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The Subtleties of Water: The Ketamine Chronicles (Part 27)

December 13, 2020November 18, 2021 Genevieve4 Comments

I’m always looking up at the sky when the water closes over me. This time, it was cold, and an eggshell-thin layer of ice formed above me while I watched. Gentle waves followed one another, freezing over the previous layer and leaving a frosty texture on the surface. Darkness spread from the periphery of my vision until I strained to see through the last window of light, the only notable image being the shadow of a person standing above me on the ice.

I didn’t put a lot of effort into remembering this IV ketamine infusion. I know there were graceful, disembodied hands dancing amid blue and red lines, swirls, and dots. There was more water – ripples and waves, mostly. There was a pyramid with a circle above it, which turned into a blinding white light. I’m certain that there was a lot more, but it’s faded away from me by now.

Treatment-Resistant Depression

My mental health is declining. I’m not sure why. IV ketamine treatment doesn’t seem to be working as well for me, now. Every day, I have to rate my mood on a ten-point scale. It’s hard to capture how I feel in numbers. Potatoes are easier, but still not quite enough. Honestly, sometimes words themselves seem too limited. How can I describe how I feel?

This morning, I woke up at 4. I got dressed in the cold – same clothes as yesterday – and went to the kitchen for some food. I walked the dog when the sun came up, but we came home quickly because of the sharp, cold air. My eyes feel heavy. Not the lids – the actual eyeballs; they sit heavy in their sockets, like wet marbles or enormous caviar. I wonder, if I tip my head forward, will they fall out? When my depression is worsening, I often notice this feeling in my face. Everything is heavy and hard to move, and I’m sure my expression is grim. I think the clinical term is RDF – resting depression face. At least my pandemic mask covers most of it.

Maybe the person above me on the ice in my ketamine dream is me. I’m on thin ice. Skating across a just-frozen lake in my wool socks at 4am. Someone else is waiting beneath the surface, straining to see through the darkness. Is she also me?

__________

Why Do I See Water in My Ketamine Treatments?

My recent IV ketamine infusions have all featured water, and I’m often drowning in it. It’s not scary – it’s peaceful. It’s soothing. I’ve never stayed up by the surface before; always finding myself sinking into the dark, quiet depths. But this time, I was floating – pressed against the underside of the ice, trying to see through it to the person on the other side. I was curious about this person, but the darkness closed in before I could begin to unravel what was happening, and then I found myself in a different scene, which I do not remember.

I’m fascinated by this recurring theme of water, especially because in my regular life, I’m not a big fan of it.

An Early Trauma

I have sensory processing disorder, and as a young child, I flat-out refused to swim. I was overwhelmed to the point of tears by the splashing, the echoes in the pool, the temperature change from air to water, and most of all, the fear of people touching me. I eventually came around to the idea, but never enough to take lessons. So, having never properly learned how to swim, I nearly drowned at a friend’s birthday party when I was 8.

I remember being uncomfortable going into the deep end, but my friend was insistent. I lost my grip on the side of the pool and began to sink. When people say that drowning is not a dramatic event – there’s no splashing or screaming – they’re right. My head tilted back instinctively as I went under, and I could see my hand, extended above me, slip under as well while the rest of my limbs flailed uselessly underwater. A panicked hopelessness overtook me as I choked on chlorinated pool water. Then, my friend’s hand broke the surface, reached down, and grabbed my wrist.

I have never felt relaxed on or in water, and it’s not just the near-drowning that explains it. The same sensitivities that kept me from participating in swimming lessons have persisted into my adulthood. I dislike the unsteadiness of water, the unpredictability of how it will splash, the feeling of water on my face.

And yet, when I’m reclined in my doctor’s office, ketamine moving into my bloodstream, visions of water are soothing. I can feel the cool, constant pressure of being underwater without the anxiety or the sensory overload. I can feel myself standing on the deck of a boat, watching the foamy water beneath me leap forward and recede, and I feel peaceful. I’ve seen whirlpools, rivers, melting glaciers, and the unbelievable enormity of oceans. It’s a strange experience to suddenly realize what water might be like for other people, as those feelings are foreign to me in my waking life.

