IV Ketamine Scares Me

IV Ketamine Scares Me

The other day I made the decision to stop my ECT treatments and to increase by Clozapine dosage. I’m currently at 200mg and will be increasing my dose by 25mg each week until I reach 400mg. This was one of the options my psychiatrist gave me. Another option was to go back to doing ECT three times a week, but I’m not willing to do that at this point. The third option my psychiatrist gave me was to do IV Ketamine. He has been offering this as an option for many months now, but it’s not something I want to do.

IV Ketamine scares me for a couple of reasons. I used to get high off of Ketamine when I was using. That was a long time ago, and I know that abusing Ketamine and using IV Ketamine are two completely different things; the side effects of IV Ketamine are nothing like the effects of getting high off of it. My biggest fear of trying IV Ketamine is the possibility of dissociation. When I would use Ketamine to get high, I would take so much that I would slip into what’s called a ‘k-hole’, which is pretty much a dissociative state. I couldn’t move or speak, but I could still feel everything that was going on around me. The possibility of dissociating scares me, it triggers my PTSD. I always need to be able to protect myself, and dissociation would take that away from me. Plus, the treatments are especially expensive.

The use of IV Ketamine is highly effective, and it works very quickly. It is known to show improvements by the end of the infusion. Maybe my reasons for not trying it are ridiculous, but they are my reasons. I’m not saying that I’ll never try IV Ketamine; I would just prefer to leave it as an absolute last resort.

Physically And Mentally

Physically And Mentally

My body is just as screwed up as my brain. I had my first surgery when I was 16 years old; it was a cardiac ablation. My heart rate would randomly jump from normal up to 200 or more, and I would pass out. A year later, I had a tonsillectomy. In 2009, I had surgery on both of my knees. A year after that, I had a tubal ligation, which I will explain. I had a total hysterectomy in 2014.

The tonsillectomy is pretty much self-explanatory. I chose to have my tubes tied in 2009 when I was living in Connecticut. This was after my total breakdown. My psychiatrist had to write a letter explaining that I knew what I was doing and was making a sound decision. I decided that I have a hard enough time managing my life. I’ve had ups and downs; no matter how hard I try, I can’t always take care of myself. I’ve seen many people struggle with being a parent; it weighed on them so heavily. I didn’t want that to happen to me or my child. I decided it was better for me not to have a child. For me, this was the right decision, but it has been really hard. It’s been extremely difficult for me to not be able to have children. I often cry uncontrollably because of that fact. A year later, I ended up having to have a total hysterectomy because of severe endometriosis.

I pretend to be okay with the fact that I can’t have kids of my own. I’m a 31 year old grandma, who has never been a mother. Of course I wish I could have kids, but if I had to do it all over again, I would still make the same choice. I made the decision because it was the right thing to do for me, not because it was easy.

Right now, the most difficult problem I deal with physically is the interstitial cystitis. I currently get treatments every week; sometimes I can stretch it out to as much as every 3 weeks. The treatment involves getting catheterized so the doctor can put medicine directly into my bladder. This problem has been getting worse over time. I also have chronic bronchitis and pneumonia among other conditions, but luckily that’s not acting up as well.

I know that I’m luckier than many people, but I’m also worse off than a lot of others. Why do I have to have both physical and mental health problems? Why are all my problems chronic? Living with and managing physical pain as well as mental health is exhausting.

Waiting Is The Hardest Thing To Do

Waiting Is The Hardest Thing To Do

Right now, I’m waiting, and I’ve been waiting for days. I’m waiting for the results to my Clozapine level blood work. The results to this test will tell my doctor whether or not he wants to increase the dosage of my Clozapine. I’m currently at 200 mg every night. I did the blood work on Friday. My normal weekly blood work was completed on Friday, but the Clozapine level takes longer to come back. I just don’t know how long; I even tried to figure out how long it would take by researching it online, but I came up empty-handed. I told my psychiatrist that I’m in a depression. I informed him that I’m sleeping too much, I’m overeating, I feel worthless and empty, and I’m easily irritable. He told me to hang in there; we are waiting for the results of the Clozapine level. Once we have the results, then we can figure out our next step.

