When I couldn’t keep my medication history straight anymore, I found myself heading toward a low point in my depression. I had moved home after graduating from college and, hoping to make my mental health a priority, began the process of finding new providers. I soon discovered that I could not remember the timeline of when I had tried which medications and for how long. In fact, after a certain number of antidepressants, tried and failed, my illness moved from being “depression” to “treatment-resistant depression”. It wasn’t a surprise to me. After years of therapy, numerous antidepressants, seemingly endless suicidal thoughts, and a hospitalization, “treatment-resistant” feels like an accurate label. While comforting to know that there’s a category for depression like mine, the next steps of treatment resistance were daunting.
Almost a year later, when a psychiatrist at the hospital I was in told me that your chances of successful treatment go down with each new medication you try, the seeds of branching out had vigorously sprouted. My psychiatric nurse practitioner had been suggesting IV ketamine infusions for months, but I was reluctant. I had gotten comfortable with antidepressant pills, and I (rightly) felt no shame in using them; they’re a very common treatment for major depressive disorder. Something more involved, like ketamine, forced me to confront the fact that nothing else was working. I needed more help than antidepressants and therapy could give me, an innocent realization that, in my state of self-hatred, dripped with shame and embarrassment. Nevertheless, I was running out of options, and ketamine was beginning to look promising.
I found a small clinic near me and submitted their online forms. In them, I described my symptoms, the medications I was taking, every antidepressant I had tried in the past, and answered numerous other questions about my medical history. The doctor called me within the day, told me that I seemed like a good candidate, let me know that he would be calling my psychiatric nurse practitioner to verify my diagnosis, and we set up my first appointment. The first appointment was scheduled to be a consultation with the doctor, immediately followed by the first ketamine infusion. The whole process started to move frighteningly fast, although in hindsight, this was great. I might have backed out, had I had more time to ruminate on it.
Upon meeting my doctor, I immediately stopped vacillating between going through with ketamine treatments or bailing on it. I was there, my doctor was kind, and my mother desperately wanted me to try it. I had no stamina left, and had decided that if ketamine didn’t work, that was it. I would give up. From that perspective, I had low expectations and could go into the process with a relatively blank slate. All that was left to do was to sit back, close my eyes, and let what happened, happen.
IV ketamine infusions are different for everyone, and they’re different each time I get one. In general, though, the feeling begins with warm dissociation from my body. Time seems to slow down and my limbs feel like they’re floating away from me. I always feel relaxed, and after a few minutes, I start to “see” shapes, colors, and sometimes entire scenes in my mind. Most people listen to instrumental music during their roughly 45-minute infusions, which makes the experience more immersive.
On the day of my first appointment, I had a vague idea of what to expect, but I was not prepared for how hallucinogenic my first ketamine infusion would be. I was always able to come back to the room, but was quickly pulled back into intense internal visions and altered physical sensations. I was expecting something more sedating and less trippy. Sometimes, I felt like I had no physical body, and at other times, I felt incredibly tall and stretched out. While intense, I was never afraid. I knew where I was and who was around me, and I could respond to questions and make statements. Interestingly, the first infusion is often the strangest, and I’ve found that subsequent infusions are much less overwhelming. I now look forward to them, as each one is so unique. I like to try different music each time, which seems to influence what I see and how the ketamine feels. I’m fascinated by the themes and images my infusions contain because I can sometimes draw direct connections to my real life, like when you dream about something you saw the previous day. Sometimes, I remember very little of an infusion, but the experience is always relaxing, and I like to imagine it up there, influencing the biochemical makeup of my brain.
Generally, people receive a series of six infusions within two to three weeks, followed by “booster” infusions at individualized intervals of several weeks. For some people, ketamine improves their symptoms after the very first infusion. I didn’t see much improvement until my fifth. I began to wake up with more motivation, feel more interest in the activities of the day, and started to enjoy a sense of hopefulness—something I’d been missing for a long time. We extended my initial series to eight infusions to try to maximize my improvement before spacing them out. Each additional infusion seemed to solidify the changes to my mood. I marveled at how much better I felt and how much easier it was to function in the world. In the depths of depression, there was nothing that anyone could have said to convince me that ketamine would work for me. I had to try it, have patience with it, and let go of my judgments when it didn’t work right away.
It hasn’t been a completely straight line from beginning to present; the factors of life will always affect depression’s grip, and I don’t expect that it will be easy from here on out. However, once it started to work for me, ketamine pulled me out of depression and suicidality like nothing else did. I wish that I had tried it earlier, but I was held back by my fear and the uncertainty of trying something new. Regardless of how many antidepressants you’ve tried or how long you’ve fought depression, there is always hope. Sometimes, considering other avenues is exactly what it takes to get on the road to recovery.
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Author Bio: Genevieve Brown is an editor and freelance writer in Boulder, Colorado. For fun(?), she writes about her experiences with major depressive disorder and sensory processing disorder on her blog, Love, Your Brain.
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