Open ocean near the surface with light filtering down from above. — *Photo by Cristian Palmer on Unsplash*

I feel as though, unhampered by the symptoms of my sensory processing disorder, I can connect to a larger, evolutionary interest in water that I am unable to find under normal circumstances. Humans have been fascinated with water for millennia. In fact, some evolutionary anthropologists believe that nearness to water supported the development of large brains – that we are, in part, the heritage of small, coastal communities of early humans whose lives revolved around the movement of water and the food within it. To this day, many island and coastal cultures retain great reverence for the ocean. When we gaze out upon a watery horizon, it is difficult to not be awed by the vastness before us. In my eye, to find our place in relation to bodies of water is akin to our struggle to find our place in the vastness of space. Questions of identity and survival are found in the depths, and I believe we carry the answers within ourselves.

Lessons from IV Ketamine Treatment for Depression

My depression is a constant in my life. It is all-encompassing, lonely, and feels like drowning. I’m not one to find meaning in every dream, but the images of water that I experience during IV ketamine treatments have begun to feel profound. What does it mean? Certainly not that I should give in, wave a white flag and let the water crush me. Nor should I wait breathlessly under the ice, squinting as if to look through a frosted pane of glass, uncertain if I’m even above or below. Rather, I believe my visions of water are windows into the nature of the human experience. Perhaps they’re snapshots of how I feel – how depression feels to me. My mind is an ocean, and at times, it’s oppressive. I sink within myself, finding it easier to let the water cradle me as I descend than to keep swimming. At other times, I find comfort in accepting the changing nature of my illness. Like a river flowing downhill, impermanence is unstoppable, and the emotions of being a human move inexorably back and forth. When we crest the top of a wave and begin to fall down the other side, we wait for the next one, just as we take each arriving day. And when you are drowning, reach up. A helping hand may be just about to break the surface.

If you’d like to read more about my experience with ketamine for depression, start from the beginning of The Ketamine Chronicles or visit the archives. Click here for mobile-optimized archives of The Ketamine Chronicles.

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The Taste of Music: The Ketamine Chronicles (Part 26)

November 21, 2020November 18, 2021 Genevieve5 Comments

The last couple of weeks have been hard for me when it comes to depression. I recently wrote about how IV ketamine can make me feel like I’ve been launched out of a metaphorical cannon. The last time, it was like a little pbthpbpthh – an underwhelming puff that was more like being propelled by air coming out of an untied balloon than like being launched out of a cannon. I don’t remember much at all of the previous ketamine infusion, so I didn’t push myself to write about it. I thought it would likely be boring, anyway.

The Ups and Downs of Ketamine and Depression

I can’t say for sure why that IV ketamine treatment was less effective than others. It could be hormones. It could be the changing seasons. It could be that I haven’t been exercising much. Maybe it’s all three. Whatever the reason(s), I’ve been front seat on the struggle bus – sleeping in my clothes multiple nights in a row and then wearing them the next day, getting my work done late or barely on time, napping by mid-morning. I find myself paring down my daily activities. Prioritizing one thing means getting rid of another thing, as the energy needed to do both is more than I have. In some ways, I’ve been getting along ok – my mood has been dipping here and there. But overall, that hasn’t been terrible. The hardest part is honestly the lack of energy.

Dissociation with IV Ketamine for Depression

So, I’m hoping that this week’s ketamine infusion can knock me back into better functioning. One change this time around is that I decided to stop using scopolamine for my infusions. I used it the last time and it resulted in a very…buried experience. I’m not sure how else to describe it. It was sort of smothering – as though I had sunk far, far below the surface of the Earth, and there was nothing I could do to get back to the room.

Every once in a while, from leagues above me, I’d hear someone tell me to take a deep breath – the pulse oximeter on my finger had alerted them to the fact that I had stopped breathing. And I found that often, I just did not care. I felt like my body was just a suit I was wearing, and maintaining it was proving to be a lot of work. I could feel that my heart rate was slowing and my lungs were waiting for me to inhale, but it didn’t feel like it was innately me, and so I was content to just watch it happen. In fact, when I was told to breathe in, my recollection is that I felt a little annoyed at having to exert the effort. A couple of times, I tried to ignore it, but the voice was persistent, so I relented.

My experience with scopolamine is not entirely strange, I don’t think. Apparently, it can add to the dissociation that ketamine produces, which explains my sense that my body was not really a part of me. My description of that infusion is a little unsettling in hindsight, but in the moment, I don’t remember being afraid or anxious at all. Actually, the whole infusion was very relaxing, minus the slight annoyance of having to breathe. You know, those fragile humans, needing oxygen. Geez.

Acceptance and Flow in Depression Treatment with Ketamine

The most notable aspect of this infusion in my memory is that at some point, my music stopped. I’ve never had an infusion in which there was no music, so when I noticed its absence, I was mildly worried about what it would be like without it. Not worried enough to move or to say something, of course. That would be too much work. So I just waited, accepting that it wasn’t what I had planned for, but that was okay.

