Long exposure blue lights in the shape of sound waves against darkness

Sound Sensitivity: The Ketamine Chronicles (Part 36)

I have found that my most vivid experiences with ketamine treatments for depression happen when I’m listening to classical music. At my appointment this week, I popped both earbuds into my ears and started listening to a classical playlist while the infusion pump started to whir. The piano in the first song was soothing, and I settled back, holding my phone in my left hand and a worry stone in my right.

Music During Ketamine Infusions for Depression

The next song was heavy on the cello, and while I love cello music, this song gave me a decidedly creepy feeling. It brought to mind lots of puffy, white items in creamy white rooms that made me feel suffocated. It reminded me of a funeral home. I thought about changing the song, but that would have required control over more muscles than just my fingers, so I just waited it out, circling my thumb around the stone in my right hand.

The Worry Stone and a Mild K-Hole

The worry stone has proven to be a useful addition to my IV ketamine treatments. Even though it’s just my thumb that I can feel, that one little point of contact helps anchor me to the real world when I start to dissolve into nothingness.

During my previous ketamine infusion, in which I did not have my stone, I had found myself unable to move. I was probably experiencing what people call a “K-hole.” At times, I was aware enough to know that I only had one earbud in and wanted to grab the other one from my lap. I just could not force my arm and hand to move toward it. I’d try for some undetermined amount of time before giving up and being whisked away from my body once again, only to repeat the whole thing a little while later.

It wasn’t scary so much as it was frustrating. There was something I wanted, and not only could I not do it myself, but I was incapable of communicating my request in any way. We lowered the dose a little for this infusion, and I think that combined with the itty bitty scrap of control I maintained through the worry stone made for a much more comfortable ketamine infusion.

Controlling My Thoughts During a Ketamine Infusion

When the next song came on, I decided that I did not like all of the white imagery I was seeing, so I changed it to a more tan color and was immediately more comfortable. I don’t think that I’ve ever been able to just decide to change something about my experience of IV ketamine, so this was an interesting development.

I’ve contemplated the connection that happens between my recent experiences and IV ketamine that occurs in the form of bizarre, distorted versions of real-life items or events. I often start to see things during a ketamine infusion that I remember having a passing thought about a couple hours earlier. For instance, the oceans of corn I witnessed after briefly thinking about movie theater popcorn before one of my early ketamine infusions.

I’ve been mostly unsuccessful in doing this on purpose by seeding my mind with ideas. I had thought that my brain simply has its own agenda, but if I can change details like color while the infusion is happening, maybe I could learn to guide myself more reliably over time.

Machinery Noises

The infusion pump next to me whirred and chugged away, and although sometimes it faded into the background, at other times, it was extremely loud and menacing. It started to sound like a deep growl, and I felt as though I were trapped in a small space with a sinister beast and a red glow all around me. This occurred for only a few seconds, as I quickly tried to ground myself using the worry stone in my right hand. I remember thinking to myself, “This isn’t real. You’re sitting upright. You can feel the stone in your hand. This isn’t real.”

Abstract red painting with black shadows and gold splatters
Photo by JR Korpa on Unsplash

Forcing myself back to the room felt like dragging myself up, up, up through a dark corridor to the surface. I turned up my music to drown out the sound of the pump and found myself floating into another feeling entirely.

What Am I?

At times during this ketamine infusion, I felt like I was a thin layer of ice spreading across a pane of glass. I watched the methodical movement of tiny ice crystals marching across the pane, like an army moving to claim new territory.

Closeup of ice crystals covering one half of a pane of glass with a view of trees outside
Photo by Sydney Rae on Unsplash

I watched it and I felt like I was it. It’s difficult to explain how disconnected I feel from my own body during a ketamine infusion. In fact, it’s difficult for me to fully comprehend after the fact, despite having experienced it many times. I still feel like myself, I’m just lacking a physical body. I’m free to move around as what feels like my pure essence, observing and sometimes participating in events that sound nonsensical to my rational mind. Although I seem not to have much control over what I see or become, it’s a somewhat pleasant experience to not feel constrained by my human identity.

