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About Atra

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    San Francisco, California
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    Cognitive behavioral therapy, dialectical behavioral therapy, podcasts, theater, opera, wine, food, crunchy-looking leaves on the sidewalk, walking, meditation, skepticism, travel.

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  1. Atra

    What Are You Listening To? #3

    Von dr Alb ra - Rock und Rollinger (feat: Moggi) A parody metal song sung in German what's not to like.
  2. Made dinner reservations for me, mom and her bestie at a pizza restaurant where all the workers (and owner) are deaf. Got to practice sign language. But anxiety made me all self-conscious, struggling to sign iced tea while the waitress patiently watched. Then she lifts the menu and demonstrates how I can simply point to the item I want. Sometimes I'm the world's biggest boob.
  3. Atra

    Random bouts of depression

    Always. I can have every reason to be cheerful, content, I can be on my way to the ribbon-cutting ceremony of Atra's Best Day Ever - my depression doesn't care. I scrape it off the bottom of my shoe, it still smells. I take a vacation, it books passage in the seat next to me. I invent a clever analogy, it surmounts because of it's generality.
  4. I feel you for wanting to know why your depression returns after you've beaten it. In the first bout with a severe episode of depression in my adult life I beat it back with exercise, meditation and nutrition. I proclaimed victory. When it returned years later and the aforementioned were ineffective, I sought help from therapists and took antidepressants. Another cycle of remission, then eventual relapse. I'm diagnosed with MDD treatment resistant. My symptoms don't appear to have a trigger -which is annoying - and they cycle from mild to severe. My approach is to continue acquiring new tools for my mental health toolbox, to some degree this is empowering. Acceptance reduces suffering but naturally, I struggle with that. My intention isn't to suggest you're like me, just presenting my own experience for you to compare with yours. Perhaps you could do with a long vacation or at least a reduction in workload. You might consider a prescription medicine for the insomnia. I assume you have concerns about pills, I bring it up because it sounds like the sleeplessness and anxiety are becoming great concerns and lack of rest tends to worsen symptoms. May you find a bit if peace in the weeks ahead.
  5. Atra

    Once a screw-up, always a screw-up

    You effed up, same as any human who ever walked upright, it doesn't follow that you suck at life or at being a dad. It'd be weird if you never made a mistake, even forgetting something routine because this is bound to happen. I know I'd beat myself up over it so I guess I am with you on the self-flagellation, it's hard to duck it. Still, when you've kicked yourself enough I hope you can consider how the outcome was not a catastrophe. In addition, lesson learned is not that you suck but rather the process that determines how your daughter gets home can't rely entrely and eternally on the infallibility of JD. Turns out, there is some fault-tolerance in the process as she did make it home, that's reassuring right? No one's happy about how but lives weren't jeopardized and noone was harmed.
  6. Atra

    What Is The “Relief Experience”?

    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. 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.
  7. Atra

    What Is The “Relief Experience”?

    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
  8. Atra


    Hi and welcome. I hope the unsteady feeling passes shortly and you're back to feeling like you again. While you're here, do you feel like writing a little about how this came about, what's going on that may be influencing your mood? Or if you just feel like complaining about it, that's also welcome here. It can help to get it out especially if you don't know anyone who can relate. We're not therapists, we do have direct experience with depression and anxiety. You've probably read some posts by now and hopefully someone else's struggles in some way resemble your own. When you no longer feel alone struggling with symptoms, it brings a measure of peace.
  9. Hi and welcome. I'm so sorry to hear you're struggling and I completely understand why you want to hibernate until the holidays are over. You mentioned assisting a stranger who had an accident and going back to work, coming after attending a funeral where you had to deal with your troubling dad. That amazes me. If it had been me I would have gone the funeral and came directly home, I think. Perhaps your sense of duty compels you to think of others before yourself and there is nobility in that. For December, with all the pain it brings you, I think it is important to be extra kind to yourself. Maybe the obligation this month is to find ways to cope without "shoulding" yourself into guilt and accept for now that your duty is to take care of yourself. What nice thing can you do for you? Clinical Depression can make compassion for oneself very difficult and if we can help you bounce around some ideas, please let us know. One last thing about telling your wife your truth. I honestly can't see how a lie could possibly have been a better choice. I think we can acknowledge her frustration without dismissing or diminishing the hard truth about your pain. Is it unfortunate that your pain is at it's peak during Christmas? Yes. Does this make your pain unacceptable? No. Life is seldom tidy. Answering her question honestly and taking yourself out for a long drive are two unfortunate choices you've had to make this month. Sadly, sometimes life only offers bad options. So if the choices you made created problems, perhaps they are better problems than the alternatives would've begot. If you can see it from that point of view, there's room for self-compassion.
  10. Peeled and shredded 20 lbs of potatoes and 10 lbs of onions with my brother and mom. We made latkes (shredded potato fritters) for a large party on Sunday. 6 hrs cooking, I'm spent and smell like a french fry factory but it was tolerable with no drama and I'm proud that i could participate.
  11. Atra

