Trying

Sometimes people write to me.

“Just checking to see if you’re OK…you haven’t been posting on your blog…”

I really appreciate it! I know as well as you do what it can mean when a generally motor-mouth blogger goes silent.

You’re right. I feel terrible. I can’t think. My imagination, usually fertile, is…somewhere. I don’t know where. I don’t know anything. I’m in The Pit. At the bottom. At least I hope it’s the bottom. I certainly can’t see daylight. If I go any deeper it will be the La Brea Tarpits.

In fact, that’s what depression feels like: black and impossibly thick and sticky. The harder I struggle against it, the more stuck I feel.

I tell you, if my dear Doggess did not need me….but she does. She is dying, very very slowly, but very surely. Each day brings some new sign of it. And there is nothing to do but to swing with it…and I don’t feel like swinging.

Brings back bittersweet memories of my father’s lonnnnnng descent. Years of enjoying him while he slowly faded, then the horror of the final months.

So I spent some time researching the latest treatments, beyond the drugs that have never worked or had side effects that laid me flat. And I found something I’d never tried before: ketamine.

Now, ketamine is a drug I’ve never had the slightest inclination to try. I saw plenty of its effects when, as a medical student in the 1980s, I had the unpleasant task of sitting with babies as they emerged from ketamine anesthesia. My job was to keep them from eating parts of their own bodies. For some reason, ketamine does that to infant brains: makes them try to gnaw their paws off, like an animal caught in a leghold trap. So my impression of the drug was somewhat colored.

Likewise, I’ve had my share of human teenagers stoked up on K in the emergency room. Not a pretty sight. I have not yet figured out what the draw is.

But I’m so damn tired of being depressed, I’ll try anything. There’s a ketamine infusion center in Tucson. I read up on the stuff and its use in depression treatment. It looked hopeful. I called.

The intake process took a week. I liked that. It wasn’t like, Oh yes, come on in, we’ll hook you up and take your money. I had to take numerous inventories: depression, of course, and personality, and a screen to rule out psychotic illnesses. Three different interviews. And in the meantime I went on Medline and read the handful of papers I found. I asked my questions, was satisfied with the answers I got.

And yesterday I had my first ketamine infusion.

I was petrified, but I’m so sick of being depressed that anything else, no matter how bizarre, felt like a good idea. I can’t be dead right now, because I can’t do that to my Doggess. So I marched into the infusion center and allowed myself to be hooked up to an IV pump full of the evil drug. I resigned myself: at least I’m Doing Something. If nothing else.

They put me in a comfy recliner in front of a TV screen that played continuous, seamless nature films. It reminded me of the endless loop of bird videos a friend of mine plays for her cat when she goes out. I synced my phone with a Bluetooth speaker and cued up a playlist I’d made for the purpose: dreamy Sikh chants. If I’m going to trip out, I want it to be holy.

The stuff flowed into my veins and I breathed, wondering what was going to become of me. I held no expectations. How could I, when I had no idea what to expect? I hoped that they would watch closely and not let me gnaw my paws off.

A warm, cocoon-y feeling enveloped me. That was all right. It was comfortable, safe, relaxing. OK, I can go with this. They asked me how I was feeling; I told them this. They turned up the rate.

The nature films flew over the Grand Canyon, Bryce Canyon, Monument Valley…all places dear to my heart, and right here in Arizona. The holy music spoke of beauty. The nurse (a man) wondered how I had chosen just the right music for the film….really.

My reptile brain flashed back to 1970, such a year full of terror and beauty, flashing like the red cherry on top of a police cruiser. The many trips on LSD, mescaline, psilocybin, peyote. “Wasted on a 16-year-old,” I observed. The nurse chuckled.

It went on forever, which turned out to be 90 minutes. 90 minutes’ worth of Eternity. I hope Eternity turns out to be something like it. Incredible beauty. No pain, not from the body and not from the brain. The best vacation I’ve had in a long time.

The dose of ketamine for this kind of vacay is 0.5 mg/kg, which for my weight turned out to be 29 mg. For comparison, the anesthetic dose is 3.0 mg/kg. Yep, that would knock you out. On the brain-pain dose, I could, with extreme effort and advance planning, make purposeful movements and even speak, after a fashion. Standing up was out of the question. At about 45 minutes into the trip I needed to pee. They turned off the infusion and, after a couple of minutes, helped me/dragged me to the bathroom, where I made use of the generous handrails to navigate to the pot. Getting my clothes down was an exercise in logic. Peeing felt incredibly great. Afterward, somehow empowered by this, I enjoyed the remainder of my ketamine+ music+ visuals treat even more.

Will it work? Is there some kind of durability to the brain reset? I don’t know, and at this point I’m withholding hope/expectation for the future. The protocol at this center is four initial treatments at every-other-day intervals, followed by another one ten days out, and reevaluate after that. I’m OK to roll with it. It’s an expensive vacation, at $500 per treatment, but I can’t use the money if I’m dead, and that’s where things are headed if I don’t do Something. I sold my Walmart stock to pay for it. That’s what money is for, right? Living.

I’m trying.

Posted by Laura P. Schulman, MD, MA on March 1, 2018

https://bipolarforlife.wordpress.com/2018/03/01/3847/