Category: Depression

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Detached Curiosity with IV Ketamine Therapy: The Ketamine Chronicles (Part 3)

Genevieve5 Comments

The days following my first IV ketamine treatment for depression were filled with anxious self-awareness (Am I feeling better yet? Is the ketamine working?) I’m pretty sure the answer to the first question was “no,” but it’s hard to say. Suffice it to say, nothing dramatic happened for me as a result of my first ketamine infusion.

In an attempt to not get my hopes up nor be overly pessimistic, I’ve decided that my approach will be one of detached curiosity. I’m going to see the entire thing- the feelings leading up to an IV ketamine treatment, the experience of the ketamine therapy itself, and the potential changes that result- as if I weren’t invested in the outcome. It’s just a fascinating experiment on my own brain. At least, that’s what I’m aiming for.

Adjusting My Ketamine Treatment for Depression

The first ketamine infusion was so bizarre that I was trying to prepare myself for anything. In fact, I was already faced with an opportunity to maintain detached curiosity. I had some adjustments planned for the second infusion, and I wondered what effect they would have on the overall experience. Instead of over-ear headphones, I brought regular earbuds in the hope that they would eliminate the overwhelming sound of my heartbeat that noise-canceling headphones created. I also decided that I would put my head back against the headrest at the beginning of the infusion so that future me wouldn’t have to consider whether giving my neck a rest was worth ripping the fabric of space-time.

As it turns out, the first ketamine treatment session is often the most strange. Subsequent infusions give people something of a tolerance to the trippy effects of the medicine. My doctor suggested that we reduce the dose a little and add a second nausea medication. So, the reduced dose, increased sleepiness from the nausea med, and improved tolerance to ketamine made my second ketamine treatment positively… relaxing. I might have even fallen asleep.

A reflection of a tree with small berries on gently moving water
Photo by Tim Johnson on Unsplash

When I got there, things were a little busier than at my first appointment. I was introduced to the nurse, who is only in on certain days, and invited into the second room (across the hall from the one I was in last time, mysteriously labeled “Staff Pool and Spa”). The nurse got my IV in, set up the EKG leads, and took an initial blood pressure reading. I then had time to talk to my doctor about the plan of action. I had a tenacious migraine after the first infusion, which he said is rare, but happens sometimes. He suggested we try an anti-inflammatory medicine to prevent another headache, but I wanted to go without. I sometimes get tension headaches that morph into migraines when I’m extremely stressed and anxious, and that’s exactly what this one felt like. I felt much more comfortable with the process the second time around, so I was pretty confident that if stress is what caused my headache, I wouldn’t get one this time.

Getting More Comfortable with Ketamine Treatment for Depression

The nurse came back in and got things started, and I did my best to relax. I put my head back against the headrest, started some soft instrumental music in one earbud, and closed my eyes. The ketamine felt much more subtle this time, which I imagine is a result of both my body becoming accustomed to it as well as the reduced dose. It didn’t hit me as suddenly, but I found myself realizing that I had stopped paying attention to the room around me. I had a thought, and before I forgot, I turned to the nurse and said, “What is this room labeled?” She looked at me blankly, perhaps thinking that I was already too high to articulate logical thoughts. I quickly clarified, “Y’know, the other room is ‘Staff Pool and Spa.’ So what’s this room?” Understanding washed over her face, and she laughed and said she didn’t know. She got up to peek around the outside of the door and came back with the disappointing answer of “nothing.” We mused that this room should have a funny name, too. Someone floated an idea, but by that point, I was really sinking into a ketamine haze and don’t remember what it was.

The nurse sat next to me, taking notes, and the machine beeped softly just behind me. My mother sat in the corner, typing on her laptop. I gently floated in half-perceived consciousness. I waited for the images to begin, but all I saw were the backs of my eyelids. Black and pale yellow shapes inflated and pushed against one another; they were more distinct than what I normally see when I close my eyes, but it definitely felt like the same process of retinal neurons misfiring. I was a little on edge, waiting for weird images to creep in, but once I realized that wasn’t going to happen, I tried to just let go and float. I put the other earbud in (groping for my ear with numb fingers) and settled back.

