When Rae Goldman arrived at her first ketamine infusion appointment, she was ready to record scenes from the hour-long treatment.
Once home in her Brooklyn apartment, she strung together snippets of footage and shared it on TikTok with her few hundred followers. Viewers saw Goldman in the waiting and treatment rooms, glimpsed the intravenous line in their tattooed arm that pushed the ketamine into her body, and a blood pressure cuff that monitored their heart rate. That initial video has garnered more than 5,000 views since October when she posted it under the #ketaminetherapy hashtag, a repository for an emerging genre of content: an insider's experience with a drug that many who experience treatment-resistant depression consider their last hope.
This is how Goldman felt. By 24, they'd been in psychiatric care for years, tried numerous anti-depressants, and had survived a suicide attempt. Then one doctor, from whom she sought a second opinion, suggested ketamine, an anesthetic that can be used off-label to treat depression symptoms when traditional options aren't effective. Research suggests that major depressive disorder is resistant to treatment in nearly one-third of cases.
Intrigued by the possibility that ketamine could do for her what other medications could not, Goldman searched the internet for first-person videos of the experience. A handful of clips left her unsatisfied, though she wasn't deterred. Goldman sought a psychiatric evaluation for a series of infusions at a Manhattan clinic, each of which costs $1,000. With financial support from their parents, Goldman has paid for more than a dozen treatments. Insurance coverage for treatment varies widely, though some patients may receive reimbursement after reaching their out-of-pocket maximum.
"Maybe I can help somebody who's going through the same thing as I am."
Given the cost, Goldman saw an opportunity to offer others a glimpse of the hard-to-access treatment and began posting footage of some sessions to TikTok.
"For my purposes, it's kind of like this doesn't need to be the most viral thing in the world," says Goldman. "Maybe I can help somebody who's going through the same thing as I am."
Goldman isn't alone, either. Collectively, the two main hashtags people use to broadcast their experiences, #ketaminetherapy and #ketaminetiktok, have earned more than 40 million views, with many clips debuting this year. Though TikTok doesn't return any results when users search for the word ketamine, the company confirmed to Mashable that content related to ketamine therapy doesn't violate the platform's community guidelines against promoting illicit drug use since it documents a medical treatment. The videos offer unique access to a therapy that feels promising yet mysterious to many. They also raise important questions about how TikTok can reduce the stigma associated with treatment-resistant depression yet spread highly curated versions of treatment that sometimes lack appropriate context about risks and benefits.
How ketamine therapy works on TikTok
While experts still don't fully understand how ketamine reduces severe depression symptoms, one prevailing theory is that it blocks one type of brain receptor and engages others. The resulting effect increases an important neurotransmitter called glutamate and leads to new connections in the brain. That can reduce depression symptoms and lead to meaningful changes in mood.
Goldman, an environmental engineer and a musician who performs under the name Goldwoman, opens with their own explanation of this in the first video, which is far more information than most creators offer, likely because the details are so complex and easy to get wrong. (Goldman unintentionally made a few factual errors but emphasized the importance of working with a mental health professional.)
Widely known as the club drug Special K, ketamine can have hallucinogenic and dissociative effects. Other side effects include feeling strange or loopy, and experiencing numbness, difficulty speaking, and auditory and visual sensitivity. In the first video, Goldman stared into the camera blankly, noting in voiceover that they felt "a little out of it." This scene is common to ketamine therapy TikToks, though some patients have euphoric reactions while others become distraught. Ketamine therapy is estimated to be effective in about half of patients, who can have very dissimilar experiences for reasons that aren't clear to experts.
Goldman had done enough research to know this, so she tried in the video to be as thorough as possible, noting the extent of her treatment-resistant depression and the fact that ketamine therapy is only available at licensed clinics or through a clinical trial. Viewers bombarded by related news coverage or search ads, however, might mistake burgeoning mail-order ketamine services as the same type of treatment but they are not. The FDA-approved nasal spray Spravato, administered only in healthcare settings, is a form of ketamine, and some TikTok creators document their treatment experience with it under ketamine hashtags as well.
Dr. Robert Meisner, founding medical director of the Ketamine Service at Harvard's McLean Hospital, browsed these hashtags and was struck by the hopelessness expressed by some creators and their fascination with the prospect that a single medication could fully alleviate their suffering. While entirely understandable, Meisner worries that such framing may unintentionally distort how well ketamine works and, as a result, inflate people's expectations. He sees a similar dynamic offline with patients who seek ketamine therapy at McLean Hospital, and tries emphasizing the importance of incorporating other forms of treatment like psychotherapy.
"We will often say to patients the goal here is not to introduce a...procedure that's going to magically make your depression disappear," says Meisner. Instead, the goal is to use ketamine's anti-depressant ability to reduce the patient's symptoms so they "fully engage" in other evidence-based treatments for depression, which may have been difficult depending on how incapacitated they've felt by their illness.
This is where Goldman actually found herself after the first few weekly treatments. In one TikTok, they're smiling broadly, reporting to viewers that they recently danced at a music show for the first time in years. The smile gets even bigger when she shares that following a phone conversation her mom remarked on how different her voice sounded. "It's really, really actually helping my mental health a lot," Goldman says at the end. In the comments, followers cheer them on while one person writes they're going to start treatment. "I want to believe so bad that this will help me," the commenter says.
The relief of feeling good again led to a few realizations for Goldman.
"Learning to let myself feel sad without spiraling was challenging."
