​I visited my BFF in New York recently and shared with him and a friend about this depression stuff and my recent depressive episode which, thankfully, I am coming out of.

​I mentioned how happy I was when I was in Costa Rica in February for two weeks and how happily I flitted from one adventure to the next last fall.
 
First, I took my 14-year-old out to Denver and visited Pike’s Peak, Buffalo Bill Cody’s Museum and Burial Ground, and listened intently as an archaeologist told us how Dinosaur Ridge was the first location where things like stegosaurus and allosaurus were ever found. We meandered the majestic red rock formations at Garden of the Gods south of Denver and climbed in the Manitou Cliff Dwellings.

​A month later I was meeting up with an old friend and her daughter in New York, exploring the Guggenheim and striding the city sidewalks like we did when we lived there 30 years earlier.
 
Then I was off to Dallas with my 17-year-old who, fascinated with JFK, wanted to see The Sixth Floor Museum at Dealey Plaza. From there we made a hardcore road trip to Jasper, Arkansas, to see an elderly friend of mine and my mother’s whom I hadn’t seen for many years, and whom I knew I’d never see again. My son was game when I coaxed him into the long drive with a promised stop in Oklahoma to learn about the Chocktaw Nation at an indigenous cultural center. The visit was sweet and poignant; a month later the friend passed away.
 
Next, I was off to Phoenix for the wedding of my college roommate. There, I reunited with our other college roommate—the three of us hadn’t been together since 1993—and instantly bonded with my friend’s new wife as well. It was profoundly sweet, fun, hilarious at times, and wonderful.

Relaying some of this to my friend in New York, he interjected.
 
“I think travel is your best medicine.”
 
I looked at him like he had just reminded me of who I was, and I have somehow been oblivious to what brings me to life. Maybe it’s just the way things have gone. The way the ball bounces. The routines I’ve gotten into. The work and home life I have chosen.

Since I've been working on this memoir and sifting through letters my father wrote me over the years, certain wisdom strikes me differently than it did when he first delivered it.

At the time he wrote this missive in 2001, it was the year I got laid off from the print-on-demand book publishing company I worked for in Philadelphia. But I had also decided to start my own business so I struck out on my own⏤the same year the Twin Towers were downed in a terrorist attack and the world stood still. Either way, I must've written to him of my struggles, whether with writing or outlook, and he wrote back. 

Dealing with depression so much in these later years, there's something about the simplicity of that statement, and maybe⏤as I'm learning more about dialectical behavioral therapy and the idea of "this exists" while "this also exists"⏤a faint experience of acceptance of my existence. Jokingly, I recently told my therapist, "Yeah, I guess if I'm not gonna off myself and I'm gonna be here, I gotta figure this shit out."

Poem excerpt from East of Nowhere, my father's unfinished novel, and words of wisdom to me

Another line in the poem struck me, reminding me of Carly Simon's "Anticipation" when she sings about "these are the good ol' days." My father writes that these are "finally the good/s times. I never knew that many that bad." And if you knew the kind of shitstorms my father would find himself in, you might wonder how that could be. But that's one thing about my father, in spite of severe alcoholism and oftentimes impaired rationale, his optimism persevered. As my brother once said, good thing Daddy wasn't all woe is me and sad sack. He would've been miserable to be around. He just kept looking to the dawn.

Check out more Chowanisms (Stuff Ed Said)

​Who knows whether it’s pain or whether it’s higher amounts of stress and general dissatisfaction with life, but I’m now officially having a “depressive episode.”

It was addressed with my therapist yesterday when I confessed I just felt like sleeping, didn’t wanna hang out with my family, was avoiding connecting with friends, and tearfully explained that I had been off of antidepressants since last autumn. It’s quite possible—I concede—that I have been able to coast through myriad life moments and experiences without the meds these many months, but now here I am and I’m low, low, low. And sinking lower.

Let alone existential depression. Let alone ketamine therapy. Let alone psychedelic medicine. What do you do when you find yourself ruminating about options?
 
Well, no, I’m not thinking of offing myself, I told her, but I’m having ideation.
 
Mine looks like this.
 
