Over the last couple of months, I’ve noticed a decline in my mood. I’m not sure why this is happening. Maybe it was stopping the ketamine, or maybe it’s the seasons changing. Or maybe it’s just the cycle my depression has taken. It was so subtle at first that I questioned whether I was imagining it. Fortunately/unfortunately, my extensive experience with being depressed has taught me to look out for several signs that my mood is trending in a concerning direction.
First, I start dreading and putting off my daily walks with Stella. When I do walk her, I get frustrated and impatient, often cutting the walk short so that I can get back inside. This sign is so consistently an indicator that my mood is slipping that I’ve learned to pay attention to it even before I notice any other symptoms of depression.
I also start crying more, which is extremely uncomfortable for me. Displays of emotion make me feel entirely too self-conscious, and crying in front of people is about seven steps too far. I dislike the feeling of losing control of myself. When I start crying at mildly poignant YouTube ads and any time I try to verbally express a slightly negative feeling, I know something’s up.
When I’m depressed, my PMS symptoms are monumentally more disruptive. The aforementioned tearfulness is elevated, my desire to do anything social disappears, and I often start to have urges to harm myself. It’s not a fun time.
Having trouble keeping up with self-care is a classic depression sign, and it’s definitely one I experience. When I start sleeping in my clothes because I just can’t be bothered to change into pajamas — even if it’s just one night — I try to pay attention. It’s easy to put off self-care tasks without realizing that I’m depressed, so sometimes I miss the significance of it. Certainly when it becomes a pattern, though, I know I’m in trouble.
Routine in general is very supportive for me. When I feel good, I adhere to my routine easily, and I feel that it helps me maintain my good mental health. But when I’m depressed, I forget to water my plants, I fall behind on laundry, and I don’t get dressed until the afternoon (when the dreaded walk with Stella becomes unavoidable).
Knowing my signs of depression is vital for combatting the slide into poor mental health, but it’s only part of the process. By the time I notice and accept that I’m becoming depressed, it’s already difficult to pull myself out of it. I’m considering reintroducing Lamictal to my list of medications, but I’m struggling with the concept of it. Being reluctant to take my medication is another unfortunate sign that my depression is worsening. I’m working on just being consistent with the ones I already take.
Seeing as tomorrow is Thanksgiving here in the U.S., I’ll end this post with some positive thoughts. I have a new job, which I really enjoy so far. I’m fortunate to be in a relationship with a wonderfully empathetic, intelligent person, and I’m looking forward to spending time with my family and friends tomorrow. My mental health may not be exactly where I want it to be, but my outlook is still largely positive, and my life is objectively amazing. Wishing you all comfort and happiness on whichever day of the year you read this.
The therapist I saw in college, having found me to be reticent on nearly every topic, encouraged me to express myself through visual art. She didn’t often give me assignments but instead preferred to let me draw what I wanted and bring my sketchbook to her each week. We’d talk about my creations and what emotions they evoked, and if we both were lucky, I’d expand on the state of my depression and suicidal thoughts. It was a fairly effective way to bypass my verbal barrier, as long as I felt confident in my artistic creations.
One week, while I was showing her my sketchbook, she exclaimed softly in reaction to one of the pages. It was just a little, “Oh!” but it triggered an avalanche of anxiety inside me that blocked off my ability to speak. I started to cry and hid my face with my hands. She asked me what was wrong, but I couldn’t answer. It was like I was trapped inside myself, all my words perfectly accessible in my mind — but incapable of being moved across my lips.
My therapist’s exclamation called attention to a drawing I was already anxious about revealing. It was a simple drawing of the materials I used to harm myself. I had found it nearly impossible to talk about my struggle with self harm, but it was an issue I wanted to work on, so I tried to initiate the discussion with a drawing. It backfired tremendously.
I felt strange – like everything was unreal and far away. I wanted to tell my therapist that I was trying to start a conversation with the drawing – even just to say I felt anxious – but I couldn’t. I felt acutely separated from everything around me and yet intensely aware of my therapist’s attention. I could feel her gaze on me, as if it were exerting physical pressure that made me want to crawl behind the couch and disappear.
