Illustration of a brain outline with colorful shapes connected by lines depicting neural network

TMS Update

I’ve been getting TMS treatments for the last several weeks. So far, it has not been helpful for me, and it seems to have worsened my insomnia. I’m extending my treatment past the planned-for 36 sessions in case I’m just a late responder, but I’m struggling to be optimistic.

I mentioned in my first post about what TMS is like that I’m doing the 10 Hz protocol. Seeing no improvement after a few weeks of treatment, we added a priming protocol called intermittent theta-burst stimulation (iTBS) to my usual treatment. This means that the coil is placed in the same spot as it normally is for me, and pulses are delivered at a different frequency and pattern for 2 minutes prior to my usual treatment.

The idea (as much as I understand it) is that the priming pulses enhance my neurons’ response to rTMS, either by preparing postsynaptic neurons to fire by affecting voltage-gated ion channels or lowering the activation threshold at which a signal can be passed on to the next neuron.

It feels very different; the 10 Hz pulses feel like a woodpecker drilling into my head, but the priming pulses (which are delivered at a lower intensity than the regular pulses) remind me of how those springy door stops fly back and forth when you pull them to the side and let go. In the beginning, it feels more like having a rubber band snapped on my head many times per second than being pecked by a woodpecker. As it increases in intensity, it loses some of its sting and becomes more similar to the dull-but-concentrated knocking that rTMS creates.

Overall, I find that iTBS feels more robotic than rTMS, probably because the pulses are delivered in multiple bursts per second. I think the rhythm of it seems less natural than a single burst pattern. Unfortunately, I haven’t noticed much difference with the priming protocol in place.

Next, we added a right-sided protocol. Treating both sides of the head may or may not improve TMS outcomes, but we figured why not try it if the left side alone wasn’t working? The pulses are delivered in the same place as they are in my usual left-sided treatments but on the other side of my head. It’s slow – only 1 Hz, meaning there is one pulse per second. The treatment goes for 15 minutes.

It reminds me of a metronome, and it can become mesmerizing if the conversation in the room stops. There is a light on the TV across from the chair that blinks at a rate slightly slower than the TMS pulses, which is somewhat maddening. Why would TV manufacturers not ensure that their lights blink exactly once per second? Couldn’t they have foreseen that a minuscule proportion of their products’ users would be in precisely my situation? Big oversight on their part not to consider this incredibly niche but potentially loyal corner of the market.

It’s interesting how accustomed I’ve gotten to the treatments on the left side of my head. Adding the right-sided treatment was surprisingly uncomfortable, even at a much lower intensity than my left-sided treatments. Just like with my usual treatments, we increase the intensity of the right-sided pulses within a certain range each time, so it starts out easy and becomes more uncomfortable as we go. That said, it’s gotten less painful with each appointment, and I can always opt to stay at a lower intensity if it’s too much.

I’m still feeling discouraged, but I decided to do some extra treatments to make sure I’m giving it as much of a chance to work as possible. I am, however, concerned about how I’ll feel if I have to accept that it didn’t work for me. Around 30% of people don’t respond to rTMS, which is slightly comforting. At least I can be pretty sure it’s not something I did wrong.

How I Track Mental Health Symptoms

My therapist has been encouraging me to track my depression and various contributing factors for years. I’ve tried several apps, journals, and charts, but I always drop the practice after a little while. Eventually, I identified why those tools never worked for me and used that information to make my own system.

Why Motivational Journals and Apps Don’t Work for Me

I understand why a system with lots of elements appeals to some people, but I tend to find them discouraging – the opposite of their intended effect.

My Depression vs. Positivity

Whenever I tried an inspirational/motivational journal, I quickly lost interest. I’d open it up to mark down that I felt like a person-shaped vat of cold, unsalted mashed potatoes. The list of weekly goals I hadn’t met would be staring up at me. Some inspirational quotes would arrive in my brain through the filter of my depression, limp and meaningless. Over time, I began to avoid them, knowing that the initial excitement of setting up a shiny new tracking system would sour.

Apps Aren’t It, Either

Apps have the advantage of offering daily reminders, but if the app is structured like the previously discussed journals, a cheery notification that it’s time to check in only distances me further. I really wanted apps to work for me, and I’ve been consistent with them for two or three weeks at a time, but I always abandon them eventually. They’re too complex, they ask me too many questions, or they document more than what I want to track.

Mood Scales and My Problem with Numbers

Number-based tracking scales usually include too much choice for me and don’t allow for flexible indecisiveness. A 1-to-5 scale just paralyzes me. What if I say “3,” but I’m really a “2?” That would be catastrophic, obviously.

Perfectionism

Maybe it’s a vestige of perfectionistic test anxiety, like I have to choose the “right” answer and be consistent in my interpretation of the scale or else anyone who looks at my data will get an inaccurate sense of my mental health. So instead, I just stop using them. When there’s no data to look at, I didn’t do it wrong!