“Hmm, I don’t want to be murdered…”
 
She was visibly concerned and pointed out that this was a major downhill shift since our last chat about a month ago.
 
I’m so in it I hadn’t noticed. When you’re “in it” it feels like you’ve always been in it. That’s what I love my therapist. She reminds me of Reality.
 
So we’re having some kind of come to Jesus with the psych nurse and the clinical team. We’ll see what comes out of it. I know I have choices. My preference is not to go back on a cocktail of antidepressants and ongoing dry mouth, constipation and a state of psychological neutrality that still left me wondering why on earth anybody cares about living.
 
I’m also seeking out a psilocybin facilitator. Been growing more interested in that direction while also keeping an eye on new ketamine therapy options coming my way via Mindbloom.
 
For stabilization purposes, however, I may have to consider a return to pharma. 

As part of the comprehensive Mindbloom package, which includes not only your consult with a clinician, your prescribed ketamine pills, a trained guide or coach available to help you work through anything that comes up for you during ketamine treatment sessions, along with myriad online articles, soundtracks and supporting resources—you have access to Integration Circles.
 
These are small private groups of Mindbloom customers just like you who are on the ketamine treatment journey and are looking to “integrate” their experiences with the medicine by sharing with and listening to others via facilitated discussion. Here's how my Integration Circle went.

One of the Integration Circle leaders reached out to me several times to work me into one of her groups but they always seemed to fill up quickly and my schedule never matched up.
 
One day she announced an open slot that worked and I was able to join the Zoom call with five or six other participants.
 
To ensure privacy, discretion, respect and presence, the leader of the Integration Circle had us agree in advance on “heart-centered communication,” defined as:
 

• Not being all up in your head when someone else is talking, thinking about how their experience relates to you (great advice for communication in general)

 

• Responding respectfully and thoughtfully so people know where you’re coming from by using “When you said X I felt or thought”-type language

 

• Or “When I heard X I was curious about…” and making sure to ask people if they were open to questions or feedback vs. unsolicited commentary

 
Several participants were dealing more with anxiety than with depression, but seemingly for many years and having tried many different types of medications and therapy.
 
One guy shared about ketamine therapy and how the experience of blank thoughts and blank mind have been so peaceful. He found that journaling was also helping and he was also sleeping better. Talking with his guide, he said, had been one of the most impactful parts of his experience.
 
“I can feel the pressure building up again,” he said. “There are definitely easy and hard weeks, and how to deal with each is greatly helped by my guide.”
 
Everyone in the group seemed to nod when the topic of thinking ketamine would be a magic pill, came up. Managing expectations was an engaging topic, from how intense a “trip” would be from one session to another, to what to expect between sessions, or at completion.
 
“The work,” as one participant pointed out, “is always in between sessions, and it’s up to me.”
 
Another girl explored the idea of boredom during ketamine therapy as there are moments of vacuousness where the ethereal music seems to just go on and on and you no longer feel like much of anything but a deep meditative state.
 
“I ask boredom, What I can learn from this?” she said. “Why is it showing up now and what does it have to teach me?”
 
I was the most emotional or had the most emotional experience to share as I reflected on my first ketamine treatment in which an emotional burst and message of loss and fear came up.

Several of the participants were already at their sixth and final course of treatment and were looking to go deeper, an option to continue with other Mindbloom packages or to simply continue to integrate the experiences and insights they’d had so far to see what opened up in the coming weeks and months.
 
Among the rest of us, you could feel the anticipation of what the next ketamine therapy session would bring, and all the questions still remaining:
 

• Would it heal me?
• Would it work long term?
• Would I have to do it again?
• Am I getting what I’m supposed to get?
• Will I always be this way?

 
The chatter that’s always there. The human condition, just louder for some of us, perhaps.

So I was sitting at Poza Blanca Lodge having a lovely meal and journaling, enjoying the late-afternoon sun going down and digging the background music, a wide variety of songs that conjured happy feelings, like “Love is in the Air" and "Girls Just Wanna Have Fun."
 