Real-World Distortions

I rebelliously opened my eyes once to see the room coated in a gently moving, gauzy film. The walls seemed to shift as the film moved, creating odd, geometric patterns over everything. The photo on the wall suddenly had an ornate frame that stood out to me as being different than the understated one that had existed before.

My mom sat in the corner, typing quietly on her laptop. I tried to focus my eyes on her, but ketamine messes with my depth perception and I couldn’t even manage to keep my gaze on her face without my eyes jumping around the room and then back again. Finding the effort of this to be tiring, I closed my eyes again.

As usual, I was underwater for a time, but I don’t remember any specifics. I don’t know if it was the ocean, a lake, a river, or a stream. All I remember is that it felt somewhat healing.

Going Home After IV Ketamine for Depression

I have vague memories of getting home from my ketamine appointment and walking Stella through the park. I must have hung up my laundry at some point. I definitely remember lamenting my poor timing before leaving them to sit in the washing machine during my ketamine infusion, but now they’re on the drying rack. I may also have filled up the dishwasher, but again – it’s a blur. Maybe I should save some truly unpleasant task for post-ketamine productivity time. That way, I wouldn’t have to remember actually doing it!

I napped from 5:30 to 7:00 PM, then ate dinner and promptly went back to bed. I woke up later on at 11:00 PM and had a snack before getting back into bed. My face felt strange – like there was something weighty resting on my cheekbone and the right side of my scalp.

My tremor was bad the next day, and I struggled for minutes on end just trying to clasp a necklace around my neck. I felt spacey for two days following my infusion, and time had an odd quality to it. I tend to sleep poorly for a few days after a ketamine treatment, but mostly because I have a burst of energy that leaves me wanting to accomplish things instead of going to bed. Forcing myself to get in bed before I’m really ready results in extreme restlessness – it’s difficult to stop moving and I have to constantly remind myself that there is no reason whatsoever why I should be tensing every muscle in my body. Besides, I spend so much time sleeping when I’m depressed that finding myself actually wanting to do things is a refreshing change.

The side effects of ketamine typically go away very quickly after an infusion, but I have the added factors of multiple anti-nausea medicines and the MAOI antidepressant I take, Emsam. In my experience, the combination of all this makes for a more intense experience of IV ketamine and slower recovery from its acute effects.

My previous ketamine infusion felt more effective than recent ones felt. I didn’t start napping again until a few days before this infusion, I’ve been fairly motivated, and my general level of hopelessness hasn’t been too bad. Hopefully, this one will have the same effect on my depression.

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.

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.

Red maple leaves growing on tall branches against a white background

How Psoriasis Affects My Mental Health

I recently took my first dose of Stelara, an injectable medication known as a “biologic” that treats, among other things, psoriasis. I’m so excited, I could pop.

What is Psoriasis?

Psoriasis is an extremely visible autoimmune condition which results in red, inflamed skin with scaly white flakes. My immune system is attacking my skin, causing the affected skin cells to turn over at a dramatically accelerated rate (7-10 times faster than healthy skin!) The severity of my psoriasis can be seen not only from the outside, but from the inside as well. My bloodwork shows evidence of systemic inflammation, which puts me at risk of developing other illnesses, including psoriatic arthritis.

Treatment with Topicals

For the past 15 years, I’ve tried to make topical creams, ointments, solutions, and for a while, UV light treatments, work for me. Using topical treatments properly requires that you follow a schedule of twice-a-day application for two weeks on, two weeks off in various combinations of steroids, vitamin D derivatives, and whatever other prescriptions you’ve been given. It takes me about 30-40 minutes each time.

After about a week, I see definite improvement, which used to be incredibly exciting but is now a pointless exercise in bitter disappointment. As soon as I begin the recommended two-week steroid-free period or simply run out of motivation, my skin begins the infuriating cycle all over again, often worse than the last time. I have never had a period of complete remission.

