Hi friends, it has been ages since I’ve posted, huh? Life has been busy and I admit I’ve been neglecting my blog.
I started working at a domestic violence shelter and crisis line. I’ve continued offering yoga classes for trauma survivors. And, I’ve been completing my first section of advanced practicum. It has been an incredible experience offering psychotherapy for a really wonderful private wellness practice. Oh, and I was completing my research seminar (so I had to write an approximately 30 page paper; admittedly, I ended up just writing the paper the day before and day of it being due).
In terms of mental health, I’ve continued to struggle with my depression (or bipolar depression if we go by the results of my psych evaluation which said Bipolar II, panic disorder, GAD, and PTSD). I have been on basically all the things, except MAOIs. I’ve been consistent in my therapy, even after J dumped me as a client and then ghosted me, refusing to offer any solace or appropriate closure. I really, really think I found a good therapist in KK. I’ve switched psychiatrists. And, this is where the topic of this blog comes into play. I started Spravato.
If you don’t know what Spravato is, it is a new treatment for treatment resistant depression. It is a derivative of ketamine. It is called Esketamine. Without overcomplicating things, it is like if you were to split Ketamine in half (probably an oversimplification). It still has some of the effects as Ketamine (yes, party drug and anesthesia): dissociation, sedation, hallucinations, increased BP, dizziness, etc. I assume the effects are just milder. Honestly, given my experience so far, I’ve not had much of what anyone else has described on the drug.
I’ve had 2 appointments. At each appointment, I am given a nasal spray. It is this fancy contraption that has really specific dosages for each nostril. You tilt your head back, insert the contraption, push to release the medication, then do the other side. You wait 5 minutes and do this with a second of these contraptions. Sometimes the medication goes down the back of the throat and it kind of burns, sort of like that feeling when you accidentally breathe chlorine water in through the nose. The office provides hard candies to mask that a bit. After administration the patient is required to stay for a 2 hour observation period. At the 40 minute mark blood pressure is taken. Mine has only ever been slightly elevated (117/68 to 127/76). My experience sort of diverges from others’ experiences after the administration phase.
In my first appointment, I only experienced a mild brain fog. I take a migraine medication that’s a barbiturate and an opiate; the brain fog of the Spravato was comparable to how it feels to be on my migraine meds. I had one really mild hallucination while talking to the intern who sat with me. I was making eye contact while she talked and her mask started to morph into a giant grin. Weird but not unsettling. It only lasted for a split second. Mostly, my brain just felt a tiny bit slower. I didn’t experience any of the sedation or dissociation that my psychiatrist expected. The 2 hour observation period and the requirement to have someone drive me home afterward seemed pretty arbitrary. As I felt 100% normal after about 20-30 minutes.
The night and days after that first treatment were Hell. I couldn’t sleep at all that night. I would close my eyes and have horrific intrusive thoughts of all the ways I could die. I felt this deep existential ache. The worst part was that I still had the depression but I also had apathy to keep it company. If I had been hit by a bus, meh, whatever. My therapist was deeply concerned when she say me for my session the next day. She has remained on-call since I started these treatments. The day after my first treatment, I was meant to have a day full of practicum clients but my supervisor was like, “nope, we will reschedule them all.” Because I felt worse. I was just weeping for no reason. And I still couldn’t sleep. I didn’t get a solid night’s rest until Thursday night (my appt was Wednesday, early afternoon).
Despite being worried that Spravato would actually make me worse, I went back for my second dose on Friday. I told my psychiatrist about the inability to sleep and the increase in intrusive thoughts and apathy. She prescribed me a sleep medication and we went forward with the second administration. This time I had even less effects in the moment. I felt 100% normal the whole time. I even attended a work meeting via Zoom. And, then I saw two clients half an hour after I was allowed to leave. Those were actually some of my best sessions with clients, I think. My supervisor posits that this is because the Spravato got me out of my head and allowed me to connect more deeply on a relational level with clients.
The days after this second treatment haven’t been nearly as awful as the days after the first. Being able to sleep helped. And, also, I think it helped that I saw clients right after. It was good, having something to keep my brain engaged. I’ve slipped in and out of the deep, existential ache over the last several days. And, I’ve made some not entirely wise decisions (nothing horribly self-destructive). But, overall, at this point I am not a fan girl of Spravato.
My psychiatrist said that I would be the first of her patients to not get better on the treatment. Maybe that will be the case. Or, maybe it will just take me longer. At least the aftereffects seem to improve each time. Eventually, she will be increasing my dose, so I take 3 of the contraptions instead of 2. I have some anxiety about what that could do; however, I’m feeling confident that I have the ability to get through whatever it does to me.