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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.

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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.

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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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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!

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Anxiety is Keeping Me Awake

And I love it. Well, “love” is too strong, but I have distinctly positive feelings about this change in my depression. From the outside, it may sound amazing to take a four-hour nap every day. Living it is a different matter. When you’re absolutely exhausted all the time and you crawl into bed simply because you don’t want to exist as a conscious person anymore, it’s not rejuvenating. When you go to sleep because you just want the day to be over and at least that way, you won’t perceive the passage of time, it’s not indulgent self-care. Instead, it’s just a black hole siphoning days, weeks, months of your life away from you. So, when you suddenly have every precious second of the day to be awake, it’s wonderful – and a little bit uncomfortable.

Wellbutrin is what’s still making me anxious – a side effect that Google says goes away within a week or two. Not so, for me, although hopefully, for a more complex reason. When I started taking propranolol, a beta blocker, to counteract the anxiety and jitters, I hoped that I could start to really enjoy my improved motivation. I’ve been mostly feeling like it arose solely as a product of anxiety that propels me from distraction to distraction. Instead, I encountered a strange result. Two propranolol per day had minimal effect, but three made me so shaky that I struggled to type or to use a spoon. This is weird, and not at all what’s supposed to happen. Perhaps I had a paradoxical reaction to it, but it’s hard to say. As for the anxiety, my psychiatric nurse practitioner theorized that the addition of Wellbutrin made for three medications in my list that deal with norepinephrine. I was making too much of it, essentially leaving me constantly primed for fight or flight. I’m now tapering down on one of those meds in preparation to increase the Wellbutrin.

Although the anxiety is improving, it still keeps me from napping most days. It’s that odd combination of being tired and full of energy at the same time. I want to close my eyes and rest, but it kind of feels like my trachea is the size of a large straw, and I can feel my heartbeat in my ears. It’s a tug-of-war between depression, which still votes in favor of sleep, and anxiety, which votes for frantic activity. Consequently, many of my days feel much longer than they used to because I’m unable to sleep. I’m still not as interested in my, well, interests as I used to be, so although I have this itch to be active, nothing seems quite right. The anxiety is also not nice, but it is a novel experience to be conscious for an entire day. There are so many hours to pass!

In an example day, I’ve:

  • fixed my clogged bathroom sink
  • drawn some potted plants
  • accomplished my part-time work in one sitting
  • refilled the bird feeder
  • took the dog to the vet
  • *perused the web for “doggles”
  • went for a walk

There have been some recent days that included naps, but on the whole, I’m pleased with my daily awakeness. Now to try not to go too far in this direction and become more anxious that I’m only doing very minimal activity and it somehow feels like a lot to me. Don’t. Over. Think. It.

*Doggles, or dog goggles, are on my shopping list because my dog, Stella, habitually develops eye infections, likely in the course of her high-speed, full-contact dog park outings. The doggles are for her to wear while we play fetch, silly as that is. But hey – ten bucks for doggles, or $180 for each vet trip? They also look awesome.

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It’s hard to get photos of dogs playing that don’t look terrifying, but I swear, this is Stella and Tugs having a great time. Imagine how cool they would look with doggles.

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Having Good Days with Depression

Every time I have a sudden improvement in my depression, I’m blown away by how much easier life is. When you live with something every day, you get used to it. It no longer catches your attention when your symptoms don’t stand out from the daily noise.

Yesterday, I had a good day. I called a friend, went for a run, attended a virtual writing group, and only napped for one hour! This is a dramatic improvement from recent weeks. I can’t believe that such a mundane day could feel so novel and exciting. Today, I woke up and thought, “What am I going to do today?” Not in my usual “I’m tired, every day is the same, and I’d rather stay in bed but I have to do something.” way. More of a “I could accomplish something today” way. I actually feel slightly enthusiastic about it. I’m looking forward to the near future but nothing in particular, which is a foreign feeling to me. It’s a kind of vague “the day is full of possibilities” feeling that is a dramatic change for me. I attribute this shift to a second ketamine infusion I had just a few days after my regularly scheduled infusion. The goal was to sort of trampoline-double-bounce me, and hooray – it worked!

I had a conversation somewhat recently about how easy it is to doubt yourself when you have a chronic, “invisible” condition. You might start to forget what “normal” feels like, which makes it hard to tell if you’re there or not. For instance, I often find myself questioning whether I’m being sluggish because of depression or because I’m not putting in enough effort. When you check in with yourself often (“Am I feeling better yet? Is _____ working yet?”) it’s easy to get bogged down in minute details and lost. But a sudden shift in my mood shows me that I can easily tell when I feel better. It’s a change that I notice right away. It’s somewhat validating, actually.

