Ketamine #5 and #6

 I finished my acute phase of ketamine infusion therapy. Overall I'm not feeling life and I've still been pretty down. I'm pretty upset/ disappointed. The first ketamine treatment helped, but ever since then hasn't been any better. I've been sleeping a lot, like 12 hours a night. Last night I slept about 12 hours, but I woke up and was able to do things. I still didn't particularly want to do things, feel like doing things, but I had the energy to. And I was able to. A lot of days I wake up and I just can't. Today I woke up and I could. I've been pretty productive so far today. Not sure what I'll do with the rest of the day. I start TMS therapy tomorrow. I'm still hopeful, but not as hopeful as I was that it'll work. I'm just tired of feeling down every day.

I was feeling really off/ anxious before my 5th ketamine treatment. Therefore I was given Ativan. It worked really well. My current nurse practitioner doesn't prescribe that class of medication so I'd have to switch providers if I want to take it again. Debating if I should or not. Ativan increases the chance for dementia with prolonged use and it can easily become habit forming. I'm wondering if it's worth it to use it short term. If it'd somehow cure this off feeling I get. 

I was told that maybe ketamine hasn't been as helpful as I'd hoped because I went off of lithium at the same time. Maybe it was helping more than I thought. I was hopeful that the ketamine would make up for the loss of lithium and I wouldn't notice a difference coming off of it, but that didn't seem to be the case. The nurse practitioner said I'd probably notice a difference in a couple weeks. I'm supposed to get a maintenance treatment of ketamine every month from here on out until I no longer need it. If I get pregnant I'll stop doing it as well. 

I've been doing a lot of research on different insurances offered by my husband's work. We'd be spending quite a bit more money a month and for the year but it includes IVF. So if we were to do IVF we'd actually save a ton of money by switching insurance. However, if we end up not doing IVF then we'll have spent a bunch of money unnecessarily. At this point I don't know what I want to do. Sometimes I wake up and I really want a baby and I want to grow our family. Other days I wake up and I don't have the energy, I don't want that level of responsibility again, and I don't know if I could take care of a baby anyway since I still feel off so much and have nausea everyday. Hopefully I get clarity sometime soon that lasts. 

Ketamine #3 and #4

 This week I have felt pretty down. Both days I had ketamine I fell asleep around 5:30 in the evening and slept pretty much straight through till 8:00 the next morning and struggled getting up still. Didn't have any motivation to do anything, pretty much just felt like I was existing. Felt hard to make it through the night. I wondered how am I going to get through tonight. Felt like a tall task. I'm hopeful that next week will be better. I really hope the ketamine works and I start feeling better like I did after the first treatment. One positive is I didn't have any serious intrusive thoughts that I can remember. 

Week 1 recap

 The first ketamine treatment seemed to be really beneficial. The next morning after doing it I woke up and started cleaning the bathrooms. I walked up and down the stairs effortlessly.  I was more productive than I had been in months. The second day after the first ketamine my stomach was hurting but I still put away some clothes before going to my second treatment. I'm not so sure if the second treatment was beneficial. The last couple days I've been kind of back to the way i was where I just want to sleep all the time. The last two nights I've just been so tired I fall asleep early not feeling off because my muscles aren't twitching or anything just like in a calm way I felt like really tired. So some was similar to when i fell off but i didn't need propranolol because my body was calm. However tonight I feel off again, my legs won't stop moving. I've taken Propranolol all that I can take. Not sure it did any good. If it did it didn't work as well as I needed it too since my legs are still shaking. Propranolol is supposed to take away the physical symptoms. Still unknown whether I have akathisia or if it's anxiety. Ever since I did the second treatment two days ago I've felt like I've been in a daze. I've been able to function just not quite feeling like I'm all the way present. 

I saw my counselor yesterday. She said it was nice to see me laughing and smiling and my facial expressions just seemed more animated or lighter or something she said. She said I was talking about stuff still, but it wasn't so heavy, it seemed lighter. My Suicidal Thoughts have increased the last couple days. That concerns me. The good thing is they've just been fleeting. I haven't been stuck on them. But still they're there and I have to fight them off. I don't think it's from coming off the lithium because last night was the first night I didn't take it and the increase in Suicidal Thoughts had started probably a day or two before that. So I'm supposed to take lithium tonight, skip tomorrow night, take it the next night, then be completely off of it. I'm hoping the ketamine makes up for it and I don't notice that I stopped taking it.

I've been listening to music pretty much non-stop for the last couple days. In the past I had to listen to it to focus on something because my mind would wander and it was just full of too much stuff. This time it's more like I'm in a daze and it's kind of like keeping me awake and engaged in something. It's also helping me fight off intrusive thoughts. 

