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Ink Blots and No Propofol : The Ketamine Chronicles (Part 24)

Yesterday, I had another ketamine infusion for my treatment-resistant depression. We tried getting rid of the propofol for this infusion, which sounded interesting because it had the potential to help me remember more about the experience as well as make the after effects easier. I can’t say that I remember everything, but the infusion feels more real in my memory than it has in recent weeks.

Is It Working Yet?

Despite having done this numerous times, it’s still hard for me to discern when the ketamine takes effect. I kept checking in with myself, thinking, “Is it working yet? Are those blob shapes my usual closed-eye blobs, or something different?” But eventually, it became suddenly obvious that it was working. I started to feel like my nose had melted, leaving just the bare nasal bones exposed. This somehow reminded me of a seal closing its nostrils before diving underwater. I wondered if what I was feeling was close to what it feels like to be a seal. In hindsight, this makes no sense. Just having no nose is nothing at all like being a seal, but it seemed logical in the moment.

Colors, Ink Blots, and Numbers

The beginning of the infusion is the part that I remember the most completely. At first, the darkness behind my eyelids felt very normal and familiar. But soon, pale colors moved gently against the black, like lava lamp goop merging and bubbling off.

The colors eventually faded and were replaced by intricate black and white designs that reminded me of kaleidoscopes. They were incredibly detailed, and I don’t think I could ever recreate it. As they morphed, their intricacy faded and I was reminded of Rorschach ink blot tests. Somewhere in my brain, it occurred to me that that association was especially funny, given the context. What does it mean if you see shapes within shapes that you created yourself?

At some point, there were pages and pages of numbers that didn’t mean anything to me. They were mostly organized into columns and lists, and I tried to focus on interpreting them, but was unsuccessful. This is something that seems to happen repeatedly in my ketamine infusions – I see overwhelming quantities of numbers or letters that I can never quite decipher.

That’s about the extent of what I remember. The rest of the infusion seemed to consist of fairly mundane experiences and scenes, although they escape my memory.

Ketamine as a Dissociative Anesthetic

I’m glad that we tried it without propofol. I was a little worried that it would be too intense, but it turned out just fine. As usual, I felt far removed from the room around me. My body was in the chair but my mind was somewhere else. It’s sort of like there’s a tiny me inside my own brain, viewing images that create a highly convincing sensation of having my eyes open. To then test it by opening my real eyes is a bizarre feeling.

The rest of my day was dramatically different compared to days when we’d used propofol in conjunction with ketamine. With propofol, I often sleep for the rest of the day, broken with occasional small tasks like walking the dog or doing some laundry. I must metabolize it slowly, because when I wake up the next day, I have a lot of trouble piecing together the order of events or even what I did at all. It becomes clear that I was lot less sharp than I thought I was.

Without propofol, the disorientation and grogginess wear off more quickly. I’ll sleep for several hours, but then can function fairly well, if a little physically unbalanced. I vastly prefer to be as alert as possible. The sensation of not actually having made decisions with my full wits about me is unsettling.

I’m hoping that my old pattern of improvement two days after an infusion is consistent. The short series of infusions we did recently helped combat my symptoms, but there’s definitely room for improvement.

If you’d like to start at the beginning of the Ketamine Chronicles, click here.

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Trying a Sleep Mask: The Ketamine Chronicles (Part 19)

While walking through the grocery store the other day, a cheap sleep mask caught my eye. My previous ketamine infusion, in which I was utterly entranced by a framed picture of what looked like a standoff between a wolf and a mountain goat but was really just a river and some rocks, piqued my interest in sleep mask-wearing. I grabbed the mask on a whim, intending to give it another try at my next infusion.

My first attempt to cover my eyes during a ketamine infusion was at my very first appointment. Not knowing what to expect and finding that I had never experienced anything like it, I was overwhelmed by the bizarre sensations. I remember the darkness behind the mask inducing a feeling of slow spinning, like turning a heavy stone on the end of a long, long string and then letting go. Soon, my head began to spin in one direction while my body spun in the other, and I took the mask off, preferring to keep my eyes open.

I hadn’t worn a sleep mask during an infusion again until yesterday. I brought my newly purchased satin mask, seemingly made for someone with no nose, and slipped it on just as the infusion started. My immediate reaction was “I don’t like this”. But, sensory processing disorder makes it hard for me to discern what exactly something feels like and if it’s to my liking or not. Therefore, my default is no new things ever. I decided to give the mask a few minutes, which I attempted to measure by the progression of songs on my playlist. By the time two or three songs had gone by, I had mostly forgotten about it.

