How I Track Mental Health Symptoms

My therapist has been encouraging me to track my depression and various contributing factors for years. I’ve tried several apps, journals, and charts, but I always drop the practice after a little while. Eventually, I identified why those tools never worked for me and used that information to make my own system.

Why Motivational Journals and Apps Don’t Work for Me

I understand why a system with lots of elements appeals to some people, but I tend to find them discouraging – the opposite of their intended effect.

My Depression vs. Positivity

Whenever I tried an inspirational/motivational journal, I quickly lost interest. I’d open it up to mark down that I felt like a person-shaped vat of cold, unsalted mashed potatoes. The list of weekly goals I hadn’t met would be staring up at me. Some inspirational quotes would arrive in my brain through the filter of my depression, limp and meaningless. Over time, I began to avoid them, knowing that the initial excitement of setting up a shiny new tracking system would sour.

Apps Aren’t It, Either

Apps have the advantage of offering daily reminders, but if the app is structured like the previously discussed journals, a cheery notification that it’s time to check in only distances me further. I really wanted apps to work for me, and I’ve been consistent with them for two or three weeks at a time, but I always abandon them eventually. They’re too complex, they ask me too many questions, or they document more than what I want to track.

Mood Scales and My Problem with Numbers

Number-based tracking scales usually include too much choice for me and don’t allow for flexible indecisiveness. A 1-to-5 scale just paralyzes me. What if I say “3,” but I’m really a “2?” That would be catastrophic, obviously.

Perfectionism

Maybe it’s a vestige of perfectionistic test anxiety, like I have to choose the “right” answer and be consistent in my interpretation of the scale or else anyone who looks at my data will get an inaccurate sense of my mental health. So instead, I just stop using them. When there’s no data to look at, I didn’t do it wrong!

So in the end, I decided to go with what my therapist suggested in the first place (I must be exasperating when it comes to tracking), and just made my own system to track my mental health.

My Method for Tracking Mental Health Symptoms

I wanted something straightforward, easy to use, and without the frills of a motivational journal. I got a completely blank, unruled journal and a set of stencils. I found these stencils online by searching something like “bullet journal stencils.”

The Mood Tracker

Each hexagon represents a day, which I’ve drawn a line through to depict AM on the top and PM on the bottom. I chose three colors to be “good,” “blah,” and “bad.” This way, I only need to pick a color and fill in the shape. If I can’t decide on a color, I can mix two of them together or shade the shape according to how the day progressed.

I also write small notes every now and then for medication changes, ketamine appointments, and other factors. I like that the bare minimum for this system feels doable for me but isn’t so scant that it’s uninformative.

The Medication Tracker

The medication tracker is similar to the mood tracker in that each section represents a day of a month. The inner row is morning and the outer circle is night. I picked a color for “Yes, I took my meds” and a color for “No, I didn’t take them.” It does help me to see how frequently I’ve missed doses, partly because the perfectionist in me hates to see too much orange.

I keep the journal and the colored pencils in my nightstand so they’re easy to get to and I don’t have the excuse of already being in bed when I remember to track.

How It’s Going

I’ve been consistent with this method for a little over two months, which is probably the longest stretch I’ve ever gone with tracking mental health symptoms. I can’t say that anything groundbreaking has come of it yet, but it is interesting to confirm some of my expectations.

I’ve tried and abandoned so many methods that I don’t think I showed my therapist my journal until I had been using it for a month. I didn’t want it to be yet another dud in a long line of tracking tools. So, I kept it to myself for a little while and am only just starting to assess its usefulness.

Just like with any mental health-tracking method, there are gaps in the data that become evident over time. I’ve been adding symbols to my mood tracker for things like self harm and my period. It’s becoming more complex, but I think the fact that I decide when to add those symbols rather than having a dedicated section for them works well for me.

That said, I’m considering adding a way to track more factors, such as appetite, sleep, and exercise. I don’t want to make it too complex, but I might have the habit established enough to expand my system without abandoning it.

There are tons of ways to track mental health symptoms and factors, and you can find many of them detailed online. What way works best for you?