Ketamine #2

 From what I understand ketamine comes in three forms which are oral, nasal and IV. I am doing the IV infusions. My nurse said that those are better than the nasal ones because you get 100% of it whereas the nasal you only get like 60 to 80% of it and you really don't know how much you got. With the IV you get it all. I thought it was interesting that they have something they can put in the bag with the ketamine to lessen the effects if they're too much for you.

Yesterday was my second infusion. The first one they put me on 40 and the runtime was an hour and a half. The second time they kept it at 40 even though I was hoping they'd up it. However,  instead of upping it they wanted to decrease my time. So yesterday I stayed on the 40 with a run time of 1 hour and 8 minutes. My nurse was very happy with that. She said now next time we can go up to 45. My target is 50 so the more I can do the more benefit I'll get out of it. They started me at a lower dose and longer time because of my history of chronic nausea and vomiting. The first time I had to do 12 mg of Zofran and eat crackers and drink ginger ale. The second one which was yesterday I did 8 mg of Zofran up front before we ever started still ate the crackers and ginger ale. I got nauseous a few times but by the time there was a break in conversation where I could say something I had either forgotten about it or it was gone. Therefore I never took the last 4 mg I was allowed to take of Zofran. So my run time was 22 minutes less and I used two doses of Zofran instead of three. I think a big reason for that was because yesterday my appointment was at 10:00 whereas the first time my appointment was at 1:00. You can't eat three to four hours before your infusion but it also can't be too long since you have eaten. There's like a little window of a perfect time to eat. So for the first one I wasn't really hungry but I had to force myself to eat about 8:30. Then come 11:30 I was starving but I couldn't eat so that made me feel nauseous. So I felt nauseous before I ever even started the ketamine the first time. The second time my stomach was messed up too but in a different way. I'm kind of upset with the nurse practitioner that she didn't just up my dose yesterday. My nurse thought she would since I got through the first one okay but she wanted to decrease the time first. My nurse has extra time so she didn't care that it took longer and thought it would be fine but the nurse practitioner says everyone has a two-hour window and I need to get my time down so I don't run the risk of getting over that. I want to get the most out of this that I can. 

Yesterday I felt the effects of the ketamine a lot more than I did the first time. I pretty much just felt like I was drunk. It got more intense towards the last like 10 or 15 minutes which I'm not sure why maybe cuz it like settled at the bottom of the bag or something maybe. I don't know but it was more intense. It was harder to stay concentrated. I had planned to just listen to music and let my mind wander but I ended up talking the whole time to the nurse instead. After talking to my counselor yesterday I realized that I can't give up control anymore. She said that it's probably linked to trauma that I've seen what happens when you're out of control so I won't allow myself to get that way. She said it's robbing me of being healthy out of control it's a controlled environment and I should just let my mind wander and see where it takes me. It might be more beneficial. But instead I talked to stay grounded and try to stay focused on something. I'm going to try talking less next time and see what happens. It's interesting because when I was younger I enjoyed being high and drunk and the feeling of just kind of being free and just going with whatever happens. But in recent years I can't allow myself to get that way and I can't even get drunk I just don't allow it.

It's really interesting because after they turn off the ketamine within like 5 minutes you come down and you feel pretty much fine. Some people find it hard to walk feeling like their feet are heavier, might wobble a little bit. I was told some people have to get pushed out in a wheelchair. It hasn't been like that for me so far I just got to walk kind of slow and be careful. But you're pretty clear mentally. I saw my counselor after yesterday and she said I was just easier. It seemed easier for me to talk and more willing to try new things. Like she took me through some visualization things to try to figure out what's going on with my stomach. Seemed kind of wonky but I went along with it. If I hadn't been on the ketamine I probably would have been a lot more skeptical. She said I wasn't loopy. I was just like a toddler halfway between being asleep and awake. She wants to see me the next two times after I've done the ketamine. 

So far I've been way more productive and able to do things the past couple days. I realized when I was cleaning the bathrooms the other morning that I went up and down the stairs effortlessly. Like I'd forget the cleaning stuff so I'd have to go downstairs and get something else and then go back upstairs to clean.  I cleaned on the bottom floor and the top floor. Most of the time in the morning when I get up I brush my teeth and I grab whatever clothes I'll need for the day so I don't have to go back upstairs. If I forget my ring or something I just don't go back up to get it. I usually don't walk back up the stairs until the night time when it's time to go to bed. But the other day I did it without even thinking. I don't think people understand how heavy depression is. Most people think that you just want to be happy and giggle and laugh 24/7. A lot of it is just being able to function and do the things normal people do effortlessly. It's been nice to feel a little lighter the last few days. I'm hoping it continues and just gets better. Today I woke up with a headache and my nose was a little stuffy. Colorado is dry so maybe that's why. There was a damn dog barking at 4:30 in the morning for over an hour so my sleep was interrupted. I don't know if that played a role in it too. It was hard for me to get up today. I wanted to stay in bed but I did get up. I went and got myself my own energy drink instead of waiting for my husband to wake up to go get it. I've been avoiding driving for a while but I did it today willingly. Well I was still kind of hesitant but I was able to do it. 

