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Switching Antidepressants: Emsam Update

I’ve been taking Emsam, an MAOI antidepressant, for a few days now, and although I can’t say that I feel amazing, I think I do feel better than I did before I started. The two weeks between ending Wellbutrin and starting Emsam were a struggle, but hopefully will be worth it.

Emsam comes as a patch that you wear for 24 hours and then replace with a new one. It’s an adjustment to not just plop some additional pills into my organizer for the week. It’s ever-so-slightly more labor-intensive this way, but I think it has been easier for me to accept than previous medicine changes have been. I have some kind of hang-up about pills and how many I need, so adding a new one always upsets me. Even though Emsam is a new antidepressant for me, it seems to have bypassed my usual judgments by virtue of being a patch. Perhaps my inner critic is secretly a child placated by cool stickers.

I’m noticing some insomnia, but nothing horrible. In fact, the napping that had returned when I stopped Wellbutrin has been reduced again. Sometimes I still attempt to take a nap because, well, my napping problem is partly fatigue, partly escapism. So even though I still try to pass a few hours by sleeping, it hasn’t been working since the introduction of Emsam.

As a result, I’ve been doing a lot of yardwork. The dandelions are quickly taking over the backyard. Luckily, endlessly repetitive tasks are my jam. I’m digging them up one by one, a byproduct of which is some unintended soil aeration! I also took down all of the rabbit fencing that I used to make our backyard fence taller because Stella was jumping it last summer. That solution did not work for long.

In fact, she jumped a six-foot-tall fence in pursuit of a squirrel the other day, so there really is no containing her unless she’s on a strong tether. Might as well get rid of the unsightly fence addition. She causes me so much anxiety sometimes, but she’s still a wonderful dog.

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Blep

Historically, I’ve been mean to myself about napping because I tell myself I should be doing something productive with that time. Now that I’m not napping (pretty much), I have lots of time to get stuff done. And I’m still mean to myself. What a surprise.

In sporadic bursts, I’ve been searching for a new job for a while. I’ll get started on it, saving postings, updating things, applying to a few here and there, but not really dedicating myself to it because my current job is “ok.” I know that I’m avoiding it. It used to be that I’d be mad at myself for wasting time by napping. Now that I’m not napping, I’m mad at myself for STILL not tackling it, despite having plenty of time as a conscious person. Then again, it’s only been a few days since I started Emsam, and perhaps it will make things easier with some more time.

I’m attempting to heed my therapist’s advice about how a gentler approach is more effective and that no, you won’t become a stagnant blob of disappointment if you stop beating yourself up about your perceived lack of progress. I’m unconvinced, but I’m trying.

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Goodbye, Wellbutrin. Hello, MAOI.

A week ago, I stopped taking Wellbutrin so that I can try Emsam, an MAOI. (I have to wait two weeks between ending Wellbutrin and beginning the MAOI.) I think it was good timing that my most recent ketamine infusion was around the same time I stopped taking Wellbutrin because I’m already feeling pretty terrible. I have the sense that without it, this change might have been even more abruptly bad. Maybe it’s a good setup for when Emsam just blows my mood out of the water, right? A nice contrast will really emphasize its effectiveness. One can hope.

It’s safe to say that Wellbutrin was holding my hypersomnia at bay, and now that I’m not taking it, I’m basically a koala. (They sleep 18-22 hours per day, and not because they’re high on eucalyptus – they’re just dedicating lots of energy to digestion.) It would be great if I could selectively dedicate all the energy I save by sleeping to something else, like hair growth. I could be a brunette Rapunzel in no time.

It is endlessly disappointing to me that I can’t seem to function very well without antidepressants. You’d think I would have accepted it by now. And yet, every single time I change one of my medications and experience a sudden worsening of my depression, I get all upset with myself for not being able to handle it.

I considered this move for a while. SSRIs and SNRIs haven’t helped me much, so branching out to an MAOI seems worth a try. Wellbutrin was clearly helping, particularly in the motivation department, but it was still less impactful than I had hoped. Eventually, I decided that giving up the motivation that Wellbutrin gives me in the hopes that Emsam will help me even more is worth it. It does kind of suck that I can’t go directly from one to the other, though. Two weeks sans antidepressant is proving to be challenging.

