Close Your Eyes: The Ketamine Chronicles (Part 16)

April 19, 2020May 5, 2022 Genevieve3 Comments

“I think Stella is a bad influence,” is a phrase I remember hearing Dr. G say during my latest ketamine infusion for depression. Stella is my willful, independent dog who sometimes flat-out refuses to listen to me. In trying to piece together the events of my day, that phrase bounced around in my head without context. What had happened?

Apparently, I had refused to close my eyes. Dr. G repeatedly told me to shut them, but dang it if that little glass dragonfly suspended from the ceiling wasn’t absolutely mesmerizing. I remember it glittering and moving gently while I stared. I closed my eyes eventually.

Some Changes to My Ketamine Infusion

This infusion was different from what I described in previous posts of The Ketamine Chronicles in a few ways. For one thing, it was a higher dose of ketamine paired with a sedative to make it less intense. I also am completely off of one of my mood-stabilizing medications, Lamictal, which can interfere with ketamine. Like my previous ketamine infusion, I took some Tagamet before my infusion to slow the metabolism of the ketamine and make it last longer. The sedative kept this infusion from being bizarre, or at least from me remembering any bizarre images I might have seen.

Abstract architecture made of long, connected panels like scales. — *Photo by Luca Bravo on Unsplash.*

Dissociation with Ketamine Treatments

At first, I didn’t feel as deeply removed from the world around me as usual. This was deceptive, though, as I soon began to feel – as trippy as this sounds – like my being was shrinking into my body. Or perhaps like my body was expanding to create a shell around my consciousness. Things were happening in the room – sounds of typing and clicking, machines beeping, Dr. G telling me to take a deep breath (which I also did not listen to, apparently) – but they all seemed so far away as to be completely beyond my caring.

I opened my eyes periodically to see what was going on and, due to the dissociative effects of ketamine, usually got sucked into the computer monitor, which displayed a series of calming images of winter mountains. This is the danger of not wearing a sleep mask; when you’re hooked up to a ketamine infusion, EVERYTHING looks interesting and it’s incredibly tempting to let all of your automatic functions, like blinking and breathing, be abandoned in favor of absorbing whatever magical thing you’re looking at. Nothing matters more than watching a snowy peak meld into a pine forest. Nothing.

Monitoring Vitals During Ketamine Infusions

It’s a strange experience to realize that you haven’t breathed in a while but not find that alarming at all. In fact, the longer I went without breathing, the harder it seemed to do. It’s sort of a heavy slowness that keeps me from breathing deeply. It has to be quite deliberate. My vital signs are monitored during ketamine infusions, so if my blood oxygenation drops or some other concerning development occurs, my doctor is alerted right away. I’ve had to be reminded to breathe during previous infusions, but a simple, “Hey, take a deep breath,” always seems to break through my trance easily. This time, Dr. G repeatedly telling me to take a deep breath reminded me that breathing was a thing that people did, but I found myself reluctant to put in the effort. There wasn’t much that I cared about doing, and I remember thinking that I felt oddly cushioned against the ketamine.

Intersecting scrabble tiles spelling inhale, exhale, and repeat. — *Photo by Brett Jordan on Unsplash*

Sleeping off a Ketamine Infusion

Afterward, I tottered down the steps to the car and marveled at my mom’s apparent lightning reflexes as she drove us home. We stopped at the pharmacy and grocery store (a whole day of essential outings!) and I simply put my seat back and waited in the car while my mom went in. Unable to get comfortable, I flopped around until the car got too warm. I cracked the door open and leaned out a little to get some fresh air, resting my head against the door frame. I wonder what people in the parking lot thought. I was clearly not very with it and kept doing that embarrassing head-jerk that happens when you fall asleep sitting up.

When we got home, I crashed for several hours, then got up and walked the dog around the block. I didn’t think much about how I was acting until I passed a house and then noticed someone sitting on their porch. I had been walking a few steps, stopping for Stella to smell something, zoning out, then repeating all the way around the neighborhood. I have no idea how long I stood in front of that person’s porch with a blank look on my face, but it might have been much too long to look normal. Who knows – maybe they thought it was quarantine brain.