First, her severe suicidal thinking stopped very early in treatment. "I had been feeling like this baseline [of] 'I don't really want to be here,' and that was eliminated from the second or third session," says Goldman.
What came next was more complicated. With relief from their most severe symptoms, Goldman recognized habits that they'd built around intrusive suicidal thoughts and depression, like staying in bed on days when getting up felt impossible. Now starting the day felt manageable, but without a new routine the inertia of her old habits could still keep her in bed. Goldman turned to their therapist for guidance on developing new coping skills now that they didn't feel so burdened by depression.
She also needed help processing the ketamine therapy sessions themselves as well as experiencing difficult emotions. When "normal" sadness struck, Goldman felt the impulse to spiral, which fed into suicidal thinking.
"Learning to let myself feel sad without spiraling was challenging," Goldman says.
Throughout ketamine therapy they've worked with a psychiatrist employed by the clinic who helps Goldman understand or integrate dissociative experiences.
Meisner says that anyone seeking ketamine treatment should do so under the guidance of a psychiatrist for various reasons. Such support can be helpful for dealing with unanticipated aspects of what many describe as a psychedelic trip.
What to look for in ketamine therapy TikToks
Like Goldman, Susana Matos Allongo desperately hoped that ketamine therapy would change the course of her years-long bout of treatment-resistant depression. In early 2020, Matos Allongo survived a suicide attempt, and her doctors recommended staying on the same medication since she'd tried more than a dozen antidepressants.
"I left the hospital just feeling there's no hope," says Matos Allongo, a 34-year-old writer, director, and producer based in Los Angeles. "There was kind of this message of 'You'll be dealing with this your entire life.'"
Matos Allongo learned about ketamine therapy soon after. By January 2022, she'd started an intensive course of daily treatments, over a period of five days, at a Los Angeles clinic for $625 each. Similar to Goldman, she began documenting the experience on TikTok after online research yielded few firsthand accounts.
While Matos Allongo expected nothing to come from the videos, her clips now rank among the highest in the hashtags. Some collected millions of views after landing on the For You Page. The platform rewards authenticity, which is why clinic-based TikToks seem to do better compared to narrated experiences filmed after treatment. Matos Allongo's first TikTok from the clinic is set to "A Diagnosis" from the television show Crazy Ex-Girlfriend. In it, Matos Allongo wipes tears from her eyes following treatment. "I woke up sobbing," she says in a caption. "They could hear me crying in the lobby."
Matos Allongo felt plunged into despair when the therapy didn't work and she felt she'd exhausted her treatment options.
"Every video I watched, people were talking about how amazing the journey was," she says. "I did not think that I would be crying this much."
Matos Allongo says she experienced disturbing imagery and extreme dissociation. At the time, the clinic offered no mental health support. Additionally, Matos Allongo's personal therapist didn't specialize in integrating ketamine therapy experiences. Matos Allongo says the clinic physician who treated her described her reaction as an outlier. Meisner, however, is unaware of evidence supporting the daily administration of IV ketamine over a prolonged period of time.
Such expertise about the research and risks is an example of what can be missing from ketamine TikTok. (The platform offers resources when people search in-app for keywords like suicide, self-harm, and drug overdose, but ketamine isn't among the words that prompt support. TikTok told Mashable it is constantly evaluating which keywords should trigger mental health resources.)
Creators also typically don't share information about what Meisner calls the field's "evolving" best practices. He recommends prospective patients work with a ketamine service that's "evidence-based," "data driven," and maintains the highest safety standards. At minimum, clinics should provide real-time, automated monitoring of vital signs and tolerance. Since ketamine interacts with several receptors, including opiate receptors, clinic staff should be aware of and monitor for any signs of addiction. Meisner says that while there are some "excellent" private clinics around the country, hospitals associated with a university tend to stick more closely to the academic consensus on ketamine therapy.
"It really makes you feel less alone in this."
If ketamine fails, Meisner says there's still hope. Some well-established treatments, like electroconvulsive therapy and transcranial magnetic stimulation, aren't well understood by the public. Meisner is also optimistic about ongoing research on psychedelic compounds, like psilocybin and MDMA, which have produced promising results so far.
"I have not ever had a patient — and we see some of the sickest people in the country and even the world — in which I've not been able to find hope and some strategy that is both evidence-based and that the patient has not yet tried," says Meisner.
Matos Allongo says there were lessons in her disappointment. As her TikToks gained viewers, people flocked to her comments with support. She first avoided looking at them, fearing the ways anonymity on the internet emboldens cruelty. But before long she felt a kind of warm digital embrace from strangers, some of whom emailed her "beautiful messages" about their own journey with treatment-resistant depression. Some asked how they could send her money to help pay for treatment, which totaled more than $3,000 out-of-pocket. Small donations sent via Venmo added up to $450.
Matos Allongo is now posting about her recent experience at an ashram in India, which she hoped would help alleviate her depression symptoms. Still, she wouldn't discourage anyone with treatment-resistant depression from trying ketamine.
While it didn't work for Matos Allongo, the act of sharing her experience on TikTok proved to her that even supportive strangers can make it easier to cope with mental illness: "It really makes you feel less alone in this."
If you want to talk to someone or are experiencing suicidal thoughts, Crisis Text Line provides free, confidential support 24/7. Text CRISIS to 741741 to be connected to a crisis counselor. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 10:00 p.m. ET, or email info@nami.org. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.
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