Suddenly, a familiar synethesized orchestra began to play, then the plunky plunk, islandy-sounding lead-in to a song that took me instantly back to 1987 when the song "It's a wonderful, wonderful life" by British artist Black first came out. I spent a London semester abroad during the days of New Order and British New Wave bands. We listened to songs like this one day and night at our hostel in Pembridge Square, the same place where we pressed our noses up against the front dining room windows to get a glimpse of Lady Di dropping the little princes off next door at the Wetherby School every morning. 

I hadn't heard the song in ages.

Who plays this song in Costa Rica? On a playlist of otherwise ordinary songs? It seemed so out of place and immediately got my attention.

The song was haunting and melancholy and happy all at once, as Black crooned, standing out there out on his own again, up straight in the sunshine, needing a friend, not wanting to be alone.

Now it was speaking to me in the mountains of Costa Rica as if my friend Sarah were still here. She died in 2014 of the craziest thing: colorectal cancer.

Now ask me if messages from the Universe aren’t for real given that I canceled three colorectal screenings last year and I’m sitting around writing about life, death, depression and the like.
 
Black was crooning, as if Sarah was channeling right through him, “It’s a wonderful, wonderful life."
 
I got chills, then tears in my eyes.
 
I still call her my sweet Sarah angel. I mean who loses a friend to colorectal cancer in their 40s? It’s so fucked up.
 
Anyway, I vowed to get in touch with my doctor about that damn test again. The message was not lost on me.

​Then, my last night in Manuel Antonio I was sitting with my long-time friend and first-time travel buddy, Richele, at Raffael’s Terrazas looking out over the Pacific Ocean, which was bathed in golden sunlight. Richele was queuing up a song for one of our jungle videos.
 
“Wait, do you know what song that is? Oh my God.” She had picked a remake of “It’s a wonderful, wonderful life,” and I was momentarily dazed, like the message was coming through again.
 
Two weeks of “integration” after my last ketamine for depression therapy session and many moments in Costa Rica of feeling Good. Like myself, like a younger, happier, freer version of myself. One that’s connected to Life and Grateful to get up in the morning and Awed by things like pink-orange sunsets and magnificent ocean waves and vast beaches and fascinating animals and interesting people.
 
And here was that song again, chosen at random and she had no idea what it meant to me. But I knew Sarah had spoken⏤twice. From wherever she is, she had a point to make, multiple points to make perhaps.
 
And I got the message.

As part of my ketamine therapy integration work, I took a winter walk some days before I left for Costa Rica and aside from the fact that it was icy and worth watching my footing, I found myself looking down the whole time. 

​When I realized my eyes were peeled to the ground, my neck was bent, my physical energy "jagged" in a way⏤I told myself, "Look up!" Metaphorical, as it were, for looking up not only at the sky but at life with a positive, upward view.

The next few times I walked or stepped outside, I had to force my head skyward, such was the tendency to look down⏤same as our tendency as humans to always find something wrong or negative, to hijack good things in life with "yeah buts" or "hopefully x won't happen" when everything's rolling along pretty well.

Absolutely.

Here's how looking to the sky instantly changes things:

Pride and posture
It instantly changes your posture, for one, so physically you're standing taller with spine pulled erect. That alone creates a feeling of confidence and pride in self.

Bigger things in life
Visually observing the sky reminds us of the vastness with-out, momentarily pausing the detrimental daydreaming (mindfuckery), reminding us to observe, "Hey, there's the sky. Wow, there's an airplane. Look, the trees are blowing in the wind." Looking to the sky stirs awe and wonder. All that's happening out there signals to us that there is far more going on in the world than what's going on in "here" (my, at times, deteriorated mental state). 

Spiritual connection
The sky also prompts me to connect with God, the Universe, Spirit, whatever floats your spiritual boat. But something about looking up⏤it's as ancient as human history and wonderment at how it all began and how it all became and how it all will be. 

"Look up, look up!" has become a mantra, of sorts, whenever my neck is bent too long on a phone or a mundane task or the monotony of my steps. It's a reminder not to tarry too long at things that don't inspire.

One thing I've noticed is no desire to use/do ketamine in between therapy sessions. Mindbloom asks along the way if you have such yearnings, and at the beginning they surveyed me about my experience with alcohol and opioid dependency. I've had both, obviously. Alcohol in my younger years, but reliant on opioids for several sober years to deal with pain from car accidents. 

