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The Night before First Ketamine Infusion


Atra

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Make Me A Believer

I really hate indoctrination. But hey, any port in a storm, right? There are lots of reasons to be skeptical about Ketamine treatment but nevertheless, I decided to set aside my doubts and buy into the notion that it could help me rewire my brain. This  began with accepting that depression had a physical impact on my brain, developing neural networks strengthened by frequent use which were rather unhealthy and I wanted to alter them. But how? I read up on neural plasticity and dendrite excitement, synaptic regeneration, even watched a boring video of a scan of a rat’s brain on Ketamine. 

In doing this I was able to convince myself that the therapeutic value of the drug is not limited by how long it remains in the body. Rather, the lasting effects must have something to do with how patient and therapist can leverage the impact on neural networks in some manner that results in psychological transformation.
Just writing that makes me think of out-there “woo-woo” stuff and I admit, it sounds like a big reach. I probably misused some words because I lack the vocabulary to describe it in scientific terms so, just bear with me. 

At bedtime, I was very anxious. I knocked back 100mg of Trazodone and crawled into bed hoping to get some rest. Moments later, the dynamic duo of Anxiety and Depression, like a pair of unwelcome pals at the local bar, pulled over a couple of chairs to count off the reasons I should dread tomorrow.

If you want a cheap laugh at my inner dialog with my two pals Anxiety and Depression, enjoy.

Spoiler

 

Depression: “Big day tomorrow.”  “Huuuuuge,” nodded Anxiety, “so have you thought enough about it? Because they're gonna take this big needle and shove it right up into a vein.”
“Not just a needle - a catheter.” added Depression, blowing a low, soft whistle. 

I hate needles. I'll distract myself. I thought.
 

Depression clicked his tongue. “Things are going really bad for you, have been for quite some time and now – I'll try to follow your thinking - you believe the solution is to trip your balls off in a doctor's office, is that the jist of it?”
Anxiety leaned over and continued the litany, “Intravenous drugs, bold but desperate. When was the last time we took psychedelics anyways, was it 25 years ago? What if you have a bad trip? I mean, how could it possibility go well with us, your chums, along for the ride?”
My eyes glance at the drawer were the Restoril pill bottle lies in wait. 15Mg shuts them right up.


“Oh... nope. No Benzos before or after treatment, doctor's orders”, Anxiety tuts, reminding me. “But no worries, we'll keep you company.” 
“We have all night!”, Depression nods with a wide, cheerful grin.
“So,” Anxiety asks, leaning in to my ear, “what if Ketamine doesn't work – just like all the other antidepressants didn't. What will you do then, we're at the end of the road, aren't we? Truth is we've gone right round the twist...”
“Or worse,” Depression cuts in, “what if it DOES work. Then you'll have to do something with your miserable wreck of a life. Taking responsibility for the mess you've made of it, for starters. Without us, who you gonna blame?”
I'll rebuild myself. I've done it twice already when you two took vacations, I thought.


Depression: “But you're older now. Much older. A grown-ass man. Too late to die young now, pal. However, if you HAD died much earlier then this sad story would  have had a cathartic moment but now, it's two chapters too long.”
Anxiety: “Maybe you'll die at the doctor's office! On a gurney with a needle in your arm, like a death row convict, that would be kinda proper, wouldn't it.”

 

I got about 2 hours of sleep.

Protocols

The list things you aren't allowed to do before infusion is long and crappy. You must fast for at least 10 hours. No liquids except water or plain tea. No Benzodiazepines, no Gabapentin. No alcohol. No drugs at all except for your antidepressant and necessities like allergy meds and stuff they think is OK. 
I decided I would walk 2 miles to the clinic because I read that exercise does good stuff for the brain, blah, blah, blah would you just get on with the infusion story, pal? Ok...

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Hi Atra,

Thanks for your anecdotal story--the plural of anecdote not "evidence", that's really good.  Your writing is lucid and has style.  My own experience with ketamine was as an observer as it was give to my cat.  I had to take my cat home early from treatment that required an overnight stay at the vets.  I forget why I had to take him home early.  He'd been dosed with ketamine.  The only situation I can compare to Jupiter's--my cat--was earlier times watching people having trouble after taking acid.  His pupils were big as his head, and he was way disoriented.

I tried to put him in comfortable spaces, in his bed, low lights, cut out noise.  The cat was just freaked.  I left a note at the vets never to use ketamine on him again for surgery or anything else. 