So in the end, I decided to go with what my therapist suggested in the first place (I must be exasperating when it comes to tracking), and just made my own system to track my mental health.

My Method for Tracking Mental Health Symptoms

I wanted something straightforward, easy to use, and without the frills of a motivational journal. I got a completely blank, unruled journal and a set of stencils. I found these stencils online by searching something like “bullet journal stencils.”

The Mood Tracker

Each hexagon represents a day, which I’ve drawn a line through to depict AM on the top and PM on the bottom. I chose three colors to be “good,” “blah,” and “bad.” This way, I only need to pick a color and fill in the shape. If I can’t decide on a color, I can mix two of them together or shade the shape according to how the day progressed.

I also write small notes every now and then for medication changes, ketamine appointments, and other factors. I like that the bare minimum for this system feels doable for me but isn’t so scant that it’s uninformative.

The Medication Tracker

The medication tracker is similar to the mood tracker in that each section represents a day of a month. The inner row is morning and the outer circle is night. I picked a color for “Yes, I took my meds” and a color for “No, I didn’t take them.” It does help me to see how frequently I’ve missed doses, partly because the perfectionist in me hates to see too much orange.

I keep the journal and the colored pencils in my nightstand so they’re easy to get to and I don’t have the excuse of already being in bed when I remember to track.

How It’s Going

I’ve been consistent with this method for a little over two months, which is probably the longest stretch I’ve ever gone with tracking mental health symptoms. I can’t say that anything groundbreaking has come of it yet, but it is interesting to confirm some of my expectations.

I’ve tried and abandoned so many methods that I don’t think I showed my therapist my journal until I had been using it for a month. I didn’t want it to be yet another dud in a long line of tracking tools. So, I kept it to myself for a little while and am only just starting to assess its usefulness.

Just like with any mental health-tracking method, there are gaps in the data that become evident over time. I’ve been adding symbols to my mood tracker for things like self harm and my period. It’s becoming more complex, but I think the fact that I decide when to add those symbols rather than having a dedicated section for them works well for me.

That said, I’m considering adding a way to track more factors, such as appetite, sleep, and exercise. I don’t want to make it too complex, but I might have the habit established enough to expand my system without abandoning it.

There are tons of ways to track mental health symptoms and factors, and you can find many of them detailed online. What way works best for you?

A metallic green hummingbird perched on a red plastic flower ring being worn by a hand held in the air with fingers bent.

Enjoying Good Days with Treatment-Resistant Depression

When I have good days with depression, it feels like coming out of a long, dark winter to find that the Earth is still spinning. In all of its complexities, the rhythms of life kept going on around me. Maybe I feel lighter, I laugh more, or I once again find enjoyment in my interests. Then, because I tend towards perfectionism and outrageous expectations, I throw myself into working on various tasks that have gotten out of hand in my mental absence.

Frantic Feelings of “Wasted” Time

Take, for instance, laundry. I tend to do absolutely none of it when I’m struggling with depression, which leaves me wearing dirty clothes or reaching into the recesses of my closet for that neglected, ill-fitting shirt I should just get rid of. Then, a good day comes along. And I have to do ALL of the laundry. In ONE day. Don’t get me wrong – I do enjoy the sense of satisfaction when this happens. It’s nice to finally have the motivation to do something and be rewarded with the feeling of a job well done. But I can’t help but notice the faintly frantic sensation I find in the background.

From experience, I know that my depression is very stubborn. If it lets up for a day or two or even a few weeks, it could be back soon. I’m like a squirrel hiding nuts for winter, except I’m vacuuming my floor and doing all my laundry because my treatment-resistant depression could come back at any moment. It’s best to be prepared for whatever is ahead.

A backlit mountain with dark pine trees in the foreground.

Being Mindful of the Good – Despite Depression

I’m always working on noticing when things don’t suck. When a good day with depression comes along, it’s nice to get things done, yes. But it’s also nice to just appreciate the little gems of each day. Dappled light on November’s yellow leaves, watching Stella roll over for belly rubs from the kids down the street, the aroma of coffee brewing in the early hours of the morning – these small moments that slip by me when I’m depressed are important because they demonstrate that there is good in the world to be appreciated.

The silhouette of a hummingbird in flight near a green tree and a red hummingbird feeder

About a month ago, I started sitting outside in the mornings with a hummingbird ring feeder. I’d just sit very still, sipping my coffee and listening to the hummingbirds zip around in the neighborhood. One day, a brave little bird came by to check out the nectar in my fake flower ring. It hovered nearby for a second before moving in and landing its tiny feet on the edge of the flower. I could feel the gusts of wind from its wings on the back of my hand. It stayed for about 30 seconds, drinking the nectar and alternately taking off and landing again before moving off into the early-morning air. It was legitimately one of the coolest things that’s ever happened in my vicinity.