My therapist sat with me for quite a while until I regained the ability to speak. I remember commenting on how strange that little episode was, saying that I wasn’t sure what had just happened. She agreed, perhaps not wanting to poke at me when I’d only just returned to verbal communication.
In hindsight, I was new to therapy and didn’t yet have the words to describe my intense anxiety, and I didn’t have the insight to trace incidents like that all the way back to my earliest memories. I’ve always had a problem with being put on the spot and asked to speak in front of people, but I’d minimized that issue in my mind.
I’ve since done a lot more therapy and introspection and am learning to connect the dots. A separate, more recent incident in which I found myself unable to speak led me to do a Google search for “inability to speak under pressure.” That Google search and a conversation with my current therapist have led me to believe that the likely explanation is selective mutism, an anxiety disorder characterized by silence in certain situations that trigger intense social anxiety.
The Beginnings of Selective Mutism
When I was very young, I remember feeling like being silent was the safest action, and if I could just outlast whoever was trying to interact with me, they’d give up and go away – and they usually did. I don’t think my silence was ever a choice, but it aligned more closely with what I wanted when I was young. It was like the expectation of speech created a vacuum around me that was impossible to fight. So I embraced it as a strategy for dealing with painful self-consciousness. I simply shut down.
But as I grew older, I became frustrated with my mental barrier. I recognized that speaking would make the painful attention go away faster – that being silent was attracting more scrutiny and prolonging the anxiety. But I couldn’t seem to break through when I wanted to. I could speak at home, and I could speak to my friends. But around strangers or when put on the spot, my words were locked away.
I’m not sure how, but I made progress. Perhaps I grew out of it to some degree. I got better at tolerating being the center of attention. For the most part, I function just fine now. I can even give presentations without shutting down. What seems to trigger selective mutism in my adulthood is the combination of being the center of attention and feeling shame or embarrassment. If I feel like I’ve done something wrong in my place at the center of attention, either by making a mistake or making a scene, I reach a level of social anxiety that punches me into my own little void.
Present-Day Therapy
Therapy is one arena where shame and embarrassment often come up, and as the client, you’re almost always the center of attention. I’ve practiced talking about the things that make me feel vulnerable and self-conscious enough that for the most part, I do okay now. I talk for most of my sessions, which is a huge improvement. But I had many sessions where I’d reach my limit and stop talking or we’d stumble into a topic that suddenly silenced me. It was very distressing. I’d be thinking a million things at once, trying to get myself to just spit out one of them. Sometimes, my therapist would rescue me and fill the silence. Other times, she would wait.
I would go home and write down everything I couldn’t say out loud and send it to her in an email. Two years ago, I wrote to her about therapy, saying, “…when I get there, I lose the ability to speak. It’s like every week, I have these big hopes that I’ll just sit down and say things and it’ll be easier. And then I sit down and remember I’m me. I have made progress, but the worse I feel, the harder it is to override my silence. […] It feels like I’m just incapable of speaking openly, like I send the words out from my brain and they hit some kind of barrier at my mouth. I don’t know how to fix it, but I’d like to.”
At some point, I figured out that I could break through with a fun fact. My intention was to distract and bamboozle with a stunning tidbit about the biology of scallop eyes or some other interesting concept. It never worked, but I did discover that I could say something when I felt like I couldn’t. There was potential. The longer I go in silence, the harder it is to speak. If I can say something – anything – I sort of reset the clock, and it’s easier for me to get subsequent words out.
Introversion and Selective Mutism
I’m glad that somewhere along the way, I learned how to get my words out in therapy and in life, but I wish I’d known that there’s a term for what I was experiencing. It’s comforting to be able to recognize and label an issue I’d never understood as selective mutism. I’ve always chalked my general quietness up to extreme introversion, but that label never seemed to explain my occasional inability to speak. Now that I know about selective mutism, I think I’ll be a bit gentler with myself when social anxiety crops up.