Noise in the IV Ketamine Clinic

The sounds of the room, which are often prominent at the beginning of my infusions but fade away as time goes on, were extremely loud. I was most aware of the infusion pump next to me, which emitted constant mechanical noise. My mother was typing in the corner, and every once in a while, I noticed the sounds of papers shuffling or a door closing. I remember thinking that I felt like a pillar in a sandstorm, tiny particles being whipped into motion around me. The sand was the noise, and as it bounced off me and flew around the room, it started to sound a little like music. Rhythmic whirring from the machine combined with staccato typing somehow resulted in organic, landscape-based images in my mind. There were lots of shades of brown, but that’s pretty much all I can remember.

Brief Synesthesia?

Another first for me this time was that I seem to have experienced synesthesia. To some degree, I think I always come close to it during ketamine infusions – the way I associate music with colors and images is not something I’m able to do when lucid. This time, though, I could taste sound. I can’t quite conjure it up enough in my memory to understand what it was like, but I do remember it dawning on me that tasting sounds is not something people usually do.

When the noise in the room morphed into strange music, I became distinctly aware of the inside of my mouth. My tongue felt oddly small in the cavernous space behind my teeth, and the general feeling was of something… earthy. There is absolutely no way I can accurately compare the experience to anything, especially because I don’t remember it clearly enough. As I wrote in my hasty, post-infusion notes, “I can taste music. Indescribable.”

Images from My Subconscious

The rest of the ketamine infusion is jumbled in my memory, but I’m pretty sure the other images I can remember were from the beginning, when the music was still playing. I remember watching dogs eating something, and then their faces stretched and stretched until they turned into alligators. Eventually, an alligator head kept on stretching until it turned into the tendons of a human hand, which stretched until they were the layers of a landscape. Somehow, my brain went from dogs to alligators to tendons to landscape. I could explain the associations from my recent thoughts and experiences, but it would be convoluted. Suffice it to say, all of the elements of that bizarre sequence somehow make sense to me. Brains are fascinating.

Seeing Improvement in Depression Symptoms

Given my general lack of response to the previous IV ketamine treatment, we tried adding magnesium to this most recent one. It’s been two days now since my infusion, and I am definitely feeling a bit better. I woke up this morning, put on clean clothes, washed my face, and did three laps at the dog park instead of one. Improvement is improvement, no matter how small!

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Owl Eye: The Ketamine Chronicles (Part 25)

October 16, 2020May 5, 2022 GenevieveLeave a comment

IV ketamine treatment for depression is one of multiple treatments I use for my mental health. We’re still adjusting it and trying new doses as things change, which makes for interesting little self-experiments. Last time, we went without propofol and discovered that it was fine for me; in fact, I preferred it. This time, I forgot to check for refills on my scopolamine prescription, so I didn’t use any prior to my appointment. With no propofol, no scopolamine, and a slightly higher dose, this ketamine infusion felt remarkably vivid. It was much like the first few ketamine infusions I had, which were dominated by immersive scenes and imagery that constantly changed.

IV Ketamine Treatment for Depression Feels New Every Time

I felt it quickly this time, the room beginning to sway and bend even before I fully settled in and closed my eyes. Still, I only saw darkness for what felt like a long time but was probably only a minute or two. Then, subtle lines took shape, and my mental lens zoomed in on an owl’s face. The eye was my focus – although the steely beak caught my attention as well. The image rotated slowly before fading away, the owl’s eye staring back at me.

After the rotating owl, the sounds of the room made an appearance in my mind. The gentle chug chugging of the infusion pump reminded me of a train, and I soon saw one on the horizon of my internal view. It belched smoke – an early, coal-powered one – and rumbled closer and closer. The black smoke filled the air, blocking my vision until all that remained was a small view of the front of the train as it trundled by. Black smoke, liquid, or goop filling my vision was something of a theme in this ketamine infusion. On other occasions, it expanded from small blobs until they met and pressed against one another, filling whatever volume my mental space contained while I tried to see through a narrowing hole.

Memory Recall During Ketamine Therapy

If I’m correctly piecing this together from my garbled and typo-riddled notes, which I took in the car on my way home, the sensation of being smothered by the black smoke brought my awareness to my mask. This, in turn, created an image of cloth above my face, with an illegible tag sewn into the seam (a common theme in my infusions is not being able to decipher letters or numbers).

