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A Ghost Town: The Ketamine Chronicles (Part 22)

I woke up a couple of hours after going to bed following my most recent ketamine infusion. It was around 1 o’clock when I began my slumber, so when Stella woke me up, looking like she needed something, I automatically fed her dinner because it felt like I had been asleep for a long time. Then I wandered into the living room, where it dawned on me that bright sunlight was streaming in through the windows.

What day is it? Is it still daytime?

Perhaps I entered a different dimension where time passes more slowly. Or maybe I’m taller than the moon and my head is therefore circling the sun at a different rate. I went back to sleep, but apparently woke up periodically to accomplish my nightly routine. Wednesday’s cubby in my pill organizer is empty, and I vaguely remember flossing my teeth. Half of what I wrote here was already done, which surprised me when I opened my laptop this morning to write. My phone informs me that today is Thursday, although it feels like several days have passed since yesterday’s ketamine infusion.

I usually go about three weeks between appointments, but my depression has made a comeback. Similarly to how I first began getting ketamine infusions, we decided to do a short series of infusions in quick succession to try to reset things and boost my mood. In addition to the short series, we’re also trying another medicine that can enhance the effects of ketamine. Scopolamine is an anti-nausea drug that comes in the form of a patch that you place behind your ear. I can tell that it did something; the infusion itself felt more enveloping than usual, and for hours afterward, I had this weird sense that I could feel my blood traveling through my blood vessels. It almost felt like being squeezed – like the boundaries of my body were working harder to keep everything contained within my skin.

I talked to Dr. Grindle (whose name frequently autocorrects to Dr. Griddle, which I think is hilarious) about our plan of action at the beginning of the appointment. My previous infusion was my first experience with ketamine assisted psychotherapy (KAP). The goal of it was to help me bypass the frustrating barriers to talking that I run into in therapy by having a ketamine infusion and a therapy session at the same time. It was a fascinating experience, but also a little overwhelming, so I decided to just do a normal infusion yesterday. I’ll revisit KAP another time.

I don’t remember much from this infusion. The addition of all these other anti-nausea and sedating medications makes it hard to remember what I thought about and saw during the infusion. They also make me crash when I get home, which lets whatever memories I do have fade away before I have a chance to write it down. One part that I can vaguely recall came from a suggestion made by my therapist. After our KAP session last week, we marveled at how much I resisted talking about particular topics, even while zonked out on ketamine. This week, she suggested that I imagine building a bridge across the moat that protects my mental fortress. I have yet to figure out why some parts of my everyday life show up in ketamine infusions and some don’t. The image of a bridge over a moat certainly stuck, although probably not in the way that my therapist hoped it would.

Thinking about castles and fortresses created an odd merging of memories and imagination in my mind. At first, I found myself thinking about the ruins of castles on the Danube River in Germany and in the rolling hills in Wales. I imagined the people who lived in those castles milling about and going about their daily lives. Then, I seemed to combine that train of thought with memories I have of going to Caribou, an old silver-mining ghost town from the 1870s. It’s situated not far from where I grew up.

We used to go up there and explore the crumbling stone structures and look for currants and wild raspberry bushes. In my distorted ketamine haze, I saw people working in the half-built structures. All of the trappings of normal life were there; a large pot in the fireplace, a sturdy wooden table on the dirt floor, women in long, pioneer dresses and aprons bustling around in the four walls under the open sky.

At some point, the ruins were surrounded by a moat, and a figure stood on the opposite side. Remembering that I was trying to let the person cross the moat, I conjured up a drawbridge. Interestingly, simply creating the bridge was not enough. I couldn’t seem to keep the drawbridge down; it kept raising over the water, leaving the moat impassable again. It was somewhat frustrating – like those dreams where everything keeps going wrong, no matter how much you try to find a way around it. I suppose next time, I should build any bridge but a drawbridge.

I feel a little bit better. When I’m awake, I feel more motivated to get things done, and my immediate reaction to being faced with an opportunity or an obligation is not automatically “Ugh. No.” This is one of the more frustrating phases of depression for me. I feel capable of doing things, I sometimes even want to do things, but I’m so unbelievably tired that I waste hour after hour asleep. I’m starting to wonder if that’s a normal depression symptom plus side effects of the medicines I take, or something else entirely. All I know is that it makes me feel enormously lazy when I wake up 5:30am and am struggling to keep my eyes open only three hours later. It hasn’t always been that way; when I was first diagnosed with major depressive disorder, I didn’t feel the need to take a nap until mid-afternoon, and I could limit it to something more reasonable. I’m not sure what happened besides a worsening of my illness and the meds I take, or if those factors explain it all. Something to ponder.

