06. The Ketamine Diaries, Pt. 1: OCD, PTSD, Depression, & Chronic Pain

(upbeat music) - Hello and welcome to a chat with Uma, with me, your host, Uma R. Chatterjee. On this podcast, I bring together all of my roles as a neuroscientist, researcher, board certified mental health peer specialist, mental health advocate, community builder, and a survivor with lived experience to bring you honest and unfiltered conversations exploring our true human experiences in their fullest form. Every week, I'm bringing you conversations bridging the gap on all things neuroscience, psychology, mental health, lived experience, advocacy, psychedelics, and more. This is a space for raw unfiltered truth to truly explore ourselves for who we are and how we are. I cannot wait to connect with you, answer all of your questions and co-create this with you. Welcome to a chat with Uma. Hello, my friends. I'm so happy to be here with you for another week, another episode of a chat with Uma, and I'm just so grateful to be co-creating this space with you. I can't believe that we're already at episode six and this has been going for a month and a half. And I just hope that y'all are having the most beautiful week and are feeling so supported and loved in your lives. I have felt so much support and care for me all, not only for the show, but for just the amazing things that have happened this week. I, for one, started the week by getting the news that I got into my dream program for a PhD in neuroscience, which is absolutely wild and I'm still processing it. And getting to share with all of you meant more to me than the news itself because of how much of a journey it's been to get to this point. And all of the ebbs and flows, the ups and downs, the just extreme nature of my past and my life and this space here on the podcast has been the place that I could get into so much of the depths of the reality of my experience. I've shared different parts here and there and of course I've had to dull it down sometimes to not be as jarring and perhaps judged for the extreme realities that I've lived through. But here has been the space where I could just be my true honest self. And for y'all to have all that context and to then share in the news with me that something that was so impossible and so out of the realm of reality for me, like actually happened, it's just, it's so special and I'm just so, so grateful for your love and support and I'm just all I want is to be able to give that right back to you. I'm also so grateful for all of y'all that joined me at my panel presentation, have the disability justice and higher education event, which was this past Saturday. And I presented on grad school mental illness which was so beautiful to see people from this community there who didn't have a space previously to be able to talk about wanting to be in grad school or already being in grad school and all of the objective experiences and realities that come with being in such a oftentimes archaic and able to space that does not account for people who are different and who have different needs and disabilities and just different circumstances in their lives. So to bring such an honest and beautifully raw and real conversation to reality at just such a well-attended conference with people who otherwise might not be partaking in or facilitating these conversations, just spent the world and having y'all there with me and actively telling me that you're in this space because of this community and being able to access resources and support that you didn't know as possible. That's what drives me and lights me up in life and I'm just so, so grateful for you showing up and being so open and honest. I am so lit up by this form of just being honest and being of service and showing up in every space as our full selves and so many more things are coming. There's so many more exciting events that I have had the privilege of being invited to speak at and that are happening that I'm so, so, so excited to share with you and to have y'all join me at. I can't wait to talk more about them in the next days, weeks and months and I just want to thank you all so much for making this happen for us, for building this version of existing together that I wish existed in the past and that's why we're doing it and I never knew as possible. I never knew this and out of community and love was possible and I'm just so grateful, so I'll stop rambling there and get to the actual point, but I just, I had to say that and I can't say it enough. And with that, that is a huge part of what brings us this week's episode, which is called The Ketamine Diaries, Clinical Ketamine for OCD, PTSD, Depression, Suicideality and Chronic Pain. And this episode is a long time coming because I actually conceived of starting the podcast well not conceived the idea, but the actual belief that it would happen during these ketamine experiences. So that's full circle and that was last year. And also ever since I experienced the bulk of my treatments last year, I have talked about doing an episode on this and talking, talked about having this podcast at all. I got so many questions and comments and messages from y'all about every aspect of this experience from how I chose to do this and what came of it for my various diagnoses and so many things that I am so excited to address in this episode as well. It's just like finally letting you in on this massive transformational journey I've been on and what did work, what didn't work and I think the results will definitely surprise you. I am just so honored and grateful to have this space of my own and with you to be fully honest about every part of this and what came up for me from the clinical side, from the emotional side, from the healing side, from the painful torture side, all of it. So this podcast will talk about everything that happened and my reflections and analysis of it bringing in, of course, my research science mind. I say as much in the side of experience as much as I could, but of course there's a lot of analysis I do and that's just who I am. So you're gonna be hearing that part as much as I can make it accessible to y'all and just really going into where I'm going from here and what that looks like and the effects it had on my life so that any parts that relate or that answer your questions about your own choices will support you. So without further ado, let's get into my ketamine diaries. As always, just a disclaimer and reminder that everything I am sharing here is personal experiences and anecdotal information for educational purposes and none of this is medical advice or medical recommendations for you or anybody else. This is not representative of the views of any organization I'm affiliated with academically or professionally. These are all my own views, experiences