Today was scheduled to be the last of my six infusions of ketamine for treatment-resistant depression. My area has been preparing for a three-day series of snowstorms, each predicted to bring several inches of snow, but we braved the roads with the rest of the Monday crowd. Wet, heavy snow from the night before covered the ground, and although plows came through early in the morning, people drove cautiously, and a long line of cars backed up into the city.

The Schedule of IV Ketamine for Depression

Seeing as today was my sixth ketamine infusion, my doctor and I discussed the course of treatments and how we want the next steps to progress. (If you’re just joining us, feel free to start at the beginning of this series about my experience with IV ketamine infusions for treatment-resistant depression.) I started to respond slowly after two or three infusions, so my total benefit has so far been moderate. The “usual” (everyone is so different, and protocols are changing all the time) way this clinic operates is to do six initial infusions within two to three weeks, followed by a maintenance infusion two weeks after the last of the initial series. If those two weeks go well and the patient doesn’t notice any decline before the maintenance infusion, the next one is scheduled for three weeks out, and so on.

If we wait two weeks before my next infusion, given that I’ve had a moderate response and rather late, there is some risk that I might lose momentum and need more ketamine infusions to make up for the lost progress. Therefore, we’ve decided to extend the initial series to eight infusions. With that decided, we began ketamine infusion number six.

Higher Doses of Ketamine

I opted to increase the dose incrementally as we went from infusion to infusion, so this one was the highest dose yet. In retrospect, I think it was too much. I was deeply relaxed, but less able to distinguish between reality and drug-induced visions. I remember very little of what I saw, and the longer it’s been since the infusion, the less I remember. I felt oddly trapped in it, but not in a particularly scary way. I was just very far away from the real world.

A Power Outage

I remember thinking about the weather; I saw fine snow like powdered sugar on the road, swirling and leaping in the wind. I remember feeling that my throat was dry and telling each muscle to contract as I swallowed in slow motion. At some point (I later learned it was towards the end), sudden darkness and a distinct silence descended on us. It forcefully pulled my attention back to the room. I opened my eyes–Were they my real eyes? Yes. Yes, I think so— and saw movement through the open door. Hushed voices and flashes of light punctuated the heavy darkness. I wasn’t sure if anyone was with me, but then my doctor hurried in and spoke to my nurse, who was still sitting beside me.

Their words were too fast for me to grasp, but I heard something about batteries. I attempted to turn and look at the voices, and my nurse reassured me. “The power went out, but everything’s OK.” With this knowledge, I closed my eyes again and sank back into the inner darkness. A strong beam of light landed on my face sometimes, and I deduced that that was the nurse aiming a flashlight in my direction to check on me. I heard the series of beeps that meant my infusion was over. I cracked my eyes open and noticed human forms enter the waiting room. They, too, had flashlights and talked in that low tone used only when sudden darkness arrives. My nurse closed the door.

A Possible Headache

It was harder to come out of it than it usually is, and my sense of time was even more skewed than normal. This might have been because of the higher dose of ketamine or the lack of overhead lighting. I imagine it was a bit of both. I feel exceptionally tired this time, and I think I’m developing a small headache. It seemed likely that the migraine I got after my first infusion was because of stress, but if this one turns out to be similar, I wonder if the higher dose of ketamine was too much for me and mimicked the first dose that was so jarring. If this is the case, it is very rare; ketamine is actually used to treat migraines, so if you’re considering ketamine for depression, don’t worry too much about headaches.

As I have more and more infusions, I’m finding that it’s harder to remember what they’re like. You know that feeling you have when something triggers a memory, but you’re not sure if it was real or a dream? I’m having that experience much more frequently, and I think it’s because the things I think about or see during a ketamine infusion feel so dream-like. There have been times when I can’t tell if I’ve told someone something, dreamed that I did, or thought about it during a ketamine infusion. It all blends together.

Here’s hoping these next two help boost my momentum to a better place, and that the power stays on.