 

silhouette of wolf standing on ridge with tall grass at sunset

The Wolf and the Goat: The Ketamine Chronicles (Part 18)

At this point, I’ve lost track of how many ketamine infusions I’ve had (they don’t line up exactly with the number of blog posts). My treatment-resistant depression has dug its heels in once again, and I’m wrestling for the millionth time with whether or not there is any chance of improvement for me (despite having experienced significant improvement that fell apart when the pandemic began. Clearly, it is possible). In a conversation with my therapist in which I explained my growing sense of hopelessness and how it makes me reluctant to keep going with ketamine infusions, she pointed out that I have said that ketamine makes a difference. It’s true. It’s tough to remember that the hopelessness is the depression talking. I can’t trust my assessment of the world when I’m getting all my info through the warped view of depression. At least, I think. Sometimes it’s all so confusing.

The Wolf and the Mountain Goat

The wolf had its mouth open, partway through devouring some kind of amorphous, green animal. Perhaps a giant frog? An algae-covered sloth? Try as I might, I couldn’t interpret the image correctly. But there, below the wolf’s fearsome jaws, was a pure white mountain goat kid. It stood perfectly still, watching the wolf eat its catch. That mountain goat should move, I thought. Directly below a hungry wolf definitely seemed like a risky place for a baby mountain goat. But nothing moved at all. The image was static. And then I remembered that I was not supposed to have my eyes open during my ketamine infusion, and I definitely was not supposed to be staring at the photo on the wall across from me. There is no wolf in that photo- nor is there a mountain goat. It’s a picture of a river flowing through rock formations with greenery on the shore. It was quite a trip.

framed photo of river flowing through canyon

framed photo of river flowing through canyon with shapes of wolf and mountain goat outlined in red

I can’t unsee it.

Ketamine Visions of Water

From the beginning, I could feel the warm air inside my mask. At some point, it started to feel like liquid, like I suddenly possessed the ability to breathe underwater. I’m fairly neutral when it comes to swimming in real life, and I don’t have any particular fascination with water. But ketamine always brings out these intense associations with bodies of liquid water and, occasionally, ice. Ripples and waves of all sorts, whales, jellyfish, cold rivers flowing downhill, being on a boat, icebergs; these are all images from previous infusions that stand out enough for me to remember them. Perhaps the physical sensations of unsteadiness trigger my brain’s water-related pathways. Except that I’m always decidedly stationary during ketamine infusions. In any case, I’d be interested to know if other people also see lots of water during their infusions.

This time, it was the ocean, or perhaps a very, very deep lake. My perspective was from beneath the surface, and I could see someone sinking slowly from the glowing blue into the inky blackness below. I was watching the person, but I also was the person. We were sinking through vast expanses of empty ocean, only water and light around us. It was striking but lonely, only the silhouette of a human form, gently falling through deep water. Slowly, the light receded above and I began to think that I didn’t want to be in darkness. It occurred to me that the person was drowning, and although I felt comfortable enough, that meant that I was also drowning. We were, after all, the same person. I didn’t know what was beneath us, and the unknown was somewhat unsettling. But everything was heavy, and the constant pull of the water was hard to resist. It was confusing; how was it possible that I was breathing the water that filled my mask? I must be drowning, but I felt fine, only incredibly heavy. Then I heard my own voice in my mind say forcefully, “open your eyes”, and suddenly, I was back in the room, looking at the wolf and the mountain goat once again.

Space and My Mental Map

Have you ever looked at a familiar room and felt like you’ve never seen it before? Like you just never really looked at the angles of the walls or the color of the furniture? I’ve noticed that my ketamine infusions often give me the sensation that a room has changed and space is distorted. When my eyes are closed, I feel as though everything is moving closer to me, but also over me. It’s like the weight of my body is folding space so that my surroundings move up and over me. Things feel much smaller, and I’m always momentarily surprised when I open my eyes, the space instantly expands, and I find myself in a bigger room than I expected. And every time, it’s as though I’m looking at a room that I’ve never really looked at before. By the time I’m semi-lucid and ready to set my legs in motion towards the hallway, the feeling has passed and the room is familiar again.