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 brown fuzzy moth with its wings outspread

Moth Wings: The Ketamine Chronicles (Part 15)

March 29, 2020November 20, 2021 Genevieve6 Comments

As I was pulled into mesmerizing moving images of purple and white half-circles, I remember pouring the words “please fix me” over and over into my mental space. Maybe if I asked it nicely, it would last longer. In a strange mixture of thought and vision, the words became part of the image, and they fanned out and seeped into the fabric of my mind. Ketamine infusions continue to be the best treatment for my treatment-resistant depression I’ve tried, but like anything else, it’s not perfect. Arriving at each appointment feeling depressed once again gives me a sense of hopelessness all its own. I know the ketamine infusion will help, but it may not last. We’re still trying to arrange the best combination of dose, timing, and medications that could help things remain more stable.

Puzzles, Puddles, and Skyscrapers

I closed my eyes and settled back, listening to the “atmospheric piano” playlist I had chosen for yesterday’s ketamine infusion. Eventually, my awareness of my hands and arms disappeared, and I spent some time wondering where they had gotten to. The gentle piano music was relaxing, and tucked under my blanket and weighted lap pad, I began to feel like I was being enveloped in something. I imagined myself being zipped into a giant pea pod, and the image was comforting. “Nothing can get me in my pea pod,” I thought. There were times during the infusion when noise outside the room intruded on me, so I just imagined my soft pea pod and retreated within it again.

There were at least two scenes involving puzzle pieces and building skyscrapers in this ketamine infusion. We’ve been working on a 2,000 piece puzzle of Monet’s garden, and the pink, purple, and white pieces are haunting my subconscious. The puzzle pieces came together to form an endlessly tall building; I craned my neck back to see it disappear into the clouds.

At some point, everything dissolved. I was “looking” at a computer screen, and as I tried to read it, the contents of the page began to melt. The lines ran together, words sagged under the force of gravity, and eventually, the entire laptop softened and melted into a puddle. I began to melt, too. I slipped into the puddle of digital sludge – it looked like an oil slick – and soon accepted my new form. I was too tired and heavy to do anything.

I was far, far, far away when I heard the PA, Erin, ask if I was ok. Finding my mouth and giving it words to say was too difficult, so I nodded and hoped that my head was actually moving. It must have been, since she seemed to accept that as an answer. A little later, she sneezed, which startled me. At the sudden noise, I instantly saw moths with shattered wings, like glass with spiderweb cracks. They fluttered around and came closer until their soft, broken wings were all I could see.

Post-Ketamine Infusion Confusion

Coming back to the room was much harder than usual. I felt a little like I was wearing 3D glasses; everything was in relief with subtle red and blue auras. When asked, I said I felt like “someone else is talking,” meaning the words were mine but the sensation of talking seemed foreign. This is something I experience every time I have an infusion of ketamine for my depression. Erin said I seemed pretty lucid, to which, in relief, I said, “Great – I’m pulling it off.”

Walking down the steps to the first level of the parking garage was challenging. I clung to the railing and stepped carefully, feeling like I was walking on pillows. I’m usually fine to walk after a ketamine infusion; I could fall asleep at any second, but I generally feel pretty with it. This time, though, I felt a lot like this:

Tracking Adjustments to My Ketamine Infusions

In an effort to make the effects of the ketamine infusion last longer, I took some Tagamet before yesterday’s infusion. It’s an H2 blocker used to treat heartburn, but it might also slow the metabolism of ketamine and give patients more time between infusions. I’m usually tired after ketamine infusions, but this was different. I got home around 4 (I think) and by 6:30, I still felt like I was periodically dissociating and then coming back to the room and remembering I was in the middle of something. Walking was hard for a couple of hours. I was off balance and wobbly and had mild vertigo. I think it’s safe to say that the Tagamet is doing something. This morning, I woke up with a mild headache and am still incredibly tired, but the sun is out and our near-impossible puzzle will provide hours more entertainment.

P.S. I remember making a mental note that Shrek appeared briefly during my infusion, but I cannot for the life of me remember how/when. It’s such a bizarre thing to remember, though, that I am sure it really happened.

How Do I Love Thee? A Haiku About Meds

February 20, 2020 GenevieveLeave a comment

New bottle of pills

Contains capsules, not tablets

Let me count the ways

Three of my nighttime pills are tablets, and I like to take them all at once to minimize the horrible dissolving-pill taste as much as possible. One time, two went down but one got stuck to the back of my tongue and began to dissolve. It was like purifying the essence of every cruciferous vegetable and mixing them with charcoal, then pouring the horrific concoction down my throat. Immediately, my esophagus’s movement reversed direction and it took serious effort not to hurl right then and there. Instead, I had to force myself to chug water and think about anything but my poor tastebuds. To this day, the memory makes me shiver in horror.

