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 ketamine infusions is actually an accurate time frame to use. That said, we’re going to go another three weeks and see what happens.

Technical Difficulties

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.

An Octopus and an Ominous Shadow

Maybe because I listened to something familiar, I didn’t have any sustained scenes like the very memorable fish wedding in a previous ketamine infusion. 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.

Ketamine Infusions Make My Hearing Sensitive

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.

Sneaking a Peek 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.

Knowing My Pattern with IV Ketamine for Depression

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.

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.

“Remind me that we need to go to the store after this,” my mom said as we pulled up to a stoplight on our way to my eighth ketamine infusion. We came to a stop, looked at each other, and burst out laughing.

“I’m not making any promises,” I replied.

This was the last of my initial series of ketamine infusions, which are treating my severe depression. After about the fourth infusion, I started to notice a significant difference in my mood, which has steadily improved since then. I feel lighter, happier, and constantly find myself marveling at how simple it feels to just get up and accomplish a task. Before I go take advantage of my newfound enthusiasm, I have to tell you about this latest infusion. Buckle up.

A Wild Ketamine Ride

Immediately after my IV was put in, I started an album by the Swedish Chamber Choir and quickly decided that, while beautiful, it was far too dramatic and would likely lead to an unpleasant infusion. So, I hurriedly found a playlist of gentle classical music and set it on low volume in my earbuds. “Are you ready?” Dr. G asked.

“I’m ready,” I said, arranging the blanket on my lap and settling in.

Dr. G pressed a final button on the machine next to me and then leaned back in his chair and put his hand over his mouth as if holding a loudspeaker microphone. “KKshSHhSH. Thank you for flying Ketamine Airlines. This is your captain speaking.” We all laughed, and that’s the last thing of the real world that I remember with clarity.

Is it Working Yet?

I closed my eyes, determined this time to keep them closed the whole time. Usually, I leave them open until I begin to feel it, but this time I shut them immediately. I watched the darkness behind my eyelids, wondering if it would be obvious when the ketamine started to kick in. It’s easy to tell when my eyes are open because things around the room start to look blurry and soft. At some point, I remember noticing a sensation of tilting to the sides. When I breathed in, I tilted to the right. When I exhaled, I tilted left.

Soon after, I began to see vibrant blue against deep, deep black. From above, still in black and blue, was a mountain lion picking her way along the snowy banks of a winding river. The image disintegrated and the blue fell away like grains of sand in an hourglass.

How Music Impacts My Experience of Using Ketamine for Depression

The music played an enormous part in what I saw. Each new song produced new scenes and images, and I remember thinking, somewhere far away, that I wanted to remember which song went with which vision. Alas, I was too captivated to do anything but be carried along with the music.

One song produced a sensation of being underwater, surrounded by jellyfish. They moved with surprising energy, but were peaceful and delicate. The song ended and as another began, I was transported to what I can only imagine were the steppes of Siberia. Nomadic people stood on the striking landscape, dressed warmly in furs, observing their herds. I then sank below the permafrost, light receding upward until I was in darkness.

Suddenly, light appeared and brightened until it was blinding and white. People came into view, carrying a large, rounded container. I knew that this was a funeral, and as they put the container down, I felt as though I were being pressed firmly into soft earth. All around me were mossy bones and skeletons that looked at me. They seemed like they had been kind people. Another song began, and the blinding white light returned. As it dimmed slightly, I realized the light was reflecting off of vast landscapes of ice. Strangely, I felt my clasped hands begin to pull apart, and at the same time, I saw an enormous ice floe crack down the middle and start to separate. There was tremendous weight on each side, and volumes of icy water were displaced as the ice floe crashed down into two.

Real-World Disorientation

Throughout all of this, I would occasionally become aware of the room around me. At one point, there was talking, and although it was distinctly english, the words didn’t make sense to me. It sounded a lot like this video. Although I felt incredibly immersed in my ketamine dreams, when Dr. G bumped into the door, my eyes flew open. As soon as I realized there was nothing to worry about, I closed my eyes and returned to my skeleton/jellyfish/ice floe visions. When the infusion was over, I left my eyes closed until I could tell that I was seeing normal darkness rather than  a d v a n c e d  darkness [cue Spongebob clip].

