A salute to the K

As strange as this is going to sound, I’m learning that it’s possible to feel low, but also not feel low, at the same time. I think this is the gift of the ketamine-infusion therapy, and now I’m glad I didn’t judge it rashly after Friday’s treatment. For all I know this gift is life-saving.

Let me explain what I mean: as I hinted in an earlier post, it seems that my body is showing the typical physical signs of low mood; I find myself sighing a lot, I lack energy, and my facial expressions are limited (usually favouring a stern look). I also have the circumstances in place for a mood drop (also outlined in an earlier post – I’m home alone for eight days), so this isn’t surprising.

What’s changed since I last wrote here is that I can see the accompanying misery, and almost touch it, but yet I’m numb. If the low mood is a coat, I can see it on the peg and even slip it on, but my skin isn’t quite in contact with it. A long sleeve t-shirt (ketamine-infusion) is acting as insulation against it. So, I know the coat is there, and I can even see it on me, but it’s not properly changing my immediate situation.

I have no idea if that makes sense to anyone other than me – I hope it does. The fact that I’m more aware of the low mood floating out there than I was a couple of days ago makes me think the ketamine is probably wearing off, which fits the timeline on the information sheet, but I’m really grateful for the time it bought me, and I hope I’ve got at least a little more time before the darkness creeps in. Unfortunately, I don’t doubt that it will creep back in, but I currently seem to be having a decent break from it.

I’ve been pretty quick to criticise the ketamine-infusion therapy I’ve had in previous posts, mostly because I hated how it played with my self-control (the pull towards dissociation during the infusions is irresistibly strong). There was no long term benefit in return for this cost, but now I see the real value for me: it keeps me safe when my mood would have me in danger. I wasn’t in this position around the time of the first two infusions, but I am now, so I can finally really understand why this form of treatment is being so keenly researched.

So, ketamine-infusion therapy, I salute you.

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So far so good

It is very strange to find yourself in a set of circumstances that have previously led you to harm yourself, and have no such intentions this time around.

The circumstances are that the family I live with have gone on holiday for eight days, so I’m home alone house-sitting. Last time this happened I tried to off myself and ended up in hospital with serotonin syndrome. Not clever. And there has been a pretty clear pattern over time: if I’m on my own for more than a day or two, my mood dives and I end up doing something dangerous. Blades, pills, fumes, bags with elastic…you get the picture.

This time it’s different. I find myself pausing and sighing like I do when my mood is low, but I don’t feel too miserable; perhaps that’s the (therapeutic) ketamine working. I’m…coping. I can do normal things, like today I invited my brother over and cooked my first ever roast dinner. I have no structure to my days this week because I don’t have any babysitting commitments, and I’m surviving the empty space pretty well so far. Perhaps more remarkable is that I’m surviving it solo – Dr T is on vacation now until next year. But I’m okay. I don’t feel like I need him, or the Day Hospital, or any of those services at the moment.

I’m okay. And that’s fantastic.

Ketamine-infusion therapy: Day Three

My third and final (therapeutic) encounter with ketamine…I’m glad this has come to an end. Strangely these sessions have become more difficult over time, not less. Knowing what to expect doesn’t lessen the strength of the drug, and it looks to me like this isn’t a beneficial course of treatment long-term.

But I’m devoting this post to the 40 minute experience itself (here are the links for the first and second infusions). The cannula was placed in my hand, the drip was attached, and as always I could feel the effects in no time at all. The walls starting shifting up, and then down. Everything moved. Time stopped and started in seemingly random chunks that I couldn’t keep hold of. I remember bits and pieces of what was going on around the ward, but they don’t fit together very well.

There was a Christmas tree on the windowsill opposite my bed, and I was almost surprised to see it – was it Christmas soon? The nurse asked me if I had plans for Christmas – what? Oh hang on, I would be with family, but when? Or was that last year?

At the optimal ketamine blood level, I could tell you my name, but I could not tell you anything that hasn’t been in my memory for years already. I had a vague idea I might have a psychotherapist, but that could be someone else. I might be job hunting, but I’m not sure. What’s my family situation at the moment? No idea. I just know that I have a family, and an awareness I’m keeping secrets from them.

