Not Much to Report & Ketamine FAQs: The Ketamine Chronicles (Part 30)

It’s part 30 of the Ketamine Chronicles! Time flies, doesn’t it? My previous ketamine infusion (which I use as part of my treatment-resistant depression treatment), was surprisingly more effective than it has been in the last couple of months. I’ve been enjoying the general lightness and ease with which I can get out of bed. Last Thursday seemed to take a downturn, although it’s always hard to tell which factors explain which results. In any case, my regularly scheduled ketamine appointment was yesterday, so it was good timing, if so.

Whereas the last infusion was extremely trippy, this one seemed more mundane. That might only be because I don’t have much memory of what I experienced, though. At the start of my infusion, my ears began feeling incredibly hot, as if I’d just said something horrifyingly embarrassing. Once I closed my eyes, I remember feeling a tad uncomfortable, like my thoughts were becoming too big for the confines of my head. It seemed like I was seeing darkness for longer than usual, and I think that the lack of engaging visual noise is what made my thinking feel too big. Of course, I don’t remember what I was pondering, just that it was happening.

Photo by: Leni und Tom on Pixabay

Once again, I fell asleep when I got home and then had several disorienting instances upon waking up and not knowing what day or time it was. It felt like I had been sleeping for many hours when my mom poked her head into my room. All that had registered in my brain a moment before was that my phone said 6:30. So, when my mom informed me of the shrimp and rice on the table, I momentarily thought, “why would she make shrimp and rice for breakfast?” It quickly dawned on me that it was, in fact, the same day. I woke up a few more times during the night, still briefly believing that it was the next morning. The pitch black scene outside my window hinted that no, it was not 11:30 AM. It took me a few seconds to reassess.

Start from the beginning of the Ketamine Chronicles! Or, visit the archives for a list of month-by-month posts. Other posts have far more absurdity and detail in my descriptions of what it feels like during an infusion.

Ketamine FAQs

Since this entry in the Ketamine Chronicles is pretty short, I thought I’d share the questions that I asked when I started ketamine therapy. I’m not sure that these are actually frequently asked, but it made the heading nice and concise, and I do love some organization. The answers to these questions are a blending of what my doctor told me, plus what I’ve learned through personal experience. Everyone is different, so the answers may not apply to everyone.

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I love strange stock images. Photo by: Tumisu on Pixabay

1. How do you know when you should get a maintenance infusion? Is it a sudden change, or more gradual?

For me, it’s usually a gradual change that I notice somewhere between two and three weeks after an infusion over the course of three or four days. I know that it’s time to get another infusion when I find myself doing a lot of nothing and feeling apathetic. My motivation disappears and I usually start thinking that acting to counter my symptoms is pointless.

However, it can be more of a sudden change for some people. They may wake up one morning knowing that, because their symptoms have returned quickly, the ketamine has worn off.

2. Do some people eventually manage their depression with just therapy, etc.? Or is the damage that depression causes a continuous process that you have to constantly work against?

Unfortunately, it’s the latter. After your initial series of infusions, you’ll need to periodically get maintenance, or “booster”, infusions. The effects of ketamine wear off at different rates for different people.

I suppose it’s possible that someone could really piggyback on the results of ketamine therapy and launch themselves into better long-term mental health, but as far as I know, the vast majority of people need booster infusions.

Exercise, therapy, social interaction, and other activities that support your mental health can help the effects of ketamine last longer. It’s possible for some people to extend the interval between their infusions. #goals

3. How do people decide whether or not to keep taking their medicine?

This is a uniquely personal decision that you make with your psychiatrist or other prescriber. I was hopeful that the benefits of ketamine would allow me to at least reduce some of my more side-effect prone medicines, but so far, trying it hasn’t worked out for me.

4. Is it possible that for some people, ketamine makes their meds work better because of the brain repair it facilitates?

Yes! As I discovered first-hand, going off some of my medications had pretty abysmal results. It’s clear that for me, the combination of my usual medications and periodic ketamine infusions is what works best. You can even try medications that you’ve taken and discontinued before, as sometimes they work better with ketamine.

5. Is my reaction to the first infusion a good indicator of whether or not it will work?

No. While ketamine works for some people nearly immediately, it takes longer for others to see any benefit. I didn’t feel better until roughly my fifth infusion.

Additionally, the way you do your first infusion is not set in stone. Sometimes, you need to change the dose or add other medications. It’s not a one-size-fits-all treatment.

6. Does ketamine ever “kinda work,” or is it all or nothing?

I apparently didn’t write down my doctor’s answer to this, so this is entirely my own experience.

I find that it can “kinda work” for me, depending on circumstances that I haven’t pinned down yet. Still, even when it’s not amazingly helpful, it’s still worth it for that small benefit. I tend to vacillate between “meh,” and “wow, I feel so much better.” So, much like question #3, it’s probably worth tweaking things if it’s less beneficial than you hoped.

However, for some people, it seems not to work at all. On the other hand, there are people for whom ketamine makes a dramatic difference almost immediately. It seems to be a continuum.

7. Will I do anything embarrassing during a ketamine infusion?

I don’t think I asked my doctor about this, but it was definitely part of my apprehension. I tend to be quiet during my infusions, in part because it feels nearly impossible to carry on a conversation. When asked if I’m doing ok, I usually just sort of nod my bobblehead a little.

