Recovery I can't go on, I'll go on

[simco]

^^
In case it helps you feel a little less alone, I'm pushing 50 too, dreamflyer!

 

[simco]

I had a really mixed day. Over the last week I've been feeling increasingly like some kind of major crash/crisis in on the horizon. Today I had an appointment with a psychiatrist (I'm living in a new town/state and haven't found a shrink here yet), feeling like I should do something *before* shit gets too bad. Somehow the appointment just bummed me out...I'm in my mid-40s and have been in therapy most of the time since I was 28. Sitting down with a new shrink just seemed like a drag. "I can't believe I'm having these conversations again!" This guy seems pretty skilled. But it's hard for me to believe that I'm suddenly going to have some breakthrough that I haven't had in a previous therapeutic relationship. Don't get me wrong...I've had some success in therapy, but not for many years.

So by the time I left I felt a lot of money poorer and like I was signing up for a familiar treadmill.

The good--or at least interesting--thing that happened today: I got scheduled at a local ketamine clinic to start ketamine therapy tomorrow. I thought it was going to take a lot longer to get in with them. But tomorrow afternoon I'll be sitting down for my first infusion (of six). There's so much hype about ketamine for depression...honestly my expectations aren't super high. But I figure at least it's not the same old same old.

The only problem is that I probably can't afford the ketamine therapy and traditional therapy, at least not until I find a therapist that takes my insurance which is nigh impossible. So I'm thinking that I'll probably put the psychiatrist on hold while I get a sense of the merits of ketamine for me.

The other thing that bummed me out today was pretty much inside my own head, but nevertheless... I could tell this new shrink got freaked out when I told him I used to be a heroin addict (I figure there's no point in therapy if I'm not forthcoming). His demeanor changed, and I could tell he got concerned that I was drug-seeking. As if I would have told about my problems with heroin if I were drug seeking. Dumb. Really, it was a minor thing...I'm just super sensitive to that kind of vibe.

Anyhow, I'll report back about the first ketamine session. I'm really hoping it will help me open up a little and cannibalize myself a little less.

 

[Jabberwocky]

That is so good to hear you are exploring your options with mental health care. That is so important. I'm looking forward to hearing how it goes tomorrow. Have you ever used dissociatives before?

 

[somnilicious]

Way to be proactive and open minded Simco.. I have always been very interested in Ketamine therapy since I first heard about it but have a very unenthusiastic opinion of it as a recreational drug. We used to get the viles and evaporate it into a powder. I don't remember the experiences to be that great but then again I have never holed on it. I usually combined it with MDMA and I remember one particular time that the whole next day after the experience I couldn't stand up without passing out. I had to lay around all day and when a friend came over I had to literally crawl to answer the door. I don't know what that was all about.

I wonder what kind of doses they give you. Would it be enough to feel the psychoactive affects?

 

[simco]

I have zero experience with dissociatives. So this should be interesting if nothing else.

From what I understand, the doses used by most clinics is low in comparison to what people tend to do recreationally. Though they offset that by repetition...I'll be doing six infusions over the next two weeks.

After so much experience in the US mental health machine, I am glad to be trying something new.

 

[simco]

I was MIA yesterday while I tried to process my first of six ketamine infusions for my current round of ketamine therapy. I'm going in for my second infusion this afternoon. Yesterday I had a strange amount of emotionality lability...getting weepy and sad spontaneously, followed my just as spontaneous leveling out. I did a lot of writing in my (pen and paper) journal.

I'll probably write a full trip report elsewhere on BL. But I thought I'd give a brief account of my first ketamine experience.

First, some details. I weigh 125 lbs. The infusion consisted of 50mg IV. I was positioned in a recliner, blindfolded with music playing via earphones. The music I brought was Bach's 'Art of the Fuge' which was a bit too intense I think, in retrospect. I think today I'm going to bring in something by Spiritualized instead.

[I just deleted a long account, as I thought it might not be appropriate for SL. Hopefully what follows is OK.]

