Ketamine and Bipolar Depression: A Therapist’s Year of Psycholytic Treatment

When I began exploring ketamine treatment for my bipolar depression in 2023, I was following a strong pull of intuition. Other treatments had begun revealing their limits, and I was drawn to the increasing availability of at-home dosing sessions for a different approach to mental health.

My curiosity was rooted in ketamine’s proven off-label benefits for treatment-resistant depression, a category of depression that does not improve after trying at least two well-established methods including medications. For me and many others with Bipolar Type II, depression fills the majority of our days in contrast to periods of hypomania. I was seeking relief from this darker side of the spectrum, with its gnawing self-criticisms and distorted thought patterns that made daily life unnecessarily difficult.

I located a well-reviewed psychiatrist who worked with me over time to prescribe an appropriate dose and dosing frequency for my biological makeup, and a therapist who guided me to create a nurturing set and setting for each at-home dosing trip. As with any promising treatment, I longed for the ketamine to work, but had to see through trial and experimentation to determine its efficacy for me. I continued taking my other medications as well after establishing no known contraindications.

In reflecting on my year of using ketamine for a chronic mood disorder, I can say wholeheartedly that the time period was a profound gift. I consistently uncovered unconscious wisdom made possible by synaptic growth, gained visceral memory for what nervous system regulation could feel like, felt the loosening grip of a condemning internal monologue, and uncovered deep longings that drove new, healthier lifestyle routines. And now I feel compelled to share about this restorative period with those who might be stuck and long for similar change.

Ketamine’s Restorative Potency

Depression is often a chronic whole-body stressor that can result in inflammation of the brain, and the withering of CNS cells. I experienced the consequences of this, including a DMN in ruminatory ruts, rejection sensitivity and cognitive distortions from a weakened salience network, and difficulty managing a central executive network that wasn’t fully online. I felt the increasing rigidity of belief systems that reinforced the visceral stress.

On a microscopic level, ketamine’s primary mechanism is the rebalancing of glutamate, which in turn supports the flourishing of Brain Derived Neurotropic Factor (BDNF), a protein that controls nerve cell health. BDNF levels determine neurogenesis, mood regulation, and capacity for learning. This is the remarkable sequence by which ketamine addresses neuronal atrophy and impaired executive functioning. For bipolar depression specifically, research continues to explore ties between ketamine dosing and decreased depression and suicidal symptoms in clinical trials.

I was also excited to learn of the medicine’s NOSC effects and hallucinogenic features. As a Licensed Marriage and Family Therapist, I’m passionate about depth psychology and receiving greater access to transpersonal realities. Whether through dream work or active imagination, I’d had illuminating experiences of tapping into my unconscious mind and integrating parts of my Self as a result. The opportunity to access unconscious material or even traumatic memories in a gentle, indirect way also seemed like therapeutic gold.

The Importance of Integration

The purpose of ketamine-assisted psychotherapy (KAP) is to partner with a trained therapist who can support our psychedelic journey. Together, by taking advantage of the window of time when neuroplasticity is highly accessible, you can find words for nameless experiences and integrate their takeaways into daily life. For those with chronic depression, this might look like reinforcing the loosening of rigid beliefs through practicing more flexible thought patterns, starting or returning to wellness habits like immersion in nature or inborn creativity, and reconnecting with your community in more intentional, open-hearted ways.

As an initiate to KAP, I knew about these intentions and soon uncovered the remarkable, deeply meaningful ways in which they could be realized in my own life.

My Dosing Experiences 

I started each of my at-home psycholytic sessions with a reflective intention setting where I wrote down a theme or challenge to hold gently to mind. I’d ask myself, “What am I ready to release? What am I open to receiving?” But I held what rang true loosely so that organic material could arise as my unconscious pleased. My primary aim was to stay present to each stage of the unfolding experience - to do nothing and just be. 

Once the sublingual lozenge had dissolved and the medicine began its work, my perceptual field would change. Time would feel less urgent as I settled into a long-forgotten resting state. Bodily awareness and external stimulation both took on a softer quality, and I was able to breathe more deeply from the somatic relaxation. The constant depressive ache in my chest would abate, making me feel safer to inhabit my body. Nervous system rest felt effortless, and I recognized it as my true baseline state without the pressures of chronic stress.

Neurologically, my brain began generating fresh neural networks that represented a non-depressed, conscious awareness of myself and the world. New dendritic pathways were born, and my brain reconnected with reward circuits in a way that felt both elating and re-orienting.

Psychologically, I was drawn into a flow state that allowed me to move more easily through mental and emotional blocks, particularly those from past relational trauma. The ketamine’s dissociative effects enabled me to reflect on painful, unresolved memories with greater emotional distance and body regulation, making them easier to hold loosely. The quieting of my inner critic, made possible by the slowing of my DMN’s chatter, increased feelings of self-acceptance and mindful presence. I was able to hear my compassionate self saying gently, “You are welcome here.” I would surrender to this experience, allowing myself to just receive.