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My Unofficial Therapy Dog

I’ve started bringing my dog to therapy. Does she sit with me and look patiently into my eyes while I cry? No, definitely not. She spends 10 minutes wandering around, smelling the smells of the week with great vigor. She pokes the diffuser with her nose, sticks her whole head in the trash can, and squeeeezes behind my therapist’s chair to not-so-sneakily smell her belongings. Then, she goes back and forth between the window and relaxing on the rug, ears perked up, listening for outside sounds. She comes over to me for pets and cookies every once in a while, but mostly, she’s just nice to have around as my unofficial therapy dog. She’s completely oblivious to my human problems. Looking at her blissful ignorance during therapy is like a brain palate cleanser.

You can’t help but wonder what she thinks of this development. Here we are, in this room we come to sometimes for no discernible reason. Pretty comfy. New smells since last week. 8/10. Would be better if I got second dinner. All that matters to her is that I feed her, walk her, and let her sleep at the foot of my bed. She’s a simple creature – intensely curious and frustratingly smart – but simple in that she really doesn’t need a lot to be happy.

She shares some of that innocent joy with me. She makes me smile every single day. It doesn’t matter how depressed I am – she does something goofy or sweet and has no clue that I find her antics ridiculous. Like how she leads with her face when encountering snowdrifts, or her exasperation at me taking constant photos of her, or the many, many hilarious faces of Sleeping Stella.

Sometimes, when I try to change something in my treatment(s), my depression says, “No, thank you.” Changing my medications has not gone well for me in the past, but I continue to clutch my personal dream of reducing the number of things I pick up from the pharmacy. I recently added a drug which required me to get off of something else, which overall, does not seem to have gone well. The options now are complicated and I don’t particularly like any of them, but I still have Stella! The routine, obligatory outdoor time, and turbo-boosted zoomies have done me immeasurable good. She demands my attention and action, and there’s really no telling her to just go entertain herself. Our walks are sacrosanct to her. No replacements. And no skimping on length, either!

This was part of my goal in adopting her, and it worked in more ways than just the responsibility of it. I thought that it would be healthy for me to be forced to get out of bed and do things, but that the emotional reward of that would come during my good times. I wasn’t expecting my unofficial therapy dog to be able to careen through the fog of my depression and make me smile every single day. A smile or laugh every day certainly doesn’t fix everything, but it’s something to be thankful for.

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“We’re snuggling! This’ll be cute.”

Search & Rescue Elephants and Other Therapy Tidbits

My mental health has once again taken a turn in a not-fun direction, which I attribute to some recent medication changes. So, instead of sitting here thinking, I should write something. I can’t think of anything to write, and then putting down anything I do write as being the worst drivel ever to appear on my screen, I’m going to take you on a little diversion.

Did you know that an elephant’s sense of smell is twice as strong as that of a bloodhound’s? (C, that documentary led me astray. Google says twice, not four times.) This is what I said to my therapist the other day in one of my many futile attempts to distract from the topic at hand. We’ve also discussed, among other things, a documentary I watched called “Octopus Volcano,” how scallops have eyes, and what “horse” is in ASL. Usually, when I share a fun fact like this, there’s a brief exchange, and then she goes, “Well, that used up about a minute and a half.” And then we’re back where we started, just a little more entertained. This time, I think we probably used up, like, at least three minutes with the elephant fact. It may have been the most productive time-wasting fact I’ve ever pulled out of my sleeve. We got going on a train of thought that I think has some incredible real-world promise.

Just imagine: search and rescue ELEPHANTS. The police force brings out the specially trained sniffer elephants in super-wide trailers. They step down, decked out in vests that say “DO NOT PET. I’M WORKING,” but the vests are really just tarps secured around their bellies with bungee cords because the elephant service vest market just isn’t there yet. Soon, they’re working in airports, sniffing for bombs and drugs. All floors have widened stairs and elephant-safe ramps, and next to the dog relief areas are rooms with piles of dirt for the pachyderms to toss over their backs. Retired sniffer elephants spend their golden years relaxing with their family herd with frequent visits from their old handlers, revered as heroes for their invaluable contributions. I think we’re on to something, here.

