Ketamine Therapy and Stroke: A Diary

Photo by JD Mason on Unsplash

WARNING: I am not a medical professional, nor am I an expert on ketamine or stroke. However, it might be helpful for some people to read about my dad’s experience as a stroke victim receiving ketamine therapy. Never take ketamine unless administered by a licensed medical professional.

Summary

Ketamine is a medication that’s gotten a lot of attention recently for its potential to help treat depression and anxiety. Unlike SSRI medications like Prozac or Zoloft that mainly target the neurotransmitter serotonin, many studies show that ketamine mainly targets the neurotransmitter glutamate. There is hope that this difference could help patients who don’t respond to SSRIs and other standard treatments. Ketamine can already be legally administered by medical professionals in the United States.

My dad had mixed results from ketamine therapy for his post-stroke conditions. On the plus side, it sometimes improved his mood and reduced his obsessive behavior, anger, and physical agitation. However, some of this might have been due to ketamine’s painkilling qualities, since my dad suffered from severe chronic pain. It would be understandable if a reduction in pain also reduced his anger and agitation. He also regained a little ability to move his stroke-paralyzed leg (though this might have been because ketamine lessened his inhibitions about moving his leg). Unfortunately, these effects were only temporary. His emotional improvements plateaued after the third treatment and disappeared a couple weeks after stopping therapy. He also lost the ability to move his paralyzed leg again after about a month.

One major side effect with both positive and negative results for my dad was that his dreams became intensely vivid. So vivid that he was often unable to tell whether he was dreaming or awake. Many of these dreams were pleasant, especially those involving my mom, who had passed away two years before. However, the vivid dreams could also cause stress, because he sometimes didn’t know if people were actually there when he was awake. Still, after all the treatments ended, he thanked me for them. He was happy for the extra chance to spend time with his wife in his dreams.

I suppose it’s possible that some of the positive effects might have continued if my dad had received ketamine treatments for the rest of his life. However, ketamine therapy is normally prescribed for only six treatments and the benefits are supposed to last long after the treatments end. The therapy is usually promoted as a “reset” of the brain that can be discontinued after the reset is complete, rather than becoming an ongoing therapy. In addition, since ketamine treatments are expensive and not covered by insurance, they would have been difficult to afford on a regular basis. Hopefully, ketamine therapy will someday be covered by insurance plans.

In the end, I found that my dad’s psychological issues, such as depression, anger, anxiety, and obsessive compulsion, were soothed better and less expensively with marijuana. (He also took a variety of prescription psychiatric medications, but these often seemed to have little effect.) Of course, I can make no claims about this for other people.

My Dad’s Medical Condition

My dad’s therapy took place when he was 79 years old, about eight years after his stroke. The stroke had affected the right side of his brain, causing extensive vascular dementia (brain damage) and hemiparesis (paralysis) on the left side of his body. He had become wheelchair-bound, mostly unable to care for himself, and required 24-hour monitoring. He had also lost much of his ability to perform basic mental reasoning or converse in an adult manner. I needed to arrange his ketamine treatments and provide transportation.

In addition, my dad had developed the following health issues after his stroke:

1. Extreme chronic pain on his paralyzed left side
2. Obsessive-compulsive behavior
3. Anger and physical agitation lasting hours, days, or even weeks
4. Severe depression
5. Significant memory loss, both long-term and short-term
6. Severe anxiety

Treatment 1 — March 15, 2019

First visit to psychiatrist. Filled out a long questionnaire with extremely personal questions about my dad’s emotional state. For a severe stroke victim like my dad, this was impossible to complete on his own, so I had to do most of it. We were told that the same questionnaire would have to be filled out before every session, which was a significant possible barrier to treatment.

The psychiatrist talked with my dad about why he wanted to try ketamine. She said some research showed that ketamine therapy could revitalize atrophied neural connections, as well as promote the growth of new neural connections. She recommended six individual treatments, each taking place on separate days. Each treatment would cost $500 (US).

The first dose of ketamine was administered by a nurse that same day. She said they normally used an IV (intravenous) connection to deliver a steady dose, but I worried that my dad would pull out the IV tube. The nurse said that another option was injecting the entire dose at once. I decided to use the injection option.

The dose was 0.5 mg/kg (milligrams of ketamine per kilogram of patient weight). My dad barely reacted to the injection itself. The nurse played sounds of ocean waves on speakers to create a calm environment. After about 5–7 minutes, my dad closed his eyes and dropped his head, which the nurse said was a sign of the ketamine taking effect. To me, however, he appeared to be merely taking a nap, especially since the treatment was happening during his usual nap time.

My dad dozed for about 30 minutes and we left soon after. There was no noticeable change in his behavior or reporting of pain, though he had liked the relaxing setting.

Treatment 2 — March 29, 2019

Very strong effect this time. Injection dose was 0.75 mg/kg. The nurse said the main effects should taper off after about 30 minutes, but my dad was still zoned out with eyes closed after 45 minutes. His body twitched a lot during the treatment, including on his paralyzed side, which reminded me of when people dream.

When my dad finally opened his eyes after 45 minutes, I asked him if he had been asleep and he said no. I asked him if he had felt like he was in the room and he also said no, but he couldn’t articulate where he had been. He wouldn’t communicate verbally for the next 30 minutes. I asked him: “Do you feel weird?” and he nodded yes. I asked “Good weird?” and he shrugged non-committedly. We didn’t leave the office until 75 minutes after the injection. He was still very groggy when we left and for the entire 30-minute drive home.

