Ketamine, Elon, and me

Elon Musk – a man I admire greatly but not unreservedly – used ketamine. It’s not just a rumor. He wrote about it in a series of posts on what was then Twitter.

Ketamine is a manufactured drug that was originally designed as an anesthetic, and is still used for that purpose. However, it was noticed some years ago that in doses much lower than the anesthetic dose, it produces hallucinations. The effect is similar to that of other hallucinogenic drugs like LSD or naturally-occurring psilocybin (“magic mushrooms”).

Ketamine, LSD, psilocybin and many other hallucinogens are thought not to be physically addictive (though, like other things that people enjoy, they may be habit-forming and psychologically addictive). In that respect, they are very different than, say, opiates such as heroin and morphine or, for that matter, coffee and alcohol.

Hallucinogens were investigated for years as treatments for emotional disorders such as depression and PTSD. But the “war on drugs” put a chill on that research.

As mind-altering drugs go, ketamine has a much better “brand” than LSD or psilocybin. That might be because ketamine came into use as a medical anesthesia, not a street drug, and because a ketamine dose under medical supervision is easily controlled. That contrasts with street LSD and magic mushrooms, both of which are notoriously variable in their potency.

Equally important, a ketamine trip lasts about an hour while an LSD trip lasts more like a day.

Finally, ketamine has a better champion in Elon Musk than LSD had in Timothy Leary. Endorsements are everything, you know.

Given all that, together with some credible clinical studies, the FDA has approved ketamine in inhaler form for so-called “treatment resistant depression.” That’s defined as depression that resists other treatments such as the ubiquitous SSRI drugs.

The biochemical mechanism of ketamine on severe depression is not well understood. In layman’s terms, it seems to have a “resetting” effect similar to electroshock treatment – but without the occasional burn marks.

Ketamine treatment protocols are still evolving. A typical protocol involves half a dozen treatments over the course of several weeks. But sometimes the patient improves with just one or two treatments.

Like other hallucinogens, ketamine is recognized as something that can be dangerously abused as a recreational drug.

Elon said his use of ketamine was not for recreation, but was with a prescription under medical supervision to treat depression. (It says something about the sinister nature of depression that the richest person in the world could be afflicted with it.) Elon says he no longer uses it.

I have a personal experience with ketamine. Regular readers are aware that I had open heart surgery a week before Christmas to replace a defective aortic valve.

Due to the particular nature of my valve defect, the preferred method of aortic valve replacement where the valve is installed via a vascular catheter – a procedure something like a transcatheter angiogram – was not feasible for me.

My procedure instead went the old-fashioned route – through the chest. They sliced open my chest, sawed open my sternum lengthwise, pried my chest apart, accessed my beating heart, put me on a heart-lung bypass machine, injected a drug to stop my heart, cut into my heart, carved out my ruined aortic valve, and sewed in a replacement valve made from bovine tissue – from a cow.

They sewed up my heart, took me off the bypass machine, restarted my heart, wired my sternum shut, and sewed up the big wound through my chest.

Surgery took four or five hours, and I was under anesthesia for a total of six or seven.

My recovery proved problematic. Although the wound healed well and I was up and about in a few days, I soon developed severe heart arrhythmias of various types. The surgical trauma to the heart from open heart surgery often disrupts the electrical pathways that control the beating of the four chambers, such that they don’t beat synchronously.

By then, I was about three months out from my surgery. Mechanically, my heart was doing very well. The new valve fashioned from the heart tissue of a cow was properly seated and functioning. I liked to say that I was doing much better than the cow.

But the electrical system regulating and synchronizing the contractions of my four heart chambers was all messed up. I was like a British sports car – mechanically I was not bad but the electrical system was reliably unreliable.

My random heartbeats not only wore me down, but also interfered with my sleep. Between the arrhythmias themselves and the sleep deprivation they produced, I was fatigued. I was indefatigably fatigued.

Unrelatedly, I had surgery on my forehead that was expected to be routine. That was bad timing. The surgery required a big, deep, star-shaped incision to carve out some skin cancer. I wound up with 19 external stitches plus another 25 dissolving subcutaneous ones. I looked like a hatchet murder victim, but was less active.

Also unrelatedly, my little brother died.

My reliably unreliable cardio-electrical system along with my indefatigable fatigue landed me in the Emergency Room. I was accompanied by a close friend who had helped me through my surgery in the months leading up to and following that.

In the ER, they did what they do in ERs. That is, they decided I was not at risk of dying that day, and they started to send me home.

The attending physician, however, began asking me questions about my situation. He had a ponytail. I liked him anyway, and I told him my recent story.

The doc suggested ketamine. I had never heard of ketamine, but my friend had. She said it killed Mathew Perry, the co-star of “Friends.”

The doc assured us that Perry had taken a huge dose or several doses of street ketamine the day he died, without medical supervision, and died in a swimming pool or hot tub – he might actually have drowned.

In my desperation, and after noting the absence of any swimming pools or hot tubs in this ER, I agreed to try this ketamine stuff. As the nurse was setting up an IV, we asked her whether I would feel anything. She answered that I would feel the pin-prick of the IV when she put it into my arm, but then I would feel nothing.

Maybe I asked the wrong question. After starting the IV, the nurse walked out of the curtained ER cubical, leaving me alone with my friend amid the gentle whirring of the machine slowly infusing ketamine into my vein.

The “disassociation” effect came first. Now I know what they mean by “out of body.”

Then came the hallucinations. They were something like a 70s light show, but crazy-intense and three dimensional – at least. I floated through walls of brilliant lights and gyrating shapes and wild colors.

Nothing had prepared me for this. I have never used recreational drugs. I had never heard of ketamine. The nurse had told me just minutes before that I would not feel anything. So, it was alarming. I whispered something like,

“. . . Oh . . . my . . . God . . .”

I wondered if I’d been given the wrong drug. I wondered if I’d been given an overdose. I wondered if this might be the end of the world, or at least the end of me.

At the same time, the feeling was freeing and exhilarating. I had the sensation of opening up and releasing tension and turbulence. I could see it – or hallucinate it – streaming out of me.

As I flew, I dimly felt that I needed to stay in sight of the ground. I asked my friend if she was still there. She answered yes. I asked her to keep talking. She did. About what, I don’t remember. But her voice reassured me that there was still an Earth, and that I was still on it, even as I floated in the cosmos.

It seemed that the whole treatment lasted no more than a few minutes, but in fact it was about 40 minutes. After the infusion stopped, the hallucinations stopped almost immediately. I was utterly spent.

The doc returned. I told him of my experience. He remarked, “Oh, maybe I should have warned you about that.”

I thought, “Yeah, duh.”

But I later decided that his little surprise was probably part of the treatment. My overall assessment of this physician is that his treatment of me was creative and certainly aggressive, but controlled and safe.

The next day at home, I researched ketamine, and I learned what I’ve written at the outset above.

I was very tired. Events leading up to the ketamine treatment, the sleep deprivation, and then the treatment itself, had physically and emotionally drained me.

But this tiredness was different than the indefatigable fatigue I’d had for months. Within a couple of days, I was much better than before the treatment. Over the ensuing weeks, my heart arrhythmias gradually disappeared. Maybe I’d been “reset.”

Note to readers: Don’t try this at home. Street ketamine can kill you.