Stacy (not her real name) is a Hanya House patient who – in 2020 – sought out Ketamine Assisted Therapy as a complementary treatment as she weaned off of her anti-depressants. Stacy had been prescribed anti-depressants by a psychotherapist (and psychiatrist) several years earlier, shortly after she had been diagnosed with dysthymia, a form of milder but longer term depression.
Back to 2020: As Stacy and her husband discussed their intention to start trying for a child, Stacy felt ready to try to come off of her anti-depressant medication, Prozac, with the intention of continuing her search for the root cause of her depression and anxiety. It’s important to note that Stacy made this decision in consultation with her functional medicine doctor and her psychotherapist.
Shortly after, Stacy started a Ketamine Assisted Therapy process with Hanya House Medical Director, Dr. Rav James, and Life Coach, Ryan James, and what follows is a summary of the journey from Stacy’s point of view.
Please note that what follows is the unedited account of one individual’s experience. Stacy’s thoughts and opinions are her own and should not be interpreted as facts or medical advice. It is extremely important that you consult directly with your personal physician/psychiatrist/psychologist or care giver regarding your own medical care and mental health.
1. Tell us about your experience with depression
Stacy: I’ve had depression since my teenage years but coming from an environment of “just pull yourself by your bootstraps” it took me years of painful suffering to seek out help. In fact, I suffer from a depressive condition called dysthymia, which is characterized by a milder but long-term form of depression. On top of that I would still get the more well-known acute depressive episodes and would suffer from anxiety. I just really couldn’t catch a break.
Despite all of that I still managed to be at the top of the class, was very involved in countless extracurricular activities, competitions – you name it – and I promise you no-one in the world would have told you I was depressed. I think there’s still, even in this day and age, such a stigma around mental illness and such an outdated perception of how a depressed person can “look like”. I read countless self-help books and tried a million techniques I read on the internet, because I thought that if I wanted it hard enough I could surely just stop it. In fact, only starting to learn more about mental illness made me release my prejudices enough to seek out help.
By the time I got there the psychologist I saw was so scared of me being a suicide risk he immediately called a psychiatrist friend to arrange an urgent appointment to see if I would be suitable for anti-depressant medication.
2. What was your experience with anti-depressant medicines and how long did you take them for?
Stacy: After the said appointment I got prescribed fluoxetine, better known by its brand name Prozac. It took a few weeks for me to see any difference but very slowly I started to feel a relief I hadn’t felt since my childhood, just a lighter way of being.
Franz Kafka describes anxiety as “the feeling of having in the middle of my body a ball of wool that quickly winds itself up, its innumerable threads pulling from the surface of my body to itself”. On top of that my ball of wool was filled with feelings of guilt, shame and self-doubt. Starting an anti-depressant helped to unwind this ball of wool. For the first time I could do the things I was doing without the crushing feelings of depression and anxiety.
My psychiatrist told me that considering how long I suffered with these conditions without any treatment, I should aim to take the meds for at least two years. This is for good reason. With the help of anti-depressants I now had the mental strength and ability to view things for what they were without the grey-tinted glasses of my mental disorders. This allowed me to react to things happening in my life in a more realistic way… things that would often swing me into a depressive spiral became bad things that happened but I could deal with, and process them, in a healthier way.
Research suggests that breaking a habit takes concerted effort at reacting to your triggers in a different way in order to break old neural connections and create new ones. This is exactly what happened in my case, where dysfunctional responses to negative stimuli slowly got shifted to more functional ones over the next four years I was taking the medication. For me anti-depressants were the enabling factor for this to happen.
3. What was your strategy for weaning off anti-depressants?
Stacy: About a year ago my husband and I decided that we were ready to increase our family and start trying for a child. I wanted to do some research into the safety of taking anti-depressants during pregnancy. While I found a few risks associated with this, I had to balance these with well-known teratogenic effects of severe depression and stress during pregnancy.
It was a tough choice to make, but I felt like at this point I was strong enough mentally to try and see if I could get off my medication. If the try was unsuccessful (i.e. if I would become severely depressed again) I felt comfortable going back on the medication. However, if I was ever going to give it a real try, the time was now. I discussed this with my functional medicine doctor and she was supportive. I started weaning off the medication slowly by lowering the dosage in two-weekly increments. It is very important to consult a doctor when doing this, as at one point a few years ago – very foolishly – I simply stopped taking my medication and, oh boy, do I not recommend that. I also spoke to my psychotherapist, letting her know that I was going to be trying to wean off the medication and she should get ready for the ride.
4. When and why did you decide to try Ketamine Assisted Therapy?
Stacy: Coming off anti-depressants presented a new set of emotional challenges. I suddenly felt a lot more vulnerable and definitely more emotional, but for me these were part of the journey. As the plan was never to simply “get off” the medication and stop at that, I knew I was going to start working on my demons if I wanted this to count. I can’t say it’s been easy or very pleasant and I’ve definitely had a few bad periods. But the new habits and ways of responding to certain stimuli I established during my time on the medication mostly stuck. Even though it was harder I was able to deal with things in much healthier ways.
