What an expert wants you to know about ketamine therapy

Tyler Baltierra, star of both 16 and Pregnant and Teen Mom, helped show the realities of teen pregnancy when he and his now wife, Catelynn Lowell, gave up their daughter for adoption when they were both 16. Now Baltierra, 31, is using the long-running MTV series Teen Mom: The Next Chapter as a platform to highlight his own emotional journey.

Baltierra, who is a survivor of childhood sexual abuse, has long spoken out about his struggles with mental health, including his 2018 bipolar diagnosis. On this season of Teen Mom: The Next Chapter, he is showcasing one of the ways he’s seeking help to navigate his past traumas: ketamine therapy.

Baltierra allowed cameras into his session with Los Angeles psychotherapist Mike Dow and recently answered three questions from Yahoo Life about his ketamine treatments and how they've helped him overcome mental health hurdles.

Why try ketamine therapy?

"Throughout a lot of my life, I’ve done normal talk therapy," Baltierra says. "I felt like that really helped me get an understanding of a lot of things and helped me heal, but as I got older, I needed something a little bit deeper and more intense — something that could get to the core of my trauma. After doing research, I found that ketamine was aligned with what I wanted to do, especially when I found out that it could help cure PTSD, depression and anxiety.

"Doing it was a little bit scary at first, to be honest, but I was ready for a deep dive, especially doing it with a therapist and medical professionals involved. Ketamine is a pretty sedating experience. Having done that recreationally and having a lot of enlightenment with that, I felt like this was the best route to really get to the core of the issues I’ve had."

How did you prepare for your treatment?

"My biggest thing was, I needed to find the right team to guide me through the experience," Baltierra says, "because I knew it was important to have the right environment and for the therapists to have experience with it and know the psychedelic so they could guide me through the journey. I spent a lot of time on research.

"There are two different versions: the IV version, which is a slow drip, which is a lighter effect, and then what I had, which is an injection in the muscle, which puts you over the edge very quickly. I really appreciated the facility that I went to, as they put a lot of care into the environment. You have the right music, a weighted blanket, a zero-gravity chair and a blindfold. It’s very intense and it’s very unexpected — I think everyone will have a different experience, as no one has the same journey, but I think it’s important to take a lot of prep time before diving into it. It’s a very intense ride."

Further, he explains, "I spent a month or two doing multiple sessions with a therapist. The therapist will tell you, ‘OK, you’re ready for this,’ or ‘Let’s do a few more sessions.’ The therapist helps guide the prep work too — you do some guided questions and fill out some forms, and I had to do some meditative work before going into the facility. The prep work was almost as intense as the therapy — they really hone in on what you want to focus on, and what trauma you want to pinpoint and what your goal is at the end of the whole journey, what you want to get out of it. It really helped me nail down my purpose.

"The first time I did it, it lasted a little over an hour. Sometimes it lasts 45 minutes, some people are done in an hour and a half. They guide you by asking you certain questions when you first get the injection. Eventually the questions stop — I don’t know if he stops asking questions or if I stop paying attention. You sort of do your own thing, in terms of visualizing. You throw your hands up — it’s like a roller coaster. You’re going for a ride and you can’t get off until it stops. You have to just surrender to the experience."

Baltierra continues, "A lot of people have different experiences with it, but for me it was a dreamlike, hallucinating state. It feels very heavy. It was very, very visual for me, which is good because even when I meditate, I need visualization, I need to tap into certain things. I knew that potential was there, but the ketamine just unlocked it for me — I could go into a meditative state within five seconds."

What results have you seen from this therapy?

"I’m slower," he says. "I don’t judge my feelings or criticize myself so much. I used to be like, 'Oh, my God, why are you angry? Why are you like this?' I would try to intellectualize my feelings as a coping strategy. That’s what my logical mind thought to do — 'I’m feeling this, I’m going to read a book about it. I’m going to read an article.' What happens is, you get so logical about it, you don’t feel what you’re feeling. Now I’ll ask myself, 'Are you intellectualizing?' If that's what I'm doing, I'll honor the feeling that I'm getting regardless of what it is. I think emotions get a bad rap. Sometimes people think anger is wrong and bad and negative. But no emotion is wrong."

What you need to know about ketamine therapy

What is the history of ketamine as a therapy?