A big part of me wanted to just leave things the same and continue to try to build on the benefits of Wellbutrin through my own “natural” efforts. Something that I wrestle with constantly is my uncertainty around what I should expect of myself. It never seems right to say, “I can’t do X because of depression,” because it pains me to be limited by my own brain. So, I continue to struggle far below meeting my perfectionistic standards for myself and then am crushed when “I can’t do X because of depression” turns out to be somewhat true. I never allow myself any grace when depression slows me down.

So, in the end, I’m feebly trying to convince myself that trying yet another medication is fine because if I could have worked my way out of depression by now, I would have. It’s important to do the work I can do day-to-day. But, as anyone with depression knows, it’s tough to do the things that you know are good for your mental health when your mental illness won’t get out of your way. Not impossible! Don’t get me wrong, I’ve been exercising, keeping up with my job, trying to eat 3 meals a day – the works. But that can only get me so far, and most of it tends to fizzle out when I’m in a mental place like this.

I felt okay on Wellbutrin, but ideally, I don’t want to settle for okay. But if Emsam doesn’t work out, it is nice to know that Wellbutrin is something I could return to. For now, I’ll just keep working on my Rapunzel hair and waiting for Wednesday of next week, when I can begin my MAOI experiment.

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Some Benefits of Ketamine Infusions for Depression (for me)

My last ketamine infusion was much less trippy than the previous one, so I’m relieved to say that I remember absolutely none of it. Much less fun to describe, but also less persistently, somewhat threateningly bizarre. We skipped the magnesium this time, and I did not have any sudden, limb-jerking spasms. It’s good to know that was likely the culprit. When I can’t remember an infusion, I feel pretty curious about the off-putting gap in my memory. I always think it’s interesting to know what I experienced during a ketamine infusion, and when I can’t, I feel like I’m missing out on something that I just can’t access. Thankfully, the benefits of ketamine infusions remain even when I can’t remember them.

Eating Food

I’ve been having some problems with nausea and appetite since starting Wellbutrin. They mimic what I feel when I’m really depressed, just amplified. Food is not appealing, neither in my imagination nor my mouth. When it’s time to eat, my goal is to find something that’s least unappetizing. Eating it is a strangely empty experience, as if I can recognize the flavors but can’t assemble them into something I like. The closest analogy I can think of is that it’s like the difference between sound and music. For a few days following a ketamine infusion, that problem is gone. It’s easy to pick something to eat, and not only does it register as, say, a grilled cheese sandwich, but my brain is also willing to exchange it for dopamine. Things taste like how food should taste, and it’s great.

Making Decisions

Ketamine makes the days following an infusion feel remarkably lighter. The difficulty I have with making even small decisions is much improved. I just go about my days without getting stuck at every turn. Speaking of turns, I’ve really been enjoying my morning walks with Stella. When we come to an intersection, I let her choose, and we amble around a ridiculously inefficient route that’s different each day. I am typically a very routine-driven person, so this microscopic spontaneity is a teeny, tiny sign that says
“ketamine helped!” If the ketamine wears off or some other factor occurs and my depression gets worse, I tend to become more rigid in the route we take. I’m sure Stella prefers our ketamine-lightened walks, and so do I.

Thinking about the Future

The bigger benefits of ketamine infusions, for me, are centered around my attitudes about the future. Depression makes me feel hopeless, and ketamine lifts that – sometimes just a little, but sometimes a lot. I’m not sure what determines the degree of helpfulness, but it’s always a welcome effect. It makes it easier to imagine myself making changes and taking big steps.

Other benefits of ketamine infusions that I notice include:

  • Sleeping less
  • Feeling more social
  • Experiencing something called “fun”
  • Feeling satisfied about completing a task
  • Noticing little things that I appreciate or find interesting
  • Reduced suicidal thoughts (hasn’t been much of a problem recently, but I’ve definitely noticed that in the past)

Lately, I’ve noticed that the most noticeable changes stick around for a few days or a week, then things level off to a pretty neutral place where I’m neither jazzed about life nor am I in the pits of despair. By three weeks, I’m in something like the salt marshes of despondency; not inescapable, but pretty unpleasant.

