“Where are you?”
It was a fairly odd question, seeing as I was about five feet from this woman, but her voice was friendly and I knew what she meant. I told her the truth.
“I am on the back of a very shiny black beetle.”
No one in the room seemed surprised.
In the beginning of 2018, therapist Maura Cohen received a referral for a patient. He was complicated, but she expected that. Over nearly two decades of private practice in Los Angeles and South Florida, she had developed a reputation for success with seemingly untreatable people. The man had been an active alcoholic for 30 years; there were no more than two hours each day when he wasn’t sleeping, hungover, or vomiting. He was also suicidal and had made several serious attempts to end his life. He had been in intensive psychoanalysis for years without success. Cohen thought about it, then said no.
“He was committed to Thanatos,” she recalls, referencing the Greek god of death. “His brain was bent on destroying itself. I couldn’t change that.” But then the referring doctor, David Wexler, told Cohen that the patient was going to begin receiving ketamine intravenously.
Developed as an anesthetic in the 1960s, ketamine—or Special K—was adopted by the counterculture of the 1970s for its recreational potential, although it never had the popularity of magic mushrooms or LSD. A generation later, club kids and ravers rediscovered its hallucinogenic and dissociative effects. In the late 1990s, some research began to indicate that it might offer the potential for treating depression in a unique way. Many antidepressants increase levels of the neurotransmitters serotonin and norepinephrine in the brain to reduce symptoms. This is effective for some, but not all, forms of depression. Ketamine appears to block a receptor called NMDA, which has been implicated in a number of neurological conditions. The growing body of evidence, while limited, was promising: a small dose stemmed symptoms in some patients with severe, treatment-resistant depression, often within hours. Wexler proposed to try treating this patient with ketamine. Now was Cohen interested?
After his first ketamine treatment, at an infusion center in Los Angeles, the man reported back to Cohen, “This is extremely powerful but terrifying. I don’t want to be alone doing this.” So for a couple of treatments, she had someone hold a phone up to the patient so they could record his free associations during the IV infusion, which usually took about an hour. Cohen and her patient would process his experiences afterward.
“This,” she says, “was so not protocol.”
The patient progressed so quickly that Wexler and Cohen arranged it so that he could administer the drug in her Westwood office. The patient and Cohen could then take the ketamine journey together. The results were, as Cohen puts it, “a transformation. He’s like a bright and shiny new penny.”
Cohen and Wexler began the treatment with other patients whose depression had not responded well to traditional medications. The patients’ responses were positive. As Wexler describes it, “the deeper the depression, the greater the results.”
Recent studies have shown that rats that are given ketamine experience a regrowth of dendrites, extensions of nerve cells in the brain that allow the cells to communicate with one another; dendrites in the frontal lobe of depressed people frequently show signs of atrophy. One theory is that increasing the number of dendrites may help reduce symptoms of depression. “Within 24 hours of a single dose of ketamine, there is sprouting of new dendritic spines and the creation of new synaptic connections,” says Dr. John Krystal of the Yale School of Medicine. What’s more, he explains, his research suggests “that behavioral changes and restoration of synapses are related.”
Cohen and Wexler’s treatment came with an intriguing side effect. Patients who relied on their creativity for their paychecks suddenly found they had more of it at their disposal. They raved to their friends. Cohen and Wexler began hearing from people in the film industry who weren’t catastrophically depressed—just regular film-industry depressed and a tiny bit creatively stagnant. A treatment that requires two professionals (a therapist and a psychiatrist) and takes more than three hours per session is bound not to be cheap. But if you, like two of their patients, are a film director for summer tentpole movies or a showrunner for a hit network program, about $6,000 for a regimen to help you break through creatively is still less than you’re going to pay your ex-wife’s nutritionist this year.
This should be where the quote from the Famous Person who does ketamine-assisted psychotherapy goes. But powerful people don’t often want to be associated with using Schedule 3 drugs. In the case of the Famous Tentpole Director, they were game, but their agent had a more modulated response, something to the effect of “You do understand that a studio will never give you a hundred million dollars to make a movie if they think you’re tripping balls, right?”
Luckily, no one cares what a writer does. Instead of an IV infusion, Wexler handed me a piece of paper to tuck between my cheek and jaw, and it tasted utterly foul. Oh, that taste. Like if hell had reflux.
As for the session, it’s like therapy, but instead of considering all the locked doors in your head behind which lie God only knows what, your brain dumps everything it owns, Marie Kondo–style, onto your cerebral bed and you ponder it. You are calmly standing in the middle of your brain noting all the stuff you’ve accumulated as a person nearby asks you questions about which things you want to keep. You also can briefly ride on the back of a beetle.
Three hours later, I awoke feeling fine and remembering everything. My college-age daughter came to drive me home. As I smiled to myself in what I thought was a secretive way, my daughter glanced at me. “I never thought I’d have to say this,” she said, “but I’m not taking you to Burning Man.”
It’s been seven weeks since my session, long enough for those dendrites to start growing in my head. Have I written Oprah’s next pick for her book club? No. But I am more tranquil, an adjective I never associated with myself before. I’m not sedated; I’m just less interested in patterns of behavior that did me no good. Imagine that your loved one is doing That Thing that always makes you shout, and instead of shouting, you think, “Huh. Oh well,” and you keep calm, and your day is a little bit better. It’s like that. Is that worth $6,000? Maybe. And the dendrites are still growing, which is good because anyone who has driven with me will tell you that I could stand to be a lot less shouty. As Cohen says, “I believe we get the medicine when we’re ready to receive it.”