At first, I was frustrated because nothing seemed to be coming to me. It was just dark. Gradually, subtle circles of purple and yellow faded in and out. I couldn’t tell if the ketamine was working yet or not, so I shifted my attention to my body and found that I was all stretched out. My feet were incredibly far away from my head, and the more I thought about it, the more I stretched. I got thinner and thinner, and I eventually was reminded of taking Flat Stanley home in elementary school. (Flat Stanley is a children’s book about a character who travels the world. As part of a literacy project, kids make paper Stanleys and keep a journal about his adventures, swap Stanleys with a partner via snail mail, then mail them back, often with photos of Stanley out and about.) I felt like Flat Stanley- like I had been rolled out with a rolling pin and then peeled back up. Briefly, I considered the strange photos that would result if somebody took me on their family vacation, this flattened-out woman waving in a gust of air, Little Timmy reaching up to hold my paper-thin hand while everyone says “cheese”.

Sometimes, the things I see in my ketamine infusions are bizarre or fantastic, and sometimes, they’re closer to real memories. After the Flat Stanley adventure, I enjoyed a slow-motion movie of my dog, Stella, running by me. We locked eyes as she rushed by, a moment captured in the dusty roll of fur on her shoulder and her tongue lolling out of the side of her open mouth. In slow motion, the prairie grasses waved lazily and Stella’s paws hung in midair, a snapshot of a great freedom gallop. I’ve seen such an image hundreds of times, yet my lucid memories never produce such a striking, detailed image as what I saw during my infusion.

My thoughts of Stella led me to a less pleasant memory. She killed a young rabbit the other day; I tried to stop her but was too slow. The weight of its still-warm body in my hands came back to me in my infusion. I looked at the delicate veins in its ears and a bit of fur stuck to one dark eye as I gently wrapped it in an old cotton t-shirt. Seeing it again during my ketamine infusion wasn’t disturbing, but it evoked some sadness and sense of wastefulness.

I only vaguely remember other images from this infusion- mostly measurement things like ticking numbers on a digital counter and tape measures stretching out. Overall, wearing the sleep mask made me much less concerned with time. I never have any idea how much time has passed, even when I try to keep track of how many songs have gone by. Usually, returning to the real world periodically reminds me that time exists, and I then wonder where I am in its course. But with the mask, I was just floating in darkness. I still don’t love the feeling of having my eyes covered, but it wasn’t as bad as I thought it might be. Occasionally, I considered taking it off but decided that lifting my arms would be too much effort. I did eventually sense that a good deal of time had passed, and I lifted a corner of the mask to peek out. Erin told me I had ten minutes left, so I leaned my head back and forgot all about time, once again.

I have not been doing well, lately. I tried to go off of one of my medications (with the OK from my prescriber), and it backfired tremendously. I’m back on it and hoping that things will return to how they were before I decided to go messing with my meds. Hopefully, this ketamine infusion will help me get back on track.

 

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Noise: The Ketamine Chronicles (Part 14)

Yesterday, I had another ketamine infusion for my treatment-resistant depression. It had been almost five weeks since my previous infusion, and while three weeks was our best guess for my interval, it seems like now I can actually go something like four weeks before really noticing it wearing off. I’m hoping that if I keep doing the behavioral things that help my depression (running, volunteering, therapy, etc.), I can at least maintain this amount of time between infusions.

Most of my ketamine infusions have been visually focused, and usually what stands out to me are snapshots of images and colors. Yesterday’s infusion, however, was much more auditory-heavy. Throughout it, conversations in the hallway and the other room sounded loud and close, and I felt as if I were being crowded around in the room I was in. Strangely, conversations outside the room sounded loud but were completely unintelligible. The boundaries of words and sentences disappeared and I was washed in streams of unending verbal noise. Nothing made sense, but I still strained to understand. The sounds of english words were familiar, but I just couldn’t parse them enough to grasp their meaning.

This theme of linguistic confusion stretched throughout the infusion. I remember a filing cabinet, stuffed with folders that I couldn’t read. The letters were there; I could pick them out, but putting them together and reading them as words eluded me. Later, messy papers with gibberish words filled my internal vision. I felt confused, I was upsidedown, my arm with the IV ached. The room seemed loud, and I saw stampedes of paper animals, painted with pastel watercolors. They piled up and tumbled around me, threatening to knock me over and crush me. The fan in the room added noise that pushed it all to an intolerable volume, so I asked Erin to turn it off. I got ready to speak, opened my mouth, and seemed to just think the words out loud.