For some people, ketamine may be seductive, I'm guessing, whether physically or psychologically. As for functionality, however, there's no way in hell you can take the dosage of ketamine that was prescribed to me and then walk around your life. It's a one-and-done thing⏤lying down, preferably. And really, the whole darn trip is over in about 15 to 30 minutes. The rest is just deep reflection and what-the-fuck-just-happened-ness.

​Oh, and neuroplasticity⏤what happens to your brain in the ensuing moments, hours, days, weeks as neurons start firing in new directions.

I've read there are other ketamine clinicians or programs approaching it differently; for example, lower doses given more frequently. If I had to compare without having tried it that way, I think I prefer having deep experiences as I have done. These experiences have been sufficiently "disruptive"⏤to my experience of what is, to my belief in how things are or who I am or what I am like. Even disruptive, albeit temporarily, to my notion of pain. Experiencing my Self as pure vibratory hum indistinct from the bed and the world, even pain became⏤as I've heard it termed elsewhere⏤"irrelevant." 

Downright Spock-like.

Then there's all the stuff I've been feeling in between sessions. More emotion, whether from the profundity of the experience of/after ketamine or from no longer have three different types of antidepresssants in my body on a daily basis, all trying to keep my proverbial shit together while simultaneously wreaking unknown havoc. 

I am moved to tears more easily (if this were possible, given I'm sometimes known to be a weepy mess anyway). Going through Christmas cards this past holiday season, I held each one in my hand and every photo and message provoked some thought or memory or happy feeling and I found myself crying tears of sheer joy at sharing in other people's lives. (That's the ketamine talking, people, no kidding, and without antidepressants to stifle or neutralize the effects of life coming at me.)
​
Oh God, and then when I was packing for Costa Rica, "Samba Pa Ti" (Santana) came on. That song just about sends me over the edge any old time, but this time it had me reflecting on leaving for CR, leaving my family behind for two weeks while also reuniting with old friends once I got there, then remembering another old friend who loved this song who’s now gone. My Big Big Bursting Heart!

"What if to love and be loved's not enough?
What if I fall and can't bear to get up?" - "Stay Gold," First Aid Kit

So I'm not here to bash drugs prescribed by doctors and developed by pharma. Nothing is black and white. And what's for one is not always for all. Sometimes you need to get fixed, and fast. There may be a million and one holistic ways to sort yourself out but if you've gone batshit crazy and you're about to kill somebody or kill yourself or just disappear into a dark hole and not come out, you might wanna take whatever the hell pills they're gonna give you.

But if I hadn't decided to explore psychedelic medicine, I might not have had the gumption to venture off of antidepressants (although in my case, I kind of wandered aimlessly away from them, unintentionally). The promise of psychedelic medicine made me confident enough to let go of the daily pharmaceutical regimen and apparently, it's working.

The beach beckons. I will walk until I am satisfied in the walking. ​

My friend Cory who is something of an expert in psilocybin ("magic mushrooms") for depression, reminded me about the critical work of integration between sessions. I have to admit I've only attended one integration circle with a handful of other Mindbloom participants. I found it useful but difficult to schedule into my busy life although the circle guides have been persistently supportive, trying to accommodate me.

Meanwhile, I've been thinking about the things I've been doing intentionally to cultivate joy (one aspect of integration), like playing a daily happy song, dancing around by myself, and being with friends whenever I can.

Mind you, this is not much different from what my regular therapist has advised me in the past. During the height of the pandemic when I was seriously making plans to order enough Xanax from China to go off myself somewhere (that was probably the second worst experience of mental anguish in the five years of depression I had endured at that point), my therapist caught me in time and prescribed weekly coffee dates, in-person with friends. 

"You're a social person," she reminded me what makes me tick. "I want you to get out there and be with people, safety permitting." 

I didn't talk about the Xanax or the rest stop on the Jersey Turnpike that might be a good location to hide out and have no one miss me for a day or so. Who asks for help when they're thinking about ending it? That's the last thing I'd wanna do is talk about it. If I was really gonna do it, I'd make plans and do it and not tell a soul. I wouldn't want help at that point. I'd be too far gone in my own reckless mind and too resigned to get help.

