Mental Health: Why a ‘Bad Trip’ With Ketamine Treatment Isn’t What You Think It Is

It was Wednesday and time for my ketamine treatment. There is a certain amount of routine to getting my treatments. When I started with ketamine I thought I would get the IV treatments once every three months or so. That’s what everything I had read said would happen. Maybe the “treatment-resistant” part of my bipolar disorder applies to ketamine too. I don’t know. In any case, we have determined that every other week works for me. By the beginning of the second week, I start to dip in mood. I can reach suicidal thinking by the time it’s time for the next infusion. We try not to let me get to that place.

The infusions are accompanied by psychedelic “trips.” That’s just part of ketamine. In the beginning, I believed that the trip didn’t matter — the drug got in me regardless of if the trip was “good” or “bad.” A lot of my trips are “bad.” I believe this is largely because of complex post-traumatic stress disorder (C-PTSD). I put bad in quotes because it’s not an accurate description. The trips can be scary. I see things and feel things that are frightening or unpleasant. I have been literally terrified several times. That doesn’t mean they’re bad, though.

The trip before last Wednesday’s infusion was terrifying. I screamed so hard that I lost my voice for almost a full week. I just screamed and screamed. I was certain that I was permanently trapped in this other world that I was hallucinating. The people in the room with me, the nurses and anesthetist, looked like stick figures. They were walking around and they were talking. I didn’t know what they were saying; I was too busy screaming, “Please, somebody, notice that I’m still trapped over here in this alternate universe. Let me out!” One of them was telling me I was OK. I was insisting, “I am not OK.” As the ketamine wore off, I returned to this world and realized everything was fine. Just like every other time.

When it was time for the next infusion two weeks later, the clinic director decided to have a nurse, Colleen, sit with me for the trip. The thinking was I would feel safer and stay calmer. Maybe not scream my head off. Colleen is special to me; she has been with me since my first infusion. She has held my hand many times when trips turned frightening, always reminding me “you are safe.” It was a logical and welcome decision to have Colleen sit with me.

Except in this trip, Colleen turned evil. The world was red and black, no other colors. The walls in the room looked like the walls in “The Matrix” with green code running down black walls. Except my “code” was red. Colleen was red and terrifying. She was saying terrible things. I was convinced that the clinic was a front for an evil organization trying to do mind control and keep me trapped in that cold, black-and-red world forever. I didn’t scream because Colleen was there. I was afraid of her. I was afraid of what might happen if I screamed. What would she do to me?

Coming out of that trip, I was convinced that it would be my last. I couldn’t keep doing this, I didn’t trust anyone; that’s part of C-PTSD after all. I sent the clinic director an email the next day and asked him if he could sedate me for my next trip. Sometimes when I get especially agitated during a trip, he will add in a little sedative toward the end. When he does that, I go home with little to no memory of anything that happened during the trip. He wisely answered that the trips were important; he wanted me to experience them.

And he’s right because here’s the thing. Those “bad” trips? They aren’t bad. They’re unpleasant. They’re scary. They’re challenging and very hard to go through. But they aren’t bad. Let me explain.

The day after the Red Colleen (sorry, Colleen) trip, I went to dinner with a friend. We talked about a lot of things. This was the first time we had gotten together since my suicide attempt two months earlier. I filled her in on what it was like when I made the attempt, the ambulance ride, the emergency room, the week spent on the medical floor of the hospital, and the week after that on the psychiatric floor. I walked her through all of it. On my drive home after dinner, I had to pull into a parking lot because I was so overcome with emotion that I couldn’t keep driving. I sat in the parking lot and sobbed, letting out all the emotion that had come up while talking to my friend. It was a good, cleansing cry. When I was composed enough to drive, I made my way home. Turned out, that cry was just the beginning.

Later that same night, after everyone had gone to bed, I was up by myself. I put YouTube on the television and played my favorite music video. I had discovered this video months earlier and it had become a constant as a self-care thing I did. This video could make me cry, it could make me laugh. Something about the music touched me deep in my soul; I physically felt the music. As it played this night, tears started to flow. And I let them.

That’s something my therapist has been working on with me for over a year: Feel the feelings. Don’t avoid them, don’t push them away. Stop the struggle. Feel them. As the song came to its end, I started to smile through my tears. This is an amazing piece of music. The next video started to play. I cried some more. For the next half hour, I cried as I listened to and felt the music. But I didn’t just cry. I was turned inside out. Something broke inside me. I sobbed. I laughed. I cried about the suicide attempt. I cried about the time in the hospital. I cried about how hard the past two years have been as I rapid-cycled through bipolar, up and down, going through six different medications on the way to being declared treatment-resistant and getting off all drugs. How much work I had done with my therapist, working through all the trauma of my childhood. And I kept crying.

Then I remembered my therapist had suggested the day before that I do a meditation we know called “Working with Difficulty.” It walks you through grounding like normal. But then the guide suggests that you take any negative emotion that is coming up and place it on the worktable of your mind. Find the physical sensations of it in your body. Where are you feeling this emotion?

The guide instructs that you don’t do anything to change your breathing, just notice it, focus on it. I was sobbing hysterically. And I kept sobbing. I was breathing; it was just sobs and hyperventilating, not the calm, controlled breathing I think of when I think of meditating. I let myself do it. I gave myself permission to feel this. To express it. As I worked through this 25-minute meditation, I let myself feel all of it. And as the crying continued, that traumatized little girl who had never been allowed to cry showed up. She started to cry. This is the miracle of ketamine: It allows your mind to do things it hasn’t been able to do before. That little girl had been shamed into never crying. It wasn’t allowed. And she desperately needed to cry. She was not going to be able to heal from the trauma until she could express all that she had stuffed so far down for so long. And I was able to give her permission. I encouraged her: yes, dear one, cry. Cry until you don’t have any tears left to cry.

And she did. She cried. She rocked back and forth. She hugged a pillow and sobbed into it. I don’t have words to describe what this experience was like. The intensity was beyond description. There was one point when I felt I was back in the psychedelic part of the ketamine trip. It’s like ketamine lets your mind open in places it hasn’t opened before. This gave me the space and the permission I needed to let this little girl cry her heart out.

This was such a healing episode. I’m not the same today. I’ve been used to learning coping skills in therapy. I assumed that was the best I could hope for — learning how to cope. But, no. This was healing. The pain that that little girl had held inside all these years was released. This isn’t the first time I’ve had such a physical reaction and release of repressed pain. And it is ketamine that allowed this — caused it.

As I said in the beginning, I believe there’s no such thing as a bad trip. Every trip I’ve had that was painful ended with something good. A new insight. An expression of long-buried pain. I feel it necessary to say that I have not arrived at these good results alone. I have needed the guidance of the people at the clinic. I have needed my therapist. I have needed my psychiatrist. I don’t know psychedelics. Had I done these trips on my own, I think I would have ended up further traumatized. These trips can get very difficult and very intense. But my subconscious has been hard at work during them. Things have bubbled to the surface — the conditioned emotional responses, the fight-or-flight triggers, the repressed memories, they have been in my mind all along. Ketamine, along with therapy, has allowed those things to surface and be dealt with. It’s a very powerful and healing combination.

For more on ketamine treatments for depression, bipolar disorder, trauma and other mental illnesses, see The Mighty Community’s posts here.