and anything that I share is for educational purposes only. Anything that I share hopefully can inform questions for you with your medical providers to make the best decisions you can make for yourself. And now that we got that out of the way, let's get into my ketamine diaries episode. This is gonna be part one of two episodes of the ketamine diaries and part one is gonna focus on all of the context and background around me coming to this decision to start this entire clinical ketamine process and all of the details in navigating choosing which treatment process and protocol to go through, picking a clinic, the financial and just basic technical parts of this decision that caused me to go the way I did because I got so many questions about that part and just the parts of the science from an accessible and just like basic high level standpoint that went into my decision making. And then part two will be everything that happened during the treatments and what has happened since then all of the considerations and whatnot. So I am so excited to share all of the things that you'll ask for and let's hop into part one of the ketamine diaries. (upbeat music) So let's start with. where on earth I was in my life when I decided to even embark on this journey because that really shapes how I navigated everything from there. So as you have heard in previous episodes in a lot more depth than I'll get into today, I was in a pretty bad place last year in 2022. Things had definitely improved since my rock bottoms in a sense. But 2022, especially towards the middle and closer to the end really felt like a weird version of a rock bottom because for the first time things were going so much more well than they had been ever. I had recovered so much from so many physical illnesses and had been in recovery for mental illnesses that had given me so much of my functionality back even though I'm still going through recovery and there's still so much to work through. It would still like the best I had ever been in my life and yet I was experiencing a very severe and strange episode of major depression and it felt very odd because it felt a little bit circumstantially related in the just sheer amount of things that I was doing and I was kind of pushing myself constantly outside of my window of tolerance and really just overstretching myself and also just in a lot of constant panic and freeze modes yet it also just felt strange though because things were just going well and it was confusing so it felt like a weird version of rock bottom because of the weird dissonance between like life going so well for the first time and still feeling this way because it kind of felt like okay at least if life is super super shitty and I'm going through horrible horrible things outwardly then it feels like if things get better maybe my mental health will improve but it's a whole new level of cluster fuck like what the hell is going on when outwardly things are pretty great and internally things are so horrible and for me I started internalizing that as wow is this the best life can get for me emotionally and mentally and you know psychologically psychologically all of that like is this what life at functional looks like because I can't do that like to be quite honest I can't keep going like this it's still too much I thought things would get a lot better perhaps from an idealistic standpoint or are hopeful depending on how you look at it probably a lot of both and it just kind of really made my situation worse and there was a lot less acceptance that I would have liked of the situation so I was progressively getting worse in my depression and it was affecting me physically of course on top of mentally and psychologically and cognitively I was just getting slower and slower and just outwardly it was getting kind of obvious to people who knew me well enough as much as I was getting things done it was just taking everything and me to do whatever I could and I had it in my mind like this is really I'm really talking about most of 2022 but especially like April May onwards I knew that I would have a good amount of break between the fall of 2022 semester and the spring of 2023 semester because I'm in my master's program right now I'm in the final semester before I graduate yay and I really didn't have a break built in until that point of five to six weeks and there was definitely possibilities of me filling all of that time with still working in the lab or taking another projects or whatnot but I knew in my mind that I could not do that I had no choice and I was holding on by half a thread is what I told everybody when I was explaining how I was doing because I was holding on because I knew I had that time to just crash and burn and see what would happen from there so that kind of fueled me to keep going and just getting by by the skin of my teeth so during that time there's a lot more detail about this in my mental health journey episodes and psychedelics episodes and my overall journey episodes basically everything before this but to sum it up I was still really struggling with a lot but especially with my OCD and PTSD of course like I said depression and treatment was at kind of a standstill so things weren't necessarily improving I didn't really know what more to do with myself because I wasn't getting the treatment I needed and something else that I have not talked as much about but plays a huge role in my life as well as this specific ketamine treatment journey is my chronic pain I have multiple autoimmune diseases disorders and one of them is fibromyalgia a huge part of my fibromyalgia on top of the fatigue and the mental stuff and the digestive stuff and everything that comes with it is my chronic pain I've had excruciating chronic pain for a very long time when I was a little kid I was seven or eight years old and my legs used to just scream and pain all the time and what was done to try to alleviate that kind of like as a quote unquote home treatment explanation of what was going on was I have my legs put into a bucket of boiling hot water and my legs would turn red and the idea was it would take away the pain and I guess it numbed it and I associated that as the only way to stop them painting as much as they did but it has been a constant since at least seven or eight I don't remember if earlier but for a very long time and I'm 26 now for context and I didn't really have like a diagnosis or name for it I kind of just thought that's just my body and I had to live with it I didn't know for a while until the last few years when I finally had my medical awakening through cancer treatments and uncovering a whole host of things that had been going wrong in my body for a really long time so I have known that I have fibromyalgia and the term chronic pain for a