Essentially, the essence of the experience has several facets. Experientially, the visions were intense and all-consuming...it was next to impossible for me not to believe that what I was experiencing some real. During the experience, everything appeared in very high-contrast black and white. There was zero color and lots deep shadows. Most of what I saw was either architectural (very Lovecraftian) or machinescape (similar to HR Giger art). The depersonalization was complete. I felt that I was at a great distance from the world, so far that returning was impossible. And I was sure that traveling that distance had taken eons and that I was now a dead spirit thousands of years in the future (this was not pleasant, but not as terrifying as it might sound). The sounds in the room entered into the experience differently than I would have expected. The music (the staccato Bach piano) was almost completely visual, appearing as a staircase impossibly high above me. Surprisingly, the very faint whisper of the room's air conditioning played a large part. During portions of the experience, I perceived it as a huge wind. At other times, it was the sound of a machinescape I was traveling through.

All in all, it was thoroughly exhausting. It had moments of being unpleasant (believing I was dead or had traveled so far from myself that returning was impossible). But the unpleasantness was always short-lived...things kept changing quickly). Definitely not an experience I would seek out recreationally. And yesterday I felt a bit leery of my second infusion. But by last night I felt more positive about it, and today I feel ready.

 

[somnilicious]

Interesting... So they gave you a dose large enough to hole. I truly am intrigued. I have had depression my whole life.. Well actually my adult life. My depression was brought on by MDMA abuse. This was actually when I turned to opiates. I have never holed before and I would be interested in reading a full trip report.

 

[simco]

Interesting... So they gave you a dose large enough to hole. I truly am intrigued. I have had depression my whole life.. Well actually my adult life. My depression was brought on by MDMA abuse. This was actually when I turned to opiates. I have never holed before and I would be interested in reading a full trip report.

I also have dealt with depression my whole life. Conventional treatments stopped working for me during my 30s, and that's also when I started with heroin (when the depression became uncontrollable). So my hope with the ketamine therapy is to try to address both issues--depression and addiction--since they're tightly coupled for me (as they are for many people).

Since I'd never done ketamine before I'm not sure how much more intense the experience could get. It certainly *felt* like what I've read about holing. And I was surprised by the dose...my understanding is that 50mg IV for someone as thin as me is pretty high. But again, I'm a complete novice when it comes to ket.

It's too soon to say much about the effectiveness of the treatment. But I can say that there was no flood of joy or anything (nor is there supposed to be). In fact yesterday I felt pretty beat up and fragile all day. *But* my usual thoughts about drugs are markedly reduced. As some of you know, I had kinda fallen into a daily kratom thing recently, and I have zero interest in that. Likewise with dope...my cravings aren't usually that strong these days, but I do tend to think of it daily. Yesterday and today the thoughts were there, but in a very abstract and distant way. Easy to handle. Lastly, I always have problems with suicidal fantasies. Those also seem to have receded. So, my mood is no better. But a few of these more concrete habits of thought seem much more manageable since the first treatment. I feel like it's premature to say any of this. But one of the startling things about the research on ketamine therapy is the speed with which people can find certain types of relief. So who knows? Maybe I'm not just making it up.

 

[Thinkwithportals]

I am glad your experience was a generally (it seems) beneficial one! I feel as if you have a positive/practical attitude about this, and that's awesome. :D It sounds like it was a very multidimensional experience. The visuals you describe are pretty astounding and profound to me. I am interested to hear how more of your therapy goes!
it is amazing that those thoughts remained fairly quiet subsequent to your therapy. I feel that if they're manageable, then that's a step up from having them breath down your neck, so to speak!

 

[Jabberwocky]

What I tend to like about dissociatives (and what tends to freak most people out under their influence) is that there is literally nothing I can do to exert control over my environment under the influence. All I can do is play like a participant and observe the experience of consciousness through some more objective third party. It is indeed hard to describe.

