Tag: mental health

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Self-Compassion When Living With Depression

Genevieve2 Comments

I had a conversation the other day about the balance between recognizing that treatment-resistant depression is chronic and pushing oneself to do difficult-but-healthy things.

It started with a question: What advice would you give someone about dealing with depression?

Personally, I find it helpful to remind myself that depression gets in the way of my ability to think clearly. Depression brain is a liar. It makes me think that I’m a stupid, horrible burden and that everyone would be better off without me, even if they say otherwise. It makes me think that feelings are forever and that I must be too weak to effectively change myself.

It’s really hard to change the way you think, especially when depression is sitting on you, yelling into your ear about how terrible you are. Sometimes it helps to remember that I have a disorder that skews my thinking. But that doesn’t mean that I shouldn’t push myself. It’s a difficult balance; to recognize that my symptoms explain my behavior, but they aren’t the be-all-end-all of what I do.

You know how frustrating it is when a well-intentioned but misinformed person tells you that if you’d just try barefoot ultra-marathon running or hot goat yoga at 5 am, you wouldn’t be depressed? That person is inside my brain all the time, and because I know that it’s unreasonable to expect myself to just *poof* try harder and not be depressed, I’ve always struggled to write something on this subject. I don’t want it to come across in the same way that my brain talks to me, because I would never, ever talk to anyone about their depression in same the way I think about my own. My brain says stuff like this:

“Yeah, you feel pretty crappy today, and you know why? Because you only ran one mile. Maybe if you’d run THREE, you’d feel better. You only have yourself to blame.”

The example that I’d like to set as a person who writes about mental illness is something more like this:

“I still feel crappy, even though I went for a run. I’m glad I did it, though, because I know that it’s helpful – even if it doesn’t feel like it.”

That kind of thinking is really hard to implement, and I won’t lie – I’m pretty far from doing it naturally. It’s hard in part because we know that things like exercise, being outside, and social connection are helpful for depression. How much pressure should I put on myself? How much am I capable of when I’m depressed? Should I be expecting these things to “fix” me? Whenever I ask myself these questions and get bogged down in the details of how much I’m doing, my plans for doing more, why I should be doing x, y, z, I miss the obvious point.

I’m mean to myself.

I’m trying to convince myself that it doesn’t really matter how much I decide to do in miles, minutes, or step-by-step sequences. It only matters that I did a little bit more than I wanted to. It only matters that I did something because it’s good for me, not because I bullied myself into it. It’s good to set goals (or clams, if you’re being fancy) for yourself, and it’s fine to go at a pace that works for you under your current circumstances. I know that for me, I often fall into the trap of expecting myself to function at the same level that pre-depression me did. Sometimes I worry that if I don’t berate myself enough, I’ll get complacent and stop striving to improve. In reality, I know from experience that the motivation to grow returns naturally when I’m feeling better. It’s tough to believe it, but my first priority should be to treat my depression, and everything else will fall into place.

If you’re hard on yourself for not meeting your own expectations while depressed, I relate. A lot of people relate. After all, feeling bad about yourself is itself a symptom of depression. And to be clear: trying to be nicer to oneself is not advice intended to invalidate that symptom. It’s not to say “you’re doing it wrong, just be nicer to yourself,” it’s that combatting negative self-talk with positivity (or at least positive-tinged neutrality) is a strategy intended to treat that symptom.

I’m not very good at it yet, but I’ll keep working on it. Gently.

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

Genevieve5 Comments

The last couple of weeks have been hard for me when it comes to depression. I recently wrote about how IV 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 ketamine infusion, so I didn’t push myself to write about it. I thought it would likely be boring, anyway.

The Ups and Downs of Ketamine and Depression

I can’t say for sure why that IV ketamine treatment 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.

Dissociation with IV Ketamine for Depression

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.

Acceptance and Flow in Depression Treatment with Ketamine

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.

Noise in the IV Ketamine Clinic

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.

Brief Synesthesia?

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.”

