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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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Some Benefits of Ketamine Infusions for Depression (for me)

My last ketamine infusion was much less trippy than the previous one, so I’m relieved to say that I remember absolutely none of it. Much less fun to describe, but also less persistently, somewhat threateningly bizarre. We skipped the magnesium this time, and I did not have any sudden, limb-jerking spasms. It’s good to know that was likely the culprit. When I can’t remember an infusion, I feel pretty curious about the off-putting gap in my memory. I always think it’s interesting to know what I experienced during a ketamine infusion, and when I can’t, I feel like I’m missing out on something that I just can’t access. Thankfully, the benefits of ketamine infusions remain even when I can’t remember them.

Eating Food

I’ve been having some problems with nausea and appetite since starting Wellbutrin. They mimic what I feel when I’m really depressed, just amplified. Food is not appealing, neither in my imagination nor my mouth. When it’s time to eat, my goal is to find something that’s least unappetizing. Eating it is a strangely empty experience, as if I can recognize the flavors but can’t assemble them into something I like. The closest analogy I can think of is that it’s like the difference between sound and music. For a few days following a ketamine infusion, that problem is gone. It’s easy to pick something to eat, and not only does it register as, say, a grilled cheese sandwich, but my brain is also willing to exchange it for dopamine. Things taste like how food should taste, and it’s great.

Making Decisions

Ketamine makes the days following an infusion feel remarkably lighter. The difficulty I have with making even small decisions is much improved. I just go about my days without getting stuck at every turn. Speaking of turns, I’ve really been enjoying my morning walks with Stella. When we come to an intersection, I let her choose, and we amble around a ridiculously inefficient route that’s different each day. I am typically a very routine-driven person, so this microscopic spontaneity is a teeny, tiny sign that says
“ketamine helped!” If the ketamine wears off or some other factor occurs and my depression gets worse, I tend to become more rigid in the route we take. I’m sure Stella prefers our ketamine-lightened walks, and so do I.

Thinking about the Future

The bigger benefits of ketamine infusions, for me, are centered around my attitudes about the future. Depression makes me feel hopeless, and ketamine lifts that – sometimes just a little, but sometimes a lot. I’m not sure what determines the degree of helpfulness, but it’s always a welcome effect. It makes it easier to imagine myself making changes and taking big steps.

Other benefits of ketamine infusions that I notice include:

  • Sleeping less
  • Feeling more social
  • Experiencing something called “fun”
  • Feeling satisfied about completing a task
  • Noticing little things that I appreciate or find interesting
  • Reduced suicidal thoughts (hasn’t been much of a problem recently, but I’ve definitely noticed that in the past)

Lately, I’ve noticed that the most noticeable changes stick around for a few days or a week, then things level off to a pretty neutral place where I’m neither jazzed about life nor am I in the pits of despair. By three weeks, I’m in something like the salt marshes of despondency; not inescapable, but pretty unpleasant.

That is a completely individualized timeline. Everyone is different, and I get the feeling from the forum I’m on that there are a lot of people who go much longer between needing infusions. I kind of try not to think about it because of what they say about comparison, I guess. (They = various quotes)

Musings about Medication

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This was tagged “medication” on Unsplash, and I thought, “that’s a weird swap of the typical ‘pills aren’t candy, kids!’ warning.” (Photo credit: Sharon McCutcheon)

My medications may change again sometime soon, and although I just said that ketamine makes making decisions easier, I’m setting that choice aside for now. It’s harder to decide soon after an infusion because I feel like I don’t need to change anything. I feel better, therefore, I should keep things the same. But, ketamine wears off at some point, and even though I feel “better,” should I stop at that point? Maybe I only feel a fraction of my potential “better” but it seems like a lot because it’s better than abysmal. These choices are always hard. I don’t want to settle for just ok, but I worry that I’m expecting too much. Maybe this is exactly how happy people feel – they’re just more grateful for it.

