Male, 48 years old at the time of this writing diagnosed with Major Depressive Disorder (MDD) treatment refractory and Generalized Anxiety Disorder (GAD). Mental Illness runs in both sides of my family, my mother was diagnosed but her mom wasn't and while she died before I was born, by all accounts she was 32 flavors of effed up. For treatment, I've gone through the most popular categories in the antidepressant alphabet soup– SSRIs, NDRI, SNRI, Tetracyclic and Trycyclic experiencing zero relief even at maximum therapeutic doses and in various combinations. I experience periodic panic attacks for which I was prescribed Benzodiazepines. I have chronic insomnia and was given medications in the hypnotic class – which did not help - so until recently I self-medicating with Cannabis.
In addition to mental illness I have an autoimmune-related skin condition called Lichen Planus for which there is no understood cause or cure. It's characterized by an itchy rash that appears and spreads and then completely goes away whenever it wants. I'm also diagnosed with a rare inner ear disorder in my left ear known as Ménière's disease for which there is no cure or treatment and is characterized by hearing loss and sudden, random episodes of debilitating vertigo lasting 20 minutes to 8 hours.
Major Depression Strikes
I experienced bouts of depression throughout childhood and adolescence and two major depressive episodes in my adult life. The first major episode came in 2006 and followed a job loss and the end of 12 year relationship. For 4 years I felt like a ghost, isolating myself from family and friends unable to job hunt, unable to socialize apart from the online gaming community I'd thrown myself into.
One random day, I woke up angry at myself and my hopelessness and decided I needed help. Rather than seek it from a mental health professional, I bought some books on meditation and began practicing. I also started walking 2-5 miles everyday. Together, this seemed to work, I began to feel empowered and my symptoms went into partial remission. By then, I'd been out of the job market about 6 years so I chose volunteer work in my field of expertise which I did for a year before seeking and landing a new job. I started dating again and showed up to absolutely anything anyone invited me to, no matter how weird or uninteresting. I still experienced anxiety and insomnia but I managed. At that time I well feeling self-assured and so very proud of having beat depression, touting my “Meditation, not medication!” slogan to just about everyone I knew.
Yeah. Pride no longer follows the statement.
Major Depression Strikes back
My second major depressive episode happened in 2014. I don't even recollect if how exactly began, depression is such an insidious disease. I know my mental health deteriorated when I was fired from my job and undertook end-of-life care for my father, who was slowly dying of heart failure. At the urging of my partner who was taking antidepressants, I finally sought help from a psychiatrist. I was prescribed antidepressants, went to biweekly therapy and joined therapy group classes to address the depression and anxiety. I didn't respond to the drugs but the classes were kind of helpful. I had trouble digesting the information, difficulty concentrating and remembering what we covered. My psychiatrist followed a drug protocol, increasing dosage to therapeutic maximum or limits of my tolerance, then augmenting with another medication followed by tapering off before introducing a new class of antidepressants.
Despite the treatments and therapy, my mental health continued to slide. I became frequently irritable, frustrated and hopeless. I had emotional meltdowns and lashed out at family, friends and my partner. For more than a year, I sunk into severe depression with loss of even basic functionality. I couldn't leave my house and felt unable to respond to invitations, phone calls or texts. I went to couples counseling in addition to the other therapy work but it wasn't helping. I didn't feel that anything in my life had value, so I left the relationship. After that, I felt emotionally numb, experienced anhedonia which was followed by suicidal ideation.
You Want To Shoot Me Up With What?
I first learned of Ketamine treatment for depression from my therapist. Let me tell you that I consider myself a skeptic, which in terms of healthcare means, I need there to be peer-reviewed, science-based evidence if I'm to believe a treatment has any merit. There's so much utter nonsense out there – especially in California, where I live. I read whatever I could find about Ketamine but was underwhelmed by the body of evidence supporting it's efficacy in treating depression, unimpressed by testimonials (the plural of “anecdote” is not “evidence”)* and dismissive of articles in popular magazines which I deemed sensationalized.
I was honestly confused as to why any doctor would prescribe Ketamine treatment when it seemed they understood so little about the mechanism by which it treats depression.
And yet, Ketamine treatment is covered by my insurance and they actually have their own program going for treating their patients. Nevertheless, it still took me 6 months of agonizing, soul-crushing MDD symptoms from when I was initially recommended for the program until I finally agreed to participate.
The blog entries that follow are my experiences in the Ketamine treatment program starting with the first of 6 intravenous infusions, which began in June 2017.