silhouette of wolf standing on ridge with tall grass at sunset

The Wolf and the Goat: The Ketamine Chronicles (Part 18)

May 21, 2020November 17, 2021 GenevieveLeave a comment

At this point, I’ve lost track of how many IV ketamine treatments for depression I’ve had (they don’t line up exactly with the number of blog posts). My treatment-resistant depression has dug its heels in once again, and I’m wrestling for the millionth time with whether or not there is any chance of improvement for me (despite having experienced significant improvement that fell apart when the pandemic began. Clearly, it is possible).

In a conversation with my therapist in which I explained my growing sense of hopelessness and how it makes me reluctant to keep going with ketamine infusions, she pointed out that I have said that ketamine makes a difference in my mental health. It’s true. It’s tough to remember that the hopelessness is the depression talking. I can’t trust my assessment of the world when I’m getting all my info through the warped view of depression. At least, I think. Sometimes it’s all so confusing.

The Wolf and the Mountain Goat

The wolf had its mouth open, partway through devouring some kind of amorphous, green animal. Perhaps a giant frog? An algae-covered sloth? Try as I might, I couldn’t interpret the image correctly. But there, below the wolf’s fearsome jaws, was a pure white mountain goat kid. It stood perfectly still, watching the wolf eat its catch.

That mountain goat should move, I thought. Directly below a hungry wolf definitely seemed like a risky place for a baby mountain goat. But nothing moved at all. The image was static. And then I remembered that I was not supposed to have my eyes open during my ketamine infusion, and I definitely was not supposed to be staring at the photo on the wall across from me. There is no wolf in that photo- nor is there a mountain goat. It’s a picture of a river flowing through rock formations with greenery on the shore. It was quite a trip.

I can’t unsee it.

Ketamine Depression Treatment and Visions of Water

From the beginning, I could feel the warm air inside my mask. At some point, it started to feel like liquid, like I suddenly possessed the ability to breathe underwater. I’m fairly neutral when it comes to swimming in real life, and I don’t have any particular fascination with water. But ketamine always brings out these intense associations with bodies of liquid water and, occasionally, ice.

Ripples and waves of all sorts, whales, jellyfish, cold rivers flowing downhill, being on a boat, icebergs; these are all images from previous ketamine treatments that stand out enough for me to remember them. Perhaps the physical sensations of unsteadiness trigger my brain’s water-related pathways. Except that I’m always decidedly stationary during ketamine treatments. In any case, I’d be interested to know if other people also see lots of water during their ketamine infusions.

Drowning in Deep Water

This time, it was the ocean, or perhaps a very, very deep lake. My perspective was from beneath the surface, and I could see someone sinking slowly from the glowing blue into the inky blackness below. I was watching the person, but I also was the person. We were sinking through vast expanses of empty ocean, only water and light around us. It was striking but lonely – only the silhouette of a human form, gently falling through deep water.

Slowly, the light receded above and I began to think that I didn’t want to be in darkness. It occurred to me that the person was drowning, and although I felt comfortable enough, that meant that I was also drowning. We were, after all, the same person. I didn’t know what was beneath us, and the unknown was somewhat unsettling. But everything was heavy, and the constant pull of the water was hard to resist.

The silhouette of a person falling through open ocean with light filtering down from above. — *Photo by Daoud Abismail on Unsplash*

It was confusing; how was it possible that I was breathing the water that filled my mask? I must be drowning, but I felt fine, only incredibly heavy. Then I heard my own voice in my mind say forcefully, “open your eyes,” and suddenly, I was back in the room, looking at the wolf and the mountain goat once again.

Space and My Mental Map on Ketamine

Have you ever looked at a familiar room and felt like you’ve never seen it before? Like you just never really looked at the angles of the walls or the color of the furniture? I’ve noticed that my ketamine infusions often give me the sensation that a room has changed and space is distorted.

When my eyes are closed, I feel as though everything is moving closer to me, but also over me. It’s like the weight of my body is folding space so that my surroundings move up and over me. Things feel much smaller, and I’m always momentarily surprised when I open my eyes, the space instantly expands, and I find myself in a bigger room than I expected. And every time, it’s as though I’m looking at a room that I’ve never really looked at before. By the time I’m semi-lucid and ready to set my legs in motion towards the hallway, the feeling has passed and the room is familiar again.