few years now but I have not really experienced a solution or treatment that has really worked for me in any way and I've kind of accepted it or I did accept it as a for-gone conclusion which really sucked but given the number of things I was dealing with I couldn't possibly give enough flux about every single one of them to be honest so I prioritized the things that were causing me the most amount of debilitation which obviously cancer to you know survive and my OCD and PTSD and just things that were adjacent to that that being said though, my chronic pain is pretty pretty bad and it really started getting to me last year because with my recovery and my regaining or gaining rather for the first time a function I really wanted to work more on my health and being more active and not only on my physical health in the sense of being active for the purposes of physical well-being that's really important and something that I started being able to care about more because I wanted to be alive more than I did before and I had the bandwidth to think about that at all but also because so much of what categorized and really drove many of my mental health conditions particularly PTSD and trauma and the intersection with OCD depression and just all of it was a dissociation from my body in the literal terms of dissociating and then also just this version of dissociation that really had me remove myself from the experience of my body most of the time and I went into that a lot in my previous episode so I really recommend listening to those to set the stage for this but in some so much of my work psychologically and otherwise has been to feel into my body and experience my body more and train myself to feel safe and being able to do so which is really really hard but what me and my clinicians also realize makes it even harder is having constant chronic pain because naturally if what is feeling constant chronic pain in their body what's easier to do or at least a safety survival mechanism is to not feel that pain but to not feel that pain also means to not feel everything else and so this constant activation of my sympathetic nervous system and needing to just constantly be aware because of the pain is also super taxing. It just seemed to really color and modulate a lot of the work I've been doing and it just felt like something that I needed to address, which really became apparent last year because of the recovery, because of the awareness that I had been growing around these parts of my survival skills and my pathology and my clinicians becoming more aware of what living in my body actually felt like, which was really important. So that had been on the horizon and in my mind for a while, but I hadn't really experienced treatments that helped the chronic pain. I just took a lot of acetaminophen to try to dull it down, but that's not really great for you and also didn't really do the job super well. There was a lot of room for it being improved. So all of that was kind of happening all at once and I knew about ketamine treatments from a lot of different angles. I knew about the research on ketamine because I'm a researcher as you all know and of course I'm especially immersed in the psychedelic field. So ketamine is oftentimes studied in the context of psychedelics for various reasons that we'll get into. It's also not a psychedelic, it's an anesthetic, technically a hallucinogen, but not a psychedelic. So it's variable and so I knew enough about ketamine, but frankly I had it in my mind as kind of the thing that psychedelics were compared to oftentimes because of their much longer lasting action than ketamine. So there's a part of me that just kind of never really considered it strongly as a possibility clinically or personally because of it kind of just being like a weaker thing in my mind compared to everything else. Nonetheless, I was aware of ketamine generally being looked at for psychiatric conditions, but what I started seeing more was ketamine not only being looked at but already being used clinically for chronic pain, which I found really interesting because the research on ketamine and chronic pain is pretty mixed and not fully clear. And spoiler alert, the research for ketamine in, you know, mental health treatments in general is very mixed. There's a lot of significant and insignificant results based on how it's administered, what it's administered for, the comorbidities and so many other things. So it was just really mixed and not definitive yet. There was a huge uptick in ketamine and ketamine assisted therapy coming around for chronic pain and psychiatric conditions. And part of that is because it is already FDA approved for human use in certain situations. I mean, ketamine is already used as an anesthetic and something to put you to sleep in surgical and hospital situations. And it's readily available. It's from the pharmaceutical perspective, relatively cheap to like extremely cheap actually, to manufacture and obtain medically. Now it's not cheap to experience as a patient, which is a whole other thing, but it's just very accessible medically. So in this space of transitioning into psychedelics and psychedelic assisted therapy becoming more mainstream and even, you know, on the route to approval for various indications with various psychedelics, ketamine has really like written that wave as this sort of kind of psychedelic oftentimes called psychedelic, which is debatable by the technical term of classic psychedelic. It is not, but just being lumped into psychedelics. It's really been this kind of loophole for clinicians and people who are able to prescribe it as a way to administer a version of psychedelics or psychedelic assisted therapy for indications that other psychedelics are being explored for. And because it's so accessible, it's legal, it just requires someone being able to prescribe it and, you know, monitor medical symptoms to make sure that the administration is safe for a person. It is extremely generally safe for people, has very little, you know, consequential side effects. It's just taken up this space in the medical industry as this, you know, hyped up, really innovative way of doing treatment for mental health conditions that are often, you know, treatment resistant and chronic pain conditions that are very underserved and the opioid epidemic is a thing. And this provides this interesting oftentimes seen as valid alternative. So that's why it's available. And there's so much more to unpack about that. And psychedelics in general, the mechanisms underlying them, what makes them different or, you know, unifies them. That's for another episode, a lot more, you know, science focused about everything. But for the purposes of really getting you into my mind of my decision making, I'm giving you the layman's