Story by Kate Carroll
Video story by Julia Fairchild Roth
Photos by Kaitlyn Dang
Shayna Dudak has always seen herself as an anxious person. As a child, she bit at her nailsassi and picked at her lips. She thought the habit would go away with time, but as an adult, the symptoms got worse. She would wake up with her lips bloodied. She was embarrassed to leave her house because of the scabs and scars on her lips.
Dudak was seeing a psychiatrist to try to manage her anxiety. As her symptoms intensified, her doctor suggested she struggled with post-traumatic stress disorder (PTSD), and things clicked. She had a challenging childhood and her anxiety was a way for her brain to avoid them.
But even with a proper diagnosis, Dudak wasn’t getting better. Medications weren’t helping and her symptoms became unmanageable. Then, a family friend recommended ketamine therapy, a relatively new treatment for depression-related disorders that uses small, safe doses of ketamine.
Dudak and her husband did some research and found Iconic Infusions, a Fayetteville, N.C.-based clinic administering ketamine infusion therapy. She did a month-long plan, going into the clinic twice a week for treatment doses of ketamine through I.V. infusion. After about three weeks, she stopped biting at her lips and her husband said her anxiety went from a 12 to a two.
“For me, it’s been a running joke even growing up. It’s like ‘stuff down, stuff it down,’” she said. “I guess I just didn’t realize as an adult that no matter how many self-help books I read, or how many psychiatrists I went to or medications I tried, it was only masking the fact that I was always in flight or fight mode. Then ketamine forced me to let that stuff go.”
What is ketamine therapy?
Photo by Kaitlyn Dang
As a treatment for depression-related disorders, ketamine therapy has become increasingly popular among medical researchers and mental health professionals, most notably for its success in providing more instant relief for patients – particularly those with disorders resistant to more traditional medications.
Photo by Kaitlyn Dang
“Ketamine has historically been used as an anesthetic drug. But in the context of psychotherapy, we use it in sub-anesthetic or really small doses,” said Sarah Tatko, a physician assistant at Carolina Wellness Psychiatry in Chapel Hill, N.C.
Tatko guides patients through therapy sessions while they experience the dissociative ketamine treatment, talking with patients as they process the emotions and memories they bring up while on ketamine.
Ketamine reacts with neurotransmitters, or the chemicals that foster communication through the brain. Researchers found that ketamine can enrich neuroplasticity, or the brain’s ability to adapt and maintain itself.
“This is something that’s novel or new and hasn’t been seen before in traditional treatment for depression,” Tatko said.
Additionally, Ketamine’s psychedelic qualities give patients a space to process emotions and trauma that can be difficult to take on otherwise.
“I describe it to patients like it’s like a Zamboni for your brain,” Tatko said. “If you’ve had the experience of skating on an ice rink for a long time doing the same thing over and over again, the ice gets chopped up, there gets to be ruts and it’s harder to go where you want to go. Ketamine works by kind of smoothing that ice out.”
Tatko said that for over a third of people with a depression or anxiety-related disorder, traditional medications aren’t effective in treating symptoms. Research has shown ketamine therapy to be up to 70 percent effective for patients. Mental health advocates suggest using ketamine in the psychiatric space is a breakthrough for patients and doctors when typical medications aren’t doing the trick.
But risks also apply to ketamine therapy. Ketamine has a reputation as a “party-drug” due to its hallucinogenic effects, but ketamine therapy uses small, safe doses in a controlled environment where patients can be monitored and receive support or care as needed.
“True addiction to ketamine is exceptionally rare and it’s also on the prescriber to recognize the signs of that,” Tatko said. “That’s why in our practice, we will not take a patient who isn’t plugged in with a psychiatrist and or therapist right because we don’t want the ketamine to be the peg that they hang their hat on. It’s part of the treatment plan.”
Treatment looks different with ketamine, too. Typically, patients are administered their ketamine treatment where they receive care and experience the effects in a calming environment. Patients usually don’t remember the majority of what they work through during a treatment, but the dissociative state that ketamine causes allows patients to process feelings from a different perspective. Most ketamine therapy treatment plans include a series of regular treatments over the course of four to six weeks.
Cory Jones is the founder and CEO of Healing Maps, a website providing information on finding ketamine therapy and psychedelic mental health care.
“I think the general feeling is that the way we’ve been treating mental health traditionally has not been very productive,” Jones said. “And I think as the new generation comes along, that looks at mental health in a very different way, and is very much more open about it. I think that has helped move the needle in terms of acceptance around the stigma of the way we treat it.”
Access to ketamine therapy in N.C.
Multiple forms of ketamine therapy are available in North Carolina in different stages of FDA and insurance approval.
Tatko and Carolina Wellness Psychiatry use Spravato with patients, a nasal spray variation of ketamine called esketamine. The FDA approved Spravato in 2019 as a treatment for treatment-resistant depression and for adults experiencing depressive or suicidal behavior.
In addition to Spravato, ketamine can be administered via I.V. infusion, which is not yet FDA approved.
Photo by Kaitlyn Dang.
Amy and Dr. Bryant Edwards, owners of Iconic Infusions in Fayetteville, practice ketamine infusion therapy with patients. Amy Edwards, a registered nurse, coordinates patients and care and assists during treatment while her husband Dr. Bryant Edwards, an anesthesiologist at the Valleygate Dental Surgery Center, administers treatment.
Dr. Edwards, a veteran himself, said his medical experience in the military introduced him to ketamine as a treatment for chronic pain and depression years before the treatment became more mainstream.
After experiencing chronic pain and depression from a major back surgery, Edwards said he couldn’t imagine what soldiers coming back from the front line were feeling, and he knew he could do something to help.
“Not all medications are effective for a person. I got to see all that,” he said. “And I realized, with this much training and access to care and information that I had as an anesthesiologist, and I was in this position, how much less prepared people may be. How are they living?”
The Edwards opened Iconic Infusions almost 3 years ago, and they serve a range of patients from people like Shayna Dudak to veterans experiencing depression, but receiving and giving this care is not as simple as walking in and getting started.
With the help of community referrals and the recent increase in media coverage of ketamine and psychedelic therapy, Iconic Infusions has been able to reach and treat more patients over time, but because the treatment is not FDA approved, it also isn’t covered by insurance, creating more challenges in accessing care.
Amy Edwards said more needs to be done to push for the coverage of ketamine therapy to make a potentially life-saving treatment accessible.
“It’s quite frustrating. And then you hear stories on the news of the government is so concerned with the veteran suicide, so they pour billions of dollars into a suicide hotline or a crisis hotline. From what I’ve seen, and then what I know about myself as a person, who calls a hotline when they’re suicidal? What do those hotlines really do?,” she said.
A recent report from Rolling Stone found 109 soldiers assigned to Fort Bragg died in 2020 and 2021, with four of those being overseas combat-related deaths, fewer than 20 being related by natural causes and all of the rest being preventable deaths either by suicide or overdose.
Amy and Bryant Edwards said opening access to ketamine treatment could prevent the prevalence of suicide or overdose in the military and anyone struggling with a depression-related disorder.
Despite the growing prevalence of ketamine therapy, cost remains a primary barrier for many people. Until insurance companies approve coverage of ketamine therapy, treatment costs can range from $400 to $2,000.
In the meantime, advocates of the treatment are focusing on educating the public and getting the word out that there is another option for people with treatment-resistant depression disorders.
“I will just ask people and make people aware that this stuff works,” Dr. Edwards said. “And start making noise.”
Photo by Kaitlyn Dang
