Warning: I am not an expert on ketamine or stroke. I am also not qualified to offer advice on treatment.
My father tried ketamine therapy with a licensed psychiatrist to help relieve several post-stroke conditions. He was 79 years old at the time of therapy. He had previously suffered a massive stroke on December 7, 2010. The stroke affected the right side of his brain, causing extensive vascular dementia (brain damage) and hemiparesis (paralysis) on the left side of his body. He became mostly unable to care for himself and has required 24-hour monitoring ever since. He also lost much of his ability to reason or converse in an adult manner.
In addition, my father developed the following ongoing problems:
- Extreme phantom pain on his left side
- Obsessive-compulsive behavior, often involving asking to be lifted
- Uncontrollable anger and physical agitation lasting hours, days, or even weeks
- Severe depression
- Significant memory loss, both long-term and short-term
- Severe anxiety
Geographical note: I live in New York City, while my dad lives in Massachusetts due to family and financial issues. I travel up there for four days every two weeks.
My dad had mixed results from ketamine therapy. On the plus side, it improved his mood and reduced his obsessive behavior, anger, and physical agitation. He also regained some ability to move his paralyzed leg. However, these effects were mostly temporary. His psychological improvements plateaued after the 3rd 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 elements was that his dreams became intensely vivid. So vivid that he was often unable to tell when he was dreaming or awake. Many of the dreams were very pleasant, especially those involving his deceased wife (my mother). However, the dreams also caused a lot of stress, because he sometimes didn’t know if people were really present when he was awake.
After the treatments, he thanked me for helping him get ketamine therapy. If nothing else, he was happy to have spent time with his deceased wife in several realistic dreams.
Finally, I have found that my dad’s psychological issues, such as anger, depression, agitation, and obsessive compulsion, have been soothed just as well and less expensively with marijuana (which is fortunately legal in his resident state of Massachusetts). Of course, I can make no claims about this for other people.
Treatment 1 – March 15, 2019
First visit to therapist. 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.
The therapist talked with my dad about why he wanted to try ketamine. She was very friendly and a soothing speaker. She said some research showed that ketamine therapy could revitalize old neural connections that had atrophied, 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 that same day. I took my dad into one of the treatment rooms. A nurse came in to administer the ketamine. She said they normally use 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 0.5g. 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. The nurse expressed surprise that it had taken as long as 5-7 minutes for the effects to start.
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 liked the relaxing setting.
Treatment 2 – March 29, 2019
Very strong effect this time. Injection dose was 0.75g. 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. He 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 van ride home.
My father’s obsessive behavior often leads him to repeatedly ask to be lifted or to pound his fist against any available surface. However, he did not perform either of these behaviors during the ride back from the therapist. 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: 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 silence.
March 31: Paralyzed leg twitching considerably during Mass, which I hadn’t seen for a long time. 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. He also told me that he was dreaming. A nurse said that when she had told him that I was coming to see him, he had cried then too and said he didn’t believe her. I eventually determined that he’d had very vivid dreams since the last ketamine treatment. 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. Prior to this, he had claimed to not remember his dreams for a few years.
I strongly considered cancelling the treatment due to my dad’s intense reaction. However, during the initial three days following his previous treatment, his mood and behavior had improved greatly. He also said that his dreams had been good. Most importantly, after over 8 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 van ride to the therapist, although he didn’t fidget much.
Injection dose was 0.75g. Frequent twitching of his paralyzed leg. 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 therapist 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 told me that he had dreamed that I’d died the previous night. In the dream, I’d 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 at a restaurant, he told my aunt and uncle that he was dreaming. More talkative than usual during lunch. Lots of 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. Said that he had been dreaming all week. None of his usual verbal or physical agitation.
Injection was 0.75g. At first he closed his eyes as he had for the last two 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.
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 is 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 (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
Considered making this the last treatment. My dad’s psychological results had largely seemed to plateau, so it seemed relatively arbitrary to stop at 5, 6, or 7 treatments.
My dad said that he was remembering all of his dreams. In the dreams, his deceased wife (my mother) would sometimes come into his room and say: “Hey, lover, why are you still in bed?” No verbal or physical agitation on the ride to the clinic.
Injection was 0.75g. Asked me to lift him at the beginning of the session, but he didn’t repeat the request. Then he fell into 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.
After treatment, 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: Pulled him up into a standing position with his old gait belt and he seemed to have more trouble than after Treatment #4. His left leg stayed stable, but only barely.
May 6: Asked me to take him to the bathroom, which he hasn’t requested for nearly a year. (He uses diapers.) Practicing standing up was still more difficult than after Treatment #4.
The following are various post-therapy observations
May 17, 2019
As soon as I arrived, my father was very agitated emotionally and physically, as if he had never had any ketamine treatments. I cancelled Treatment #6. My father said he was dreaming when I arrived, but after about an hour said that he wasn’t dreaming anymore.
May 31, 2019
Physical agitation returned to pre-therapy levels. Not very talkative or responsive to questions, although this might have been due to his regular psychiatric medications. Less ability to move his paralyzed left leg. 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
My dad verbally thanked me for bringing him to ketamine therapy. I asked if he was glad that he had done the therapy and he said yes. He said he was happy to have dreamed about my mother.