    What Are You Listening To? #3

    Mechanism - Carbon Based Lifeforms
  12. For showing patience, willingness to learn and to adjust for her condition you deserve credit and gratitude. I appreciate what you're doing and respect the efforts you're making. I'm also aware this means a lot less coming from some rando on the internet when you really want that recognition from her. Yes, depression's effect on relationships is felt the most by those who are closest to the one suffering. The helplessness and frustration you're feeling, she's feeling it too. Very often depression doesn't respond to acts of kindness and generosity which in turn adds to the tension of both sufferer and caring individual(s). It's the reason why getting some relief from symptoms needs to come first. Fortunately, depression does respond to medication and psychotherapy and it sounds like she's on track to getting both. You may be able to participate if couples counseling becomes a viable option. Caregiving is emotionally exhausting work. I agree with the others that doing something nice for yourself on a regular basis will help sustain you. Also, consider talking to a counselor yourself, it may relieve you of the tough feelings you're carrying around. Please update us with how you're both doing, I hope we can continue to be helpful.
  13. I've wanted to do the same, you're not the only one. I broke up with my ex three years ago yet I wanted to remain a part of her life in some regard. While my feelings for her may no longer be romantic, I still care about what happens to her, I don't write off exes. Yet it's not for me to decide. I was advised as you are, keep silent keep my distance. Let healing happen. Also, I stopped inquiring about her through mutual friends which wasn't easy but it tends to makes them uncomfortable.
  14. Hi. I also think it's a very good idea to gently encourage her to meet with a mental health professional. She may not respond cheerfully to the suggestion, as is often the case because mental health stigma is a thing. Let us know how that goes for you and we'll help you help her best that we can.
  15. Hi @StoicLady I hope the budding friendship/romance continues between the two of you and that my response isn't too late to be of use. Rather than rules, let's call the following realities of online dating. Everything comes faster. Acceptance, rejection, attraction, fascination, falling in love, falling out and so on. The pace beginning with "Hi, I'm curious" to "We're officially dating" is counted in days rather than weeks because as you know, communication comes speedily as do answers to important questions. Consequently, each believes she/he knows the other person really, really well in a week or three but it is very often they're really, really wrong. Why do I say that? Reasons. In writing, anyone can put himself in the best light and can do so with nearly no special effort required. For example, perhaps I'm banging out this long, thoughtful reply to your post as imagined or perhaps this is the 14th time I've copied/pasted it. It might not have been written by me at all. The delete key also enables us to not be ourselves by erasing our irritations, frustrations, overreactions, prejudice and together with quick replies gives the appearance we are always thoughtful, never ill-mannered or short tempered. There are no number of emails, chats, texts that will indicate if this guy is a total jackass to waitstaff and anyone working behind a desk. Or that he screams at his kids daily. Nothing about personal hygiene. And so on. Perhaps all of the above has already occured to you so the only rule you really must hold to in online dating is to protect your heart. Every one of us is self-deceiving in that we tend to see people and things as we wish them to be and not as they are. I don't want my cautious talk to be considered a rant against online dating, in my experience there's nothing inherently troubling about it if you accept it's peculiarities and the honest truth that people do let you down. I hope this man is right for you in all the ways that matter. But until you can observe him being his ordinary self doing ordinary things, sequester your heart just a bit.