NOTE: I am not suicidal.

I am writing this in retrospect. I had suicidal ideation quite often, for a long time. COVID triggered it again and at one low point, I really did start fantasizing about a plan. That's as far as it ever got. I've never taken Xanax. I didn't like the idea of having to come up with $300 for a shipment either. Then I remembered, "Shit, life insurance." We're beaucoup protected as a family, unless of course somebody screws it up with suicide. So that was, frankly, one of the strongest deterrents. 

Plus, my therapist swooped in along with my psych nurse, who changed up my Prozac and Wellbutrin cocktail and all was well once again. I'm glad I'm not dead (at least not like that). That's the best I can do for now as I still don't get a great thrill from living.

But I think my friend was referring more to the thoughts and insights that become available from having taken a psychedelic journey, with whatever it may be, and journaling is especially conducive to teasing it all out (which I vowed to do daily but have yet to succeed at). ​

It all started last summer when I responded to an ad for ketamine for depression with clinical therapists, all guided and overseen but from the comfort of home.

​Better yet, it was reasonably affordable. The cost of a six-session ketamine therapy program through Mindbloom is $386 x 3 - charged to my card over the course of several months. Like I said, reasonable.

Why was I interested in ketamine for depression? I've been curiously following the whole psychedelic medicine movement, noticing it gaining traction in more mainstream circles and hearing about its myriad applications for mental health issues from anxiety and depression to PTSD and other types of trauma, to addiction to alcohol and drugs.

I'm sober 30+ years, so my interest isn't so much in dealing with alcohol addiction. Fortunately, that craving was lifted from me in early sobriety. What has lingered heavily, however, over the last five years, is residual depression triggered by a car accident and exacerbated by perimenopause.

For some reason, I feel like I have to defend my decision to choose ketamine therapy and psychedelic medicine as a "last resort" when in fact⏤the more I read and understand about psychedelic medicine⏤if I could have chosen it first, I might well have done so.

Although I have eschewed the associated stigma of psychedelics, I'm still rationalizing it in my brain, like:

"You wouldn't be doing this if you didn't have issues with existential depression. You wouldn't have any 'excuse,' otherwise."

As if⏤my other viewpoint says (the one I actually believe)⏤one needs an excuse to have a mind-expansive experience that elevates mood, triggers new neuronal firings, and enhances the brain's neuroplasticity (ability to make new connections).

If you're wondering if I really tried hard enough to deal with depression in other ways, here's more about my journey to ketamine therapy as a sober psychonaut.

Ketamine, while not exactly psychedelic in the sense that LSD and mushrooms are psychedelic and produce elaborate visual and auditory experiences, is usually spoken of as a psychedelic drug.

It has been used as a legal anesthesia medication in hospitals since the early 1970s and only in recent years was discovered to be effective in lower doses as a treatment for anxiety and depression, among other maladies.

Unlike some LSD or psilocybin (mushroom) journeys, taking ketamine involves about 20 to 30 minutes of mental and physical preparation (think, nice shower, lighting candles, writing in your journal) and only about an hour-long period during which you're under the influence, if you will, of the medication.

I had my first ketamine for depression treatment in December and I have just completed my fifth out of six total treatments. I have also explored other types of psychedelic medicine, including psilocybin, in search of similar benefits.

Here are the best things I've gotten from trying psychedelic medicine:

• Feeling hopeful⏤Whether this is psychosomatic or it's genuine, the fact that I'm focused on the possibility of lifting up out of a lifetime ahead spent living with depression, is different.
  
  
• Connectedness⏤I wouldn't say it's there every moment of the day, but feeling disconnected from Self and Source was a big part of my malaise when I decided to try psychedelic medicine for depression. I've had moments during ketamine treatment of total integration, way beyond one-ness with All That Is (just yesterday morning, for my fifth ketamine therapy session, I was pure vibration, inseparable from vibration itself, with no sense of Self or my physical body at all) as well as in between sessions, when with people, noticing the sheer joy and appreciation of being with people I love to be with.
  