Attempting Mindfulness During IV Ketamine Therapy

Large chunks of time were punctuated by movement in the room. I heard my mom close her laptop and take out her knitting. The metallic needles clinked together softly. The nurse put her hand on mine and told me to take a deep breath, in through my nose and out through my mouth. Apparently, I had forgotten to breathe and my blood oxygen level dropped. At some point, the doctor cracked the door open and I heard him whisper to the nurse that I should keep my eyes closed so as to minimize nausea. Later, the nurse and the doctor switched. I noticed the differences in how they walked, sat down, and how much noise they made while taking notes and shifting around. I kept my eyes closed the entire time. My usual discomfort in having my eyes closed around other people and activity was suppressed by the ketamine; I was paying attention when something happened, but I was content to only listen.

Having Patience with Ketamine for Depression

When the ketamine infusion was done, it seemed like it took less time for me to return to normal. The additional nausea medicine worked wonders, although I did feel more sedated. I’m happy to report that I did not get a headache following the infusion. However, I’m not happy to report that I’m not happy. Definitely still depressed. I’m trying really hard to not get discouraged, as I’m only 1/3 of the way through the initial series. I won’t lie, though, it’s tough to not be disappointed.

Reminder to myself: detached curiosity.

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It’s a Trip: The Ketamine Chronicles (Part 2)

Genevieve6 Comments

I learned a lot about what to expect from my first IV ketamine treatment for depression when my doctor asked if I had ever tried any hallucinogenic drugs. My response was “no,” and my experience was about as trippy as I could expect from that lead up.

My First Ketamine Treatment for Depression was Bizarre

I’m writing this from my bed at 8:20 pm, the evening after my first ketamine infusion. I do have work to be doing, and I tried that for a while, but I figured, “Hey, I spent 45 minutes today coming to terms with the fact that I was just a floating head who no longer had a body, then blessedly reunited with my limbs over the course of 20 nauseating minutes, only to come home and do work? I don’t think so.” So, in an effort to empty my brain, here are my first impressions, unexpected experiences, and mundane realizations of today.

The door to the room I was in was labeled “Staff Pool and Spa,” and I’m not at all sure what to make of that. My doctor seems to have a good sense of humor. I did wonder what the other room was labeled, but was too focused on not letting my baby giraffe legs buckle on the way out. I’ll report back.

If you missed Part 1 of The Ketamine Chronicles, I’m getting a series of six infusions of ketamine for treatment-resistant depression. I was afraid of this for a couple of reasons, one being the uncertainty of what the ketamine treatment itself would be like. I wish that I could give some kind of concrete answer to that question for anyone with the same anxiety. There are commonalities, I’m sure, but there’s no way anyone else could see the exact same quilted rocket launching into outer space that I did. Or, if for some reason you do, we should hang out sometime.

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Photo by Nathan Dumlao on Unsplash

What Ketamine Treatment for Depression Feels Like

For me, the general feeling of an IV ketamine infusion is one of warmth, dissociation, and internal images. The first sensation I noticed was warmth, particularly in my arms and chest. It was quickly joined by the feeling that my limbs were all floating away from me. Looking around the room became extremely disorienting. It was like my brain could interpret whatever my eyes started on and where they stopped, but nothing in between.

Thinking and Speaking

For a while, I was pretty with it. My doctor asked me some questions to gauge how far gone I was, and I had no trouble answering them. I had to remember three words and repeat them back a few minutes later, and I had to count backwards from 100 by 7s (not very far). The comprehension and answering of these questions was no problem. What was weird was the sensation of talking itself. It was like there was no space between thinking and talking, so as soon as I had a thought that I had some intention to speak out loud, I heard it coming out of my mouth as if someone else had said it.

Losing Touch

After a while, I started to retreat from the room and into my mind. When I closed my eyes, I was unnerved by the sensation that my body and my head were very slowly spinning in opposite directions. So, I tried to keep my eyes open. Everything in the periphery of my vision faded out until I could only see what my eyes were focused on. But even then, my brain would pull me in, and although my eyes were open, I wasn’t seeing anything.

