How Ketamine Nasal Spray Treatments Affected My Bipolar Depression

Treatment options for mental illness have evolved over the past few years and have opened up new avenues for those of us living with treatment-resistant depression.

• What is Bipolar disorder?

I first heard about the use of ketamine to combat severe depression from my sister, who has always been extremely supportive throughout my roller coaster journey with bipolar disorder. Every once in a while, she has offered to join me on a trip to a renowned psychiatric hospital, like John Hopkins or Menninger Clinic, to get second opinions from other doctors. She’s always been a loyal, caring advocate and has never given up hope that I’d find a successful treatment for my illness. So, when she mentioned this brand-new FDA-approved medication for depression, I jumped on the internet and searched high and low for information, feedback and patient reviews.

But, since it was so new, with FDA-approval in March 2019, there simply wasn’t much data out there. And it was incredibly pricey — insurance companies weren’t covering it yet, and the average cost for a single Ketamine treatment started at about $1,000. I put it on the back burner and kept plowing along. But, after a couple more debilitating depressive episodes wreaked havoc on my life, my psychiatrist and sister both convinced me to get a consultation for Spravato, which he said was now being covered by Blue Cross Blue Shield. This is Janssen’s branded Esketamine and is administered as a nasal spray.

The medication is a controlled substance and must be given in a doctor’s office. I needed to arrange for transportation because driving on treatment days is strictly prohibited. Patients are closely monitored for two hours after each treatment. But, despite all of these restrictions, I decided to give it a go. I didn’t have anything to lose except for a couple of hours twice a week for a month. I can handle sitting in a dimly lit room, zoning out in a comfy chair, right? I mean, what’s the worst thing that could happen?

So, several weeks later — once my insurance approval came through — I scheduled my first month’s Spravato treatments. My manager at my part-time job agreed to schedule me off Mondays and Fridays and my husband was able to finagle his schedule in order to accompany me to each session.

My first appointment was on a gloomy Monday morning in November. I didn’t know what to expect and honestly was in an anxious, agitated and frustrated state of mind. I was guided into the treatment room, which had four leather recliners, each separated by partitions for privacy. The blinds were all drawn except one, and the room felt sterile and impersonal.

The experience was surreal, strange and unfamiliar — I felt sedated but also spacey and detached. For me, it was like an out-of-body experience. I tried to catch up on emails and social media on my phone in an effort to distract myself, but I kept tucking the device away because of my inability to focus. Spravato took me to a far-away place without ever leaving the confines of my psychiatrist’s office.

I quickly learned why patients are required to stay for a two-hour observation period after each treatment. Throughout these two hours, staff popped in and out of the room, sometimes to take my blood pressure and other times just to check in with me. The administering technician, nurse practitioner and the psychiatrist himself made themselves readily available. They all created a sense of normalcy for me, which was reassuring and comforting.

I desperately wanted to write about the experience but didn’t have the capacity to form a simple thought while immersed in each session. I wondered how I could possibly explain the effects of this new-fangled treatment if I wasn’t able to type anything remotely coherent.

Honestly, I didn’t think I’d be affected at all — a friend from my weekly depression support group said the beginning dosage was very low and I might not even notice a difference once administered. Much to my surprise, the effect was extremely intense. At times, I felt anxious and at one point started to panic, with my heart racing and my thoughts running in numerous directions. But, fortunately, I was able to calm myself down, realizing how critical it was to give this medication a chance.

The first few treatments were challenging because my anxiety was high and my expectations were low. I had tried a plethora of psychotropic drugs throughout the years, in addition to cognitive behavioral therapy (CBT), transcranial magnetic stimulation (TMS) and eye movement desensitization and reprocessing (EMDR). Oh, and we can’t forget the electroconvulsive therapy (ECT) treatments I endured consistently for two years. I can’t say this form of treatment didn’t temporarily ease my depression, but I did sustain quite a bit of memory loss — primarily the last 10 years of my life. After more than 100 sessions, I decided to stop and move on to something else. Then, there was the four-week stint at a renowned residential treatment facility in Arizona, where I met a couple of billionaires, a few celebrities and a politician. Wow, that place was beautiful and the people I encountered were beyond interesting, but did it offer me long-term relief? Not so much.

Since I was so accustomed to trying new treatments with little to no success, I was skeptical at best with regard to the Spravato treatments. But, I knew I needed to have an open mind and give it my best shot. And, I’m happy to report I have found some relief from my treatment-resistant depression, which has plagued me for decades.

I still find myself doubting its efficacy and long-term benefits, and out of sheer habit I am standing guard, bracing myself for the next depressive cycle. But, so far, I only have good news to share. I’m actually quite baffled by the significant improvement in my mood. Overall, I feel less stressed, less anxious and more relaxed. I feel a genuine sense of happiness, which is quite different from the hypomanic highs I typically encounter. I feel lighter, as if a burden has been lifted off my shoulders.

I realize ketamine is not a panacea — I still must maintain the healthy habits and coping mechanisms I’ve developed over the years. But, if these two-hour “k-cations” (as a friend coined them) can keep my depression at bay, there is a brand new world out there for me to embrace.

Maybe I’ll be able to plan a vacation six months out. Maybe I will flourish at my part-time job without calling out sick for weeks every time depression rocks my world. And, maybe I won’t have to worry about the holiday get-togethers with family. Maybe, just maybe, I’ll stick around in the land of the living indefinitely.

This could perpetuate a miraculous shift in my journey with bipolar depression. Since I’ve been down this road more times I can count, I am cautiously optimistic about the future. But I can’t help wondering: Could this be the treatment I’ve been searching for? Could ketamine significantly alter my life with bipolar disorder? Is it possible I have truly discovered something that will relieve symptoms of an illness I’ve battled for 35 years?

Only time will tell. But I am hopeful that my life will become more stable, freeing me from the hypomanic highs and rescuing me from the soul-crushing depths of depression. And, I am hopeful that I can begin a new chapter in my life, leaving the roller coaster cycling behind.