That is a completely individualized timeline. Everyone is different, and I get the feeling from the forum I’m on that there are a lot of people who go much longer between needing infusions. I kind of try not to think about it because of what they say about comparison, I guess. (They = various quotes)

Musings about Medication

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This was tagged “medication” on Unsplash, and I thought, “that’s a weird swap of the typical ‘pills aren’t candy, kids!’ warning.” (Photo credit: Sharon McCutcheon)

My medications may change again sometime soon, and although I just said that ketamine makes making decisions easier, I’m setting that choice aside for now. It’s harder to decide soon after an infusion because I feel like I don’t need to change anything. I feel better, therefore, I should keep things the same. But, ketamine wears off at some point, and even though I feel “better,” should I stop at that point? Maybe I only feel a fraction of my potential “better” but it seems like a lot because it’s better than abysmal. These choices are always hard. I don’t want to settle for just ok, but I worry that I’m expecting too much. Maybe this is exactly how happy people feel – they’re just more grateful for it.

But then a couple of weeks pass and I slowly start sliding backwards into napping and apathy and isolation, and I realize that there was no in-between. It was mildly happy and then increasingly depressed. There must be something more than that. I habitually blame myself for depression in the short term. A bad day or week makes me think that I let myself wallow and didn’t try to change things. I think that I’m lazy and burdensome and why can’t I just be cheerful? But when I look at the long-term – the years I’ve spent with depression – I feel kind of robbed. It’s easier to see the trends of it and the forks in the road where I didn’t pick the option the non-depressed me would have chosen. I may try to blame myself for all of that too, but the more reasonable answer is that depression has been in my way. Sometimes, that perspective makes me determined, and all of the other times, it makes me tired.

My last few months have been saturated with medication changes and mood fluctuations. I go up and down, up and down, and I’m thankful for the ups, but there’s something about the downs that feels so much more impactful. Despite the incremental progress I’m making after starting Wellbutrin, I feel completely insecure in that success, like it’s just visiting and will have to leave soon. A large part of me says that would be disastrous and I’ll just have to claw my way forward from here on out because losing ground would be unacceptable. I guess we’ll find out.

scrabble tiles reading Mental Health with sprig of greenery on side

What’s in a Diagnosis? MDD and SPD

This post first appeared on Mental Health @Home in Ashleyleia’s Emerging Blogger series.

Many thanks to Ashley for hosting me!


Diagnoses are a contentious topic. Logistically, they’re important for clinicians and insurance companies who need proof of your conditions. But for the individual, they come with pros and cons. I carry the well-known diagnosis of Major Depressive Disorder and the less well-known diagnosis of Sensory Processing Disorder. The effects of the diagnoses themselves feel very different to me, and I’ve spent some time reflecting on why.

Well-Known vs Little-Known

A diagnosis of Major Depressive Disorder made me feel much less alone in my suffering. Depression is astoundingly common and increasingly talked about. Stigma remains, to be sure, but awareness surrounding depression is thankfully improving. I can be pretty sure that when I tell someone that I have depression, they’ll know what I’m talking about. The same cannot be said for Sensory Processing Disorder.

Insecurity in a Diagnosis

Having a diagnosis of MDD, maybe more than making me feel less alone, makes me feel understood. Simply saying the word “depression” makes most people, I think, picture the same constellation of symptoms: low mood, lethargy, loss of interest, etc.. This is not to say that I haven’t encountered stigma or innocent ignorance- I have. But when I tell someone that I have depression and they tell me that their brother or friend or significant other has depression, too, it connects us for a moment, and I know that on some level, they know what I’m going through.

This is not generally the case for my diagnosis of Sensory Processing Disorder, at least in my own lived experience. A person with SPD has difficulty processing the information that comes in through their senses, including the usual five (touch, sight, sound, smell, taste) as well as the less well-known senses of proprioception (where your body is in space) and interoception (internal body sensations like hunger). SPD can make you over-sensitive or under-sensitive to these stimuli. I’m over-sensitive to most, just plain bad at proprioception, and relatively unaffected when it comes to taste. Sensory Processing Disorder is overwhelmingly common among people who have Autism Spectrum Disorder, but you don’t have to have ASD to have SPD. They are separate disorders that have a TON of overlap. Despite the growing body of literature from occupational therapists, scientists, and doctors, SPD is not included in the DSM V.  It is, however, its own diagnosis in the ICD 10. This discrepancy is what throws me off. I know that SPD is real. And yet, when I try to explain to someone what it is and how it affects me, I flounder. It’s challenging to describe how I’m affected by a diagnosis that not everyone agrees upon. It leaves me feeling vaguely defensive, or like I’m grasping at straws to explain my symptoms. In this sense, the label of SPD does not make me feel secure in my experience of the disorder.