And now, a change in the formulation of one of my meds means that I have received capsules instead of tablets. It’s the little things.

green-mug-with-steam-rising-sitting-on-side-table-with-rumpled-sheets-on-bed-in-background

Taking Stock of My Life with Depression

January 14, 2020April 1, 2021 Genevieve2 Comments

text about not having energy for anything — *Not my meme. Not sure whose.*

In my experience, severe depression creates a kind of tunnel vision whereby the non-essential tasks of life get shuffled to the edges and only the act of surviving can be focused on. It’s not that you don’t know what’s on the edges, you just don’t have the energy to expand your field of view and look directly at them. I’m in an increasingly healthy place right now, and I’m taking stock of the state of my life with depression. I always knew that I was “falling behind” in my self-imposed timeline. In fact, I’m acutely aware of how much time has passed without me accomplishing the milestones and achievements someone my age is expected to be doing. My life looks very little like what I hoped it would by this point, a fact that is heavy with self-judgment and regret.

I still struggle to believe that depression happened to me. That it wasn’t poor planning, laziness, or a lack of ambition that kept me from moving forward, but an illness. I think that there are two helpful ways of looking at this. In one, the state of my life is a result of severe depression, a disorder that has kept me from functioning at the level I used to. This view helps stop me from blaming myself for every perceived inadequacy and from expecting too much from myself too soon; I do, after all, still have a serious mental illness that requires daily management.

On the other hand, I try to consider the state of my life to be in spite of severe depression. I didn’t do nothing while horribly depressed, I fought for my life. I studied and graduated, I worked part-time, and I adopted a dog. I went to therapy and tried medications and pushed myself to do things when I just wanted to sleep. Most importantly, my life – even as a life with depression – has continued. The things that I consider important for young adults to do or have mean nothing if there is no life to be led.

If you’re struggling right now, give yourself some credit for the courage and persistence it takes for you to show up for yourself every day. There is no timeline.

A woman wearing a black one-piece swimsuit floating in dark water with her knees bent and her arms outstretched to the sides

Underwater: The Ketamine Chronicles (Part 12)

January 5, 2020November 19, 2021 Genevieve1 Comment

Breaking through the thin boundary between water and air is easy, but the farther down you are, the harder it is to swim to the surface. Higher doses during IV ketamine infusions for depression make me feel like I’m sinking beneath vast volumes of water, and the barrier between my mind and the outside world is very far away.

I don’t remember much from this IV ketamine infusion, which I have every few weeks as a treatment for my severe, treatment-resistant depression. I remember sitting in the chair and closing my eyes. Then, a minute later, the machine beeped and the nurse reached over to me. She fiddled with the IV, smiled wryly, then said, “We have to have the clamp open.”

“That helps,” I replied with a smile.

After that, I remember very little. I was listening to classical music in my earbuds, which seems to create (for me) more memorable images than meditation music, but apparently not memorable enough to outweigh the sack of bricks that hit me when the ketamine kicked in. I do remember bursts of thin lines that became ripples on water, and finger painting a nature scene with varying shades of pink. I remember a crocodile, a puffy dress, and watching my inner set of eyelids close to darkness.

It always takes some work for me to come back to the room when a ketamine infusion is over. This time, I kept thinking that people were waiting on me to come out of it, so I thought I should hurry up and return to my body. But, when I dragged my real eyelids open and looked around, somebody said, “Just a couple more minutes.” Oh. That’s why it was so hard to pull myself back. It wasn’t even over yet.

Slow to Return to My Body and Mind

At lower doses of ketamine treatments, I generally feel normal within 30 minutes of the infusion ending, if a little tired. This time, though, it’s all a blur. I remember the rest of the day in jumbled snapshots. Returning to the room around me and talking to Sarah, who mysteriously took the place of the nurse at some point; telling Dr. G that I didn’t remember what I saw; pushing the footrest down with my heels, then walking to the car with my mom. Two kids sprinted past us, almost colliding– wait– was that before the infusion or after? That was before. When I woke up on my bed hours later, I was mildly unsettled that I could remember so little of the day. I know that I wouldn’t have said that I felt weird in the moment, but my memory of it all is so broken that I clearly was pretty impaired.