A brown cardboard sign with white letters in cursive that say "feeling flaky?"
Yes, yes I am. (Spotted in a Safeway. Puff pastry, I think.)

Treatment with Biologics

I reached a tipping point. I don’t know what exactly pushed me over the edge, but I know that I can’t take it anymore. My psoriasis is “severe,” meaning at least 50% of my body’s surface area is affected. Topical treatments aren’t enough, so my dermatologist and I decided that Stelara is the best option for me.

Biologics like Stelara function by suppressing the immune system, which puts you at risk of infections and certain cancers, but the newer biologics are more targeted than older ones. They attempt to treat only the parts of the immune pathways that are going wrong, which reduces the impact on other immune system functions.

Take That, Psoriasis

It makes me anxious to include photos of myself in this post, but I’m tired of trying to navigate the steps I take to hide my skin. Do I dare wear something with an open back? Should I stick to shirts that go up to my neck? Better avoid dark colors so the flakes aren’t obvious.

Psoriasis has been squashing the self-confidence out of me since I was 10 years old. Knowing that I’ll likely deal with psoriasis in one way or another for the rest of my life, I’ve worked to derive my confidence from who I am rather than how I look, but it’s an internal conflict that I’ve never completely solved. I desperately want Stelara to work for me. It’s exhausting to be, on some level, constantly self-conscious. I can’t fully imagine how much of a relief it would be to put that behind me, but I also don’t want to forever be embarrassed about these years of my life. I don’t want psoriasis to win.

This is what I look like, and if you look like this too, know that you don’t have to fit societal standards to be confident in the skin you have.

A person's torso with large psoriasis plaques.

Living with Psoriasis and Self-Criticism


[In this post, I describe my feelings about life with severe psoriasis. I do not want readers who have skin conditions or any physical differences to be hurt by my self-judgments and insecurities. My words are about my experience only.]


It’s taken me so long to come around to the idea of taking a biologic because I blamed myself for not being more consistent with topical treatments. I thought that if I could just be more diligent, my psoriasis wouldn’t be so bad.

It was like boiling a frog; maybe I could have kept it at bay in the beginning, but it just got worse and worse. Eventually, I was so accustomed to it and so convinced that its severity was my fault that I chose to stay in the scalding water rather than get a lift out on a ladle. I also do this with my mental health; I must not be trying hard enough. If I just keep at it, I won’t need to accept more help. If that sounds completely unreasonable, it is – but it’s hard to change thought patterns like that.

Bottle it Up (don’t, though)

I’m 25 now, and my psoriasis is so severe and I’m so disillusioned when it comes to making a dent with topicals that I only use them “as needed” (in my view of “need”). When just twisting at the waist splits the plaques down to raw, bleeding skin and I can’t stand the torture of having unreachable itches in my ear canals, my motivation is briefly renewed. When it inevitably worsens again and I can’t manage it, I’m hard on myself for letting it happen then and all the times that came before. So in order to deal with despair over what I came to see as a failure to fix myself, I became an expert at avoiding the emotions of it. If I let myself fall apart every time I thought about it, I’d never move. It’s far more comfortable to disconnect.

The reality of living every day in this burning, itching skin is too horrible to acknowledge all the time. Instead, I bottle it up until it explodes. I can go long stretches of time feeling like I genuinely don’t care – as long as I cover it with my curated wardrobe of acceptable garments and don’t have too much psoriasis on my face, I’m really quite good at pushing it out of my mind.

But eventually, it’s like I catch a glimpse of it from a stranger’s perspective and am knocked over by the pure shock of it. It hits me suddenly and I break down into tears and fury and grief over how it holds me back and the hopelessness that it could be forever. I’m suddenly overwhelmed by how disgusting and ugly I feel – judgements that I try to keep beneath the surface, but which sometimes bubble up painfully. Then, I gather myself up, shove it all back down, and tell myself that self-pity is pointless. I basically close the Faulty Logic Door on the Emotional Vault until the next time it explodes. Super healthy.