Images from My Subconscious

The rest of the ketamine 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.

Seeing Improvement in Depression Symptoms

Given my general lack of response to the previous IV ketamine treatment, 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!

If you’d like to read more about my experience with ketamine for depression, start from the beginning of The Ketamine Chronicles or visit the archives. Click here for mobile-optimized archives of The Ketamine Chronicles.

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Therapy Code Words

Genevieve2 Comments

Unfortunately for me and my therapist, my ability to write words does not always translate well to being able to speak them. I need time to think through an entire thought before I speak it, and I struggle sometimes to get the words out when the topic is something challenging. And not just for sensitive topics like self-harm or suicide, but even for topics like life goals.

In fact, the word “goals” makes my stomach twist. I feel so much internal pressure when it comes to my ambitions that any discussion of the topic overwhelms me. It’s as if I know that once I start really acting to reach my goals, I’ll have to go all out because I don’t know how to not do something 100%. And that’s overwhelming. And unrealistic. So I try to avoid talking about it or thinking about it beyond my daily sense of guilt for not “doing more.”

It goes without saying that I don’t like this. Goals are important, and they should be exciting, not something you dread. Yes, they often take hard work to reach, but I think the balance of work to reward should be worth it. I don’t want to put in work just to alleviate an unhealthy internal pressure; I’d rather work for something because I want the excitement and fun and pride of achieving the thing. Depression makes this hard. Excitement and fun and pride are not feelings that depression wants around. So, I find myself terrified of adding more to my plate and pursuing my goals, and terrified that I’ll do nothing and fall even more behind my self-imposed schedule. Trapped in between the two, “goals” is a scary word.

Here’s where the code word comes in. Instead of “goals,” my therapist and I talk about “clams.”

It’s groundbreaking, I know.

There’s no significance to clams, it was just the first word my therapist thought of, but it stuck. Much like the Potato Scale of Depression is useful in its humor, “clams” are somehow easier to talk about because of the silliness. It takes away the gravity of having a discussion about goals and replaces it with a lighthearted conversation about a bivalve often eaten with a lemon-butter sauce.

And this is how I want my goals to be. Not so scary. Not so enormous. Just little steps to bigger results, like shucking one clam at a time to make a chowder.

Photo: Andy Castille – @kikini

5 Ways I’m Reducing My Depression Naps

Genevieve2 Comments

I sleep ok at night and WAY too much during the day. When I’m really depressed, I can get up early to take care of my dog and then go back to sleep until late afternoon. Sometimes, I can limit my depression naps when I have a lot keeping me busy, such as any work tasks I might have – which I do from home and largely on my own schedule within a day. But for the most part, I find myself frustratingly vulnerable to the sandman’s influence. Plus, now that Stella is no longer a puppy, she’s happy to spend hours on end with me, dreaming of whatever dogs dream of while we sleep on my bed. She used to wake me up every couple of hours to demand something from me, but now, it’s all snoozing.

1. Running

Running is a two-birds-one-stone solution for me, because it offers both the physiological and biochemical benefits of exercise in addition to the incredible fact that you can’t sleep when you’re running. I’ve lost a lot of my endurance, but I’ve been maintaining at least some regular running, which is remarkably easier to do the more recently I’ve had a ketamine infusion. I recently noted that the day after an infusion, I ran three miles without stopping, which I hadn’t done in months. Then, a few days before my next one, I struggled just to run one mile. Why is it so different? I guess that as the ketamine wears off, I lose the mental energy to push myself very far, and I’m worn out as soon as I start. It’s frustrating, but I try to just be pleased that I got out there at all. Perhaps, if I manage to rebuild my endurance a little, it’ll be easier to keep it up even through the changes to my ketamine buffer.

2. Setting the Intention with No Nap Monday

No Nap Monday was created in response to the smashing success of Yes Day, both of which were proposed by my therapist. No Nap Monday has been far less successful, but I do try to at least sleep less on Mondays. Sometimes I set an alarm for something reasonable, which is definitely subjective and changes week to week. Sometimes, my depression naps are an hour. Sometimes, they’re three. But no matter what, it’s good to at least have the intention.