Somehow, the fact that I experience social anxiety has been quite a recent realization. I knew I was very shy as a child, but I thought that I magically overcame that. Maybe it was wishful thinking. I’ve always worried that my quietness might be interpreted as aloofness, and I’ve been told I’m quiet so often that I’ve developed a little shame pearl – layers of practice to cover up the sharp edges of my grain of silence. Talking is expected, and if I don’t meet that expectation, I feel guilty. As if my lack of social grace might make someone else uncomfortable or ruin their time in some way.
I think I’ve learned to operate in social situations so seamlessly that I forget how much effort I’m putting into them. I feel somewhat adept at socializing, but only because I’m constantly monitoring my own facial expressions and trying to match others’ body language so that I appear comfortable. The rules of conversation – the progression of topics and little linguistic customs – are old hat to me now.
I still default to quietness, which frustrates me sometimes. I’ve often wished I were outgoing and talkative and tried to will myself to be different. I didn’t recognize the legitimacy of what I experienced as a kid or that I’ve been working against it this whole time. I thought I was fighting what I saw as a flaw in my personality. It seemed the introversion was to blame and that if I could just overcome that, navigating the social landscape would be easy and enjoyable. I’ve come to realize that, while I am highly introverted (and it’s not something to be overcome), there’s an additional factor in the form of social anxiety.
Teasing apart introversion and social anxiety is sometimes difficult, so knowing when to let myself hang back and when to challenge myself isn’t always clear. I push myself to talk and engage in conversation, but I’m also working on accepting and appreciating my quiet nature.
For people with sensory processing disorder, weighted blankets can be valuable tools. I use mine for more than just sleeping; it helps me ground myself when my senses are overwhelmed, it helps me focus, and it helps me calm my anxiety. Many people report feelings of safety and relaxation when they use their weighted blankets for sensory processing disorder. In this post, I discuss the science of weighted blankets when it comes to sleep and relaxation, as well as my own experience using a weighted blanket for SPD.
Weighted Blankets and Sleep in SPD
Tools like weighted blankets and vests use deep pressure, which is thought to reduce the body’s level of arousal, leading to relaxation. They’re highly popular among kids and adults alike, and some people swear by them for alleviating insomnia. But when it comes to whether weighted blankets help you fall asleep, stay asleep, and enjoy better-quality sleep, the evidence is mixed.
I found studies that offer evidence for and against the idea that weighted blankets can improve sleep in people with sensory processing difficulties, often defined by falling asleep faster, waking up less during the night, improved mood in the morning, and other measurements like sleep efficiency.
Surveys
Some research shows that weighted blankets are effective at improving sleep quality and sense of restfulness as well as shortening the time to fall asleep. Weighted blankets were shown to improve morning mood in this study, but the overall results were inconclusive. Most of the studies I looked at that concluded that weighted blankets can improve sleep used surveys to collect their data, which have their limitations.
Observational and Experimental Studies
While surveys offer valuable insights into subjective experiences, experiments can provide a more objective look at a question. In a study that used actigraphy (small accelerometers that measure movement), weighted blankets had no effect on the number of times participants moved in their sleep. In a different study on people without SPD, weighted blankets were associated with a significant 32% increase in salivary melatonin, but they didn’t affect cortisol, oxytocin, subjective sleepiness scores, or the duration of sleep.
On the other hand, another study that used a sleep sensor and surveys (funded by Gravity Blanket) found a significant 7% improvement in a measure called Wake After Sleep Onset and improvements of 2% or less in other sleep measures.
To me, the most interesting part of that last study is that participants’ subjective reports seemed to overshoot the measurements – by a lot. They thought they were sleeping 36% better without waking up in the night. Compare this to the 7% improvement in Wake After Sleep Onset, and this seems to match what we see from other surveys; people feel like they sleep better when they use a weighted blanket, even if the objective measurements don’t match.
More research is needed to understand the effects of weighted blankets on sleep in people with sensory processing disorder, but if you feel that they help you, why not use one?
Do you have medical conditions that would be a concern?
Do you have claustrophobia?
Don’t walk around with it over your head.
