I’ve started bringing my dog to therapy. Does she sit with me and look patiently into my eyes while I cry? No, definitely not. She spends 10 minutes wandering around, smelling the smells of the week with great vigor. She pokes the diffuser with her nose, sticks her whole head in the trash can, and squeeeezes behind my therapist’s chair to not-so-sneakily smell her belongings. Then, she goes back and forth between the window and relaxing on the rug, ears perked up, listening for outside sounds. She comes over to me for pets and cookies every once in a while, but mostly, she’s just nice to have around as my unofficial therapy dog. She’s completely oblivious to my human problems. Looking at her blissful ignorance during therapy is like a brain palate cleanser.
You can’t help but wonder what she thinks of this development. Here we are, in this room we come to sometimes for no discernible reason. Pretty comfy. New smells since last week. 8/10. Would be better if I got second dinner. All that matters to her is that I feed her, walk her, and let her sleep at the foot of my bed. She’s a simple creature – intensely curious and frustratingly smart – but simple in that she really doesn’t need a lot to be happy.
She shares some of that innocent joy with me. She makes me smile every single day. It doesn’t matter how depressed I am – she does something goofy or sweet and has no clue that I find her antics ridiculous. Like how she leads with her face when encountering snowdrifts, or her exasperation at me taking constant photos of her, or the many, many hilarious faces of Sleeping Stella.
Sometimes, when I try to change something in my treatment(s), my depression says, “No, thank you.” Changing my medications has not gone well for me in the past, but I continue to clutch my personal dream of reducing the number of things I pick up from the pharmacy. I recently added a drug which required me to get off of something else, which overall, does not seem to have gone well. The options now are complicated and I don’t particularly like any of them, but I still have Stella! The routine, obligatory outdoor time, and turbo-boosted zoomies have done me immeasurable good. She demands my attention and action, and there’s really no telling her to just go entertain herself. Our walks are sacrosanct to her. No replacements. And no skimping on length, either!
This was part of my goal in adopting her, and it worked in more ways than just the responsibility of it. I thought that it would be healthy for me to be forced to get out of bed and do things, but that the emotional reward of that would come during my good times. I wasn’t expecting my unofficial therapy dog to be able to careen through the fog of my depression and make me smile every single day. A smile or laugh every day certainly doesn’t fix everything, but it’s something to be thankful for.
I’m always looking up at the sky when the water closes over me. This time, it was cold, and an eggshell-thin layer of ice formed above me while I watched. Gentle waves followed one another, freezing over the previous layer and leaving a frosty texture on the surface. Darkness spread from the periphery of my vision until I strained to see through the last window of light, the only notable image being the shadow of a person standing above me on the ice.
I didn’t put a lot of effort into remembering this IV ketamine infusion. I know there were graceful, disembodied hands dancing amid blue and red lines, swirls, and dots. There was more water – ripples and waves, mostly. There was a pyramid with a circle above it, which turned into a blinding white light. I’m certain that there was a lot more, but it’s faded away from me by now.
Treatment-Resistant Depression
My mental health is declining. I’m not sure why. IV ketamine treatment doesn’t seem to be working as well for me, now. Every day, I have to rate my mood on a ten-point scale. It’s hard to capture how I feel in numbers. Potatoes are easier, but still not quite enough. Honestly, sometimes words themselves seem too limited. How can I describe how I feel?
This morning, I woke up at 4. I got dressed in the cold – same clothes as yesterday – and went to the kitchen for some food. I walked the dog when the sun came up, but we came home quickly because of the sharp, cold air. My eyes feel heavy. Not the lids – the actual eyeballs; they sit heavy in their sockets, like wet marbles or enormous caviar. I wonder, if I tip my head forward, will they fall out? When my depression is worsening, I often notice this feeling in my face. Everything is heavy and hard to move, and I’m sure my expression is grim. I think the clinical term is RDF – resting depression face. At least my pandemic mask covers most of it.
Maybe the person above me on the ice in my ketamine dream is me. I’m on thin ice. Skating across a just-frozen lake in my wool socks at 4am. Someone else is waiting beneath the surface, straining to see through the darkness. Is she also me?
__________
Why Do I See Water in My Ketamine Treatments?
My recent IV ketamine infusions have all featured water, and I’m often drowning in it. It’s not scary – it’s peaceful. It’s soothing. I’ve never stayed up by the surface before; always finding myself sinking into the dark, quiet depths. But this time, I was floating – pressed against the underside of the ice, trying to see through it to the person on the other side. I was curious about this person, but the darkness closed in before I could begin to unravel what was happening, and then I found myself in a different scene, which I do not remember.
I’m fascinated by this recurring theme of water, especially because in my regular life, I’m not a big fan of it.
An Early Trauma
I have sensory processing disorder, and as a young child, I flat-out refused to swim. I was overwhelmed to the point of tears by the splashing, the echoes in the pool, the temperature change from air to water, and most of all, the fear of people touching me. I eventually came around to the idea, but never enough to take lessons. So, having never properly learned how to swim, I nearly drowned at a friend’s birthday party when I was 8.
I remember being uncomfortable going into the deep end, but my friend was insistent. I lost my grip on the side of the pool and began to sink. When people say that drowning is not a dramatic event – there’s no splashing or screaming – they’re right. My head tilted back instinctively as I went under, and I could see my hand, extended above me, slip under as well while the rest of my limbs flailed uselessly underwater. A panicked hopelessness overtook me as I choked on chlorinated pool water. Then, my friend’s hand broke the surface, reached down, and grabbed my wrist.