I notice this feeling often during infusions, and it’s interesting to note how little deliberate control over our mouths’ movements we need in order to make coherent sounds. All I do is form an intention to say something, and it just…happens. It feels a little like I’m inhabiting my body separately from its direct controls. I can still talk, but it feels like someone else is doing the talking. In any case, my request apparently worked, as she got up and switched the fan off. That lowered the ambient volume enough that I could focus again on my music.

I remember there being more visual scenes after that, but I don’t recall them very well. The only one I have memory of is a scene set in a grocery store with a broken jam jar, shards of glass glinting under the fluorescent lights and wine-red jam splattered on the linoleum.

The rest of the day is a blur; I slept off and on, interrupted by Stella periodically. It wasn’t until about 6 P.M. that I started to feel more like a person, but I was still glad to crawl into bed at night and sink into sleep. This morning, I’m tired. I’d like nothing more than to go back to bed for the rest of the day, but I know it’s important to get myself up and moving. I do best with routine, so in the interest of helping my brain repair itself, I’ve already had coffee and been to the dog park. So far, so good.

 

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Tower of Shrimp: The Ketamine Chronicles (Part 13)

This ketamine infusion features a crime scene, a tower of shrimp, and a painting of a carnivorous giraffe. Folks, I couldn’t make this stuff up if I tried.

I remember feeling it almost immediately, and I closed my eyes as I lost track of my limbs. The music I was listening to was a lively classical piece, and my mind created intersecting lines to the notes that formed long evolutionary trees. There were noises around me that distracted me at first; something that sounded like hammering from the floor above us, then quiet conversation in the room, and a door opening and closing. Soon, though, the ketamine pulled me away, and I wasn’t concerned with anything outside my mind.

Silhouettes of a human face and a bull in profile, carefully stretched-out tape measures arranged in rows, and thousands of old family photos being sent on a conveyor belt to be turned into decorative pebbles were just some of the odd things I saw this time.

The crime scene was set in an arid landscape; there were shrubby bushes and reddish-brown caked dirt as far as the eye could see. Two or three people stood around a small body of water- what seemed like the only one for miles and miles. I got the sense that they were pondering something, as a detective would do when a puzzling scene presents itself. As I tried to read more of the scenario, my perspective began to shift. I zoomed out smoothly but quickly, like I had scrolled down on Google Maps with intention. Perhaps I’ve been watching too many police procedurals and true crime shows lately.

The shrimp tower stretched higher and higher, eventually reaching the edge of the atmosphere. The singular shrimp at the very top swayed back and forth, pondering the shrimps holding it aloft and balancing in the wind. Each shrimp interlocked with the shrimp around it, like that barrel of monkeys in Toy Story. I don’t know if you know this, but the sensation of perching on top of a stack of shrimps that stretches all the way to the edge of the atmosphere produces some stomach-dropping vertigo. If you’ve ever read the Dr. Seuss Book, Yertle the Turtle, the shrimp tower may remind you of that. Instead of an incredibly arrogant shrimp forcing the others to form the tower so that it could sit at the top, this was the reverse. The top shrimp wasn’t entirely sure how it got there and was not very comfortable with it.

There are some interesting parts of my infusions that seem to blend my identity with strange scenarios and characters. For instance, how did I know that the shrimp at the top of the tower didn’t know how it got there? Was I the shrimp? Similarly, the funeral scene in my seventh ketamine infusion also evoked a sudden understanding. I was watching the scene, but when the coffin was set down, I felt like I was being pressed into the ground. Was I watching, or was I in the coffin?

The day before this ketamine infusion, my aunt and I did one of those paint-n-sip classes. The painting to emulate was a cute, cartoonish giraffe with multi-colored spots. We noticed that there were two kids in the back who had really taken their paintings to the next level. Their giraffes had blood-red eyes, thick, metal earrings, and gaping smiles filled with pointed teeth. One also had thick blue stripes rather than spots, but that’s neither here nor there. We got a big kick out of these kids’ creativity and confidence to go off-book. They seemed proud of their paintings, and we thought they were awesome.

Imagine that painting in the style of a ten year old’s artistic skills, and then imagine how taken aback I was when a dark silhouette in my ketamine dream revealed itself to have that giraffe face. It was both unsettling and hilarious at the same time.

After the carnivorous giraffe, my brain may have opened the door to where the creepy images are held because I remember seeing dark forms standing over me, laughing. Thankfully, something in the room beeped, and I reoriented myself to my surroundings. That was probably the most disturbing thing I’ve experienced during a ketamine infusion, and even that was not bad. I knew that it was creepy but didn’t feel especially scared.

Most of the time, I just see bizarre scenes like the tower of shrimp, marvel at how much my teeth feel like stale marshmallows, and wonder if I’m slowly tilting in one direction or another.

 

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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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.

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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.