ketamine treatment for cPTSD

[Kyle]

Hello everyone,

I'm being treated with Ketamine along with psychotherapy.  It is a dissociative anaesthetic which, in low doses, is now being used as a rapid acting antidepressant, and a treatment for most of the symptoms of cPTSD.  Worldwide, studies have shown that between 60 and 80 percent of those treated respond to, and benefit* from the medication.  In some places it is administered every two or three days, with between six and ten treatments, in others it is given weekly, for 10 -12 weeks.   At the right dose, it allows the patient to 'lose control', often a very frightening experience for trauma survivors, and usually after that initial phase, to become an almost uninvolved observer of both relived experiences of trauma, and processes of thinking and experiencing.  This can lead to insights which are best processed in a therapy relationship. 

Ketamine is short-acting and depending on the mode, (slow IV infusion, intramuscular or subcutaneous injection are the three most common), the most intense experience lasts between half an hour and two hours, with some residual dissociative effects for a couple of hours afterwards, depending on how quickly it leaves the body.

My initial treatments were traumatic, I found it very hard to navigate the experience of losing control and the flashes of terror moved quickly into uncontrolled flashbacks.  At first, my condition both improved and worsened.  There was little support during the process or understanding of how the medication can affect survivors of trauma.  While those being treated for treatment-resistant Major Depressive Disorder seemed to look forward to their treatments, which many found pleasant, I became phobic about returning.  Others seemed on a trajectory of increasing improvement and consolidation, whereas for me, after the (often) horrible experience of the treatment, I usually had two to three days of relief of my anxiety and obsessive symptoms, combined with a deeper sadness.  A couple of times it made me worse with no benefit. When the crash came and the symptoms returned, they often felt worse than before.  It's hard to know if they were objectively worse or if the experience of relief made it all feel worse.  Overall, I think I was destabilised in good ways and bad.  My mind felt like more of a roller coaster, I was all over the place psychologically.  Emotional flashbacks were deeper and darker, but I started to experience peace and self acceptance, gradually strengthening.  More recently, my mood and sleep have improved.

I now see benefits increasing over time, but it has been erratic. Psychotherapy has been intensified, sometimes turbo-charged.  It is impossible to describe.  There is no way of knowing where your mind will take you, and it is strange to leave the driver's seat (to the extent that we like to imagine we are in it).  I've found it has taken me where I've needed to go, whether I wanted to go there or not (usually not).   I think I have experienced the gamut of effects and side-effects. They shouldn't be underestimated.  It hasn't been fun.  I think it could potentially be dangerous for some trauma survivors, especially outside of a very strong therapeutic alliance.

I don't think any two people experience this treatment in the same way.  For me, it has been diving into losing control, fear uncertainty and trauma, over time it has felt like learning to swim.  I don't believe Ketamine is a silver bullet or magic cure, but for me, it has been a powerful adjunct to psychotherapy.   

*to different degrees and for short, medium and long term.

[Three Roses]

Hello and welcome, Kyle! Thanks for joining

[Kizzie]

Hi and welcome Kyle    It sounds like quite the experience you have been through and very much like the MDMA trials I've read about that MAPS is conducting.  Were you part of a clinical trial or is Ketamine treatment legal where you live?

I can only imagine how that must have felt to be able to see/feel the trauma straight on - it's easy to understand why we have so many defenses in place so that we don't access too much too quickly without first building up our ability to self-soothe and be compassionate.  It sounds like you were able to stand back from the experiences though, but did you feel any emotions like compassion, etc about the trauma you went through?

I was surprised to hear that there was little support during the process.  From what I have read about the MDMA trials the patient is guided throughout by at least one trained psychologist.  How soon after your treatment would you see the psychologist? And did s/he use a particular approach in therapy?

Sorry, lots of questions but I know the mental health field in Canada, the US and the UK are exploring the use of medications like Ketamine so it's good if we can learn from you. 

[Kyle]

Hi Kizzzie,
Yes it is a legal, but very new.  I'm not in a triaI. I believe that in Ketamine trials, a course of treatment includes either a random 50 percent of treatments with a placebo substance, or placebo group that never receives the active agent, and they are double blind, so neither patient nor provider knows whether the treatment contains the agent being trialed.

As far as I'm aware, I'm the only patient they have treated who suffered cPTSD (or PTSD as is my official designation).  It is being used to treat severe treatment resistant Major Depressive Disorder, but I advocated strongly to be allowed to be in the programme.  I think most patients who experience the treatment as traumatic, as I did in the beginning, would simply give up, believing the cure to be worse than the complaint, and I think that is a pity. 

In some centres the treatment is individualised according to the patient and those with ptsd would start at a much lower dose and someone would stay with them, maybe hold their hand if they felt comfortable with that.  They would receive more information about what to expect.  Where Ketamine is infused, the infusion would be turned off at the patient's signal, and only resumed when the patient felt able to continue,  so the whole experience would be subject to a degree of control.  Ketamine effects are also very context dependent. Having someone trusted and caring present has been shown to make a big difference to the amount of fear experienced and can be part of the therapeutic benefit.  I wish I had been able to have my therapist my me.  I was able to talk to her by skype the next day, and it deepened my trust and our relationship, but it would have been great to have her present.   I learned to soothe myself, and it is unusual to be dissociated into different aspects of yourself so that you can actually experience being soothed by your own words in the moment.

One of the greatest gifts to me was the loss of defences during the process.  When I've tried EDMR I've become dissociated from the feelings and there has been little benefit.  Once the treatment takes hold you have no choice but to experience the feelings, and when it goes well, that leads to a place of calm after the initial terrors, in which you can look at your feelings, memories and thoughts from a place in which your ego isn't attached to them.  This allows parts experiences you may not usually be aware of to arise.  It can also allow you to watch your experiences without judgement and with a degree of compassion that isn't usually possible.  There can be deep insights into yourself.

After the first treatment, I went into an extremely deep depression as I was emerging.  I suppose the lack of usual defences was a factor is how deeply I was affected by this grief.  I had an experience that stayed with me and has remained through all the turbulence since.  I realised that I'm not a bad person, that I'm okay, and was never the identity that is, I believe, always projected from the abuser into the abused by abuse.  It is something that is easy to say but very hard to believe.  I know it now.  It's not a whole answer, and can be a catalyst for intense anger, and I've needed to work through that and will continue to do so over time,  but it makes a big difference.

[Kizzie]

Thanks so much for taking the time to answer and provide details, I do think we will see more and more of this type of treatment becoming available so it helps to hear from you what it was like and what are the benefits and drawbacks. 

It sounds tough I have to say, but in the end it seems to have given you access to more of the positive and objective aspects of you to deal with the trauma.  That is what I have heard about MDMA.

It also sounds like you do think you would have benefited  from having your T there to guide and support you during the treatment.  Were you able to talk with those in charge of the treatment program to let them know this?  What happens now by the way?  Are you done with the Ketamine or do you go back at some point? 

I am so glad to hear you know now you are not the person your abusers taught you to think you were, that is huge     I hope you let us know how that helps you in recovery over time.