At the Bottom of a Well: The Ketamine Chronicles (Part 33)

I forgot to put on a scopolamine patch the evening before this ketamine infusion, but other than that, this one was packed with stuff intended on making the ketamine more effective. Cimetidine, magnesium, petocin, some anti-nausea drugs, to be honest, it’s all a blur. It was “the kitchen sink.” Getting infusions of IV ketamine for treatment-resistant depression is kind of a balancing act. It works best as an individualized recipe, and it seems that mine is always changing.

I don’t usually start out my ketamine infusions with chit chat, but this time, I spoke to Sarah for a couple of minutes before closing my eyes. What we talked about, I no longer remember, but it was casual and light. When I did close my eyes, I had the sense that this infusion might be a gentle experience at the surface between lucid and zonked. I was very wrong. I think that focusing on my conversation with Sarah diverted some of the weird sensations of ketamine from overcoming me, but they hit me later.

Sand and some lessons about depression

I remember a lot of sand. I was in a desert near some ancient stone ruins, and the sand was shifting like a river in the sunlight. I was on the ground, watching a snake struggle to squeeze between a crack in the stone building before the sand could drag it down. The snake succeeded, turning into a blooming flower as it rose up from the river of sand.

Photo by @wolfgang_hasselmann on Unsplash

At some point, I was looking down a long tunnel into the ground – like a well – at some people on the other side. But as I strained to see who they were, I realized that I wasn’t looking down, I was looking up from the bottom. The people far above me leaned over the edge to gaze down, and the walls of the well crumbled into sand and buried me in darkness. It was quiet. It was something of a relief.

These experiences of being buried or of drowning are never frightening, but they do evoke a certain hopelessness. I used to have whole infusions dominated by water and the feeling of sinking, but lately, that theme has been absent. This theme of sand is different, but it feels much the same. I wonder if it has to do with the state of my depression at the time. In thinking back to the last few times I had a water-based internal experience, I do remember feeling similarly to how I feel now. I’m treading water, still moving a little in the direction of my goals, but I’m decidedly denser than my surroundings. Sinking would be so much easier than pulling myself upwards.

When I’m drowning or being buried in my ketamine infusions, it feels completely out of my control. The forces of water, sand, or perhaps depression, in this metaphor, are simply overwhelming. I think that my perception of depression is manifesting itself as unbeatable natural forces in my ketamine infusions. Most of the time, it doesn’t seem hopeless to that extreme in my real life, so it’s interesting that that’s how it comes out in my ketamine appointments. But, maybe that’s the only way my mind can conceptualize it in that setting.

In my visual experience of ketamine, depression feels like sinking alone in the dark, open ocean. It feels like being buried in sand at the bottom of a well, while people far away can only watch. But in reality, it’s neither of those things. It’s an illness that, like others, can be treated. Reality is clouded by depression, and it’s easy to forget how turned around I can become in my own mind.

Is the ketamine infusion over? Should I get up now?

At the very beginning of this ketamine infusion, my doctor pointed at the photo on the wall across from me and said, “We’ll just see if this starts moving.”

“I’m not supposed to have my eyes open,” I replied, referring to our frequent conflict in which I open my eyes and stare at various entrancing objects while he patiently reminds me over and over again that I’m supposed to have them closed.

“That was a test. You passed.” He laughed.

And then at some point in the infusion, I proceeded to leave my eyes open for what felt like a really long time.

In my defense, I was confused. I opened my eyes because I thought the infusion was over and that everyone was waiting for me to get it together. Let me tell you, trying to fight ketamine while it’s still infusing into your bloodstream is pretty impossible. I kept thinking that I needed to get up and walk to the car, and that seemed utterly beyond my capabilities.

Photo by Michael Dziedzic @lazycreekimages

I vacillated between anxiously willing myself into wakefulness and resigning myself to living the rest of my life in that very chair. Words can’t describe how disoriented I was. Every time I blinked (which wasn’t often and was probably more like a short time with my eyes closed), the room seemed to change somehow. It was wider than I remembered, then it was taller, then the picture was farther away, and everything was tilting to the side. I couldn’t understand why it was taking me so much longer than usual to regain my faculties.

I distinctly remember thinking, “I wish someone would just tell me what I’m supposed to be doing.” That thought gave me some satisfaction because after all, how could anyone get frustrated with me for being slow when they didn’t even tell me that I was supposed to be speeding up? “That’s *their* problem,” I thought. Having convinced myself that transportation to the parking garage was not my concern, I stared at the wall with the photo of the wolf and the goat and found that there actually were three frogs hidden in there, too. I occasionally thought things like, “What time is it?” or, “When did we start?” or, “Which way is up?” only to realize that the answer would mean nothing to me and there was no point in mustering up the energy to ask.

