I’ve been on and off anti-depressants since I was 36, and since I’m turning 59 in 2025, that’s a lot of pills. The latest attempt to find a prescription drug that works started in September 2024. By January my psychiatrist realized what she had prescribed (Wellbutrin and Lamictal) wasn’t doing anything, earning my depression the label “treatment resistant.” So she prescribed ketamine, the brand name for which is Spravato.

Actually, ketamine is the drug used as an anesthetic for animals and a party drug for humans. The variant of ketamine engineered to treat depression is esketamine. I started esketamine sessions in February 2025, not knowing what to expect, but also not able to bear living with the depression I was in.

What My Ketamine Sessions Are Like

I’m not supposed to eat anything for two hours before a session and I’m not supposed to drink anything for half an hour before. That’s to reduce the chance of getting nauseated. A session lasts two hours and I have to go to a medical facility that dispenses the drug.

There I’m led to a room about as big as an examination room but with a vinyl-covered recliner and a mood light. I fill out a form that asks the depression questions (how often do I think I’m a failure, how often do I have no energy, etc.). An attendant takes my blood pressure. (Update Oct. 2025: an esketamine session slightly raises the blood pressure, so they watch it carefully.) Spravato comes in a nasal spray dispenser and the attendant brings me three of them, five minutes apart. After the first one, I relax and read a book or emails (others listen to music).

Five minutes later the attendant brings the second dispenser. She darkens the room and turns on the mood lamp. Soon after that I feel woozy enough to stop reading. Five minutes later the third dispenser comes and I can’t do much more than sit back and relax (I started out with just one dispenser and gradually worked up to three).

My first esketamine session was very intense. I had no tolerance for drugs and I don’t even drink. My body became heavy and I didn’t move a muscle for maybe 20 minutes. With a mind that could only focus on what was happening in that moment, I stared at the colors moving across the ceiling. After 20 minutes, it occurred to me: “Maybe I should swallow.” Esketamine can cause increased saliva flow and make your eyes water. 

The most intense part of the session is those 20-30 minutes. Even now that I’ve developed some tolerance, I still can’t do much more than relax during that part. I experience dissociation which means I’m not nearly as aware of my body as usual. Movement takes concentration and while I know the hand coming up to scratch my nose is mine, it doesn’t quite feel like mine. I didn’t like feeling so out of control at first, but now that my sessions aren’t as intense, I appreciate it as a vacation from my mind.

Some sessions are more intense than others, which depends on how hydrated I am, what I’ve eaten that day, and I don’t know what else. For a while I wondered if the doses might be different from day to day because my experience varied. But the attendants say the doses are uniform; it’s me that changes.

Thirty minutes after my third dose, the attendant comes in and takes my blood pressure again. Also around that time the most intense feeling, the sensation of immobility and mental blankness starts to ease. One hour into the session I’m once again aware of all the parts of my body.

I stay for a second hour so I can be monitored. It also gives me time to feel fully in control of my body. At the end, the attendant takes my blood pressure once more and tells me I’m cleared to leave. By then I haven’t eaten for at least four hours so I go eat and rehydrate. (The reason I know how long the different phases last is that listening to podcasts gives me markers I use to estimate the time.)

In the early weeks, I usually left the facility still feeling woozy. I learned to walk down the street not looking like I was slightly high (a skill many of my peers learned in high school). After several weeks, I figured out that the more quickly I rehydrated, the more quickly I recovered. After getting Spravato treatment for three months, I started feeling completely in control of my faculties before I left.

The Effects of Ketamine for Me

My treatment plan was twice a week for four weeks, and then once a week. The first time I went, hopeless and scared, I asked the attendant, “How long do I wait before I decide this didn’t work?” She said most people feel results after a month or two. The main symptoms I was managing at the time were:

• Hopelessness
• Hatred of my fat body
• Self-loathing (which had started long before I got fat)
• Not wanting to live much longer
• Feeling trapped in my failure
• Envy of everyone who was dead
• Loneliness
• Despair

No change after one month, but about five weeks in, I noticed my mood was better. I didn’t feel as dark and self-hating all the time. After six weeks I heard an item in the news that reported people dying in some accident, but the envy didn’t come. That was when I knew it was working.

After that, week by week, I experienced my mood continuing to get lighter. The self-hatred eased. After three months I had to admit all my depression symptoms were gone! Today I no longer feel anything on that list except loneliness.

It’s stunning to me. I’ve been managing varying degrees of depression symptoms for over three decades. Even when I wasn’t actively depressed, I still had the belief that I wasn’t supposed to be born and this mistake will be corrected when I’m dead. I’ve had a low level death wish since I was in my 20s. I didn’t even think that was part of my depression. I thought it was part of my belief system.

How Much is the Cost and For How Long?

Depending on whether or not you have insurance (and what kind), a single session can cost $400 to $800. When I started, I had a Blue Cross/Blue Shield plan that brought my out-of-pocket cost per session to $25. When I asked how long I’d need to continue, the answer was that on maintenance the sessions are once a week and they can go on for a year or two. At that point, I was told, many people stop because their depression is permanently gone. (Since then I’ve had to switch to Medicaid, but I was relieved to learn they also cover esketamine treatment and the clinic where I go accepts Medicaid).

It’s stunning to me that this treatment has an actual end. I didn’t think there was a cure for chronic depression, but apparently esketamine helps the brain rewire so that it no longer goes into the depression rut. It helps the brain heal from depression. I’m extremely grateful for this treatment. It wasn’t developed and prescribed until 2019, so I consider myself lucky to still be alive to benefit from it.

But people have different responses to it and for some it doesn’t work. I mainly decided to blog about this to counter the bad name “ketamine” has gotten recently because of Elon Musk. I heard commentators on a New York Times podcast speak critically of ketamine treatment for depression, confirming that taking too much can cause bladder problems and talking about how incapable of functioning Musk was while he was on it. Uh, yeah, I would definitely agree that no one should try to function normally while on esketamine. In fact, no one should take it on their own at all.

As for the bladder problem Musk said he’s had, the NYT podcast admitted that you only get those problems if you take it several times a week. Apparently that’s how often Musk was taking it, but people who aren’t very wealthy can’t even get a hold of esketamine in those quantities. It was an irritating New York Times podcast and I thought it was irresponsible of them to suggest that esketamine is a dangerous drug. It’s also irritating that people use the word ketamine when they’re actually talking about esketamine, but maybe there’s no getting around that. I use the words interchangeably in this post because I want this post to show up in searches for ketamine.

There are no guarantees that esketamine will work for any given person’s depression, so I can’t actually recommend it. But I wanted to write this because in February 2025 I couldn’t find an account of what an esketamine session actually felt like from the inside, from someone who’d had one. So here’s mine.

Related: My Link Between Sodium and Ketamine

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