It will soon be year since I started treatment with ketamine. Though it may well be the miracle many of us with treatment-resistant depression had all but given up waiting for, learning to live with ketamine still takes trial-and-error and time, just as with every other medication.
After learning that with this treatment it is actually possible for me to be relatively free from depression, I learned that maintaining remission can nevertheless be difficult. Beyond the need to keep going for infusions every 3-6 weeks, I discovered the hard way that taking clonazepam regularly can prevent the infusions from having much effect. (When high stress at work had me taking clonazepam at least daily, I became increasingly depressed, and quite scared about that.) Thankfully, ketamine did start working for me again once I got off of clonazepam, but now I’m adjusting to receiving a higher dose. Whereas I found the treatment peaceful and pleasant at lower doses, I find it draining at higher doses — a lot like when you have such vivid dreams that you wake up exhausted.
One of the ways the treatment is different at higher doses is that it takes much longer to be functional again afterwards. Trying to get up, leave, and catch my train on what had become my usual schedule, I started feeling surprisingly groggy and not quite in control of myself. This made me start worrying a lot about how I may be coming across to my doctor and other people while in this strange state. I also started feeling quite hung over the next day, and I don’t know to what extent this is a physical effect of ketamine or a psychological reaction to the intensity of the whole procedure. The twelve hours of traveling, the intoxicated interactions, and the rapid, colorful, dream-like experiences during the treatment can all add up to be quite a lot for someone as introverted as I am.
It is like this: first my teeth and fingertips feel strange, and there is a sort of metallic taste. Now that I’m on a higher dose, noticing these sensations is often my last reality-based thought for the next 45-60 minutes, and the signal that I’ll soon lose the ability to do anything (such as change the song on my mp3 player). I’m certain that the music I choose to listen to makes a difference in keeping the thoughts/images relatively familiar. In fact when my mp3 player recently dropped to the floor during a treatment session, the landscape changed completely — as if everything became untied — though I didn’t even realize what had happened until after the session finished. The treatment is also oddly social (given that I’m really in a dark room alone), because I keep thinking about people I’ve known throughout my life.
And here is what most frequently goes through my mind:
- Being in bed staring at my hands at around age 4, thinking this is me.
- Everything is related to everything else, and it has all been leading up to this.
- Various words and names are really very weird, in ways that seem to mean something, when you really think about them.
- OK, that was weird. No, wait. THIS is even weirder.
- Infinite things within things, tunneling inward. Like trees or neural networks with branches off of branches off of branches…
- Being thrown or pulled far out into the universe somewhere.
- Oh please, could this even possibly be more of a cliché?
- The environment becoming increasingly dingy-looking and solid as the treatment finishes. Transparent layers fall away and I am becoming embodied.
- OK, I’m back now. No, wait. I’m back NOW. No, wait.
But seriously, I never expected that an effective treatment for a severe and intractable illness ought to be quick, easy, or fun; after more than 40 years of depression I was unable to imagine any way out at all. Ketamine has let me dream of what was previously only impossible.