“Sir? Sir! This is a service animal. Please don’t feed her the limp lettuce off your hamburger.”

Is this a breakthrough? Did I have a breakthrough in therapy?! Yeah, yeah, it’s not about me, but a striking realization is a striking realization. Elephants are the next sniffer dogs. Maybe they’re not as motivated to please humans, and they do need to eat a tremendous amount of foliage as they travel great distances throughout the day, but I think those problems could be overcome with some creativity. There really is no limit to what you can take away from therapy.

Non-sequitur segue! Other problems that can probably be overcome include my current difficulties with changing my clothes and eating and getting work done and my general depression problems. Titrating down on an antidepressant can be tricky. I’m trying to figure out whether this dip in my mood is because this antidepressant was helping me more than I thought it was, regular old withdrawal, ketamine wearing off, or any number of other variables. I suppose time will tell. Let’s persist in our efforts to overcome wacky, theoretical elephant scenarios and the challenges of living life.

P.S. Good luck to the Google algorithm in trying to figure out what the heck this post is about. 🙂

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Working on Depression

Sometimes I feel like a bird that can’t figure out how to fly. I periodically get launched out of a cannon (in this metaphor, that’s due to IV ketamine treatment for depression), then flap and flap to no effect. I’m trying to make progress, but gravity is always there. Eventually, I sink lower and lower, just exhausting myself with all that flapping.

That’s how it feels, but I don’t think that’s entirely accurate. Yeah, ketamine wears off eventually, and yeah, my brain has a biochemical problem that means I can’t fix depression just by flapping. But the flapping is doing something. All that work I put into therapy and maintaining a routine and getting exercise must be functioning in tandem with the IV ketamine to push my little bird wings just a smidge farther.

I know this because my mood still dips pretty low sometimes, but on the whole, I’m in a better place than I was a few months ago. Perhaps it’s that I bounce back faster, now. Or maybe it’s just knowing that it won’t last forever.

And now, being able to look back and see that I’m flippity flapping on my own a little makes it just a little bit easier to continue. Chipping away at something day by day is tedious and frustrating, but all of that work adds up. If you can look back at where you were a little while ago, it helps to notice that in working on depression, you have made progress, even if it’s just in the personal growth or a skill you’ve learned or the support you’ve gotten.

Keep flapping, everybody.

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Therapy Code Words

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

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

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

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

It’s groundbreaking, I know.

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

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

Photo: Andy Castille – @kikini

A blurry woman holding a magnifying lens up to her eye so that her body is upside down and her eye is right side up.

Ketamine-Assisted Psychotherapy 2: The Ketamine Chronicles (Part 23)

Compared to my first ketamine-assisted psychotherapy session, the second one was wildly more entertaining for me, but much less productive in terms of the number of words coming out of my mouth. KAP stands for ketamine-assisted psychotherapy. The idea is to utilize ketamine’s ability to lower your mental barriers in order to more comfortably talk about difficult topics with your therapist. I know that I was very nervous for my first session and likely fought the ketamine in an effort to stay in control, but I didn’t expect my slightly more relaxed approach this time to produce such a dramatic difference.

A Delicate Balance Between IV Ketamine and Therapy

I think I remember that there was a slight dose change from last time to this time, but I don’t think it was enough to really impact my experience. But, in a bewildering turn of events, being more relaxed actually led to me saying less. Rather than unleashing a flood of thoughts and feelings, I found myself being washed away by images and colors. My ability to imagine images certainly made my conversation with my therapist more bizarre, and most of the time, quite disjointed.

We started out by talking about bridges. I had tried to create a metaphorical bridge that crossed into my protected mental fortress during a previous ketamine treatment infusion, but I got stuck with a drawbridge that lifted every time somebody tried to cross.

This time, I saw a fraying rope bridge with missing wooden slats. It stretched across a dark chasm with no visible bottom. It was a long bridge with not enough tension, making it sag in the middle. Despite its frayed appearance, the connections to the edge of the cliff on either side were sturdy. It would be a harrowing journey to the other side, but you could do it.