The hummingbirds have migrated south by now, but that experience has stayed with me and reminded me of the value of being still. Depressed or not, taking time to observe the world around me almost always gives me a positive feeling. It’s good to stop and smell the roses, as they say. Or maybe they should say, “It’s good to stop and let a tiny bird drink sugar water out of a gaudy piece of jewelry on your finger.”

Depression Recovery isn’t Perfect

Instead of preparing every item of clothing I own for the possible approaching depression, I’d like to store away moments of gratitude. I’m trying to let go of the fear that my good days with depression will inevitably end. I’ll have to loosen my grip on perfectionism – do a little of what needs to be done, but save space for noticing the delightful morsels of a good day. I know that I rarely remember them in the same light when I’m depressed, but perhaps having an entire hollow tree filled to the brim with pleasant moments will convince me that if past me thought they were worth storing away for winter, future me will, too.

A laptop on a woman's lap while she sits cross legged and uses the trackpad

Ketamine for Depression: Misconceptions, Stigma, and Prejudice Online

I just watched a video that Kyle Kittleson of the MedCircle YouTube channel posted about IV ketamine. It’s called, “What It’s Like to Do Ketamine Treatment for Depression.” The video itself was great; I love that Kyle and his producer, Brigid, were so open about sharing their first ketamine treatment experiences with over 950,000 subscribers. I think their courage will have a big impact on the public’s understanding of why and how professionals administer ketamine for depression.

Online Discussions about Ketamine for Depression

Building awareness about ketamine in mental health treatment is good because we have a LONG way to go. Scrolling through the comments on Kyle’s ketamine infusion video was a rollercoaster of feelings. I have a ketamine infusion about every 4 weeks. I write about ketamine on my blog, and if someone were to ask me about it in public, I would happily talk about it. But I don’t tell just anyone that I use this treatment. I thought that I was being overly cautious, but frankly, after reading the comments I’m about to present to you, I’m not so sure. The judgment, condescension, flippant jokes, and dangerous misinformation were hard for me to read. I could imagine people reading those comments and losing hope in a potentially lifesaving treatment.

Abstract landscape with orange trees and blue sky with lines of movement
Photo by Jr Korpa on Unsplash

Ketamine has many uses as an anesthetic in human and veterinary medicine, and yes, as a recreational drug. It works as a powerful treatment for suicidal thoughts, depression, PTSD, and more. When I get a ketamine infusion, I’m using a legal treatment that helps my brain repair itself. Then, I go home and resume the rest of my regular mental health practices – therapy, medication, being outside, confronting painful issues – the whole nine yards.

I was so excited to see that many comments on the MedCircle video were positive, ranging from support to curiosity to stories of success with ketamine treatments for depression.

Other comments featured honest questions about addiction, cost, what it feels like, and how to get a referral.

And then there were THOSE comments. The ones that spread misinformation, jumped to conclusions, and judged others for their choices. The ones that doubted Kyle’s depression, saying, “He looks fine to me.” And the ones that declared ketamine a dangerous street drug and the people who use it for depression irresponsible high-chasers who can’t face their problems.

Let’s visit some of these comments. I’ve covered the names, but these are real comments from the comments section of Kyle’s ketamine infusion video I linked above. My intent is not to harass anyone with this post. I only want to point out misinformation and address some damaging attitudes about ketamine infusions.

The “this is just a high” comments:

youtube comments about the effectiveness of ketamine treatment for depression against suicide

I haven’t found a source for the 99% statistic, but there are many studies demonstrating the rapid improvement of suicidal thoughts in a majority of patients following a single ketamine infusion. Assuming you share the moral conviction that people deserve to live, that is a wonderful thing. So to respond with a flippant question is insensitive, and that particular question is such an oversimplification that it misses the point entirely.

To be clear: the way in which ketamine leads to improvements in mood is not simply through the perceptual experience of being high, although it’s possible that contributes to the benefits. The biochemical effects of ketamine in the brain, which happen as a consequence of the part where you’re high, can improve depression for weeks or months at a time.

The “not even once” comments:

Here, we get into just a few of the many, many comments about Kyle’s interest in experiencing a ketamine infusion again. In the brief interview immediately following his treatment, he emphatically expressed a sense of amazement and wonder. He said that he wanted to go back to “where [he] got it.” He wanted to be back “in that space.” Lots of comments labeled Kyle’s enthusiasm a “red flag” for addiction.

Youtube comment with two upvotes stating looks like dude just made himself a k addict
He literally just turned into a fiend....
text comment saying thats how you make drug addicts I suppose
text comment saying kyle is a drug user
Text comment discussing ketamine for depression

I have to wonder if those commenters are reading into Kyle’s words a little too much. I don’t know Kyle, so I can’t say whether he really is in danger of abusing ketamine, but he and Brigid were screened and each consulted their psychiatrists. It’s not something that anyone can go into lightly. I didn’t become a candidate for ketamine infusions until I had spoken to my psychiatric nurse practitioner, my therapist, and the doctor at my ketamine clinic. I explained my lengthy history with antidepressants, consistent psychotherapy, and my hospitalization for suicidal ideation. The doctor then spoke to my psych NP, I filled out a whole lot of forms and then had an initial appointment, in which I asked questions and he explained the process, its risks, and what to expect. I take a pregnancy test before every infusion, I’m still in therapy once a week, and I still take my oral medications. I couldn’t have just rocked up to the ketamine clinic and demanded they accept me as a patient. If I had indicated that I’d had a history of addiction, I’m sure the screening process would have been altered to address that.