Some Thoughts on Masks and Privacy During Treatment with Ketamine

I don’t often relax in places that aren’t my own home. Even friends’ and family’s places give me that tense feeling of being a guest; I’m less familiar with my surroundings and therefore need to be alert and polite. It’s uncomfortable to imagine that someone might walk by and catch me making myself at home by taking a nap or, I don’t know, putting my feet up.

I’ve obviously been forced to let that go to a very large degree while treating my depression with ketamine infusions. But it’s gotten me thinking — this might be why I tend to open my eyes so much. My vulnerability alarm goes off when my eyes are closed anywhere that’s not my home. I guess it periodically yanks me out of whatever trip I’m on so that I can look around for a second. Maybe that also explains some of why I remember such vivid scenes. It’s like when you wake up in the middle of a dream and can recall it with perfect clarity, versus sleeping all the way through it, and then all you know in the morning is that Shrek was there.

A hand holding a stack of neatly folded, colorful face masks. — *Photo by Vera Davidova on Unsplash*

That said, lots of people wear a sleep mask during their ketamine infusions and find that the darkness helps them immerse themselves in the experience. I have found that wearing a mask that covers my nose and mouth does make me feel oddly secure – like it’s hiding me from any eyes that may look in my direction. I wonder if a sleep mask would have the same effect, or, as I expect it might, just make me feel more vulnerable by preventing me from looking around occasionally. Who knows – I may try it someday.

(Imagining my entire face covered in masks makes me feel like the spider in that viral voice-over video: I cannot see you, you cannot see me…I am hidden.)

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.

A stretch of straight open road with a body of water to the left and blue sky above

The Day 2 Mystery of Depression Treatment: The Ketamine Chronicles (Part 17)

May 10, 2020November 20, 2021 GenevieveLeave a comment

It’s been two days since my most recent ketamine infusion, which I have administered by my doctor to treat my depression. Usually, I write these posts in The Ketamine Chronicles as soon as I’m able so as to not forget too much of the bizarre experience. This time, I found that I didn’t have much to say immediately following my ketamine infusion.

Ketamine for Depression Has Not Been a Straight Line

For transparency’s sake in my attempt to document my experience with ketamine treatment for depression, I’ll just say it. My mental health has been in decline over the last few weeks, to the point of struggling once again with self-harm, something I thought I had kicked over a year ago. The previous ketamine infusion seemed not to do much for me in terms of mood, but gave me more energy and motivation, a mismatch that left me restless and confused. I felt the drive to do something but had no desire to follow through. Perhaps this is what led me back to self-harm. Multiple stressors, not exercising as frequently, and a strange mix of motivation and hopelessness led me back to an old, unhealthy coping mechanism.

A dense forest with thick fog and a path extending down the middle. — *Photo by Andrew Neel on Unsplash*

No Memory of Higher Ketamine Doses

I had my most recent ketamine infusion on Friday. Like last time, it was relatively empty of bizarre images, at least that I can remember. At this point, my dose is pretty much at the upper limit of ketamine for my body, so Dr. G has been giving me propofol to make the experience less trippy. In my last ketamine infusion, I stubbornly kept my eyes open for a lot of the infusion and seemed not to care about breathing. This time, I don’t think I could have opened my eyes if I’d tried. I remember chatting with Erin, the PA, while she got the I.V. set up. I know we talked about haircuts, but I’m not sure what else. The propofol hit me way before the ketamine did, and the last thing I remember is Dr. G taking an exaggerated deep breath and wagging his finger at me sternly before leaving me in Erin’s capable hands.

Breaking the Speed Limit

When I closed my eyes, the world disappeared above me as I sank down into peaceful nothingness. At some point, I remember feeling as though I were a passenger in a car on a highway, open road stretching ahead of me. We began to go a little too fast for my liking, but I was stuck– carried along by the seat beneath me. This is the only image I remember with clarity from this infusion. I also remember that, because I couldn’t feel my face, I was occasionally concerned that I may have taken my mask off. Laughable in hindsight that I thought I could have moved with enough coordination to do that.