Some Thoughts on Masks

I don’t often relax in places that aren’t my own home. Even friends’ and family’s places give me that tense feeling of being a guest; I’m less familiar with my surroundings and therefore need to be alert and polite. It’s uncomfortable to imagine that someone might walk by and catch me making myself at home by taking a nap or, I don’t know, putting my feet up. I’ve obviously been forced to let that go to a very large degree for my ketamine infusions. But it’s gotten me thinking — this might be why I tend to open my eyes so much. My vulnerability alarm goes off when my eyes are closed anywhere that’s not my home. I guess it periodically yanks me out of whatever trip I’m on so that I can look around for a second. Maybe that also explains some of why I remember such vivid scenes. It’s like when you wake up in the middle of a dream and can recall it with perfect clarity, versus sleeping all the way through it, and then all you know in the morning is that Shrek was there.

That said, lots of people wear a sleep mask during their infusions and find that the darkness helps them immerse themselves in the experience. I have found that wearing a mask that covers my nose and mouth does make me feel oddly secure – like it’s hiding me from any eyes that may look in my direction. I wonder if a sleep mask would have the same effect, or, as I expect it might, just make me feel more vulnerable by preventing me from looking around occasionally. Who knows – I may try it someday.

(Imagining my entire face covered in masks makes me feel like the spider in that viral voice-over video: I cannot see you, you cannot see me…I am hidden.) 

 

 

The Day 2 Mystery: The Ketamine Chronicles (Part 17)

It’s been two days since my most recent ketamine infusion. Usually, I write these posts as soon as I’m able so as to not forget too much of the bizarre experience. This time, I found that I didn’t have much to say immediately following my infusion.

For transparency’s sake in my attempt to document my experience with ketamine, I’ll just say it. My mental health has been in decline over the last few weeks, to the point of struggling once again with self-harm, something I thought I had kicked over a year ago. The previous infusion seemed not to do much for me in terms of mood, but gave me more energy and motivation, a mismatch that left me restless and confused. I felt the drive to do something but had no desire to follow through. Perhaps this is what led me back to self-harm. Multiple stressors, not exercising as frequently, and a strange mix of motivation and hopelessness led me back to an old, unhealthy coping mechanism.

I had my most recent ketamine infusion on Friday. Like last time, it was relatively empty of bizarre images, at least that I can remember. At this point, my dose is pretty much at the upper limit of ketamine for my body, so Dr. G has been giving me propofol to make the experience less trippy. Last time, I stubbornly kept my eyes open for a lot of the infusion and seemed not to care about breathing. This time, I don’t think I could have opened my eyes if I’d tried. I remember chatting with Erin, the PA, while she got the I.V. set up. I know we talked about haircuts, but I’m not sure what else. The propofol hit me way before the ketamine did, and the last thing I remember is Dr. G taking an exaggerated deep breath and wagging his finger at me sternly before leaving me in Erin’s capable hands.

When I closed my eyes, the world disappeared above me as I sank down into peaceful nothingness. At some point, I remember feeling as though I were a passenger in a car on a highway, open road stretching ahead of me. We began to go a little too fast for my liking, but I was stuck– carried along by the seat beneath me. This is the only image I remember with clarity from this infusion. I also remember that, because I couldn’t feel my face, I was occasionally concerned that I may have taken my mask off. Laughable in hindsight that I thought I could have moved with enough coordination to do that.

Yesterday, the day after my infusion, I felt no different than I have for the past few weeks. Actually, I think I may have felt worse. But today, I awoke with a wonderful sense of relief from my symptoms. Whether this lasts remains to be seen, but it follows an interesting pattern. The day immediately following an infusion is often disappointing for me. I’ve learned to not put too much stock into whether or not an infusion has helped based on the day after. The second day, however, is usually when I notice the changes. I don’t know how common this is, but I think it’s interesting.