Starting treatment with ketamine for depression was a fascinating experience for me, and it still is. I think it’s reasonable to expect a bit of wonder and excitement about the experience. Without knowing Kyle Kittleson personally, I don’t think anyone can determine whether those feelings indicate anything more than innocent fascination for him.

lilypads-on-blue-water-with-reflected-clouds

Exploring the way my mind works on ketamine is sometimes bizarre, sometimes soothing, and sometimes it gives me new ways to think about my depression. And yes, when I’m severely depressed, it’s nice to escape for 45 minutes in a dim room with a blanket and people I trust. That doesn’t mean I’m going to “chase down” ketamine and become addicted. I have absolutely no desire to seek out illegal sources of ketamine, nor would I know how.

While I’m glad that last commenter is content to live their life sober, I’m also glad that I have access to medically supervised ketamine infusions. I didn’t start ketamine infusions so that every day can be “sunshine and lollipops, cherries and all that stuff.” I did it so I could stay alive. So that I wouldn’t spend every waking moment in crushing depression anymore. Let’s not minimize the suffering that people with treatment-resistant depression endure.

A Drug By Any Other Name…Would Act the Same

There is a subset of comments that argue that using ketamine for depression is dangerous. Many of those comments revolve around the fact that it has other uses. The comments were full of references to each of ketamine’s names as a party drug. Those who disagree with ketamine treatments for depression seemed split between people who worry that patients will become addicted and people who look down on its history as a recreational drug.

(Why leave a comment if you haven’t watched the video yet??)
text comment saying how can k treat anything its crazy stuff

Ketamine was developed in the 1970s and was quickly adopted as a battlefield anesthetic. It now has uses in elective and emergency surgery and chronic care settings. And yet, the applications for ketamine that everyone seems to focus on as reason not to use it are its uses in veterinary medicine:

Text comment discussing ketamine infusion and animal tranquilizer
text comment reading ketamine is also used to euthanize animals too isn't it
A youtube comment discussing depression, ketamine, and ssri antidepressants

SSRIs are commonly prescribed for depression, and they work great for some people. This person’s claim that THE chemical cause for depression is about serotonin is not accurate. Many other neurotransmitters are involved in depression – possibly even more than we know about yet. Not to mention, the antidepressant effect of ketamine involves, among other neurotransmitters, serotonin.

Chemicals are everywhere. They are everything. The combinations and amounts of them are what make them behave differently in different environments. Ketamine is used to anesthetize animals, whether they have four legs or two. Things that can be deadly in large amounts can also be safe and therapeutic in small amounts.

The “say it with conviction and people will believe you” comments:

A youtube comment describing misinformation about the risks of ketamine for depression as including tooth loss and itchy skin

Good God, my teeth will fall out?! How horrifying and comically inaccurate. Barring accidental facial trauma due to intoxication, the only way you’ll lose teeth on ketamine is if a dentist is removing them while you’re anesthetized. Memory loss and anxiety can be associated with a ketamine high, but the half-life of ketamine is short and, as these researchers found, “ketamine-induced long-term cognitive deficits were confined almost exclusively to frequent users.” There is a big difference between using ketamine for legitimate medical purposes and abusing it.

I noticed that many of the comments expressing shock, derision, or confident predictions about Kyle’s ketamine infusion came from people who identified themselves as having experience with addiction in one way or another. I can see how learning that people are using ketamine to treat depression could be initially disturbing, especially if you have a background with addiction. What I don’t understand is that people left comments like this when the video very clearly states that there is research to back it up, people are carefully screened beforehand, and it’s administered by a licensed anesthesiologist. This isn’t the guy down the street telling vulnerable people he can cure their depression with some special k. This is science.

woman face in profile with eyes closed against dark background
@gabrielizalo on Unsplash

Understanding the Risks of Ketamine for Depression

The bottom line with many of these comments is that they argue against the use of ketamine treatment for depression because it has risks. Everything has risks. NOT using ketamine to treat depression has risks. When the alternative is death and you’ve tried the other options already, it’s ok to take a calculated risk. Ketamine may not be safe for people who are prone to addiction – it’s a very individualized decision that should be made with communication between every mental health professional who treats you.

Although a StatPearls overview of ketamine toxicity argues that, “…patients…should [be] risk-stratified similar to those under consideration for chronic opioid therapy,” we see a significant difference of opinion from practitioners and strong evidence that ketamine can be used to treat addictions of many kinds, including alcohol, cocaine, and opioid use disorders.