I do know that other people are far more chatty than I am and can just talk the whole time. I doubt they divulge any deep, dark secrets without meaning to, though. Even though I can’t muster up the energy to speak, I have contemplated whether or not I should say something. Some of the things I see behind my eyelids are so absurd that I want other people to know about them. But even with that desire to share something funny, I’m still capable of deciding whether or not to say it. I probably would talk more if it weren’t so hard to work around my bubble gum tongue.

Feel free to leave questions in the comments. If I have an answer, I’d be happy to share it with you.

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Depression on Fast-Forward

Being anxious and depressed at the same time feels like a mental contradiction. I feel mismatched, like my head and my body are going at different speeds. Many times during a day, I’d like to sit and do nothing, but my body impolitely declines that option. I feel an almost constant low level of adrenaline, like someone jumps out of a closet and startles me 15 times a day.

Still, for me, this level of anxiety is vastly preferable to the hibernation I was doing before Wellbutrin. At least now, I have more motivation to stay out of bed and put my energy towards something productive. I feel more like a regular human who can get stuff done, as long as I can focus long enough to do it. I’ve decided to call this combination of symptoms “Depression on Fast-Forward”. If these were potatoes, they’d be hot potatoes, never in one hand for very long. Sometimes, they fall on the floor and split open, to later be relegated to the bin.

Distractions are helpful, as I wrote in my last post. My mom and I recently started cross-country skiing again, and wow, does it really shake your confidence in being proficient at standing upright. I fell five times on our first outing, and three times on our second outing, so I’m really improving on my wobbly wipeout score. That’s pretty good, I’d say.

I just recently figured out yet more issues with my pharmacy, so I’ll be able to try a beta blocker to help with the jitters. An added benefit of this is that it may help reduce my essential tremor. Upon hearing the news of my upcoming fine motor skills, my mom said, “You could do eye surgery!” And I said, “That is what’s holding me back from my love of eyeball operations.” My tremor has worsened in recent years, probably due to the lithium I take, which is totally worth it, but still annoying. Sometimes, if I wake up very suddenly, I find my hands shaking so badly that I can’t unlock my phone. It’s somewhat disturbing, but again- worth it.

Depression on Fast-Forward is troublesome. I’m more active, but most of it is hollow. The bigger things I’m doing, like skiing with my mom, feel meaningful, but the rest of my time…not so much. Well, except for all of the puppies I’ve met lately. They were all amazingly, infectiously joyous creatures. That’s the solution – I need more puppies.

Depression in Men: Why is it Different?

Four times more men die by suicide than women, and yet half as many men are diagnosed with depression as are women (1). In researching this topic, I was encouraged by the shift our society is making towards understanding depression in men and the factors that push them to such lengths. However, there is clearly still a long way to go. A book I skimmed early on in my search, aptly titled Men and Depression, by Sam Cochrin and Frederic Rabinowitz, mentions in the introduction that “A book that examines distress and depression in men may be seen by some as politically provocative.” In 2000, when that book was published, many researchers and clinicians were working to move public perception of mental disorders in men inch by inch. They recognized that the disparity between the number of men diagnosed with depression and the number of men who kill themselves indicates a hidden population of men who battle their depression in secret. 21 years later, the number of articles under a “depression in men” search in Google Scholar numbers over 3.5 million.

As a woman who suffers from depression, I feel relatively safe in disclosing my diagnosis. People are generally sympathetic and understanding when I discuss my symptoms. But how do men feel about the way their depression is received? A man I know has been dealing with depression for a long time, so I asked him exactly that question. Thankfully, he told me that his social circles have been largely supportive, which I think is an encouraging sign for our culture’s direction. But what factors make the rates of suicide between men and women so different? If we’ve come from “politically provocative” to millions of research articles in two decades, why are many men still suffering in silence? I want to dig into this issue to understand the historical trends, what makes depression in some men different, and what we can do to keep the conversation going.

Historical Epidemiology of Suicide

In a really deep dive, we could go way back to Hippocrates and Galen to explore the perceived gender divide on mental disorders, which would be interesting. But in this context, we’ll stick to the 20th and 21st centuries. Let’s take a look at this set of data from the CDC’s Data Finder (12). It’s compiled mostly by decade between 1950 and 2015. This graph of the data, which I made with my rusty skills in Excel, illustrates the suicide trends by rate among men in various age groups.

Although the rate of suicide among all ages has remained relatively stable, trends within age groups are concerning. Suicides among 15-24 year-olds have increased dramatically, as have those among 25-44 year-olds. Despite a somewhat steady decline in the suicide rate of men aged 65 and older, they remain the group with the highest rate. By 2019, the rate of suicide in men had increased from 21.1 deaths per 100,000 to 23 deaths per 100,000 (13). For every 100,000 men, 23 deaths doesn’t immediately sound shocking. But to illustrate the numbers in a different way, consider that in 2019, a horrifying total of 37,256 men killed themselves in the U.S.

It introduces another layer of complexity to compare the data on men to the data on women. The suicide rate among women of all ages has increased since the 50’s more than it has among men, but it still sits markedly lower. In 2019, the overall suicide rate among women was 6.2 deaths per 100,000 people (13). Compared to 37,256 male suicides, the country saw 10,255 female suicides. Both of those numbers are unimaginable to me, but it’s worth investigating; why is the rate for men so much higher than it is for women?