Post-Trip Integration

After the equanimity of the dosing sessions had faded, I’d enter into periods of integration. My integration journey was a profoundly generative process, where contemplating spontaneous insights from dosing sessions inspired creative expression, wiser awareness of depression’s pervasive effects, and follow-through on essential lifestyle changes. The results were more than a decrease in symptoms; it was a whole-person enhancement of mental, emotional, physical, and spiritual functioning. But these changes weren’t loud or immediate. Instead, transformation happened incrementally in its own time.

In addition to integration support from my provider team, on days following dosing I’d reflect on the notes I’d jotted down during trips, and also use visualization meditations to internalize the compassionate messages I’d received. The empathogenic effects of ketamine played a large part in shifting how I began to relate to myself and others, by softening rejection sensitivity and inspiring more vulnerable communication with loved ones. The medicine gave me the creative spark, and I was the one carrying out these longings from my truest self.

Executive functioning also noticeably improved. Mental connections occurred as I suddenly knew what to do in several challenging situations, as the inner monologue quieted and I could hear the wise perspectives of my inner Self. And taking empowered action on it became more attainable. Sometimes this looked like sending a delayed message to someone I’d been avoiding out of self-doubt. Or it meant executing values-focused actions that depression had made it difficult to follow through on.

I also experienced a major change to my interpersonal life. Over the course of several months of treatment, I gained the clarity and confidence to leave an emotionally and psychologically abusive relationship. Looking back, I believe this decision was made possible by an increased understanding of old attachment wounds and relationship trauma, and how they’d been distorting my self-beliefs and standards.

It’s important to note that in some sessions there were no significant discoveries, only a reassuring sense of calm and relief. Often in the trance-like flow of consciousness my mind would drop lightly into old memories, then pivot away to other things. I didn’t try to grasp on to these moments, instead trusting in the timing of inner wisdom to register the most relevant material.

In this way, my ketamine and integration experiences helped me reunite with my deeper self. And there is one area of discovery that I’m still integrating to this day: the spiritual encounters I had while in a NOSC state. I’d known of the sacramental uses of entheogens across time and cultures who attuned to their mystic qualities. As a former person of faith, I felt the tug to reconcile my dormant spiritual imagination with the new contact I’d made with the transpersonal. What was the meaning behind my renewed sense of collective belonging and community with my fellow man? I marvel at how this gift from ketamine interplayed with my deeper needs for slow, progressive spiritual integration, and there was no lightning strike of conviction that could serve to cause more confusion.

All in all, having therapist support through multiple telehealth integration sessions, both within critical windows of neurogenesis and long after, helped me to expand nascent insights and capitalize on their heartfelt encouragement and accountability as an extension of my own.

No Magic Bullet

While KAP now has an established presence alongside other evidence-based treatments, our expectations for its results must be grounded in realism. I found it effective as an adjunct approach alongside my existent medications, as my psychiatrist had already alleviated my concerns about concomitant contraindications. 

The healing effects attributed to ketamine must also be taken within context. When our inner healing intelligence is activated by the medicine, we have an invitation to reawaken strengths and capacities for making sustainable lifestyle changes. The medicine effectively catalyzes our own innate strengths, which are the true mechanisms of action for lasting growth, improvements in our mental health, and further actualization.

The Psychedelic Harm Reduction and Integration (PHRI) model rightly emphasizes that ketamine and other psychedelics mustn’t be viewed as a magic bullet for alleviating suffering. This is why I disagree with reliance on a medical model for ketamine therapy that bypasses structured integration. We need to be active participants in our own healing process, and clients should be fully educated on how self-examination is the true mode of transformation.

Indeed, the real work happens in the preparation and integration stages, where behavioral activation goals are created and later become much easier to achieve. The cumulative impact of deeper self-knowledge and reconciliation with parts of yourself is the true destination; the substance is merely the entryway.

As therapists would say, the process of state to trait change that embeds new ways of being in the world isn’t automatic. Instead, it requires energy investment and honoring your own timing. Oftentimes lingering challenges such as anger or grief, fear of secondary loss (e.g. the loss of depression as integral to your identity), and pushing for major changes too quickly need to be reconciled. This can be supported through collaboration with an attuned and well-trained therapist, and highlights how well psychedelic therapies can blend with traditional therapies.

Final Thoughts

For those considering KAP for mental health and whole-person growth, I’d encourage working with the most affordable, reputable psychiatrist and therapist providers that can meet your needs. Whether via a local clinic or through telehealth, you deserve to receive dedicated support from the very start of your psychedelic therapy journey.

After my own transformative year of ketamine treatment, I can see how increasing accessibility to these ancient substances is paramount. More individuals with treatment-resistant challenges, and those carrying interpersonal or existential questions that conventional therapy has never quite reached, deserve this kind of profound encounter with themselves. And we as therapists, have an opportunity and a responsibility to hold this work with both rigor and reverence.

What I followed into my first dosing session was my intuition. What I found there was something I hadn't expected - not a cure, but a homecoming. The medicine didn't give me anything new; instead, it cleared enough space for me to remember what had always been there: my own capacity for aliveness, discernment, and return. For those of us who have spent years managing symptoms rather than meeting ourselves, this remembering can be everything.