My mind then conjured up a lovely memory of building a couch fort with my brother as kids. The memory itself was jumbled and consisted of snapshots – balancing the cushions just right, sliding head-first over the arm of the couch and down into the fort, and sitting with my knees pulled up in the dark confines of our shared space. The most convincing parts of the memory were the sensations. I could feel the texture of the couch upholstery and the give of the stuffing in the cushions. I noted the darkness with cracks of light where the cushions didn’t meet, and the feeling of the seat cushion grazing the top of my head. I don’t think I’ve ever re-experienced a memory during a ketamine infusion before. It was a comforting feeling to be returned to the experience of being a kid, entranced in the moment by the fantasy of a simple couch fort.

Recurring Themes in Depression Treatment

As usual, water made an appearance in my ketamine dreams. This time, it began with a slowly spinning whirlpool of green/yellow water, lit from within to make the water glow. Soon, I was in the whirlpool, and it turned into the ocean. The water swelled around me, and wave after wave overtook me until I was underwater. It was not frightening, although in describing it, I realize it sounds a lot like I was drowning. Once underwater, I saw an apparently incredible scene which I do not remember but my notes describe as, “Turtle? Fish on lines like balloons. Underwater city of fantastical things.”

A purple striped fish with spiky fins in the ocean. — *Photo by Sophia Muller on Unsplash*

If only I could remember. What treasures have been lost in the depths of my brain? (Water puns fully intended.)

Altered Visual Perception and Ketamine

I returned to the room several times during this infusion, convinced that it must be over soon, only to find that the people had swapped or left or reappeared. My mother had gone to run an errand and had dropped me off but returned partway through my infusion. I saw her sitting in the corner maybe four feet from me, yet it seemed that she was very, very far away. It was a little like looking through the wrong end of binoculars. I tried to read her expression – was she even looking at me? The more I tried to settle my gaze on her, the more my eyes refused to cooperate. They jumped around and made double images, and eventually, I admitted defeat and closed them once again.

Sense of Time During Ketamine Infusions

The scenes and images I was seeing were so numerous that they seemed to be packed into time in an unbelievable manner. It’s strange to think that I could experience so much in such a short amount of time, but even after all of that, there was more. I remember walking over a mountain range with an enormously tall man – I was also enormous – while he proudly described in great detail how he made the mountains. In another scene, a golden dog (I think it was a statue?) was hidden in a room packed with items. My notes reference my teeth feeling soft, something about lizard scales, and robotic cats. “What if they found my head underneath San Francisco?” must have been in response to an extremely bizarre episode of Star Trek that I recently watched in which Data’s head is found during an archaeological dig underneath – you guessed it – San Francisco.

I’m so glad that I took notes on my phone immediately after my ketamine appointment, because I find that the memory of it fades over time unless I can remind myself of what I saw. I was functioning pretty well after my IV ketamine treatment and was able to get myself to take notes rather than close my eyes on the way home. The rest of the day was fairly pleasant. I greatly prefer infusions without propofol both because of its effects during the infusion as well as because of how it alters the rest of the day. Of course, I wasn’t entirely myself until several hours afterward. I took my shoes off somewhere in the house upon getting home and promptly lost them. I could not figure out where I put them until I found them the next day in a closet. Why would I put them away?! In a closet?? Absurd.

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Ink Blots and No Propofol : The Ketamine Chronicles (Part 24)

September 27, 2020November 18, 2021 Genevieve1 Comment

Yesterday, I had another IV ketamine treatment for my treatment-resistant depression. We tried getting rid of the propofol for this infusion, which sounded interesting because it had the potential to help me remember more about the experience as well as make the after effects easier. I can’t say that I remember everything, but the infusion feels more real in my memory than it has in recent weeks.

Is It Working Yet?

Despite having done this numerous times, it’s still hard for me to discern when the ketamine takes effect. I kept checking in with myself, thinking, “Is it working yet? Are those blob shapes my usual closed-eye blobs, or something different?” But eventually, it became suddenly obvious that it was working. I started to feel like my nose had melted, leaving just the bare nasal bones exposed. This somehow reminded me of a seal closing its nostrils before diving underwater. I wondered if what I was feeling was close to what it feels like to be a seal. In hindsight, this makes no sense. Just having no nose is nothing at all like being a seal, but it seemed logical in the moment.

Colors, Ink Blots, and Numbers

The beginning of the ketamine infusion is the part that I remember the most completely. At first, the darkness behind my eyelids felt very normal and familiar. But soon, pale colors moved gently against the black, like lava lamp goop merging and bubbling off.