I'm glad to hear it sounds like the treatment is tolerable simco. Something I think I might have forgotten to mention to you yesterday is that like 2/3 of people who try dissociatives hate the experience. Of course the setting your taking ketamine is a little different, but, especially for your first time, getting a little unsettled by the experience is entirely normal. It should become more tolerable in terms of difficult side effects, and the positive side effects should become heightened the more sessions you have. Like ketamine reducing your tolerance to ketamine. Compared to opioids, it's entirely a different kind of beast.

 

[simco]

I had my second infusion yesterday. This one was less intense. Some things were similar--the visual aspect was still completely in black-and-white and there were no animate objects/creatures. But instead of the cities, deserts, and machinescapes of the first time, my field of view was populated by abstract, undulating geometric shapes this time. The doctor agreed that when I go to my next session, we're going to increase my dose. The depersonalization was there again, but less completely so.

The effects since my first session are a bit clearer to me now. This could simply be psychosomatic, but I believe what I'm sensing is due to the ketamine. Let's see if I can explain it...

I have, for a long time, been very interested in mindfulness and related meditative practices. But I have always struggled (unsuccessfully) to integrate these into my own life. Racing thoughts, anxiety, agitation--stuff like that makes it next to impossible for me to be quietly with my own mind. And I've always felt that a good deal of my depression relates to this...basically a deep exhaustion from 'guarding' myself, from hypervigilance 24/7. This also extends to issues related to sleep. The insomnia I've had my whole life always entails waking up with a mind that wants to range all over the past and present, ruminating and obsessing.

For the last two days, this has felt quite different from what I'm used to. I've been able to complete a few guided meditations. This may not sound like a lot. But I'd never been able to make it through more than ~5 minutes of such a thing before. During these meditations, my mind has wandered as always. But the difference is that I have been able to experience that wandering as it is, accepting its phenomenology without feeling compelled to follow it, to babysit it. I have been able to let my mind do what it needs to while continuing to be present in the moment as well...Hard to explain. But in this state, my thoughts seem to return to the here-and-now on their own fairly easily.

Likewise in bed at night. The last two nights I've woken up several times as I always do. But instead of launching into worry and speculation, it's been pretty easy simply to focus on my body, on being present in the dark with my physical tiredness. And I get back to sleep without much trouble.

To me, this feels like a direct extension of coming to terms with ketamine's depersonalization. During the infusions, I've had to get OK with being--essentially--split into multiple pieces...being conscious in several "places" simultaneously. Obviously outside of ketamine experiences this issue is much diminished. But I feel like the basic skill, the forced flexibility of thought could be very valuable.

 

[Jabberwocky]

That is very cool simco my theory with dissociatives is that they inhibit chronological memory (a kind of analytical process) and force the user to engage more in procedural memory (something more basic than analytical logic).

I wonder if your experience with mindfulness and dissociatives is common, because it definitely sounds like something I have experienced, the dissociatives enhancing a more objective, non-judgmental mindspace. Hey, if we can finding a doctor to work with on this, we could have our own new mental health protocol

Keep up the great work my friend, it sounds like this treatment is going well for you. Who knows what the after effects will be, but you're experiencing important, insightful lessons with this right now, and that is far more important than what might come down the road. You know what I mean

 

[simco]

I have today off from ketamine treatments. That's good, because I felt pretty wrecked after my infusion last evening. It was my strongest reaction so far (I've gone up to 80mgs). Unfortunately, I don't remember it as well as I'd like. But several moments stand out. Particularly being in the presence of a dead crow god in the pitch black who said over and over that the universe had been 'banished.' Then I settled into the sand at the bottom of the ocean, only to realize that in fact the chasm I was in (which seemed impossibly huge) was a notch on the side of a vast mountain/cliff. Meanwhile, the world was churning on two axes simultaneously...that has been a recurring theme throughout my sessions--the two-axis rotation.

From a more therapeutic standpoint, I do feel like the treatment is helping me. Today is a week since I had my last kratom and I don't miss it at all. Since I'm taking things slow due to the ketamine therapy, any WDs from the kratom are negligible. I do think I was ready to be done with that already, but I also believe the treatment is helping (I'll explain below).

