A temperate forest with a large waterfall and misty fog overhead.

Depression is a Sinkhole: The Ketamine Chronicles (Part 4)

When I was looking for information about ketamine infusions for treatment-resistant depression, I didn’t find a lot of descriptions of what a ketamine infusion actually feels like. My internet forays left me with the impression that it would be like what I experienced in my second infusion– that feeling of being so relaxed that you’re near sleep and aren’t aware of your physical body. What I read online certainly didn’t prepare me for my first infusion, which was extremely bizarre and hallucinogenic, nor did it reassure me that the right dose of ketamine for me would produce a different experience entirely.

Comparing IV Ketamine Infusions for Depression

My third ketamine infusion happened last week. I had persistent nausea after the first one, so we lowered my dose for the second infusion. Not seeing any improvement, this time we increased the dose of ketamine and doubled up on some nausea medications. I was given five milligrams more than my initial dose, so my doctor assured me that if it was too intense, it would be okay to tell him and he’d either slow it down or give me a gentle sedative to make it less overwhelming. Writing about this today, only four days later, I’m already struggling to remember what it felt like. It was absolutely less intense than the first infusion, but it was more intense than the second one.

Where the second ketamine infusion was pretty boring from a descriptive standpoint, the third had slightly more of a visual component. I remember watching organic shapes fill my mind, colored in blues, browns, and oranges. Lots of small circles packed into varying levels and areas. Then, thin lines with colors in between resembled layers of sediment, flowing out of sight.

The Commonalities Between Ketamine Infusions

One common experiential thread between all of the ketamine infusions I’ve had is the altered sense of time. I get sucked into my brain and completely lose connection with anything identifying time, then am shocked (as shocked as a partially-anesthetized person can be) when I’m told that much more time has passed than I think. Or, the opposite happens and it seems that time moves incredibly slowly. It’s oddly freeing to accept that for roughly 45 Earth minutes, I have no choice but to abandon all concern for time. I’ve checked out of humanity’s need to measure minutes; talk to me when I return to my bipedal meat suit.

Coming out of it is also a similar feeling each time, which is unfortunate because it’s not super pleasant. It’s not terrible, either, but it does leave me feeling vaguely unbalanced and zonked out pretty much until I get the chance to sleep it off. This was difficult for my third ketamine infusion because I was traveling later that day. I shuffled through security with the rest of my bleary-eyed fellow travelers, then felt eternal gratitude when, after the flight, my mom led us to the car pick-up area and even engaged our talkative Uber driver in conversation at almost midnight. I was ready to curl up in the fetal position on the vacated shoeshine stand and give in to blissful sleep.

The Fourth Ketamine Infusion

I returned home and yesterday, I had my fourth ketamine infusion. I tolerated the last dose and feel, possibly, a tiny bit less depressed. It’s unclear. In any case, we decided to increase it again in the hopes that we just haven’t hit the right number yet for my depression symptoms. Like always, I twiddled my thumbs a little before I started to feel it. I vaguely remember asking the nurse if this ever gets boring for her, as she sits quietly next to me and makes notes on her clipboard. She said something like “No, everyone reacts differently. I don’t get bored.”

To which I replied, “Oh, good, I’m gl a d  i’m n o t bor i ng  y o o o u u,” and promptly left this dimension.

As I described it to my doctor at the end, this ketamine infusion felt like a combination of the first and second infusions– both somewhat visually engaging and also relaxing. The very first sensation after leaving my nurse sitting next to me was of sinking into inky blackness. Normally, that would sound terrifying, but this was very soothing. At first, all I saw was black behind my eyelids. I began to think that I should think of something to think about. This was more difficult than I expected, because every time I had an idea, it floated away. My mind seemed to have its own plan for yesterday’s infusion. Much like with time, I’m learning that trying to control anything during a ketamine infusion is futile.

Depression is a Sinkhole

Despite trying to think about my dog, I saw landscapes. Many moving landscapes empty of people, buildings, or animals. I saw a desert with packed, cracked sand. I saw a beach with gravel and sand underwater with volcanic stones bobbing and rolling. I saw a forest, and when I began to think about depression, I saw a great sinkhole open up. It swallowed pine trees and boulders, sucking everything closer. It was like pulling on a tablecloth, everything dragged inexorably towards the central force.

The landscapes were beautiful, and unlike looking at photos of nature, these felt real, like they were part of me. I felt connected to them, and I was glad, then, that time was moving slowly (it had only been ten minutes- I thought it had been 30). Occasionally, something would tug at my awareness, and I’d come back to my body.

Body Awareness on IV Ketamine for Depression

humanoid statue with large hands and head

The blood pressure cuff would suddenly tighten, reminding me that I did indeed have an arm. I was reminded of the cortical homunculus concept (a humanoid figure with body parts proportional to the density of nerves dedicated to sensing and moving those parts), as my hands felt very large and very close to my face, although I knew they were resting in my lap.

The position of my body in space, which I generally have trouble detecting because of Sensory Processing Disorder, was also a strange experience. I could have sworn I was upsidedown, but somewhere in my mind, I knew that was absurd. Several times, I was captivated by the feeling that my eyes were open, even though they were definitely closed. I remember thinking that maybe this is what people mean when they describe a third eye; my body’s eyes were closed firmly, and yet it felt for all the world like I was looking around.

The whole experience of my fourth ketamine infusion for depression felt rather profound, although I couldn’t tell you why. Maybe that’s a good sign? I’m doing my best not to feel discouraged, and to continue on with detached curiosity and a tiny bit of optimism.

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