version of what goes on in my head from like a research science perspective so that I can in any way inform your own decisions and you don't have to be a scientist to think about these things. So it's been interesting knowing about ketamine for a while. And like I said, I had it considered it for a long time. But as my need to work on my chronic pain increased. And also my mental health continued to deteriorate. And my treatment wasn't really progressing because of all of the nuanced reasons around that that I've talked about before. I frankly started getting more desperate. And yes, like I talked about in the last episode, I was microdosing. So I've been through last summer. And that seemed to help me hold on to that half a thread. But I wasn't improving to the point where I was gaining back functionality. Or, you know, really even seeing the point of continuing or having a decent life experience, you know. And I was starting to really increase in my experience of suicidality. My OCD and PTSD were just stagnant and constant. No matter how much I engaged in treatment as I knew how on my own supported a little bit by my, you know, general PTSD therapist. But we were stuck because of the OCD and not getting proper help for that and the comorbidity. And things were just pretty bad. So it kind of hit me around August or September of last year that something really needed to change. And I needed something to jostle shit up. And things would be very bad if I didn't have something that I could try to do to help me, both from a standpoint of my morale and feeling like I was just stuck and helpless and unable to be helped in the state I was in for all the lack of accessibility and treatment complication purposes. But also because I was just struggling to exist. And it really helps to know that something's coming or something's possible, even if it's hard to get your hopes up, because things haven't worked very well before. So I started considering trying to find some version of ketamine treatment. And the thing with navigating that decision, the considerations I had to think through were that ketamine treatments vary so much across different clinics and different ways of administering it. And there's also the part of my experience where one would think that why not try other psychedelics and try more higher dosages, different combinations, perhaps even enrolling in a clinical trial to be able to go through traditional psychedelic treatments or psychedelic assisted therapy treatments, if things were that bad. And I address those questions now because I definitely did think about all of that. And there are a few considerations that went into not pursuing those avenues at the time. So of course, all of my psychedelic history up till this point is in my last episode on yes, I've done psychedelics. But the short of it all is that my experience with psychedelics up till the point of ketamine, up till what I'm going to talk about in this episode were almost unanimously largely quote unquote bad. And when I say bad, I don't mean like they were bad for me. I can't know that for sure. And I don't even think that they were necessarily bad for me. Overall, but the experience of the trip itself, almost every single one of them were so painful and jarring and just, you know, re-engaging of trauma. I didn't feel equipped to be able to handle everything that came up and I was largely navigating them alone without a clinician because that's where we're at right now. And I just didn't think that I could keep putting myself through that. I also was really scared that me continuing to put myself through that. Like, what is that doing to my mind and my, you know, neurophysiology? Like, what is that doing to my system? I don't actually know. And at least experiencing a really positive trip, like most people or many people do would indicate some level of confidence in what it's doing to me long-term. Perhaps that's, you know, not necessarily guaranteed. But that would give me some level of confidence. But the fact that I was having almost constantly just such tragic, painful experiences really scared me from continuing to do it more until there was more research and also just more of like a bio individual awareness of me and like me being able to trust people, clinicians, practitioners, to be able to guide me through that or at least help me conceptualize what was going on and make sure that it was still going to likely be in that positive. So that kind of fell off the table for me and in terms of going through clinical trials, there's a lot of reasons why I didn't necessarily feel like that was an idea for me. Number one, I don't really qualify for most of them because I have so many co-occurring or comorbid conditions that it kind of just muddles the shit out of testing very linear, like does the psychedelic improve outcomes for this disease or this disorder. Like, I have too many things going on oftentimes they go inversely and I just don't even meet the criteria. Even if I did manage to meet the criteria for anything, I because of my own research and the project that I have undertaken going through, you know, every single aspect of psychedelic assisted therapy and what has been explored and what's being proposed for the, you know, FDA approval clinical trial pipeline right now. I found so many plot holes and things that would affect me adversely and negatively that I don't necessarily necessarily have the confidence to put myself in that situation right now. I think it's really great for less complicated cases and for most people, but it's not for me because I'm aware of how much is being missed. And so with that, I already have this bias that it probably will negatively impact me. It would probably, I probably wouldn't be able to like necessarily trust the process and surrender, which is a large amount of needing to go through a treatment in the first place and going, especially altering your consciousness. So just didn't really resonate. I haven't yet found a trial or situation that I feel like super safe going through right now. So there's so much to unpack and that again, a whole other episode. I swear I have like a hundred episodes than me that I could just put out right now, gotta pace myself and that being said, that's why I haven't done those. And in terms of the considerations with going down the ketamine route itself, like I said, wasn't super confident, wasn't super top of mind for a while, but because those things were off the table, like I talked about extensively in my past episodes, general psychiatric medications, I have had experienced them. They have had more of negative impacts than positive. So those were off the table at this point. I've done almost everything I can. And what I had it tried was ketamine. So I figured, why not