3. Adding Activities

Ultimately, my goal is to not only sleep less, but also do more. It follows that I should attempt to add things to my routine. Volunteering is option that interests me. Over the years, I’ve volunteered or worked with animals in a few different capacities, and I always really enjoy it, so I tend to look for opportunities in that area. There’s an animal rescue near me that needs volunteers to feed the bunnies, and that sounds right up my alley. I just have to tackle my expert-level overthinking habit and then plow through my anxiety about new things and I’ll be right on track!

4. SAD Lamp Makes Me Happy (or at least less sleepy)

It’s now mid-October, so I pulled my seasonal depression lamp out of my closet the other day. The weather doesn’t affect me as much here in Colorado as it did in Michigan, but I can tell after a few cloudy days that I’m in need of some sun. Simulated sun will have to do.

5. Changing My Routine with Depression Naps

Much as I hate doing it, deviating from my routine often keeps me from giving in to depression naps. I tend to get irresistibly tired as noon approaches, and my mood slopes downward in the afternoon anyway, so that’s my prime depression nap opening. By forcing myself to be busy doing other things during that time, I keep my brain on its toes. The downside to this is that I do well with routine for other reasons, so abandoning that makes me anxious and sometimes decidedly cranky. But at least I can prove to myself that I am capable of functioning without depression naps.

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Owl Eye: The Ketamine Chronicles (Part 25)

GenevieveLeave a comment

IV ketamine treatment for depression is one of multiple treatments I use for my mental health. We’re still adjusting it and trying new doses as things change, which makes for interesting little self-experiments. Last time, we went without propofol and discovered that it was fine for me; in fact, I preferred it. This time, I forgot to check for refills on my scopolamine prescription, so I didn’t use any prior to my appointment. With no propofol, no scopolamine, and a slightly higher dose, this ketamine infusion felt remarkably vivid. It was much like the first few ketamine infusions I had, which were dominated by immersive scenes and imagery that constantly changed.

IV Ketamine Treatment for Depression Feels New Every Time

I felt it quickly this time, the room beginning to sway and bend even before I fully settled in and closed my eyes. Still, I only saw darkness for what felt like a long time but was probably only a minute or two. Then, subtle lines took shape, and my mental lens zoomed in on an owl’s face. The eye was my focus – although the steely beak caught my attention as well. The image rotated slowly before fading away, the owl’s eye staring back at me.

After the rotating owl, the sounds of the room made an appearance in my mind. The gentle chug chugging of the infusion pump reminded me of a train, and I soon saw one on the horizon of my internal view. It belched smoke – an early, coal-powered one – and rumbled closer and closer. The black smoke filled the air, blocking my vision until all that remained was a small view of the front of the train as it trundled by. Black smoke, liquid, or goop filling my vision was something of a theme in this ketamine infusion. On other occasions, it expanded from small blobs until they met and pressed against one another, filling whatever volume my mental space contained while I tried to see through a narrowing hole.

Memory Recall During Ketamine Therapy

If I’m correctly piecing this together from my garbled and typo-riddled notes, which I took in the car on my way home, the sensation of being smothered by the black smoke brought my awareness to my mask. This, in turn, created an image of cloth above my face, with an illegible tag sewn into the seam (a common theme in my infusions is not being able to decipher letters or numbers).

My mind then conjured up a lovely memory of building a couch fort with my brother as kids. The memory itself was jumbled and consisted of snapshots – balancing the cushions just right, sliding head-first over the arm of the couch and down into the fort, and sitting with my knees pulled up in the dark confines of our shared space. The most convincing parts of the memory were the sensations. I could feel the texture of the couch upholstery and the give of the stuffing in the cushions. I noted the darkness with cracks of light where the cushions didn’t meet, and the feeling of the seat cushion grazing the top of my head. I don’t think I’ve ever re-experienced a memory during a ketamine infusion before. It was a comforting feeling to be returned to the experience of being a kid, entranced in the moment by the fantasy of a simple couch fort.