But then a couple of weeks pass and I slowly start sliding backwards into napping and apathy and isolation, and I realize that there was no in-between. It was mildly happy and then increasingly depressed. There must be something more than that. I habitually blame myself for depression in the short term. A bad day or week makes me think that I let myself wallow and didn’t try to change things. I think that I’m lazy and burdensome and why can’t I just be cheerful? But when I look at the long-term – the years I’ve spent with depression – I feel kind of robbed. It’s easier to see the trends of it and the forks in the road where I didn’t pick the option the non-depressed me would have chosen. I may try to blame myself for all of that too, but the more reasonable answer is that depression has been in my way. Sometimes, that perspective makes me determined, and all of the other times, it makes me tired.

My last few months have been saturated with medication changes and mood fluctuations. I go up and down, up and down, and I’m thankful for the ups, but there’s something about the downs that feels so much more impactful. Despite the incremental progress I’m making after starting Wellbutrin, I feel completely insecure in that success, like it’s just visiting and will have to leave soon. A large part of me says that would be disastrous and I’ll just have to claw my way forward from here on out because losing ground would be unacceptable. I guess we’ll find out.

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Post-Infusion Confusion: The Ketamine Chronicles (Part 32)

My experience of receiving IV ketamine for depression this time around is now almost completely lost in the recesses of my brain. I do remember having an odd, somewhat uncomfortable feeling early on that I recognized from one of my recent ketamine infusions. My best description of this feeling is that my thoughts were physically too large for my head and too fast to really grasp. But what was most interesting about this infusion was what happened afterward.

First of all, I was so incredibly disoriented that when I thought that my mom was driving in the wrong direction, I asked, “Wait. Where are we going?”

“…Home…?” She replied. It then dawned on me that we were leaving my appointment rather than being on our way there. I was so impaired that I didn’t even remember going to the appointment at all.

The second very strange thing that happened post-infusion was that I began having brief, uncontrollable muscle spasms combined with sudden knee buckling that affected my entire body. I was wobbling along, trying not to fall in the parking garage, when it hit me. My arm shot out in front of me, flinging the apple juice I was holding onto the floor, and the rest of me doubled over for a second. It felt sort of like when you fall asleep sitting up and then violently jerk awake. Except, I was walking. For the rest of the afternoon/evening, this happened in varying degrees at least once per hour. At least, that’s my estimate. Then again, maybe we shouldn’t trust the person who couldn’t even remember going to a ketamine infusion.

The muscle spasms are mysterious but may have been due to the magnesium we’ve been adding, which helps some people see better results from ketamine. We plan to skip it next time, as it hasn’t made a dramatic difference for me, mood-wise. While magnesium may not be important for my depression, something was very different about this experience. The infusion itself seemed the same, but the bizarre visual, proprioceptive, and even auditory components extended far past the time when they usually disappear for me. I can only attribute this to the other measures we take in the effort to slow down my metabolism of ketamine, plus the somewhat recent increase in dose, but to be honest, I don’t know why this one was different.

Generally, by the time I’m capable of putting my shoes on to leave the clinic, things look pretty much normal. This time – not so much. Once home, I noticed that a piece of crumpled paper appeared to have cobwebs on it with tiny insects crawling around inside it. At first, I was completely fooled. Fascinated, unsettled, and fooled. I peered at it from a close-but-safe distance, trying to get my eyes to focus on its movement. I tried alternately holding my breath and blowing on it to see if the gentle movement was actually caused by my own proximity; I tried holding my hand above it to feel for a draft, and I tried touching it with another piece of paper. But, no matter what I did, the cobwebs continued to wave slowly back and forth at their own pace, and the small bugs never explored past the cobwebs. My little tests helped me realize that it wasn’t real, but I was so interested in it that I continued to stare.

Eventually, I dragged my eyes away from the paper to look behind me, and when I turned back, the bugs and cobwebs were gone. After the rather large amount of time I spent engrossed in a crumpled piece of brown paper, I suddenly understood via first-person experience why ketamine’s effects make for a useful clinical model of psychosis. The entire event was bizarre and deeply unsettling in a way I can’t quite describe.

