That’s probably the best description of how I feel.

The ECT has me confused, hard to follow a train of thought, and scattered. Today I don’t feel like I can do anything. Anything electronic has me drifting off within minutes. My phone, which is normally like an extra limb, is confusing. I’m having trouble finding icons, remembering how to start applications, and forgetting why I was going to use it in the first place.

I have a credit card expiring this month so I have nearly a dozen accounts I need to update the new credit card info — I honestly don’t know how I am going to be able to do that.

No appetite, haven’t slept the past few nights, and I’m exhausted. Headache but can’t take any pain meds this close to the anesthesia.

So here I sit in the darkening afternoon light, waiting for something to happen. Dreading something to happen, given my low energy and motivation. Tomorrow I have an appointment with my psychiatrist, a ketamine injection, and an initial consult with a neurosurgeon about implanting the VNS device.

I’ve been in some difficult spots in the past, but this feels like something completely different. Everything seems foreign. Difficult. Someone else’s life. It really makes me wonder how I’m going to survive this.

Bottoming Out

This week has been one of the toughest. Ever.

First, the MAOI – the patch isn’t really helping, so we’re likely going to go over to the oral form, which includes the dietary limitations. This includes items with high tyramine. No, I hadn’t heard of it before either. Things included on the no fly list:

  • Aged, cured, pickled, or smoked meats (such as chorizo, sausage, corned beef, salami, and pepperoni)
  • Pickled or smoked fish
  • Some aged and matured cheese (such as cheddar, gouda, and parmesan)
  • Fermented soybean products (such as miso, tofu, soybean curd, and tempeh)
  • Fermented or pickled foods (such as sauerkraut, kimchi, caviar, pickles, and kombucha)
  • Fermented bread, like sourdough
  • Breads with aged cheeses and processed meats
  • Tap beer
  • Any food that has gone bad, or is overripe

With the exception of the last item, this is a list of some of the foods I love the most. It reads a bit like a shopping list.

I have begun ECT (electroconvulsive therapy) again. Three days a week. Monday was only at 30% and it was hard to handle for the rest of the day. Tuesday was ketamine, so I was trashed after that afternoon visit. And Wednesday was at 60% (we’ll end up at 100% eventually) and I felt every bit of it afterward. My memory went from goldfish level to rock. Thoughts that used to come to me long enough to note them or take them on are now fleeting. Leaving me with a feeling of loss, confusion, concern that it was important, and sadness. I’m confused about things I thought were second nature. I can’t remember which pocket I usually use to keep my phone. My appetite has gone completely south, nothing sounds good and more often than not tasted like cardboard once I try it. And a deep sadness has settled in, knowing I’m not at full strength and I have weeks of this to go.

The ECT process is the same as before, with the exception of the waiting. Last time they had a tiny waiting room (10 chairs?) that had to fit the patients in line, plus their family or friend helper. It was fairly loud, though part of that was the 24×7 home improvement shows. Wife hated Mondays because that’s when the new batch came in, and you could feel the anxiety rolling off of them in waves. I just remember feeling like I was with my people. Now the waiting area is down by the TMS area, and there is a nice huge waiting area with comfy couches. The old waiting room as turned into the “wake up” room where they wheel you after you’re awake but before you have any idea who, where, or what you are. And we still get mini blueberry muffins and juice. Which is nice. So the whole process is easier, more comfortable, and well done. Also, there is still the pre-procedure interview to check that you haven’t taken certain meds, take your vitals, and do a quick check in on your mental state. In the old waiting room you would do this in front of the whole crowd, including the “are you safe” questions. Now they have a proper exam room and it feels more professional.

On the mixed bag side: The external review for my VNS (vagus nerve stimulator) has finally approved it, and things are now moving. Have an appointment next week for the surgical consultation with a neurosurgeon, and it sounds like COVID hasn’t gotten in the way of operations at the University, where this will be done.

Again, the VNS has a surgery to implant a little box the size of a matchbox just below my clavicle. They’ll also attach a wire to my Vagus Nerve. After two or a few weeks of healing, I’ll go back to my doc at the treatment resistant depression clinic. He will activate the device and program it for my introduction. An example would be every five minutes the box sends a 30 second impulse to the Vagus Nerve. Forever. No immediate results, it could take weeks if I’m lucky, but more likely months or a year to see benefit. So the VNS update is good news but intimidating and scary.

After much discussion, we have moved the consultation with the Mayo clinic out a month. Not sure if I mentioned it before, but I wanted a different perspective, with their unique patient engagement. Also, my grandfather was a (chief) neurosurgeon there, and my mother was Nurse Ratched the head nurse of the locked psych ware there in the 50’s. (I’m sure she was very nice and not sadistic.) But given the way ECT has done a number on me this week we’re going to wait until I’m a bit more lucid.

