Carly Schwartz arrived in San Francisco convinced the city’s culture of relentless innovation would finally crack her treatment-resistant depression. She submitted to intramuscular ketamine injections administered by an underground shaman while blindfolded on a stranger’s living-room rug, endured eight months of daily transcranial magnetic stimulation, and even provided a stool sample for a WeWork nutritionist’s elimination diet. None of it worked. The lasting relief she eventually found came not from a “disruptive” therapy but from a 12-step programme in a church basement – a century-old framework built on metal folding chairs, watery coffee and the simple, unscientific principle of shared human connection.
Experimental treatments in the innovation capital
Schwartz returned to San Francisco in 2016 after a year living in a Panamanian jungle eco-community, where the relentless rainy season and lack of local mental health resources had worsened her depression. A suicide hotline operator advised her to board a one-way flight back to the United States. Back in the Bay Area, she was struck by the futurism of the city: twelve-dollar cold-pressed juices, a municipal composting programme, electric-assist bikes and one-tap credit-card payments. It seemed the logical place to tackle mental illness.
The mid-2010s Bay Area was a petri dish for the wellness industry. People stirred yak butter into their morning coffee and guzzled Soylent for breakfast. Therapy and nutrition startups occupied WeWork offices across the region. Mental health apps such as Calm, BetterHelp and Lyra Health were founded locally; later additions included Headspace, Spring Health and Talkspace. Terms like “cold-plunging”, “nootropics” and “intermittent fasting” entered the casual lexicon. Big tech companies, including the one Schwartz joined, offered generous benefits such as paid medical leave and in-house therapists.
Schwartz sampled the avant-garde treatments on offer. After cycling through nine different combinations of pharmaceutical antidepressants with no success, and finding an outpatient psychiatric programme cold and disconnected, she tried intravenous ketamine infusions at a holistic health centre in Marin County. A nurse escorted her to the “IV Lounge”, fitted an eye mask and giant headphones playing new-age music, and let ketamine drip into her bloodstream for 45 minutes. She felt woozy but little else. She returned four more times, paying cash under the table, drawn by reports of ketamine’s miraculous effects on persistent depression. A recent study cited by Schwartz showed that 52% of participants who received intravenous ketamine infusions achieved complete remission. A 2023 study published in JAMA Psychiatry found that esketamine nasal spray – a related compound – was effective in reducing depressive symptoms in adults with treatment-resistant depression, though it noted potential side effects such as dissociation and increased blood pressure.
In the United Kingdom, ketamine is primarily used as an anaesthetic, but its use for depression is gaining traction. The National Institute for Health and Care Excellence (NICE) has issued guidance on esketamine (Spravato) for treatment-resistant depression, recommending it be used in conjunction with an oral antidepressant and under strict clinical supervision. Private clinics offering ketamine infusions are available in the UK, though their cost and regulation vary. The distinction between clinically administered ketamine and the “underground” shaman Schwartz visited – who injected her thigh muscle with liquid ketamine in a Bernal Heights bungalow while two rescue terriers sniffed her feet and Pink’s F**kin’ Perfect played in the background – is significant. The risks of unsupervised use, including potential for abuse and adverse psychological effects, are considerable.
After the ketamine ran its course, Schwartz began an intensive cycle of transcranial magnetic stimulation (TMS). The therapy involves attaching a magnetic coil to the side of the skull that pulses against areas of the brain associated with mood stability. To be effective, it required daily sessions, every weekday. Schwartz detoured from the office to a sterile beige office above a jewellery store in Union Square, where a nurse monitored her as she sat still, the device jabbing at her scalp like tiny, rhythmic needle pricks. She appreciated the routine but the depression did not budge. Eight months in, the clinic’s head doctor recommended she end the sessions. Research continues to refine TMS protocols; a 2022 review in the World Journal of Psychiatry suggested that intermittent theta-burst stimulation (iTBS), a faster form, is as effective as standard TMS and may be more time-efficient. In the UK, NICE has recommended TMS as a treatment option for adults with treatment-resistant depression, available both through the NHS for certain patients and via private providers.
When all else failed, Schwartz visited a WeWork nutritionist who put her on an elimination diet and asked her to produce a stool sample for a faecal analysis. She does not recall the conclusion, but her symptoms did not improve – not even when she switched to sugar-free coconut-milk yogurt and cut out all gluten except beer. Research that would be published two years later revealed that more than half of surveyed tech workers struggled with anxiety or depression, and roughly 30% of people with major depressive disorder have a treatment-resistant form of the disease.
Community, sobriety and the 12-step programme
A few months after the shaman episode, a fleeting moment of honesty during a particularly brutal hangover led Schwartz to residential rehab. Until then, she had not been willing to face the idea that the very thing offering temporary relief – increasingly frequent drug and alcohol benders – was preventing her from getting well. Rehab immersed her in a supportive environment surrounded by individuals with similar struggles. For the first time in her adult life, she could address the root causes of her illness without the manufactured respite of substances making everything worse.
Newly sober and back in the real world, Schwartz began attending 12-step meetings in church basements and community centres. These gatherings were the antithesis of San Francisco’s dazzling futurism: watery coffee, metal folding chairs arranged in a circle, unflattering fluorescent lighting overhead. They cost nothing except for an optional dollar or two in a collection basket. The treatment regimen could hardly be described as innovative – it relied on a framework developed nearly a century earlier – and attenders did not “optimise” for anything except staying clean.
Yet inside those rooms, Schwartz learned she was not alone. Through candid conversations with others who understood her darkness, she began to cultivate a sense of true belonging. Within a full year, the depression that had gripped her body and mind released. A meta-analysis of 100 studies involving 500,000 people found that greater social support was associated with significantly lower odds of depression across all life stages. Longitudinal research suggests loneliness not only correlates with but causes and worsens depression over time. The church basements offered something that could not be coded into an app: deep, emotional connections with other human beings.
That sense of support helped Schwartz foster belonging among other loved ones – the 13 quirky housemates with whom she shared a big communal home, her family across the bridge in Oakland, and dear friendships she had taken for granted during the worst of her illness. Seven and a half years later, her community continues to keep her sober and depression-free. The 12-step programme, while not a panacea, provided a structured framework for mutual aid and shared experience – a form of peer support that research, including studies published in The Lancet, has consistently linked to improved mental well-being.
The limits of innovation
The treatments Schwartz tried in San Francisco have genuinely transformed some people’s lives. The same research that showed 52% remission for intravenous ketamine, and the promising data on TMS, continue to drive investment. Wellness is even hotter now than it was when she returned to San Francisco a decade ago. AI therapists are on the rise, venture capital is pouring into ketamine clinics, and biohacking trends – a Silicon Valley movement that uses technology and scientific approaches to optimise human performance, encompassing practices from nootropics to genetic testing – have become outright bizarre.
None of these “disruptive” advancements put a dent in Schwartz’s depression. Tech culture, she concluded, has a tendency to turn everything into a product, a platform or a scalable solution. She learned from experience – lots and lots of experience – that she could not hack human nature in order to find happiness.
Carly Schwartz is the author of the new memoir I’ll Try Anything Twice: Misadventures of a Self-Medicated Life and the former editor in chief of the San Francisco Examiner.