Other than going to the gas station and now writing this blog, I haven't really done anything today yet. Not sure what I'll do when I'm done with this.  If I'll just hang on the couch and wait for my appointment at 11:00 or clean or fold clothes or something I don't know. I guess we'll see. My next ketamine infusion isnt for multiple days, not until next week. So we'll see if I start feeling worse by then or if things just maintain or what. I'm a little anxious to see what happens with going up to the 45 next week. Also I'm on my last three lithium. I'm hoping that with starting the ketamine infusions I don't even notice that I go off the lithium. I'm a bit nervous about that too. I'm getting off the lithium because if I were to get pregnant it can be harmful to the baby. 

Ketamine #1

 The ketamine treatment went much different than expected. I was wondering how I was going to pass the time. I thought I would listen to music. However I ended up talking to the nurse the whole time. It made the time to go by faster. I didn't feel as much as I thought I would. I may feel more next time cuz they're going to do it a little faster. It took an hour and a half because I have chronic nausea and vomiting. Most people take 40 to 50 minutes. So they're trying to cut my time down before increasing my dose. This upsets me. I wish they'd just increase the dose first. I'm supposed to be at 50 but they only have me at 40. Makes me think I could be getting more out of it than I am.

Today was the first good day I've had in quite some time apart from being on vacation. I woke up like 3:00/3:30 but it wasn't bad cuz I had fallen asleep about 9:30. So I didn't get 8 hours sleep but I got a decent amount. In the past I felt best when I sleep about 6 maybe 7 hours. After waking up I stayed in bed until about 5:30 and then got up. After getting up I was on my phone and just hanging out for a little bit. Then instead of just laying around or sitting on the couch I decided to clean while my son was doing school. I cleaned the bathrooms. I can't even remember the last time I did that. We can actually see clearly in the mirrors now, it's amazing. I was more productive today than I have been in months. I decided to go for a walk around the park while my son was at OT instead of just sitting in the car or staying home and laying down while my husband took him. I'm hoping it was because of the ketamine and it just continues to get better.

Lithium, Lamictal new psychiatric np

 I went on lithium a little over a month ago do to having suicidal thoughts. There was one night in particular that was pretty scary so that's why I went on the lithium. Things have been much better since then. I'm not sure if it's me or if it's the lithium. I only had those thoughts for the one night and I hadn't had them a couple nights before starting the lithium. However instead of going off of it I decided to stay on it another week or so so I could start the ketamine before I get off of it and hopefully not notice a difference.  

I increased my Lamictal from 250 to 300. This is supposed to help with depression. I'm not sure it's really doing anything. I'm doing better, but I think that's because of vacation. When I got back I started going a little downhill again. Not as bad as before I left, but it's still there. I have to take 150 twice a day and I keep forgetting if I already took it or not or how many times. Therefore I'm thinking I need to ask if I can just go back to taking it once a day, this twice a day thing is not working out too well for me I don't think. 

Last week I saw a new psychiatric nurse practitioner to hopefully get referrals for ketamine infusion therapy and TMS therapy. She said she couldn't diagnose me after just talking to me for an hour. What a relief.  Everyone else diagnoses me in that amount of time. She said she thinks I could have bipolar disorder but she also thinks it's possible I don't have bipolar disorder. She said what makes her wonder is that I was on SSRI's for multiple years before I ever had a manic episode. Often this is how they discover someone has bipolar disorder because it pushes them into Mania. She said having a manic episode can definitely make you not sleep for 2 weeks and feel like you don't need to eat. But it wasn't the manic episode that caused me to not sleep it was the sleep and the trauma that caused the manic episode. She also said my medications don't even tell her that I have bipolar disorder. She's prescribed Latuda and Lamictal to people with treatment resistant depression without bipolar. My insurance currently only covers TMS therapy for major depressive disorder. However this new psychiatric nurse practitioner thinks she can put up a good enough argument that I'll receive TMS therapy. She's just not going to put a diagnosis. She's going to put treatment resistant depression. I'm hoping this gets approved. 

I start ketamine therapy today. I'm pretty nervous. I think I'm most nervous that it won't work. And I really don't want to throw up. I'm nauseous pretty much every day anyway. I don't want this to make it worse. In addition the nurse told me to prepare to be there for at least two hours. That seems like a long time to just sit in a room. I'm hoping I don't realize the time while doing it. Ketamine is supposed to help rebuild connections that get lost due to prolonged depression and Trauma. So it helps with treatment resistant depression and PTSD. I will do two treatments a week for 3 weeks making a total of six treatments. After that maintenance is usually once a month. They can't say for how long everyone's different. I'll probably be at least halfway done with ketamine before I find out if TMS will be covered or not.