Four or five hours after getting home, I pushed myself out of bed and tottered to the kitchen for some food. When I turned or bent, mild vertigo briefly grabbed me. A can of soup and a clementine later, I pulled out my laptop to jot down some notes about the infusion, only to sit, stumped by my lack of memory. Listening to the music I chose over again prompted flashes of scenes and images, but I still have the sense that there are some rich plots that I’m missing. It’s like when you know you had a bizarre dream, but you just can’t quite remember what it was about. Ah, well. It’s entertaining to remember my ketamine dreams, but the important part is that it’s getting to work in my noggin to treat my depression as we speak.

person-extending-hands-with-open-palms-in-stop-gesture-as-contamination-ocd-concept-in-black-and-white

An Encounter with Contamination OCD

December 28, 2019May 6, 2022 Genevieve7 Comments

I haven’t been consumed by OCD in several years, something I’m immensely grateful for. That particular kind of mental torture is truly awful and not something I would wish on anyone. One of the subsets of OCD that I had was contamination OCD. My body and belongings had to be whatever my disorder deemed to be “clean,” or else some unnamed disaster would occur. There were often no actual illnesses I was afraid I might contract – I was just terrified of potential contamination by unknown germs/viruses/entities.

The Endless Compulsions

Beyond the fear, maybe the worst part of contamination OCD was how time-consuming it was. If something was “dirty” and it touched something “clean,” or if I touched the dirty item and then the clean item, they were both dirty. I spent a lot of time planning out sequences of actions that would combine touching dirty items because otherwise, I would spend half the time washing my hands raw so as to not contaminate anything else. My hands were always painful. I scrubbed them under hot water until I’d stripped them of any moisture barrier. Any movement cracked and split the skin open, which, ironically, made my bleeding hands perfect entry points for bacteria and viruses. But, OCD is not swayed by reason and rationality. It creates doubt that can’t be rooted out with reassuring facts.

Contamination OCD After Recovery

For the most part, I don’t deal with OCD anymore, contamination OCD or otherwise. My day-to-day life is not consumed by it like it was before, but every once in a while, I encounter something that stirs those obsessions up. My perfectionism around self-harm is one, and tapeworms appear to be another.

Unexpected OCD Triggers

I’m not squeamish, despite what you might think after learning of my past with contamination OCD. Again, OCD is not rational. Parasites are fascinating and don’t bother me from afar, but when I found a tapeworm segment in my dog’s stool, I felt the familiar stomach twisting of contamination OCD.

Once the initial shock passed, I found myself thinking about all of the things I would have to clean. First and foremost, the hand that held the poo bag. I must not touch anything between there and home, not even to put my hand in my pocket. The bed in her crate would need to be washed, and all of my sheets and blankets because she often snoozes on my bed. Should I wash her leash and harness? Perhaps I should stop petting her– would that be going too far? On second thought, that would be impossible. I’ll just wash my hands every time I touch her. So, like, 80 billion times per day.

OCD is Irrational

Keep in mind that the most common species of tapeworm is passed to humans only when you ingest a flea that carries the tapeworm eggs. Not likely. There is also a species of tapeworm that can be passed from dog to human through ingested feces on unwashed hands, but it’s not common in the U.S., and I’m a frequent hand-washer as it is. In other words, it’s very unlikely that I would get tapeworms from Stella.

I Fell into Old Patterns

That night, I lay in bed, Stella at my feet, and tried to control my rising panic. The vet was closed for the holidays, so I had left a message. Having no idea when they would return my call, I did what any smartphone-wielding person would do; I looked it up. Unfortunately, Google played the role of the reassuring-but-clueless friend who says something terrifying right at the very end of the conversation.

“Oh, it’s very uncommon for people to get them? OH, you might not show signs until years after ingestion?!”

Not gonna lie, my concern for Stella was overshadowed by my selfish, irrational fear for myself. The thought of something living inside me usually doesn’t bother me. After all, we are made up of more bacterial cells than human cells. Maybe it’s an evolutionary adaptation to be totally wigged out at the thought of parasites taking up room in your gut.

Facing Contamination OCD with Exposures

The good news is, I realized that I was obsessing about this right before I returned to the scariest thought of them all: “What if I already have tapeworms?” This is good news because it really kicked me into the best way to face OCD thoughts, which is to say, “Yeah, and?”

In the dark in more ways than one, with my tapeworm-host dog not three feet from me, I had to say, “Maybe I do have tapeworms. What am I gonna do about it right now?” Just sitting with the uncertainty brings you to the stunning realization that there is absolutely nothing productive about rumination. So, with a little more deliberate relaxation, my hypothetical tapeworms and I went to sleep. Well, maybe not the tapeworms. Do tapeworms sleep?