Feeling Alone with SPD

While it is incredibly validating and relieving to have an explanation for symptoms that aren’t frequently talked about, the very fact that it’s not often discussed makes for an isolating diagnosis. I feel much more uncomfortable when I have to explain SPD than I do while explaining MDD. Once you grow up and leave behind the allowances of childhood, you’re expected to conform to a lot of social and institutional rules. I think this is why kids who have SPD grow up to be adults who hide their symptoms with willpower. They put themselves into situations that cause them distress because it seems like they “should” be able to. The problem here is not that you might push yourself to do uncomfortable things – that’s how we grow. The problem is that people with SPD often hide their discomfort and end up feeling alone and wrong for feeling how they do. It also leads to overstimulation and meltdowns, chronic anxiety, and exhaustion. Ultimately, I am so glad that I know about my SPD, not just because it explains all those sensory symptoms that make me think “why can’t I be like other people?”, but because it offers me room to advocate for others who feel alone in this diagnosis, too.

How a Diagnosis Can Hurt

For me, whether the diagnosis is well-known or not, simply having a name for what I’m going through is incredibly helpful, and I believe outweighs the downsides of having a label. That said, there are some potential dangers of diagnoses.

Mental Health and Identity

I’ve heard lots of discourse about the risk that you might allow diagnoses to seep into your identity until there’s no room for anything else. I enjoy writing about mental health, and at the moment, a lot of my focus is placed on managing my depression. Our experiences shape us, so it’s natural that I find parts of my identity rooted in depression and Sensory Processing Disorder, but I know that I am a whole person without them.

Is a Diagnosis Confining?

The risk that I don’t hear much about when discussing diagnoses is the ease with which a label can trap you in a definition. It’s subtle sometimes, but having a diagnosis of depression can make you perceive even mundane things as attributable to your disorder. For instance, I recently read a book for the first time in a long time, a hobby I abandoned when depression settled in again. The book was humorous, but I didn’t laugh out loud or even pause to appreciate the jokes. At first, I thought it must be because I’m still depressed. I didn’t even consider the possibility that maybe the book just wasn’t that funny. Feeling confined within my diagnosis, the sub-par experience of reading that book became a product of my depression.

A new diagnosis can, understandably, push you to look for information online. Reading case studies and statistics, while informative, might be discouraging. I think it’s very easy to slip into a set of criteria and forecasted outcomes because a diagnosis feels official. It’s easy to forget that a diagnosis is an explanation of symptoms, not a set of imposed rules. Not only is this likely to feel suffocating- like a diagnosis of depression means that any end to an episode will inevitably be followed by another episode (something I struggle with all the time)- but it makes any attempt to counteract it feel futile. I constantly need to remind myself that a diagnosis does not confiscate my agency over my life.

There is Always a Choice

Even within a diagnosis with symptoms outside of your control, there is always a choice. You can always take action, be it reaching out for help or making the choice to take your medications. I take solace in the fact that I’m not alone in my diagnoses, even if it sometimes feels that I am. At the same time, I work to recognize that I am an individual with my own course through life and my own opportunities to fight.

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Detached Curiosity: The Ketamine Chronicles (Part 3)

The days following my first ketamine infusion for treatment-resistant depression were filled with anxious self-awareness (Am I feeling better yet? Is the ketamine working?) I’m pretty sure the answer to the first question was “no”, but it’s hard to say. Suffice it to say, nothing dramatic happened for me as a result of my first infusion.

In an attempt to not get my hopes up nor be overly pessimistic, I’ve decided that my approach will be one of detached curiosity. I’m going to see the entire thing- the feelings leading up to an infusion, the experience of the infusion itself, and the potential changes that result- as if I weren’t invested in the outcome. It’s just a fascinating experiment on my own brain. At least, that’s what I’m aiming for.

The first ketamine infusion was so bizarre that I was trying to prepare myself for anything. In fact, I was already faced with an opportunity to maintain detached curiosity. I had some adjustments planned for the second infusion, and I wondered what effect they would have on the overall experience. Instead of over-ear headphones, I brought regular earbuds in the hope that they would eliminate the overwhelming sound of my heartbeat that noise-canceling headphones created. I also decided that I would put my head back against the headrest at the beginning of the infusion so that future me wouldn’t have to consider whether giving my neck a rest was worth ripping the fabric of space-time.