at this point, I was really, really hopeless and desperate. So the thing with navigating taking ketamine is there's actually so many different forms of doing it. And I'll briefly go over some of them to illustrate this point, but that warrants its own conversation because there's so much nuance in this. But ketamine in terms of being in a legal approved way administered as a treatment for psychological conditions or ant or chronic pain involve a number of different modalities. So it can be done intravenously, which is ultimately what I went through. And I'll talk about why it can be intramuscularly. So an injection that way. And it's a lot more fast acting and fast ending and a lot more intense by in terms of the trip. Some people have likened it to ayahuasca before, which is wild because ayahuasca is, you know, from a phenomenological standpoint, sometimes like the most, one of the most deeply intense and conscious is altering experiences one can have on platyderth. So there's, yeah, intramuscular versions. There's also sublingual. So taking a form of ketamine that dissolves under your tongue and it's generally less intense, but does a job in a certain way. And they're all obviously absorbed differently and have different amounts of impact, different amounts of time of impact, and also just are generally sometimes indicated for different ways of treating things or even just different conditions. So that's some level of variability of ketamine. There's also other ways of doing it, but those are the ones that really came to mind from a clinical standpoint. There's that. There's also the actual dose amongst each and every one of those, right? Like the amount that you actually get in one setting, if it's a constant receivle of it. So for IV, which is what I did, it's like not only how much you're getting, but how long you're getting it for and how constant it is. There's also how often one receives it in the container of a treatment. So is it once period? Is it once every day? Is it once every week? Is it once every few days? How long is that period? There's just so many variables. I think you're getting my point. So that made things really overwhelming to decide, but what greatly held to narrow it down for me was the fact that I knew financially, if I was going to do this, I needed this to be covered under insurance because I am not in a financial place to be able to pay for the vast majority of versions of ketamine treatment, even the ones at home are really, really expensive. The ones at home, by the way, are still supervised clinically, they're just done at home and they're suppling well oftentimes, which you can find out from different companies and things. But I knew that I needed a version of it that was covered by insurance, and that led me down a few factors of narrowing. So number one, to get insurance covered ketamine in Texas is possible, but no easy feat. And the only way that I could get it covered by insurance is to do it from a chronic pain perspective, not a mental health treatment perspective. And that is to my knowledge, the case at this time, you know, it's February of 2023, at this time, that's generally the case for ketamine treatments across the board insurance wise. They tend to cover it for a chronic pain, they don't tend to cover it for mental health treatment because from their perspective, it is far of less proven to be efficacious, not that there is not proof, but it's not the standard of care. And for chronic pain, it really isn't either, but it's more, it's further along than it is a mental health treatment. And there's also far fewer options for chronic pain and chronic pain is so expensive, is such a financial burden to insurance from a financial incentive perspective. So ketamine seems to, and people who it works for just greatly ease that burden from an insurance perspective. So it seems like they're more willing to pay for it. So luckily, I have an insurance plan right now through being a graduate student that does get accepted by the ketamine clinics around me, which there are like three, like I think in this state that I found, or at least three companies that have different clinics. So with those three, they all were for chronic pain, and it had to be like a central nervous system version of chronic pain, so not like facial syndromes or anything, but pretty much fibromyalgia or other related syndromes. So that is why I chose the route of IV ketamine and how it by default became for chronic pain, which I say this obviously sarcastically, but luckily I had. So I could get it covered by insurance. And of course, I was seeking it out. for chronic pain and equally and maybe even more importantly, but at least equally My various mental health conditions. So and I have a whole long list of them, but the ones that were generally Advertised by these kind of mean clinics, which is whole other topic, but they tend to advertise that they can help It's usually always depression and then the one that I went to also said that they could help OCD PTSD and Suicideality so Technically those were the Indications I could have gone for as well. So so far in my decision making it was narrowed down kind of By force based on the fact that I needed insurance coverage that it was going to be IV intravenous ketamine and it was going to be under the primary indication of chronic pain the thing about Chronic pain being the primary condition that it's being covered under is that This is and this is the case for the clinics that I've studied so far this might differ if you're looking at other clinics but generally speaking what IV kind of even looks like for mental health conditions is roughly a Few sessions every other day for like an hour long of the IV receivle and It could for my for my clinic particularly it was all Mental health conditions like whatever you're coming for which based again was depression OCD PTSD and or suicidality you come in and you have what you call your stabilization treatments, which are one hour of IV ketamine for Three days every other day maybe four days every other day So like a Monday Wednesday Friday and the next Monday or just like a Monday Wednesday Friday then you go a few weeks and then you start doing Maintenance treatments, which is one one hour treatment every few weeks spacing it out longer longer until You're done and you feel like you're fully Finished with treatments and you've gotten what you needed and you're basically in remission So that's the mental health version, but the chronic pain version is actually far more intense so the way that my clinic did it and all the other clinics I looked at generally were that you come in and for Five days in a row. It's actually like three to five days, but for me it was going to be five at the max because of my the the intensity and