Ketamine on the Second Day

Yesterday, the day after my ketamine infusion, I felt no different than I have for the past few weeks. Actually, I think I may have felt worse. But today, I awoke with a wonderful sense of relief from my symptoms. Whether this lasts remains to be seen, but it follows an interesting pattern. The day immediately following an infusion is often disappointing for me. I’ve learned to not put too much stock into whether or not a ketamine infusion has helped based on the day after. The second day, however, is usually when I notice the changes that ketamine creates. I don’t know how common this is, but I think it’s interesting.

I have already put on my exercise clothes, anticipating a long run later in the day. I’m looking forward to today’s project of re-painting the grape arbors. I have mental plans to clean the kitchen and change my sheets, and maybe even vacuum. It’s great to feel better, but the previous few weeks have me apprehensive about this infusion; will it last? Will I need to adjust my medication or have more ketamine infusions to stabilize my depression?

We shall see. But for now, it’s nice to feel a bit better.

ink drawing of dandelion seed heads growing in grass

Observations From the Garden

May 4, 2020 Genevieve2 Comments

I got up at 6 and walked through my routine because that’s what I always do, depressed or not. I fed the dog, made the coffee, poured a bowl of cereal, and then stared into it while the dog did her rounds in the yard. But by 8, I was beginning to wonder why I ever got up in the first place. So, back to bed with the window open and my blankets pulled up to my chin.

Lately, depression has overtaken my days with sleep and restless boredom. What time is it? Doesn’t matter; every day feels like a week. At night, the anxiety comes. I feel like I’m crawling out of my skin. Or like I want to reach inside my chest and pull out my lungs, let them spin out the twist in my trachea. Maybe then I could breathe.

To pass the time when the sun is up, I move between sleep and hobbies. Sitting outside in the backyard, my sketchpad page is still blank. Pen or pencil? I pick up the pen but am unable to draw more than a few dandelions from the scene I’m observing. A flock of house finches has found our backyard – it’s more dandelions than grass, and they’ve all gone to seed. The birds are foraging, bobbing their heads and moving among the unmown grass. One finch struts up to a tall dandelion, and, with an almost imperceptible flutter, attempts to perch on its vertical stem. The dandelion head begins to bow to the ground, and the finch rides the bending stem to meet the grass. Foot firmly planted to hold the flower down, the finch returns to bobbing and pecking.

There’s a sound behind me, and I turn to see a five-foot garter snake glide through the raspberry bushes, following a taste in the air. A busy robin chatters while it gathers last year’s grape leaves for nesting material. Stella digs a layer out of the hollow she’s claimed as hers, then situates herself in the cool dirt she’s uncovered. A hummingbird trill draws near, then it whizzes by on its frenetic journey. Everything around me moves, yet I feel like I’m in stasis. Animals and plants follow their daily rhythms, foraging, hunting, racing the sun to get enough calories, and I feel disrupted – out of sync.

I don’t know how to fix it. Usually, I keep up with my treatments — meds, therapy, ketamine — and simply wait for it to pass. I use what coping mechanisms I can—preferably the good ones, and let the turning of the Earth carry me from one day to the next. This time, I can’t help but feel the uncertainty of the time we’re living in. The disruption is not just to my mind, but to the world. When will this sense of weightlessness, of falling through empty space be soothed? When can we once again feel the ground beneath our feet, knowing by its predictability that it is moving us inexorably from today to tomorrow?

Connecting During the Pandemic

April 23, 2020 Genevieve3 Comments

As a highly introverted person, I didn’t expect social distancing to have much of an effect on my mental health. After all, I don’t get out much to begin with. But what I’m finding, and what I’m hearing from others, is that the few social interactions we introverts had prior to pandemic life were more important than we realized.

I’m starting to really feel cooped up. I miss my library, my dog park, volunteering with other humans, and not sucking air through a mask while I run. My world, small as it was, has shrunk. But perhaps more than the social isolation, it’s the uncertainty about when it will end. Before, I might have chosen to stay in, but it was a choice. Now, this strange, lonely way of life stretches on indefinitely. I’m feeling restless, anxious, and sad. I sometimes joke that I’d like to go live on a mountain by myself, and while I’ve always known that wouldn’t actually be good for me, it still sounds tempting. But now, the social interaction that used to threaten to overwhelm me is in short supply, and I’m finding myself a little bit lost.