Living with Uncertainty

I still don’t know if I have tapeworms, and it’s honestly probably something that I’ll worry about off and on for a while. I do know that I’m much better at squashing obsessions than I used to be, maybe because I know it’s something I’m prone to and can catch it early on. Stella is on a deworming medicine and continues to behave like a dog. That is to say, eats anything and everything with gusto and drinks water out of the Christmas tree stand when nobody’s looking.

woman in orange jacket holding flowers in front of face

5 Tips for Therapy Clients Who Don’t Like Talking About Themselves

December 4, 2019November 10, 2021 GenevieveLeave a comment

If you ever feel like a deer in headlights when asked to talk about yourself, I empathize. Whether it’s one of those dreaded get-to-know-you icebreakers or your therapist asking you a question, having to talk about yourself is uncomfortable for many people. By now, I’ve been in mental health treatment for several years, and I have a few tips for therapy I’d like to offer.

When I first sought therapy for myself, I found it extremely difficult to engage with it fully. If you don’t like being the center of attention, beginning therapy can be overwhelming. After all, the entire point of it is to focus on you. Early on, talking about myself in therapy felt, at times, nearly unbearable. Too many questions too fast made me shut down, and too loose of a structure lead to lots of awkward silences, both of us waiting for the other to say something. Over time, however, I’ve gotten much better at it. Here are some of the ways I’ve found to help me feel more comfortable about talking about myself in therapy.

The essentials

Any list of tips for therapy wouldn’t be complete without a soapbox moment about the therapeutic relationship. It doesn’t matter if you’re just starting therapy or you’ve been in it for a while; it’s vital that you like your therapist. The struggle of talking about yourself will be even worse if you don’t feel understood or accepted in therapy. In fact, research shows that therapy is much more effective when you and your therapist click. Don’t feel bad about shopping around or about switching therapists if it’s just not working out.

Secondly, remember that therapy sessions are for you. Push yourself out of your comfort zone, but go at your own pace. Therapy is your time to do with it what you will.

Communicate what you want to get from sessions

This is a tough one. There’s a lot that falls under this umbrella, but mostly what I mean by it is: tell your therapist if you would like to direct the topic of each session or be given more structure. Maybe it’s hard to talk about yourself because answering questions feels too probative, and you’d rather start off with a narrative. I prefer to have more structured questions because if I’m given free rein, I go blank and have absolutely nothing to say. Regardless of which end of the spectrum you’re on, your therapist is always there to help direct you and keep you on track.

Practice saying how you feel

I struggle hardcore with identifying how I feel. Maybe it’s sensory processing disorder, maybe it’s Maybelline. Sensory discrimination issues have extended into the emotional realm and mean that I often don’t know how I feel about something. If you have a hard time verbalizing how you feel, my advice is to practice. It sounds silly, but just as if you were a little kid, practice saying “I feel ____” and then fill in the blank with something more specific than “okay” or “fine.” Even on your own, check in with yourself; am I feeling excited? Lethargic? Irritated? It really does start to feel more natural over time.

I also find that using metaphors breaks the tension and allows me to communicate more comfortably. For example, my therapist and I talk about “clams” instead of “goals” because the very mention of goals used to make me a sweaty, anxious tear factory. The Potato Scale of Depression is another way that I like to remove a little of the scrutiny from myself and package it up in a statement about mashed potatos or soggy gnocci. There are many ways to get used to talking about your feelings!

Make the Space Comfortable

Of course, it’s not your office. You can’t go swapping out furniture and changing the overhead lights. But you can do some things to make the space more comfortable for you. A therapist I saw in college noticed that I have a very wide bubble of personal space and offered to move her chair a little further away from me. You can ask to close the blinds if it’s too bright for you, bring a small blanket to help you feel cozy, and be sure to wear comfortable clothing.

Stay (Mildly) Busy

Something that I learned in occupational therapy but haven’t put into practice (maybe I should!) is that talking about difficult things is often easier when your hands are busy. Bring a coloring book, a fidget toy, or a craft- if you’re a knitter, crocheter, or have some other portable project. Of course, this is one of my tips for therapy clients that is only good advice as long as your therapist doesn’t need you to be completely present during your work together. It doesn’t hurt to ask.

For us reticent folks, therapy can be scary even just to think about. But, like so many things in life, working on what’s difficult often leads to the best outcomes. With time and practice, talking about yourself in therapy gets easier, especially if you find what will support you and then advocate for yourself.

Love, Your Brain

Tag: mental illness