Thinking about this as a lucid person, it strikes me that the metaphor breaks down at some point. Clearly, I have a well-protected area of mental privacy. I don’t open up easily, and I don’t tend to rely on many people. But to picture a dry, brittle rope bridge stretching across a dark chasm implies that it would be frightening to attempt to cross it. It’s scary for me to allow people to cross the bridge, but I certainly hope the crossing isn’t scary for them. Perhaps the drawbridge was a better metaphor for me. In any case, I only come up with bridges that are difficult to cross.

Distractions During Ketamine-Assisted Psychotherapy

I found it extremely hard to stay focused on the topic at hand during this infusion, sometimes pausing and saying things like, “The blood pressure cuff makes me think of fish being squished.” (The cuff periodically tightened, which distracted me and produced a feeling of what I imagined felt like raw fish being rolled and squelched under pressure.) If an answer to a question didn’t immediately pop into my mind, I found myself floating away from it – the room and the people within receding into the distance.

An assortment of round analog clocks arranged on a wall
Photo by Jon Tyson on Unsplash

At times, I remembered that I was supposed to be answering something, but wasn’t at all sure of how much time had gone by since my therapist asked the question. Is she still waiting for me to answer? Are we still on that topic or did we move on already? I don’t think I remember the question. It was chronologically confusing – seconds slipped by without my notice like water flowing over stones, and yet the small movements of my therapist and doctor in the room were auditory markers of real time. How much time passed between my last thought and this one? It’s too hard to think in words. Better to just float. I don’t usually try to hold onto the real world during ketamine infusions, and it proved to take a lot of effort.

Articulating Thoughts and Images

I also don’t usually talk during my regular ketamine treatments for depression, so it was interesting to discover just how hard it is to describe the images I see. I can write about them in detail after the fact, but in the moment, they just escape description. Take, for instance, when I said I was seeing “a bunch of…cleaning things.”

What I actually was seeing was more like a set of rectangular brushes that fit together into a grid. They were a very light pastel range of purples and blues. Why was I thinking about puzzle-piece bristle brushes during my IV ketamine treatment? I have absolutely no clue. Part of what made it hard to describe was that the image was so enthralling that pulling myself out of it to come up with words was difficult. But part of it was that I knew that what I was saying came across as completely bizarre. Trying to describe why such a mundane-sounding image was so pretty just kind of stumped me.

The random and nonsensical images that I was trying to describe reminded me of “Drinking Out Of Cups,” a video from the mid ’00s of Youtube (contains profanity). I tried my hardest to explain it, but seeing as it’s a video about nonsensical things, I had a hard time putting it into words while lost in my own nonsensical world. I think I slipped into fits of giggles halfway through and had to finish up with, “I dunno, I’m not doing it justice, but it’s really funny.” Also, “outta” is a really hard word to say when you’re on a mixture of ketamine and propofol. Just in case you wondered.

A Featherless Parrot

At some point, vials of colorful sand spilled into a desert, creating clouds of blowing particles with swirls of color. I was seeing it from above, and the drifts and valleys the wind created were captivating. It was a beautiful but rather lonely landscape. A parrot with no feathers appeared in the foreground, and when I mentioned this, my therapist questioned me for clarification. “Yeah, like a…a plucked chicken,” I answered.

“Aw, poor guy,” she said.

To which I then said, “No, h-he seems ok, though.” Well. That’s a relief.

blue and yellow parrot
Photo by @davidclode on Unsplash

Staying on Topic in Ketamine-Assisted Psychotherapy

I wonder if, despite being more relaxed this time, I had a harder time engaging with therapy because I don’t know how to filter my mental experience. Last time, I may have been so nervous that I just locked everything down indiscriminately and tried to function as “normally” as possible. I was more open to KAP this time, which left me free to be distracted by anything and everything that entered my thoughts. It seemed to take enormous effort to hold on to the real world while holding the door open for therapy. I’m imagining a large wooden door to Ketamine Land, and within the door to Ketamine Land, a smaller door labeled “therapy.” I think I accidentally opened the big door to Ketamine Land and was bowled over by the peculiar sights within. I should have only opened the door-within-the-door and accessed the loosey-goosey-ness of Ketamine Land in a smaller, more manageable way. I’m not sure how to do that, but perhaps it takes practice.

