A Bridge Between Knowing and Feeling - My Success with Esketamine
Over the past 19 years I have had several stays in psychiatric wards after bouts of severe depression and suicidal ideation. In the last few years I started having maintenance electroconvulsive therapy (ECT) which eventually became weekly.
In November 2025 my psychiatrist suggested seeing if esketamine could help. I had a positive mindset going into the first session; if it didn’t work I decided I was not going to persist with weekly ECT. I would ask if I could go back to monthly ECT and explore any additional lifestyle changes that were needed.
Esketamine was amazing right from the first session. My summary of those first few weeks was that I was developing new perspectives and practicing shifting into them. There were also other things at play; I had a prior academic understanding of Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) from group therapy and one-on-one psychology sessions, however in the esketamine sessions some of these ideas became powerful lived experiences.
Esketamine is a dissociative; it made me feel out of body and then also distanced me from my thoughts. For me the experience was a chemically assisted opportunity to practice CBT. I saw things from a brighter perspective and it shone a spotlight on how this is different from my usual mode of thinking. I could see decades of behaviour that were locked into a mode that was sad and heavy, and that this is not the only way to see reality.
Shifting perspective
During times of deep depression my ability to see beyond the depression would disappear. In a very convincing way it felt like I’d always been this sad and would always feel this sad. Its misery was all-encompassing, it stretched out beyond the horizon.
Although at the time I was convinced this sadness was how I had always felt, I knew rationally that was incorrect. While I could not recall anything positive, I knew I had not been struggling like this a week prior. I would cling to this as proof that I was not thinking clearly.
Though my thoughts felt like facts, it was obvious something was not right.
I had found the idea that ‘Thoughts are not facts, they’re just words in your head’ (mentioned in CBT and ACT) a difficult concept to get my head around and apply to my situation. Practitioners would list examples of thoughts that could trap someone, but this depression was not something I could put into words, it was an entire worldview.
Esketamine demonstrates that your worldview, your perception of the universe, is not a fact, it is all just a collection of thoughts and sensations. It illustrates viscerally that everybody’s experience, sober or otherwise, are all unique interpretations of reality.
My construct of reality is not a fact, it’s just thoughts in my head.
I have witnessed that my brain is capable of creating other perceptions. Now I have a very vivid one of an esketamine induced perception of a universe that is peaceful, warm, safe, and cosy but paradoxically also free of constraints. When my brain returns to acute sadness I recall there is this alternative view. The sadness is my mind playing tricks, but the mind has other tricks up its sleeve. This concept helps me challenge unhelpful emotions and thought patterns, and change my response.
Defusion
ACT talks about cognitive defusion which involves untangling yourself from your thoughts.
Fusion is where a person identifies as their thoughts and sees them as the source of truth. I was wedded to thinking that my thoughts and feelings were accurate, and at the core of my identity. I felt that my perceptions about how other people were thinking was “the truth”. I often jumped to the conclusion that I was hurting others.
Defusion is the practice of distancing yourself from your thoughts. It posits that thoughts and feelings arise for many reasons. They are not “the truth” and they are not always worth paying a lot of attention to. Defusion is about detaching from your thoughts and observing them as an independent phenomena that are short-lived.
Each esketamine session was like strength training for defusion. As the esketamine took effect I would find myself pausing during the middle of a chain of thoughts and examining them from an external perspective. I wasn’t doing this as a deliberate invocation of CBT or diffusion, it came naturally in this state.
From this external perspective I was curious about these “thought events”:
- What was the genesis of the thought? What steps had my mind taken to get there?
- Was there a precursor? An event, a conversation, or a dream in the preceding hours or days?
- Do I have a history of similar lines of thought? Is there a pattern?
- What feelings and other thoughts were provoked? Is there a history to these feelings?
I would go on to analyse these meta-thoughts:
- How interesting that I am here reflecting on these meta-thoughts, that I can freeze thoughts for a moment and decompile them.
