What role does enhanced insight play in the benefits of ketamine?
Many patients with whom I consult after they receive ketamine infusions not only report increased mood and decreased anxiety, but also report that while receiving the infusions they had moments of searing insight, during which they saw negative, self-defeating patterns in their lives for what they were--and resolved to break free of those patterns.
I recall being astounded by these insights when patients first reported them to me. Now, I have learned that they are not unusual for those receiving the treatment.
Unlike fantasies of remaking one's life that might be triggered by using illicit drugs, only to disappear as the "high" wanes, the paths of intention opened up by ketamine often seem to be permanent--and actionable.
I have had patients describe that, during ketamine infusions, they no longer saw the idea of pursuing different professions as impossible or outlandish. And, in the weeks and months following their infusions, they went about making the necessary changes to follow their hearts. I have had patients describe that, during ketamine infusions, they began thinking about relationships that had triggered deep fears of commitment, but saw that their fears had been irrational. And, in the weeks and months following their infusions, they were able to commit to those relationships.
Patients with all sorts of unfounded misgivings about next steps in their lives have returned to college, pursued graduate education, decided to begin dating, again, decided to communicate more openly in their marriages and decided to pursue creative projects in the arts.
What is happening? Certainly, depression and anxiety can cause fear and indecision. Ketamine substantially relieves these 70 percent of the time. So, it could be that all that stood in the way of these patients moving forward so dramatically was relief of their symptoms. But, it seems to me that more is happening.
It seems that the expansive thinking triggered by ketamine, along with its capacity to stave off the anxiety that might come with such expansive thinking, may be a window through which patients can see the next steps they ought to take in their lives, but no longer see them as inherently fraught with hazard.
The renewal of synaptic connections between brain cells may then pave the way for patients to follow through with their plans.
This raises the possibility that ketamine may have the potential to augment and accelerate psychotherapy. After all, one lauded goal of psychotherapy is to free patients to actualize their heartfelt plans and dreams.
Researchers will, no doubt, examine the molecular basis for ketamine-triggered "insights" for many years to come. But for those whose lives, marred by depression and anxiety, also are circumscribed by the fear of following their hearts, ketamine can help unlock the steps they need to take to be self-actualized. And to this psychiatrist, that seems like nothing short of astounding.