So now I’m just waiting. I’m waiting for my blood test results, I’m waiting to find out what change my psychiatrist wants to make, and I’m waiting to start feeling better. When you’re waiting for something, every moment seems to drag on and on. I’m just trying to get through this, one moment at a time, but how much longer do I have to wait? Even if my psychiatrist decides to add a new anti-depressant, we all know that it takes 4 to 6 weeks for the medication to start working, if it’s going to work at all. So that’s more waiting. No one should have to wait this long to feel better.

I’m compliant with anything I’m told to do by my doctors. However, I am getting sick and tired of it all. I wouldn’t mind the waiting, if I knew that there were going to be positive results. I also wouldn’t mind the waiting if I knew that the positive results that I was going to get would be more than just temporary. We all know that no medication to treat bipolar disorder is permanent. Every time we try a medication, our bodies react differently; we almost never react the same way twice. How a medication works varies depending on our current mental state, the medications we’re currently taking, and any treatments we’re currently undergoing.

I just wish there was an easy answer to treating bipolar depression and mania. There should be an answer, an easy way to help us, where we don’t have to spend most of our time waiting. My bipolar disorder is very gray, nothing is absolute, and everything is questionable. I wish my bipolar disorder was more black and white, I wish it had easier, faster, and more accurate answers.

Another ECT

I have another ECT treatment today. I do them every 4 weeks; I can’t believe it’s already been that long. I hate going and doing this. It is helpful, but I guess I’m just tired of it. Maybe I would feel okay about it if doing ECTs made me able to reduce the amount of medicine I took, but it doesn’t. The people there are very nice and know me well since I’ve been doing this for more than a year. The procedure doesn’t take long, but I do feel somewhat crappy the rest of the day; mostly headaches, body aches, and memory loss.

I’m too scared to stop. What happens if I stop and it turns out that it was the one thing that was holding me together, in a way. I don’t want to go, but I always go because I’m afraid not to go and because it’s the right thing to do at this point for my treatment. Sometimes, I wish I wasn’t so compliant. Time for me to go now.

Monthly ECT

Monthly ECT

At 8:15am I had my 32nd ECT treatment (I miscounted before). I now do the treatments every 4 weeks; they’re maintenance treatments. They’re done under general anesthesia; the treatments only take a couple of minutes. I usually leave the hospital within 90 minutes of getting there. Normally, I get home and go to sleep for a little while. When I first started the treatments, I could go back to sleep for a couple of hours, but the amount of time I’m able to rest afterwards has been decreasing with every treatment. Today, I got home from my treatment and was unable to go back to sleep at all for the first time.

I’m not a fan of the recovery and after effects. My jaw hurts so bad that it hurts to chew anything and my entire body is muscle sore. It feels as if I just ran a marathon, or two days after a massive workout, when you have to brace yourself for every movement you make. My memory gets even worse than normal after the treatments; the memory issues last longer than the physical ones. The memory issues make me feel like an idiot. I’m constantly asking questions, and I usually ask the same questions over and over again.

I’ve been doing these treatments for so long now, I wonder if I will ever be able to stop them. My psychiatrist wants me to be stable for 6 months before stopping, and I just don’t see that happening. I could just tell him I want to try stopping the treatments, but then what happens if I end up in a huge depressive or manic episode? Then I would have to go back to doing the treatments 3 times a week. I don’t want to do that, and I’m not sure if my body can even handle that. I wonder what the long-term effects are of ECT; maybe that’s something I should look into.

 

I Finally Accept Who I Am Instead Of Hiding It

I Finally Accept Who I Am Instead Of Hiding It

I’ve been living with bipolar disorder since I was 14 years old, in 1999. It has never been easy, but I’ve made it through with the help of my family and friends. I turned to drugs at age 12, which probably triggered the beginning of my episodes. I started seeing a psychiatrist and began taking medication in 1999. The best thing I had going for me was that I was always honest; I told on myself any time I did something I shouldn’t have. I have always felt the need to be honest. I was truthful about how I was taking care of myself. I always took my medications as prescribed, I went to every doctor’s appointment, and was honest with my psychiatrist/psychologist about the drugs I was using. I was even willing to admit myself to a psychiatric unit when necessary. I did these things, but was never happy about it.