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Photo by Mykyta Martynenko on Unsplash

Diagnostic Factors

The wildly higher rate of suicides among men than in women, combined with the average 2:1 ratio of depression diagnoses in women versus men, convincingly suggests that depression in men is going undiagnosed. An increasingly accepted hypothesis regarding this conclusion is that men and women can experience depression in different ways (10). The current diagnostic tools don’t capture all of the symptoms of depression that men commonly face. The gender differences in symptomatology have led some to argue for the recognition of separate depression diagnoses for men and women. Magovcevic and Addis conceptualized the differences as constituting typical depression plus a subtype, masculine depression (6). Subsequent research shows that some men who don’t fully fit the diagnostic criteria on traditional depression questionnaires may be diagnosed when masculine depression symptoms are considered.

Masculine Depression Symptoms

“Masculine depression” (also called male depression and a variety of other terms), is characterized by more symptoms of anger, aggression, risk taking, and substance abuse than tend to occur in women. These symptoms are examples of “externalizing features”. They serve to express a person’s emotions in an outward, active way. “Internalizing features” of depression are identified by retreating into one’s self, such as by ruminating, engaging in negative self-talk, and isolating from others.

New Self-Report Scales

To investigate the efficacy of adjusted self-report scales at identifying depression in men, researchers created the Gender Inclusive Depression Scale (GIDS) using two other male depression scales validated with small cohorts. When symptoms of masculine depression – the externalizing features – are included in a traditional diagnostic survey, the rates of depression diagnoses among men and women are not significantly different (7). In other words, the gender differences disappear. Another scale, the Male Depression Risk Scale (8), measures emotion suppression, drug use, alcohol use, anger and aggression, somatic symptoms, and risk-taking. The sensitivity of the MDRS is similar to that of the PHQ-9 in recent suicide attempt identification (9).

Why is Depression in Men Sometimes Different?

To be clear, it’s a continuum; many men are diagnosed with depression using traditional questionnaires. But for the ones who aren’t, the answer is probably based in gender norms. Men who have depression and who identify with traditional ideals of masculinity are more likely to experience masculine depression symptoms (4). In a society that has traditionally viewed men who express sadness as “weak” or “feminine”, it makes sense that some men display their depression as anger or attempt to cope with it through substances. Sadly, it’s more socially acceptable for men to express anger than sadness, self-doubt, or anxiety.

Photo by Jordan McQueen on Unsplash

Why is the Suicide Rate Among Men so Much Higher?

If newer diagnostic scales indicate that the rates of depression among men and women are actually more alike than previously thought, what is going on with the suicide rates? Why would men die by suicide four times more often than women? It’s hard to know how many suicides could have been prevented by mental health intervention, but it’s logical to think that men who aren’t seeking counseling or who are dismissed without a diagnosis would be more likely to turn to suicide as the answer. Additionally, we know that although men complete suicide more often than women, women attempt it more often (11). Men tend to use more lethal methods, and for some men, the act of suicide represents an affirmation of strength and independence (2). It is crucial that we improve identification and treatment of depression in men (5).

A Note on “Masculine” and “Feminine”

With all of this discussion about a “masculine” depression facet, I have a small fear that readers of this post will leave feeling as though their diagnosis of depression must have been of the feminine kind. It’s not. It’s just depression – men, women, nonbinary people – it doesn’t impose judgement on your identity, it simply is. Just as men may experience more anger and impulsivity as part of their depression, women may be more likely to suffer body image issues and self-harm behaviors. But it’s a bell curve; just because men are more likely than women to exhibit anger as a sign of depression doesn’t mean that women can’t as well. Statistically, neither gender is more closely associated than the other is with the typical symptoms (8). The only gendered difference exists in the subset of “masculine” symptoms. The core set of symptoms that are covered in typical scales like the PHQ-9 remain the main diagnostic components of what we know depression to be. Expanding the criteria by creating a subset of symptoms more associated with men is just a way of widening the net in order to keep people from falling through the cracks.

For more reading on how men can view depression, suicide, and masculinity, check out this article. The author provides evidence for a variety of views that men hold about how mental health and suicide relate to masculinity.

Going Forward

For a long time, our definition of depression was too narrow. The research on gender differences in depression, which I have only barely scratched the surface of, is vast and still growing. Although the standard depression questionnaires remain focused on internalizing features to the exclusion of the externalizing ones, authorities on the matter have acknowledged the issue in other ways. The American Psychiatric Association has a webpage from 2005 that describes the early research and what to watch out for in men who may have depression. They now have a number of web pages, magazine articles, fact sheets, and books about men and depression. Someday, I hope that standard depression questionnaires will include measures for symptoms that men exhibit, but until then, we can continue to reduce stigma and spread the word about how depression can manifest in men.

Photo by Marco Bianchetti on Unsplash

You can pass online resources on to the men you know. You can talk about it with your doctor. You can listen to your friends, fathers, brothers, and sons. Assure them that having feelings doesn’t make them less of a man, it just makes them human.

Resources

  • National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255)
  • Advice on looking out for friends: beyondblue.org
  • Potential symptoms and tips for self-care: texashealth.org
  • Information, resources, and community: headsupguys.org

