Eric Novikoff slid a mask over his eyes, covered his ears with headphones, then sunk into a brown leather chair and floated into the void.
As the ketamine took effect, the room at the Mental Health Center of Denver “disappeared.” Novikoff’s body disappeared, too. His consciousness existed in a black nothingness, a space that made him feel as if he could start over, like an empty house waiting for new furniture.
And afterward, Novikoff felt an emotional “spark” that he hadn’t felt in months.
Novikoff, 60, was “dopey” all day after that first ketamine treatment, but as the hours went by, he felt his depression lifting. The heavy weight that hung over him was a bit lighter. The urge to kill himself slowly subsided.
The former computer consultant is one of 15 patients undergoing treatment at the Mental Health Center of Denver’s ketamine clinic, the only such clinic in the state at a community mental health center and one of few in the nation for low-income patients.
The Federal Drug Administration approved the use of esketamine — a version of the drug ketamine that is twice as potent — for people with “treatment-resistant depression” in 2019, the first new medicine for depression in decades. While some private-practice therapists in Colorado offer the treatment, and a host of clinics have opened around the country, it’s still hard to come by for those who can’t afford to pay or lack private insurance.
The low-profile success of this form of ketamine to treat Colorado patients with severe depression comes as state policymakers scrutinize the use of ketamine outside of hospitals after the 2019 death of Elijah McClain, who was placed in a chokehold by Aurora police and then injected with the tranquilizing drug. It also comes as Denver narrowly voted in 2019 to decriminalize psilocybin mushrooms and some policymakers want to make mushrooms legal statewide.
After getting the go-ahead from the FDA, the community mental health center stepped into esketamine treatment cautiously, beginning with just two patients in late 2020. The first two men came twice a week for about two months before the clinic opened up to more patients. Now, there are 15 patients receiving regular treatments at the mental health center’s east Denver offices and about as many on a waiting list.
Nurses who run the clinic are thrilled to see patients who have suffered for years find some relief, and hope the program can expand.
Patients who come in for their weekly or twice-weekly doses of esketamine, delivered as a nasal spray, can choose one of a handful of rooms to ride out the high. Each has comfy chairs and partitions to separate them from other patients, and one has a wall of windows overlooking a parking lot and, farther away, rows of Denver homes and lawns. Some patients prefer no windows and darkness.
Every treatment begins with a patient filling out a PHQ-9, a nine-part questionnaire that gauges mental health status, and a nurse checking their blood pressure. A patient takes one up-the-nose dose of esketamine, then a second dose about five minutes later. After 40 minutes, a nurse checks their blood pressure again, and returns regularly to assess for nausea and make sure any hallucinations and psychosis are under control. Side effects noted by the FDA include increased blood pressure, vomiting, vertigo and anxiety.
Some patients report superhuman hearing, like to the point of hearing their blood rushing through their veins or a conversation between a staff member and a patient several rooms away. Everyone hallucinates or experiences some disassociation.
We have some folks, actually, that have very pleasant psychosis.
Denise Hosier, nurse practitioner
“We have some folks, actually, that have very pleasant psychosis,” said Denise Hosier, the mental health center’s clinical director of nurse practitioners. One woman always chooses the room with all the windows. “We’ll check on her, and I’m like, ‘How you feeling today?’ and she is watching some bunnies in the trees, just very pleasant.”
One man listens to Pink Floyd’s The Wall during his treatment. “He’s like, ‘I think I just had a really great trip,’” Hosier recalled. “They feel like they’re really drunk. Or they say, ‘I kind of feel high.’”
Patients are required to stay a full two hours and can’t drive themselves home. So far, only two have quit the treatments — one was a petite woman who got extremely nauseated from the drug, while the other was a large man who reported feeling nothing.
No one has had a frightening psychotic episode that was dangerous to staff, Hosier said. To avoid this, nurses will talk to patients when they arrive and spend extra time helping them decompress if they’ve had an upsetting or anxiety-provoking day. A bit more time to calm down leads to a more pleasant trip.
Patients typically start by coming twice per week, then drop that to weekly and then, eventually, every other week. All of them have reported decreased depression over time, some almost instantly or within a few hours. After three or four days, it wears off and patients are ready for another treatment, Hosier said. Everyone starts at the lowest dose 56 milligrams of Spravato, the brand name for esketamine, and can move up to 84 milligrams as their treatment continues.
“It doesn’t stay in their system for long or make them groggy for days after,” she said.
Patients can continue as long as it’s still working. The esketamine treatment costs about $2,500 per person per month, which is reimbursed at about 75% by Medicaid, Medicare or private insurance.
Researchers have studied using ketamine, which was used by hospitals as an anesthetic during surgeries, to treat depression for the past two decades. Scientists at Yale University found that more than half of patients showed a significant decrease in depression 24 hours after a ketamine treatment, and these were patients who had no improvement after multiple antidepressant medications.
Ketamine pushes the brain to make new neural connections, giving patients the opportunity to form more positive thoughts and behaviors, according to Yale researchers.
For most patients, it’s a last-ditch attempt to recover after months or years of depression that prescription medications could not cure. Patients are eligible to try esketamine only after at least two failed antidepressant medications, according to the FDA.
Novikoff tried six.
By the time he confided in his primary care doctor that he was severely depressed, Novikoff already had a plan to kill himself. He’d gone through a breakup, the death of his father, the end of a computer company he jointly operated, and then the COVID-19 pandemic.
Afraid of what he might do, Novikoff told his doctor of his suicide plan, and his doctor called him every three hours on a Friday night to make sure he was OK. He also set him up with an appointment at the mental health center.
For the next few months, Novikoff tried multiple antidepressants, but none worked. Plus, the side effects, including feeling drugged and not being able to urinate, were unbearable. Then his mental health center psychiatrist suggested the esketamine clinic, which at the time was just about to take on patients. Novikoff got his first treatment in January 2021.
For him, it was a spiritual experience, one that — combined with therapy to unpack the meaning of him floating in a vacuum — helped him improve his mental health.
“I was able to really look at my life and realize, OK, you know, some things have gone badly, some things have gone really well and I’ve given it a good shot, versus the depressed me with like, ‘Everything’s ruined. There’s no future,’” he said. “That void place was like a spring in my consciousness for me. And when I came back, I felt completely changed. I felt I could still feel that depressed feeling in the next few days, but there was like a little spark that was growing.”
In one session, the question, “Who is here?” appeared in the void, Novikoff said. So he tackled that one during therapy.
“That gave me the idea of reviewing my life with compassion,” he said. “Ketamine can make you feel loved, peaceful. And so it’s easier to be compassionate when you look at your mistakes.”
Another time, the words in the void were “trust the process.”
“That felt really relaxing, like there is a path and I just need to go down the path,” he said. “I don’t have to fight it. I don’t have to push forward. I just need to go down the path.”
The treatments have been so life-changing that Novikoff has given up on the tech industry, which never made him happy, and is enrolled in Naropa University graduate program to become a mental health counselor.
He gets esketamine treatments every other week, usually while listening to relaxing music by Liquid Mind. The scores on his PHQ-9 have dropped from a worrisome 18 points to a 3 or 4, and he feels an emotional connection to life that he hadn’t felt in years, he said.
“When I was depressed, I felt like I was kind of running the clock out,” he said. “That moment where I decided to kill myself was a low point, and I feel like I’ve been going up ever since. And the ketamine, by taking me out of that box I put myself in … it was like the box just disappeared, like hey, you still have a chance to be whatever you want to be.”