The colors eventually faded and were replaced by intricate black and white designs that reminded me of kaleidoscopes. They were incredibly detailed, and I don’t think I could ever recreate it. As they morphed, their intricacy faded and I was reminded of Rorschach ink blot tests. Somewhere in my brain, it occurred to me that that association was especially funny, given the context. What does it mean if you see shapes within shapes that you created yourself?

Black and white ink blot swirl. — *Photo by Hulki Okan Tabak on Unsplash*

At some point, there were pages and pages of numbers that didn’t mean anything to me. They were mostly organized into columns and lists, and I tried to focus on interpreting them, but was unsuccessful. This is something that seems to happen repeatedly when I have an IV ketamine treatment for depression – I see overwhelming quantities of numbers or letters that I can never quite decipher.

That’s about the extent of what I remember. The rest of the ketamine infusion seemed to consist of fairly mundane experiences and scenes, although they escape my memory.

What IV Ketamine Therapy for Depression Feels Like

I’m glad that we tried it without propofol. I was a little worried that it would be too intense, but it turned out just fine. As usual, I felt far removed from the room around me. My body was in the chair but my mind was somewhere else. It’s sort of like there’s a tiny me inside my own brain, viewing images that create a highly convincing sensation of having my eyes open. To then test it by opening my real eyes is a bizarre feeling.

The rest of my day was dramatically different compared to days when we’d used propofol in conjunction with ketamine. With propofol, I often sleep for the rest of the day, broken with occasional small tasks like walking the dog or doing some laundry. I must metabolize it slowly, because when I wake up the next day, I have a lot of trouble piecing together the order of events or even what I did at all. It becomes clear that I was lot less sharp than I thought I was.

Without propofol, the disorientation and grogginess wear off more quickly. I’ll sleep for several hours, but then can function fairly well, if a little physically unbalanced. I vastly prefer to be as alert as possible. The sensation of not actually having made decisions with my full wits about me is unsettling.

I’m hoping that my old pattern of improvement two days after a ketamine infusion is consistent. The short series of treatments we did recently helped combat my depression symptoms, but there’s definitely room for improvement.

A blurry woman holding a magnifying lens up to her eye so that her body is upside down and her eye is right side up.

Ketamine-Assisted Psychotherapy 2: The Ketamine Chronicles (Part 23)

August 22, 2020May 5, 2022 GenevieveLeave a comment

Compared to my first ketamine-assisted psychotherapy session, the second one was wildly more entertaining for me, but much less productive in terms of the number of words coming out of my mouth. KAP stands for ketamine-assisted psychotherapy. The idea is to utilize ketamine’s ability to lower your mental barriers in order to more comfortably talk about difficult topics with your therapist. I know that I was very nervous for my first session and likely fought the ketamine in an effort to stay in control, but I didn’t expect my slightly more relaxed approach this time to produce such a dramatic difference.

A Delicate Balance Between IV Ketamine and Therapy

I think I remember that there was a slight dose change from last time to this time, but I don’t think it was enough to really impact my experience. But, in a bewildering turn of events, being more relaxed actually led to me saying less. Rather than unleashing a flood of thoughts and feelings, I found myself being washed away by images and colors. My ability to imagine images certainly made my conversation with my therapist more bizarre, and most of the time, quite disjointed.

We started out by talking about bridges. I had tried to create a metaphorical bridge that crossed into my protected mental fortress during a previous ketamine treatment infusion, but I got stuck with a drawbridge that lifted every time somebody tried to cross.

This time, I saw a fraying rope bridge with missing wooden slats. It stretched across a dark chasm with no visible bottom. It was a long bridge with not enough tension, making it sag in the middle. Despite its frayed appearance, the connections to the edge of the cliff on either side were sturdy. It would be a harrowing journey to the other side, but you could do it.

Thinking about this as a lucid person, it strikes me that the metaphor breaks down at some point. Clearly, I have a well-protected area of mental privacy. I don’t open up easily, and I don’t tend to rely on many people. But to picture a dry, brittle rope bridge stretching across a dark chasm implies that it would be frightening to attempt to cross it. It’s scary for me to allow people to cross the bridge, but I certainly hope the crossing isn’t scary for them. Perhaps the drawbridge was a better metaphor for me. In any case, I only come up with bridges that are difficult to cross.

Distractions During Ketamine-Assisted Psychotherapy

I found it extremely hard to stay focused on the topic at hand during this infusion, sometimes pausing and saying things like, “The blood pressure cuff makes me think of fish being squished.” (The cuff periodically tightened, which distracted me and produced a feeling of what I imagined felt like raw fish being rolled and squelched under pressure.) If an answer to a question didn’t immediately pop into my mind, I found myself floating away from it – the room and the people within receding into the distance.

