The tech industry has a vocabulary problem: everything is "burnout." The on-call rotations, the layoff cycles that leave survivors doing three jobs, the vesting schedules that make leaving feel impossible, the founder years where the company's survival and your own feel like the same thing. Rest fixes actual burnout. But when a sabbatical, a job change, and a year of therapy have come and gone and the flatness is still there — the inability to feel excited about anything, the 3 AM dread, the sense of watching your own life through glass — that is usually not burnout anymore. It is depression or an anxiety disorder wearing burnout's clothes, and it deserves to be treated as the medical condition it is.
Ketamine's evidence base is strongest exactly here: depression and anxiety that have not responded adequately to two or more conventional treatments. Response rates in the treatment-resistant population run 60-70% in the clinical literature, with improvement measured in days rather than the 4-6 weeks of a new SSRI trial. The mechanism — glutamate-driven neuroplasticity — is a different lever entirely from serotonin, which is why prior SSRI failure does not predict ketamine failure.
And the format fits the life. The consultation is a video visit you can take from home after standup. The sessions happen in your own space, scheduled around your sprint, with two hard rules: no driving for the rest of that day and the following day, and no work after a session. No commute across the Bay Bridge to sit in a clinic chair.