Citations

  1. “By the Numbers: Men and Depression,” December 2015. https://www.apa.org/monitor/2015/12/numbers.
  2. Canetto, Sylvia Sara, and Anne Cleary. “Men, Masculinities and Suicidal Behaviour.” Social Science & Medicine 74, no. 4 (February 2012): 461–65.
  3. Cochran, Sam, V, and Frederic Rabinowitz E. Men and Depression: Clinical and Empirical Perspectives. Academic Press, 2000.
  4. Genuchi, Matthew. “Anger and Hostility as Primary Externalizing Features of Depression in College Men.” Psychological Sciences Faculty Publications and Presentations, August 1, 2015. https://scholarworks.boisestate.edu/cgi/viewcontent.cgi?article=1223&context=psych_facpubs.
  5. Keohane, Aisling, and Noel Richardson. “Negotiating Gender Norms to Support Men in Psychological Distress.” American Journal of Men’s Health, October 11, 2017. https://pubmed.ncbi.nlm.nih.gov/29019282/.
  6. Magovcevic, Mariola, and Michael Addis. “The Masculine Depression Scale: Development and Psychometric Evaluation.” APA PsycNet, 2008. https://psycnet.apa.org/record/2008-09203-001.
  7. Martin, Lisa, A, Harold Neighbors W, and Derek Griffith M. “The Experience of Symptoms of Depression in Men vs Women: Analysis of the National Comorbidity Survey Replication.” JAMA Psychiatry, October 2013. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1733742.
  8. Rice, Simon, M, and Anne-Maria Moller-Leimkuhler. “Development and Preliminary Validation of the Male Depression Risk Scale: Furthering the Assessment of Depression in Men” 151, no. 3 (December 2013): 950–58.
  9. Rice, Simon, M, John Ogrodniczuk S, David Kealy, and Zac Seidler E. “Validity of the Male Depression Risk Scale in a Representative Canadian Sample: Sensitivity and Specificity in Identifying Men with Recent Suicide Attempt.” Journal of Mental Health, November 2017, 132–40.
  10. Rutz, Wolfgang, Jan Walinder, and Lars Von Knorring. “Prevention of Depression and Suicide by Education and Medication: Impact on Male Suicidality.” International Journal of Psychiatry in Clinical Practice, January 8, 1997. https://www.tandfonline.com/doi/abs/10.3109/13651509709069204.
  11. Schumacher, Helene. “Why More Men than Women Die by Suicide.” BBC Future (blog), March 17, 2019. https://www.bbc.com/future/article/20190313-why-more-men-kill-themselves-than-women.
  12. “Table 30. Death Rates for Suicide, by Sex, Race, Hispanic Origin, and Age: United States, Selected Years 1950-2015.” CDC, 2017. https://www.cdc.gov/nchs/data/hus/2017/030.pdf.
  13. “Underlying Cause of Death, 1999-2019 Request.” Data Table. CDC WONDER. Accessed January 17, 2021. https://wonder.cdc.gov/controller/datarequest/D76.

Fighting Anxiety with Purposeful Action

When my depression lifts, I often suffer from a kind of aimless anxiety that seems to have no discernable cause. Unfortunately, I also get anxious about how long I’ve been putting off large goals. Double anxiety. Having recently started taking Wellbutrin, I’m also dealing with the jitters. Triple anxiety. Luckily, feeling less depressed gives me newfound motivation and energy. I’ve been putting that motivation to use in an effort to calm my anxiety.

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I’ve been writing more, for one thing. I’m much more motivated to be creative when my mood is ok. And, maybe the cortisol increases my typing speed. Gotta get that words per minute rate up, right?

I’ve also been renewing my dog training efforts. I work with Stella on our daily walks to teach her polite leash walking skills. I generally let her wander the length of the leash and sniff around. She knows not to pull (too much), but I’d like her to walk at my side on command. We’re definitely making progress. In a silly-but-functional goal, I’m also attempting to train her to open her mouth on command and let me brush her teeth without her writhing around like an unearthed worm. It’s ambitious, but hey – they teach hippos at the zoo to do that. Surely, Stella is smarter than a hippo.

Tackling tasks that I’m already comfortable with, like walking the dog or writing something, is one thing. It’s a great way to distract myself from anxiety that I can’t address at the source. But tackling the anxiety that comes from avoiding something is different. When I’m anxious about something large – something that I perceive as a big step – I’m paralyzed. If you struggle with procrastination, you might relate to this. The thing is scary, so you avoid the thing, which makes you anxious because you haven’t done the thing yet, but the cycle continues. The more you avoid it, the bigger and scarier it becomes in your mind.

These are the two sides to the “big step anxiety” coin for me. There’s the anxiety of doing the thing, and the anxiety of knowing I’m putting it off. Usually, I remain inactive until the latter anxiety outweighs the former. At that point, I’m forced to examine the steps I’ll need to take in order to alleviate the discomfort of procrastination. I have this problem where I jump ahead to the end goal and get overwhelmed by all the steps in between. Even though I know that I can break it down and do a little at a time, it feels like a big commitment to get started because I know that I’ll have to do all of the hard parts at some point.

I have a lot to work on in this department, so I’m obviously not the picture of success (yet). What I do know is that in the same way that purposeful action helps me deal with general anxiety, getting started on something I’ve been putting off usually feels better than procrastinating. Having a direction to go in, as long as I can get my motivation past some undetermined threshold, is comforting. I like structure. It helps me organize myself and not do that thing where I skip to the end and get overwhelmed. (It helps a little. I always do that thing).

By procrastinating, you’re suffering both sides of the anxiety coin. Rationally, you can save yourself some stress by chipping away at unpleasant tasks bit by bit, right away. Too bad people are not always rational, and avoiding immediate pain is more attractive than choosing the benefit of the long view. So in essence, fight human nature, beat back entropy, and go conquer your goals! Boom. Fixed procrastination.

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Having Good Days with Depression

Every time I have a sudden improvement in my depression, I’m blown away by how much easier life is. When you live with something every day, you get used to it. It no longer catches your attention when your symptoms don’t stand out from the daily noise.