Post-Ketamine is Mundane

When we got in the car, I pulled out my phone and began writing down as much of the ketamine infusion as I could remember. This resulted in notes like “skeletons everywhere” and “SHARP blue shapes.” I’ve done my best to interpret them, but I’m sure there’s more that I can’t remember anymore. When I got home, I slept for five hours, woke up at 9 PM, ate a banana, and went back to bed.

As this was the last in my initial series of IV ketamine for depression, I now have two weeks until my next infusion. This blog series will continue, but with less frequent posts. If you have questions about what treatment with ketamine for depression is like or about anything I’ve written about here, please leave them in the comments or contact me directly. I’d be happy to answer them!

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.

Today was scheduled to be the last of my six infusions of ketamine for treatment-resistant depression. My area has been preparing for a three-day series of snowstorms, each predicted to bring several inches of snow, but we braved the roads with the rest of the Monday crowd. Wet, heavy snow from the night before covered the ground, and although plows came through early in the morning, people drove cautiously, and a long line of cars backed up into the city.

The Schedule of IV Ketamine for Depression

Seeing as today was my sixth ketamine infusion, my doctor and I discussed the course of treatments and how we want the next steps to progress. (If you’re just joining us, feel free to start at the beginning of this series about my experience with IV ketamine infusions for treatment-resistant depression.) I started to respond slowly after two or three infusions, so my total benefit has so far been moderate. The “usual” (everyone is so different, and protocols are changing all the time) way this clinic operates is to do six initial infusions within two to three weeks, followed by a maintenance infusion two weeks after the last of the initial series. If those two weeks go well and the patient doesn’t notice any decline before the maintenance infusion, the next one is scheduled for three weeks out, and so on.

If we wait two weeks before my next infusion, given that I’ve had a moderate response and rather late, there is some risk that I might lose momentum and need more ketamine infusions to make up for the lost progress. Therefore, we’ve decided to extend the initial series to eight infusions. With that decided, we began ketamine infusion number six.

Higher Doses of Ketamine

I opted to increase the dose incrementally as we went from infusion to infusion, so this one was the highest dose yet. In retrospect, I think it was too much. I was deeply relaxed, but less able to distinguish between reality and drug-induced visions. I remember very little of what I saw, and the longer it’s been since the infusion, the less I remember. I felt oddly trapped in it, but not in a particularly scary way. I was just very far away from the real world.

A Power Outage

I remember thinking about the weather; I saw fine snow like powdered sugar on the road, swirling and leaping in the wind. I remember feeling that my throat was dry and telling each muscle to contract as I swallowed in slow motion. At some point (I later learned it was towards the end), sudden darkness and a distinct silence descended on us. It forcefully pulled my attention back to the room. I opened my eyes–Were they my real eyes? Yes. Yes, I think so— and saw movement through the open door. Hushed voices and flashes of light punctuated the heavy darkness. I wasn’t sure if anyone was with me, but then my doctor hurried in and spoke to my nurse, who was still sitting beside me.

Their words were too fast for me to grasp, but I heard something about batteries. I attempted to turn and look at the voices, and my nurse reassured me. “The power went out, but everything’s OK.” With this knowledge, I closed my eyes again and sank back into the inner darkness. A strong beam of light landed on my face sometimes, and I deduced that that was the nurse aiming a flashlight in my direction to check on me. I heard the series of beeps that meant my infusion was over. I cracked my eyes open and noticed human forms enter the waiting room. They, too, had flashlights and talked in that low tone used only when sudden darkness arrives. My nurse closed the door.

A Possible Headache

It was harder to come out of it than it usually is, and my sense of time was even more skewed than normal. This might have been because of the higher dose of ketamine or the lack of overhead lighting. I imagine it was a bit of both. I feel exceptionally tired this time, and I think I’m developing a small headache. It seemed likely that the migraine I got after my first infusion was because of stress, but if this one turns out to be similar, I wonder if the higher dose of ketamine was too much for me and mimicked the first dose that was so jarring. If this is the case, it is very rare; ketamine is actually used to treat migraines, so if you’re considering ketamine for depression, don’t worry too much about headaches.

As I have more and more infusions, I’m finding that it’s harder to remember what they’re like. You know that feeling you have when something triggers a memory, but you’re not sure if it was real or a dream? I’m having that experience much more frequently, and I think it’s because the things I think about or see during a ketamine infusion feel so dream-like. There have been times when I can’t tell if I’ve told someone something, dreamed that I did, or thought about it during a ketamine infusion. It all blends together.

Here’s hoping these next two help boost my momentum to a better place, and that the power stays on.