Prioritizing Experience over Appearance

Despite the harsh messages I send to myself about my appearance, I still want to move through the world unhindered by social stigma. Lately, I’ve been pushing myself to wear clothes that make me a tad anxious and, with the exception of swimming, I never let it stop me from participating in things. I’m always worried that people will be rude or hurtful, but that’s rare and stems from ignorance, not malice. Some people stare at me and I occasionally get well-meaning but unsolicited and questionable advice from strangers, but I’ve found that the vast majority of people don’t even bat an eye.

Facial Psoriasis

By virtue of being literally on the face I present to the world, facial psoriasis is particularly hard to deal with. Everyone sees it and has thoughts about it that I’m not privy to. My fears that those thoughts might be judgmental and mean are hard to set aside.

I decided a long time ago that wearing makeup to cover my psoriasis was not worth it. Besides the issues of time, money, and probable skin irritation of heavy-duty foundation and concealer, my desire to fit in and feel confident bumps up against my belief that it shouldn’t matter. It seems like a step too far for me, but for others, it makes a huge difference in their confidence, so, to each their own.

Mild topical steroids and other prescription creams do improve my facial psoriasis considerably, but only for as long as I’m using them, which is sparingly. The skin on your face is delicate, and the decade and a half that I’ve spent using topicals makes me reluctant to risk the side effects of overuse or – God forbid – getting them in my eyes. That’s tricky for me, because I have psoriasis on my eyelids.

On the left is how I wake up during a period of average/low inflammation. With very gentle soap, some careful flake removal, and unscented moisturizer, I can sometimes go from that to the righthand photo without using a prescription cream, which I save for really terrible days. I tend to have wonky, uneven eyelashes because, during bad flares, psoriasis spreads along my lash line and causes sections of eyelashes to fall out.

A psoriasis plaque that looks like a smiley face
A different kind of “facial” psoriasis

Interference and Feedback Between Psoriasis and Mental Health

Stress is a common trigger of psoriasis, which is hard to fix because having psoriasis is pretty stressful. As my mental health waxes and wanes, my psoriasis follows suit in an awful feedback loop. The stress of depression makes my psoriasis flare, and the hit to my self-esteem certainly doesn’t do good things for my depression.

My mental health definitely gets in my way when it comes to skincare. Even if I didn’t have depression, I probably wouldn’t be able to keep up with the treatment routine, but when depression makes getting out of bed and changing my clothes difficult, you can bet that I’m not spending an hour and 20 minutes per day applying goop to the skin I hate looking at.

Overwhelm and Support

Depression and psoriasis are both chronic and painful, and they both take a lot of work to manage. Metaphorically, the overwhelmingly hopeless experience of depression feels like trying to beat back a chronic rash that covers your whole body using nothing but a little tube of ointment. Each is a monumental effort that seems to never end. I’ve learned that tackling difficult, stigmatized issues gets a little easier if you don’t do it alone.

Balancing Impacts

Lithium, which treats my depression and suicidal thoughts, has the unfortunate side effect of causing or worsening psoriasis. (Is that a cruel joke, or what?) I’m not sure how much of an impact it’s had, but I suspect it’s contributed somewhat to the progression of my psoriasis.

[Left: After a dedicated effort to clear my skin in time for a wedding in 2018. It was brief but wonderful. Right: A terrible flare in the cursed year that was 2020.]

Starting Stelara

Any time I spent bullying myself about my skin and my willpower was too long. This change is not a failure, but a success in finally allowing myself to accept help.

Stelara is a momentous step for me; I’ll admit it’s filled with a fair amount of bitterness about how many years I’ve spent suffering, but also acceptance, excitement, and hope.

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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.

a rushing river with white rapids and pine trees on the banks

Turmoil

Well, my family is going through some big changes, I left my job, I’m doubting my medication choices, and I have no idea how to write about any of it. I want this blog to be helpful to other people, so I try to at least be informative and destigmatize conversations about mental health by being open with you. Over the last few months, though, I just haven’t known how to do that.