Yesterday, I had a good day. I called a friend, went for a run, attended a virtual writing group, and only napped for one hour! This is a dramatic improvement from recent weeks. I can’t believe that such a mundane day could feel so novel and exciting. Today, I woke up and thought “What am I going to do today?” Not in my usual “I’m tired, every day is the same, and I’d rather stay in bed but I have to do something.” way. More of a “I could accomplish something today” way. I actually feel slightly enthusiastic about it. I’m looking forward to the near future but nothing in particular, which is a foreign feeling to me. It’s a kind of vague “the day is full of possibilities” feeling that is a dramatic change for me. I attribute this shift to a second ketamine infusion I had just a few days after my regularly scheduled infusion. The goal was to sort of trampoline-double-bounce me, and hooray – it worked!

I had a conversation somewhat recently about how easy it is to doubt yourself when you have a chronic, “invisible” condition. You might start to forget what “normal” feels like, which makes it hard to tell if you’re there or not. For instance, I often find myself questioning whether I’m being sluggish because I’m depressed or because I’m not putting in enough effort. When you check in with yourself often (“Am I feeling better yet? Is _____ working yet?”) it’s easy to get bogged down in minute details and lost. But a sudden shift in my mood shows me that I can easily tell when I feel better. It’s a change that I notice right away. It’s somewhat validating, actually.

I also try not to dwell on the anxiety that this improvement could be short-lived. I’m accustomed to the very slow seesaw of my moods, which makes a worsening of my depression at some point in the future seem likely. It’s an exercise in mindfulness to focus on the day as it happens. Right now is pleasant and noticeably easier than just a few days ago. The future will unfold as it will, so I may as well appreciate the present.

Here are some things I appreciate: As I’m writing this, my dog is asleep with her head on my legs. I can feel her twitching as she dreams of canine life. I’m astonished at how much she helps me – how important she is to my mental health. I’m grateful beyond words for her. It’s almost noon and I am still awake, having made it several hours past my usual nap. I’m getting tired, but that’s ok. I’m going to enjoy the improvements and be kind about the symptoms that remain. I appreciate comfortable clothing, raspberry tea, and the flexibility my job provides. I recently learned that clams have internal organs but mussels do not, and I’m thankful for Wikipedia. I appreciate my curiosity, both for random facts and for how far I can go with this newly lightened mood.

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Kaleidoscope: The Ketamine Chronicles (Part 29)

Right away, I could hear my heartbeat in my ears and head, and my face seemed to be pulsating with the rhythm. My ears became surprisingly hot, but all of that faded away after a few minutes. Usually when I close my eyes, I see bizarre images, but they’re mostly distinct and recognizable. This time, there were points when I felt like I was traveling through a three-dimensional kaleidoscope – just shapes and colors that morphed together as they moved. The real world was also especially distorted this time, and once, when I opened my eyes, the wall across from me appeared to be covered in pale yellow cobwebs. There were two tiny silhouetted figures standing among the cobwebs, engaged in what looked like a silent argument. After a minute or so, one of the figures sprouted wings and fluttered away like a moth. I don’t think I’ve ever had my ketamine dreams intrude upon the real world when my eyes are open before. It was really trippy.

I don’t remember much of the internal experience, but I know that there were a ton of lines – straight lines, wavy lines, crosshatched lines, diagonal lines, lines moving away from me, and lines coming closer. Sometimes, I was looking for something among the lines, but it was always hidden out of sight. If you’ve ever seen those “deep dream” images created by Google’s neural net API, you know roughly what my experience was like this time. Here’s one I just made out of a picture of a sloth.

I had always assumed that trippy pictures like that were just weird approximations of what it would be like to be high. But no, it really looked a lot like that. Just take that image and imagine it moving, and that’s pretty much it.

There were rarely any distinguishable objects in my inner view this time, though. It was mostly just a sea of odd, moving blobs and spirals. When the lines and colors and moving kaleidoscope patterns got to be too much, I’d open my eyes briefly. I’m technically not supposed to do that, but it did serve as an effective break from my brain’s wild mishmash of subconscious vomit.

At some point, I switched my crossed ankles and was immediately struck by the sensation that my legs were melting. My bones seemed rather rubbery, and the weight of my feet extending past the footrest made me feel as though my shins were bending in the middle. I remember thinking that I felt just like a Salvador Dali clock, melting over the edge of the footrest. My whole body threatened to melt, at which point I’d slip off the chair into a puddle on the floor. It occurred to me that it would be difficult to get back to the car that way.

During my moments of open-eyed room viewing, I noticed that the door looked unusually soft. It appeared to be made entirely of clay or putty. The color was the same, but it looked temptingly squishy, like if I went over there and pressed my hand on the edge, it would just mush in on itself. Perception is so interesting. Just 20 minutes earlier, I had interpreted the same visual signals in a completely different way.

Ever since I wrote that post about water in my ketamine dreams, I haven’t had any further peaceful drowning experiences. Maybe it’s a coincidence, but I do think it’s interesting that after contemplating potential meanings of that recurring image, I no longer find myself experiencing it. What does still happen is the spreading darkness. This time, I was trying to look through a bright skylight while inky blackness approached from all around. It closed in until all that was left was a pinprick of light. Whenever that happens, my mind just switches gears and I begin a new dream-like vision.

My next appointment is three weeks from now. I think I already feel lighter, although still a little spacey. My memory of yesterday is kind of foggy, and conversations I had feel choppy and surreal. I got home mid-afternoon and promptly fell asleep. At 11pm, I awoke suddenly, wondering where I was. I had fallen asleep on top of my blankets, oriented the wrong way with my feet on my pillow. I sometimes nap this way in order to differentiate naptime sleeping from nighttime sleeping, but it was still incredibly disorienting. I managed to do all the usual things I do before bed and then crawled under the covers the right way.

