How to Talk with Friends, Family, and Chosen Family about Ketamine and Esketamine
In 1637 French mathematician and philosopher René Descartes wrote "I think therefore I am." In Western culture we put a high priority on how we think, feel, and experience the world with how we identify. In this way, the parts of ourselves that feel most intrinsically self are our mental faculties. While our bodies age, our hair can change color, our ability to hear or see can diminish over time, and so on, so long as we have our memories and the ability to think, we feel, colloquially, “like ourselves.” This close identification with how we think and feel in terms of how we identify presents a unique circumstance in psychiatry and psychology as both are practices that specifically address the portions of ourselves with which many of us most closely identify. Letting someone in to help us change the parts of ourselves that think, feel, and experience the world requires tremendous trust and tolerating no small measure of vulnerability.
How do I talk about Mental Health?
While many of us avoid conversations about our medical histories with friends, family, and chosen family, this can be especially true of psychiatric conditions. There may be concerns about stigma, not to mention the potential exposure of some of our most intimate and potentially special attributes with the outside world. The conversation about how to talk about ketamine and esketamine with family and friends must first, therefore, begin with a conversation about how we speak with friends and family about mental health, in general. If a person decides to open up a conversation about his/her/their mental health, the first and most important condition is that it happens on that person's own terms: what gets disclosed, to whom, and when are all critical components in how we bring these topics up. It’s not a bad idea to speak with a mental health care provider before initiating a conversation with friends and family to strategize. These conversations can help clarify the point of the conversation and how to structure it.
Our cultural shyness around these conversations hides an open truth: mental health conditions like depression, anxiety, bipolar disorder, PTSD, OCD, substance use disorders, schizophrenia, etc. are extraordinarily common. Many people have experienced some period in their lives when they have struggled with a mental health condition. For those who, by chance, have not had this kind of personal experience, the highest likelihood is that they have experienced someone in their family or friend group who has. It is important to recognize that, despite this near universal familiarity, some people need to be prepared to engage in these sorts of conversations. It is also important to note that how anyone of us comes to experience a mental health condition may be different from how someone else experiences it. Take your time in these conversations, go about them intentionally. Be open to questions that come up and prepared for disclosures on the part of the person with whom you are chatting as they may have their own story to tell.
How do I talk about ketamine and esketamine (Spravato)?
The conversation around ketamine and esketamine begins first with acknowledgment that a person is managing a mental health condition. At their core, ketamine and esketamine are biological agents that can change how the brain operates and can change how the mind thinks. In this way, these medications fall very much under the same conceptual rubric as standard psychiatric medications and psychotherapy, respectively. And yet... Insofar as both ketamine and esketamine are psychedelic substances, they come with a whole other set of considerations. People have associations with psychedelic substances, for example: they can free the mind, they can expose people to uncomfortable experiences, they are not part of mainstream culture and can suggest an interest in challenging authority, they have been a natural component of healing for tens of thousands of years, they are weird, they are exciting, and so on, and so on.
In the ways in which these medications are prescribed, administered, and how their effects are evaluated, both ketamine and esketamine are regarded by the medical establishment as medicines. In the case of esketamine (Spravato) (a derivative of ketamine), this medication is used to treat treatment refractory major depressive disorder and suicidal thoughts that are happening in the midst of a depressive episode.[1,2] Ketamine, the parent molecule, has evidence for the same, and is being studied in conditions such as PTSD, anxiety, OCD and some substance use disorders, with results that range from promising to mixed.[3,4,5] There are many ways in which people access psychedelic experiences, some legally, some less so. In the specific case of ketamine and esketamine, these are medications that are monitored in a medical setting and the structure that surrounds them is one of safety and agreeability with the medical establishment. Contextualizing both ketamine and esketamine in this way can help resolve some of the "otherness" that people might associate with these medications.
That said, some of the "otherness" that these medications provide is exactly what a person might be after. It is important to acknowledge how these medications can elicit internal, mental environments in which one can experience curiosity, wonder, journeying, and alternative experience. For some, openly inviting this otherness into the experience, without hesitation or reluctance, and speaking about that interest with friends and family can set an important tone in the conversation about ketamine and esketamine. Knowing that the individual who may be undergoing ketamine or esketamine treatment is okay with exploring these internal spaces can help those with whom the individual is having a conversation also feel comfortable and curious. It can also serve as an interesting topic of conversation.
For others, the otherness afforded by the medications (i.e., the exploratory, psychedelic component) is less of a priority and regarded almost like a side effect. Communicating that is also important.
What we are trying to do in these communications is to be known, relatable, and to set the tone for how our friends, family, and chosen family regard both us and the treatment. The people with whom we come to speak regarding both our mental health as well as available treatments will likely incorporate this information as an important point, among countless others, in how they think of us. Questions about mental health and treatment will come up and this can serve to deepen the connections we have with our loved ones.
Remember these principles when discussing ketamine treatment:
· Disclose what you want and when you want. People have the right to ask any question that comes up, but we can choose if and how we respond.
· Some people need to be prepared to hear meaningful things about us. Make sure the conversation is ready (both for you and your conversation partner).
· Try to understand yourself and your viewpoint as best as possible. Thinking clearly and without judgment will help you in the conversation.
· Invite questions.
· You can prepare for conversations with your mental health providers.
- Benjamin Yudkoff, MD, MA
References
- Popova V, Daly EJ, Trivedi M, et al. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study. Am J Psychiatry. 2019;176(6):428-438. PubMed
- Fu DJ, Ionescu DF, Li X, et al. Esketamine Nasal Spray for Rapid Reduction of Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent: Double-Blind, Randomized Study (ASPIRE I). J Clin Psychiatry. 2020;81(3). PubMed
- Feder A, Parides MK, Murrough JW, et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71(6):681-8. PubMed
- Glue P, Medlicott NJ, Harland S, et al. Ketamine's dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders. J Psychopharmacol. 2017;31(10):1302-1305. PubMed
- Bloch MH, Wasylink S, Landeros-Weisenberger A, et al. Effects of ketamine in treatment-refractory obsessive-compulsive disorder. Biol Psychiatry. 2012;72(11):964-70. PubMed
Take the first step today.
If you or a loved one in Massachusetts and the greater Washington DC/Maryland area is struggling with depression or anxiety, Lumin Health's team of experts is ready to help. Book a free 20-minute consultation to learn if ketamine therapy could be the breakthrough you've been looking for.
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Frequently Asked Questions
How do I start a conversation with friends or family about ketamine or esketamine treatment?
Start on your own terms: decide what you want to share, with whom, and when. It can help to talk with your mental health provider first to plan how to bring it up. Invite questions, and expect that people may want to share their own experience too.
How can I explain what ketamine and esketamine treatment are for?
You can describe them simply as biological medications that can change how the brain and mind work, used to treat conditions like depression. Esketamine (Spravato) specifically treats treatment-resistant depression and suicidal thoughts that come with a depressive episode. Ketamine, the related molecule, is being studied for conditions like PTSD, anxiety and OCD, with results that range from promising to mixed.
What if I don't want to share details about my treatment at work or with acquaintances?
That's entirely your choice. You can disclose as much or as little as feels right, and you're not obligated to explain your care to everyone who asks. Deciding in advance what you're comfortable sharing can make these conversations feel less exposing.
Why might people react differently when I mention ketamine or esketamine treatment?
Because of ketamine's existing reputation, people often bring strong existing associations, like curiosity, unease, or a sense that they're outside mainstream medicine. Framing the conversation around your mental health condition and the medical, monitored setting where treatment happens, rather than the substance's reputation, can help people meet you where you are.