It’s a turmoil of therapies and appointments right now. If we keep it up, it’s going to suck. If we stop it’ll suck and I won’t have a method for improvement. But it’s hard nonetheless, and Wife and I are both feeling the strain.

I know the ECT will stabilize, and everything is going as planned. But yesterday I began questioning whether I was actually going to survive this major depressive episode. And that I’m not in control at all. Those are unsettling thoughts. (Yes, I’m safe, and I’m well supported)

Back to ECT

A week from Monday I will be restarting electroconvulsive therapy, or ECT.

It’ll be unilateral this time, which is supposed to keep memory loss lower. That’s how we started last time but went to bilateral because it just wasn’t working. Unilateral means just on one side of the head, bilateral is both sides, which is more effective. I’m not ruling out the possibility that we’ll go to bilateral again.

I’m still processing the reality of it, but this time around it’s got me thinking about what I’m going into. I’m wondering if these moments or days will be erased. Will I lose this month of my daughter being home from college? How will this affect my existing memory issues? How will COVID affect there whole process?

We’re running out of things to try, and this seemed to work a bit last time, so here we are. I’ve recently stopped caring, so I’m just going along with my care team’s recommendations. Not caring actually makes everything a little easier, but certainly not better. I think I swore I wouldn’t go back to ECT, but those were different days.

I will be making an effort to blog more during this series.

Lost in my happy place, but not in a good way

COVID. Yay. Always something new and horrible happening with the pandemic. This is a short (I think I’m lying about “short”) piece about my experience getting a booster, and how my cognitive, memory, and physical stuff got in the way.

I needed the booster shot, and spent a bit of time looking for a location that could do it soon, not in a month. I found that the state (I think?) had a vaccine and testing site set up at a really big mall near us. Got a same day appointment and headed out.

Now, this is a mall I have spent many years shopping, or rather wandering, and it’s a guilty pleasure to just wanted in the plastic and stone environment. I like to people watch, see what stores are new, see how the mall evolves over time. It’s been around for many decades, and like any other mall it goes through different renovations that change it in interesting ways, but always remains the same underneath.

Because of my experience there I know it like the back of my hand. Where certain shops are, which “moods” the different parts of the mall exhibit, and what’s the best way to get from point A to point B, even during black Friday level crowds. I even know the secret Easter eggs hidden here and there, and how much of the behind the scenes logistics work. I always know how I’m oriented in the mall, and which way it north, etc.

But on that day, it all went a bit sideways. I waited the requisite 15 or 30 minutes after the shot, can’t remember how long it was. Didn’t feel off in any way and thought I’d get a coffee and go through the mall for some winter exercise and maybe even holiday shopping.

Right away the sheer volume of stimulation got to me. My vertigo kicked in as expected, and I felt light headed, dizzy, panicky, etc. Just your standard anxiety attack. Not a panic attack, but a good dose of anxiety and fight or flight. It was bad enough that I was going over scenarios in my head if I fell or passed out. Could I sneak out without drawing attention, or would someone call 911 and complicate things? I get tired quickly, and that wasn’t helping. But the thing that kicked me hard in the stomach was that I was getting lost. I would occasionally have the “wait, where am I and how did I get here?” or the “Ok, I don’t think I’ve ever been here before” feelings, knowing full well that before the latest episode(s) I could have navigated in my sleep. I got “actual lost” and had to use a directory, but even after looking things up I was frustrated by not remembering the things along the journey. This used to be my happy place, somewhere to walk and clear my mind while getting my commercial marketing fix. But all I wanted to do was get my coffee and get out of there.

Less upsetting: One of my secret tricks is that the Big & Nicely furnished corporate bookstore has a Starbucks branded coffee shop. But you can pay for your books there, and it often has a much shorter line than the serpentine lines at the main store cashiers. While waiting for my coffee I saw two seemingly normal ladies chatting, not quietly. But they weren’t talking about boring suburban things, they were going on and on about the illuminati, and some other pretty deep conspiracy theories. I guess you never know by looking.

By the time I got to the car I was pretty shaken up. I didn’t cry, because I apparently can’t, but felt on the verge of a bit of a breakdown. I texted my sister something innocuous but maybe indicating I could use a pep talk. I can’t remember what it was, but she called me right away as I sat in my car in the parking ramp. I talked about the experience and how it bothered me, but mostly we just chatted. That always helps.