My eyesight was frustratingly blurry, to the point that things actually looked clearer without my glasses. I’m not sure exactly how the physics of that works, but wearing my glasses seemed to make it much more difficult to focus my eyes than it was without them. Attempting to lock my gaze on something flat and relatively close to me, like texts on my phone, made the object recede and push forward into subtle 3-dimensionality on repeat.

Perhaps the most persistent phenomenon of this post-ketamine experience was the sound of voices next to me. I’ve been re-watching a show I like lately, and at some point in the afternoon, I realized that I had been “listening in” on the dialogue of several fictional characters off to my right for at least an hour — not sure about that timeline, though. Their voices sounded exactly like the actors’ voices; so much so that I felt I could identify the person speaking at any given time. There seemed to be a choppy plot- not one familiar to me from the actual show. My brain must have created a whole new plot, but I couldn’t tell you what it was. I again reminded myself that I was just not quite past the effects of ketamine, and that it would pass. It wasn’t that I ever thought those fictional people were actually next to me; the voices just wouldn’t stop. It was like listening to a podcast that I couldn’t turn off. I kept trying to distract myself with something else, but I would eventually drift away from it, back to the voices. Then, after what felt like a few minutes, I’d remember that it’s generally not good to be hearing voices and would try to distract myself again. I was moderately creeped out, but mostly exasperated by the fact that I couldn’t reliably corral my thoughts back to reality.

All of this – the experience of seeing and hearing things so long after an infusion is distinctly new to me. There have been times when I thought I heard things post-infusion, but I’m never quite positive that those sounds weren’t real, and they always happened much closer to the infusion. It seems possible that I might have just been thinking about that show and gotten pulled into an imaginary scene, which doesn’t necessarily count as hearing things. But the cobwebs – which I also saw once during an infusion when I left my eyes open for too long – definitely appeared to be taking up space in the real world, and long after I’m usually good to go.

Today, I feel much more like myself, although I’m strangely exhausted despite doing basically nothing all day yesterday. My vision is still a tad blurry, which I think might have been the scopolamine patch I was wearing, which can dilate your pupils. I’m going to make a checklist before the next time of things that I need to do when I come home from a ketamine infusion. It’s difficult to keep things straight when you can’t remember whether you even made it to the infusion in the first place! I’m going to take this weird continuation of my ketamine infusion experience to mean that it might be more effective against my depression this time. Or, maybe it’s a really bad sign and nobody else ever experiences this. When I find out, I’ll let you know.

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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A Gold Monocle: The Ketamine Chronicles (Part 31)

The warm, vaguely citrusy feeling of ketamine spilled down my back while I tried to get my earbuds in and my music started. I fumbled around for a moment, not sure which earbud was which, but finally settled with the knowledge that I had a 50/50 chance of getting it right. I jammed those puppies in there while the world outside my eyeballs spun around. After some time, I realized that I had left my index finger suspended in the air with the pulse oximeter on it. One of those deep-seated memories, the ones that you wish you could get rid of because they always seem to displace more critical information, rose to the surface. Yes. I remembered that SpongeBob episode in which Patrick teaches SpongeBob that holding your pinky up is fancy, so, “the higher you hold it, the fancier you are.” I kind of wanted to laugh, but was afraid that if I started, I wouldn’t able to stop and I’d just spend the whole infusion cackling over fancy pinkies.

I’ve learned that if I don’t put my head back and try to relax my neck before the ketamine gets started, it takes a herculean effort to do so later on. I find this strange. Like I did when I left my finger pointed up, I can go long stretches of time without even noticing that I’m doing it. One would think that sitting in a reclined position with their neck bent to keep their head aloft would be really uncomfortable. But somehow, it’s just easier to forget about it than to try to move. It reminds me of that locking mechanism that birds do with their feet so that they don’t fall off of telephone wires while they sleep. I just get stuck in whatever position I’m in when the ketamine hits me.