Carry it in an ergonomic manner.
Do not use it as a restraint.
As far as weight recommendations, I had trouble finding an authority on the matter. A 30-lb weighted blanket was shown to be safe as measured by heart rate, blood pressure, and blood oxygenation. Manufacturers typically say their weighted blankets are safe only for adults, adolescents, and older children due to the risk of suffocation in young children. But overall, we can be confident that weighted blankets are safe when used appropriately.
Should You Sleep with a Weighted Blanket for Sensory Processing Disorder?
If using a weighted blanket to fall asleep feels good to you, I say go for it.
I get a little too hot when I sleep with a weighted blanket during the summer, so I tend to only use mine for that in the colder months. Part of why I find those studies so interesting is that they surprised me. Based on my own experience, I expected to find a consensus on their efficacy.
Turns out, I do the same thing those study participants did; I think of my sleep as being vastly improved by my weighted blanket. I even identify waking up fewer times a night as one of the most dramatic differences I notice!
Photo by Daniela Constantini on Pexels
Sleeping with a weighted blanket is a cozy, relaxing experience for many people. There’s something kind of special about using a weighted blanket. It’s like it elevates my sleeping experience from regular relaxing to extravagant relaxing.
Throughout the day, our senses are bombarded by stimuli. In my experience of sensory processing disorder, being tired makes my nervous system feel spring-loaded. My ability to handle sounds, lights, and movement declines as the day progresses. Making decisions gets harder, driving gets harder, and by the time I get to bedtime, it can be hard to decompress and fall asleep. Compounded by some of the medications I take and my tendency to think too much, my insomnia sometimes features a lot of restless tossing and turning. Fortunately, my weighted blanket is there to help me. Using a weighted blanket for sensory processing disorder can look like a lot of things, though — not just sleep.
Calming Overstimulation and Anxiety with Weighted Blankets
Where the literature is iffy on weighted blankets for sleep, it solidly supports the claim that weighted blankets are effective at reducing anxiety. Occupational therapists have used weighted blankets for sensory processing disorder and associated anxiety for decades, and there’s a good reason for that.
In 1992, Temple Grandin published a study on the effects of her groundbreaking “hug machine.” The machine is designed to deliver deep-pressure stimulation using a set of pads that squeeze the user’s body. Dr. Grandin’s hug machine was found to have a calming effect on people with ASD, college students, and animals. Deep pressure stimulation has been further explored as a therapy for those with sensory processing disorder, even leading to the development of inflatable smart vests, pneumatic compression garments, and shape memory alloy spring garments.
Weighted blankets provide the same kind of deep pressure touch that a compression vest, Dr. Grandin’s hug machine, or a real hug from someone you trust does. It’s this consistent, firm pressure that can settle your senses and put you back in the moment.
Sensory Over-Responsivity, Sensory Defensiveness, and Anxiety
If you have sensory over-responsivity (SOR) as part of your sensory processing disorder, you know how quickly you can go from cool to completely overwhelmed. When your nervous system is highly activated, you might have trouble functioning in the way you usually do, whether it’s focusing, planning actions, or keeping your emotions regulated. SOR is also associated with sensory defensiveness, which means that you have strong negative reactions to stimuli that aren’t dangerous.
It’s incredibly draining to live with sensory defensiveness. I’m fortunate to have gotten treatment when I was young, which improved my symptoms in that arena. I remember being so terrified of getting water in my eyes as a kid that I screamed and sobbed if one tiny droplet rolled down my forehead during a bath. These days, my sensory defensiveness is much better, especially when I’m well rested.
There’s a complicated interplay between SOR and anxiety. When you have bad experiences with stimuli that are too much for you, it’s easy to get anxious about encountering them unexpectedly. Being prone to anxiety can mean your guard is always up, which sensitizes you to your environment. SOR and anxiety can feed into one another, and teasing apart the causative mechanisms is an individual process.
In general, we know that sensory over-responsivity (SOR) and anxiety often co-occur, and deep-pressure interventions are commonly used by occupational therapists to reduce discomfort and sensitivity. One such intervention is a weighted blanket.