And I did have a “booster hangover” but it mixed in with all of the other crap I have going on, so it wasn’t too terrible the next day.

More Ketamine Experiences

I struggle with knowing how much to share and how much to keep to myself when it comes to the ketamine “trips.” I don’t want to sound like someone babbling about their acid trips or some burned out drug fiend. I understand that it’s very difficult to describe these things, and to the reader it sounds like disjointed, confusing, odd stuff. But I do want to share some of those things, regardless.

I am continuing a weekly ketamine session, and they go pretty much as expected. Blood Pressure, then an injection. Within a very few minutes I am feeling it and disassociate sometimes as expected and sometimes more intensely.

I wrote previously about the first really, *really*, intense session, in which I felt as though I was in an infinite loop. Nothing else, no universe, no me, no space, just that loop. When I am there I am overwhelmed but the simplicity of it brings me comfort, and any anxiety I get is from knowing I’ll come out of it, that it won’t last forever.

In the chair, in reality, apparently I am experiencing different emotions. I have had sessions where I have sworn, sometimes loudly, often with an air of being upset about what is happening “in there.” The other week I manifested a bit more physically, twisting around in the chair and looking extremely uncomfortable. I was given an ice pack to ground myself, and I threw it against the window. They put a weighted blanket on me to ground me, and it just ended up pissing me off. What I remember is that it was complicating things, pulling me out of the simplicity, and that was upsetting me.

From the look of concern on Wife’s face when I came back out of it, I’m guessing it was pretty scary. I trust her completely, but felt like they weren’t totally telling me how bad it was. When talking later with her, she was relieved to hear that the experience I had inside did not match what they were seeing. Next time I want video. 🙂

My therapist had a bit more concerning thought – and that was if I acted up too much, it’s possible I would need to be restrained, and that would be pretty traumatizing. This has been a bit of fun and amusing to hear about my acting up, but realizing it could get me strapped down or worse – checked into inpatient – bothers me a bit.

The intensity could be a from a variety of things. First, I have been fasting before appointments, as that is the recommendation typically for Ketamine therapies. Much like some rTMS providers put you in a soft helmet for rTMS, others simply have a unit placed on the forehead. Yes, the fasting is taking advice from the Internet. I know how wise that is or isn’t.

I am also recently on a higher dose by 30 or 50 percent, can’t remember – but it’s a bit of a jump. So that could have something to do with it. But oddly enough it started ramping up when I *stopped* listening to music. I’ve been doing Gorecki’s 3rd for so long that I knew where I was in the hour based on the musical movement. It also felt like it guided me in the same path every time. One week I forgot my earbuds and went without music at all. The difference was quick and strong. I remember the texture of my jeans standing out and beginning a beautiful journey through tans and yellows before dropping me deep in the disassociation. So I think I prefer without music at this point.

The other interesting thing that’s happened a couple times now are the ketamine tears. Sometimes I know when it’s happening, sometimes I know it happened when I “come back” because I can feel it in my eyes. It’s not crying, it’s just as if my eyes fill with tears. When I’ve known it was happening it didn’t seem like weeping, but more of an intense sadness that almost breaks the surface tension of tears but never quite gets there. And as usual it makes me wonder what’s really happening during my sessions. Interesting more than upsetting.


I will preface this with the fact that this is a catch up post, and the latest “real” post is coming next.

Started the emsam patch, an MAOI. It does not have the usual dietary restrictions, but any higher dose they switch me to will have them. It reads like my grocery list of favorite foods. No ill effect from the patches so far. Sometimes they leave a red mark, and I change locations enough that it doesn’t get too bad. I was working on a series of red blotches from one bicep to the other, across my chest. Didn’t quite get there. On ketamine days I usually go “iron man” style with the patch right in the middle of my upper chest area.

I am back to full strength on my sleep med, and the vertigo has returned with some additional random dizziness. But I’m getting to sleep eventually. Forgot to take my night meds one night and was wide awake until near-dawn. That was a hard day.

Therapist says I need to buy in. believe, and try. Fight, even. And I understand that. But to be honest I gave up caring a couple weeks back. This is me forever and I can’t find the physical strength to fight it. I’m just like a weed in a stream, totally letting the current shape me.

I have finished the intensive outpatient program, and finished with complete therapy burnout. So now my structure is much less, which means I have to come up with my own routine and somehow gather the self discipline to stick to it. I think we all know that’s not going to happen easily or soon. But I’ll try.

Talking about everything with family, friends and therapist feels good but usually sends me deeper. The more I talk about the depression or focus on it, the more I feel it. It does feel like not talking about it and just doing a hobby is avoiding the issue, but sometimes I think I need that.

