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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.

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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.

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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.

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Balloon Head: The Ketamine Chronicles (Part 28)

Before yesterday, it had been about three weeks since my last IV ketamine infusion for depression. Lately, I notice an improvement in my depression in the days following a ketamine treatment infusion, but it doesn’t last for as long as I’d like. Changing or adding a medication seems like a good option at this point. For a couple of weeks now, I’ve been battling my pharmacy and insurance for access to Wellbutrin. It’s been quite a hassle, but I hope it will be worth it.

For this infusion, I used a scopolamine patch and took cimetidine, both of which may help the effects of ketamine last longer. When we’ve done this combination in the past, I’m pretty well zonked for the rest of the day, and the experience of the infusion mostly disappears from my memory. Scopolamine makes me feel slightly off balance, and it gives me wicked dry mouth. Not just dry mouth, though – it’s also inside my nose and throat. Yuck.

What Does IV Ketamine Feel Like?

Often, the first sensation I notice during an IV ketamine treatment is warmth in my head and neck. This is quickly followed by a sense that my head is either expanding or shrinking. This time, it was shrinking. It felt a bit like the skin around my head stayed in place, but everything underneath it was crumpling into a little tin foil ball. At some point, the feeling reversed. The warmth radiating upward evoked a strange floaty sensation, and I remember thinking that my head felt like a hot air balloon, stretching out and lifting off.

The Visuals

Perhaps the dryness in my mouth and throat is what led to the first image I can remember: a drab, grey fish drying out on a sandbar. Somebody came by and tossed it back into the ocean, only for it to find itself surrounded by sharks.

The fish dream did not last long, and I soon moved on to other things. Once again, numbers dominated parts of my ketamine therapy experience. Spreadsheets, tickets, and measurements scattered throughout my brain. My mind seemed to be going a mile a minute, and interspersed with the numbers were seemingly random objects and animals that flashed into focus and then disappeared. It started to become overwhelming, so I opened my eyes a few times. After the speed and intensity of my split-second ketamine dreams, the room was suddenly, jarringly quiet and still.

Dissociation and Blurred Vision

Something I’ve noticed about IV ketamine is that when I open my eyes, everything is so blurry and unstructured that I can’t tell where the people around me are looking. It’s interesting to note how much it bothers me to not be able to read people’s expressions or body language. I don’t notice that being so crucial in my daily life because it just happens naturally for me. But when I suddenly can’t do it anymore, it’s almost like the people around me are aliens whose emotions and thoughts are completely inscrutable.

Sound and Distortion

At times, quiet conversations and activity in the hallway and other room seemed incredibly loud and close. I wondered if there were people standing right over me, but when I opened my eyes, the noise stopped and the same calm, serene room greeted me. When I looked up, the ceiling tiles resembled oil paintings of pastel landscapes. I closed my eyes and was met with more odd images, many of which I don’t remember. There were translucent shrimps on the sea floor, skeletons, and a curtain made of long, interwoven strips of orange, red, and pink fabric.

Absurdity in IV Ketamine Experiences

At one point, a sequence of images told a bizarre story. I had found two birds and put them in a cage until I could figure out what to do with them. But as I turned away, the larger of the two birds veeery slowly swallowed the smaller bird whole. WTF. I’m relieved that I managed to interpret my post-infusion notes, because what I wrote down in reference to that particular ketamine dream was “mbira dram” (bird dream). Even autocorrect couldn’t help me with that one.

Some Mildly Unpleasant Side Effects

I went to bed early last night but woke up around 11pm extremely confused about what day/time it was. I had completed my whole nighttime routine before going to bed, so I just decided to not worry about it and went back to sleep. I was awoken a couple more times in the night because of how dry my throat was. It felt so desiccated that just breathing irritated it. Definitely unpleasant, but bearable if it means the ketamine works better against my depression. I was developing a headache when I went to bed, and it’s still hanging on around my right eye and forehead, but in a mild way. I had a headache after the previous infusion as well, which I had assumed was PMS. Perhaps not, though.

To try to boost my mood, we’re going to do another ketamine infusion in a few days. In the meantime, I’m going to enjoy the fact that 2020 is officially over.

Happy New Year!

If you liked this post, consider starting at the beginning of the Ketamine Chronicles, or visit the archives to find month-by-month posts.

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

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.

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

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.

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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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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.