longevity of my pain. It's five days in a row for Four to six hours every single day. So huge difference from every other day for like one hour a day four to six hours Constant IV ketamine every single day for five days Then take a two week break and then come back for two days in a row again of the four to six hours every single day And then from then on every few weeks coming in for those two days in a row four to six hours multiple times until Your fully in remission and you feel like you're complete once again So clearly the chronic pain protocol is far more intense and high in its treatment than the mental health indications That was something that was really interesting to me because I definitely wanted it to help my chronic pain but I was curious if that level of treatment would inadvertently hurt my mental health or make it not as effective on my mental health because it's too much maybe there's a reason that the Lower doses were more helpful for you know mental health conditions and they didn't just up it but It was told to me over and over by the clinic and the other clinics I talked to that You could kind of look at it like it would be it it's like pay for one get it all like the chronic pain would definitely cover all of the mental health conditions underneath it because the more of the better so I was getting a win-win situation and that's what I skeptically went in Just hoping to be the case the other part that was really interesting to me about considering Doing the chronic pain protocol and then hoping it would help my mental health was that The way ketamine is studied in humans and in pre-clinical models across the board in the various trials for Different mental health conditions something that's very inconsistent in those trials and treatments is the dosage amount and the dosage frequency so there really wasn't like a very linear way of looking at ketamine does help OCD ketamine does help depression like because Certain trials did it multiple times at different dosages some of them did it only once in measured outcomes and so the general like gathering of information I did and how I distilled it down in my head as a possibility of understanding and comprehending just the data all over the place was that It seemed to look like ketamine administered more frequently and Also at higher dosages tend to make a more long-lasting effect due to the plasticity it was inducing and the just kind of like keeping that window of relearning and rewiring more open rather than it being just so short acting Like it is traditionally like in a single dose like basically just the more the better to a degree so I took that into consideration when thinking about this very intensive chronic pain protocol It being every day for a long long time and then repeating it over time for a while. I was hopeful that maybe it would be able to cause a more long-lasting difference than The traditional way it's administered or the ways it's looked at clinically and you know the lack of efficacious data and shorter bursts of experiencing it so that gave me some level of optimism or hope about the situation and Ultimately what it just came down to was I really needed to try that and try something because I was really really suffering and losing hope and needed something to hold on to so I decided that I was going to finalize Making this happen. I went through a very long process of needing to get everything approved by insurance and getting by Documentation in and really just like making a case to insurance that my fiber my algebra could possibly be treated by this clinic and Ultimately, I chose the clinic that was closest to me and that did this chronic pain protocol and I Will say that there were a lot of things I went into this situation with that You can take for consideration possibly if you're doing it on your own. So Of course, there was the payment There was the fact that I needed several weeks to be able to do this treatment and I obviously couldn't do anything else during this treatment so it had to be during my winter break and it needed to be a time and space where I was able to just like become completely dysfunctional because hello I'm on ketamine all day every day and then what I would find out later is I was also recovering from the ketamine after doing it and so because I knew that I had a Whole week of treatments and then I was gonna have further treatments just as intense a few weeks later So I just knew that like I needed a good amount of time and so Luckily, I had that winter break built in for me that would be a consideration for anyone going down this path also On top of of course the payment and the logistics of it all something else to consider is that Generally the clinics especially taking insurance don't do ketamine or psychedelic assisted therapy they do the treatment and nothing else now Let's not to say that they don't have people on staff to like make sure that you're not entirely losing your binder having a mental breakdown But they're also not qualified to do anything about whatever mental state you're in and oftentimes what I found to be the kind of way of subverting that Issue what I've asked about it because I'm very very familiar with psychedelics versus psychedelic assisted therapy and the framework of having actual Licensed clinicians there guiding you through your psychological experience through being on these treatments especially not being in normal consciousness and all the things that can come up Because effectively it's a trip depending on the dosage and the intensity of it all Their way of subverting it was by saying that this is just a treatment that you get IV and you could sleep You could watch TV you could hang out you could do whatever you wanted as if that was even a possibility for people and I guess I can only speak for myself and anyone I've heard talk about these treatments, but I knew That likely wasn't going to be the case that This was going to definitely alter my consciousness at the intensity It was going to be at I also know myself and know what that experience is oftentimes like for me because of my long history of experiences before that. So I frankly did not go in really trusting the clinic to be super aware at its best or honest at its worst about that. It felt very much like this was just a way to give the medication with no consideration for what one was experiencing during the actual session. And that was even more troublesome for me because it's one thing to maybe say that for chronic pain it wouldn't even really matter what one's experiencing during the session. But the same clinic and the same clinics in general also give these treatments for mental health conditions. Like I just said this particular clinic that I'm not naming but if anyone wants to know to have really