Luckily, we have options for connecting with others from a distance. I’ve been enjoying video calls with friends, yelling across the fence to my neighbors in their backyard, and texting extended family members. We have social media, phone calls, blog posts, any number of ways to get in touch with people who are far away. Even when digital methods fail, there are still connections to be made at home, and creativity goes a long way.

Towards the beginning of the pandemic’s reach in the U.S., when schools were closing and people started staying home from work, some kids in my neighborhood took it upon themselves to spread some positivity. I stepped out the door with Stella’s leash in hand and headed down the sidewalk for a quick walk around the block. At my mailbox, there was a message written on the sidewalk in chalk. It said “keep calm” and had a pink heart and a blue flower next to it. It made me smile and, frankly, gave me some warm fuzzies. All the way around the block, there were short messages encouraging everyone to stay safe and some adorable drawings of flowers and butterflies. It was a great reminder that we are all feeling the stress of the pandemic in our own ways and in our own homes, but we can still find ways to connect.

Close Your Eyes: The Ketamine Chronicles (Part 16)

April 19, 2020May 5, 2022 Genevieve3 Comments

“I think Stella is a bad influence,” is a phrase I remember hearing Dr. G say during my latest ketamine infusion for depression. Stella is my willful, independent dog who sometimes flat-out refuses to listen to me. In trying to piece together the events of my day, that phrase bounced around in my head without context. What had happened?

Apparently, I had refused to close my eyes. Dr. G repeatedly told me to shut them, but dang it if that little glass dragonfly suspended from the ceiling wasn’t absolutely mesmerizing. I remember it glittering and moving gently while I stared. I closed my eyes eventually.

Some Changes to My Ketamine Infusion

This infusion was different from what I described in previous posts of The Ketamine Chronicles in a few ways. For one thing, it was a higher dose of ketamine paired with a sedative to make it less intense. I also am completely off of one of my mood-stabilizing medications, Lamictal, which can interfere with ketamine. Like my previous ketamine infusion, I took some Tagamet before my infusion to slow the metabolism of the ketamine and make it last longer. The sedative kept this infusion from being bizarre, or at least from me remembering any bizarre images I might have seen.

Abstract architecture made of long, connected panels like scales. — *Photo by Luca Bravo on Unsplash.*

Dissociation with Ketamine Treatments

At first, I didn’t feel as deeply removed from the world around me as usual. This was deceptive, though, as I soon began to feel – as trippy as this sounds – like my being was shrinking into my body. Or perhaps like my body was expanding to create a shell around my consciousness. Things were happening in the room – sounds of typing and clicking, machines beeping, Dr. G telling me to take a deep breath (which I also did not listen to, apparently) – but they all seemed so far away as to be completely beyond my caring.

I opened my eyes periodically to see what was going on and, due to the dissociative effects of ketamine, usually got sucked into the computer monitor, which displayed a series of calming images of winter mountains. This is the danger of not wearing a sleep mask; when you’re hooked up to a ketamine infusion, EVERYTHING looks interesting and it’s incredibly tempting to let all of your automatic functions, like blinking and breathing, be abandoned in favor of absorbing whatever magical thing you’re looking at. Nothing matters more than watching a snowy peak meld into a pine forest. Nothing.

Monitoring Vitals During Ketamine Infusions

It’s a strange experience to realize that you haven’t breathed in a while but not find that alarming at all. In fact, the longer I went without breathing, the harder it seemed to do. It’s sort of a heavy slowness that keeps me from breathing deeply. It has to be quite deliberate. My vital signs are monitored during ketamine infusions, so if my blood oxygenation drops or some other concerning development occurs, my doctor is alerted right away. I’ve had to be reminded to breathe during previous infusions, but a simple, “Hey, take a deep breath,” always seems to break through my trance easily. This time, Dr. G repeatedly telling me to take a deep breath reminded me that breathing was a thing that people did, but I found myself reluctant to put in the effort. There wasn’t much that I cared about doing, and I remember thinking that I felt oddly cushioned against the ketamine.