I have already put on my exercise clothes, anticipating a long run later in the day. I’m looking forward to today’s project of re-painting the grape arbors. I have mental plans to clean the kitchen and change my sheets, and maybe even vacuum. It’s great to feel better, but the previous few weeks have me apprehensive about this infusion; will it last? Will I need to adjust my medication or have more infusions to stabilize my depression?

We shall see. But for now, it’s nice to feel a bit better.

Thoughts on Perspective and Depression

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Photo by Chase Murphy on Unsplash

When I’m moving out of severe depression and into something closer to happiness, I’m intensely aware of the fact that I will soon forget what it felt like to be depressed. Not intellectually, of course. Having the experience of depression makes me forever able to empathize with others and remember, in objective terms, what it felt like. But the internal feelings– the heaviness, the soul numbness, the twisting slowness of being utterly squashed by life’s requirements- all of those will trickle away until I can only comprehend them from afar. Just as I can’t quite grasp the truth of happiness when I’m depressed, I can’t quite understand depression when I’m well.

It’s a problem I contemplate fairly often. Holding two perspectives at once isn’t fully possible, so I find myself slipping between two conclusions with different contexts. When I’m depressed, I vaguely remember feeling better. That memory, however, always pales in comparison to current pain. I eventually end up concluding that dragging myself back to mediocre happiness would not be worth the effort.

Inevitably, when the depression ends or at least improves, I understand how clouded my judgment was. Over time, I forget just how sharp and all-encompassing depression can be. I disregard its immediacy, letting healthy coping skills fall to the wayside. When I move beyond the basics– eating, bathing, stepping outside– to more advanced skills like socializing and nurturing my ambition, the basics are the first to go when stress hits. This is especially true when time has faded the memory of how quickly depression can return.

It scares me that depression so thoroughly warps my thinking, and recalling the cycle of depression and recovery makes me wonder if any number of episodes will teach me to ignore my depressed brain. It’s easier when each day is different; I can tell myself that this will pass– and I might believe it. But when I’m entrenched in depression, it stretches ahead of me until it’s all I can see. Then, the lies my brain tells me seem awfully convincing.

Right now, I’m going day by day. Things aren’t wonderful, but they’re not terrible, either. When I want to crawl back into bed in the middle of the day and not get up until tomorrow, I try to remember that I’ve been here before. I’ve been here before and I’ve done that before, and it never changes anything. Eventually, things will get better, and maybe I can get there faster if I make those hard but healthy choices. So, I’m back to the hardest self-care of all: doing what’s best for you even when it’s the last thing you want.

What to Consider When Switching Therapists

There are lots of reasons you might go from one therapist to another. You might be moving, looking for another perspective, or simply feel ready for a change. Or, it could be that your therapist is leaving; career change, maternity leave, any number of scenarios in which you must decide what to do with your treatment. And, pretty much no matter what, switching therapists is hard.

I’m in this boat right now, and I’m finding it more tricky than I expected. For one thing, I’ve had the same therapist for almost two years. We’ve gotten to know each other (in a heavily one-sided way), and when I’m not completely shut down with depression, I really enjoy her company. It takes me a minute to be comfortable with someone, so the thought of switching therapists and beginning that process again is daunting.

Online Research

When I began my search for a new therapist, I started with Psychology Today’s therapist directory. You can filter it by issue, insurance, gender, and other factors that might help you narrow it down. I also tried googling a combination of “therapist” with “depression” and my area.

Contact Method

Some therapists provide an email address with their contact information. Text, be it emails or SMS, is BY FAR my favorite way to communicate. Making phone calls is an arduous process, what with the scripting and practicing and heavy sweating. But, leaving a message on an answering machine is, in my experience, more likely to get you a speedy reply. [Pro tip: if you approach phone calls the same way I do, keep a list of potential therapists and the status of your contact. I can just imagine leaving the exact same scripted message for the same person twice and being mortified enough to cut contact entirely.]

Make Appointments with Multiple Therapists

I highly, highly, highly recommend that you make appointments or consultations with multiple people. It’s way more time-consuming, and I’m finding it difficult to tell my story again at each new appointment, but it’s the best way to find a therapist that you like. Your current therapist might give you a list of people to call, you can search the web, and if you meet with someone and it doesn’t work out, ask them if they have any colleagues they can recommend.