I don't see you've continued your story.  Too bad, I was enjoying it.  So I don't know how you reacted.  The "cleansing" is typical of modern medical prep.  It's also typical of historic ritual taking of hallucinogens for spirit "searches" or quests.  I've done it:  no food, lots of that ultra salty stuff laxative to keep you going to the bathroom to empty yourself.  I'm not even sure about all that, it's just a common sense approach to cleaning out your system to get maximum results from your vision quest.  I've only done that in recreational, spiritual sessions--and I use the term loosely.  I used to take a shower or bath so I was clean before hallucinogens, but that was about it for preparation. 

Both the modern attempts, and the cultural tribal efforts seem similar to me.  Mainly the setting has changed significantly.  Either case also emphasize the intervention of support and council before and after the infusions.  As you say, the drug has to be facilitated to reset those brain paths.  The contemporary setting has you talking to a therapist, and the tribal has you reorganizing with a shaman of some sort.  Modern medicine requires an antiseptic environment, a sterile surrounding. 

Older ways emphasize the experience, modern medicine emphasizes the translation of the experience into everyday awareness.  Of course, I and my friends used to wonder how we might carry the mystical knowing back to work with us, always a problem. 

Obviously, personally, I favor the old ways.  Like Shakespeare said, the plays the thing.  Both paradigms were and are shots in the dark.  I don't know if you can re-route those pesky brain habits into a better place.  It seems the world has to participate in the change or shift to a degree, and it never comes through on that. 

I wish you luck.  It's an interesting story, a good effort. 

Bulgakov

 

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@Bulgakov Thank you for the compliment and encouragement - I really appreciate both and I'll be continuing the story. Also thanks for your thoughtful commentary about use of hallucinogens culturally, spiritually, medically and personally. I also see some convergence there, most visibly in the work of the Multidisciplinary Association for Psychedelic Studies (MAPS.org) and in the recent large-scale clinical trials of psilocybin and MDMA for treatment of mental illness. I've also spoken with a Clinical Psychologist who specializes in the integration of psychedelic experiences with conventional therapy. Your insights about ritual preparations and guides providing context for the experience seem to really agree with what's going on in the field.

You pointed out some important distinctions and similarities between the clinical and spiritual methods. In the clinical setting, there is sometimes a psychotherapist present who wears the robe of the shaman/guide but in Ketamine therapy it is uncommon for a few reasons. Unlike drugs in the psychedelic category, Ketamine is an anesthetic and it's difficult to talk when one's tongue feels heavy and numb. Also, therapeutic doses of Ketamine leave the system so much faster - 40 minutes to 1 hr - than what is typical for LSD, mushrooms, MDMA or DMT doses, so the dissociative episodes are brief. And finally, Ketamine therapy is already expensive enough without the billable hours of another professional. 

In the posts to come, I'll be explaining how a personalized music playlist can take on the mantle of guide during a dissociative episode and how it provides context to the trip.

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Apropos of nothing, I vividly remember seeing ketamine in action around 35 years ago. My ex insisted on declawing one of our cats and the vet used ketamine during the procedure. That cat's eyes were open and her pupils were fully dilated. Yet she was "out", or at least "not there." It was creepy because she was such an active kitty, full of life...and here she was lying on the table, staring at nothing as if dead. Gah!

Since then I've learned that declawing cats is akin to chopping off a person's fingers at the first joint. I'm willing to put up with some torn furniture in order to spare the poor kitty a lot of trauma.

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14 hours ago, JD4010 said:

Apropos of nothing, I vividly remember seeing ketamine in action around 35 years ago. My ex insisted on declawing one of our cats and the vet used ketamine during the procedure. That cat's eyes were open and her pupils were fully dilated. Yet she was "out", or at least "not there." It was creepy because she was such an active kitty, full of life...and here she was lying on the table, staring at nothing as if dead. Gah!

Since then I've learned that declawing cats is akin to chopping off a person's fingers at the first joint. I'm willing to put up with some torn furniture in order to spare the poor kitty a lot of trauma.

That had to have been difficult. My ex has three cats and I was never, ever a cat person - right up until the moment when I was. I never had to see what you saw when your cat had the procedure. I did have to feed a feline preparation of Fluoxetine to one cat at the advise of a vet and got kitty-hated for it. I'm with you on the matter of cats keeping their claws, I'm glad I never tried to push for that - good analogy.  

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