blogthecat: March 2023

I have tried so many antidepressants that I can’t even remember which drug last sent me into a worse state of mind than when I started it. Whatever it was, its unintended effects had me dragging myself into the doctor’s office a couple of years ago, trying to figure out next steps. Again.

Not even bothering to wipe away tears, I squinted at the computer screen with my GP as she pulled up my chart. A psychiatrist had seen me years ago, and though I never saw her again (I may still be on a waitlist), she sometimes contributed notes about new drugs that might finally relieve my recurrent, and ever more debilitating, anxiety/depression disorder.

Together, my GP and I read the psychiatrist’s guidance:

“If drug X doesn’t work at this dose, do not attempt a different dose. Consider it a failed trial.”

Huh. Another dead end. My GP and I talked a bit more about symptoms, etc. Then she said, “So should we increase the dose then?”

“Of what?” I asked, turning my head slightly toward the glowing computer screen still showing the psychiatrist’s notes.

When she answered, I wasn’t even surprised. I just cocked my head a little more pointedly towards the computer. “I think probably not, right?”

So, we didn’t load me up on still more drug X that day. We could have, but I decided it was likely not the right treatment plan. Over the years, I have always known at least as much as my GP about which drugs are meant to do what things for patients presenting with my symptoms. This is because my GP is not a mental health specialist and has no time to read the latest literature on new treatments. I have made that time because there has been no other option.

I like my GP, by the way. That she is not the right doctor for me is not her fault. She is not a psychologist or psychiatrist, yet our healthcare system forces her into a position where she must try to act like one.

As anyone who has suffered from mental illness knows, there are very few mental health practitioners in Canada who are both accessible (say, within eight months?) and good. This leaves you with this option: Try to keep afloat, wait to find help, and keep your mind open to the zillienth antidepressant prescribed to you in the meantime.

There’s a catch, though. Many people can’t do that. A lot of people are too sick to wait, even for brief amounts of time. Or they have tried too many times to find help, and they’re wearing down, because nothing is working. That was me not too long ago.

For most of my adult life, I fought back against countless episodes of depression, anxiety, and OCD. I could never have done so without the most patient, loving family ever. I battled as quietly as possible, especially because I have kids (that’s a whole other story … the superhuman effort you make to avoid passing on your pain to them) and a career I did not want to jeopardize. Being quiet, masking pain in public, was a choice I felt I had to make. But it came at a cost: so many missed opportunities for connection, and so much unnecessary shame and exhaustion.

Sometimes I felt like a conqueror. I had blissful spells of remission, and you could not find a happier person in the world during those times. The relief you feel when you don’t have to pretend to be okay – because you are actually okay – is overwhelming. You get so much energy back because you can finally do other things than fighting your stupid thoughts all the time. You are yourself – but better, because this version of yourself is so exciting (and relaxing) compared to the other one you know so well.

Unfortunately, in 2021, reprieves of wellness were fewer and farther between. By the end of the year, I couldn’t surface and rebound. The grooves in my brain where depression and incessant worrying had run for so long were getting too deep. I stopped going out, stopped reaching out to my best friends, couldn’t work, and cried all the way through the Christmas holidays, even though my brother’s family had braved the Covid odds and travel hell to get here from California.

Before sinking, though, I had thrown myself into yet another round of intensive research about how to get better. I consulted with my sister-in-law, Nicole, who has always found the time to help me research alternative therapies, and investigated something called ketamine, a psychedelic drug sometimes used recreationally (with serious risk) and frequently used in hospitals as an intravenous anaesthetic. Rarer and more recent is ketamine’s use as a treatment for mental illness.

Nicole’s friend in California had taken ketamine, and still does from time to time, so I reached out to her. Ketamine worked for her in a way nothing else had. It wasn’t a cure, but it lifted her almost immediately out of the very serious place she had gotten to. When she did find herself depressed again, which was less often, she could make her way out more quickly and take a booster of ketamine.

I read and read and read (please see the bottom of this post for some of the materials I consulted – let’s just say this was a tiny fraction of my research and excludes scientific studies). There are risks. Ketamine does not work for everyone. The science is still coming in on how exactly it functions in the brain and whether there are consequences down the line. Johns Hopkins Medicine sums up the way it differs from typical antidepressants like this:

“Esketamine … increases levels of glutamate, the most abundant chemical messenger in the brain. The result? A greater impact [than antidepressants] on more brain cells at one time.”