Recurring Themes in Depression Treatment

As usual, water made an appearance in my ketamine dreams. This time, it began with a slowly spinning whirlpool of green/yellow water, lit from within to make the water glow. Soon, I was in the whirlpool, and it turned into the ocean. The water swelled around me, and wave after wave overtook me until I was underwater. It was not frightening, although in describing it, I realize it sounds a lot like I was drowning. Once underwater, I saw an apparently incredible scene which I do not remember but my notes describe as, “Turtle? Fish on lines like balloons. Underwater city of fantastical things.”

A purple striped fish with spiky fins in the ocean.
Photo by Sophia Muller on Unsplash

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

Altered Visual Perception and Ketamine

I returned to the room several times during this infusion, convinced that it must be over soon, only to find that the people had swapped or left or reappeared. My mother had gone to run an errand and had dropped me off but returned partway through my infusion. I saw her sitting in the corner maybe four feet from me, yet it seemed that she was very, very far away. It was a little like looking through the wrong end of binoculars. I tried to read her expression – was she even looking at me? The more I tried to settle my gaze on her, the more my eyes refused to cooperate. They jumped around and made double images, and eventually, I admitted defeat and closed them once again.

Sense of Time During Ketamine Infusions

The scenes and images I was seeing were so numerous that they seemed to be packed into time in an unbelievable manner. It’s strange to think that I could experience so much in such a short amount of time, but even after all of that, there was more. I remember walking over a mountain range with an enormously tall man – I was also enormous – while he proudly described in great detail how he made the mountains. In another scene, a golden dog (I think it was a statue?) was hidden in a room packed with items. My notes reference my teeth feeling soft, something about lizard scales, and robotic cats. “What if they found my head underneath San Francisco?” must have been in response to an extremely bizarre episode of Star Trek that I recently watched in which Data’s head is found during an archaeological dig underneath – you guessed it – San Francisco.

I’m so glad that I took notes on my phone immediately after my ketamine appointment, because I find that the memory of it fades over time unless I can remind myself of what I saw. I was functioning pretty well after my IV ketamine treatment and was able to get myself to take notes rather than close my eyes on the way home. The rest of the day was fairly pleasant. I greatly prefer infusions without propofol both because of its effects during the infusion as well as because of how it alters the rest of the day. Of course, I wasn’t entirely myself until several hours afterward. I took my shoes off somewhere in the house upon getting home and promptly lost them. I could not figure out where I put them until I found them the next day in a closet. Why would I put them away?! In a closet?? Absurd.

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.

Things That Don’t Suck

GenevieveLeave a comment

The last two days have been washed in heavy winds. The leaves, just turned golden-yellow, are being stripped off of their branches to accumulate near the front door, where they’re much less pretty. It’s a small thing to be disappointed about, but it seems as though so many things in the world suck right now. For one thing, our Home Depot skeleton, David S. Pumpkins, is constantly buffeted by wind on the seat from which he offers a cheery wave. Every morning, I find him slumped over as if we force him to sleep outside on the park bench, when really, he just doesn’t have the muscle tone to stay upright. What must the neighbors think? He likes it out there, I promise.

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Up and at ’em, Dave!

You know what else sucks? Depression. I recently had my regular mental health bloodwork done to make sure my lithium level is within the appropriate range, as well as to measure my thyroid function. All is well. Lithium can cause hypothyroidism, which can cause fatigue. We thought it would be worth investigating as a potential cause of my excessive sleeping, but no – that’s just depression. Don’t get me wrong, I’m glad I don’t have to make adjustments or take new steps to deal with a whole new problem, but reducing my lithium dose or adding a thyroid med sounded like a simpler answer. Instead, the answer is just to carry on treading water in the sea of treatment-resistant depression. Just keep swimming, right?

So, let’s make some teeny tiny inflatable water wings to keep us afloat. Here’s what hasn’t sucked lately.