reach out I'm just not naming them right now because I'm obviously putting them on blast. They literally on their website have it that they treat PTSD and OCD and depression. Did they actually know what those are especially OCD and no and that was very clear from them talking about OCD. It was just they were going off of oh the data that oh maybe ketamine helps OCD so we can just say that we're doing that and we're not going through insurance but technically it's legal to give ketamine to people. So here we are saying that we can do that and I of course being who I am with my knowledge and my awareness like definitely saw that and was concerned. I still ended up choosing to do it because I wanted to get the ketamine but with my awareness of the oftentimes importance of the actual conscious experience and what what is processing during the ketamine itself and having consideration for navigating that and the impacts of that on the long-term effects of and the efficacy potentially of the ketamine for whatever it is. What is treating. I knew that and I knew that if I was going to go down this route I needed to do whatever I could to make myself as prepared for whatever possibility would come up and to ensure as much success as I could could not control it or you know guarantee any of it for myself but I wanted to set myself up for as much success as I could have and to really reap the benefits of this experience beyond just having ketamine pumped into me and just assuming that the only effects it's going to have are completely pharmacological and nothing else. I just know that that's probably not the case. I can't guarantee it but that's probably not the case. So all that being said because there was no remote association of assisted therapy in this situation I kind of try to create my own version of that and what that was for me was in part preparing myself again for being in an ultra-sative consciousness and being aware of what might come up and not trying to necessarily like predict it like self-prophasize the whole thing but just at least be prepared and also have intentions and I mean intentions like knowing what I'm deeply struggling with right now and just trying to process whatever comes up around those things and allow that to happen on its own and then in a very tangible way. Number one I assisted that at my husband be allowed to sit with me through the whole thing because he is someone who very much knows me and knows what I'm going through and feels very safe and is some tether to reality and of course I had not experienced ketamine before so I didn't know how much I would be removed from reality and to have that tether around and to feel safe amongst potentially very unsafe feelings coming up seemed to be really important so that angel of the human sat through every single treatment with me in that room for hours and dealt with everything and I am so beyond grateful but I'm getting ahead of myself. I set myself up to have him sit with me and then what else I did was talk to my therapist about this whole thing and she was so gracious and willing to meet with me virtually for most of the days I did it not all the days didn't work out schedule wise but most of the days she was able to meet with me virtually for an hour it was too far for her to be able to come in person and she wanted to but it was like super far outside of like the main metropolis so that's also something my husband did by the way drove me like basically an hour each way every single day for all these treatments which means the world to me but nonetheless I created a small version of assisted therapy by at least having my therapist tell a health tell a therapy with me most of the days for an hour which was a whole experience because I've never done that under you know a different state of consciousness before and we had no idea what to expect she also admittedly is not trained at the time in any form of psychedelic assisted therapy she's very trauma informed and an incredible psychologist but has not done that before so that was new for both of us and was going to be an experiment but at least I had some version of peace of mind that she would be checking in on me and have some pulse on my state of psychological being depending on how everything went so those were the checks I put in place to try to ensure that if indeed I was right about this experience being far more than me just laying down and having IV ketamine stuck up in my body for days and nothing else happened that if I were actually going to have processing experiences and it be not just pharmacological then I had some tethers to safety and support that were outside of the very little that the ketamine clinics offered so that's how I set myself up and what it really looked like then was I booked it after all of the hurdles of getting insurance approval and making sure that I was financially taking care of and I booked it for a week in December during my winter break and then there was a two-week period in between and then I had my first so the first week with that whole week is called stabilization sessions and then I had my maintenance sessions like the two sessions after two weeks those were booked and then from there we were going to see when I need to come in next based on my pain levels because that's mainly what they were quantifying and just in theory continue to come in every few weeks or months space it out more and more until I am completely in remission so I had my plan and really just counted down the months weeks and days until I could start this whole process in the middle of December and I remember just looking at it very neutrally and being just pretty chill about it other than I was slightly hopeful to have something to look forward to as something that could potentially induce change and it was just pretty good in terms of how it landed in my mind until the until we got really close to it the last few days maybe the week before and that's when things started to get a little scary as they could and would for many people especially just starting to really consider the enormity of what I was going through and I mean I had of course done psychedelics and experienced altered state of consciousness and kind of extreme senses in the past but it started really hitting me that whatever it is I was getting myself into it was going to be all day every day for multiple days and the repetitiveness of it as well as the kind of snowball effect across the days started getting to me in terms of just thinking about what might happen and what that would be like and I can tell you that nothing could have prepared me for that but I was right to start thinking about it luckily not stopping myself from doing it because of thinking about it but it was good to think about and all I could really