I don’t remember much from this ketamine infusion, although I know that it was one of the most choppy, disconnected visual experiences I’ve had during a ketamine infusion. There was a man dressed in 19th century clothing – ruffled white collar peeking out from a buttoned up, navy tailcoat jacket, with a gold monocle arranged over his left eye. He was leaning over me, large grey beard waggling while he spoke, telling me something about achievement and perfection and getting started before it’s too late.

I don’t think that I’ve ever heard my ketamine dreams make any noise at all, except for one time when I heard some garbled gibberish in the center of my head after an infusion, when I was on my way home. Who knows what that was, though – the radio, people on a crosswalk, etc. But in any case, it was startling to realize that someone imaginary was speaking to me during an active ketamine infusion. I don’t remember exactly what he said, but the advice the man was giving me wasn’t encouraging. It was more like a stern lecture, siphoned from my own inner dialogue about failure, perfectionism, and growth. Quite strange.

Side note: I started writing this when I got home from my infusion. This morning, I opened up my laptop to see that I had written “before it’s two late.” I must have been more impaired than I thought. It’s not as bad as, say, waking up to find that I’d spent all my money on vintage beanie babies or clown figurines, but whoo, boy. What an egregious mistake for an editor to make.

The image of monocle man is what I remember with the most clarity, but I also remember a taxidermized rat with an oblong hole in its neck. A live white rat emerged from the hole, pulling itself free like some kind of disturbing mammalian version of a snake shedding its skin. Seriously creepy. Other than a lot of colorful TV static and a white sand beach, that’s all I remember.

I wish I had a better way to end this post, but that’s all I’ve got. Go look at something heartwarming to get that rat image out of your brain. Bye, for now!

Not Much to Report & Ketamine FAQs: The Ketamine Chronicles (Part 30)

It’s part 30 of the Ketamine Chronicles! Time flies, doesn’t it? My previous ketamine infusion (which I use as part of my treatment-resistant depression treatment), was surprisingly more effective than it has been in the last couple of months. I’ve been enjoying the general lightness and ease with which I can get out of bed. Last Thursday seemed to take a downturn, although it’s always hard to tell which factors explain which results. In any case, my regularly scheduled ketamine appointment was yesterday, so it was good timing, if so.

Whereas the last infusion was extremely trippy, this one seemed more mundane. That might only be because I don’t have much memory of what I experienced, though. At the start of my infusion, my ears began feeling incredibly hot, as if I’d just said something horrifyingly embarrassing. Once I closed my eyes, I remember feeling a tad uncomfortable, like my thoughts were becoming too big for the confines of my head. It seemed like I was seeing darkness for longer than usual, and I think that the lack of engaging visual noise is what made my thinking feel too big. Of course, I don’t remember what I was pondering, just that it was happening.

Photo by: Leni und Tom on Pixabay

Once again, I fell asleep when I got home and then had several disorienting instances upon waking up and not knowing what day or time it was. It felt like I had been sleeping for many hours when my mom poked her head into my room. All that had registered in my brain a moment before was that my phone said 6:30. So, when my mom informed me of the shrimp and rice on the table, I momentarily thought, “why would she make shrimp and rice for breakfast?” It quickly dawned on me that it was, in fact, the same day. I woke up a few more times during the night, still briefly believing that it was the next morning. The pitch black scene outside my window hinted that no, it was not 11:30 AM. It took me a few seconds to reassess.

Start from the beginning of the Ketamine Chronicles! Or, visit the archives for a list of month-by-month posts. Other posts have far more absurdity and detail in my descriptions of what it feels like during an infusion.

Ketamine FAQs

Since this entry in the Ketamine Chronicles is pretty short, I thought I’d share the questions that I asked when I started ketamine therapy. I’m not sure that these are actually frequently asked, but it made the heading nice and concise, and I do love some organization. The answers to these questions are a blending of what my doctor told me, plus what I’ve learned through personal experience. Everyone is different, so the answers may not apply to everyone.