  
• Big love⏤It's bound to come up in the psychedelic experience at some point: Everything comes back to Love. Everything is Love. All you need is Love. I am Love. I am Loved. We are Love. Love, love, love. Maybe some people don't need to be reminded, but apparently I did.
  
  
• Creative expansion⏤This means multiple things to me. As a writer, my urge to express, inform and persuade, to put something out in the world, is scratching at the door constantly. My interests in a variety of new things, including psychedelic medicine, are expanding exponentially, and I'm hungry for learning and growing while also writing in order to help others catch a similar wave.
  
  
• Moments of not wanting to miss out on life⏤I'd say this is the closest I've come to joie d'vivre⏤the ultimate measuring stick for my happiness. I chose joie d'vivre because I used to have it so I know what it feels like and if it were ever to return I would know I have triumphed over existential depression. To have savored a few magical moments these last few months, especially in the company of old friends and family, and felt my heart swell with love for people and the moments of life I was getting to live, that was indeed something akin to "loving living.

Oh right⏤and I'm completely OFF of all antidepressants!
A multi-years' long cocktail of Prozac and Wellbutrin, and later Gabapentin for neuropathy/pain issues. 

I won't denigrate the moments in between (it's true: I've still struggled with chronic pain, stress, a gloomy mindset) but prefer to allow for the fact that I have had some benefit from my experiences with psychedelic medicine these past few months.

And on it goes. The ride ain't over. 

At the moment, I am:

• Tired 
• Weary
• Resigned
• In pain
• Anxious 
• Resistant

 
I can accept that all of that is just “life” creeping in, as it does. But I’ve been feeling it for a few weeks and questioning whether ketamine for depression is really going to do it for me.
 
This is me without antidepressants.
 
Or is this how everybody feels on Life? (Go figure⏤everybody’s on antidepressants.)
 
Throw in a wild card:
 
The pain
 
The pain
 
The pain
 
The pain
 
What started with a car accident has accelerated to severe osteoarthritis and now knee pain. Pain is what started this whole fucking depression thing with me in the first place.

Hellerhoff, CC BY-SA 4.0, via Wikimedia Commons

 Swirl, swish went the medicine (nowadays I hold this shit in my cheeks and practically gargle before I spit it out).
 
All I remember of my fifth ketamine session was the vibration. I was the vibration. It was me. I was inseparable from it and could feel no pain, no legs, no body, nothing—no sense of Self, only that I was vibration, sound and darkness. The Mindbloom music track took me there. 
 
It was, as I’ve noted in past entries, blessed relief to feel Nothing-ness. 
 
I had very few visuals because it was so dark but when I could see it was just the most exquisite, satisfying sense of Self; Self as Everything, moving as one through all of it—a black, pillowy sky with dim stars and no physical heaviness to contend with. I experienced the greatest comfort being cradled by All-ness. By Being All-ness.
 
I was tripped out, man!
 
It was all vibratory and humming—the audio—and when I finally noticed my body again, it was like being buried up to your neck in sand at the beach. Maybe a toe could be sensed somewhere. Perhaps more like being a melted chunk of chocolate, stuck and half-absorbed into the earth for good.
 
Things became more landscape-y, the music more harmonious, ethereal, and then it seemed to go on forever, making me wonder if that intense part happens for barely 15 to 30 minutes and the rest of the hour I’m just cruising, wandering, waiting for the clock. Time gets lost in down in a K-hole—and I was there for sure.
 
(Mindbloom and psychedelic therapists who practice ketamine therapy for depression probably prefer not to use the term K-hole as that’s more associated with dance party drug trips on ketamine and with ketamine abuse.

I’m just sayin’, the K train came and it was the express. I got on and went all the way.

Here's how it shook out on each intention I created:

Trust – I trusted the medicine and the journey
 
Hope – I experienced painlessness, thus a glimmer of hope
 
Vitality – I was sparked because of the adventure I had just returned from.

The real work, however, still happens in real life; that is, in between sessions. My friend Cory reminded of the importance of doing the integration work so I'll be writing more about that soon.