do to prepare other than of course just trying to hear as many people's experiences as possible without internalizing it as my end-all be all and kind of actualizing that into my own experience but just hearing other possibilities of what people have gone through and maybe reading up on the literature a little bit too much to try to get some realistic expectations but also hope but the truth of it is that I could not predict or even really hinge on any sort of result because I was going in with so many different conditions and it's not like I said it's not like these conditions even on their own had all been studied in the context of the form of ketamine treatment I was going to go through and I say all this because this might be very common for people who are navigating this new interesting form of treatment and the treatments in general that are experimental and kind of established and kind of not and making choices like at the end of the day we can make the most informed choice that we can and we can be hopeful but in this space there's not really a way to actually know what it's going to do to us in our unique systems and all of the you know co-occurring conditions that at least I had and something that really stuck out to me in this and this might resonate for people as an example who have comorbid conditions especially people who have OCD depression the literature on ketamine and OCD trials is kind of interesting and some contradicting results that exist or that there have been trials on people with OCD and again it's not even comparable because it's not the same exact dosage or dosing schedule but even just shorter versions of ketamine singular doses I think on people in OCD people with OCD in one trial did not show long lasting results because they also had comorbid depression is what it speculated and it to help the depression until it didn't but it didn't necessarily help the OCD but then for people who don't have comorbid depression who just have OCD and another trial it seems to help their OCD for a few weeks instantaneously until it were off and so for that's just one of a bazillion examples of just different co-occurring conditions and the differences they have in results and again there's so many variables that I guess what my point is is that there was no way for me to even have any remote idea what would happen let alone guarantee or just expectation and of course with treatments there's no guarantee for anything but oftentimes there's an expectation in a kind of a linear way of things going but with the very complex nature of psychiatric illness and altered states of consciousness and rapid induction of plasticity in these very novel therapeutics who knows so I was going into a lot of uncertainty a lot of fear and also a little bit of hope but also some settlement into this might not do anything it could even make things worse and I just have to accept that and move forward and try because that's what I felt called to do so that leads me into the first week of stabilization treatments so we'll close out part one of two of the ketamine diaries here and next week part two we'll bring everything about the actual experiences virtually a recollection of every day or almost all days the significant ones because so much came forward during those and then all of the hindsight the integration how I navigated you know my own version of assisted therapy with it the actual outcomes in the longer term since then with all of the diagnoses I was looking to tackle and just the different changes that I've come up in my life how I'm proceeding with ketamine treatment and the decisions I'm making and just everything you want to know about the actual experiences and I just hope that this part one of the episode was really supportive and informative for y'all to just hear all of the countless factors that went into deciding exactly how to proceed with which form of treatment and you know the clinic financially the technicalities all of the questions that I was asked in so many different ways especially around accessibility and decision making just you know to illustrate the point that there is no linear form of accessing this form of treatment and in general these more experimental yet powerful potential forms of treatments in the space and if anything I just hope that it offers you perspectives on considerations to take in the decisions you make and just navigating and traversing the different elements of different diagnoses and their comorbidities and taking research into consideration also just being open to what is possible and not necessarily having any form of like a linear guarantee and kind of piecing your own treatment process together sometimes so I am so excited to share everything about the actual experiences next week and thank you so much for sticking with me through these episodes I know that there's so much in here and I just hope that the support of to you it truly means more to me than you'll ever know to be able to co-create the space with you and it is such an honor and privilege to be just sharing in the most honest and true and compassionate and vulnerable way that I know how so that we can all do that together and to support me in continuing doing this it would be in the world if you could just take a second right now to leave a rating and review on the show wherever you're listening to it because I cannot tell you how much it helps grow the show and make this space more accessible and open and safe for people who might not know about it or might not know how to engage with us so you sharing your thoughts and sharing how the show has supported you truly makes such a difference in being able to grow this community and continue to support me in doing this every week so thank you so much for that also it would mean so much if you could take any episode that you love or just this podcast and send it to whoever you think would love to hear these conversations and who would benefit from existing in the space together with us sharing the show with the people you love is what helps the show grow and thrive the most so thank you so much for co-creating this with me supporting me as I continue with this I can't wait to bring you part two of this episode next week and as always message me or send me any questions you have any ideas I truly could make 100 episodes right now so co-creating this together with whatever is coming forth for you whatever you're wondering whatever you want to hear right now that's what drives us and we get to do this together so thank you so much I hope you have most beautiful week I can't wait to see you next week with part two of the Kennedy Diaries sending you all the love in the world and I hope that this episode of chat with Emma is just the biggest hug to you. Tatya, on next time.