The Choice

The Choice

One of the questions a professional athlete receives regularly is why they work with a particular coach. Why this one and not that? Why distant and not local? Why a different gender? Why the same gender? Why someone who never raced as a pro? The logic tree that leads to an individual decision isn’t always easy to follow. In a similar way, I’ve been receiving a number of questions about my depression treatment. I’m going to address most of the questions on my treatment as well as update on where things stand.

This may be as close to an AMA as I’ve ever taken on. Hmm.

The single biggest question I get is: Why Ketamine? The why comes in many forms: why Ketamine and not psilocybin, LSD or Ayahausca? Why not SSRIs? Why not cognitive behavioral therapy?

The why is fairly simple, the way I see it. I’ve done loads of cognitive behavioral therapy. The nature of my intellect is such that when I turn that knife against myself, I can find the most curious loopholes in ironclad logic. I can find doubts that sidestep the entire question of self-belief, dodge kindness and parry with the seemingly obvious. To refresh: my most recent descent into acute depression (as differentiated from my chronic, probably life-long depression), was initiated when a piece I’d written about personal growth, an evolution of spirit was denounced for its selfishness and self-absorption and though I knew what I’d written and why, I faced a question that my brain was happy to let run rampant through all my hard work: If someone doesn’t see what I see, and if I can’t convince them that my perspective is valid, is true, then what’s the point? In this era of fake news, how do you turn the tide on crazy?

In short, I didn’t know how and the tailspin is something familiar to me and it was easier to do 360s toward the ground than to wrestle with accepting that some people just won’t see me accurately and the only sensible thing to do is to say goodbye and stick with the work at hand of being a decent person. I did a two-week, intensive program for people at the precipice and I sat in a circle with defeated souls with whom I felt nothing in common. None of them had any desire to live, but I didn’t think any of them had enough personal will left to do anything definitive.

One-on-one work was more helpful, but relapses of thought are as common as getting a cold from a toddler in daycare. It’s just a thing that happens every damn month.

I didn’t go the SSRI route because by the time I identified that I really needed more help than I had understood, I concluded that I needed a Death Star-sized intervention, not something that may work … or may not, but we won’t know for sure for at least six months. With my relationship to my sons dangling from a vine that wouldn’t hold Tarzan, I wanted something where the effect would be known this week, not 180 days later. I was concerned about the side effects of SSRIs as well as the fact that while they might work, we may have to try several to find the right one and it may stop working after a while. When my psychiatrist discusses a treatment with me and part of his evaluation involves shrugging his shoulders, I have to restrain my fuck that gene.

Why psychedelics? There is a long evolution of thought here, a very gradual opening of my mind that began with me learning about the science that underpins flow states. Without that start, I’d never have read Michael Pollan’s “How to Change Your Mind.” The title of that book holds an inherent promise, that this is something that can be done, that it isn’t possible in some theoretical sense, but that it is absolute and here is a sort of instruction manual.

I can’t state this strenuously enough. Michael Pollan’s book is indispensable to anyone considering this variety of intervention as well as to friends and family of anyone who is or might undertake this care. And for anyone who finds the notion of using psychedelics so insane they won’t contemplate reading Pollan’s work, my article on flow states for Bicycling Magazine could help bridge that gap. Thinking less moralistically about drugs and instead viewing how endogenous (produced by the body) neurochemicals affect the brain’s operation is a critical step in that journey. Seeing this as a natural process rather than something to render a good/bad verdict upon is absolutely necessary.

But why Ketamine and not psilocybin, LSD or any other psychedelic? This is perhaps the easiest question to answer. This flavor of treatment demands raw material, an active ingredient and securing said ingredient can be a felony. And while my current employer wouldn’t fire me for a felony conviction, it would end any opportunities with any other employers in the future, should I ever consider such a path. Let’s jettison for a moment the reality that due to the peculiarity of my skill set, by many standards I’m unemployable.

I simply couldn’t find psilocybin or LSD and didn’t have the money to fly to South America to do an ayahuasca retreat. And believe me, I’ve got friends who tell me they can source mushrooms, but when shove and push met, everyone held out empty palms. Ketamine, by comparison, is legal and I was able to find a clinic in Marin County that offered the treatment. I think this is what they mean by process of elimination.

For the person who needs significant intervention now, Ketamine was the smartest option. With all due respect to Monty Python, my cheese shop had but one cheese. Colby Jack it is.

I want to revisit the evaluation momentarily. I really hadn’t given much thought to whether or not I was an appropriate candidate for this treatment. There are any number of people who don’t merit this severe a therapy. There are plenty others who due to family history might not be appropriate and I just dodged that disqualifier. I hadn’t considered whether I was suited to it, just whether I thought it might help me. So when the evaluation was conducted, I had an episode of real anxiety about whether I might not qualify. When my evaluation came back indicating that I was precisely the person appropriate to this intercession, the effect was sobering: I was more badly in need of help than I understood.