Additionally, my usual chorus of self-hate and suicidal thinking is markedly diminished. I wouldn't say I feel joy or anything...but the absence of those unpleasant and exhausting symptoms is a huge relief.

As I mentioned in an earlier post, my perception of the effect of the ketamine therapy is--as much as it's describable--like so. I find the dissociation during the sessions to be strongly scary. I didn't want to admit that to myself at first, but so it is. Everything in that world is dead and bleak; it's not a comfortable place to visit. But since I *am* visiting it, I have to work very hard to be OK with experiencing those extremes. Because I'm more or less self-aware during the experience (not rational or coherent, but aware that I exist...or don't exist) surviving becomes a matter of balancing competing realities, each with their own intense emotions.

I feel like strengthening the ability to perform this balancing act is very important for me. When I deal with drug cravings, when I get thoughts about hating myself, a similar balancing act is in play...on one hand, there's the intense emotions drawing me towards behavior and desires that--while sometimes massive--I know I want to avoid. At the same time, there's the healthier side of me that wants to grow and change my behavior and thinking. Usually, I have a lot of trouble with this balancing act...I feel like I have to choose one or the other of these drives. But, if this makes any sense, I feel like surviving the ketamine experiences is strengthening my ability to let both 'realities' exist simultaneously, without either of them owning me.

 

[Jabberwocky]

Definitely makes sense. It is certainly quite uncomfortable, but when one can let go of the desire to experience life any one particular way, that is incredibly profound. Struggling against it just makes it worse and letting go is really the only way to move through the experience with any relative comfort. This is an invaluable lesson for anyone who struggles with equanimity.

I also noticed how the way this kind of medicine help me "disassociate" from the stories I cling to in terms of my own identity and sense of self. That is also very profound.

I'm really impressed with how you are going about this, considering how difficult the experience can be for those less naturally inclined to it.

Have you thought about integrating CBT or DBT or some kind of goal oriented therapy with this? I found I became far more suggestiable following dissociative use. That can be good and bad depending on the circumstances, but if you surround yourself or just spend time around people who are kind and compassionate, it is incredibly useful. It's a great time to relearn how we see ourselves and locate our sense of self beyond our experience of dis-ease.

 

[somnilicious]

Those k-holes sound serious. My friend described everything being made up of geometric patterns kind of like a Picasso painting. I can't believe I have never holed before because I used to snort the hell out of it. All I remember about k is that everything looked like fun house mirrors and very disproportionate. Like if I bent my knees and then stood straight again I felt as if I was going to go through the roof. I mostly took it with MDMA so I don't know if that effects your ability to hole.

 

[simco]

Those k-holes sound serious. My friend described everything being made up of geometric patterns kind of like a Picasso painting. I can't believe I have never holed before because I used to snort the hell out of it. All I remember about k is that everything looked like fun house mirrors and very disproportionate. Like if I bent my knees and then stood straight again I felt as if I was going to go through the roof. I mostly took it with MDMA so I don't know if that effects your ability to hole.

There's definitely a lot of weird geometry going on...sometimes abstract stuff like fractals...other times more concrete things like clockworks and architecture.

I can understand the desire to go really deep. In fact, I was disappointed with my one session that was less profound. But once I'm there, it really does (as TPD said) require a lot of flexibility to let the experience happen without things getting *really* unpleasant.

I don't want to get to nitty gritty here on SL, but my guess is that the ROA has something to do with how the ketamine hits you.

