View of milky way in night sky

Renewing The Ketamine Chronicles: Troches Part 1

I wrote in my last post that my ill-advised attempt to get off my medications is not going well. Not much of a surprise, I suppose. My psychiatrist suggested I try an oral formulation of ketamine, known as troches (pronounced “tro-keys”). These are dissolvable tablets that you take home and administer to yourself on a schedule. I’m doing it twice a week for two weeks.

One of the main drawbacks of troches is that the ketamine is less bioavailable compared to IV ketamine, which makes precise dosing a challenge. The risk of addiction can be minimized by carefully monitoring patients’ responses and prescribing ketamine troches in small batches with limited or no refills. An Osmind article written by a physician notes that the ketamine doses that are commonly prescribed are much lower than typical recreational doses but that doctors should have carefully outlined plans for restricting use and halting patients’ access to ketamine troches if necessary.

I got ketamine infusions fairly regularly for two years and then stopped with no problem, so I’m not very concerned about my own risk of becoming addicted. However, a cautious approach seems prudent.

An article on RX Insider describes ketamine troches quite positively, saying that they are a more affordable option than infusions and that they offer relief for patients who may not have access to other forms of ketamine due to logistical constraints or COVID-19 safety concerns.

Even with the experience I have from ketamine infusions under my belt, I was nervous about trying troches. In general, I’m uncomfortable with the idea of not being in control of myself. I managed to let that go when I did ketamine infusions, but the medical monitoring involved in that alleviated some of my anxiety. The uncertainty about what to expect when taking ketamine at home put me on edge, but it has turned out to be fine so far.

What Do Ketamine Troches Feel Like?

I’ve tried two ketamine troches and had very different results each time. Having some idea of what to expect based on my experience with ketamine infusions, I tried to set myself up for a smooth ride. The dog had been walked, my curtains were closed, and I had no obligations waiting for me. I wore comfortable clothes, arranged my weighted blanket on my lap, and chose some gentle-but-compelling instrumental music to listen to.

The first time, I put the troche under my tongue, waited until it dissolved (about 10 minutes), and then waited about 5 more minutes before spitting it out. I may have felt something, but it passed quickly, and I felt completely normal about 5 minutes later. It was so mild that I wasn’t even sure whether I felt it because I expected to or because the ketamine actually had some effect on me. I’d been advised to spit the ketamine out to minimize nausea, but when I reported feeling pretty much nothing, my psychiatrist told me to wait ten minutes after it dissolved the next time and, if I still didn’t feel anything, I could try swallowing it the following time.

A few days later, I tried it for a second time and waited longer than recommended. I think the ketamine that was absorbed under my tongue gave me a very mild dissociative feeling, but it again passed very quickly. This time, I took notes on my phone so I could keep track of the timing. I started at 2:45 and didn’t feel anything until 3:04. I felt a very low level of spatial wobbliness – a lot like how I feel when I’m a little overwhelmed in a busy grocery store. It felt like things were getting a bit hard to track with my eyes, and I felt ever so slightly floaty. By 3:15, it seemed like the effect had already peaked in a mild way and worn off. I felt pretty normal, so I swallowed the ketamine, and a second wave came a few minutes later.

At 3:30, I noted that my fingers felt a little numb and that I was going to close my eyes. Seven minutes later, I wrote, “Music too intense. Felt like being carried on a river of sound.” What does that mean? I no longer know. You might think that I was completely zonked, based on that tidbit, but only one minute later, I held a brief conversation with my mom and managed to seem totally coherent. Compared to ketamine infusions, troches seemed to create a more fragile dissociative state. I was much more able to pull myself out of it when under the influence of troches than I was when I got infusions.

I think my anxiety about what would happen had me coming back to the room frequently, which resulted in a very fragmented experience. I would get sucked into a song for a couple minutes and then reorient myself and write a quick note on my phone about what was happening.

When I closed my eyes, my sense of where my body was and where certain parts of my body were in relation to each other was distorted. It’s a feeling I also tend to experience when I’m on the edge of sleep or when I sit still for too long. Sometimes, it’s only a small discrepancy, such as the difference between whether my hands are resting on my lap or next to me.

The sensation is cranked up on ketamine. This time, it resulted in me feeling like my head was somehow directly connected to my knees. I experienced this kind of bodily confusion frequently during ketamine infusions, so I knew it was nothing to be concerned about. I tried to let go of my desire to organize my body in a certain way and just float along in whatever form I had taken.

Every time I checked back in to the real world, I was surprised to find that only a few minutes had passed. It felt more like 20 or 30.

What I was seeing and feeling during those few minutes was nothing so detailed or bizarre as what ketamine infusions created, but I have the sense that if the experience had not been so fractured, I might have approached a similar level of immersion.

I remember one song evoking an image of the night sky as viewed from a very dark place, with the vast swath of the milky way stretching out overhead. Another song made me feel as though I were standing in my old house as it burned down, sparks and ashes falling around me. The wind had begun to howl outside in earnest, which makes me nervous these days.   

At 3:48, Stella decided to sit on the window seat. She found the break in the curtains and pushed her way through, light streaming in behind her. The light held my attention for a few minutes, but by 3:53, I wrote that I was feeling more normal but also rather sad. I had a bit of a cry, noticed that time was jumping ahead in small increments, and then got up to go to the bathroom at 4:10. Looking in the mirror was an unsettling experience, but I expected that, so it wasn’t too disturbing.

By 4:22, I felt like I was completely past the effects of the ketamine. So, all told, the entire process took about an hour and a half from the time I first noticed the ketamine affecting me.

I haven’t noticed any improvement from the ketamine, but I have two more to do before the end of my two weeks. In the meantime, I’ve decided to get back on lithium. It seems obvious that stopping it was a bad idea and that I’ve clung to the hope that I could make it work without it for too long. I’m trying to keep the perspective that my experiment was informative, and it’s good that lithium helps me. But to be honest, I just feel defeated. The better I feel, the easier I am on myself for needing medication, so hopefully, this ultra-critical side of myself will quiet down when the lithium starts working.

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