People ask what to expect. This is both easy to answer and impossible to answer. Much like in the movie 2010 when Dave Bowman (played by Keir Dullea) tells Heywood Floyd (Roy Scheider) “Something wonderful,” in response to Floyd’s question about why they must leave Jupiter’s orbit in two days, I can’t give specifics, but I can assure those curious, the transformation is something wonderful. Not all of the experiences in that state are pleasant. More and more, I see what happens in that state like cooking food. When you cook food over an open fire, flame is just the visual component of the heat that actually cooks the food; one need not see flame to have sufficient heat to cook food. So what the flame looks like isn’t terribly important. I’ll grant that the more pleasant experiences have carried more profound lessons, but the Ketamin changes the pathways in the brain whether I like the experience or remember the experience or not. Even after the most inscrutable K-holes, I emerge the next day lighter, more at peace, more desirous of being a part of this world.

The other question I’ve received repeatedly has been whether I’m done, fixed as it were, after I complete this course of treatment. To me, the answer is no. Some people contemplating this course of treatment may find that frightening. I do not, nor should any cyclist, because we, better than most anyone—save other endurance athletes—understand why this must be true.

Being a cyclist is a practice. It isn’t, like an afternoon of ziplining, a single experience. Being a cyclist necessitates developing a routine and maintaining that habit. I now view my mental health in the same way that I view my physical health. I’ve got to work at its upkeep. The regimen isn’t the same, of course, but I’m not daunted by the thought that once a quarter I’ll take a day to surrender to a K-hole. Honestly, I’m reassured at the thought that I have a mechanism to tend to myself in a way that I have conclusive proof works. I don’t ever want to look into my palm at a tablet and think, “Eh, it might be helping.”

And that’s really the thing: This really, truly works. I can feel the change in my brain. To use Eliot’s concept of the objective correlative, the thing that proves the statement, I will point to my once famously dour nature. Sure, I could be happy and smiley with friends, and I could experience pleasure, but joy was not a common experience for me. I’m aware that I frequently frowned upon encountering a person. Imagine if your experience upon seeing a face was to frown. Consider what that would do to that person’s experience, whether they knew you or not, but especially if they were family. Today, when I encounter a face, I smile. Doesn’t matter if that face is new to me or someone I’ve known 20 years. When I see a face, I smile. I didn’t do that at 40, at 30, at 20 or even at 10. That smile is something I can’t fake; it’s something that comes from my system software in the form of a reaction, not a premeditated choice, which is why I’m able to trust that there has been a change and that the metamorphosis is to other people’s benefit as much as it is my own. That smile is an unimpeachable good in this world.

That smile is enough.


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  1. Michael

    Thanks for this thoughtful explanation, Padraig. I used lots of different drugs as a teenager and first part of my 20s, and I stopped the day I realized I was no longer learning from them. You may encounter that at some point, too. However, I was wrong, in a way, because I continue to learn from those experiences, now 40 years later. I think about them, and what they taught me, but also sometimes they teach me something new even today, just thinking about the experiences and the feelings/emotions. I do think they changed my cognition, in many ways for the better but in a few for the worse. Well worth it, in balance. Now, I look back at myself at that age and realize I was depressed, but I am able to better monitor, and then help ameliorate, that depression ever since. Perfect, nope, but okay always, and often quite good.

    1. Author

      I think one of the single most important skills where mental health is concerned is just knowing when you are struggling and being able to put a name to what you are experiencing. Getting help is so much easier when you can identify the problem.

  2. Rodrigo Diaz


    I’m in no position to comment on the effectiveness of psychotropics for therapy. But I’m glad they seem to be improving your psyche. That ultimately is the real proof and purpose.

    Godspeed – more happy people is always a good thing.

    1. Author

      Thanks much. In many ways, I’m happier for those around me (my sons especially) than I am for myself.

  3. Andrew Law

    Hi Padraig.
    Thank you for sharing your journey. Very moving and instructive. Would you be willing (eventually) to link this series of articles together and include the links back and forward at the end of each installment? I would love to share the entire set. I work in mental health care and your direct experience with this kind of treatment would be of interest to colleagues and clients, even if they don’t have access to or decide to take the route you decided on. Thanks, man. Glad you’re getting better! Journey on! AGL

    1. Author

      I will absolutely do that. I’ll create a kind of table of contents post linking to each piece the way I did with the Enter the Deuce series. I’m interested in writing about this for a general interest magazine and your feedback is helpful.

    1. Author

      Yeah, that was a really interesting study. I noticed that my own alcohol consumption (which was never high) dropped in the weeks after I began. I literally forgot about it for a while.

  4. Dave

    Thank you so much for this Patrick. It answered all the questions I had and I am now convinced I will go down this path.

    Be well and thanks!


  5. AusTex

    Admittedly I am reading this late, in 2020 but as someone well into middle age it saddens me to realize that it takes so long for so many people to try and find help but whatever means necessary, myself included. There is such a cultural bias against almost all forms intervention and instead “suck it up” and “snowflake” seem to be the bumpersticker wisdom that has infected this society. Depression takes many forms but all of it life sucking. I am glad you are feeling better and I hope this continues, your writing brings us comfort. Thank you.

  6. PK

    Have you ever considered the possibility that the Bay Area, with all the tectonic plates slamming into each other may, for some, be a euphoric and exciting environment full of magic and mystery, but for you and many homeless may be just too much?
    I know a few folks who have relocated away from The Front and their mental health has improved.
    There is a reason animals go crazy right before an earthquake.

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