In all of the turmoil with my family, I’ve done a lot of thinking about growing up, boundaries, and how to deal with a changing perspective. The prospect of writing about it has been bumbling around in my brain, but I haven’t yet figured out how to write about it in a generic way so as to respect my family’s privacy. When I think about writing about other things like my job search or my depression, I don’t know how not to simply complain about them – how to add something more valuable. I miss writing on here, but it’s so hard to restart that I’ve been overwhelmed at the thought of trying.

For honesty’s sake: I’ve been struggling with my mood. My last ketamine infusion was not helpful, I secretly stopped taking my medicine for a bit (don’t do that), and I’m awash in feelings about finding employment – being a burden, feeling underprepared and incapable, the pressure of time, the stress of having no income, etc.

Maybe this short post will help me break through the inertia and get moving again. I have an old draft that will soon be relevant due to an upcoming positive change(!!!), so I might publish that soon. Ketamine is tomorrow, and that will also be altered, so I might have something to share about that in the coming days. Thanks for sticking around or for reading for the first time; I appreciate all of it and I hope that I’ll get back into the swing of things here going forward.

Genevieve ❤

Abstract orange, red, and yellow paint bubbles on a black background

An Overdue Ketamine Infusion Report: The Ketamine Chronicles (Part 34)

It’s been a while since I’ve posted anything about my ketamine infusions. My dose of ketamine is high enough now that, combined with the rather sedating anti-nausea medications, I don’t tend to remember much. I have still been getting infusions, though, and I hope that despite the lack of fantastical details, my experience can still be informative.

A Recent Ketamine Infusion

My most recent ketamine infusion was a slightly lower dose than it has been lately. I requested it because the upper limit of what we’ve tried makes me feel like my insides are getting too big for my skin. It creates an unpleasant feeling of high pressure that suggests an impending explosion. We’ll all just be sitting there, listening to the beeps and whirring sounds of the equipment around us, and then BAM – insides suddenly outside. I don’t think there’s a pre-infusion form for that.

The slightly lower dose, while still intense, was much more comfortable. I’ve noticed that, for me, the most prominent experience with higher doses tends to be the physical disorientation. I’m very preoccupied with whether I’m upside down or right side up, whether my eyes are open or closed, or whether I’m still in possession of any of my limbs. The about-to-explode sensation starts out something like how having restless legs feels, which is interesting because sometimes it’s difficult to sleep when I go home. I lie down and feel like I have restless… body. It’s like my muscles are on an automatic movement setting, and holding them still is deeply uncomfortable.

Ketamine’s Dissociative Qualities

In general, at higher doses of ketamine it feels like I leave my body behind but am periodically compelled to figure out where it is. I find myself much less aware of what’s happening, and because it’s hard for me to just let go, that confusion is somewhat uncomfortable. I’ll get all immersed in some spinning whirlpool in my mind and then realize that I have no idea what’s going on, what time it is, or where I am. I used to be able to move in and out of my ketamine dreams and the real world with relative ease. I could pull myself out of it and remember in an instant what was happening. At higher doses, the information is there, but it’s slow to come to me and I have to sort of fight my way over to it in order to remember where I am.

An abstract blue whirlpool of concentric circles
Photo by Derek Thompson on Unsplash

This is where the preoccupation with my physical location comes in. When I’m unsure of what’s happening, it seems prudent to first sort out whether I’m as backwards and upside down as I feel. There is, however, no way to verify that when you’re still under the influence of ketamine. So I just keep trying to reality test my experience with no satisfying answer. “I think my eyes are open. They feel open, but something tells me they’re not. Wait. What am I looking at? Is this what I would be seeing if my eyes were open? I don’t remember. Where am I?” It’s like I know where I am and that there’s nothing to worry about, but the answer is just barely out of reach and I’m slogging through knee-deep molasses to get there. It’s also interesting to note that my ability to think in words in my mind is significantly reduced at higher doses of ketamine. I might think the words, “Where am I?” in my head, but the rest of it is more a kind of conceptual thought that is hard to explain.