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I love strange stock images. Photo by: Tumisu on Pixabay

1. How do you know when you should get a maintenance infusion? Is it a sudden change, or more gradual?

For me, it’s usually a gradual change that I notice somewhere between two and three weeks after an infusion over the course of three or four days. I know that it’s time to get another infusion when I find myself doing a lot of nothing and feeling apathetic. My motivation disappears and I usually start thinking that acting to counter my symptoms is pointless.

However, it can be more of a sudden change for some people. They may wake up one morning knowing that, because their symptoms have returned quickly, the ketamine has worn off.

2. Do some people eventually manage their depression with just therapy, etc.? Or is the damage that depression causes a continuous process that you have to constantly work against?

Unfortunately, it’s the latter. After your initial series of infusions, you’ll need to periodically get maintenance, or “booster”, infusions. The effects of ketamine wear off at different rates for different people.

I suppose it’s possible that someone could really piggyback on the results of ketamine therapy and launch themselves into better long-term mental health, but as far as I know, the vast majority of people need booster infusions.

Exercise, therapy, social interaction, and other activities that support your mental health can help the effects of ketamine last longer. It’s possible for some people to extend the interval between their infusions. #goals

3. How do people decide whether or not to keep taking their medicine?

This is a uniquely personal decision that you make with your psychiatrist or other prescriber. I was hopeful that the benefits of ketamine would allow me to at least reduce some of my more side-effect prone medicines, but so far, trying it hasn’t worked out for me.

4. Is it possible that for some people, ketamine makes their meds work better because of the brain repair it facilitates?

Yes! As I discovered first-hand, going off some of my medications had pretty abysmal results. It’s clear that for me, the combination of my usual medications and periodic ketamine infusions is what works best. You can even try medications that you’ve taken and discontinued before, as sometimes they work better with ketamine.

5. Is my reaction to the first infusion a good indicator of whether or not it will work?

No. While ketamine works for some people nearly immediately, it takes longer for others to see any benefit. I didn’t feel better until roughly my fifth infusion.

Additionally, the way you do your first infusion is not set in stone. Sometimes, you need to change the dose or add other medications. It’s not a one-size-fits-all treatment.

6. Does ketamine ever “kinda work,” or is it all or nothing?

I apparently didn’t write down my doctor’s answer to this, so this is entirely my own experience.

I find that it can “kinda work” for me, depending on circumstances that I haven’t pinned down yet. Still, even when it’s not amazingly helpful, it’s still worth it for that small benefit. I tend to vacillate between “meh,” and “wow, I feel so much better.” So, much like question #3, it’s probably worth tweaking things if it’s less beneficial than you hoped.

However, for some people, it seems not to work at all. On the other hand, there are people for whom ketamine makes a dramatic difference almost immediately. It seems to be a continuum.

7. Will I do anything embarrassing during a ketamine infusion?

I don’t think I asked my doctor about this, but it was definitely part of my apprehension. I tend to be quiet during my infusions, in part because it feels nearly impossible to carry on a conversation. When asked if I’m doing ok, I usually just sort of nod my bobblehead a little.

I do know that other people are far more chatty than I am and can just talk the whole time. I doubt they divulge any deep, dark secrets without meaning to, though. Even though I can’t muster up the energy to speak, I have contemplated whether or not I should say something. Some of the things I see behind my eyelids are so absurd that I want other people to know about them. But even with that desire to share something funny, I’m still capable of deciding whether or not to say it. I probably would talk more if it weren’t so hard to work around my bubble gum tongue.

Feel free to leave questions in the comments. If I have an answer, I’d be happy to share it with you.

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Owl Eye: The Ketamine Chronicles (Part 25)

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.

IV ketamine infusions are one of multiple treatments I use for my treatment-resistant depression. 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 infusions I had, which were dominated by immersive scenes and imagery that constantly changed.

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 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.

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, 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.

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.”

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

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.