Therapists Understand that Switching Therapists is Hard

Switching therapists is an interesting process to go through after being in therapy for a while and having done the search a few times before because I feel much more sure of myself. I know what kinds of approaches I’m looking for and I know roughly what to expect at an initial appointment. But, I also have more of a history within the mental health treatment sphere to explain in a coherent manner. The sequence of events is too long to describe in detail at a first meeting, so I have to decide how to summarize in a way that gets everything across. I don’t always succeed, and then we’re left filling in important gaps that I forgot about. Fortunately, therapists understand that the transition can be a difficult process.

It can be hard to leave a therapist who has helped you through really tough times. They’ve supported you and listened to you, and it’s natural to be sad that your time with them is over. But, it’s not meant to be a relationship that lasts forever. I’m going to miss my current therapist, but I’m also looking forward to getting a new perspective. It might be just what I need to put all the pieces of my recovery together.

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Taking Stock of My Life with Depression

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.

grey cat in sunlight yawning

My Depression Naps are Unnecessary (Shocker)

Over the last week, I have taken a grand total of one nap. ONE. This is grossly reduced from my usual minimum of six depression naps per week, each spanning roughly three hours. I cut back on naps this week because I was spending time with my family, instead. Between running errands, cooking, cleaning up, and catching up, there wasn’t much time to sleep during the day, and if there was, I prioritized family time.

The week is over, and I’m learning that I’m capable of being more active than I feel I am. My depression and the medication I take to treat it make me tired, and I might need a whole ‘nother week to recoup from this napless week, but I can function without naps. I think I should take this to mean that doing more is more sustainable than I thought.

I’ve been nervous that adding activities outside the house would be a disaster, because how could I go out and do stuff when I sleep for three hours every afternoon? This is probably a cart and horse problem; I’m worried that I won’t be able to fulfill my commitments if I still feel the need for excessive sleep. But perhaps adding more commitments to my schedule will make me less depressed, and therefore, I would sleep less. There’s bound to be an unhappy medium in the middle, but it would probably settle out eventually. In (wildly simplified) essence, be tired and have nothing to do, do more and briefly be more tired, then be a normal amount of tired and have fun doing whatever you want. This is something that everyone in my life has been saying forever, but sometimes it takes a while for you to come to the same conclusion, right?

A large part of my robust depression nap schedule is due to the lithium I take in the morning. However, I’m sure that another part of it is, at this point, a habit. My brain has learned that every day at the same time, we go to sleep for a few hours. It’s come to expect it. Breaking out of that habit is tough, but if I eliminate that and reduce my depression as much as possible, I’ll be left with just the lithium tiredness. That’s manageable, and as I’ve learned this week, very possible to function with.

Before I was even taking any medication, I slept as an escape. I went to bed before dinner because I didn’t want to be awake anymore, and I took long naps because I couldn’t stand the feeling of experiencing an entire day. Maybe this was what I needed, for a time. It helped me face my existence in more manageable chunks, but then it spiraled into something more damaging. I’m not going to stop taking naps entirely. I feel best when I give in and curl up on my bed for a few hours, sleep it off, and wake up partially refreshed. But I’m also going to remember that I don’t have to do that.

three-tiered cake with blackberries sitting on wooden table with vase of white flowers in background

A Fish Wedding: The Ketamine Chronicles (Part 8)

It’s been two weeks since my last IV ketamine infusion, and I’m still feeling much better than I did before I started. Minor setback due to my lithium experiment aside, it seems like the ketamine hadn’t started to wear off yet, meaning we could schedule the next one for three weeks out.

As they all are, this infusion was pretty…different. I popped my earbuds in and started a classical music playlist. Like last time, I closed my eyes and waited for it to begin. It was subtle, and when Dr. G asked me a few minutes later if I was feeling it yet, I opened my eyes and was met with a normal-looking world. “Not really,” I said. Of course, I was eating my words when, a couple of minutes later, I felt like my nose was sinking into my face. (It should be noted that none of this is ever scary for me. I had the sensation that my nose was sinking, but I was completely aware that it wasn’t.)

I thought that maybe I should say “my nose is sinking into my face,” as Dr. G wanted to know when I felt it taking effect. Somehow, this got lost when I began seeing a whirlpool in a lake that turned into the eye of a storm, spiraling endlessly (song: Full Room Empty Space by Vincent & A Secret).