John Krystal, chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the US, calls ketamine "the anti-medication" medication, and says:

“This is a game changer. With most medications, like valium, the anti-anxiety effect you get only lasts when it is in your system. When the valium goes away, you can get rebound anxiety. When you take ketamine, it triggers reactions in your cortex that enable brain connections to regrow. It’s the reaction to ketamine, not the presence of ketamine in the body that constitutes its effects."

I accepted the risk profile of ketamine (which to me is no worse than that of most antidepressants) because I just couldn’t keep going on the way I was. Anticipating the appointment I had made in November to begin ketamine treatment in the new year provided hope through Christmas, as difficult as that holiday was for me and my family.

My treatment in January 2022 took place in Ottawa at a private practice called Braxia. The protocol was twice a week for the first month (the “acute” phase), then after that every week for a couple of months. Now it’s once every three weeks/month. I feel better the next day after taking it.

I ingest it sublingually (it tastes absolutely awful), though the “gold standard” is to take it intravenously. Ketamine is already terribly expensive in the sublingual form ($250 a pop) and intravenous is a heftier bill than that. It is not covered by OHIP, which makes me sad and angry. There are so many people who could get lifesaving help from ketamine who cannot because they would have to pay out of pocket. In my case, heightened productivity at work offsets the cost of the treatment … many times over.

The experience is always a bit different. I always go into a trance 30–40 minutes after putting the lozenges under my tongue or tucked into my cheeks. The trance wears off in about two hours. A nurse comes in every so often to check my blood pressure and make sure I'm not overly freaked out. When the drug is wearing off, I sit in my recliner chair for a bit before trying to walk. I can't drive for 24 hours; Craig comes to pick me up. I stay off screens for several hours afterwards. I like to take it in the evening so I can work the next day. If I take it in the morning, work is a no-go for the rest of the day – I'm just too spaced out.

Sometimes the experience is intense, sometimes less so. That unpredictability stems in part from taking it sublingually. Intravenous allows for a more precise effect. I have had wonderful times on ketamine, where I enter a world full of brilliant colours and textures and come to realizations I wouldn’t have come to otherwise. Those feel like trippy dreams, and they are more common when I am in a great, relaxed mood before the treatment. I have also had rough experiences where I am fearful and worried that I won’t emerge intact. Both types of experience have produced the same result the next day: a noticeable lift in mood that lasts for weeks.

Ketamine has changed my life. I no longer suffer multiple bouts of illness a year, am so much more present with the kids and my family, have never felt better in my career, have my sense of humour back, and am more connected with my friends than I ever have been (lucky for me because I have the best friends in the world). Sometimes I have dips, but they last for a couple of days rather than weeks at a time, and they are much less vicious than they used to be.

Studies of ketamine have found that it is beneficial for half or more of those with TRD (treatment-resistant depression). It works immediately for those it does help, as opposed to antidepressants which, if they end up working at all, take weeks to take effect.

I could go on and on, but I won’t. I never thought I would write much about this very private topic, especially because the kids are teens and I’m nervous about sharing too much for that reason. I decided to in the end because I am aware of too many people suffering silently right now. Maybe it was the pandemic, maybe it’s the state of the world, but it seems like more people are feeling pulled under.

Sacrificing a bit of my privacy is worth it if it helps anyone who is beginning to lose hope. If antidepressants don’t work for you, there are other options to explore and discuss with your doctor, who may or may not be aware of them. If you don’t have enough energy to do the research and the advocacy, hopefully you can reach out to ask someone who can.

Ketamine is something to investigate. So is electric convulsant therapy (ECT), which got a bad rap in its infancy and in sci-fi/horror movies, but which is much safer, more effective, and less shocking (ha) than many imagine. Neurofeedback is also helping patients suffering from a wide range of disorders, including ADHD and anxiety.

Important to keep in mind with this post: I am not a doctor (though we joke in my family that I am because of how much medical research I sometimes do). I have no idea if ketamine would be right for you or anyone you are worried about. It’s not a “first-line” treatment for depression, but rather an option if nothing else is working. The reason I wrote this post is that there needs to be more awareness in Canada of new treatments that have been proven to dramatically improve the quality of people’s lives – or even to save lives.

If any of this is interesting or relevant, the next step is to research lots and lots and have your questions answered by a reputable practitioner. I can only speak for myself.

Most of all, I want you to know that if you are suffering, or watching a loved one suffer, there is still hope. Antidepressants are not the only option. If they don’t work for you, don’t give up.

The picture is of the sign that greeted me, along with fairy lights in our bedroom, when I returned from my first treatment. I know.