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 the infusion, 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 appointment, 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.

silhouette-of-person-standing-in-shallow-water-near-shore-at-sunset

Just Float Away: The Ketamine Chronicles (Part 20)

Erin, the PA, tells me I have gorgeous veins. It’s just one of my many redeeming qualities. Prone to perfectionism and crippling indecision? Yes. But hey – at least I have great veins. Starting the IV for my ketamine infusions is always an easy process, which is nice. This time, we once again did a pretty robust dose of ketamine with some propofol to make it less intense. Erin got me set up while we chatted, and then Dr. G popped into the doorway, explained just how many anti-nausea drugs I got (technically four(?), if I remember correctly), and then stopped. “What are we NOT going to do a lot of this time?” He asked.

“[brief silence] Looking around!”

I got a figurative gold star for my answer. I promised Dr. G I’d keep my eyes closed, popped in my earbuds, and settled in.

The familiar floating sensation reminded me strongly of water, as usual. Behind my eyelids, the blackness rippled and flowed, hinting at some unseen current. Soon, minuscule red specks glittered against the dark, moving with the gentle waves and forming dynamic shapes. It seemed as if there were something beyond the darkness that I could nearly see, like I needed to travel through the black, quiet water to reach something.

I began to imagine that I was lying on a beach, submerged in shallow water, looking up at the sky through the water that lapped at the shore. The sand beneath me was gritty, but the water was clear and the sky was blue. It was peaceful. Soon, though, the movement of the water reminded me of my recent road trip vertigo and the anxiety it created, and the peacefulness was ruined. I wondered if it would even be possible to have a panic attack while mildly sedated, but decided that I should put effort into preventing one, regardless. After all, it would be rather counter-productive. Bobbing and rolling in the imaginary water did make me anxious, although part of it was at the thought that freaking out would be pretty embarrassing. In trying to resist the anxiety, I realized that I was only making myself more aware of the movement. I needed to not fight it – to just accept that I was not going to feel completely still.

Once I let myself float away, the infusion seemed to speed up, and large chunks of time just disappeared. I don’t remember anything except standing in a room in a family member’s house, recalling the details of my surroundings with what seemed to be incredible accuracy. I actually worried momentarily that I might be flouting Dr. Grindle’s orders by having my eyes open. He might confiscate my gold star. Except wait- my eyes were closed. And yet, the windows let bright sunlight in through the blinds. The ones on the right were broken three slats up. The wicker chair with the yellow cushions was angled just right in the corner. The dresser with a sand dollar and a starfish on top sat just how I remember it. That rug that years ago was closer to shag but is worn and aging now, laid on the floor. I took in the scene quietly. There was nothing happening; I was just absorbing the room’s contents.

It seems like the more I think about it now, the less I remember of how I got home. The infusion finished and Erin took the I.V. out. Then, Dr. G handed a bottle of apple juice to Erin, who offered it to me. I reached out and took it with my wacky inflatable car dealership arms and then decided to wait for my facial features to materialize before trying to drink it. Somehow, I got my shoes on and made it to the car with my mom, who politely stopped after every three or four steps down the parking garage stairs and turned slightly to make sure I was still on my feet.

I may have fed the dog twice that night. My memory of post-infusion actions is incomplete, and I don’t doubt for a second that Stella would take advantage of that. Maybe that’s why she begs for food in the evening after I’ve already fed her– because sometimes it works! This is why it’s important to not make any important decisions following a ketamine infusion. You might end up with a new boat or no house or, you know, a spoiled dog.

 

 

jar of peanut m&ms

The Sound of Peanut M&Ms: The Ketamine Chronicles (Part 9)

Part of figuring out what your individual limit is between ketamine infusions for depression is to stretch it out bit by bit until you find the length where it wears off. My daily mood metrics show a drop a few days ago that stayed steadily lower than my previous (good health) average. However, there were several possible factors that may be to blame, so it’s not clear to me whether three weeks between infusions is actually an accurate time frame to use. That said, we’re going to go another three weeks and see what happens.

I had a lot of trouble with my music this time. The playlist I chose stopped playing shortly after I started to feel the ketamine, but I kept thinking that it was just really quiet. It was like when the radio is on in your car on low volume, and part of your attention gets sucked into it and you’re going what IS that? I just kept turning the volume up again and again over the course of several minutes before realizing that no, nothing was playing. My brain was just making something up that was barely audible because I expected to hear something. I managed to find a different playlist that I’ve heard many times, so it was comforting but not very interesting.

