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First Ketamine infusion – 6/11/2017, 50mg


Atra

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I Wanna Feel Everything

You know the feeling of not having had enough sleep. Reduced cognition, lack of alertness and awareness, all the soft-headed sensations. I suffer from chronic insomnia so that's my baseline most days but on this day adrenaline from the 2 mile walk and anticipation of getting the needle compensated. I met with the doctor and nurse and they explained the procedure and answered my many questions. They took vitals, then put me in a soft leather reclining chair and placed a blood pressure cuff on my arm and an O2 saturation/pulse monitor on a finger before undertaking the tortuous task of sticking me. Thankfully, the nurse was very competent and managed to get the catheter into a cooperative vein after only two tries. I have needle phobia so this process sucked more and took a lot longer than it should've.

I didn't bring a companion with me so they asked if I'd like someone to stay by my side and I replied that it didn't really matter to me; do what you do. The nurse informed me that most patients cover their eyes with a sleep mask and their ears with noise-canceling headphones playing music during infusion, it makes for a more inward experience and it's generally more relaxing. Nope, I said. I wanted to be aware of my surroundings so that I could collect all the information I could about the experience. To my thinking, if Ketamine was an effective treatment for depression then it shouldn't matter and since this was my first of six infusions, why not make it a sort of controlled experiment.

I'd come to regret that.

What followed was alot of self-monitoring which certainly didn't make the experience enjoyable. Without distractions, my ever-chatty anxiety was with me in each moment, narrating every perceived drug effect – light nausea, anesthetic numbness and the heavy tongue feeling that gives you. If you've been given Novocaine for a dental procedure you know what I mean. Ketamine is an analgesic so that part is actually nice, any soreness or pain in my body was totally masked. However, this was very different from my recreational drug experiences, I wasn't prepared for the strength of the anesthetic sensation and this and my constant body-monitoring was making me uncomfortable. Five or ten minutes into the infusion, I wondered with some apprehension how strong these effects were going to get. My eyes kept drifting to the IV stuck in my hand.

I began to smell and taste rubber although none was in or around my face, kinda strange(1). I got the doctor's attention and asked him some random question about Transmagnetic Stimulation, or TMS. I wasn't really interested in it, just wanted to try speaking and I think I was also a little scared. I desired an intellectual moment for some semblance of normalcy, The doctor kindly declined my invitation to discuss it and gently suggested that I relax into the experience.

The blood pressure cuff attached arm to my arm constricted every 5 minutes. I used it as a reminder to shift my attention to my breathing so that I wouldn't allow anxiety control the entirety of my awareness.

About 15 minutes into the infusion, things started to get kinda weird.

Sound Distortion

I'd brought some music with me, Brandenburg Concerto by JS Bach so I decided to listen. This is orchestral music so, lots of instruments playing harmoniously in a precisely composed piece but under the influence of Ketamine, it sounded as if the orchestra was playing in an underground parking structure. Ketamine distorts sounds by giving them a flanging(2) and/or a stuttering effect – which you might be familiar with if you've ever taken Nitrous Oxide. That didn't work well with classical music and after a few tracks I pulled out the earbuds.

I heard the fussing of a young child that seemed to be coming from the hallway outside the door to the treatment room but I wasn't sure if it was real or hallucinatory (turns out it was real). The sound was distorted, stretching into a wail, then stuttering. The noise wasn't bothersome, it was like an anchor to reality and it also called to mind pleasant memories of playfulness as a child.

At about the midpoint of the infusion, things started to get really weird. 

Time Perception Distortion/Dilation

I observed the doctor and nurse standing at the foot of my chair looking over some papers attached to a clipboard. I perceived their perfectly still bodies in a kind of frozen, timeless moment that I'll try to describe: they're standing there (at this present moment), they were there - but it was some time ago (like an afterimage) and they will be standing there (the moment is yet to happen). My brain is perceiving and processing all three temporal states as happening in the moment they're observed.

Now, that is some kinda freaky so I'm going to attempt an awkward and inadequate analogy.

Imagine you're observing a pendulum in motion with a strobe light behind it flashing at quick intervals. As you watch it swing, you can't determine at any given moment if it's at it's equilibrium point in the center or in one of many points along it's trajectory. Vision reports to your brain from moment to moment that the pendulum is simultaneously at rest and oscillating.

sleep2.jpg

This perceptual distortion brought with it no feeling of dissonance or anxiety for me, I'm familiar with this effect from my recreational experiences with psychedelic drugs. I regard the event as an “a-ha” moment: were we not creatures forever trapped in linear time, I imagine this is how we might perceive our world. 

Some time later though impossible to know how long, I noticed the doctor sitting on a stool by my chair. I probed my feelings, did I feel scrutinized or uncomfortably exposed/vulnerable? No. I self-soothed anyways by acknowledging that it's comforting to know I was being cared for and should anything at all go wrong, there is no safer place I could be than here. I don't see him leave but the doctor vanishes. I probed my feelings again – did I feel lonely? No.

Visual Distortion

When looking directly at the faces of the doctor and nurse, they appeared elongated or misshapen. This is not the same as a visual hallucination because the external stimulus is actually there. The effect is similar to passing a lens over a photograph, but in three dimensions. I decided it's unpleasant so I looked away.

Completed Infusion And After-effects

For the remainder of the infusion I felt fairly calm despite near-constant monitoring of my body and the drug's effects. I didn't experience any emotional distress, no symptoms of my MDD manifested. My anxiety, whenever it felt present, as felt far away which is strange for me. Anxiety returned at the end if the infusion when the IV machine began to beep and a red light atop the unit began flashing. While the still semi-aware observer in me understood this indicated that the infusion was complete my anxiety, always up to the task of distorting my thoughts, informed me that a red flashing light never, EVER indicates anything good. I was mindful of how silly that sounded and regarded it with mild amusement.