I was never really ashamed of my diagnoses, but I wasn’t willing to tell people. I know it was mostly obvious, especially since I was a cutter for many years, but it wasn’t something I wanted to shout from the rooftops. I remember feeling worried what my friends and family would think. I told my immediate and extended family, and I received unconditional support from everyone. I even had a few family members take the NAMI Family to Family classes so they could better understand what I was going through.

After I got sober in 2004, I began a life across the country. I got a great job and I even received a fantastic promotion after 1 year. I kept my mental health diagnoses mostly to myself. I was concerned of what my co-workers and my friends from the 12-step program I attended would say. I had a couple experiences where I felt looked down upon when people found out about my mental health, however, I think most of it was in my mind.

In 2009, I had an episode that was so extreme, I had to leave my job, move back in with my mother, and go on disability. At this point, I couldn’t hide anything, and I decided it would be too much work to try. As it turns out, most people didn’t even think twice about it. I even found several people that lived with the same things, these people became my friends. I became comfortable with my diagnoses; now, I don’t care who knows about my mental health. If someone thinks differently of me because of my mental health, then that’s their problem and their ignorance. It has taken a long time, but I have finally become comfortable with my diagnoses. Even though I struggle daily due to my mental health, I also feel that it has made me stronger.

It may have taken me many years to become comfortable with this part of who I am, but now that I have, I can spend my time and energy working on myself instead of trying to hide myself. Becoming secure with my diagnoses has allowed me to truly live my life. To manage my mental health I continue to take medication as prescribed, follow-through with all treatments, be honest with my friends and family, try to stay productive, find things I’m passionate about (I enjoy cooking, cleaning, and hiking), try to keep on a schedule, and try to get a good night’s sleep. None of these things are easy, but if I regularly work towards these goals, life becomes easier.

I am blessed with family and friends that support me no matter what. My husband, mother, and other family encourage me to do things that are healthy for me. If it wasn’t for them, I probably would never leave my house or see any friends. It is because of their love and support that I can accept myself for who I am. My bipolar disorder and other mental health diagnoses are only a part of who I am, they do not define me or dictate my life.

ECT – Electroconvulsive Therapy

ECT – Electroconvulsive Therapy

Electroconvulsive therapy, ECT, is one way to treat severe depression and mania. The treatments are done under general anesthesia, allowing the doctor to induce a seizure by passing small electrical currents to the brain. ECT is known to be controversial because of how it was administered many years ago and the serious side effects it used to cause, but it is now much less dangerous.

I started ECT in February 2015 because no other treatments were working and I was desperate for something to help. In the beginning, I was doing the treatments 3 times a week for 4 weeks, then once a week for 4 weeks, then every other week for 8 weeks, and finally once a month. It has been a successful treatment for me. It has not solved all my problems or completely removed my depression, but it did get me out of a major depression when every other treatment failed. At this point, I want to stop the treatments, but I remind myself how beneficial they have been for me.

ECT is physically demanding the day of the treatments. I’m groggy (I assume from the anesthesia), I have confusion, my jaw hurts badly from the seizure clenching, and my body is overall exhausted. All of these symptoms go away within at least 24 hours. The only lasting effect I have is memory loss. Supposedly, the memory loss for most patients is temporary and only goes back a couple weeks or months at the most. Memories generally comes back shortly after treatment ends. However, my memory loss goes back years. I had even forgotten that my grandmother passed away, so I had to deal with her death all over again. Since I’m still doing monthly treatments, my memory does not improve. The cost is also a difficult aspect to handle, but all of the side effects and aspects are still easier to deal with than many months of a major depression with no relief.