How to Use a Weighted Blanket for Sensory Processing Disorder
(According to me, your well-read layperson.)
Firstly, if you don’t yet have one, it’s important to get one that you like. The main function is, of course, the weight, but as this article is about sensory processing disorder, I imagine you have concerns about a blanket’s other sensory features as well. When sifting through the options online, think about:
Weight (Super heavy? Just a tad weighty?)
Material (Softness, durability, how to wash, etc.)
Dimensions (I love my bed-size blanket, but I used to have a lap pad that was great.)
What’s inside the blanket? (Consider the tactile and auditory aspects of beads vs. sand, for example.)
One way I like to use my weighted blanket is to get into a seated position and wrap the blanket around me like a cape so that it drapes over my shoulders. Then, I take a moment to arrange the extra material on top of my legs, grab the edges of the blanket in each hand, and pull it closed in front of me so that I basically just look like a floating head. A really relaxed floating head.
I don’t think there’s a wrong way to use a weighted blanket, as long as you’re being safe. Sleep with it, sit with it, put it on your lap — whichever way you choose to use it is right.
Life has been good lately. I’ve been taking Mirapex for a few months, and it’s turned out to be very helpful for me. My depression has improved dramatically. I’m more social, more interested in doing things, and more positive in my everyday life. I’m still taking lithium, Seroquel, and Deplin, which I’ve found through trial and very painful error to be completely necessary. All in all, I’m fairly content to continue my current medication regimen — with some minor adjustments.
Balancing Side Effects and Improvement
While Mirapex has proven to be effective at improving my mood, it has also had an effect on my appetite. I struggle with low appetite as a result of my depression anyway, so being even less inclined to eat has become a problem. I’m significantly underweight and struggling to gain. I tried reducing my Mirapex dose in the hopes that it would help my appetite and decrease my anxiety, but it wasn’t a very impactful change in those departments. I also started to notice some worsening depression symptoms, so I returned to the slightly higher dose.
Recognizing Depression Symptoms
I’m glad that at this point, I can put my extensive experience being depressed to good use in recognizing when symptoms are returning. I’m always very aware of how much I’m sleeping during the day. Napping tends to be a reliable indicator that my mood is declining. It’s both a result of the fatigue depression brings as well as a good old-fashioned escape mechanism. When I lose interest in doing anything, sleep seems like a great way to pass the time I don’t want to be conscious for anyway.
I also get this aimless, melancholy feeling that accompanies the anhedonia. I feel like I should be doing something, but I don’t know what, so I move from activity to activity, room to room, feeling lost. When I finally just sit down and embrace the lack of productivity, I feel a sinking, hopeless feeling in my chest.
Dealing with Anxiety
Seesawing between depression and anxiety is an unfortunate pattern for me. Mirapex helps lift my depression, which naturally ushers in the anxiety. The anxiety is augmented by the Mirapex, which tends to make me feel more awake and energized. I feel generally more tightly wound lately. Driving seems to set the anxiety off — to the point of crying, shaking, hyperventilating panic attacks on a few occasions. Even when nothing anxiety-inducing is happening, I find myself feeling restless and tense.
I struggled with debilitating OCD and generalized anxiety as a child and teenager, and I fear going back to that. When I start to get anxious now, as an adult, it feels horribly familiar. So, I try my hardest to combat it. If it’s an intrusive thought that feels like OCD, I do whatever the anxiety tells me not to do. In some ways, the idea of giving in and avoiding the thing makes me more anxious than doing it because I have such a fear of slipping back into old patterns.
Even though I’m fairly good at doing exposures and keeping the OCD in check, being anxious about being anxious is tough to get out of.