"Ketamine is a medication that was discovered in 1962 and approved by the FDA in 1970 as an anesthetic for use in humans," Dr. Steven L. Mandel (who has not treated Baltierra) tells Yahoo Life. An anesthesiologist and psychologist, Mandel is an expert in the use of ketamine infusion therapy to treat mental health disorders and chronic pain and the founder and president of Ketamine Clinics Los Angeles. "It enjoyed spectacular successes as an anesthetic — for more than three decades was the single most widely used anesthetic on Earth. In the ’90s it was also discovered that with a totally different method of administration and totally different dosage range, it could be very effective at helping people with mood disorders. It took over a decade before people could really wrap their heads around this anesthetic being a profound effector of behavioral change."

Mandel opened his clinic in 2014, and there, he says, "we give six 55-minute infusions over two to three weeks, and we see 83% lift their depression, eliminate the suicidality, and be able to deal with the demons and their PTSD."

While ketamine is approved by the Food and Drug Administration as an anesthetic, there is as yet no FDA-approved treatment for use of ketamine for any psychiatric condition. Still, physicians are legally allowed to prescribe drugs off-label, allowing ketamine clinics to operate legally. In 2019, the FDA approved esketamine (Spravato), a more potent ketamine-molecule derivative, for use in adults to target treatment-resistant depression and major depressive disorder with suicidal ideation when used in conjunction with an oral antidepressant.

How does ketamine therapy work?

"Essentially, ketamine appears to enable people to reexperience their trauma without freaking out about it," Mandel says. "People's trauma has several components. One component is what actually happened. What happened is what happened. It's in the past, we're not changing that. Another component is the component people carry with them. And that is their story around what happened — the narrative they tell themselves about what happened and their place in it. Our role in it is subject to interpretation."

He adds, "Most people are so discomforted by the experience, so traumatized by the experience, that they can't revisit it. And if they can't revisit it, they can't look at their narrative and consider the possibility of revising that narrative. [Ketamine therapy] enables people to have the courage to approach the event with their eyes open and saying, 'What was my role in this? And did that happen? Or is it a story I'm telling myself about what happened?' They can come to a understanding. It permits them to let it be, to stop fussing with it and to move on."

How does ketamine differ from other treatment options for depression, like medication and talk therapy?

"Most people who are depressed, who are looking at a conventional approach, take a pill. The pills operate by a different neural mechanism, and they have different effects," Mandel explains. "They have to be taken daily, and they tend to lose their effectiveness over time. They produce, pretty reliably, a side effect that nobody wants to talk about, which is weight gain and loss of libido, which isn't convenient for depressed people who are demoralized and not feeling good about themselves. That's not a happy state of affairs for anybody."

He adds, "The oral antidepressants tend to lift the floor, so your lows are not as low — but in exchange for lowering the ceiling. Many patients come in saying, 'I feel like a zombie. I feel locked in.' Yes, they are able to get out of bed and go to work, but they're not experiencing joy. Routine antidepressants don't restore pleasure — they may relieve the triad of depression, which is hopelessness, helplessness, worthlessness, but they don't restore a sense of pleasure. Ketamine does.

"People have been in psychotherapy for many years, sometimes decades, and they can't really confront the elephant in the room. The therapist can’t make them. The ketamine enables patients to look the elephant in the face. It's necessary to walk the elephant back into the closet so they can get on with their lives."

What can make ketamine treatment more effective?

"We have a five-pronged approach to care: sleep hygiene, exercise, nutrition, intimate interpersonal relationship and talking therapy," Mandel explains. "We facilitate and advocate for and refer for all of those interventions, and all of them make a difference. People get great results without paying attention to any of them — just getting their infusions — but they get much better results if they incorporate those things into the process. Ideally, the talking-therapy aspect of it starts before the infusions and the infusions are incorporated into it. In advanced stages one comes to one’s infusions with intentions in cooperation with one therapist."

Is ketamine treatment covered by insurance?

Ketamine is very poorly and unevenly covered by insurance, Mandel notes, "which is inexplicable, because most of my patients have very high-quality PPO insurance. This is a moving target, however — 10 years ago when I started my clinic, nobody got coverage, and now maybe 15% are getting coverage. It's moving in the right direction, but slowly."