An assortment of round analog clocks arranged on a wall — *Photo by Jon Tyson on Unsplash*

At times, I remembered that I was supposed to be answering something, but wasn’t at all sure of how much time had gone by since my therapist asked the question. Is she still waiting for me to answer? Are we still on that topic or did we move on already? I don’t think I remember the question. It was chronologically confusing – seconds slipped by without my notice like water flowing over stones, and yet the small movements of my therapist and doctor in the room were auditory markers of real time. How much time passed between my last thought and this one? It’s too hard to think in words. Better to just float. I don’t usually try to hold onto the real world during ketamine infusions, and it proved to take a lot of effort.

Articulating Thoughts and Images

I also don’t usually talk during my regular ketamine treatments for depression, so it was interesting to discover just how hard it is to describe the images I see. I can write about them in detail after the fact, but in the moment, they just escape description. Take, for instance, when I said I was seeing “a bunch of…cleaning things.”

What I actually was seeing was more like a set of rectangular brushes that fit together into a grid. They were a very light pastel range of purples and blues. Why was I thinking about puzzle-piece bristle brushes during my IV ketamine treatment? I have absolutely no clue. Part of what made it hard to describe was that the image was so enthralling that pulling myself out of it to come up with words was difficult. But part of it was that I knew that what I was saying came across as completely bizarre. Trying to describe why such a mundane-sounding image was so pretty just kind of stumped me.

The random and nonsensical images that I was trying to describe reminded me of “Drinking Out Of Cups,” a video from the mid ’00s of Youtube (contains profanity). I tried my hardest to explain it, but seeing as it’s a video about nonsensical things, I had a hard time putting it into words while lost in my own nonsensical world. I think I slipped into fits of giggles halfway through and had to finish up with, “I dunno, I’m not doing it justice, but it’s really funny.” Also, “outta” is a really hard word to say when you’re on a mixture of ketamine and propofol. Just in case you wondered.

A Featherless Parrot

At some point, vials of colorful sand spilled into a desert, creating clouds of blowing particles with swirls of color. I was seeing it from above, and the drifts and valleys the wind created were captivating. It was a beautiful but rather lonely landscape. A parrot with no feathers appeared in the foreground, and when I mentioned this, my therapist questioned me for clarification. “Yeah, like a…a plucked chicken,” I answered.

“Aw, poor guy,” she said.

To which I then said, “No, h-he seems ok, though.” Well. That’s a relief.

blue and yellow parrot — Photo by @davidclode on Unsplash

Staying on Topic in Ketamine-Assisted Psychotherapy

I wonder if, despite being more relaxed this time, I had a harder time engaging with therapy because I don’t know how to filter my mental experience. Last time, I may have been so nervous that I just locked everything down indiscriminately and tried to function as “normally” as possible. I was more open to KAP this time, which left me free to be distracted by anything and everything that entered my thoughts. It seemed to take enormous effort to hold on to the real world while holding the door open for therapy. I’m imagining a large wooden door to Ketamine Land, and within the door to Ketamine Land, a smaller door labeled “therapy.” I think I accidentally opened the big door to Ketamine Land and was bowled over by the peculiar sights within. I should have only opened the door-within-the-door and accessed the loosey-goosey-ness of Ketamine Land in a smaller, more manageable way. I’m not sure how to do that, but perhaps it takes practice.

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A Ghost Town: The Ketamine Chronicles (Part 22)

August 6, 2020May 5, 2022 Genevieve3 Comments

I woke up a couple of hours after going to bed following my most recent IV ketamine treatment for depression. It was around 1 o’clock when I began my slumber, so when Stella woke me up, looking like she needed something, I automatically fed her dinner because it felt like I had been asleep for a long time. Then I wandered into the living room, where it dawned on me that bright sunlight was streaming in through the windows.

What day is it? Is it still daytime?

Temporary Disorientation After IV Ketamine Treatment for Depression

Perhaps I entered a different dimension where time passes more slowly. Or maybe I’m taller than the moon and my head is therefore circling the sun at a different rate. I went back to sleep, but apparently woke up periodically to accomplish my nightly routine. Wednesday’s cubby in my pill organizer is empty, and I vaguely remember flossing my teeth. Half of what I wrote here was already done, which surprised me when I opened my laptop this morning to write. My phone informs me that today is Thursday, although it feels like several days have passed since yesterday’s ketamine infusion treatment.