Perception of Sounds

I was listening to calm, instrumental music through over-ear headphones, but the music was dramatically overshadowed by the sound of my own heartbeat. This was somewhat distressing, so I took the headphones off. Without the headphones, the buzzing fluorescent lights held my attention. It began to sound like cicadas were all around us, and I was reminded of warm, spring evenings in Michigan. I closed my eyes.

Small, white daisy flowers in a field with tall grasses and gently sunlight.
Photo by Daiga Ellaby on Unsplash

Leaving My Body Behind

What I saw in my mind during the ketamine infusion is fading and jumbled, and I remember it in much the same way that I remember my dreams- just out of reach. I do know that the beginning was defined by knit and quilted geometric shapes moving and growing slowly. Dark purple colors against dark backgrounds, shapes like wheel cogs and tower spires. For some of it, I felt like my mind was falling (at this point I didn’t have a body), but not in a frightening way. Just a slow, gentle descent. Later on, I felt impossibly tall and constantly growing. I stretched through the atmosphere, into outer space. I soared past the moon and out beyond our solar system. I thought about telling someone but decided it might sound a little grandiose to describe my incredible, galactic height.

Time is Impossible to Follow

My sense of time was warping; when my doctor said it had been about 30 minutes, I felt like it had only been 10. After that, though, time seemed to move agonizingly slowly. When I heard “just a few more minutes” I was a little relieved, but soon began to wonder why my definition of “a few” and his definition seemed to be so wildly different. My mother was sitting across the room; why would they leave me here for another hour? Eventually, some beeping next to me indicated that things were ramping down. I slowly returned to my rapidly overheating body. I managed to say “very hot,” and the blanket was removed, along with my scarf. The room wobbled, my stomach turned, and I closed my eyes again.

The time it took to fully come out of the effects of the ketamine infusion was probably about 20 minutes, but again, I wasn’t the best timekeeper. Moving my head and eyes provoked the nausea, so I tried to stay completely stationary. We chatted about what it felt like, what kinds of things I saw, and what I thought about during the ketamine treatment. When I felt sturdy enough to bring my legs up to my chest, I put my head down on my knees and cried. I can’t say why – the anxiety beforehand, the nausea, the fear that it won’t work, maybe all of the above. It was an overwhelming experience, but I’m told that it gets easier.

Trusting the Process of IV Ketamine Therapy

I was hoping that I would sit down to write this and be able to say that I feel miraculously less depressed, but that isn’t the case. For some people, ketamine therapy for depression makes them feel better within hours of their first treatment. For others, it takes a few more infusions. And for still others, it doesn’t work at all. So, for now, all I can do is wait.

Until next time.

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Ketamine Treatment for Depression: The Ketamine Chronicles (Part 1)

Genevieve9 Comments

This is the beginning of a series of posts chronicling my experience with IV ketamine for depression. Starting something new, something very different from the numerous antidepressants I’ve gone through in the last few years is overwhelming. I’d like to document my experience as a way for me to process it through writing, as well as to provide a first-person account of what this might look like for others who are considering ketamine for depression. The use of ketamine to combat treatment-resistant depression is effective for many, many people. So, whether it works for me or not, I’ll try to use The Ketamine Chronicles to be as honest as possible.

Why Use IV Ketamine for Depression?

Several months ago, my psychiatric nurse practitioner suggested that I look into IV ketamine infusions as a potential new avenue in the search for something that will work against my treatment-resistant depression. Every antidepressant I’ve thrown at it has had little to no impact, and I’ve effectively become chronically suicidal. I said “ok, sure,” and then pretended that conversation had never happened. Weeks passed, then months passed, and as I got closer to the present and could no longer ignore my reality, ketamine seemed more and more like the next logical step. Nothing I’ve tried has given me much relief, and my depression has steadily worsened.

The silhouette of a person standing in a field in a thick fog.
Photo by Dimitar Donovsky on Unsplash

Luckily for me, my lovely mother is an avid Googler. By the time I was ready to go down the ketamine treatment path, she had bookmarked and downloaded every resource and testimonial in a three-page radius of a “depression ketamine” Google search. When I came home from a difficult appointment and told her that I’d decided to schedule a consultation at a clinic, she said, “Great. I’ll send you the website of the one near us that I think is best. You can start filling out their forms.”