In comparison, lower doses were more visually trippy. I used to watch entire scenes play out like dreams – sometimes nonsensical, sometimes a little disturbing in hindsight, but often beautiful and occasionally profound. Things feel much more disconnected at higher doses. There are images, but I don’t remember much of it being distinct, fully-formed scenes or plots. Some of that seems to be connected to the type of music I listen to; I used to choose slow, gentle, classical music, something with a beginning, middle, and end that lends itself to creating cohesive images. But even that has become too intense with higher doses, so I tend to go with something even more chill, now – meditation music, usually. As far as I can tell, my visual experience these days is more about slowly shifting, spinning, zooming shapes and colors punctuated by bizarrely realistic images of mundane life.

Ketamine Feels Less Novel with More Experience

I suspect that although part of why I don’t remember as much of my ketamine infusions these days is the higher dose, part of it is that I’m more comfortable with it and am paying less attention to my experience. I used to have moments of clarity in my earlier infusions when I’d think to myself, “That was SO weird. I have to remember to tell someone about that.” And then I’d come up with a couple of words to describe the scene (which often became the titles of blog posts in The Ketamine Chronicles) and repeat them a few times in my mind so that I would remember whatever it was whenever I regained sensible thought.

Now, I find myself so apathetic that although I might notice when something really bizarre happens in my mind, exerting the effort to remember it just seems impossible. Instead, I just float along through my ketamine infusions, seemingly going both forwards and backwards in time, and arriving back in the room with half-materialized body parts and very little recollection of what I saw. I’m also less “with it” when we leave the office, which makes it challenging to hold the fading memories of what I saw during the ketamine infusion while also trying to walk to the car.

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

Is It Still Working?

All in all, ketamine infusions still help my depression, even if I don’t remember as much of them. The value comes from the alterations that ketamine facilitates in the brain. I haven’t been experiencing the sudden improvement on the second day after an infusion that I used to, but I do feel a decline in my mood in the same time frame as always. I’m slightly uneasy about the possibility that that might be the power of suggestion; do I start to feel worse because I’m expecting to? It definitely feels different when it seems like the ketamine is wearing off. Like something changes in my brain and I’m less able to pull myself out of those negative mood states we all have, I lose motivation, and I start sleeping more. I’m still wary of my interpretation of that, but I’m really not sure how to determine what the real cause is. It seems like the improvement from a ketamine infusion is more subtle than it used to be. I’m not sure why that is, although it could be because some of my current problems are less biochemical and more unavoidable life stressors. With the addition of Emsam, I do think that my mood has been more stable, which makes the wearing off of ketamine feel a little less abrupt.

So, that’s everything I can think of to share in this post. Sometimes, it seems less entertaining to write about when I don’t have bizarre tales of fish weddings and oceans of corn to share. Nevertheless, it’s always interesting to compare infusions and ponder the factors that make each one different. As always, if you have any questions about what it’s like to get a ketamine infusion, want to share your own experience, or anything else, feel free to leave a comment!

An open laptop with the screen angled down and a bright swirl of colors being displayed against a dark background

How Sensory Processing Disorder Can Make Screens Unbearable

Twice this week, I surpassed my daily limit of 5 consecutive hours of high-focus screen time. This limit is one imposed by Sensory Processing Disorder, and if I carry on without adjusting my environment and practices, there are unpleasant consequences. These include nausea, vertigo, and intense anxiety bordering on sudden panic.

Visual Stimuli and Sensory Processing Disorder

My job as an editor is done entirely on the computer, and it’s very detail-oriented work. I have to focus intently on the screen in order to catch typos and fix grammar and punctuation mistakes. I also have to do a lot of tab switching and scrolling up and down as I add words and change headers. Some sensory stimuli, like bright lights and visual movement, bother me more than they might bother someone who doesn’t have Sensory Processing Disorder. Taking breaks helps stave off the effects of digital screens, but when I spend too much uninterrupted or eventually, cumulative time looking at my laptop or phone without taking steps to reduce my level of stimulation, something gets mixed up in my brain. As a non-expert, I don’t know the precise details of what happens, but I do know that it feels TERRIBLE.