An IV Ketamine Therapy Reset

I usually go about three weeks between appointments, but my depression has made a comeback. Similar to how I first began getting ketamine infusions, we decided to do a short series of infusions in quick succession to try to reset things and boost my mood. In addition to the short series, we’re also trying another medicine that can enhance the effects of ketamine therapy.

Scopolamine is an anti-nausea drug that comes in the form of a patch that you place behind your ear. I can tell that it did something; the infusion itself felt more enveloping than usual, and for hours afterward, I had this weird sense that I could feel my blood traveling through my blood vessels. It almost felt like being squeezed – like the boundaries of my body were working harder to keep everything contained within my skin.

I talked to Dr. Grindle (whose name frequently autocorrects to Dr. Griddle, which I think is hilarious) about our plan of action at the beginning of the appointment. My previous infusion was my first experience with ketamine-assisted psychotherapy (KAP). The goal of it was to help me bypass the frustrating barriers to talking that I run into in therapy by having a ketamine infusion and a therapy session at the same time. It was a fascinating experience, but also a little overwhelming, so I decided to just do a normal ketamine infusion yesterday. I’ll revisit KAP another time.

Building a Metaphorical Mental Health Bridge

I don’t remember much from this infusion. The addition of all these other anti-nausea and sedating medications makes it hard to remember what I thought about and saw during the infusion. They also make me crash when I get home, which lets whatever memories I do have fade away before I have a chance to write them down. One part that I can vaguely recall came from a suggestion made by my therapist. After our KAP session last week, we marveled at how much I resisted talking about particular topics, even while zonked out on ketamine. This week, she suggested that I imagine building a bridge across the moat that protects my mental fortress. I have yet to figure out why some parts of my everyday life show up in my IV ketamine treatments and some don’t. The image of a bridge over a moat certainly stuck, although probably not in the way that my therapist hoped it would.

Mixing Memory and Imagination

Thinking about castles and fortresses created an odd merging of memories and imagination in my mind. At first, I found myself thinking about the ruins of castles on the Danube River in Germany and in the rolling hills in Wales. I imagined the people who lived in those castles milling about and going about their daily lives. Then, I seemed to combine that train of thought with memories I have of going to Caribou, an old silver-mining ghost town from the 1870s. It’s situated not far from where I grew up.

Caribou-Colorado-silver-mining-town-in-1911-black-and-white

Caribou-Colorado-ghost-town-during-summer-of-early-21st-century

We used to go up there and explore the crumbling stone structures and look for currants and wild raspberry bushes. In my distorted ketamine haze, I saw people working in the half-built structures. All of the trappings of normal life were there; a large pot in the fireplace, a sturdy wooden table on the dirt floor, women in long, pioneer dresses and aprons bustling around in the four walls under the open sky.

Mental Barriers

At some point, the ruins were surrounded by a moat, and a figure stood on the opposite side. Remembering that I was trying to let the person cross the moat, I conjured up a drawbridge. Interestingly, simply creating the bridge was not enough. I couldn’t seem to keep the drawbridge down; it kept raising over the water, leaving the moat impassable again. It was somewhat frustrating – like those dreams where everything keeps going wrong, no matter how much you try to find a way around it. I suppose next time, I should build any bridge but a drawbridge.

A Middle Ground with Major Depression

I feel a little bit better. When I’m awake, I feel more motivated to get things done, and my immediate reaction to being faced with an opportunity or an obligation is not automatically, “Ugh. No.” This is one of the more frustrating phases of depression for me. I feel capable of doing things, I sometimes even want to do things, but I’m so unbelievably tired that I waste hour after hour asleep. I’m starting to wonder if that’s a normal depression symptom plus side effects of the medicines I take, or something else entirely. All I know is that it makes me feel enormously lazy when I wake up at 5:30am and am struggling to keep my eyes open only three hours later. It hasn’t always been that way; when I was first diagnosed with major depressive disorder, I didn’t feel the need to take a nap until mid-afternoon, and I could limit it to something more reasonable. I’m not sure what happened besides a worsening of my illness and the meds I take, or if those factors explain it all. Something to ponder.

An unidentifiable woman wearing a jean jacket sitting with her hands clasped in her lap and her legs crossed while talking to a therapist in the foreground.