What About Overdose?

It’s difficult to find statistics on ketamine-related deaths, possibly because there are so few that major trend-monitoring bodies don’t seem to report them in their own category. Instead, I can only guess that, if there are any deaths at all, they might be included under broad diagnosis codes that encompass several other substances. When researchers use death certificate data, they sometimes attribute the deaths to ketamine use when, confusingly, multiple drugs were involved or physical accidents were the direct cause of death. This strikes me as extremely misleading; actual ketamine overdoses are rare.

One review, stated to be the most comprehensive review of ketamine-related deaths published to date, found that there were 283 ketamine-related deaths in England and Wales between 1997 and 2020. The majority of these deaths involved the use of other drugs. Only 32 involved just ketamine, and only 23 were attributed strictly to the drug as opposed to accidents resulting from its use.

Mysteriously, the authors go on to say, “[This review] should dispel the myth that ketamine-related deaths are rare events.” On the contrary: while tragic, 23 deaths over the course of 23 years indicates that ketamine-only-related deaths are quite rare, as are ketamine-related deaths in general.

As for the StatPearls quote about risk stratification, there were 2,263 opiate-related deaths in England and Wales in 2020 alone. In 2019, there were 49,862 fatal opiate overdoses in the US. I can’t find a single mention of ketamine-related deaths in 2019 from US statistics providers, either because the few cases are hidden among various ICD codes or because there are zero. (I have also heard the latter from experienced professionals who may have access to data that I don’t.) Regardless, the fact is that ketamine is implicated in far, far fewer deaths than opiates are. Its use in surgery can reduce postoperative opioid consumption and, as previously mentioned, it can be a valuable tool for treating addiction.

Ketamine in medical contexts is highly controlled, constantly monitored, and the patient should always be active in therapy while undergoing ketamine treatments for depression. No, this isn’t foolproof, and not every clinic provides adequate support for their patients. On the whole, though, ketamine is very safe. I hope that as ketamine becomes more widely accepted for this use, our understanding of the entire picture will improve. Discouraging all people from getting a lifesaving treatment because “drugs are bad” and, as some of these commenters want you to think, risks inevitably become reality, is a dangerous attitude to take when it comes to treating mental illness.

The “stop avoiding your problems by getting high” comments

This comment is like saying, “They have the ability to help people without TMS. It’s just zapping magnets on your head.” It dismisses a complex treatment without considering the actual mechanism by which it works.

A youtube comment saying That's what I'm thinking as well - people need to deal with their problems head on not just get high for awhile as pleasant as that sounds
text comment reading This guy just wanted to get high - what bs
A youtube comment arguing that ketamine infusions are a temporary escape no different than a street drug user
text comment reading Just drink a bottle of nyquil and lie on the couch - same thing
text comment reading This is just taking drugs man - but somehow legal

I’ll speak for myself when I say that all of these commenters seem to think that by being in therapy once a week for several years straight, revealing extremely painful, personal details about myself, digging into my thought patterns and history and beliefs, spending time in a psychiatric hospital, patiently titrating up and down on numerous medications, and working every day to improve my treatment-resistant depression through behavioral change, I’m simply avoiding my problems now by getting high on ketamine.

It’s also important to note that some of these types of comments are problematic in more than one way. People getting ketamine treatment for depression shouldn’t be shamed, and neither should people suffering from addiction. The stigma of having ketamine treatments relies in part on the stigma of drug abuse and addiction, and ultimately, I think it creates more division and fewer solutions.

A reputable clinic will not allow you to start ketamine infusions for depression unless you’ve demonstrated a clear need for it. It’s a tool like any other. It does help people “get to the root of it” and ketamine patients often use their experience to change their mindsets and heal from trauma.

I agree with the overarching message of this comment. It is hard work to treat depression, and it does take more than one strategy. However, I dislike the implication that people who turn to ketamine for depression are trying to avoid doing that work. Ketamine infusions should not be used in isolation. In my experience, it’s less like a band aid on a cyst and more like a life raft on the ocean. I still have to deal with the waves, but at least I’m floating.

(Band-Aid on a Cyst is going to be my new punk rock band name. I called it first.)

Ketamine for Depression Saves Lives

Ultimately, I’m disappointed but not surprised that so many people left ignorance, insensitivity, and moral judgments in the comments of the MedCircle ketamine video. Kyle took a chance and shared something he likely knew would be controversial. I don’t want to gloss over the fact that there were lots of comments supporting him and Brigid, as well as ones expressing excitement and interest in this emerging treatment. I loved seeing other people refuting misinformation and sharing their own stories of healing with ketamine for depression. There was a significant portion of the comments section that was bursting with positivity.

text comment reading Yes-thanks for doing this-ketamine completely changed my life-thanks kyle
Youtube comment reading-gave me my life back-didn't realize I had lost the joy of life-saved a friend from committing suicide-love yourself enough and just do it
(I’m not encouraging anyone to do it without careful consideration. Just a positive comment I liked.)
text comment reading-k infusions saved my life-simple as that
text comment written by a ketamine infusion patient describing the positive outcome they had from ketamine

And those were just a few. ❤

More Research is Always Needed

It’s absolutely true that more research is needed on the long-term effects of ketamine treatments for depression, chronic pain, and PTSD. Ketamine has been in use for over 50 years, but we still need to understand more about its effects in order to more accurately predict its efficacy in each patient and its risk of addiction when used for depression in this way. I just wish that we could all respect each others’ mental healthcare decisions and keep an open mind about a promising treatment.