Today was my 33rd treatment. It’s a lot on my body and mind. I don’t know how much longer I can handle these treatments. I know that my psychiatrist and my mother want me to continue with the therapy because they have been mostly successful. They are concerned about what will happen if and when I stop because of the success. This I understand, but I wish they would put themselves in my shoes. I feel that if ECT got rid of my depression and made me stable, then I would be happy to continue. However, I still take 7 different psych medications every day and an additional 2 medications as needed. In addition to all of that, we are going to be adding another psych medication within the next couple weeks. I also have to take 3 other medications for some medical conditions. I hope I get to stop ECT at some point, but I fear that if I do, I will regress to a horrible depression or mania.

IV Ketamine vs Clozaril

IV Ketamine vs Clozaril

I know I need another form of treatment, and my psychiatrist is respectful enough to give me a choice. However, as stated in my last post, making any decision is extremely difficult. This decision feels as if it’s nearly impossible.

At first thought, IV Ketamine terrifies me. I used to get high off of Ketamine, I’m now 11 years sober, but the possibility of dissociation is what scares me the most, it brings back traumatic memories which trigger my PTSD. I’ve already tried Clozaril once and ended up with a fever around 2 weeks. I had no other symptoms and my weekly blood work came back completely normal. Even though Clozaril is a very risky medication, it doesn’t scare me like the IV Ketamine does.

The information I found out about Clozaril after research and talking to my psychiatrist:

  • Giving Lithium with Clozaril can help prevent the low white blood cell count with a 94.5% success rate. I am already on Lithium, so this is beneficial to me.
  • The risks of this drug are increased for me because I’m Ashkenazi, which is Eastern European Jewish heritage.
  • Only 1-2% of patients that take Clozaril develop agranulocytosis, a blood disease that increases the susceptibility to infection. Only 1-5% of patients may have seizures, but that can be avoided by titrating the dose up slowly.
  • Clozaril is 60% effective for patients.
  • I would have to do weekly blood tests for 6 months, then do blood tests every 2 weeks for 6 months. I could then go to blood tests every 4 weeks if there were no problems. Blood tests are required to get medication.
  • From what I understand, my worst case scenario is: I start to get a fever or other symptoms, I call my psychiatrist, he would send me to the hospital where I would get blood work done and they would make sure my fever goes down. Then I stop the medication again and have to try something else. This is what happened last time.

The information I found out about IV Ketamine after research and talking to my psychiatrist:

  • The IV Ketamine trial consists of the first 2 treatments, which are done within 1 week. I would generally start to see some type of result within 24 hours. If I don’t see results after the first 2 treatments it would be considered ineffective for me.
  • This treatment is very effective, and patients don’t have to wait 6 weeks for medication to start working.
  • I would be monitored at all times by a doctor. If I had a panic attack during the infusion, he/she would be able to treat me.
  • I can take something for my anxiety before the treatment to help me stay calm.
  • Some patients experience dissociation during the infusion. Dissociation can cause a lack of control mentally and/or physically. This is the part that is a trigger for me. Just writing about it now is causing a massive anxiety attack.
  • Maintenance treatments are done anywhere from every 3 weeks to every 3 months. Every patient is different.

Now that I have all of this research, I should be able to make a decision, but my indecisiveness is always there. I’m leaning more towards the Clozaril rechallenge. I understand the risks and as long as I immediately tell my psychiatrist about any symptom I have, I should be okay. I know I could get a fever again and it won’t work, but then my options will be narrowed down for me. I also have several reasons not to do the IV Ketamine. First of all, it terrifies me. I’m having an anxiety attack right now just thinking about it, what will happen when it’s time for the actual treatment? It is very expensive and not covered by insurance. The first 2 treatments are $600 each, and every maintenance treatment is $400. The IV Ketamine is also new to me, and new things scare me. I’ve done the Clozaril before so I know what to be on the lookout for.

The only reason I’m considering either is because the psychiatric benefits outweigh the medical risks. Writing this post has helped me realize how scared I am of the IV Ketamine. I don’t think I could handle the treatment. I think my best option is to rechallenge the Clozaril.