I hope this ketamine infusion works; I’m feeling discouraged again. I’m tired of being tired and unmotivated. The pandemic set me back a good deal, and I find myself forgetting that I had made some good progress last winter. It just feels like I’ve felt this way forever.

If you liked this post, consider starting from the beginning of The Ketamine Chronicles, or visit the archives for month-by-month posts.

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Balloon Head: The Ketamine Chronicles (Part 28)

Before yesterday, it had been about three weeks since my last ketamine infusion. Lately, I notice an improvement in my depression in the days following an infusion, but it doesn’t last for as long as I’d like. Changing or adding a medication seems like a good option at this point. For a couple of weeks now, I’ve been battling my pharmacy and insurance for access to Wellbutrin. It’s been quite a hassle, but I hope it will be worth it.

For this infusion, I used a scopolamine patch and took cimetidine, both of which may help the effects of ketamine last longer. When we’ve done this combination in the past, I’m pretty well zonked for the rest of the day, and the experience of the infusion mostly disappears from my memory. Scopolamine makes me feel slightly off balance, and it gives me wicked dry mouth. Not just dry mouth, though – it’s also inside my nose and throat. Yuck.

Often, the first sensation I notice during a ketamine infusion is warmth in my head and neck. This is quickly followed by a sense that my head is either expanding or shrinking. This time, it was shrinking. It felt a bit like the skin around my head stayed in place, but everything underneath it was crumpling into a little tin foil ball. At some point, the feeling reversed. The warmth radiating upward evoked a strange floaty sensation, and I remember thinking that my head felt like a hot air balloon, stretching out and lifting off.

Perhaps the dryness in my mouth and throat is what led to the first image I can remember: a drab, grey fish drying out on a sandbar. Somebody came by and tossed it back into the ocean, only for it to find itself surrounded by sharks.

The fish dream did not last long, and I soon moved on to other things. Once again, numbers dominated parts of my experience. Spreadsheets, tickets, and measurements scattered throughout my brain. My mind seemed to be going a mile a minute, and interspersed with the numbers were seemingly random objects and animals that flashed into focus and then disappeared. It started to become overwhelming, so I opened my eyes a few times. After the speed and intensity of my split-second ketamine dreams, the room was suddenly, jarringly quiet and still.

Something I’ve noticed about ketamine is that when I open my eyes, everything is so blurry and unstructured that I can’t tell where the people around me are looking. It’s interesting to note how much it bothers me to not be able to read people’s expressions or body language. I don’t notice that being so crucial in my daily life because it just happens naturally for me. But when I suddenly can’t do it anymore, it’s almost like the people around me are aliens whose emotions and thoughts are completely inscrutable.

At times, quiet conversations and activity in the hallway and other room seemed incredibly loud and close. I wondered if there were people standing right over me, but when I opened my eyes, the noise stopped and the same calm, serene room greeted me. When I looked up, the ceiling tiles resembled oil paintings of pastel landscapes. I closed my eyes and was met with more odd images, many of which I don’t remember. There were translucent shrimps on the sea floor, skeletons, and a curtain made of long, interwoven strips of orange, red, and pink fabric. At one point, a sequence of images told a bizarre story. I had found two birds and put them in a cage until I could figure out what to do with them. But as I turned away, the larger of the two birds veeery slowly swallowed the smaller bird whole. WTF. I’m relieved that I managed to interpret my post-infusion notes, because what I wrote down in reference to that particular ketamine dream was “mbira dram” (bird dream). Even autocorrect couldn’t help me with that one.

I went to bed early last night, but woke up around 11pm extremely confused about what day/time it was. I had completed my whole nighttime routine before going to bed, so I just decided to not worry about it and went back to sleep. I was awoken a couple more times in the night because of how dry my throat was. It felt so desiccated that just breathing irritated it. Definitely unpleasant, but bearable if it means the ketamine works better. I was developing a headache when I went to bed, and it’s still hanging on around my right eye and forehead, but in a mild way. I had a headache after the previous infusion as well, which I had assumed was PMS. Perhaps not, though.

To try to boost my mood, we’re going to do another ketamine infusion in a few days. In the meantime, I’m going to enjoy the fact that 2020 is officially over.

Happy New Year!

If you liked this post, consider starting at the beginning of the Ketamine Chronicles, or visit the archives to find month-by-month posts.

Mental Health is More Important Than Academic Success

Growing up, I was always motivated by grades. I liked having that definitive mark to indicate whether I did well or not. Clearly, the beginnings of my perfectionistic tendencies go way back. Even in middle school, I remember carrying around a lot of anxiety about tests and grades. When I got to college, I was excited to be focusing more time on my interests – biology and anthropology – but the pressures of academia wore me down.

Still, I was determined to do well. I had learned that I could earn good grades if I just put in enough work, even in subjects that didn’t come naturally to me. School was what I knew, and I felt tantalizingly close to the finish line. So, when I was diagnosed with major depressive disorder in the middle of my college career, I didn’t slow my progress down. Like many students, I simply forced myself to put my mental and physical health behind academic success.

At its worst, I went back and forth from my bed, desk, and class, taking naps when necessary but skipping meals and forgoing social interaction to conserve emotional energy. I thought about suicide a lot. I had several plans in mind, and I kept the worst of it from my therapist, fearing that she would force me to go to the hospital. The worst part of that potential event, in my mind, was missing class and falling behind. When I look at photos of myself from this time, I remember how forced it often felt to smile. Even on graduation day, I didn’t look happy; I just looked exhausted.