Shaming People Who are Desperate for Help is Counterproductive

The comments I’ve highlighted here may come from people who have experience with addiction and a strong bias against the use of ketamine. They have a right to their opinions, and I hear their concern. Ketamine is a schedule-III drug that should continue to be handled carefully in medical settings. When people come to a judgment about something without being informed and then leave comments intended to divide through fearmongering, insulting assumptions, and straight-up incorrect information, it moves all of us back in the fight against mental illness stigma.

scrabble tiles reading Mental Health with sprig of greenery on side

I struggled immensely with the idea of treating my depression with ketamine. The unknowns of what it would feel like scared the pants off me and I was completely intimidated by the social implications of using a mind-altering substance for any reason. If I had read these comments when I was in the process of deciding to try ketamine infusions, I might have been ashamed enough to reconsider. That might have been catastrophic for me. I was recently past my hospitalization and subsequent partial hospitalization and I had been thinking about suicide every single day for years. Ketamine became my life raft, and I’m so thankful that I have the privilege to access it.

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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A close-up image through a magnifying glass of a plant with small yellow flowers

A Strange Effect: The Ketamine Chronicles (Part 35)

The last time I had a ketamine infusion, my experience was dramatically bizarre. I have reached the upper limit of what is comfortable for me, so the infusion itself was intensely immersive. More unusual, though, were the days following the infusion. In hindsight, they were a touch disturbing.

Possible Mania After My August Ketamine Infusion

For a few days after the infusion, I frequently felt detached from myself, as if I were simply occupying another person’s body. Looking at myself in the mirror was unsettling, as my reflection was subtly unfamiliar to me. I slept very little – just a few short hours each night – and yet felt perfectly energetic and motivated. I busied myself with tasks that would otherwise have quickly lost my interest. Being still resulted in a pronounced worsening of my tremor and a building pressure to move. Similar reactions had been happening after ketamine ever since I started taking Emsam, an MAOI antidepressant. They started out mild and became more intense with subsequent infusions, especially after I increased my dose of Emsam. Thus, the last infusion felt far more impactful than its predecessors.

There were small black dots that began in the periphery of my vision but soon moved of their own accord across the space in front of me. They traveled incredibly quickly and in a manner not unlike insects – a creepy scuttling that startled me every time. It felt a little like the kind of jumpy sleep deprivation that results in a tense awareness of your surroundings, except instead of momentary startle reactions, it progressed into actual visual hallucinations. I somehow felt alert and productive, while also experiencing an odd disorientation that made time and recent memories disappear out of reach.

The silhouette of a person standing in a field in a thick fog.
Dimitar Donovski, Unsplash

If you’re considering ketamine infusions or are already getting them, I should stress that my odd reaction to the last infusion was mysterious and apparently unrecognized as a side effect. None of the mental health professionals I see had ever heard of it happening. For me, that means an unanswered question that makes me feel uneasy. For others, I hope that the rarity of what I’ve described is comforting.

The Following Days

When I came out of the strange state of what my therapist called “miniature mania,” I was initially unbothered by what had happened. But as I considered it in the following week, I became slightly disturbed by it. In the moment, I was uncomfortable due to the jittery, giddy feeling I had, but I felt otherwise like myself. Looking back, I’m not sure why I didn’t reach out to my doctor. It felt like I was in a fog that I didn’t know was there.

After a few days, the energy that the infusion gave me ended abruptly and I could feel myself sinking rapidly back into depression. My doctor isn’t sure why that was the case; even though the feeling of being impaired by the ketamine high was somewhat uncomfortable, it seems logical that its extension into the following days should have boosted my mood, not caused it to worsen. In any case, we decided that the combination of Emsam and ketamine was likely the factor to blame for the sudden decline of my mental health. Yesterday’s infusion was adjusted to a lower dose of ketamine and a planned reduction of my Emsam dose. We hoped that they had just been too much when combined at the levels of the last ketamine infusion.

Recollections of a Ketamine Infusion

The infusion itself was more comfortable this time, although it still pushed my limit. During ketamine infusions, my hearing becomes so sensitive that even the lowest volume of my music is too loud. The pump next to me chugs away, adding to the ambient noise in the room. Without thinking about it, I often turn the volume down on my phone, not realizing that I actually muted it until some time later when I start searching for the music that isn’t there. I haven’t been able to remember my infusions for the past couple of months, which, while not the goal of the treatment, was frustrating and unsettling. This time, I have much clearer memories of what I saw and felt during my infusion.

