For what it's worth, my experience is that almost all ketamine use I know of personally erased that person's depression for a week or so. I think it's less uncommon more and more.
While I'm certainly not implying you are referring to yourself, this reminded me of "swim", a delightful euphemism used by drug users online, for obvious reasons.
I would strongly suggest that anyone reading this with depression disregard personal anecdotes like these. The placebo effect is powerful, and it's dangerous to self-medicate when suicide is a possible side effect or consequence.
“In a nutshell, I feel confident telling patients who have had little help from previous treatments that ketamine provides meaningful relief from some of their worst symptoms for at least a few days or even weeks,’’ said Dr. Gerard Sanacora, professor of psychiatry and director of the Yale Depression Research Program and primary author of the JAMA report. “But I can’t tell them with any degree of certainty how long the benefit can be sustained or how safe it is to repeatedly administer the medication over periods of months or years.”
The method of action of ketamine is thought to be via hydroxynorketamine, not placebo which I don't really see as being pertinent - maybe confirmation bias, but not placebo. I also contend that suicidality is not long-term stable- supposing a typical antidepressants regimen is ineffective and only frustrates a patient, then to not pursue a treatment with a pretty strong effect strength would lead to more suicides as the outcome, imo.
Considering it's once weekly, tolerance would decrease significantly back towards baseline - ketamine is 99% eliminated in 21 hours (7 half-lives). iirc the mechanism is BDNF expression and reverting neuron energy metabolism conditions - one could potentially speak of the antidepressant effect of exercise also increasing in tolerance via that mechanism, but what I know about what we know so far makes it seem like it is worth the decrease in anhedonic/depressive symptoms.
The other options are pretty much worse, although more common:
- a daily SSRI (thus increases tolerance much faster), and has a larger range of significant side effects, such as anorgasmia, increased depression or emergence of suicidal tendencies, weight gain, "electric zaps"/spontaneous muscle spasm/discontinuation syndrome for months after cessation, dulled affect, increased proclivity towards serotonin syndrome
For now, it seems to be most useful as a rapid-onset suicide prevention treatment.