- How has this analysis changed over time? Is it easier or more difficult to study my thinking today than it was yesterday or 6 months ago? How am I continuing to develop these skills?
- How do I feel right now about the examination process?
I am not new to a little introspection, but I have never experienced extracting thoughts to this degree to interrogate them as discrete external objects.
Transcendent self
ACT defines the transcendent self, or “self as context” as the idea that a person is not their thoughts or feelings but instead a person is their consciousness experiencing and observing their thoughts and feelings.
I arrived at a slightly different definition of this concept. My body is a bag of biology propping up some neuro-circuitry. This is the infrastructure of my thoughts, which powers my consciousness. My thoughts and consciousness are not me, nor is the machine of biology and circuits. I am their symbiotic relationship, their collaborative arrangement to maintain homeostasis. Being able to see this agreement in motion is my transcendent self, a vantage point where I can look at these two somewhat erratic systems.
The traditional way transcendent self is described in ACT always felt spiritual and supernatural, which does not resonate for me. My definition associates transcendent self with an idea: the agreement between two systems. During esketamine sessions I regularly felt a detachment from my body and then a detachment from my thoughts. In one session I also visualised a detachment from my consciousness. I gazed back from afar and saw everything associated with the concept of “me”. From there I appreciated the relationship between my components. I can see how easily people interpret these experiences as being very spiritual but to me this was a philosophical revelation; the agreement between these systems is a concept, not a supernatural apparition.
Similar to ACT’s transcendent self, this agreement is something that has persisted since I was very young and will continue until I die. My biology and cognition do not always agree, but we are committed to keeping this system working.
Acceptance
Acceptance in ACT is about allowing your inner thoughts and feelings to occur without trying to change or ignore them. A number of times I tried to focus my sessions on particular topics but my concentration was impeded and would never comply. I sometimes felt stuck, unable to steer my thinking, and literally locked in place by the disembodiment. I had taken the drug and I was now committed to this situation for another forty minutes whether I liked it or not. When this occurred I decided I should just roll with the experience and see where it took me. Whatever the content of my thoughts were it was natural to just observe them without attachment, travelling freely with the experience as it unfolded.
Lasting perspectives
For months I thought I needed to be able to replicate the sensation of esketamine in my day to day life; to be able to summon that dissociative state to gain distance from my thoughts. That should not be the goal. The important thing is learning that I am not stuck in my current state. I have now internalised the concept that every situation is transient. I can be mindful of my perceptions, consider them critically, and monitor them as my perspective continues to change. That is enough.
Things that are easier now
- Socialising with people no longer drains me. I no longer worry that I will drive others into depression.
- I no longer feel miserable looking back at old photos, emails, documents or other records.
- I have more energy, motivation, and optimism.
- I manage stress better. I no longer dread the future, I can see there is a long positive arc and that I will iron out the kinks.
- Potential relapse no longer feels like part of a downward spiral. The burden of this treatment is less and I am confident I will return to a great quality of life.
- I keep in mind that my thoughts are transient. I have striking memories that show that the radical ways I can think come and then go.
Conclusion
Esketamine gave me vivid, embodied evidence that my thoughts and perceptions are not immutable facts. Intellectual understanding alone had never been enough to instil this concept. Following esketamine treatment this is a lived experience I cannot unsee.
The concepts of CBT and ACT including defusion, perspective-shifting, the transcendent self, and acceptance; are beneficial frameworks. But again, there is a chasm between understanding them cognitively and feeling them viscerally. Esketamine was a bridge to cross that chasm. It reinforces these ideas by showing me that my brain is capable of generating radically different interpretations of reality.
The real transformation was not in achieving a permanent altered state. Instead, through experiencing that I am not my thoughts, I am not my mood, and I am not locked into a single way of seeing the world, I have broken out of the cycle I was in. This has profoundly improved my quality of life.