As it turns out, the first ketamine infusion is often the most strange. Subsequent infusions give people something of a tolerance to the trippy effects of the medicine. My doctor suggested that we reduce the dose a little and add a second nausea medication. So, the reduced dose, increased sleepiness from the nausea med, and improved tolerance to ketamine made my second infusion positively… relaxing. I might have even fallen asleep.

When I got there, things were a little busier than at my first appointment. I was introduced to the nurse, who is only in on certain days, and invited into the second room (across the hall from the one I was in last time, mysteriously labeled “Staff Pool and Spa”). The nurse got my IV in, set up the EKG leads, and took an initial blood pressure reading. I then had time to talk to my doctor about the plan of action. I had a tenacious migraine after the first infusion, which he said is rare, but happens sometimes. He suggested we try an anti-inflammatory medicine to prevent another headache, but I wanted to go without. I sometimes get tension headaches that morph into migraines when I’m extremely stressed and anxious, and that’s exactly what this one felt like. I felt much more comfortable with the process the second time around, so I was pretty confident that if stress is what caused my headache, I wouldn’t get one this time.

The nurse came back in and got things started, and I did my best to relax. I put my head back against the headrest, started some soft instrumental music in one earbud, and closed my eyes. The ketamine felt much more subtle this time, which I imagine is a result of both my body becoming accustomed to it as well as the reduced dose. It didn’t hit me as suddenly, but I found myself realizing that I had stopped paying attention to the room around me. I had a thought, and before I forgot, I turned to the nurse and said “What is this room labeled?” She looked at me blankly, perhaps thinking that I was already too high to articulate logical thoughts. I quickly clarified “Y’know, the other room is ‘Staff Pool and Spa’. So what’s this room?” Understanding washed over her face, and she laughed and said she didn’t know. She got up to peek around the outside of the door and came back with the disappointing answer of “nothing”. We mused that this room should have a funny name, too. Someone floated an idea, but by that point, I was really sinking into a ketamine haze and don’t remember what it was.

The nurse sat next to me, taking notes, and the machine beeped softly just behind me. My mother sat in the corner, typing on her laptop. I gently floated in half-perceived consciousness. I waited for the images to begin, but all I saw were the backs of my eyelids. Black and pale yellow shapes inflated and pushed against one another; they were more distinct than what I normally see when I close my eyes, but it definitely felt like the same process of retinal neurons misfiring. I was a little on edge, waiting for weird images to creep in, but once I realized that wasn’t going to happen, I tried to just let go and float. I put the other earbud in (groping for my ear with numb fingers) and settled back.

Large chunks of time were punctuated by movement in the room. I heard my mom close her laptop and take out her knitting. The metallic needles clinked together softly. The nurse put her hand on mine and told me to take a deep breath, in through my nose and out through my mouth. Apparently, I had forgotten to breathe and my blood oxygen level dropped. At some point, the doctor cracked the door open and I heard him whisper to the nurse that I should keep my eyes closed so as to minimize nausea. Later, the nurse and the doctor switched. I noticed the differences in how they walked, sat down, and how much noise they made while taking notes and shifting around. I kept my eyes closed the entire time. My usual discomfort in having my eyes closed around other people and activity was suppressed; I was paying attention when something happened, but I was content to only listen.

When the ketamine infusion was done, it seemed like it took less time for me to return to normal. The additional nausea medicine worked wonders, although I did feel more sedated. I’m happy to report that I did not get a headache following the infusion. However, I’m not happy to report that I’m not happy. Definitely still depressed. I’m trying really hard to not get discouraged, as I’m only 1/3 of the way through the initial series. I won’t lie, though, it’s tough to not be disappointed.

Reminder to myself: detached curiosity.

 

 

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It’s a Trip: The Ketamine Chronicles (Part 2)

I learned a lot about what to expect from my first ketamine infusion when my doctor asked if I had ever tried any hallucinogenic drugs. My response was “no,” and my experience was about as trippy as I could expect from that lead-up.

I’m writing this from my bed at 8:20 pm, the evening after my first infusion. I do have work to be doing, and I tried that for a while, but I figured “Hey, I spent 45 minutes today coming to terms with the fact that I was just a floating head who no longer had a body, then blessedly reunited with my limbs over the course of 20 nauseating minutes, only to come home and do work? I don’t think so.” So, in an effort to empty my brain, here are my first impressions, unexpected experiences, and mundane realizations of today.

