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What Is The “Relief Experience”?


Atra

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Baseline improved

After three Ketamine infusions, what if any improvements to my condition did I notice? To answer that I'll begin with a recap of where I was before treatment.

My baseline emotional state for longer than a year featured many MDD symptoms, such as Anhedonia (loss of pleasure in anything), an acute loss of purpose, despair from lack of therapeutic response to drug treatments and pessimism for my future. I was alive but I wasn't living. The only distinction I drew from experiences was the tolerable from the intolerable and during any social obligation, my goal was to just maintain until it's over. Though there were few obligations I had left. I wasn't working, having been fired from my job a year before and I had no significant other, having put an end to a 3 year relationship in the midst of our couples therapy session (girlfriend: jaw-drop; therapist: jaw-drop; me: wondering if I could somehow melt into the sofa).

Stripped of these obligations, I didn't feel liberated at all. I felt like a ghost of my former self returning to the same activities, coping mechanisms and the same problem behaviors that once supplied some meager nourishment to my troubled existence. They no longer gave me any relief or satisfaction yet still I "haunted" them, I guess because these are habits of the brain.

After three treatments something changed. Anhedonia dissolved. Words were pouring out of me and because I had begun a journal there was someplace for them to go. Suddenly I'm interested in searching for unfamiliar music to assist in the creation of new neuronal pathways. Suddenly there is hope. Experiencing excitement after feeling nothing for so long resembled hypomania and it's a wonder I got any sleep. Was I feeling like Bradley Cooper's character in the TV show Limitless? Nah, not really. Only in the sense that I'd begun to see there were possibilities for me that didn't seem to exist before.

Is Functionality Relief?

Yes, it is. The Ketamine Advocacy Network informed me that I shouldn't expect mood elevation so soon after beginning treatment, rather I might notice an increase in “functionality” – meaning, the ability to do stuff. I did notice what seemed like a larger reservoir of energy to draw on for activities. Self-cares, chores were no longer arduous struggles requiring mental energy to fight off impairing, negative thoughts. I felt motivated to set aside time for physical and mental exercise (meditation). I wondered if I should attribute this uptick in functionality to Ketamine therapy or was I was merely convincing myself that it was? You're probably familiar with the placebo effect and other reactivity influencing phenomena(1), anyone who's been on countless medications has experienced it for a week, maybe two. I decided I didn't have to answer that question but instead, just decide how use the functionality for however long it would last.

Improvement in therapy

Like any antidepressant, Ketamine alone isn't enough to tackle major depression. Post-infusion, my time spent in therapy sessions seemed more productive. I felt I could concentrate and participate which resulted in a better grasp of the concepts and how I could apply them. There were some moments of realization, such as how negative thoughts had been left alone to define me for so long.

Are The Side-effects Of Ketamine Therapeutic?

I'm asking if the euphoric, analgesic, anesthetic and dissociative effects have therapeutic value. I spent a lot of time wondering about this and I have a lot to say about the euphoric side-effect, as you'll see.

The euphoria felt like a vacation from my symptoms – especially anhedonia. Only a 40 minute vacation and a drug-induced one at that but I can't complain. I believe that going on an actual vacation someplace can help alleviate mild depression but for treatment resistant major depression, where symptoms can't be managed, it's near impossible to plan a trip let alone enjoy time away. A lot of people just do not understand this concept: depression is the demon shadow that goes with you everywhere, it's not something you decide to pack. The last actual vacation I went on was for two weeks and it was a disaster.

A 40 minute break from symptoms felt nice but I also believe it was therapeutic. Why? Because I'd forgotten what joy, pleasure or relaxation felt like until they pumped 50mg of Ketamine into my vein. Most mental health professionals push back on that, pointing out how the drug-experienced euphoria of Ketamine is a dangerous path to addiction or at best, a false hope for patients. Well, they can go suck it. 