After some amount of time that may have been five minutes or five hours, I was told to close my eyes and that there were eight minutes left. Oh my God, what a relief. “How long did I just spend thinking I needed to get up? No matter, now.” Somewhere in my mind, I found some wry humor in my ability to carry my anxiety about inconveniencing people into Ketamine Land. I guess it follows me everywhere.

After that, I spent some time thinking about oobleck, which is a non-Newtonian fluid often made in middle school science class composed of corn starch and water. It moves like a fluid at rest, but solidifies when you exert sudden force upon it. I felt like I was surrounded by oobleck. Or maybe that I was made of oobleck. Things were flowing like a lazy river when I let go and rested, but when I tried to move, I found myself glued in place.

The eight minutes that were left when I closed my eyes instantly shrunk down to about twenty seconds, and then before I knew it, I was back to searching the inside of my brain for control of my limbs. I got my coat on, missed my face a couple of times trying to put my glasses on, wobbled out the door, and successfully made it to the car.

IV ketamine for depression is different every time

The rest of the day passed uneventfully. I was interested to see if the reintroduction of magnesium into my infusion would result in the wild limb jerking that happened the last time we used it, but thankfully, it didn’t. The bizarre afternoon I had that time has continued to be an isolated event. This time, I slept for most of the day, got up for dinner, then went back to bed. I think. To be honest, I don’t remember the details, but I know that it was fairly mundane.

Every infusion I’ve had has been different, which is why I find it so interesting to write about them. Even my experience once I get home tends to change, and I can’t always pinpoint why. Sometimes, I go about my day – working, writing, walking the dog – and sometimes, I just crash.

It doesn’t even seem like a wackier or more mundane experience correlates with any particular result. At least, as far as I can tell. Maybe there are just too many factors for a clear pattern to emerge.

For the time being, I’m planning some more changes to my medication regime, trying not to nap too much, and carrying on with tiny clams.

sunrise casting orange glow on sparse clouds above shadowed trees

Depression: The Ketamine Chronicles (Part 1)

This is the beginning of a series of posts chronicling my experience with IV ketamine infusions. 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 the infusions. 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 be as honest as possible.

Several months ago, my psychiatric nurse practitioner suggested that I look into ketamine 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.

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

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.

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? That’s easy: I’m scared. Naturally, the next question is: why am I so scared? Not so easy. For one thing, getting ketamine infusions 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 this 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, although you can’t think your way out of it, certainly affects the way that you think.

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. 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.


Considering My Next Mental Health Treatment

I have an appointment coming up with my psychiatric nurse practitioner, and that means my thoughts frequently settle on the effectiveness of my mental health treatment. By now, I’m familiar with the questions she’ll likely ask me, but somehow the answers never come easily. Determining how I feel is not something I’m very good at, although I’ve gotten better at it. This time, I’ll attempt to describe the seemingly endless plateau of “meh” on which my mood currently resides. I have occasional dips into the dark chasm of “really bad,” but for the most part, things are ok. But as I decided after I was released from the hospital, I’m not settling for “ok” this time. I want to feel great, exuberant, joyful, even- happy. Happy would be good.

At this point, it seems like I’m running out of viable mental health treatment options that come in pill form. I was told I was a candidate for and encouraged to try Electroconvulsive Therapy (ECT) while in the hospital (a treatment that has changed immensely since it first began). My mother’s worried googling turned up IV ketamine as a promising treatment that my psych NP also encouraged. I knew people in my partial hospitalization program that moved on to do Transcranial Magnetic Stimulation (TMS). These are all safe treatments that, if they work, can change your life for the better. So, why am I so resistant to the idea?

I think it comes down to acceptance. When I first became depressed, it took me a long time to get to a place where I felt comfortable taking antidepressants. I clung to (and sometimes still do) the idea that if I just¬†tried harder, all my problems would be solved. This is because, like many of us, I’m way too hard on myself. But it’s also because it was scary to fully accept that I have an illness that can’t be overcome through sheer force of will; a fact that my biochemical imbalance predetermines. On one hand, taking responsibility for your mental health is an important part of managing it. On the other, there’s an element of frightening imposition that comes with accepting that the very fact of your diagnosis is out of your control. I carry my depression around with me- not by choice or through lack of effort, but because its complex tangle of symptoms, neurological effects, and genetic alterations are not things I can leave behind.

Despite coming to terms with the apparent chronic nature of my depressive episodes and the fact that right now, I need antidepressants, I see this next step in mental health treatment options as Phase Two of my personal acceptance hurdle. It was tough to accept that I needed antidepressants, and now it’s tough to accept that I may benefit from another level of psychiatric treatment. I like to mull things over for a very¬†long time, so until or if I decide to make that leap, I’m just considering it.