First of all, because I’m a woman of child-bearing age, I’m required to take a pregnancy test. I had better improve at peeing in a dixie cup because it’s not just one test, it’s before every infusion. Why am I so bad at that?

Second of all, the door to the room I was in was labeled “Staff Pool and Spa”, and I’m not at all sure what to make of that. My doctor seems to have a good sense of humor. I did wonder what the other room was labeled, but was too focused on not letting my baby giraffe legs buckle on the way out. I’ll report back.

If you missed part 1, I’m getting a series of six ketamine infusions to combat my treatment-resistant depression. I was very scared about this for a couple of reasons, one being the uncertainty of what the treatment itself would be like. I wish that I could give some kind of concrete answer to that question for anyone with the same anxiety. There are commonalities, I’m sure, but there’s no way anyone else could see the exact same quilted rocket launching into outer space that I did. Or, if for some reason you do, we should hang out sometime.

For me, the general feeling of a ketamine infusion is one of warmth, dissociation, and internal images. The first sensation I noticed was warmth, particularly in my arms and chest. It was quickly joined by the feeling that my limbs were all floating away from me. Looking around the room became extremely disorienting. It was like my brain could interpret whatever my eyes started on and where they stopped, but nothing in between. For a while, I was pretty with it. My doctor asked me some questions to gauge how far gone I was, and I had no trouble answering them. I had to remember three words and repeat them back a few minutes later, and I had to count backwards from 100 by 7s (not very far). The comprehension and answering of these questions was no problem. What was weird was the sensation of talking itself. It was like there was no space between thinking and talking, so as soon as I had a thought that I had some intention to speak out loud, I heard it coming out of my mouth as if someone else had said it.

After a while, I started to retreat from the room and into my mind. When I closed my eyes, I was unnerved by the sensation that my body and my head were very slowly spinning in opposite directions. So, I tried to keep my eyes open. Everything in the periphery of my vision faded out until I could only see what my eyes were focused on. But even then, my brain would pull me in, and although my eyes were open, I wasn’t seeing anything. I was listening to calm, instrumental music through over-ear headphones, but the music was dramatically overshadowed by the sound of my own heartbeat. This was somewhat distressing, so I took the headphones off. Without the headphones, the buzzing fluorescent lights held my attention. It began to sound like cicadas were all around us, and I was reminded of warm, spring evenings in Michigan. I closed my eyes.

What I saw in my mind during the ketamine infusion is fading and jumbled, and I remember it in much the same way that I remember my dreams- just out of reach. I do know that the beginning was defined by knit and quilted geometric shapes moving and growing slowly. Dark purple colors against dark backgrounds, shapes like wheel cogs and tower spires. For some of it, I felt like my mind was falling (at this point I didn’t have a body), but not in a frightening way. Just a slow, gentle descent. Later on, I felt impossibly tall and constantly growing. I stretched through the atmosphere, into outer space. I soared past the moon and out beyond our solar system. I thought about telling someone, but decided it might sound a little grandiose to describe my incredible, galactic height.

My sense of time was warping; when my doctor said it had been about 30 minutes, I felt like it had only been 10. After that, though, time seemed to move agonizingly slowly. When I heard “just a few more minutes” I was a little relieved, but soon began to wonder why my definition of “a few” and his definition seemed to be so wildly different. My mother was sitting across the room; why would they leave me here for another hour? Eventually, some beeping next to me indicated that things were ramping down. I slowly returned to my rapidly overheating body. I managed to say “very hot”, and the blanket was removed, along with my scarf. The room wobbled, my stomach turned, and I closed my eyes again.

The time it took to fully come out of it was probably about 20 minutes, but again, I wasn’t the best timekeeper. Moving my head and eyes provoked the nausea, so I had to settle with the awkward feeling that I wasn’t making enough eye contact while people were talking. We chatted about what it felt like, what kinds of things I saw, and what I thought about during the infusion. When I felt sturdy enough to bring my legs up to my chest, I put my head down on my knees and cried. I can’t say why- the anxiety beforehand, the nausea, the fear that it won’t work, maybe all of the above. It was an overwhelming experience, but I’m told that it gets easier.

I was hoping that I would sit down to write this and be able to say that I feel miraculously less depressed, but that isn’t the case. For some people, ketamine makes them feel better within hours of their first treatment. For others, it takes a few more infusions. And for still others, it doesn’t work at all. So, for now, all I can do is wait.