Familiar Water

A sunny landscape with a large blue lake, green vegetation, mountains, and a blue sky with fluffy white clouds
Photographs are my own unless otherwise attributed

Once again, I was visited by deep water. I started out by observing a landscape from above. There were trees and grasses waving in the breeze and woodland creatures going about their daily lives. I soon noticed, however, that I was not looking at a terrestrial scene, but rather an underwater ecosystem that bustled with aquatic activity. Fish darted around swaying seaweed and hid among rocky crevices. I watched for a few moments (or maybe much longer – who’s to say?) and then moved on to a different scene.

The other images of water are jumbled in my memory, but I remember being next to a tall building, looking up to the top. Water flowed over me and covered me up so that my view of the building was distorted by light and water. It carried a calm peace because it was a relief to stop straining to see the top. There was another, similar scene in which I was slowly submerged in water while looking up at the sky. I have another fuzzy recollection of being buffeted by waves until they overtook me and I was deep underwater, pressed on by the water on all sides of me.

A blue lake with mountains in the background and a dark sky at night

Stretching and Tangling

My other memories of what I saw and felt were centered around layers of earth-toned colors that I understood to represent landscapes. The layers stretched out like bubble gum, getting thinner and thinner while I felt the pulling as well, as if I were connected to the layers myself. At other times, I was tangled up in green vines, hopelessly lost in their confusing loops and knots.

Two natural pillars of red rock at Garden of the Gods in Colorado Springs, Colorado

Layers of Abstraction

In between these scenes, I found myself being sucked into abstract, moving visions of colors and shapes. I felt completely absent at times, as if my body had completely disappeared. During ketamine infusions, I occasionally realize how strange it is to lose my attachment to reality. This time, I frequently forgot what was going on and would reach the end of a song or a scene in my mind and begin to wonder how long I had been immersed in my own imagination to the exclusion of all else. It was like a whirlpool, pulling me in after I got just a split second of clarity.

Tethering Myself to Reality

I experimented this time with the addition of a worry stone. I held it in my right hand so that I could move my thumb in circles around the center. I found it helpful in bringing myself back to the room for a brief moment, which offsets the overwhelming feeling of drifting away into the bizarre soup of my internal universe, never to be seen again.

A beautiful red and grey worry stone with a concave shape

Although I typically dislike not being in control of myself, the all-encompassing embrace of ketamine is hard to shrug off. I’m constantly in conflict with myself because on one hand, I’m uneasy about letting go of the threads that connect me to the real world. On the other hand, I feel so far away from the boundary between my mind and the tangible world that it seems too late to fight my way out. In those moments, I’m fairly content to never come back.

Going Within My Consciousness

Part of why these ketamine infusions are so intense is because there seems to be no space between my sense of self and what I’m experiencing. I watch it happen while being combined with it, my own essence bleeding into the experience. The visions exist in a realistic way in my mind, and I feel that not only am I observing it, I also am it. I don’t necessarily feel like I’ve traveled somewhere else during a ketamine infusion but rather descended into the very center of my being. Thus, the images seem to have always existed, with me now sinking inside them. It seems that I’m nearly undistinguishable from them.

An abstract swirl of blue and green paint
Joel Philipe, Unsplash

Insomnia Again

So far, I feel somewhat normal, except for a few remaining symptoms, including the unbeatable insomnia. I fell asleep after taking my nightly Trazodone, but even that couldn’t overpower the alertness for long. I woke up around 1:30 AM, made some tea, and sat down to document my memories of yesterday’s ketamine infusion. I managed to get a few more hours of sleep after staying up for a while. This morning, I do feel an inkling of the uncomfortable giddiness which flips back and forth with anxiety and dominates my memory of the days following the previous infusion. I also keep forgetting what I set out to do, becoming easily distracted with other tasks. It’s still a bit difficult to move my arms and hands without conscious thought; they get rather stuck if I leave them alone for too long, and my attempts to do some fine motor movements take a couple of seconds to recalibrate. Overall, the reaction seems to be more mild than the last time, which is reassuring. Hopefully, this one will have more of a positive effect on my mood than the last one did. Fingers crossed.

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.

EMSAM-patch-packaging-with-label

I’m Mildly Depressed!

This is momentous. I took my regularly scheduled depression questionnaire and, instead of the “moderate” or “moderately severe” that it’s been for a long time, it said “mild” when I submitted it! I’m mildly depressed! Hooray!

I’ve been taking Emsam for a few weeks, now. I don’t think I’ve felt such a dramatic improvement in my depression since the mega-high dose of lithium I was taking for a little while or the times I’ve done several ketamine infusions in quick succession.