Towards the end of today’s ketamine-infusion I was lying on this hospital bed knowing I was off my head, but unable to do anything about it, so I panicked. I had to work very, very hard to keep my breathing even, and I managed to tell the nurse I felt sick. I just wanted a clear head again; to be able to remember myself what the date is, and what my current life involves etc. I felt uncomfortably out of control, which manifested itself physically. I feel slightly bad because I think I looked ill enough to worry the nurse; she even checked my pulse at one point.

About five or ten minutes after the infusion ended I regained a firm sense of self, and after about an hour or so I was steady enough to walk and move around. I was sent over the the Day Hospital, where I promptly discharged myself.

I’m going to write a full post in the next day or two about what I make of this therapy as a whole. For now, I find myself emotionally numb again, which is not unpleasant. I really am glad these infusions are over; they test my self-control to the limits, and are a total mind****. Reality is not supposed to stop, and you’re not supposed to feel like you’re now existing in a new dimension. Time is meant to be straight and constant, not clunky.

But at least I tried it.

Ketamine-infusion therapy: Day Two

Today hosted round two of the ketamine-infusion therapy I’m having on a fortnightly basis, and I think it happened to be well timed – my mood has been really low recently, so I was quite keen for a dose of emotional-numbness.

The experience itself was mostly the same as it was the first time, so if you’re interested in the details check out that post. Once again I was off my head within two minutes of the drip being attached, but since I knew what to expect I was better able to keep myself grounded. The nurse laughed at her memory of what I was like last time (‘You found it quite…profound!’), and I had already made a mental decision to stay as silent as possible today.

I can’t accurately describe how intense that forty minutes was, as before. You lose all sense of time, and you can’t remember what year it is, let alone what day it is. You can hear what’s going on around you, but it’s hard to keep a memory of it (this time I made a real effort, and I can remember the various things that happened on the ward, although I can only guess how much time passed between each one). When you reach the halfway point of the treatment the nurse (/’sitter’) asks you what you’re experiencing, and you come across crazy just because you don’t have the words. For forty minutes, life stops. The world spins too fast. Nothing stays still. There’s a time delay in moving your body, while the words in your head are magically heard by those around you unless you concentrate on keeping them private.

I told the nurse that as stupid as it might sound, the closest I could come to describing the scale of the experience was that it was like being in the matrix (as in, the film trilogy). The nurse told me that she’d had patients saying the same thing, and that they described being able to see the code of the universe, but that’s not what I meant. No hallucinating. Just the overwhelming sense that time has been stopped.

Towards the end of the forty minutes, I decided I didn’t like it. I had hoped that since I knew what to expect this time, I might have better luck fighting the worst of the dissociation, but I didn’t make much headway. and I struggle with that lack of control. It took me half an hour to even be able to stand up once the drip was finished, and I came away feeling like I’d been through more of an ordeal than last time.

That said, I don’t feel sad, and I did before I went in. I feel numb. I can’t even imagine feeling sad (or happy, or angry, or excited etc etc). The nurse says this treatment does seem to be helping me. I think I’ll reserve judgement until I can think a bit straighter.

Working?

I think I might actually be feeling a bit better (mood-wise) after yesterday’s ketamine-infusion. It’s strange; this morning I felt almost cheerful, and then I returned back to numb. Part of me wonders if I’m imagining change, like a placebo.

I guess either way it beats feeling miserable!

Dr T wasn’t keen on me having this therapy because he thought it might cut me off from my emotions/dampen them…I think he was right. Hopefully it’ll wear off before we meet on Monday.

Ketamine-infusion therapy: Day One

Today I had my first ketamine-infusion treatment for depression, and OH MY WORD it was not what I expected. The information sheet I was given a week ago said I might feel a bit drunk and disoriented…Ha. Ha. Ha. Understatement alert.

My appointment was at 10:30 this morning, and when I arrived I found the team was running late. The treatment is given in the same department as ECT, and it was a bit unnerving sitting in the shared waiting room with a confused patient who kept insisting she’d seen me before. Fortunately a nurse came and led her off to the ECT room after a few minutes, and eventually a nurse we’ll call Nurse K came to get me.