Why'd I write that? Because unremitting anhedonia is life-threatening. No matter what activity I forced myself into, I was checking the time at regular intervals so as to know when I could finally go home and be alone. Anhedonia was binge-watching TV while at the same time playing a game on my phone - not for entertainment but as a desperate distraction from suicidal thoughts. Self-gratifying activities like sex or masturbation were just chores that yield nothing but more frustration and self-hatred.
That is anhedonia. I hope you're feeling me.

Mental health professionals do grasp this intellectually but most don't get it emotionally so for those finger wagging Higher Minds, I prepared this rant: spare me the methodological purity sourced from your good conscience, your professional training, your best intentions and use your finger to plug your mouth-hole closed before it dispenses any more saccharine slogans. If there's no risk of physical dependency, a chemical vacation can be therapeutic for severely depressed psychiatric patients experiencing anhedonia. Yeah, I said it. Blow me away with your Straw Man sliding down a Slippery Slope argument(2).

Right. Now, what about the analgesic and anesthetic effects? They may help one to sink into the experience, especially patients who endure chronic pain daily. The floaty feeling can be pleasant. It would nice if the anesthesia element relieved anxiety but it doesn't, it's only a body sedative .The numbness adds an immobilizing quality to infusion which I don't particularly enjoy, it makes me feel sickly numb. Anxiety about Ketamine infusion is a thing, lots of patients are justifiably frightened of losing control to a drug. I'm told some patients get a dose of the sedative Versed (Midazolam) if they present with severe panic disorder.

Is there therapeutic value in the dissociative effects of Ketamine? From my experiences, I think there is. I've asked Psychiatrists about it. They wonder about the relationship and there's actual research going on to try and determine what - if any - relationship exists between dissociation and the antidepressant effects of Ketamine. I'm interested in exploring the question but that conversation belongs in it's own entry

In the next entry I'll detail my fourth Ketamine infusion, when my soaring confidence airplane got grounded and I had a “bad trip” - a scary, disturbing and revealing dissociative experience. While from another visualization, I drew some insight about why I felt so unfulfilled working in my previous jobs

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  1. For example, Novelty Effect, Subject-expectancy effect, Hawthorne Effect. It's important to be aware of these when evaluating how effective a drug really is. The quality of the research depends to some extent on how well researchers control for these and other factors.
  2. I want to anticipate some of those unasked questions, for example: So you're saying all mental health patients should self-medicate...? NO. I didn't write that. So you think euphoric drugs will...? NO, I'm pretty sure the word "can" is not a synonym of "will". So you're saying we should give every mentally ill patient every time...? No and NO again, that's not what I wrote and not what I think. Aren't you aware there's an opioid addiction crisis...? Yes, are you aware I'm not writing about or advocating for opioids? These questions come from Straw Man and Slippery Slope arguments. I don't mean to suggest that there aren't any valid questions to ask, I welcome having my thinking challenged by those questions however, I am not interested in indulging anyone making arguments that are not to the point of what I've written.

 

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...for treatment resistant major depression, where symptoms can't be managed, it's near impossible to plan a trip let alone enjoy time away. A lot of people just do not understand this concept: depression is the demon shadow that goes with you everywhere, it's not something you decide to pack. The last actual vacation I went on was for two weeks and it was a disaster.

I spend my "vacation time" worrying about the massive pile of crap that will await me upon my return.

I'd even be depressed laying on a white sand beach with the warm, gentle surf washing over me. Yes, that's "crazy". But it's my experience.

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9 minutes ago, JD4010 said:

I spend my "vacation time" worrying about the massive pile of crap that will await me upon my return.

I'd even be depressed laying on a white sand beach with the warm, gentle surf washing over me. Yes, that's "crazy". But it's my experience.

I’m sorry JD, I wished you could enjoy your time away from work more better than what you are currently doing.  Hang in there my friend and hopefully things will change in the near future 

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2 hours ago, JD4010 said:

I spend my "vacation time" worrying about the massive pile of crap that will await me upon my return.

Yes and I hear this from folks who don't struggle with depression. Even pre-major depression it took 5 days to a week away for me to forget work anxiety and feel like I was on vacation. 

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