I have never felt relaxed on or in water, and it’s not just the near-drowning that explains it. The same sensitivities that kept me from participating in swimming lessons have persisted into my adulthood. I dislike the unsteadiness of water, the unpredictability of how it will splash, the feeling of water on my face.
And yet, when I’m reclined in my doctor’s office, ketamine moving into my bloodstream, visions of water are soothing. I can feel the cool, constant pressure of being underwater without the anxiety or the sensory overload. I can feel myself standing on the deck of a boat, watching the foamy water beneath me leap forward and recede, and I feel peaceful. I’ve seen whirlpools, rivers, melting glaciers, and the unbelievable enormity of oceans. It’s a strange experience to suddenly realize what water might be like for other people, as those feelings are foreign to me in my waking life.
Photo by Cristian Palmer on Unsplash
I feel as though, unhampered by the symptoms of my sensory processing disorder, I can connect to a larger, evolutionary interest in water that I am unable to find under normal circumstances. Humans have been fascinated with water for millennia. In fact, some evolutionary anthropologists believe that nearness to water supported the development of large brains – that we are, in part, the heritage of small, coastal communities of early humans whose lives revolved around the movement of water and the food within it. To this day, many island and coastal cultures retain great reverence for the ocean. When we gaze out upon a watery horizon, it is difficult to not be awed by the vastness before us. In my eye, to find our place in relation to bodies of water is akin to our struggle to find our place in the vastness of space. Questions of identity and survival are found in the depths, and I believe we carry the answers within ourselves.
Lessons from IV Ketamine Treatment for Depression
My depression is a constant in my life. It is all-encompassing, lonely, and feels like drowning. I’m not one to find meaning in every dream, but the images of water that I experience during IV ketamine treatments have begun to feel profound. What does it mean? Certainly not that I should give in, wave a white flag and let the water crush me. Nor should I wait breathlessly under the ice, squinting as if to look through a frosted pane of glass, uncertain if I’m even above or below. Rather, I believe my visions of water are windows into the nature of the human experience. Perhaps they’re snapshots of how I feel – how depression feels to me. My mind is an ocean, and at times, it’s oppressive. I sink within myself, finding it easier to let the water cradle me as I descend than to keep swimming. At other times, I find comfort in accepting the changing nature of my illness. Like a river flowing downhill, impermanence is unstoppable, and the emotions of being a human move inexorably back and forth. When we crest the top of a wave and begin to fall down the other side, we wait for the next one, just as we take each arriving day. And when you are drowning, reach up. A helping hand may be just about to break the surface.
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.
Sometimes I feel like a bird that can’t figure out how to fly. I periodically get launched out of a cannon (in this metaphor, that’s due to IV ketamine treatment for depression), then flap and flap to no effect. I’m trying to make progress, but gravity is always there. Eventually, I sink lower and lower, just exhausting myself with all that flapping.
That’s how it feels, but I don’t think that’s entirely accurate. Yeah, ketamine wears off eventually, and yeah, my brain has a biochemical problem that means I can’t fix depression just by flapping. But the flapping is doing something. All that work I put into therapy and maintaining a routine and getting exercise must be functioning in tandem with the IV ketamine to push my little bird wings just a smidge farther.
I know this because my mood still dips pretty low sometimes, but on the whole, I’m in a better place than I was a few months ago. Perhaps it’s that I bounce back faster, now. Or maybe it’s just knowing that it won’t last forever.
And now, being able to look back and see that I’m flippity flapping on my own a little makes it just a little bit easier to continue. Chipping away at something day by day is tedious and frustrating, but all of that work adds up. If you can look back at where you were a little while ago, it helps to notice that in working on depression, you have made progress, even if it’s just in the personal growth or a skill you’ve learned or the support you’ve gotten.
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 ketamineinfusions 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.”
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.
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?
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.
May is Mental Health Awareness Month, and Mental Health America has several initiatives to spread awareness during May. One of these is #mentalillnessfeelslike. Peruse different categories on their website, where MHA has compiled Instagram posts from people participating in the hashtag. It’s always comforting to find validation in others’ experiences.
The hashtag got me thinking about my own attempts to represent what mental illness feels like to me. This blog is mostly writings that describe my experiences with depression, anxiety, and their various treatments. So, for something different and a trip down memory lane, I thought I would take a jaunt through some of the art I’ve made on the topic of mental health/illness.
The following slideshow was my attempt to depict a strange sensation brought on by an antidepressant I no longer take. It left me feeling “better”, but in an artificial way, as if I could feel my depression just outside the boundaries of myself. It was sort of like being squeezed into a neutral mood that didn’t fit.
And then we have The Potato Scale of Depression, born when I responded to “how are you” with “everything is mashed potatoes”. What I meant by that was that the world was dull, my senses felt mushy, and seeing past any of it felt impossible. The beauty of the potato scale is that it opens the door to describing your mood in a creative, silly way, while still communicating a serious topic. And, you get to have eye-opening conversations about how you and your conversation partner rank various types of fries. Of course, this is an abridged version of the scale; there’s a whole world of poorly-prepared potato dishes to choose from. (Soggy latkes, undercooked gnocci, etc.)
Clearly, analogies are my favorite way to say how I feel. This next one is a good reminder for present me.
The rest are simply some depictions of what mental illness feels like to me.
Love, Your Brain 