 

[twang]

Just caught up on your thread simco, haven't kept up on it the past few days. That's really cool you're getting to do that, and even more so that it's actually helping. It always surprises me when someone comes across as level headed as you have, only to find out they have thoughts of suicide and hate themselves. I'm not problem free but that's one I've always been grateful for not having been afflicted by it. Depression seems to affect so many people, in varying degrees obviously, but I feel like a lot of people I know take some anti-depressant for various reasons. I know some people just naturally have chemical imbalances but some people take anti depressants because something traumatic happened in their life...what is your take on this? Is medication warranted in that situation or do you think not enough focus is being put on talking to these people? I only ask you because I assume you're educated on the subject and I don't want to ask the people I know in real life that take anti depressants for fear of being misconstrued/misinterpreted. If it's something you're comfortable talking about and won't think I'm downplaying the severity of depression and how it affects people, I have more questions/concerns about the general attitude of prescribing and taking antidepressants in this country.

 

[Jabberwocky]

Of course, with ketamine treatment and NMDA antagonists generally the antidepressant effects of the medication does eventually wear off. It doesn't do a whole lot longer term except help alter afflictive thought patterns, perhaps, but even then it's easy to slide back into depressive feelings like self loathing. But by the same token, any respite from those kind of habituated, deeply entrained thought patterns is exactly what many people most benefit from.

I just wanted to emphasize that, as amazing as it truly is, it's no panecea. It is a great way to get grounded for a few months though, not to mention jump start the ability to benefit from other forms on non-pharmacotherapy (actually it probably would sensitize one to other forms of pharmacotherapy as well, but I can't really speak to that).

 

[Stargazer]

Sim. Wow. That's intense. Everything you describe. (racing thoughts, waking up panicky, etc) is how I felt prior to being on Neurontin. Its understandable why we self-medicated.

You are so brave. I think its awesome that you're giving different methods a chance. I hope this is beneficial for you. ❤

 

[simco]

First, thanks everyone for the nice wishes ... I'm sitting here in a haze right now, having had another infusion this morning. For the most part I try to stay offline after my sessions, but I can't read well right now (blurry vision) so I thought I'd do a quick BL scan.

I'm planning to write at length about my experience with ketamine therapy when I finish the initial course of treatments (just one more to go). But I wanted to reiterate TPD's point...it's definitely not a panacea. At best, it's another piece of the complicated puzzle of how we treat depression.

I did want to reply to what twang asked about. As just-another-guy-with-an-opinion, it's my guess that antidepressants are overprescribed in contemporary America. But that's really just a guess. What I also think is that we do have an epidemic of deeply unhappy people in this country. Some unhappy people are gentically predisposed to depression. Others suffered trauma during crucial developmental stages of growth. Still others live with chronic stress, dissatisfaction with their lives, and ennui. Any of these scenarios can lead to a persistent problem in mood and outlook. Of course, not everyone with these problems becomes depressed, but some do.

For those people, antidepressants can be a real godsend. I resisted going on them for many years. I had my first suicide attempt at 9 years old but didn't start medication until I was in my 20s. When I did, it was life-changing. For whatever reasons, a cloud was lifted from me. I was able to go to graduate school and get married (two of the best things that ever happened to me). Antidepressants IN CONJUNCTION WITH SOME REALLY GOOD THERAPY not only saved my life, but gave me my life...allowing me to reach potential that I simply never would have reached without that help.

Now in my case, at some point, the antidepressants stopped working as well as they did before. Maybe this is something that happens if you stay on them long enough (I'm in my mid-40s now), or maybe it's idiosyncratic to my case.

My overall feeling about the large number of antidpressant Rx's in this country is that it's not ideal but it's not very bad either. All evidence that I'm familiar with suggests that giving antidepressants (especially SSRIs) to someone who might not really need them doesn't incur a high cost. The pills are cheap and their effects in that case are mild (and if they aren't mild, the person is likely to stop the medication). But telling someone they aren't depressed enough to receive medication can have truly disasterous results. So personally, I'm a believer in prescribing SSRIs with a low bar.

The only caveat is that I also believe *strongly* that by far the best results come from combining meds with talk therapy...good talk therapy. And the bummer is that good therapy is expensive and hard to find. That's a real shame.

OK, I sense that I'm rambling now. Time to go back to holding an audience with the dead crow god at the bottom of the universe.