because there are no wires and especially under ketamine, it feels like the sound is coming from inside your head, as opposed to feeling like you're wearing headphones.

> Could you describe what your depressive symptoms were like before/after treatment?

My depression manifest itself in extreme anhedonia, and after my 3rd infusion, I played, and enjoyed playing, a video game again, for the first time in over a year. Also, at that point in my life (3 years ago) I was going through a lot of difficult personal life problems, and dealing with those problems went from "completely insurmountable" before, to "this is shitty but I can figure it out" after.

In other words, it helped me deal with my life and enjoy things again, but it didn't turn me into someone who will never experience sadness again. It doesn't mean you'll never have a bad day again, but it does mean you'll be able to handle those bad days a lot better.

> How many sessions did it take before you saw improvement?

The way my doctor recommended starting ketamine treatment was to have 6 doses over the course of 2 weeks (m/w/f, m/w/f), and then after that "as needed", which for me turned out to be every 4 weeks. It was after the 3rd dose in my initial course of 6 that I noticed a significant effect.

> Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)?

I can answer this in two parts.

First, one reason it is effective for me is because I don't take any other drugs that conflict with ketamine. Regular benzodiazepine use, or opiate use, or lamictal (this list is not exhaustive) significantly impact the effectiveness of the treatment. Lamictal completely kills the effectiveness. I had just started on lamictal treatment a month prior to discovering ketamine treatment, and had to come off it for 10 days before starting. Same with benzos.

Second, and this is just my personal theory about my own experience, I think one thing ketamine does that helps me is to get my mind out of ruts. The experience of ego death, or near ego death, that I get with ketamine feels like a complete reset for the problems my brain was relentlessly focusing on before. Afterwards, I still care about those problems, but obsessing over the negative parts of my life abates significantly. I would say that before, my focus on the negative vs positive was quite lopsided to the negative, to the point that I rarely noticed / felt the positives. Whereas now, the two are much more balanced. I still lean a bit towards the negative, but just a bit.

One more personal anecdote: Before ketamine, I was dating a lot, but almost out of desperation because of how extremely lonely I felt, rather than because I was being thoughtful/intentional/patient about finding a great partner. The ladies I dated picked up on this quite easily, and it lead to a lot of negative outcomes. And each negative outcome felt like the world ending, which made things worse. A few months after starting ketamine I tried dating again, and it went so much better. I wasn't as desperate, and I took the time to figure out who I was and what I really wanted, and what I offered. It still took a while before I found the right partner for me, about one year after starting ketamine treatments, but we're happily married!