I'd read about Ketamine being a dissociative anesthetic with out of body experiences, commonly referred to in the literature as depersonalization, being a side-effect. One study even suggests the dissociative features of Ketamine might predict a greater antidepressant response(3). Well, there was no dissociative episode in my first infusion which wasn't a let-down, I think. I didn't want the first one to be too overwhelming and I went into it with a view towards collecting information rather than seeking a specific experience.

The nurse informed me she was hanging a saline bag and that I had completed my first transfusion. I felt a sense of pleasure and relief knowing that I had completed the therapy without serious incident. When she spoke she used a lot of hand gestures, which really seemed helpful in that it facilitated communication, I was still very intoxicated. It also conveyed a sort of gentleness and openness - as if careful word choice and sweet intonation could not be trusted to do so alone. Her hand movements left vague trails which I recognized as mild hallucinations. The executive function of my brain seemed to be “waking up” and I was surprised by just how quickly the drug effects seemed to leave my system once the saline flush began.

15 minutes later, the doctor met with me to ask about how I felt and if I felt any change in my mood. I was slightly disappointed to report that I didn't feel an elevation in mood or could report some definitive, significant change in my condition. He explained that only a small number of patients do after their first infusion and referred me to the Ketamine Advocacy Network web page to read more about the therapy and what to expect in the infusions to come.

A family member picked me up and drove me to her house for lunch. I was super hungry and devoured the meal. In the middle of a casual conversation with her, I realized that I felt more “like me” than I had in a year - it's hard to explain the feeling. Afterwards, I felt I had enough energy to walk the 2 miles home. As soon as I arrived I got to work on a musical playlist for my next infusion and realized I was feeling excitement at actively working on shaping the Ketamine therapy. I paused just long enough to acknowledge that I hadn't been excited about about a damn thing in over a year. 
I was able to fall asleep with some ease around 1am.

 

The next post will be about my second infusion which happened the following afternoon and did include a dissociative event. I'll write about how I believe I changed the context of the Ketamine trip using music as a guide and to cue a particular response.

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(1) I asked an Anesthesiologist if he could explain the rubbery taste and smell. He said strange tastes and odors can be rare after-effects of general anesthesia but he'd never heard of this in connection with Ketamine. I'd been put under with inhalation anesthetic for surgery before and it occurred to me that my first experience was when I was only 6 or 7 years old. Back then, anesthesia gas was delivered through rubber tubes. Did Ketamine's anesthetic sensations in my body trigger a sort of recollection of that taste?

(2) See Flanging in Wikipedia to listen to a sample of this sound effect.

(3) "Ketamine-Induced Dissociative Symptoms Predict Antidepressant Response", Psychiatry Advisor, May 17, 2018.

 

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Whoa. Great description of your experience. I am fascinated by what I read.

Over the decades, I have "experimented" with all kinds of substances to alter my consciousness. I realize that I'm trying to escape (or maybe enhance) mundane reality with such experiments, but so what?

I'm happy to know that you experienced some uplift in your mood after the first infusion. That bodes well, I think.

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@JD4010 thank you for the comment. Altered states of reality or consciousness fascinate me. There's controversy and concern about the treatments that psychiatric patients are getting high. My response is, if that's a side-effect of the drug then finally it's one I can live with. I remind the doctors that we patients are asked to tolerate alot worse during the process of finding a medication that's effective in treating symptoms of major depression. 

You mentioned experimentation. Ironically, my past experience with psychedelics was, for the first time ever, viewed in a favorable light. As I was told by one doctor before my first Ketamine treatment, my lack of "psychedelic naivete" should make me better able to tolerate the dissociative effects. That still amuses me. 

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Hahahaha. That's great! I'd like to think that I've pushed the boundaries of my mind so that I can "handle" pretty much anything that comes along.

I'd like to slowly wean myself off of the two Big Pharma meds I'm currently on and rely solely on the herb. It is by far the most effective in keeping me on an even keel. And yeah, so I'm high--that's a bonus! 😁

On edit: One big advantage of being single again is that I can do more experimentation. My ex was dead set against any consciousness altering substances...never even tried cannabis.

Edited by JD4010
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Thanks for your description Atra, and for your comments JD.  With JD, I say it's not bad to get high if it doesn't interfere. 

Lots of great relations in your ketamine story.  Lots of history for me, both academic and experiential.  Especially struck by the analogy of the metronome.  Maybe you know, it's almost a text book definition of looking into Schroedinger's cat box, which I've been looking over lately in relation to the end of David Lynch's movie, "Mulholland Drive".  The narrative is very analytical.  To be expected, as are mine when I set out to describe such trips.  You can't relate what can't be said, always the situation.  As JD says, point is in this case, if it gives you any relief, entertaining or enlightening me is less important.  So, I look forward to any positive effects in the future.  

Bulgakov

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@JD4010 I had to give up Cannabis in order to participate in the Ketamine program - they screened me for any number of drugs. Another irony maybe, giving that up so I can have Ketamine pumped into my vein? I spoke with the program director about it - and I mean spoke, not flipped a table and jabbed a finger in his face while demanding he make sense of it. They want to know what is working and if not working, why. That means limiting the variables and I get it.

@Bulgakov I'll re-watch Mulholland Drive, it's been so long I only have a vague memory of the film. Schroedinger's cat/box is as good of an analogy as the one I hazarded, although I don't know that either analogy adequately describes the experience of seeming to observe past, present and future as one. Can't even use language properly because the word "moment" describes a period of time but time was meaningless. Makes me remember Jodi Foster's line in the movie Contact, "They should have sent a poet!"

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