Finally, every moment of the day in my head I am saying “I’m sorry I’m sorry I’m sorry” to everyone and everything. I feel guilty for making Wife go through this with me, as well as my whole family and network of friends. I feel like I am a sinkhole of emotion and resources.

MAOI you’re talking!*

Rather than 50,000 words, I’m going with a summary before the content:

  • Still feel broken, like crap. Slow and thick in the mind and body
  • Getting the booster vaccine today, so tomorrow might suck
  • IOP is frustrating me with it’s endless clichés and soothing voices
  • I have that sadness in my chest that makes it hard to take a full breath
  • Anxiety is floating around back there somewhere but depression has a great seat in the bus. SI is still sulking in the back, but she keeps winking at me.

It’s not all bad though.

  • I’m trying quite hard
  • Also putting a lot of time into my freelancing, but with little traction
  • No interesting updates on the VNS insurance coverage. Rejections followed by appeals
  • Ever pressing onward
  • Ketamine is still weekly, still trying to find that place that itches that spot in my brain and makes me existentially frightened and satisfied at the same time

But the real point of this post is the new med I’m beginning. I’m starting my Emsam patches Friday. It’s an MAOI and new acronym to add to the list.

No, not those.
No, not those.

Monoamine oxidase inhibitors (MAOIs) and reversible monoamine oxidase inhibitors (RIMAs) are a type of antidepressant drugs given for the treatment of depression. They are good at treating atypical depression, Parkinson’s disease, anxiety disorders, social phobia and have also shown to help people to stop smoking tobacco.

As MAOIs drugs can be fatal if someone takes too much, they are usually only ever given when other antidepressant drugs have failed. Some newer drugs such as selegiline and moclobemide have proven to be safer than the older MAOIs and are prescribed by physicians in the first instance.

-From Simple English Wikipedia

Because it’s a patch and a low dose, I don’t have to follow the dietary restrictions. Yet. They read like a menu of my favorite foods. I also had to flush the Prozac from my system for five weeks, so it’s been quite a while since anything changed or inspired me for a solution.

There is also a long list of potentially strong side effects. Some, most, or none of them may apply. But that makes me a bit nervous and excited to be trying an old school, powerful hammer of a drug. Maybe this one will make a difference. It makes me feel giddy like I’m on a scary rollercoaster. But this time it’s fun instead of horrifying.

With my booster and it’s potential after effects, plus Ketamine on Friday, and adjusting to the MAOI – it could make for an interesting weekend.

In the meantime I’ll be watching Moulin Rouge, and by the time I get to El Tango De Roxanne, things will be just that little bit better.

* I just found out there is an online encyclopedia for puns. Oh my.

Therapist Homework, again.

Another wonderful prompt from my therapist. I really need to post all of them.

What is the biggest lie that you consistently tell yourself?  Why do you continue to do this?

My depression is the lying.

I tell myself that my depression isn’t real.
It’s laziness.
It’s wanting attention, and it’s drama.
I can just pick myself up at any time and become a real person again.
Do some laundry, work, walk, love my family.
Get over it.
I haven’t been able to do anything successfully in life, I hide behind this fiction that is depression.
I am so good at lying about how I feel.
I know all the right things to say to convince those around me that I have a mental illness.
People who really have depression are weak and boring.
But mine is special somehow, because I’m acting it out.
It’s not real.
It’s the ultimate theater, and sooner or later they’ll find out.
My suicide attempt was simply attention seeking.
If I really meant to do it I would have.
So here I am enjoying the life of Riley pretending to be sick.
I am no different than I was in grade school trying to stay home from school.
I am no different than I was in grade school.
Lazy, dirty, gross, and unmotivated.

I tell myself that my depression is real.
It’s a medical condition.
Nobody understand’s what I don’t want, but need.
I try time and time again to pick myself up, but the depression makes me fail.
Get a todo list, schedule stuff, plan ahead.
Accept it.
The depression has been hindering me all my life, the history is there, it’s real.
I am so good at lying about how I feel.
I know all the right things to say to convince those around me that I’m safe, stable.
People who don’t have depression don’t understand.
Mine is special, because it hasn’t been successfully treated.
It’s not my fault.
It’s everything in me through and through, and they’ll never figure it out.
I took the pills so easily, there was no hesitation.
I was frustrated only because it didn’t work.
So here I am working my ass off to stabilize and have quality of life.
I am no different than all the years behind me, it’s always been there.
I am no different than I was before.
Tired, ashamed, exhausted and weak.

I continue to do this because I believe both lies.