As an aside, let me point out that my mom is so wonderful. She did hours of research and planning but respected my right to choose my treatments enough to wait for me to make the decision before piling it on. Thanks, Mom

How Does Ketamine Treat Depression?

OK, so what is ketamine for treatment-resistant depression? In brief, ketamine is an anesthetic that, when used in very low doses in a clinical setting, has been shown to dramatically improve symptoms in participants with treatment-resistant depression. Chronic depression that doesn’t respond to traditional antidepressants is associated with significant alterations in brain structure and function, as well as deficits in BDNF, a marker of neuroplasticity. Evidence suggests that ketamine facilitates the repair of those damaged areas by increasing the levels of BDNF.

Wrestling with Depression Treatment Decisions

At this point, my depression is severe, and it has been for a long time. I probably met the criteria for what would make me a candidate for IV ketamine treatments a long time ago. So, why did I wait so long to do this? For one thing, a ketamine infusion is a procedure, a word packed with health-anxiety overtones. For another, moving from antidepressant pills to a treatment administered by an anesthesiologist feels like a big deal. It forces me to confront the fact that my depression is really serious; if I don’t up my game from antidepressants, I could die. That’s scary. What’s even more scary is that for a long time, that’s exactly what I’ve wanted. I’ve had thoughts of suicide in varying degrees for years now, and at this point, the thought of dying doesn’t shock me at all.

Right now, despite having an appointment already booked for tomorrow, I’m on the fence. I know that it sounds absolutely bonkers that I would still be considering suicide, even when faced with a very promising treatment that I have access to. But, that’s depression. It’s an illness that you can’t reason your way out of because the illness itself affects the way that you think.

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Photo by: Tomas Williams, @tomaswilliamsa on Unsplash

Finding Hope for Better Days

I have never known what it’s like to be a young adult without depression symptoms. When I think about the possibilities that life holds, my mind can only conjure up images tinted by depression. I can imagine having a job that I like, but my mental image of it includes the constant fatigue and loss of focus that my depression brings. “Feeling Better” no longer holds much meaning for me because I no longer remember what it feels like to Feel Better. So, when I think about how other treatments have affected me (minimally), it makes trying another one seem… not worth it. I can’t fathom what life would be like without depression, but then again, depression makes my imagination dull and limited.

In one more day, I’ll have had my first IV ketamine infusion for depression. I’m trying to keep an open mind, to admit that maybe life with fewer symptoms is better than I can imagine, and to allow myself to have a little bit of hope. Although I don’t have much faith, I’ll have to take a leap.

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I’m a (Self)-Control Freak

GenevieveLeave a comment

I’ve trained myself to be restrained whenever possible. I hold myself back when I don’t like something, and even my enthusiasm is tempered. People find me hard to read, and I don’t open up immediately, a little later, or even a bit after that. It takes a while.

Some of this is surely a product of my Sensory Processing Disorder. The world is abrasive to my nervous system; it’s loud, fast, bright, and unpredictable. So, to avoid standing out, I bury my reactions. I’ve developed excellent self-control. Of course, this has repercussions for me when I go home in a haze and need to do a lot of nothing for a while. Hiding how I feel about outside stimuli often protects me from two of the things I dislike the most: interrupting people and being the center of attention. Sometimes, enduring the feeling of people crowding around me is more bearable than attracting attention by elbowing my way to the door on legs that don’t feel like mine.

I have a fear of not being in control of myself. I find nearly every environment to be full of stimuli that are “too much” for me. Even my internal body sensations are problematic. My brain doesn’t always know exactly where in space my body is located or how things are moving around me. All of this feels very much out of my control, so I cling to my self-control for safety. However, I think my self-control has expanded past its allotted jurisdiction, and it’s time to address it.

