Getting advice on integration after ketamine for depression

Read Sober Psychonaut disclaimer for people in sobriety exploring psychedelic medicine

My first follow-up integration session with Katherine, my ketamine clinician.
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She skimmed the notes my guide had written about the emotional flood I had experienced at the start of my first ketamine session. I thought about what I was going to say about the last few days. Not much had opened up it seemed.

But when she asked me what things were like for me, I couldn’t help but blurt out that I felt a bit easier, lighter.

“I spent the evening decorating the Christmas tree with my boys and husband.”

“Is that different for you, being easier, lighter?”

“Not really, it’s just I’ve been somewhat more hopeful, I guess, had a more hopeful feeling about things, since this whole thing started.”

“Good,” she said.

Getting the right ketamine dosage for depression

She then asked about my first ketamine journey, which I described as intense at the very beginning, as though I were going to be in that state the whole time, but then it waned and evened out and I was just in a deeply relaxed state lying there on the bed. I let my mind wander without trying to control anything.

“Did you have any body sensations?”

“No, nothing in particular.”

“The reason I ask is I started you with the 400mg dosage. Do you think you need a higher dose?”

“I think I could probably use a higher dose, but I’m not the prescriber,” I laughed.

“Well I mean—could you feel your legs?”

“Oh yeah, I was aware of my body, the blankets, the feel of everything around me.”

“Okay, when you achieve the right dose you have a dissociative experience from your body. You can’t feel your legs. You’re removed from your physical self.”

(Oh right, I’m thinking to myself, I remember that from my recreational ketamine days. I just wasn’t sure what low doses of ketamine were supposed to feel like.)

“So I’m going to up your dose by 125 mg to 525 and see how you do with that. We’ll get that ordered and it looks like they’re backed up with shipping, possibly until late-January.”

Bummer, I’m thinking. I was hoping for back-to-back experiences all through the holidays and I’d be magically cured in 2022.

“Okay.”

'I don't want to be left alone' message from ketamine therapy

Then we talked about my “stuff.”

“Let’s talk about this ‘I don’t want to be left alone in this world’ statement. How young is the person saying that?”

“Pretty young,” I recognized it right away, “like two.”

“Two years old! Yes, a child left alone in the world with all these adults, not wanting to be abandoned. Of course that’s terrifying for a two-year-old. But whenever that happens, you can say to her that you’re right here, you’re a 53-year-old adult woman and everything’s okay and she’s not alone.”

Reading this back to myself I wonder though, what if my 53-year-old self is also terrified of being left alone? I’ll have to run that one by her another time, if it’s still there.

​“How about physical activity?”

“Um, yesterday I went for a walk with my work walking buddy, we FaceTime.”

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Thank God we walked for the first time in weeks. Otherwise I would’ve had to tell the truth, that I’d been sitting like a slug in my living room chair.

“Otherwise, I haven’t done much.”

“Okay, you’ll definitely want to mother the body just like you’re mothering your spirit and doing these other things for yourself. You’re expanding in these other ways and it’s important to take time to nurture your physical self.”

“Got it,” I nodded, wondering how I was going to break out of my lazy rut.

She also suggested an article [30+ Techniques to Help Integrate Psychedelic Experiences] so I’ll be reading that one.

Ketamine therapy and weaning from antidepressants

“Oh, by the way," I announced. "I am completely off Prozac and Wellbutrin now."

I accidentally weaned myself from antidepressants because I forgot to take them when traveling. But now I’d noticed a real dip in my energy level. My regular therapist has advised me in the past, if my energy level dips, my mood dips, and if my mood dips, it can trigger depression. I wondered what Katherine thought about this, in light of ketamine therapy for depression.

Katharine has short, cropped, salt-n-pepper hair, lovely smooth skin, a no-nonsense forthrightness about her and clearly a strong background in psychology while also being able to point to universal truth and psychic experience. In this conversation, she radiated warmth, much more than our initial consult.

I accidentally weaned myself from antidepressants because I forgot to take them when traveling. But now I’ve noticed a real dip in my energy level. My therapist has advised me in the past, if my energy level dips, my mood dips, and if my mood dips, it can trigger depression. I wondered what Katherine thought about this, in light of ketamine therapy for depression.

She said notice if the low-level mood lingers for one day, two days, or three days.

“Do you know how to recognize a pattern?” Katherine asked. “Happens one time, it’s just an occurrence, happens twice, you notice it could become a pattern and there’s an opportunity to do something about it, happens three times and now it becomes a pattern. The idea is to recognize it before it becomes a pattern and do something to alter it. So keep an eye on that and check in if you need to.”

Her answer was satisfactory enough. I hadn’t felt so low-energy that I couldn't get up and do things, but I had been feeling like I crashed more easily or tapered off more quickly.

“Are you reading any books or giving any books for Christmas?” she asked.

“Michael Pollan’s How to Change Your Mind."

“Oh, do you know they’re making a documentary out of that and our business is just going to explode once that happens."

I made a mental note that I better keep writing, and write faster. I hoped my own ketamine experiences could provide something for others who’ve been in a similar state.

“Keep bringing your exuberance Kennerly, the world needs it,” said Katherine, as we signed off.
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Ain’t it funny how the world’s most exuberant are often the world’s most pained.

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