When patients come back for their third infusion, I ask the same question every time: “What’s different?” I’ve been asking that for four years now — over 3,000 infusions — and the answer is always fascinating.
People don’t always say “I feel happy.” Sometimes they say “my depression is gone,” but not always — those answers often come later. At infusion three, what they say is usually smaller, and much more interesting, because it’s about capacity.
“I got out in my yard and did stuff.” — 46-year-old man
“I have more energy than I did in high school.” — 27-year-old in tech
“I noticed I could stay out of a negative head space.” — 60-year-old engineer
“I had words for what I was feeling.” — 36-year-old executive
“I’m not planning my death every day.” — 41-year-old whose previous baseline included passive suicidal ideation
The First Sign of Healing Is an Absence
Read those out loud and you might miss why they matter. They’re not transformations in the usual sense — they’re absences. The absence of dread. The absence of the negative loop. The absence of the dead weight in the chest.
Depression doesn’t get fixed by adding things. It gets fixed by removing what it had been laying down on top of the actual person. The first sign that the work is working is that something stops happening — the crying for no reason, the Sunday dread, the 3 AM rumination. The patient is still themselves. They’ve always been themselves. Depression was a layer.
Healing Isn’t Becoming Someone New
Most new patients push back when I tell them this. They’ve been told — and told themselves — that healing means becoming someone different: a better, more disciplined, more positive person. It doesn’t. Healing means losing the layer that was hiding the version of you that was already there. What changes first is the layer.
One Thing to Try This Week
Reset your bar for “better.” If you’ve been measuring against “do I feel happy yet,” try measuring against “did I notice one thing get quieter today” — the Sunday dread, the 3 AM rumination, the dead weight in the chest. Notice an absence, not a presence. That’s the metric that moves first.
You can learn more about ketamine therapy at AlphaOmega Wellness, or watch the video that walks through the mechanism (glutamate, NMDA receptors, and BDNF release).
— Dr. Dee Bonney, MD
Board-Certified ER Physician & Founder of AlphaOmega Wellness
Frequently Asked Questions
What do patients notice at their third ketamine infusion?
Often it’s not “I feel happy” but returning capacity — doing things around the house, having more energy, staying out of a negative headspace, or finding words for feelings. These are absences of old burdens as much as new gains.
Does healing from depression mean becoming a different person?
No. Healing isn’t becoming someone more disciplined or positive. It’s losing the layer depression laid over the person who was already there — the real you becomes accessible again.
How should I measure early progress in treatment?
Shift the bar from “do I feel happy yet” to “did one thing get quieter today” — less dread, less rumination, less heaviness. Noticing absences is usually the metric that moves first.