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.

This is one of the hard days

Today’s post is going to be a shit sandwich. Fun, good stuff on the outside, crap in the middle.

I found an ancient Ande’s mint today and it was the first one I thought didn’t taste like nostalgia and happiness. It kept chasing me. I think it was haunted. When I disturbed it in it’s tomb, the back of my snack cupboard, I kicked off the minor but tasty curse.

I have a snack cupboard. I chide the kids for having food in their rooms, or for marking their names on food in big back letters, since it’s pretty much “everyone’s” food, unless they bought it themselves. Which in later years, they have. Battles can be lost if you keep the big picture on the War. So this is my bunker.

When we’re at the grocery store and I’m randomly dropping smokehouse almonds, bags of Andes mints, or a package of traditionally flavored Oreos in the cart, those are my treats. Back in the day, the kids would holler for this or that and we’d throw “we have that at home” at them while cackling internally.

When we get home I grab all of my precious snacks and put them up in a high cupboard. Wife is short, and the kids used to be. So it wasn’t a hiding place, it was an inaccessible place. After years though treats pile up, get pushed to the back, and get hidden under containers of Oats that are I-have-no-idea how many years old now.

On the master “To Do” list one of the tasks is “clean out the snack cupboard” and today I found myself confused, standing in the kitchen waiting for a thought or purpose in life to swing back around into my brain. I thought I might as well hit the snack cupboard. The “Everything Bagel” rice crisps and a bunch of other health intended items went right in the trash. All of them were opened with hope and abandoned with a taste that wasn’t hopeful.

I tidied up the snacks that remained, and found one lone Ande’s mint. They’re a weak spot for me, as they taste just like Fanny Farmer mint chocolate combination bars. Just went to find a helpful illustration to steal, and found out Fanny Farmer got bought out by Fanny Mae, and now the perfect treat is associated with student loans. They had a “bar” that was chocolate with a layer of light green chocolate on top, and tasted like Ande’s mints do now. Only 1000 times better. They came in fancy foil wrappings. The Fanny Farmer shops were always bright and clean and full of chocolate. Buying something that wasn’t chocolate was like going to the salad bar instead of taking the all you can eat steak option at Fogo.

My aunt would take us there when we visited her downtown. She was very hip. Called her apartment a “pad” back when that was actually a thing, and tells great stories of the political unrest in Chicago in the late 60’s. In the 70’s she had a variety of jobs while getting hired for her profession here in town. One of the jobs was to hand out chocolate samples at convenience stores. Also, she lived next to a convenience store, so every time we visited her, it was time to load up on the candy and pop! No matter how old that aunt and uncle get, they’ll always be the cool ones. She would buy us one thing at Fanny Farmer, usually, and it felt a bit like the scenes early on in Willy Wonka, with the candy shop.

So now I get Ande’s mints (please sponsor me, Ande’s Mints!) and it remembers me of those times. And they taste good. I ration them out, for the most part. And I don’t often share them. The package sucks though, as you’re pretty much all in once you open it. Invariably one or two sneak out and you have to deal with them later. Well, this one was old. Like, so old it seemed like it would call it’s first apartment a “pad.”

The mint jumped out of the cupboard, onto the counter, and down to the floor. It didn’t fall, it jumped. Like it knew the jig was up and it wanted to escape or just get it over with. As I’m bending down to capture it, the tea boxes on the other side of the cupboard see their opportunity and decide to go for it while my back was turned. I grabbed one of them, but it back up, and another jumped out. I finally contained them and closed the doors solidly, but couldn’t help but feel like something, or someone, was telling me it was time to finish off the little mint. It was the curse!

I ate the mint, and while it wasn’t as sharp as they usually are, it was still a good thing. And I got to check off “clean the snack cupboard” from the task list today. Little victories.

Today is not one of the good days. It’s one of the bad days prophesized by everyone on my care team. I wouldn’t even say it’s interesting enough to be called a “one step back” day, it’s just a hard day. It’s cold outside, though I did get some porch time. It seemed gray out before the sun set an hour too soon, not that I went out to find out. I haven’t slept properly in a couple days, and that’s always bad for the mental health. So I’ve decided not to write anything or give any of my feelings validity today, because of the exhaustion and where they’ll put me, mentally. Then a 250 word post turns into 1500. Oops.

I’ve had a headache, which doesn’t help. I think the last time I was this tired I was in the hospital. We’re changing up my sleep meds and it’s not going well, but “it’s a process” so I’ll suck it up for another night to see if things settle down. I don’t think they will. So today – and this week – feel like writeoffs. But they aren’t.

I am still broken. I feel like I have a broken leg, got my ambulance ride, a cast, and sent home with a pillow. Now it’s the inconvenient state of healing. Only I’m not sure I got any salve? We’re waiting for meds and regimens to kick in, which is the professional depressive’s worst activity. We just get to sit in whatever we have at the time and “use our tools” to deal with situational issues. These are the days when there is no trauma, no drama, and nothing to be able to complain about. “Same” is how you answer when someone asks how you’re doing. I’m not flat, I’m not deep in the hole, but it’s all there, and reminding me that some of us are just a head cold or broken toe away from falling back into the pit. My perspective is still pretty bright though.

It’s the kind of day that you don’t need support. You want support. But you have nothing you need specifically. And to be honest, you really don’t want support, because that involves putting the human face on and being thankful. It’s the kind of day that’s actually boring. You’re not getting worse, you’re not getting better, and the Anxiety and Depression personalities must be taking a day off, because it’s actually a bit lonely without them making noise in the head. They’re there, somewhere. I don’t miss Suicidal Ideation, though I may think of her from time to time, remembering the good times.

But I cleaned out the snack cupboard. And have started and am dedicated to completing one basket of laundry. And I did some cross stitching during program this morning, and played a bit of Animal Crossing as a mindfulness activity. I ate lunch (2+ meals a day, remember, regardless of how you feel) and made a bologna and cheese sandwich. So it’s good to notice the things I got done, and the time I didn’t spend in bed or on the couch. Also, I remembered the awe inspiring, actually spiritually beautiful moon last night.

I guess it wasn’t so much a shit sandwich post, it was more of a cheese sandwich post.

That’s a term from the old days of “weblogs” when people would write a post about having a cheese sandwich for lunch. Isn’t it great that Internet content has evolved to much since 2004?