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.

2nd ectopic and miscarriage

 Since the last time I wrote in this blog I had another ectopic pregnancy and now a miscarriage. I'm going in in a couple hours for a D&C (surgery) to clean out my uterus since I haven't yet miscarried on my own. It has been a very long week just waiting for it to happen. That's why I decided on the D&C so I wouldn't have to wait any longer. It's been consuming me. I found out a week ago yesterday that there was no heartbeat. I held on to it for a couple days hoping that the ultrasound was wrong, that they just missed it and everything would be okay. But it wasn't. It isn't. 

I was encouraged this time because we made it over the hurdle of getting the pregnancy in the uterus. But something still went wrong. I wonder if I'll ever be able to have another child and question how badly I really want one. A counselor thinks maybe I don't want any more because I may not be able to have one and it's my way of coping. Maybe in part, but I've questioned if i want another one for several years. I just decided I was getting older and I didn't want to regret not at least trying for another child. I think if I just never would've gotten pregnant again I could go on knowing I tried and give it up much easier. Having been pregnant now 3 more times and experiencing the roller coaster of emotions there are times when all I can think about is another child and I want nothing more than to have a healthy child. 

Doing better, productive

 It is now Friday. I woke up at 3:45, but since I first fell asleep at 8 last night i guess that isn't too bad.  Since starting the EnLyte prescription Tuesday night I feel better. My days have been far more productive than they have in a long time. I still don't necessarily feel like doing stuff. For instance I don't feel like cleaning the house. However,  I want it clean and my son wants Christmas decorations up, so I have been. Today I started an iron and Herb supplement. It's supposed to give me more energy. So we'll see. My blood work revealed an iron deficiency thus the reason for the supplement.

I had my third visit with my psychiatric nurse practitioner yesterday. We decided I'd try going from 100 mg of Latuda down to 80. She says the dose of Latuda is very high which is easy to believe seeing how they don't even make 100 mg tablet. The hope is that I can get down to 40 to 60 mg Latuda which is a more ideal dosage. She thinks either I'm on such a high dose of latuda it prevents all the anti depressants from pushing me to Mania or I don't have bipolar disorder. Generally they try not to put people with bipolar on any antidepressants yet I'm on 3. She wants me on the least amount of meds at the lowest affective dose. So we'll see what that ends up being.  I have a feeling this is going to be a long road.  However, I'm hopeful it won't be a hard one. 

Lamictal 150mg and EnLyte

 I have been on a reduced amount of Lamictal for nearly two weeks now. I was on 200mg for years. Now I'm on 150 mg. Thanksgiving was a good day. However the day before that and the days after it until yesterday I was feeling fairly down and hurt. I know the cause of the depression was the ectopic pregnancy, but I think the reduction in Lamictal made it even worse. I hadn't been down and stayed down for several days like that for awhile. My desire to take a shower was gone and I felt like crying even though I'm not much of a crier.

Last night I finally had the desire and energy to wash my hair in the shower. Last night was the first time I took EnLyte.  They say you won't feel the full effects of it for two weeks just like any other medication. However,  I tend to be very sensitive and notice things right away. Today is day two of taking EnLyte. I hope today is a good day and the days to follow are as well. It's an all natural prescription that's supposed to help improve my mood and give me more energy. I'm also waiting on an iron and Herb supplement that should help my energy as well. I'm hopeful these changes will be beneficial. I have a follow-up appointment with my psychiatric nurse practitioner tomorrow. Wondering what we'll do with my medication. Will we continue to go down on the Lamictal since the EnLyte seems to be working or will we stop where we're at since the decrease in Lamictal seemed to increase my depression and make me feel down. 

Today I'm just sitting here playing games on my phone so far. Trying to find the motivation to clean the house so I can get the Christmas stuff out. Still don't really have the motivation to do it, but I feel more willing than I did the last few days. I know I shouldn't go back to sleep at this point. We'll see what I do with this day. 

New providers

 I finally changed providers a week or two ago. Turns out it was long overdue. My new counselor helped me more in two sessions than my previous counselor did in over a year. I thought about either switching counselors or stopping going for awhile just didn't take the initiative cuz I wasn't doing terrible and I dread intakes. I actually look forward to my next appointment with my new counselor. 

I also found a new provider to manage my medications. She is a psychiatric nurse practitioner. This is the first time my main provider hasn't been a psychiatrist. Her approach is much different than anything I've experienced in the past. Time will tell if this is a good thing or not, but I'm hopeful and optimistic it will be. The first thing she did was go over my history and then she ordered genetic testing and more thorough blood work. My insurance covers it all which is a wonderful thing, but I'm frustrated given it's a covered benefit that no one has ever mentioned genetic testing to me before or try to do more thorough blood work. Supposedly the genetic testing will give my provider insight as to which medications and what doses may work best for me. I'm hopeful the results are accurate.

I thought I was on all the right medication until I started feeling better and having more energy and motivation. First I thought it was hypomania I was experiencing. However, now I think this is "normal" and before I was in a state of depression. Initially it was the right combination of meds I was on, but at some point that changed. Now the challenge is to figure out how to stay where I'm at and figure out a way to not feel so tired all the time.

This psych is a holistic provider and believes strongly in gut health and mental health being closely related. This is new to me, but I'm definitely open to learning and trying something new. Plus maybe it'll help me understand why my stomach is always hurting and make me feel better as a whole. 

After going over my mental health history my new psych mentioned she wasn't convinced that I have bipolar 1 disorder. She said I've experienced a lot of trauma and all my mental health concerns have been linked to that. She said that with depression you can experience psychosis. Manic episodes and psychosis have overlapping symptoms so it's hard to distinguish what your diagnosis should actually be. She also said depression can cause not sleeping. Since when I ended up in the hospital I hadn't slept for 12 days, she says anybody will be psychotic after that long with no sleep. I agree with that. For a long time I was in denial that I had bipolar 1 disorder because there were a lot of factors that went into why I ended up in the psych ward for nearly two weeks.  She said usually with bipolar disorder in childhood or adolescence you have a lot of ups and downs. I didn't experience any of that.  My problems other than depression didn't come to light until after I witnessed the suicide and acquired ptsd. Ptsd can cause a lot of problems too. She said she's going to keep my diagnosis as is, but she would like to get to know me better to see if it should be changed. 

This gives me mixed feelings. For years I was in denial that I had bipolar 1 disorder. Then I finally learned to accept it, even embrace it, live with the lifelong sentence, take my medication, and just roll with the punches. However hearing that it might not be bipolar disorder made me feel like maybe I was right all along and validated my feelings.