Nausea

When I’m tired and not paying attention to my sensory state, I start feeling some vague nausea around hour 4 of mostly continuous work. It spikes when I switch tabs or close windows- the little “whoosh” of a window disappearing into one corner is not something I notice at other times, but when I’m getting overstimulated, it makes my stomach turn. The light of my screen is physically painful to look at, so I turn it progressively lower as I go on.

Panic

Scrolling is the worst; short vs. long makes a big difference, but they’re both bad. A long scroll makes the nausea much more severe and gives me an indescribably strange pulling sensation in my sternum. It’s something like how I imagine having a long, wet string pulled slowly up and out of your chest would feel. It creates an intense feeling of horror and high anxiety distilled down into the 1.5 seconds it takes to scroll from the top of a page to the bottom. Short-term panic. Something about the movement on my screen is powerfully repelling. The longer I push on past my limit, the more the panic sensation bleeds into the time around the scrolling.

Sensory Strategies for Managing Overstimulation

For a little while, turning the brightness down low and wearing sunglasses helps, but eventually, even that doesn’t work. I take short breaks to press my feet into the floor and look at something stationary in the middle distance. I often close my eyes while scrolling, but this just prolongs the experience because I never scroll to exactly the right spot. If I’m typing anything, I look away from the screen. As the anxiety gets worse, I take deep breaths and pause to look elsewhere. My 5 to 10-minute breaks become time for me to lie on my back on the floor and squeeze my knees to my chest – trying to ground my frazzled nervous system.

A glowing blue laptop screen over a backlit black keyboard
Photo by Markus Petritz, @petritz on Unsplash

It became the worst it’s ever been this week when I carried on to about 7 hours of editing. The two hours leading up to the end were miserable. I was doing everything I could to make it through my remaining work, to the complete detriment of my body. I found myself involuntarily rocking back and forth after particularly awful scrolls, just trying to keep it together while my nervous system went haywire. I should have stopped, but I’m perfectionistic and had decided that it was my un-shirkable responsibility to finish all of it myself. When I did finally finish it, I barely held down vomit after booking it to the bathroom.

Problem-Solving Sensory Processing Disorder Triggers

I wonder if it has to do with the blue light (I plan on trying some blue-light-blocking glasses) or the frame rate of my screen. I haven’t been sleeping well lately, and I suspect that my sensitivity is heightened when I’m not well rested. Sensory Processing Disorder does weird things to my ability to handle multiple types of stimuli at once, and being tired just exacerbates it. In the same way that an escalator on its own is fine but an escalator after a busy day in an airport filled with noise and movement gives me vertigo, being tired makes handling the imperceptibly flickering light and movement of a laptop screen way harder.

There’s something different about this exact setup and workflow that makes things worse. I haven’t pinpointed what that is, but I suspect it has to do with the amount of scrolling. The platform on which I edit requires me to span entire pages numerous times within a very short timeframe.

In contrast, I often work on my blog for hours at a time, just as I worked on my computer for long periods of time on schoolwork or on other jobs I’ve held. Those activities have never had the kind of effect I’ve been experiencing recently, despite being quite similar.

Acceptance of SPD Symptoms

I spent many years not paying attention at all to the way my Sensory Processing Disorder impacts me. I knew I had it, but I told myself that I should be able to do all of the things that other people can do. So I minimized it in my mind. Despite having learned more about Sensory Processing Disorder and having gotten some treatment in the form of occupational therapy in the recent past, acceptance is something I still need to work on.

When simply looking at my laptop screen for too long has such debilitating results, SPD is something I should be considering more carefully. Pushing myself to the point of throwing up was extremely unwise and points to a general disregard for my own wellbeing. I didn’t want to inconvenience other people by being late with my work or shuffling it off onto someone else. And ultimately, I just did not want to admit defeat when it came to something as innocuous as looking at a screen.

I think I’ll try to reframe “admitting defeat” as “taking a really big hint from my body.” If it means living in a way that doesn’t leave me green with nausea and crying, that seems more like winning to me.