I also try not to dwell on the anxiety that this improvement could be short-lived. I’m accustomed to the very slow seesaw of my moods, which makes a worsening of my depression at some point in the future seem likely. It’s an exercise in mindfulness to focus on the day as it happens. Right now is pleasant and noticeably easier than just a few days ago. The future will unfold as it will, so I may as well appreciate the present.

Here are some things I appreciate: As I’m writing this, my dog is asleep with her head on my legs. I can feel her twitching as she dreams of canine life. I’m astonished at how much she helps me – how important she is to my mental health. I’m grateful beyond words for her. It’s almost noon and I am still awake, having made it several hours past my usual nap. I’m getting tired, but that’s ok. I’m going to enjoy the improvements and be kind about the symptoms that remain. I appreciate comfortable clothing, raspberry tea, and the flexibility my job provides. I recently learned that clams have internal organs but mussels do not, and I’m thankful for Wikipedia. I appreciate my curiosity, both for random facts and for how far I can go with this newly lightened mood.

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Balloon Head: The Ketamine Chronicles (Part 28)

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

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

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

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

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

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

At times, quiet conversations and activity in the hallway and other room seemed incredibly loud and close. I wondered if there were people standing right over me, but when I opened my eyes, the noise stopped and the same calm, serene room greeted me. When I looked up, the ceiling tiles resembled oil paintings of pastel landscapes. I closed my eyes and was met with more odd images, many of which I don’t remember. There were translucent shrimps on the sea floor, skeletons, and a curtain made of long, interwoven strips of orange, red, and pink fabric. At one point, a sequence of images told a bizarre story. I had found two birds and put them in a cage until I could figure out what to do with them. But as I turned away, the larger of the two birds veeery slowly swallowed the smaller bird whole. WTF. I’m relieved that I managed to interpret my post-infusion notes, because what I wrote down in reference to that particular ketamine dream was “mbira dram” (bird dream). Even autocorrect couldn’t help me with that one.

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

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

Happy New Year!

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

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Changing My Depression Medication

It’s come to my attention that my depression medication doesn’t seem to be doing much. IV ketamine infusions are also doing less than they used to, unless it’s the case they they’re doing just as much but my brain is kicking its level of stubbornness up a few notches. Who’s to say what the cause is? Maybe it’s just the curse of 2020.

I got sidetracked. The point of this post is this: I’m about to start taking Wellbutrin, a medication that I tried a few years ago and really liked. I was only on it for about a week, though, because I promptly broke out in a blotchy rash that spread from my chest, up my neck, and all over my face.

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(the rash of 2018)

It seemed like a cruel joke played on me by the universe. The only oral antidepressant I’d ever tried that made a sudden, discernable difference in my depression is one that I’m allergic to.

Cut to now – I’m once again finding myself floundering in the soupy mashed potatoes of my depressed brain, looking for some way to change things. I’ve always carried a little bit of disappointment about my failed Wellbutrin trial, especially because I was taking the generic at the time. What if I wouldn’t have a reaction to the brand name version? Would it be stupid to try?

You know those prescription medication commercials that include a disclaimer like “Don’t take [name of drug] if you’re allergic to [name of drug],” and you’re like “Well, DUH”? I am now the person that those disclaimers target. To me, the risk of an allergic reaction is worth the potential benefit of taking Wellbutrin. I think it’s telling that when faced with the possibility of a rash, swelling, even anaphylaxis (unlikely), my reaction is “sign me up.”

I remember being so amazed at how motivated Wellbutrin made me feel. It was the only oral depression medication that’s ever given me that “I didn’t fully realize how depressed I was until I wasn’t” feeling. I was in my last semester of college when I took it. By that point, I had tried several medications and was struggling to get through the last few months before graduation. I was over the moon when I realized that Wellbutrin was working for me. It was SO much easier to get my work done and interact with people, even just for the few days that I was on it. When I got the rash, I stopped taking it abruptly, and the sudden changes did not do good things to my mental health. I had already been utterly overwhelmed by classwork and worn down by the near-constant suicidal thoughts that had plagued me for over a year. I canceled my trip home for spring break because I wanted to be alone, and I reluctantly started yet another combo of meds. I just remember the whole thing being bitterly disappointing. It was like Wellbutrin had swooped in, showed me how much easier everything could be, and then ditched me with the gift of an itchy, burning rash after just a few days.

So, I’ll take the chance of a rash if it means I might feel better. That said, if I let myself get too hopeful and the result is a letdown, I know I would feel incredibly defeated. I’m trying to temper my expectations. If I get a rash or if it doesn’t work, at least I’ll finally know for sure if it’s an option for me. I’ll write an update soon.