Until next time.

sunrise casting orange glow on sparse clouds above shadowed trees

Depression: The Ketamine Chronicles (Part 1)

This is the beginning of a series of posts chronicling my experience with IV ketamine infusions. Starting something new, something very different from the numerous antidepressants I’ve gone through in the last few years, is overwhelming. I’d like to document my experience as a way for me to process it through writing, as well as to provide a first-person account of what this might look like for others who are considering the infusions. The use of ketamine to combat treatment-resistant depression is effective for many, many people. So, whether it works for me or not, I’ll try to be as honest as possible.

Several months ago, my psychiatric nurse practitioner suggested that I look into ketamine as a potential new avenue in the search for something that will work against my treatment-resistant depression. Every antidepressant I’ve thrown at it has had little to no impact, and I’ve effectively become chronically suicidal. I said “ok, sure,” and then pretended that conversation had never happened. Weeks passed, then months passed, and as I got closer to the present and could no longer ignore my reality, ketamine seemed more and more like the next logical step. Nothing I’ve tried has given me much relief, and my depression has steadily worsened.

Luckily for me, my lovely mother is an avid Googler. By the time I was ready to go down the ketamine treatment path, she had bookmarked and downloaded every resource and testimonial in a three-page radius of a “depression ketamine” Google search. When I came home from a difficult appointment and told her that I’d decided to schedule a consultation at a clinic, she said “Great. I’ll send you the website of the one near us that I think is best. You can start filling out their forms.”

As an aside, let me point out that my mom is so wonderful. She did hours of research and planning, but respected my right to choose my treatments enough to wait for me to make the decision before piling it on. Thanks, Mom

OK, so what is ketamine for treatment-resistant depression? In brief, ketamine is an anesthetic that, when used in very low doses in a clinical setting, has been shown to dramatically improve symptoms in participants with treatment-resistant depression. Chronic depression that doesn’t respond to traditional antidepressants is associated with significant alterations in brain structure and function, as well as deficits in BDNF, a marker of neuroplasticity. Evidence suggests that ketamine facilitates the repair of those damaged areas by increasing the levels of BDNF.

At this point, my depression is severe, and it has been for a long time. I probably met the criteria for what would make me a candidate for IV ketamine treatments a long time ago. So, why did I wait so long to do this? That’s easy: I’m scared. Naturally, the next question is: why am I so scared? Not so easy. For one thing, getting ketamine infusions is a procedure, a word packed with health-anxiety overtones. For another, moving from antidepressant pills to a treatment administered by an anesthesiologist feels like a big deal. It forces me to confront the fact that this is really serious; if I don’t up my game from antidepressants, I could die. That’s scary. What’s even more scary is that for a long time, that’s exactly what I’ve wanted. I’ve had thoughts of suicide in varying degrees for years now, and at this point, the thought of dying doesn’t shock me at all.

Right now, despite having an appointment already booked for tomorrow, I’m on the fence. I know that it sounds absolutely bonkers that I would still be considering suicide, even when faced with a very promising treatment that I have access to. But, that’s depression. It’s an illness that, although you can’t think your way out of it, certainly affects the way that you think.

I have never known what it’s like to be a young adult without depression symptoms. When I think about the possibilities that life holds, my mind can only conjure up images tinted by depression. I can imagine having a job that I like, but my mental image of it includes the constant fatigue and loss of focus that my depression brings. “Feeling Better” no longer holds much meaning for me because I no longer remember what it feels like to Feel Better. So, when I think about how other treatments have affected me (minimally), it makes trying another one seem… not worth it. I can’t fathom what life would be like without depression, but then again, depression makes my imagination dull and limited.

In one more day, I’ll have had my first IV ketamine infusion. I’m trying to keep an open mind, to admit that maybe life with fewer symptoms is better than I can imagine, and to allow myself to have a little bit of hope. Although I don’t have much faith, I’ll have to take a leap.

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Considering My Next Mental Health Treatment

I have an appointment coming up with my psychiatric nurse practitioner, and that means my thoughts frequently settle on the effectiveness of my mental health treatment. By now, I’m familiar with the questions she’ll likely ask me, but somehow the answers never come easily. Determining how I feel is not something I’m very good at, although I’ve gotten better at it. This time, I’ll attempt to describe the seemingly endless plateau of “meh” on which my mood currently resides. I have occasional dips into the dark chasm of “really bad,” but for the most part, things are ok. But as I decided after I was released from the hospital, I’m not settling for “ok” this time. I want to feel great, exuberant, joyful, even- happy. Happy would be good.