I hoped that if I could just make it to graduation and go home, I could rest and recover, and my mental health would improve. Instead, the sudden lack of structure combined with my admittedly fragile emotional state made things much worse. I tried – for months, I went diligently to therapy and attempted to pull myself out of my depression, but ultimately slipped back into suicidality. I was hospitalized for over a week, then released on condition that I do a partial hospitalization program for two more weeks.

I don’t know that all of that was caused by the stress of college. I am in my early twenties, when many mental illnesses make their presence known, so it’s possible that my symptoms would have been just as severe had I not gone to college at all. But I suspect that my perfectionism surrounding academics and the pressure I put on myself to succeed made an already risky situation worse.

When I can find compassion for myself these days, it makes me sad that I treated myself so poorly. Yes, I got a good GPA, but at what cost? To imagine anyone else doing what I did – valuing their academic success over their own life – is unbelievably sad. There is no grade that matters more than your wellbeing. I’m not exactly sure how my perspective was so narrow for so long. I knew that I could have taken a semester off – my mom suggested it, once – but I was vehemently opposed. I didn’t want to fall behind my peers. The thought of returning to campus without my friends made me anxious, and it left a vaguely shameful feeling in my chest. To take a semester off felt like a failure to me. That was my perfectionism speaking. There is absolutely nothing wrong or bad about taking a semester off. Or two. Or however many you need.

If I could go back, I would do things differently. I did love my majors – I would keep those. In fact, finding subjects that sparked my curiosity was probably what kept me going. Knowing that I had something to use in a career gave me a sliver of hope that was enough to let me imagine a future in which I wasn’t depressed. But two majors in four years is hard. I took a lot of credits each semester, and there was no way to avoid pairing difficult classes together. If I could go back, I would do it all more slowly. I’d take fewer credits per semester and accept that it would take me longer than four years. I’d also apply for accommodations. Beyond the assistance of longer exam times, it would have been nice to have my professors in the loop about my depression.

A lot of my perfectionism surrounding academics existed long before college, but there is something to be said for the culture that permeates my alma mater. There’s a sort of competitiveness among perfectionistic students for who can push themselves the hardest. If you say you’re stressed, people ask you how many credits you’re taking, as if your stress doesn’t count unless your course load is full. It’s not stated outright, but the general atmosphere is one of suffering-related humblebragging. If you’re stressed, it means you’re pushing yourself. If you’re not stressed, you might be slacking. Again – I love my university, and I’m proud to have gotten my degree there. People are motivated to achieve at Michigan, which is wonderful. That said, the limitless pressure to succeed can be dangerous.

Suicide is the second-leading cause of death for college-age people in the US, and its rate is increasing. Around 1,000 college students die by suicide each year. When young people are off at college, often away from home for the first time, they’re vulnerable to the prevailing ideas. Submerged in a competitive culture, it’s bizarrely easy for students to believe that their future will be ruined by a bad grade. And I get it – students have plans beyond college that require top-notch GPAs. For a while, I thought that veterinary school would be my next step. Instead, my plans seemed to come to a screeching halt after college. Depression has altered my life enormously. If I could talk to sophomore me, I’d say “I haven’t gone to grad school, but my life is not ruined.” Through the waves of depression, I catch glimpses of what really matters, and none of it is a letter grade or a GPA. I think I have a healthier perspective on life and academics now.

I sincerely believe that most of my depression is biochemical. That said, I’m pretty sure my college experience sped things up significantly. Again – I don’t regret going to college, but I do think that if I had taken time to consider my innate traits, really thought about the stresses of being a highly introverted person at a university with more than 40,000 students, things might be different for me today. I did my best at the time, but I wish that I had honored those parts of myself; the quiet parts, the parts that need calm and routine, which were frazzled and burnt out after four years of high pressure. My sensory differences made the pace of life I’d chosen at university unsustainable, and by the time I graduated, I had an almost constant low level of vertigo, loud noises made me cry, and lots of movement in my visual field (like in a busy dining hall or a crowded hallway) made me disoriented.

I would encourage anyone who is pursuing a degree now or considering doing so to remember that it’s your education and your life. Everyone goes at their own pace, and what anyone else thinks about your pace doesn’t matter. Furthermore, what you think other people are thinking is likely more harsh than the reality. Taking care of yourself is not always easy, and going against the grain takes courage. Think about the resources and environments that would support you and seek them out. Make friends who understand you, and above all, put your health first.

(There were parts of college that I really loved. The friends I made and the things I learned were priceless. Football games, waffles, fancy events at my dorm, exploring campus – there are tons of great things about college! I didn’t intend for this post to turn out so dark. It’s all about moderation.)

Watching rotund squirrels eat nonspecific trash was always fun, too.

top-down-view-of-pill-bottle-with-tex-hold-tab-down-turn-with-arrows

Changing My Depression Medication

It’s come to my attention that my antidepressant doesn’t seem to be doing much. IV ketamine infusions are also doing less than they used to, unless it’s the case they they’re doing just as much but my brain is kicking its level of stubbornness up a few notches. Who’s to say what the cause is? Maybe it’s just the curse of 2020.

I got sidetracked. The point of this post is this: I’m about to start taking Wellbutrin, a medication that I tried a few years ago and really liked. I was only on it for about a week, though, because I promptly broke out in a blotchy rash that spread from my chest, up my neck, and all over my face.