Maybe because I listened to something familiar, I didn’t have any sustained scenes like the very memorable fish wedding. But, like always, I sank into flowing images that seemed to come from my subconscious. A deep red octopus slithered around my mind, only one day after I marveled at a captive one in a butterfly pavilion. Under the influence of ketamine, I tried to imagine what it would be like to be an octopus; how would it feel to have eight limbs, each one a sensing individual capable of independent reactions? At some point, a vibrant green light was disrupted by a dark shadow moving up from the bottom of my internal “visual” field. Like when someone stands up in front of a projector, this vaguely ominous shape rose up again and again. As it reached the top and had obscured all of the green light, the bottom thinned out and the light shone through again. Then, the shadow started again from the bottom.

I have no idea how far into the infusion this happened, but at some point, my doctor sat down at the desk in the room and began preparing something with plastic bags and vials. It sounded exactly like he had taken an enormous bag of peanut M&Ms and dumped them out on the desk, then rolled them around with his hands. The sound reminded me of how on road trips, my dad used to stop at the gas station before we left and get “a duffle bag” of skittles, peanut M&Ms, whatever was the largest bag available. I tried not to laugh at this memory, as that might sound weird out of the blue, and then I’d have to explain it with my too-big tongue. Instead, I cracked my eyes open and tried to discern what he was actually doing, because I knew, rationally, it definitely wasn’t the M&M thing. Too blurry. I got distracted and started looking around the room.

The walls looked sort of like I was looking at them through a big sheet of cling wrap. Subtly shiny, a little distorted, and slightly moving. The edges of things were indistinct, and trying to focus on any one thing produced a weird motion that was like looking at something far away with one eye, then switching to the other eye. It felt like a very subtle change in perspective, despite looking at it from up close with both eyes open. The M&M noise had paused momentarily, so I looked over at Dr. G, who motioned for me to close my eyes. Ah yes, I’m not supposed to be looking at things. That’s how you get a bad case of nausea. I shut my peepers and was swept away by…something. I don’t remember.

Later, I laughed about the M&M sound with my mom, who apparently didn’t even notice it, despite sitting directly next to my feet. I’m sure Dr. G was actually being very quiet, but something about ketamine can make your hearing sensitive while the infusion is going.

I’ve been noticing that, for me, it’s the second day after an infusion when I wake up and feel better. The day after an infusion is usually a pretty sluggish day, but then the day after that is when things start to look up. If I didn’t know that, it would be pretty discouraging to wake up the day after an infusion and feel crummy. Now I know to wait it out and not let that first day throw me off. Experience is a great teacher.

Oh No. More Depression Naps

The irony of my recent post about unnecessary sleeping in the form of depression naps is glaringly obvious. Yesterday, I got up at 6, took care of Stella’s morning routine, then took a four-hour nap. Then, I fell asleep at 7pm, woke up at 2am still wearing my clothes, took my meds and brushed my teeth, then went back to sleep until 6. Big oops.

At this point, I don’t think I can still use the “I’m tired from traveling” excuse, much as I would like to. Sleeping too much is, for me, a big indicator of depression. I’m really hoping this is a fluke and not the ketamine wearing off. If it’s the latter, that would make my time between maintenance infusions about three weeks, which is a little short for my liking.

I had errands to do today, which I managed to do after an entirely too-long nap. I’m putting my foot down. Time to drag myself outside and go for a run, because you can’t sleep if you’re moving. Curse you, depression symptoms!

Update: My run was lovely, despite stepping in an icy puddle and getting my socks wet. Also nearly ate it on some ice deceptively camouflaged with snow. It definitely woke me up. I saw some cute dogs, though, and the mountains were pretty. All in all: would recommend, minus the puddle and the ice.

three-tiered cake with blackberries sitting on wooden table with vase of white flowers in background

A Fish Wedding: The Ketamine Chronicles (Part 8)

It’s been two weeks since my last IV ketamine infusion, and I’m still feeling much better than I did before I started. Minor setback due to my lithium experiment aside, it seems like the ketamine hadn’t started to wear off yet, meaning we could schedule the next one for three weeks out.