Adding Another Medication
In an effort to try to reduce the anxiety, I’m starting to take pregabalin, which is Lyrica. It’s more accurate to say that I’m re-re-restarting Lyrica. I have a really hard time adding medications because of my deeply seated issue with “needing” them. I have this belief that I should be able to fix my psychological problems on my own. Even though, intellectually, I know there’s nothing wrong with taking medications, I still fight with myself over it. At this point, it’s a habit for me to resist any new medications. I’ve “started taking Lyrica” several times now and haven’t continued long enough to get anywhere near an effective dose. This time, though, I’m actually doing it. The balance between anxieties — the general one and the one about taking a new medication — is shifting, and I’m inclined to do something about the everyday anxiety.
For now, I’m just taking a basically homeopathic dose while I get used to having a new pill in my organizer. I’m easing myself into it.
Ketamine Troches
Taking ketamine troches has continued to be somewhat helpful. I definitely notice a decline in my mood when I don’t take them, so I suppose they’re doing something.
My experiences with them are wildly varied, ranging from being trapped on the bathroom floor for an hour while time warped around me to contentedly eating pizza while scrolling the internet. Sometimes, I feel it intensely and dissociate for an hour, and other times, I barely notice anything at all.
I have discovered that on the occasions when I feel the ketamine a lot, it’s important that I not eat too much before bed because if not, I will wake up several times to go vomit.
Moving House
I moved again a few months ago, and aside from the conveniences of living in a house vs an apartment or a townhouse, living in the house has been an interesting transition.
For a while, it just felt like we moved again – this one makes four times in a year and a half if you count “moving” to the hotel after the fire. The significance of having a house after losing the old one sometimes slips by me, and I feel a numbness that I don’t like. I also feel strangely unattached to my new belongings now. I know they’re mine, but they just feel bland and unimportant. If they were damaged or I lost them, I wouldn’t be upset. Perhaps that’s healthy. I don’t know.
On the positive side, Stella has a yard again, which is a major improvement compared to our last place. Of course, she has found ways to crawl under the low deck in search of rabbits, and she’s dug little dirt beds into the two shady spots. Dog-proofing aside, I’m just glad she likes it.
My recent experiment, in which I got off all of my medications and became horribly depressed, taught me that I do not do well without lithium and that lithium alone is not enough. This information wasn’t surprising, but I was hoping for a different outcome. I was really hoping. I was hoping that I could exercise, socialize, and exert enough effort to work my way to a healthy mind. By the time I realized I was losing weight and struggling to brush my teeth every day, those options felt out of reach.
The more depressed I became, the less I wanted to give up on my experiment. Some of it was a sunk cost fallacy, but some of it was my clouded thinking. I saw medication as an outside force that would influence my thoughts and distort reality. I felt suspicious of it. Looking back, I can see that I was not thinking clearly. I’m much more in control of myself now that I’ve been back on medication for a couple months.
Not only am I keeping up with hygiene and sleep, but I’m capable of appreciating the sensations of life outside my bedroom – a flock of house finches chirping in a bush, the sun on my eyelids, Stella’s wet nose against my hand. I no longer go to bed immediately after work, and I also don’t sit on my bed at night, staring into space in an apathetic stupor. I’m getting out and meeting people, running errands, and picking up my hobbies again.
I don’t feel good every day right now, but I feel capable enough to put the usual lifestyle tactics to use. My situation feels more manageable. These developments are partly thanks to therapy and my efforts outside of it, but I think they’re mostly due to medication.
So, I know very well that medication helps me, and I’m working on accepting that. I don’t have any desire to stop taking them, which is a step forward for me. But an internal conflict still exists within myself. I certainly still have some shame about it. I was uncomfortable when I was asked to list my medications at my recent dental appointment, knowing another patient was right behind the curtain. I feel reminded of my mental illness every time I pick my meds up at the pharmacy. I struggle when I pour them into my palm at night, and I see a number of pills that exceeds my mind’s arbitrary “acceptable” number.
Most of my difficulty with medication is eased when my mood improves, but the remnants come from my perfectionism. I want to be able to get better on my own, and I have a tendency to tell myself that it’s not that bad.
Despite the background beliefs that are tough to get rid of, I feel like my perspective on medication has shifted compared to a few months ago. I’m happy that my medications are working. I’m no longer uncomfortable with the idea of them affecting my mind.