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(the rash of 2018)

It seemed like a cruel joke played on me by the universe. The only oral antidepressant I’d ever tried that made a sudden, discernable difference in my depression is one that I’m allergic to.

Cut to now – I’m once again finding myself floundering in the soupy mashed potatoes of my depressed brain, looking for some way to change things. I’ve always carried a little bit of disappointment about my failed Wellbutrin trial, especially because I was taking the generic at the time. What if I wouldn’t have a reaction to the brand name version? Would it be stupid to try?

You know those prescription medication commercials that include a disclaimer like “Don’t take [name of drug] if you’re allergic to [name of drug],” and you’re like “Well, DUH”? I am now the person that those disclaimers target. To me, the risk of an allergic reaction is worth the potential benefit of taking Wellbutrin. I think it’s telling that when faced with the possibility of a rash, swelling, even anaphylaxis (unlikely), my reaction is “sign me up”.

I remember being so amazed at how motivated Wellbutrin made me feel. It was the only oral medication that’s ever given me that “I didn’t fully realize how depressed I was until I wasn’t” feeling. I was in my last semester of college when I took it. By that point, I had tried several medications and was struggling to get through the last few months before graduation. I was over the moon when I realized that Wellbutrin was working for me. It was SO much easier to get my work done and interact with people, even just for the few days that I was on it. When I got the rash, I stopped taking it abruptly, and the sudden changes did not do good things to my mental health. I had already been utterly overwhelmed by classwork and worn down by the near-constant suicidal thoughts that had plagued me for over a year. I canceled my trip home for spring break because I wanted to be alone, and I reluctantly started yet another combo of meds. I just remember the whole thing being bitterly disappointing. It was like Wellbutrin had swooped in, showed me how much easier everything could be, and then ditched me with the gift of an itchy, burning rash after just a few days.

So, I’ll take the chance of a rash if it means I might feel better. That said, if I let myself get too hopeful and the result is a letdown, I know I would feel incredibly defeated. I’m trying to temper my expectations. If I get a rash or if it doesn’t work, at least I’ll finally know for sure if it’s an option for me. I’ll write an update soon.

Overcoming Phone Anxiety, One Vet Trip at a Time

I hate making phone calls. A strange sort of performance anxiety makes me script it out in my mind and practice over and over with the number dialed in, waiting for me to hit the call button. I never feel ready. Eventually, I get so fed up with myself that I have to just press the button and hope that my verbal skills are adequate for getting me through the act of ordering delivery or making an appointment or whatever it is. And, they are. I’m not actually bad at phone calls. I don’t think I’ve ever had a call that validated my fear – that I’ll just forget how to talk and have to hang up after embarrassing myself with gibberish. Once I’m on the phone with someone, it usually goes smoothly. For whatever reason, the lead-up is the worst part.

I’ve had to call the vet numerous times in my two short years as a dog owner. My dog, Stella, is what you’d call “high-energy”.

close-up-of-dog-face-while-running
Zoomies around the couch.

She needs activity, either vigorous exercise or a long, meandering “smell outing”, as I call them. (There’s not much walking. It’s mostly smelling.) She gets into a lot of weird, wonderful stuff outside – sometimes she puts it in her mouth, sometimes she rolls on it. She plays fetch with reckless abandon – skidding to a stop or wiping out in a cloud of dust. Stella’s ability to seek out disgusting, physically risky situations is pretty incredible. First, it was giardia. Then, it was an eye infection. Then tapeworms, then another eye infection, kennel cough, a bloody, broken nail, and finally, another eye infection. Actually, this time she had an ulcer on her eye. Yowch. When I woke up and saw her swollen, watery, goop-laden eye, it wasn’t hard to pick up the phone.

I think it’s common to feel braver when you’re doing something for someone else than when doing the same thing for yourself. It’s easier to give up when the only one impacted will be you. When you’re being depended upon, either by volunteering to help or because it’s your responsibility, there’s much less room to waffle. I’ve found that in calling the vet for vaccinations, checkups, eye infections (ugh!) my anxiety is dramatically reduced because I don’t consider it an optional task. When I have to do it, I have to do it; there’s no point in waiting.

I also find an extra boost of authority in advocating for someone else. It’s like I’m calling up the vet and saying “Ah, yes. I’m calling on behalf of my dog. She… doesn’t know how to talk, so I promised to call for her.” And then it’s like I’m not even a part of the phone call. I’m just a proxy for a four-legged creature with a goopy eye.

I think I might start using that when I have to make other phone calls. I’ll just imagine that I’m calling on behalf of my anxious self, who I promised to take care of. “Yes, hello? I’m calling about Gen’s prescriptions. Yeah, she’s overthinking right now and can’t come to the phone.” I’ll be her more courageous counterpart. She needs me, poor thing.

I know people who use this tactic for public speaking – pretend you’re someone else. You’re playing a character. That way, the attention isn’t actually on you, because you’re not really being yourself. It’s an interesting little mental trick that, I’d imagine, takes a lot of commitment to pull off.

For a while, I thought that my anxiety about phone calls was because of the lack of visual social cues. It seemed like the potential for misunderstanding or blundering mistakes was higher when I couldn’t see the person I was talking to. But why, then, wouldn’t texting make me anxious? The written word is where I’m most comfortable, mostly because it gives me time to think through what I want to say and edit before I hit “send”. Maybe that advantage outweighs the anxiety of not being able to see the recipient of my words.

In any case, I hope that Stella chooses to be a little more cautious in the future. But if not, I’m prepared to call the vet for her, seeing as I’ve had plenty of practice.

A “low-energy” moment