My First Ketamine-Assisted Psychotherapy Session: The Ketamine Chronicles (Part 21)

August 1, 2020November 18, 2021 Genevieve1 Comment

Ketamine-Assisted Psychotherapy was completely new to me. I’ve had numerous IV ketamine treatments for depression and I’ve been in therapy for years, but I’ve never merged the two in the same setting. The first goal was to find a dose of ketamine that caused me to dissociate enough to let my defenses down, but not so much that I was incapable of answering coherently. I was nervous beforehand; the unknowns of it were stressful. Once we got started, though, that anxiety faded.

What it’s Like to Do Ketamine-Assisted Psychotherapy for Depression

My doctor asked me to tell him when I started to feel the effects of the ketamine, and when I didn’t, he asked me again a few minutes later. “It’s hard to tell with my eyes closed,” I said, “but yes, I think so.”

“Why is it harder to tell with your eyes closed?” My therapist asked. I paused to think.

“I guess because I don’t have any reference points. When my eyes are open, I can see that things are getting fuzzy or moving slightly, but with my eyes closed, all of that is gone.”

This is where my memory of the infusion gets a little foggy. I remember talking about particular topics, and I remember it being easier to answer quickly. In my normal therapy sessions, I take time to think about my answers, which leaves lots of space between our talking points. During ketamine-assisted psychotherapy, I found myself answering with less deliberation.

The majority of what we talked about flowed fairly well, but then we’d hit a tricky topic and my defenses went up. I’d stop talking, trying to decide if I should speak or not, and if my therapist pushed a little, I’d open my eyes. Opening my eyes seemed to be an indicator of my resistance to an especially uncomfortable topic. I must have been trying to exert some control over the situation, although I wasn’t fully aware of what made me open my eyes.

Anxiety about Ketamine-Assisted Psychotherapy

I had been worried that ketamine would make me incapable of holding back or deciding what I would or wouldn’t speak on. It turns out that the brick wall of lucidity also exists under the influence of ketamine. The presence of that brick wall usually makes me anxious; I worry about it. Why can’t I just talk about this stuff? There’s nothing behind it that’s secret or an enormous revelation. I feel like I’m wasting everyone’s time by being so silent, but I just can’t seem to break through it. Ketamine made me too relaxed to care much about what my therapist and my doctor thought of my silences.

Setting Goals with KAP for Depression

For a few weeks now, Friday has been “Yes Day.” On Yes Day, I make a deliberate effort to say “yes” to opportunities that come my way. It’s a step towards becoming more spontaneous and a way for me to push myself to get out of the house. This ketamine appointment was, of course, on Friday. At some point during the infusion, my therapist mused that we could have No Nap Day in an attempt to combat my excessive sleeping. When asked if I was on board with Mondays being No Nap Day, I jokingly accused my therapist of exploiting Yes Day in order to create No Nap Day. In the end, I said “ok,” which I think counts as “yes.”

How IV Ketamine Treatment Feels During KAP

Unlike my usual trippy IV ketamine treatment experience, I didn’t “see” anything this time. I think focusing on the conversation kept me from getting sucked into any kind of creative extensions of whatever random thoughts usually pass through my mind. All I saw was the darkness behind my eyelids, although it did seem somehow more dark than what I see when I simply close my eyes. It was deeper than that, as if I were farther away from access to my eyelids. I felt as if I had to swim upwards to reach them.

With my eyes closed, I sort of forgot that there was a person attached to the voice I was hearing. Not entirely – I knew somewhere that I was talking to my therapist, but it was easier to just focus on the disembodied voice without any of my usual curiosities. In our normal sessions, I often wonder what she’s thinking about my answers, but during KAP, all I could think about was responding to the question immediately at hand. It was an interesting change.

Doing Ketamine-Assisted Psychotherapy with a Trusted Therapist

Being able to remember only parts of the infusion is odd. The gaps in my memory that I notice after an infusion usually feel like how dreams disappear when you wake up. I’m often left with the impression that I’m forgetting something rather inconsequential. This time, however, the knowledge that we were talking about real things has left me feeling slightly raw. I feel sort of scrubbed at in a nonspecific way, and it’s mildly uncomfortable. I imagine this would be more intense if I didn’t already know my therapist well.

I also feel like this ketamine infusion consisted of a lot of work. Usually, they’re relaxing and somewhat meditative; I just float along and let whatever comes into my mind pass by. This time, the effort of speaking and of thinking in sentences made it feel a lot less restful, but a lot more purposeful.

If you’re thinking about ketamine-assisted psychotherapy, remember that this post is only my experience, and only of my very first one. Apparently, I’m tenacious in my resistance to open up; it may be easier for you to let your defenses down. While parts of it were uncomfortable, it was never scary.

I now have to think about how I want to proceed. Choices, choices!