Intersecting scrabble tiles spelling inhale, exhale, and repeat. — *Photo by Brett Jordan on Unsplash*

Sleeping off a Ketamine Infusion

Afterward, I tottered down the steps to the car and marveled at my mom’s apparent lightning reflexes as she drove us home. We stopped at the pharmacy and grocery store (a whole day of essential outings!) and I simply put my seat back and waited in the car while my mom went in. Unable to get comfortable, I flopped around until the car got too warm. I cracked the door open and leaned out a little to get some fresh air, resting my head against the door frame. I wonder what people in the parking lot thought. I was clearly not very with it and kept doing that embarrassing head-jerk that happens when you fall asleep sitting up.

When we got home, I crashed for several hours, then got up and walked the dog around the block. I didn’t think much about how I was acting until I passed a house and then noticed someone sitting on their porch. I had been walking a few steps, stopping for Stella to smell something, zoning out, then repeating all the way around the neighborhood. I have no idea how long I stood in front of that person’s porch with a blank look on my face, but it might have been much too long to look normal. Who knows – maybe they thought it was quarantine brain.

My MTHFR Gene is a Problem. Again.

April 15, 2020April 1, 2021 Genevieve4 Comments

You would think I had learned my lesson. Refilling my medicines is not something I find easy to do if a phone call is involved. I waited until the very end of my supply to refill my Deplin, and now, because of shipping delays, I’ve been without for several days. Deplin contains l-methylfolate, which fills a metabolic gap caused by a mutation in the MTHFR gene. Essentially, it helps my antidepressant work. Not taking my Deplin is what pushed my suicidality to new lows last year when I was hospitalized. It seems like I can feel my brain slowing down. I sleep all day like I’m hibernating in reverse by starting in spring. There is nothing to get me up except the dog, who stands by my bed and huffs at me, threatening to wake me with a full bark if I do not move. I accomplish the necessary and return to bed, already sinking into sleep. The occasional diversion brings some welcome entertainment, but it’s just a momentary distraction.

tired raccoon lying on platform with black container on its back and foliage in background — *Me. It’s me. (Unsplash user @successfullycanadian)*

I took some time off of work when my grandfather passed away last week, but then I decided it would be more helpful to have something to do. So, I went back to work (which I thankfully do from home under normal circumstances) on Monday. Unfortunately, it’s shaping up to be a slow week, anyway. I suppose I should turn to hobbies to fill my time. I’m partway through a drawing that I promised to someone, but like many of us judging ourselves for not utilizing all of this time to finish household projects or write a sonnet or whatever we think we should be doing, motivation eludes me.

My shipment of Deplin is finally at my local post office and should be delivered by the end of the day today. It couldn’t come too soon. I plan to rip it open right there at the mailbox and throw one down the hatch. Well, okay, maybe I’ll go inside for a glass of water.

Blowing Bubbles with My Dog

April 10, 2020April 9, 2020 Genevieve1 Comment

Recent events have me, like many of us, feeling untethered. I was making good progress on my depression. I was getting out more, volunteering, talking to people at the dog park, all things I can’t do right now. It’s an additional element of the pandemic that sprinkles more discouragement on top of the physical and financial fears that so many are facing globally. So, while I don’t feel like I’m making much progress, I’m proud to say that Stella has come a long way.

When I adopted her, Stella had a LOT of fears. Bags of potting soil, kites, people wearing big hats, bicycles, snowmen, car rides, piles of rocks, the list goes on. For the most part, she’s faced them all. The neighbor’s animatronic Halloween decorations were just too much for her and we had to cross the street, but those are meant to be scary, after all. She tends to be afraid of things that look unusual (to her) or regular things that are in unexpected places. But as long as I put on an air of confidence and stroll up to the scary thing, she can pluck up the courage to approach and give it a good sniff. Our most recent endeavor has been… bubbles.

At first, she was uneasy. She backed away from them and skirted around their path to get away. Then, she crept up to one that had landed on the ground without popping. She leeeeaned in close, and- pop! Her head flinched back and I could almost see the gears turning as she tried to comprehend where it had gone.

A few more bubble-blowing sessions and we have successfully conquered her fear.

She is now completely indifferent to bubbles. No joy or delight whatsoever. She can be so playful when it comes to other games, but she just doesn’t care at all when it comes to bubbles. They’re almost an annoyance to her, popping on her fur while she’s guarding the backyard. I mean c’mon, bubbles are the most frivolous, fun thing ever! Ah well, I’d call that at least halfway successful.