My need to be in control of my reactions has seeped into my sense of what is my responsibility and what is not. It’s easy for us to think we’re responsible for others; we come to think that their feelings, their setbacks, and their decisions are on our shoulders. What any good friend would tell is you that you aren’t. You’re not responsible for how other people move through the world. We make our own choices, manage our own feelings, and deal with change on our own terms.

small black sign with white letters reading make today tolerable with succulent in wooden container next to sign

My particular misplaced sense of responsibility lies in how I think about my depression. I have always had a nagging (or roaring) sense that my depression is my fault. If I could just do more, or try harder, maybe I could fix myself. I’ve recently been faced with a treatment option that forces me to confront the fact that I have treatment-resistant depression, and that it’s not my fault. Seeing my severe depression as an illness that is out of my direct control is terrifying. It’s simply more comfortable for me to think that I’m just not doing a very good job at solving a problem that can be solved with enough effort.

And that’s how I realized that I’m a (self)-control freak.

I actually would rather believe that I’m a failure than that I drew the short mental health straw. At the same time, it’s freeing to view my depression as something that has happened to me rather than something I caused. It takes some of the burden off of me, but it also takes some of the control away from me. Brains are weird, and sometimes they have a mind (har har) of their own. Sudden relapses, triggers, and even seemingly spontaneous ends to episodes are not entirely understood. It’s scary to think that after all of this- the numerous medications, the hospitalization, the group therapy, the individual therapy, the occupational therapy– my brain has stubbornly remained depressed.

If I’m going to get better, I need to stop blaming myself. I need to accept that some things are out of my control and that I don’t need to hold myself entirely accountable for my symptoms. I’ve learned a lot about healthy coping mechanisms in my years of therapy, and although right now I feel too debilitated to put them into useful practice, I hope that a new approach might relieve my symptoms enough to let me begin to heal on my own, the way I like to do it: with hard work.

The term “control freak” has plenty of negative connotations, and it can be hurtful to people who struggle to trust others or to let go of perceptions about the “right” way to do something. This post is in no way a jab at others, only at myself. The title is meant to be humorous, to poke fun at a coping mechanism that holds me back. I’m a self-described self-control freak, and as the term does not bother me, I hope that it doesn’t come across as insensitive.

Several Bad Weeks

Genevieve3 Comments

You’d think that bad weeks would push me to write- to channel my too-full brain into words on a page. But no, bad weeks leave me unable to open my laptop and string words into sentences that express how I feel. Describing my symptoms feels repetitive, like I have nothing new to say. And maybe after four years of severe depression, I don’t. This is a symptom; I don’t want to write, and I don’t want to think.

Lately, I’ve been feeling suicidal, almost like how I felt before my hospitalization. After weeks of bad days, I finally had a good day. I got things done, I said “yes” to invitations out, and I had a microscopic feeling of hope. Then, like I knew it would, it ended. I woke up with the same depression I had two days before.

It’s taken me two weeks to write this much. It’s only 300 words, but I have to come back again and again to chip away at it. I feel disorganized in my thoughts, and if I had the spark to edit this, I would. I haven’t posted in a while because I feel the need to end each post on as hopeful a note as possible, and I don’t think I can muster that right now. Is it better to say nothing in order to preserve a positive message, or abandon optimism to illustrate real life with depression? I’ll strike it somewhere in the middle.

Sometimes you have bad weeks, and sometimes there are many, one after another. I’ve been told, and have experienced in the past, that if you keep going, good days will fall into place. At first, they’re few and far between, but then they start multiplying. I’m not there yet. I don’t see many good days, and I feel far from optimism. But it’s possible that I’ll get there.

Update: It took me so long to finish this post that I’m now feeling better enough to continue blogging. However, I thought it important to post this anyway.

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Mental Health and Resilience

GenevieveLeave a comment

Is it ever ok to give up? Cultures around the world are inundated with myths, lore, and tales of a protagonist overcoming seemingly insurmountable obstacles and emerging triumphant. They’re admirable, they’re heroic, and we strive to be like them. How do they do it? It’s not that they’re unaffected by tragedy and hardship. Their secret is resilience.

The concept of resilience can be difficult to pinpoint, but I think this quote by Janna Cachola encapsulates what I think of as the essence of resilience.

“Resilience is not about being able to bounce back like nothing has happened. Resilience is your consistent resistance to give up.”