This is when I started looking into alternative therapies that could help me in working through some of the years-long trauma I was still carrying and hadn’t fully dealt with. I came across Ketamine and psilocybin (otherwise known as “magic mushrooms”). I read testimonials and research showing how Ketamine had the ability to alleviate depression in people who had unsuccessfully tried numerous anti-depressants and how it could be used as an adjunct to therapy.
At this point I had gone off my medication fully and I was in one of my depressive episodes, I really wasn’t doing well. Readings about Ketamine promised long-term relief without medication and some even reported total remission from symptoms. Anyone who has ever been depressed, especially if they have been in this state for years (or in my instance I still had a very good memory of how bad it can get), will know the feeling that they would pretty much try anything to alleviate their symptoms. In fact it promised more than that – it promised to help me work through issues and traumatic experiences that I have been battling with and trying to push away for years. After all, going off anti-depressants my goal was to finally address the reasons why I became depressed and anxious in the first place. Ketamine is extremely safe and the emerging research on mood disorders is really promising – it really felt like the worst that could happen is that it wouldn’t work for me as well as I wanted it to, but not trying seemed silly.
5. Describe your first Ketamine Assisted Therapy session?
Stacy: I think even though I read plenty about Ketamine, trying something new for an anxious and depressed person is, well, anxiety provoking. But, as I had said earlier, I was ready to try anything that I could that had any promise of helping me. Rav and Ryan walked me through how I might feel during and after the session, which was useful, we meditated to get into a calmer state, and we set an intention for the session. We started very slowly with a very small dose, which is important, as one still doesn’t know how they will react to Ketamine.
To be honest I think in the first session, for me personally, the effect was relatively small and at this point the therapeutic environment of the session was a more important factor. The Ketamine simply opened me up just a little to allow me to talk through things that I needed to talk through. Rav and Ryan are so attentive, supportive, and competent during these sessions that it wasn’t hard. In my experience Ketamine was simply the enabler in the therapeutic process that Rav and Ryan went through with me. There were certainly a number of things that “clicked” in my mind during this session on a much more visceral rather than just mental level in terms of things that were making me unhappy.
6. How did you feel directly after that first session and in the days following?
Stacy: I think very simply I felt lighter and less anxious. I don’t think I fully realised the literal feeling of heaviness that depression is until suddenly I didn’t quite feel it anymore. This feeling does wean off as time goes by, but realisations from the session stay with you.
7. There is a lot of focus on set and setting in Ketamine Assisted Therapy. What was your intention or mindset as you went into the first session and how important was the setting to your experience?
Stacy: The setting is SO SO important. On Ketamine you become so open to things around you and you experience everything much more vividly, which is why you can get insight into issues that you may have been pushing away for so long. Rav and Ryan created such a calming therapeutic environment with calming music, smells and light that I truly had no other choice but to heal.
8. After the full protocol of six sessions, can you describe any differences that you experienced in your day-to-day life and/or in your life outlook?
Stacy: Depression and anxiety are both internalizing disorders, meaning that the person directs their problematic thinking onto themselves. However, it also means that the person struggles like that ball of wool contracting into itself to see beyond their struggle and the debilitating thoughts they suffer from. There is a great illustration by Catherine Lepage to illustrate this:
I think the above is true both for depression and anxiety. In my case Ketamine sessions helped me direct this “field of vision” to the outside, something that otherwise took me extreme effort and has rarely been truly successful.
9. What changes – if any – did you make in your day-to-day life as a result of the Ketamine treatment?
Stacy: I think it’s important to remember that at Hanya House Ketamine treatment doesn’t simply mean being administered a dose of Ketamine. It is a holistic treatment mode accompanied by a psychotherapeutic component. I doubt that Ketamine on its own would make too much of a difference in my habits. I think Ketamine helped me become more open to change that I realized needed to happen through the pre and post briefing sessions with Ryan and Rav.
10. After a gap of four months, you recently returned for a maintenance session. What made you decide to do that?
Stacy: As I found out later through reading on Ketamine more, some people may need these booster sessions every once in a while. I wasn’t surprised when certain negative thoughts and habits slowly started creeping back in until they were consuming me more than I would like to. After all I’ve been depressed for the majority of my life. I felt like I needed to remind myself of the things I realized in my earlier sessions. It was also a way for me to spend time on myself and with myself, something that I often struggle to do.
11. To people interested or curious about Ketamine, what would you share with them over a cup of coffee?
Stacy: It would be a cup of coffee with someone I knew struggled with issues similar to mine. I think I would tell them that there is really absolutely nothing to be scared of. But they do need to be ready to face themselves as this is essentially what Ketamine allows you to do. They need to be motivated to actually get to the bottom of what is making them unhappy. The good news is that – I believe – Ketamine Assisted Therapy really makes this journey easier.
If you would like to find out more about Ketamine Assisted Therapy at Hanya House, please email us with your questions and we will answer as well as send you a comprehensive document that outlines our method and approach.
*While Ketamine is a well-known drug with a good safety profile it is an anaesthetic agent so it must be given in an appropriate clinical environment by a medical professional.
*Dr. Rav James Inc. is a member of the American Ketamine Society of Physicians, Psychotherapists & Practitioners
*Ryan James is a qualified Martha Beck Wayfinder Life Coach
*South African Suicide Crisis Hotline: 0800 567 567