It’s strange to look back on what I was thinking when my depression was worse. I had this idea that if I relied on medication to function, I wouldn’t really have earned that improvement. It would mean I wasn’t in control of myself enough to pull myself out of depression on my own. It’s a horrible thought that nobody else should ever believe about themselves. I shouldn’t believe it, either.
I was also very preoccupied with the idea that lithium prevented me from thinking about suicide in the same way as I did without it. Even though I knew that was the point, it made me very uneasy. I thought that I was seeing the situation more clearly than I did when I was less depressed and on medication. Part of me knew that was absurd, but part of me was sure it wasn’t.
Once it was long past obvious that getting off lithium was not going well, I really struggled to come around to the idea of restarting it. When you can’t trust your own logic, having people around you to tell you how they see things is very helpful. Still, for weeks after I restarted lithium, my evenings were spent arguing with myself about which side was right and whether I should take it or not. I think the combination of ketamine and Mirapex has improved my mood enough that I’m not concerned with it anymore.
There have been a few times in my history with depression when I found a treatment that worked but only briefly. Either I’d start to feel better and then something would go wrong, it just would stop working, or it would affect me too much, and I’d fly into an uncomfortable, sleepless state of heightened perception. After which, I’d descend back into depression, sometimes worse than before the improvement. This time feels different.
I think the last time I felt this positive about my improvement was in 2020, when I was getting ketamine infusions and they had started to work. I remember feeling amazed by how much easier life was and how motivated I felt to accomplish my goals. I feel a similar sense of improvement now. It is, as usual, accompanied by increased anxiety, but overall, my mood seems fairly stable in its new, elevated position.
I have a tendency to move my decisions from nice, logical decision trees into an underground network of convoluted root balls. Aboveground, choices are determined based on simple, bifurcating factors. Underground, no such rules exist.
Sometimes my decision root balls are so confusing that they’re also wrapped up in other trees’ roots. Those aren’t even my trees! When this happens, it feels like there’s just so much to think about that I can’t consider all of it at once. I’m left with a horribly overwhelming feeling that makes me want to say “no” to everything. It’s like going a million miles an hour and coming to a sudden stop, somehow at the same time.
Overthinking Decisions
I’m a habitual overthinker. I feel compelled to organize all possible plans and outcomes before even considering making a choice. The anxiety stems from the powerful feeling that I have to make the “right” decision, or else. The “or else” is vague and in most cases, probably entirely fictional.
And yet, often, I don’t have a specific worst-case scenario in mind. It’s just a sudden feeling of doom. Once I get myself to slow down and think through the choice in actual words, the real overthinking happens. The pros and cons of each choice are easier to hold onto, but they go straight into the center of a decision root ball. Then they get tumbled around for a while before I get frustrated enough to make the decision.
Untangling a Decision Root Ball
I’m learning that, for slightly longer-term choices, I do better when I force myself to not try to make a decision right away, but to instead let it sit for a day or two so as to avoid my immediate reaction. Of course, I can’t always stop myself from thinking about it all the time and being anxious, but I can reduce the pressure a little.
When I succeed at this strategy for overthinking, I’m much better at choosing the option that’s scary but leads to more growth. The positives start to outweigh the anxiety. The decision root ball starts to become a little less constricted.
For shorter-term decisions, I’ve found that I have to do the opposite of the long-term strategy. If I let myself waffle too much, I become paralyzed and am overwhelmingly likely to pick whichever option involves the least uncertainty.
To illustrate this with a mundane example, imagine me considering the benefits and drawbacks of various food court establishments. If I’m overwhelmed by attempting to balance the benefits and drawbacks, I will pick the option with the least uncertainty and go home empty-handed. And by benefits and drawbacks, I mean things like the length of the line, how harried the employees look, the likelihood that I’ll have to shout to be heard, and how chaotic the space around the line is. I mean, seriously. Sometimes, I’m deterred by not knowing what sizing system they use for their cups. It’s a wonder I can function at all.
Maybe someday I’ll progress to making decisions on the spot with minimal anxiety, but that sounds like an expert-level endeavor. For now, I’ll stick to gradually pruning my decision root balls and trying to say “yes” to some things.