As they all are, this infusion was pretty…different. I popped my earbuds in and started a classical music playlist. Like last time, I closed my eyes and waited for it to begin. It was subtle, and when Dr. G asked me a few minutes later if I was feeling it yet, I opened my eyes and was met with a normal-looking world. “Not really,” I said. Of course, I was eating my words when, a couple of minutes later, I felt like my nose was sinking into my face. (It should be noted that none of this is ever scary for me. I had the sensation that my nose was sinking, but I was completely aware that it wasn’t.)

I thought that maybe I should say “my nose is sinking into my face,” as Dr. G wanted to know when I felt it taking effect. Somehow, this got lost when I began seeing a whirlpool in a lake that turned into the eye of a storm, spiraling endlessly (song: Full Room Empty Space by Vincent & A Secret).

[I tried to remember which songs went with which images by taking screenshots of my lock screen. I’m finding it tough to remember the majority of this infusion, but I’ll do my best to match up the songs with what I saw.]

When I got home, I sat down with my laptop and my phone and began trying to recreate the images I saw by listening to the songs over again. Most of them only evoke general feelings and a vague memory of an image. For example, I remember that Prelude and Fugue in C by Bach produced a vision of bright red ink spreading on a ceiling of thick watercolor paper with a chandelier hanging down from the middle. Concerto in D Minor by Handel gave me a feeling of very old royalty and led to images of stately, historic stone buildings. At some point, there was a song – I think it was River Free by Boil the Ocean – that paired with images of vast open ocean and a whale shark swimming slowly near schools of fish. While most of these have faded in my memory and I have screenshots of more songs than I can remember images, there was one that stuck with me:

The fish wedding.

The song is “Songs My Mother Taught Me” by Dvorak. It begins with two fish tucked into a bed, the linens pulled neatly up to their fins. Then, the bed falls away and the fish are dressed in wedding attire; tuxedo on one and dress and veil on the other. The fish bride is moving down the aisle (conveniently, I can only see her top half. Not sure about the mechanism of movement, having no legs.) There are rows of guests on either side, and I cannot figure out if they’re fish or human. Either way, they watch her breathlessly. Now, we’re at the reception. The bride and groom are cutting the cake, fins gripping a large knife. As it cuts into the cake, the entire thing collapses in on itself, as if the cake were made of cardboard. The song ends, Allegri’s Miserere mei, Deus begins, and we return to the church with the fish bride.

And then it’s like my brain went “wait a minute- we can’t have an anthropomorphized fish in a wedding dress in here, at least not with THIS song” and the entire feeling of the vision changed. If you can consider your brain to have “cinematography” in ketamine scenes, the images went from “Pride and Prejudice meets quirky, French cartoon,” to “emotional history documentary.” The fish disappeared, and it was just soaring views of an empty cathedral with light streaming in through stained glass windows.

It’s mildly frustrating to remember thinking “wow, this song goes perfectly with what I’m seeing” and not being able to remember what it was that I saw. Sometimes patients will ask the doctor to write down things they think of while the infusion is going, thinking that it’s incredibly profound, only to read it later and either have no idea what it means or be entirely underwhelmed by its meaning. I imagine that’s what would happen if I could remember every image with its accompanying song. It probably wouldn’t be as perfect as I thought it was.

This was definitely an entertaining infusion, and when I came back to the room, I had no words to describe it other than to say “there was a FISH. WEDDING.” and then laugh and shake my head. The best way I can explain what it feels like to come out of a ketamine infusion is that it’s like waking up over and over again. You’re listening to someone talk, definitely paying attention, and then all of a sudden you feel like you just woke up again. The words you remember them speaking bounce around in your head for a minute- were they dreams? This happens several times, each coming a little further out than the last one. Eventually, you’re solidly awake and can go home to contemplate the love lives of fish.