Feeling Worse When Starting Treatment

Some patients feel worse when starting treatment. This is a notable but not a significant minority experience; e.g., perhaps 50% but not 70% of cases (as a crude guesstimate). There are several reasons for this, explained below.

We urge you to persist with ketamine therapy. This medicine works, in part, by making you aware of the subconscious causes of your distress, bringing them into conscious awareness. It’s commonly said, ‘ The way out is the way through.’ The only way to resolve your trauma is to experience it in a way that allows you to resolve, and heal, the trauma finally.

You have strived to suppress your experience of your trauma for years. It didn’t work! Did it? Now ketamine (as well as certain other drugs such as MDMA or psilocybin) are, at once:

• bringing your trauma into consciousness and
• helping you to tolerate the experiencing of the trauma in a healing way. Cleaning and salving the emotional wound.

You must stick to the treatment to reap the benefits. If you are among the minority of patients who experience the ‘It gets worse before it gets better’ phenomenon, recognize the choice you face. You know how much you have suffered for years. Ketamine therapy has a high probability of relieving your suffering. Will you continue your suffering? Or will you endure a short period of increased discomfort with a reasonable expectation of relief in a couple of months?

Brain Changes that take time and repeated doses are one of the most critical factors to getting better. Don’t start ketamine, see an adverse reaction and stop – instead, be patient and stick with it so you can develop the new neurology and feel better.

• Your brain has not yet regained its healthy neurons, synapses, and dendrites, so you’re still coping with depression until that happens.
• Ketamine brings trauma to the surface, so there is a lot of intense emotion to wrestle with.
• Ketamine brings to the forefront of your awareness the mental health issues you struggle with, which for some, can amplify their disabilities.
• Side effects: Ketamine can produce side effects, such as dizziness, blurred vision, nausea, dissociation, or altered perception. These effects might be unpleasant or distressing for some patients, leading to an initial worsening of symptoms.
• Psychological reaction: Some individuals may have a psychological reaction to the ketamine treatment, such as increased anxiety or emotional discomfort. This could be due to the unfamiliarity of the treatment or how ketamine affects the brain’s neurotransmitter systems.
• Temporary nature of ketamine’s effects: Ketamine’s antidepressant effects may be rapid but transient, meaning the benefits may wear off relatively quickly. This temporary nature of the treatment could lead to mood or symptom severity fluctuations, causing some patients to feel worse before they notice a sustained improvement.
• Adjustment period: The brain needs time to adjust to the changes induced by ketamine therapy. As the neural pathways and neurotransmitter systems adapt to the treatment, a person’s mood and emotional state could be affected, leading to an initial worsening of symptoms before improvement is observed.

Source: Abdallah, C. G., Sanacora, G., Duman, R. S., & Krystal, J. H. (2015). Ketamine and rapid-acting antidepressants: a window into a new neurobiology for mood disorder therapeutics. Annual review of medicine, 66, 509-523.

Source: Murrough, J. W., Iosifescu, D. V., Chang, L. C., Al Jurdi, R. K., Green, C. E., Perez, A. M., … & Charney, D. S. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. American Journal of Psychiatry, 170(10), 1134-1142.

Source: Short, B., Fong, J., Galvez, V., Shelker, W., & Loo, C. K. (2018). Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry, 5(1), 65-78.

Source: Niciu, M. J., Henter, I. D., Luckenbaugh, D. A., Zarate, C. A., & Charney, D. S. (2014). Glutamate receptor antagonists as fast-acting therapeutic alternatives for the treatment of depression: ketamine and other compounds. Annual review of pharmacology and toxicology, 54, 119-139.