It bothers me periodically that I’ve lost interest in my hobbies. I used to enjoy going to the library, but I don’t read anymore. I try every once in a while to draw something or start an embroidery project, but I usually just end up staring at the materials for a while and then giving up. Art has always been something I do sporadically. I have periods of inspiration and periods in which I set it aside, but I always cycle back through. Not lately. I feel like I’ve lost all motivation to create anything – even in writing. My drive to write on my blog has been exceptionally low, even though I maintain a desire to keep up with it. It’s a frustrating space to be in.
Part of my problem with visual art is that I get too caught up in making it match my mental image. It leads me to give up or not start at all. It occurred to me that it might be easier to get started if I tried to make something after taking a ketamine troche. I have tried writing while dissociating on ketamine, but something about articulating my thoughts in full sentences proves to be very difficult, and I usually abandon it.
Turns out, painting is entirely different. I sketched out a landscape based on a photo and pulled out my watercolors before taking a troche.
I found the process of putting colors on the paper to be engrossing, and I think that since I was curious to see how it turned out, I wasn’t so worried about it looking “bad.”
By the time the ketamine had worn off, I had made it to this point:
It was unfinished, so the next day, I went back to it with all of my faculties and spruced it up. I still don’t love how it turned out, but I can label it a ketamine experiment and be content with that.
Other hobbies I’m attempting to resume include running, drawing, and volunteering. Each of them is in the tiny beginning stages, but I have to start somewhere.
My experiences with ketamine troches have been varied. Sometimes it hits me, and I decide that being horizontal is better than attempting to sit up, so I get in bed. I’ve definitely noticed that remaining still makes me less likely to get nauseated, but it also makes it harder to perceive the dissociative effects of ketamine. I frequently think that I’m past the dissociation and get up, intending to go walk the dog or clean the kitchen, only to realize upon standing that I most definitely am not ready to practice such advanced life skills.
Then again, sometimes it seems like nothing happens when I take a troche. This is somewhat disappointing, given how much mental preparation goes into overcoming the revolting medicinal flavor. I could just swallow the troche without letting it dissolve, except the edges of it are sharp. Believe me – I’ve tried. It’s painful. The best way I’ve found to take ketamine troches is to sip lukewarm tea while it’s dissolving in my mouth. It helps with the flavor, and the liquid speeds up the dissolving process.
My first few troches were more intense than subsequent ones, and overall, I’ve found that they produce much less absurdity in my mental images than ketamine infusions did. Troches tend to lead me down memory lane or explorations of personal questions rather than bizarre, imaginative storylines.
I think that because taking prescription ketamine at home still seems strange to me, I often ponder the question, “How did I get here?” My experience with mental illness started early, so naturally, my childhood comes to mind when I pose that question to myself. Sometimes, when the ketamine kicks in, I begin to review my life as if I were watching a movie, skipping ahead and replaying certain parts. It either leads to me feeling like perseverance is my path or just feeling utterly lost. When I separate from myself a little, it often just adds to my pre-existing sense of confusion and nonbelonging.
More often than not, I cry when the ketamine kicks in. I don’t know if that’s common or expected, but it’s definitely a pattern for me. And it’s interesting because I don’t cry with much regularity in my everyday life. I’m not sure why dissociating would make me feel my emotions more, but it seems to me like it does.
I do feel a bit better, but I’m not sure whether I should attribute that to being back on lithium, the ketamine, or the new medication I’m taking, Mirapex. Historically, lithium has been very helpful in tamping down my suicidal thoughts and allowing me to be more functional. It doesn’t usually do much about the anhedonia, which leaves me feeling the need to accomplish things but not getting much satisfaction from it.
I also started taking Mirapex a few weeks ago. It’s a dopamine agonist used for Parkinson’s disease, restless leg syndrome, and – off-label – depression. I’m in the middle of increasing the dose, and so far, I’m not sure whether it’s helping. It certainly could be part of the combination.
Love, Your Brain 