[I tried to remember which songs went with which images by taking screenshots of my lock screen. I’m finding it tough to remember the majority of this infusion, but I’ll do my best to match up the songs with what I saw.]

When I got home, I sat down with my laptop and my phone and began trying to recreate the images I saw by listening to the songs over again. Most of them only evoke general feelings and a vague memory of an image. For example, I remember that Prelude and Fugue in C by Bach produced a vision of bright red ink spreading on a ceiling of thick watercolor paper with a chandelier hanging down from the middle. Concerto in D Minor by Handel gave me a feeling of very old royalty and led to images of stately, historic stone buildings. At some point, there was a song – I think it was River Free by Boil the Ocean – that paired with images of vast open ocean and a whale shark swimming slowly near schools of fish. While most of these have faded in my memory and I have screenshots of more songs than I can remember images, there was one that stuck with me:

The fish wedding.

The song is “Songs My Mother Taught Me” by Dvorak. It begins with two fish tucked into a bed, the linens pulled neatly up to their fins. Then, the bed falls away and the fish are dressed in wedding attire; tuxedo on one and dress and veil on the other. The fish bride is moving down the aisle (conveniently, I can only see her top half. Not sure about the mechanism of movement, having no legs.) There are rows of guests on either side, and I cannot figure out if they’re fish or human. Either way, they watch her breathlessly. Now, we’re at the reception. The bride and groom are cutting the cake, fins gripping a large knife. As it cuts into the cake, the entire thing collapses in on itself, as if the cake were made of cardboard. The song ends, Allegri’s Miserere mei, Deus begins, and we return to the church with the fish bride.

And then it’s like my brain went “wait a minute- we can’t have an anthropomorphized fish in a wedding dress in here, at least not with THIS song” and the entire feeling of the vision changed. If you can consider your brain to have “cinematography” in ketamine scenes, the images went from “Pride and Prejudice meets quirky, French cartoon,” to “emotional history documentary.” The fish disappeared, and it was just soaring views of an empty cathedral with light streaming in through stained glass windows.

It’s mildly frustrating to remember thinking “wow, this song goes perfectly with what I’m seeing” and not being able to remember what it was that I saw. Sometimes patients will ask the doctor to write down things they think of while the infusion is going, thinking that it’s incredibly profound, only to read it later and either have no idea what it means or be entirely underwhelmed by its meaning. I imagine that’s what would happen if I could remember every image with its accompanying song. It probably wouldn’t be as perfect as I thought it was.

This was definitely an entertaining infusion, and when I came back to the room, I had no words to describe it other than to say “there was a FISH. WEDDING.” and then laugh and shake my head. The best way I can explain what it feels like to come out of a ketamine infusion is that it’s like waking up over and over again. You’re listening to someone talk, definitely paying attention, and then all of a sudden you feel like you just woke up again. The words you remember them speaking bounce around in your head for a minute- were they dreams? This happens several times, each coming a little further out than the last one. Eventually, you’re solidly awake and can go home to contemplate the love lives of fish.

 

white sign with black capital letters reading "you are worthy of love" near telephone pole, green bush, and asphalt walkway

Considering Worth and Achievement

I’m going to therapy tomorrow morning. Last week, there was a moment when we were talking about my goals and I became very quiet. Something in my thoughts had made me feel emotional, but as I was enjoying having a normal conversation with my therapist, I pretended nothing happened. (Haha, nice try. I think she knew.) Now that I’ve had a week to think about it, I’m planning on bringing it up when I go to my appointment tomorrow.

Here’s the issue: there were parts of me that I had thought were stemming directly from my depression. Feeling worthless, after all, is a symptom of depression. But now that I’m feeling better, I find that I’m still thinking of myself as less valuable than other humans. Whether that’s a product of having been depressed for a while, or it was there all along, I’m not sure how to change it. Talking about my goals led me to this realization because I started thinking about the value of my accomplishments and the cost of my depression. Treatment for my depression has become expensive, and when I pondered that in therapy last week, I suddenly concluded internally: “I’m not worth that much.” Reaching my goals and accomplishing what I want to is, in my mind, the way for me to become “worth” the expense.