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.

Moose Revelations & the Magic of Yes Day

In an effort to help me become more easy and breezy, Fridays have been dubbed “Yes Day” by my therapist. I’m supposed to not hesitate when I’m faced with a decision on Fridays – just say yes. I mentioned this in a recent post, in which a therapy session combined with ketamine saw the creation of No Nap Day, which was slipped past my steel sieve mind on Friday under the guise of a Yes Day opportunity. Just kidding- I knew exactly what I was agreeing to.

I had good reason to say “yes” to No Nap Day. My Yes Day adventures have already resulted in positive experiences, so it only follows that I should keep it up. I’m not generally a spontaneous person. I rarely do anything on a whim, and sudden changes to my plans make me anxious. Sensory processing disorder makes me strongly prefer routine over spontaneity. I know that I like all of the sensory aspects of my familiar routine; anything new is overwhelming and could be very unpleasant.

Then again – it could be wonderful, and by saying “no” to new things, I run the risk of missing out on some great stuff. Take last month, for example. I go hiking with my mom every week. We usually pack lunch, make frequent stops to look at wildflowers, and generally have a wholesome nature experience. I usually enjoy these outings a great deal, but on this particular day, I was tired. The fresh air and pre-hike coffee did not perk me up, and I trudged up the mountain with heavy boots.

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We reached the first of two lakes about 2 miles up the trail, and as we rested on a flat boulder, we discussed our options for the rest of the day. My mom wanted to continue on to the second lake and the glacier, but I was reluctant. Heading back to the car and going home sounded pretty good to me, but it was Yes Day, after all. So, I said “yes” to continuing on. Stella led the way up the trail, and although I was still tired, we got into our usual pace before long.

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Stella was awed by snow in July, we humans were awed by the views and the beautiful waterfall, and I managed to be distracted from my fatigue enough to enjoy myself. We almost made it to the glacier, but our second wind was fading in earnest, so we took in the view and then headed back down the trail.

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Going downhill is easier than uphill in some ways and much harder in others. Upon reaching the parking lot, we hurried to the car and got the AC going. Stella had her head out the window as we turned onto the road, and we all enjoyed the bliss of sitting down.

Almost immediately, we came upon a car stopped in the middle of the lane. We waited for a few seconds, and then my mom said “Maybe there’s a moose!” I admit – I scoffed.

“They’re probably looking at Google Maps, trying to figure out if they’re going the right way.” I said. We chuckled a bit as we crawled forward, until the driver of the stopped car waved us around them. As we passed, I looked to the right and blurted “There IS a moose!”

“What?! Really? Should I…”

“Yes, back up!” I urged her. We rolled backwards until we could see it. An enormous moose (all moose are enormous, I suppose) was standing calmly by the road. He was munching on the thick vegetation around him, ears flicking lazily at the gnats.

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His antlers were velvety and magnificent. They’re such strange-looking adornments – one might even say goofy – and yet they’re so sturdy and solid. They make an effective reminder that moose are very, very, very strong animals. This one was content to carry on chewing, paying no mind to the gawking humans. I think that’s part of what makes them so interesting to watch; they’re completely unbothered by activity around them. They’re not as skittish as white-tailed deer, not as pugnacious as, say, a brown bear. They just sort of…stand around. Not to say that they won’t charge and cause you serious bodily harm, but this one’s general demeanor was one of complete and utter boredom. He was so unimpressed with us that it was almost like he was thinking “Yeah, yeah, snap some pictures. Now go home, kids. I have important vegetarian work to do, here.”

My mom and I rode that excitement all the way down the canyon. Along the way, it occurred to me that I had Yes Day to thank for it. After all, we would not have seen the moose if we had turned around when I first wanted to. Instead, I said “yes” to the rest of the hike, putting us in exactly the right place and time to witness that moose’s dangly neck thing (I now know it’s called a dewlap) waggle above the leaves. Moose are so silly, and yet so distinguished. Truly a creature of contradictions.

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