Ketamine Therapy Is Going Mainstream. Are We Ready? – The New Yorker

Ketamine Therapy Is Going Mainstream. Are We Ready? – The New Yorker

But, a few weeks later, she was ready to return. At her second session, she received a lower dose, and the effects of the drug were milder. She saw a sea of waving Japanese maneki-neko cat figurines and tried to find her mother’s face among them. A day or two later, she began to have a recurring feeling that seemed new. “This new feeling was, What if it works out?” she told me. It was a hopeful, expansive feeling. Then, one day, it was gone. “I guess it’s worn off or something?” she said. “It’s funny how it’s something you can’t talk yourself into feeling.”

For the countercultural therapists who have been administering ketamine to their patients for years, the current boom is seen with bemusement and not a small amount of worry. Phil Wolfson, who co-edited “The Ketamine Papers,” first took ketamine in 1990, and began giving it to select patients twenty years later. (Prior to that, he had used MDMA in therapy, but stopped when the drug became a Schedule I substance, in 1985.) Now in his seventies, he has trained many psychotherapists in the use of ketamine, including several at Field Trip Health. In his own practice, he offers both psychotherapy with lozenges and more intense guided trips with intramuscular injections. He is fluent in the neuroscientific theories about how ketamine works but regards them as reductionist. “Everything causes neuroplasticity,” he told me. “Having great love, or climbing a mountain, or having a terrible tragedy—it all creates movement of dendrites”—the branched tips where neurons form pathways—“because movement of dendrites is an essential adaptive function. We change because of experience.” We were speaking on the day after the anniversary of Wolfson’s son’s death, more than thirty years ago, from leukemia, at the age of sixteen, which Wolfson honors each year with a memorial.

Wolfson, who has a corona of silver hair and whose New York accent has resisted decades of living in California, is not eager to categorize ketamine as an antidepressant. Change is not merely a chemical by-product, he told me, and diagnostic categories help only up to a point. He believes that ketamine’s particular power is in the way that it offers a “subjective time-out.” Unlike ayahuasca or mushrooms, which often produce visions that coalesce into narratives, ketamine usually gives a brief experience of the void. “Ketamine really makes no sense,” he said. “It’s not attached to subjective experiences—themes don’t occur, or, if they do, they might not be particularly psychological in nature. I’m not reformed by neuroplasticity; I’m reformed by having had a break from the obsessions of my mind.”

The most striking results from ketamine therapy do not involve people like my filmmaker friend, who has manageable anxiety, but those who are experiencing chronic, treatment-resistant depression. Zachary Rice, a twenty-eight-year-old TV writer, has seen a therapist since he was ten. At sixteen, he was diagnosed with clinical depression, and in his early twenties he was diagnosed with acute post-traumatic stress disorder and obsessive-compulsive disorder. He began taking antidepressants at eighteen; since then, he has been prescribed thirteen different medications and has attempted suicide. In March, 2020, as the pandemic started to spread, he …….


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