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The Taste of Music: The Ketamine Chronicles (Part 26)

The last couple of weeks have been hard for me. I recently wrote about how ketamine can make me feel like I’ve been launched out of a metaphorical cannon. The last time, it was like a little pbthpbpthh – an underwhelming puff that was more like being propelled by air coming out of an untied balloon than like being launched out of a cannon. I don’t remember much at all of the previous infusion, so I didn’t push myself to write about it. I thought it would likely be boring, anyway.

I can’t say for sure why that ketamine infusion was less effective than others. It could be hormones. It could be the changing seasons. It could be that I haven’t been exercising much. Maybe it’s all three. Whatever the reason(s), I’ve been front seat on the struggle bus – sleeping in my clothes multiple nights in a row and then wearing them the next day, getting my work done late or barely on time, napping by mid-morning. I find myself paring down my daily activities. Prioritizing one thing means getting rid of another thing, as the energy needed to do both is more than I have. In some ways, I’ve been getting along ok – my mood has been dipping here and there. But overall, that hasn’t been terrible. The hardest part is honestly the lack of energy.

So, I’m hoping that this week’s ketamine infusion can knock me back into better functioning. One change this time around is that I decided to stop using scopolamine for my infusions. I used it the last time and it resulted in a very…buried experience. I’m not sure how else to describe it. It was sort of smothering – as though I had sunk far, far below the surface of the Earth, and there was nothing I could do to get back to the room. Every once in a while, from leagues above me, I’d hear someone tell me to take a deep breath – the pulse oximeter on my finger had alerted them to the fact that I had stopped breathing. And I found that often, I just did not care. I felt like my body was just a suit I was wearing, and maintaining it was proving to be a lot of work. I could feel that my heart rate was slowing and my lungs were waiting for me to inhale, but it didn’t feel like it was innately me, and so I was content to just watch it happen. In fact, when I was told to breathe in, my recollection is that I felt a little annoyed at having to exert the effort. A couple of times, I tried to ignore it, but the voice was persistent, so I relented.

My experience with scopolamine is not entirely strange, I don’t think. Apparently, it can add to the dissociation that ketamine produces, which explains my sense that my body was not really a part of me. My description of that infusion is a little unsettling in hindsight, but in the moment, I don’t remember being afraid or anxious at all. Actually, the whole infusion was very relaxing, minus the slight annoyance of having to breathe. You know, those fragile humans, needing oxygen. Geez.

The most notable aspect of this infusion in my memory is that at some point, my music stopped. I’ve never had an infusion in which there was no music, so when I noticed its absence, I was mildly worried about what it would be like without it. Not worried enough to move or to say something, of course. That would be too much work. So I just waited, accepting that it wasn’t what I had planned for, but that was okay.

The sounds of the room, which are often prominent at the beginning of my infusions but fade away as time goes on, were extremely loud. I was most aware of the infusion pump next to me, which emitted constant mechanical noise. My mother was typing in the corner, and every once in a while, I noticed the sounds of papers shuffling or a door closing. I remember thinking that I felt like a pillar in a sandstorm, tiny particles being whipped into motion around me. The sand was the noise, and as it bounced off me and flew around the room, it started to sound a little like music. Rhythmic whirring from the machine combined with staccato typing somehow resulted in organic, landscape-based images in my mind. There were lots of shades of brown, but that’s pretty much all I can remember.

Another first for me this time was that I seem to have experienced synesthesia. To some degree, I think I always come close to it during ketamine infusions – the way I associate music with colors and images is not something I’m able to do when lucid. This time, though, I could taste sound. I can’t quite conjure it up enough in my memory to understand what it was like, but I do remember it dawning on me that tasting sounds is not something people usually do. When the noise in the room morphed into strange music, I became distinctly aware of the inside of my mouth. My tongue felt oddly small in the cavernous space behind my teeth, and the general feeling was of something… earthy. There is absolutely no way I can accurately compare the experience to anything, especially because I don’t remember it clearly enough. As I wrote in my hasty, post-infusion notes, “I can taste music. Indescribable.”

The rest of the infusion is jumbled in my memory, but I’m pretty sure the other images I can remember were from the beginning, when the music was still playing. I remember watching dogs eating something, and then their faces stretched and stretched until they turned into alligators. Eventually, an alligator head kept on stretching until it turned into the tendons of a human hand, which stretched until they were the layers of a landscape. Somehow, my brain went from dogs to alligators to tendons to landscape. I could explain the associations from my recent thoughts and experiences, but it would be convoluted. Suffice it to say, all of the elements of that bizarre sequence somehow make sense to me. Brains are fascinating.

Given my general lack of response to the previous infusion, we tried adding magnesium to this most recent one. It’s been two days now since my infusion, and I am definitely feeling a bit better. I woke up this morning, put on clean clothes, washed my face, and did three laps at the dog park instead of one. Improvement is improvement, no matter how small!