Resilience does not mean that you’re the same after your ordeal as you were before; we’re constantly changing. It means that even in the darkest of times, we either wait for it to pass, or we work to change our reality. These are both demonstrations of resilience- sometimes you just have to hunker down and hold on. But no matter what, we refuse to give up.

TW: This section discusses suicide

September 10th is International Suicide Awareness Day. In the last few days, I’ve been reflecting on what it means to be resilient in the context of mental health.  Cultivating resilience is one way to help us resist hopelessness and feelings of helplessness. It puts the power back in our hands. It says “I can get through this, no matter what.” This line of thinking is in no way a judgment on those who have died by suicide. It’s simply an attempt to continue a conversation started by researchers, therapists, and people fighting mental illnesses every day.

I’m no stranger to the importance of resilience in mental health. I’ve thought about suicide in such detail and for so long, sometimes it seems like an acceptable option. At the same time, the part of me that values hard work and persistence is appalled that I would consider giving up. It’s a dangerous balance that I need to monitor carefully in order to remain safe. Resilience doesn’t mean that you have to do it on your own. Rely on the people who care about you and all of your other resources. Ask for help, and accept it when it’s offered. As the saying goes, you’ve survived every single bad day so far- that’s a damn good track record.

– Love, your brain

 

“i was not born with roses
in my chest
to be afraid of thorns.i was born to
bloom
in spite of them.”
― Vinati Bhola, Udaari

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3 Things My Dog Teaches Me About Listening to My Body

Genevieve4 Comments

Ever since I welcomed my puppy, Stella, into my life, I’ve noticed some things about how she treats her body. Unlike Stella, I have trouble recognizing what my body needs; Sensory Processing Disorder can make it hard to discriminate one feeling from another, and to identify what actions would fix an uncomfortable sensation. My dog, however, is especially in tune with her body. Sometimes I marvel at how good she is at giving herself what she needs. In honor of that, here are three things I’ve learned from Stella about listening to my body.

Test Your Surroundings

Stella has no qualms about finding a new place to hang out, no worries about offending others by moving. She goes from place to place as she wants. If the bed becomes too hot or too soft, she switches to the floor. If she feels too exposed around loud noises, she finds somewhere sheltered to lay.

The number of times I’ve kept myself from moving or adjusting my surroundings because I might stand out is too many to count. The little things can make a big difference in how you see your environment and how you feel in your body. Small adjustments help us regulate our nervous systems– a cold drink can wake you up while a warm one can calm you. Do you like your feet to feel secure, or do you prefer the freedom of open-toed shoes? Break up the monotony of your schedule by riding your bike to school or work every once in a while. I work on the computer a lot, and when my slouch has reached extreme levels, I know it’s time to get up and stretch. Take a page from Stella’s book, and feel free to get comfortable in your environment.

Express Your Emotions

Dogs don’t lie about how they feel; if you know how to read their body language, it’s easy to tell when they’re feeling happy, anxious, confident, or any other reaction to outside stimuli. There’s a certain amount of uncomfortable stimuli that we all must face every day. Maybe you hate the feeling of brushing your teeth, yet you do it because it’s important for your health. Maybe you’re sensitive to temperatures and dislike walking to work in the heat, but have limited transportation options. There are times that we have to prepare ourselves for and recover from unpleasant feelings that are unavoidable. There are also times when we suppress our instincts because we think we “should” be able to handle something. If there’s a way that you or someone else can adjust your surroundings to make you more comfortable, speak up!

Look for Joy

Stella loves a lot of things; she loves barking at rabbits, playing in sprinklers, and rolling in the grass. The things that she enjoys the most are the ones that require spontaneity. She approaches every dog she meets with a play bow; there’s no time like the present to make a new friend. She lives entirely in the moment, and whatever feels right to her is what she does– (sometimes to my immense frustration).

Look for joy in the little things. Find ways to have fun with boring activities. When no input is exciting or fun, we become understimulated and listless. So, jump in those puddles, paint with your fingers, and put your waste paper basket far away so you have to toss things from your desk. I don’t know, whatever brings you joy.