Previously, my dad’s obsessive behavior often led him to repeatedly ask to be lifted or to pound his fist against any available surface. However, he did not do either of these behaviors during the drive back from the psychiatrist. Lots of wide-eyed staring out the window. I asked if he wanted lunch and he rasped “ice cream,” so we stopped for a cone.

March 30: My dad was in a good mood during lunch at a restaurant. Laughed a lot more than usual and was asking questions of my aunt and uncle instead of his usual general silence.

March 31: Paralyzed leg twitched considerably during church. Similar to the twitching that happened during the ketamine treatment.

Treatment 3 — April 14, 2019

My dad began crying when I picked him up at his nursing home. He told me that he didn’t believe I was really there and that he was dreaming. I eventually determined that he’d been having very vivid dreams. In some of the dreams I would come to see him, but then he would wake up and I’d be gone, so he didn’t believe when I actually did arrive. He said the dreams were good, though. Prior to this, he had claimed to not remember his dreams for a few years.

I strongly considered canceling that day’s treatment due to my dad’s intense reaction. However, in the days immediately following his previous treatment, his mood and behavior had improved greatly. He also said that his dreams had been good. Most importantly, after over eight years of post-stroke hell, I didn’t want to give up so soon.

As usual, my dad asked obsessively to be lifted for almost the entire drive to the psychiatrist, though he didn’t fidget much. Injection dose was 0.75 mg/kg. As with the previous treatment, he soon closed his eyes and zoned out. His paralyzed leg twitched frequently. He moved his non-paralyzed arm and hand a lot. Very groggy after coming out of treatment, but not as much as the previous time. The psychiatrist came in to talk with him after this treatment, but he was barely responsive verbally.

About an hour after the injection, he was mostly back to his normal level of alertness. During his post-treatment ice cream, he finally claimed to be awake instead of dreaming.

April 16: My dad said he had dreamed that I had died the previous night. In the dream, I had come into his room, lay down on his bed, and died there. He began crying. He also said that he was still dreaming and that I wasn’t really there. During lunch, he told my aunt and uncle that he was dreaming. More talkative than usual during lunch. Lots of his usual obsessive asking to be lifted, but not much fidgeting.

Treatment 4 — April 19, 2019

My dad didn’t cry when I arrived, but he claimed again to be dreaming. None of his usual verbal or physical agitation.

Injection dose was 0.75 mg/kg. At first he closed his eyes as he had for the previous treatments, but he opened them again after about 20 minutes. After opening his eyes, he began moving his head a lot, though slowly. Lots of loud exhaling. Later in the treatment, he seemed to be observing the room, as if it looked different. Pulled his right arm back and stared at his hand and wrist. Some twitching of both legs. Lots of small movements and torso shifting. After the treatment, he didn’t ask to be lifted until almost the end of the 30-minute drive home.

April 20: Good mood. Said he was dreaming, but it was a good dream because I was there. Very little asking to be lifted. Talkative with my aunt and uncle at restaurant.

April 21: I asked my dad to move his left leg, which was normally paralyzed. He could slightly lift his left foot and calf. I said: “You haven’t done that in a long time!” He got wide eyes and replied: “No, I haven’t…” I tried using his old gait belt (used for supporting someone with weak legs) to stand him up, which he had not been able to do for nearly two years. (He could walk a little for several years after his stroke, but had gradually lost this ability.) He couldn’t stand fully erect, but his left leg was stable during three separate standings. The last time I had tried to stand him up (a year before), his left leg had collapsed immediately due to his paralysis.

Treatment 5 — May 3, 2019

My dad said he was remembering all of his dreams. In the dreams, his deceased wife (my mom) would sometimes come into his room and say: “Hey, lover, why are you still in bed?” No verbal or physical agitation on the drive to the clinic.

Injection dose was 0.75 mg/kg. He asked me to lift him at the beginning of the session, but didn’t repeat the request. He soon closed his eyes and fell into what some ketamine patients refer to as the “k-hole.” Lots of left leg twitching. Breathing normal this time. Maybe some subtle twitching of his paralyzed left hand, but difficult to tell.

His behavior after the treatment seemed about the same as the previous two treatments. I asked him to move his paralyzed left leg and he could still lift his foot and calf a little. Asked him to squeeze his paralyzed left hand, but he couldn’t do it.

May 4: I pulled my dad up into a standing position with his old gait belt, but he seemed to have more trouble than after Treatment #4. His left leg stayed stable, but only barely.

May 6: He asked me to take him to the bathroom, which he hadn’t requested for nearly a year. (He used diapers.) Standing up was still more difficult than after Treatment #4.

Considered making this the last treatment. There was only one prescribed treatment left and my dad’s psychological results had largely seemed to plateau or even diminish. Since ketamine therapy is supposed to be a “reset” of the brain, my dad’s brain appeared to be about as reset as it was going to be. Stopping at 5, 6, 7, or 100 treatments seemed relatively arbitrary unless the therapy became a regular part of his medical regimen.

The following are various post-therapy observations.

May 17, 2019

As soon as I arrived, my dad was very agitated emotionally and physically, as if he had never had any ketamine treatments. This seemed like a significant relapse. I canceled Treatment #6. He said he was dreaming when I arrived, but after about an hour said that he wasn’t dreaming anymore.

May 31, 2019

Physical agitation had returned to pre-therapy levels. Not very talkative or responsive to questions, though this might have been due to his regular psychiatric medications. Less ability to move his paralyzed left leg. We practiced standing up, but he was unable to maintain a standing position anymore, even with me doing most of the work in lifting his body.

June 14, 2019

No ability to move his paralyzed left leg anymore.

July 14, 2019

I asked my dad if he was glad that he had done ketamine therapy and he said yes. He said he was happy for the extra time with my mom in his dreams.