I don’t want to get too philosophical- that’s not my area- but I’m comfortable declaring all human life inherently valuable. Let’s exclude those variables like violent crime and abuse, and consider everyone without any actions in their past. John Locke considered the mind at birth a blank slate, which experience acts upon to form our beliefs and knowledge. This leaves us with two possible conclusions, I think. Either the “blank slate” of human life is worthless until some positive attributes or achievements earn that person value, or all people have innate value by virtue of simply existing with potential.

It’s clear to me, and to most people, I think, that human life is innately valuable. So, why am I so stumped when it comes to believing in my own value?

Sometimes, I try to trick myself by arguing that because I think I am fairly average, there is no reason that I would be special enough to be an exception to such a universal rule like “all people have value.” Then I reach some kind of does not compute error in my brain and start the whole thing over again.

Aaand this is probably the point where my therapist would tell me that I’m very cerebral and maybe should return to feeling feelings. Yeah. I get stuck in existential loops a lot.

white bell-shaped flowers pointed down during dusk light

Setbacks in Depression Recovery

Lately, I’ve been excited to begin going in the other direction with medications as part of my depression recovery- reducing rather than adding. Through years of treatment, it seemed like I was always either increasing a medication or trying a new one. I never got much relief from antidepressants (except the one it turns out I’m allergic to), and lithium, the mood stabilizer that has probably saved my life, comes with the risk of kidney damage if the levels of it in your blood creep too high. I still take an antidepressant, two mood stabilizers, and Deplin (because I’m a mutant). These drugs help me function, and although they don’t kick my depression completely out the door, they are important.

I have a love/hate relationship with lithium. It dramatically reduces my suicidal thoughts, and that’s amazing. If I were to describe how it felt when I was at my highest dose of lithium: it’s like you’ve been gritting your teeth for years, and then all of a sudden you realize you’ve stopped. All of that pressure, the wear on your teeth every single day as you work your jaw muscles without cease, suddenly vanished. Like the peace you feel when static background noise shuts off, and you’re left in silence. When I got to a high dose of lithium, I was floored when I realized that I hadn’t thought about suicide all day. In fact, lithium makes it a little bit difficult for me to think about suicide in the same way I do without it. Focusing my thoughts on the idea feels a bit like trying to push the same poles of two magnets together. But when I had to reduce my dose because of the risk of lithium toxicity, the suicidal thoughts started to come back. Not to the degree that they once were, but it was clear that the change in my lithium dose was to blame. Still, I’ve enjoyed a lesser degree of suicidality than I experienced without lithium.

Lithium restrains my thoughts from straying into suicidal ideation, but it comes with some unpleasant costs. Because it’s processed through your kidneys, it has a tendency to make people thirsty. If I go too long without water, I feel like I’m shriveling up like a dry sponge. It also makes me feel absolutely exhausted, napping excessively (even more than I normally do when I’m depressed). So although it does some wonderful things for me, I’ve always hoped that I wouldn’t need it forever.

Overall, I’ve been enjoying a recent improvement in my mental health. This is because of IV ketamine infusions, which treat, among other conditions, treatment-resistant depression. When I started to feel better and my depression recovery seemed to be on track, the spark of hope that I might someday be able to come off some of my medications began to grow. I was excited- why stay on meds that are only half-working if you have something better?

I talked to my psychiatric nurse practitioner about reducing my lithium dose by about a third. Within a week, the consequences of reducing my dose were becoming clear. I started to feel less interested in things again, tearful, and guilty about my depression. The slip was minor; I wasn’t feeling much worse, but it was compounded by my thoughts about the situation. I was looking forward to reducing my medications so much that when it went badly, I let disappointment carry me into catastrophizing. I thought that I’d never be able to leave lithium behind me, and would always rely on it to keep me safe from myself.

I quickly went back to my previous dose and waited for my symptoms to subside. Honestly, if it turns out that I do need it forever, that would be okay. There’s nothing wrong with needing medication. For now, though, I’ll tell myself that I was just too hasty, and try again someday soon.

It’s tempting to beat myself up for “losing progress,” but that’s all just part of life. When I feel trampled by my mental illness, I try to reframe the “progress” I think about as being more about the time you spend living and the things you learn along the way than about the state of your mood. Progress is existing each day and surrounding yourself with ideas and actions that keep you going. You’re living along the course of your own life- whatever that might be- and that’s progress.