At this point, it seems like I’m running out of viable mental health treatment options that come in pill form. I was told I was a candidate for and encouraged to try Electroconvulsive Therapy (ECT) while in the hospital (a treatment that has changed immensely since it first began). My mother’s worried googling turned up IV ketamine as a promising treatment that my psych NP also encouraged. I knew people in my partial hospitalization program that moved on to do Transcranial Magnetic Stimulation (TMS). These are all safe treatments that, if they work, can change your life for the better. So, why am I so resistant to the idea?

I think it comes down to acceptance. When I first became depressed, it took me a long time to get to a place where I felt comfortable taking antidepressants. I clung to (and sometimes still do) the idea that if I just tried harder, all my problems would be solved. This is because, like many of us, I’m way too hard on myself. But it’s also because it was scary to fully accept that I have an illness that can’t be overcome through sheer force of will; a fact that my biochemical imbalance predetermines. On one hand, taking responsibility for your mental health is an important part of managing it. On the other, there’s an element of frightening imposition that comes with accepting that the very fact of your diagnosis is out of your control. I carry my depression around with me- not by choice or through lack of effort, but because its complex tangle of symptoms, neurological effects, and genetic alterations are not things I can leave behind.

Despite coming to terms with the apparent chronic nature of my depressive episodes and the fact that right now, I need antidepressants, I see this next step in mental health treatment options as Phase Two of my personal acceptance hurdle. It was tough to accept that I needed antidepressants, and now it’s tough to accept that I may benefit from another level of psychiatric treatment. I like to mull things over for a very long time, so until or if I decide to make that leap, I’m just considering it.

Medicine

medicineIt’s nothing to be ashamed of I tell myself twice daily. What day is it? They all blend together. I open the third compartment, pour the pills into my palm, wait for a moment. Maybe this day will be the day. Maybe if I give the medicine a moment of silence; infuse it with my desperation before I let it fall down the dark well of my esophagus.

How many have I tried? Not enough that all hope is lost. How many have I tried? Enough that they call it “treatment resistant” depression. I call it drowning by degrees. Later, I open the third compartment, pour the pills into my palm, and wait a moment.

It’s nothing to be ashamed of.

Love,

Your brain

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How I Learned to Advocate for Myself

I’ve been enjoying all of the content online for Mental Health Awareness Month, and I thought I’d contribute my own story. Here’s my own experience of why advocating for yourself is important.

I have severe psoriasis, an autoimmune skin condition that makes itchy, flaky plaques where my skin cells regenerate too quickly. During my recent hospitalization (for severe depression), I let my doctors know about this in a brief, it’s-not-that-relevant-but-you-asked kind of way. When the psychiatrist asked if I had any physical conditions, I informed him of my psoriasis.

A few days later, I was meeting with my social worker to discuss my treatment plan. Under “diagnoses”, Major Depressive Disorder and psychosis were listed. Before I even said anything, my social worker quickly brushed it off and said “don’t worry too much about the psychosis- it might just be that you were confused when you came in”.

Now, I’m the kind of person who will eat the wrong food at a restaurant rather than speak up and point out a mistake. I’m the kind of person who willingly takes the middle seat on an airplane because my neighbor explains that she has to pee a lot. Seriously. I am not assertive.

However, diagnoses are a whole ‘nother bucket of fish. When I saw that on my treatment plan and heard my social worker minimize it, I made it clear that I was confused by it and wrote my concern in the questions portion of the form. The next time I saw the psychiatrist, I steeled myself in preparation to ask about the mysterious psychosis that I definitely didn’t have. Before I could bring it up, he sat down, sighed, and said “it turns out that they couldn’t read my handwriting and thought I wrote ‘psychosis’ when really, I wrote ‘psoriasis’. It’s all fixed, now.”

I laughed about it at visiting hour that night and for many nights after. Really, we’re still laughing about it. We’re getting some serious mileage out of that one.

The important thing is that I spoke up for myself and that it got remedied. I almost had an incorrect diagnosis which could have caused more confusion down the line. So, speak up! If something doesn’t look right or feel right, let your doctor know. They’re people too, and sometimes mistakes happen.

Also, handwriting is more important than you might think.