I had to make myself comfy on a hospital bed stuck in the corner of a room, and an anaesthetist came and put a cannula in the back of my hand. Nurse K took my blood pressure, and then connected the ketamine drip.

The info sheet said I would start feeling the side effects after about ten to twenty minutes.

Within two minutes I was losing touch with reality.

I don’t know how to accurately describe the next forty minutes. I’m not sure how accurately I remember it. My hearing was fine, but I had double vision, and everything was moving. It felt like my body was moving too, even though I was lying still on the bed. There was some kind of delay between thinking and acting, and I could hear that I was talking without registering that my mouth was moving.

The weirdest thing was that it felt like I kept waking up/coming round, repeatedly finding myself thinking ‘Oh okay, I’m back to normal alertness now, the last however long was dreamlike’, over and over, despite never losing consciousness. Apologies if that makes no sense…I guess that was the break with reality. Deja vu x 100, staring at the picture of a penguin on the wall and using it to centre myself now I was ‘back’.

Nurse K sat next to me the whole time, and I tried very hard to try and appear normal to her, even though I felt like I was on the trip of a lifetime. I’m not sure why I bothered. We were able to chat and joke, but she knew I wasn’t all that ‘with it’, as demonstrated by some crap attempts to explain what I was experiencing. She had to do a questionnaire with me at the start, middle, and end, asking about the side effects, and it was hard to concentrate enough to answer her questions.

The forty minutes passed (I lost all track of time, it could have been five minutes or a lifetime for all I knew), and once it was up Nurse K disconnected the drip and gave me some time for the worst of the disorientation to wear off. It took a good twenty minutes to lose the double vision etc, and once I was safe to walk I was led through to the recovery room where another nice nurse made me a cup of tea and some toast. I gradually regained my sense of mental-sharpness, and was finally allowed to spend the rest of the day in the Acute Services (Day hospital) centre. It was nice to spend the afternoon chatting to one of the friends I’d made there, and it certainly beat sitting around in the recovery room until 4pm.

Now I’m back at home, and while I do feel a bit odd, it isn’t too bad. I felt sick for a while this afternoon, but that has passed. Mood wise…I don’t know. I think I might be numb.

I’m going to try and sleep the rest of the ‘oddness’ off, and I’m curious to see how I’m feeling tomorrow.

But I will say again, I did not expect the treatment to be as intense as it was. I was almost completely off my head. Nurse K said some patients have panic attacks during treatment, and I can see why. And yet, the dose we receive is only 20% of what recreational users take – I can’t imagine what the full lot is like, and I don’t want to. This was not my idea of fun.

The ‘K’ countdown ends

…tomorrow. The closer I get to starting this ketamine treatment, the more I feel nervous, but overall it’s not too bad. I just hope it’s worth the gamble of lying to my parents.

I saw my psychiatrist this morning, and I’m increasingly realising how lucky I am to have her; she’s nice, but not sickeningly-sweet-smiling-all-the-time nice, and she seems to actually give a s***. We’re tweaking my lithium dose to see if it improves the memory problems I’ve been having recently. There wasn’t much to say apart from that, as now we need to wait and see if the ketamine treatment works. I’ll see her again in about a month’s time.

My mood isn’t amazing at the moment, as evidenced by some recent shopping sprees. Dr T cancelled therapy yesterday, and I guess that didn’t help.

I just keep struggling with this big question of ‘what’s the point (of living)?’. What am I looking forward to? What do I want from life? Currently it feels like the answer is ‘nothing, I’m done’, but given what I’ve learned recently about the deceptive nature of depression, I’m managing not to act on it. It is hard though, and when my mood falls I know I might lose that insight. This is why I was nervous when my psychiatrist said we should lower my lithium dose, since I have found lithium to live up to the anti-suicide claims, but we don’t have much choice.

So, I plod along, waiting for a miracle like a breakthrough in therapy, or a good response to the ketamine-infusion tomorrow. But it does feel exactly like that, waiting for a miracle, which makes it frustrating that I’m putting myself through the potentially endless waiting period.