  • My houseplants are doing great. Man, they look healthy.
  • I learned how to use my new, short ChuckIt to throw a tennis ball like I’m skipping rocks rather than overhead. (My rodent-obsessed dog prefers to chase things that go along the ground.)
  • I unearthed two whole sets of flannel sheets that I forgot I had.
  • I swapped out the hummingbird feeder for the regular bird feeder, and it’s becoming quite popular.
  • The coyotes woke me up with their howling the other night. I always find it eerily mesmerizing. 7/10 spooky.
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Hi, little chickadee.

What hasn’t sucked for you, lately?

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Ink Blots and No Propofol : The Ketamine Chronicles (Part 24)

Genevieve1 Comment

Yesterday, I had another IV ketamine treatment for my treatment-resistant depression. We tried getting rid of the propofol for this infusion, which sounded interesting because it had the potential to help me remember more about the experience as well as make the after effects easier. I can’t say that I remember everything, but the infusion feels more real in my memory than it has in recent weeks.

Is It Working Yet?

Despite having done this numerous times, it’s still hard for me to discern when the ketamine takes effect. I kept checking in with myself, thinking, “Is it working yet? Are those blob shapes my usual closed-eye blobs, or something different?” But eventually, it became suddenly obvious that it was working. I started to feel like my nose had melted, leaving just the bare nasal bones exposed. This somehow reminded me of a seal closing its nostrils before diving underwater. I wondered if what I was feeling was close to what it feels like to be a seal. In hindsight, this makes no sense. Just having no nose is nothing at all like being a seal, but it seemed logical in the moment.

Colors, Ink Blots, and Numbers

The beginning of the ketamine infusion is the part that I remember the most completely. At first, the darkness behind my eyelids felt very normal and familiar. But soon, pale colors moved gently against the black, like lava lamp goop merging and bubbling off.

The colors eventually faded and were replaced by intricate black and white designs that reminded me of kaleidoscopes. They were incredibly detailed, and I don’t think I could ever recreate it. As they morphed, their intricacy faded and I was reminded of Rorschach ink blot tests. Somewhere in my brain, it occurred to me that that association was especially funny, given the context. What does it mean if you see shapes within shapes that you created yourself?

Black and white ink blot swirl.
Photo by Hulki Okan Tabak on Unsplash

At some point, there were pages and pages of numbers that didn’t mean anything to me. They were mostly organized into columns and lists, and I tried to focus on interpreting them, but was unsuccessful. This is something that seems to happen repeatedly when I have an IV ketamine treatment for depression – I see overwhelming quantities of numbers or letters that I can never quite decipher.

That’s about the extent of what I remember. The rest of the ketamine infusion seemed to consist of fairly mundane experiences and scenes, although they escape my memory.

What IV Ketamine Therapy for Depression Feels Like

I’m glad that we tried it without propofol. I was a little worried that it would be too intense, but it turned out just fine. As usual, I felt far removed from the room around me. My body was in the chair but my mind was somewhere else. It’s sort of like there’s a tiny me inside my own brain, viewing images that create a highly convincing sensation of having my eyes open. To then test it by opening my real eyes is a bizarre feeling.

The rest of my day was dramatically different compared to days when we’d used propofol in conjunction with ketamine. With propofol, I often sleep for the rest of the day, broken with occasional small tasks like walking the dog or doing some laundry. I must metabolize it slowly, because when I wake up the next day, I have a lot of trouble piecing together the order of events or even what I did at all. It becomes clear that I was lot less sharp than I thought I was.

Without propofol, the disorientation and grogginess wear off more quickly. I’ll sleep for several hours, but then can function fairly well, if a little physically unbalanced. I vastly prefer to be as alert as possible. The sensation of not actually having made decisions with my full wits about me is unsettling.

I’m hoping that my old pattern of improvement two days after a ketamine infusion is consistent. The short series of treatments we did recently helped combat my depression symptoms, but there’s definitely room for improvement.

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.