Again – *knock wood, toss a pinch of salt, do all of the superstitious things to avoid a jinx* – it’s still early. I’m nervous about declaring it a success because my positive track record with antidepressants has always been sadly brief. But so far, it’s been very, very nice to feel better. So nice, actually, that I think I’m tricking myself into glossing over the symptoms that remain.

As soon as I hit “submit” on my PHQ-9, I considered that I may have been a tad overzealous in my answers because of how exciting it was to not be selecting “nearly every day” for every question. Not that I don’t think “mild” is an accurate descriptor, I just might have fudged on my answers a teensy bit.

Every time I’ve experienced a sudden improvement in my depression, I get really excited to, you know, not be so depressed and I get ahead of myself. I seem to think that a large improvement means I’m fine now and should push myself to do all of the things that I’ve been struggling to do for years.

And I do this EVERY TIME. It gets me into trouble when I take a nap and then feel immensely disappointed in myself because I expected to be instantly, spectacularly healthy. I’m reminded of this comic by ChuckDrawsThings:

Antidepressants don’t fix all of your life’s problems, but boy, do they make it easier for you to go about fixing some of them yourself. It’s amazing that I keep thinking, “I should do XYZ” and then finding myself just doing XYZ. There is so much effort that goes into every tiny decision and step of my life when I’m significantly depressed. It’s kind of mind-blowing how much easier it is to function as a human person. Is this how other people feel, or is this just early excitement of feeling better? I’m afraid that it won’t last.

I do feel a little less awesome than I did in the last two weeks, so I wonder if starting the Emsam right before a ketamine appointment sort of trampoline double-bounced me. It is unrealistic to expect that Emsam will just make everything better forever, so whatever benefit I can have, I’ll take. I’m curious about my next ketamine infusion; will it double-bounce me again?

Not everything is fixed, but overall, I feel remarkably lighter than I did pre-Emsam. Conversation is easier, I feel like I laugh more, and I find myself once again delighted by the little things – figuratively and literally – like this tiny prickly pear I saw yesterday.

An index finger and thumb indicating the height of a small prickly pear paddle growing outside

I love dopamine.

scattered-white-pills-in-upper-right-quadrant-on-light-blue-background

Goodbye, Wellbutrin. Hello, MAOI.

A week ago, I stopped taking Wellbutrin so that I can try Emsam, an MAOI. (I have to wait two weeks between ending Wellbutrin and beginning the MAOI.) I think it was good timing that my most recent ketamine infusion was around the same time I stopped taking Wellbutrin because I’m already feeling pretty terrible. I have the sense that without it, this change might have been even more abruptly bad. Maybe it’s a good setup for when Emsam just blows my mood out of the water, right? A nice contrast will really emphasize its effectiveness. One can hope.

It’s safe to say that Wellbutrin was holding my hypersomnia at bay, and now that I’m not taking it, I’m basically a koala. (They sleep 18-22 hours per day, and not because they’re high on eucalyptus – they’re just dedicating lots of energy to digestion.) It would be great if I could selectively dedicate all the energy I save by sleeping to something else, like hair growth. I could be a brunette Rapunzel in no time.

It is endlessly disappointing to me that I can’t seem to function very well without antidepressants. You’d think I would have accepted it by now. And yet, every single time I change one of my medications and experience a sudden worsening of my depression, I get all upset with myself for not being able to handle it.

I considered this move for a while. SSRIs and SNRIs haven’t helped me much, so branching out to an MAOI seems worth a try. Wellbutrin was clearly helping, particularly in the motivation department, but it was still less impactful than I had hoped. Eventually, I decided that giving up the motivation that Wellbutrin gives me in the hopes that Emsam will help me even more is worth it. It does kind of suck that I can’t go directly from one to the other, though. Two weeks sans antidepressant is proving to be challenging.

A big part of me wanted to just leave things the same and continue to try to build on the benefits of Wellbutrin through my own “natural” efforts. Something that I wrestle with constantly is my uncertainty around what I should expect of myself. It never seems right to say, “I can’t do X because of depression,” because it pains me to be limited by my own brain. So, I continue to struggle far below meeting my perfectionistic standards for myself and then am crushed when “I can’t do X because of depression” turns out to be somewhat true. I never allow myself any grace when depression slows me down.

So, in the end, I’m feebly trying to convince myself that trying yet another medication is fine because if I could have worked my way out of depression by now, I would have. It’s important to do the work I can do day-to-day. But, as anyone with depression knows, it’s tough to do the things that you know are good for your mental health when your mental illness won’t get out of your way. Not impossible! Don’t get me wrong, I’ve been exercising, keeping up with my job, trying to eat 3 meals a day – the works. But that can only get me so far, and most of it tends to fizzle out when I’m in a mental place like this.

I felt okay on Wellbutrin, but ideally, I don’t want to settle for okay. But if Emsam doesn’t work out, it is nice to know that Wellbutrin is something I could return to. For now, I’ll just keep working on my Rapunzel hair and waiting for Wednesday of next week, when I can begin my MAOI experiment.