Apathy

At this stage I'm experiencing a greater problem: that of near complete apathy. I can't feel anything but numbness and sadness 24/7. I care less and less about everything. I'm outside looking in. It's so disturbing.

The Lithium was a big disappointment. I was prescribed the highest dose that didn't cross the toxicity threshold. It did no good, in fact, it caused a noticeable increase in fatigue which was something I had no shortage of to begin with. The decision to discontinue was a let down because I liked the idea of taking something that was a naturally occurring element in the body and initially didn't have any adverse side effects or withdrawals. Even though it required regular blood draws for monitoring, I could deal with it.

Next I was given something called Fetzima. Never heard of it. Didn't really matter. She gave me another brown paper bag with a month's worth of samples as she commented that I would be her guinea pig with this one because she'd never given it to anyone before. After a month, it did nothing. No effect whatsoever. In fact it affected my urinary system with prostate-like problem symptoms. Those symptoms stopped immediately when it was discontinued. The doctor was perplexed but seeing as she's given it to very few patients she didn't have a whole lot of experience to comment on it. She brought up ECT again as an option but I just shook my head. I simply can't deal with taking that on. I fear irreversible damage. At least with a pill, I can stop.

Next up, Aplenzin. It sounded so familiar to me but I couldn't remember if I'd tried it or not. I told her it's possible I already took it. She said regardless, she'd like me to take it WITH the Lexapro that's been a constant for quite a while. After checking my list, sure enough, it was there. Seems new ideas are in short supply. I'll jump through this hoop and see what happens. This is what it's been, this is what it might always be.

In Sickness and in Health

The Brintellix was miserable. Either the side effects of it or the withdrawal from the Lexapro or a combination of both caused sleeplessness, hightened anxiety and shortness of breath so I immediately abandoned it and went back to the Lexapro. I used to be able to power through the side effects of a new drug but I'm weaker now and can't weather it as easily. My "pdoc" suggested Lithium. I tried it several years ago prescribed from a different doctor. That doctor paired it with another drug called Lamictal. Lamictal can cause a side effect of a skin rash that can become quite dangerous if not caught in time. As luck would have it, I noticed early signs of some kind of skin change on the sides of my torso. When I showed him he didn't want to take any chances so both the Lithium and Lamictal were stopped and we went on to something else. I never learned if Lithium may have been of any help. So now I've told my current doctor that I'm not opposed to trying it again by itself. I'm finding it so hard to care.

Things are progressively getting worse in ways that leave me feeling utterly powerless. This depression is like a slow, creeping fog that permeates every nook, cranny, crevice, gap and aspect of my life. I've written a couple of times in this blog that my situation has affected my marriage. It's becoming serious now as my wife is requesting counseling for us.

We recently went on a family vacation that I tried to enjoy as best I could but my inability to do so ultimately caused several instances of unrest and tension. What should have been a relaxing, memorable getaway degraded into frazzled nerves and resentment several times. Mostly my fault. I have a low irritability threshold that rears its ugly head at all the wrong times and wrong places. Vacations are very important to my wife. For this most recent one to be a bad memory has me feeling guilty and insensitive. Since returning back to our daily routine, we have not been getting along. I blame her, she blames me. Stalemate.

I spoke to my counselor about possibly seeing us both to discuss our marital problems but she wants to speak to my wife alone first. We saw a counselor a few years ago but he bluntly told us that I need to get myself together first before the marriage can be addressed. My wife did not like him. We saw him twice and that was that.

I'm the first to admit that I'm terrible with communication. I've not really had too many friends in my life. I have a younger brother who's the polar opposite of me. We had a falling out a hundred years ago that was completely my fault. We patched things up long ago but many years were lost. It was the biggest mistake of my life.

I struggle with the spoken word. I'm better with writing things down so I can give some thought to prevent foot in mouth syndrome which I experience often. Lack of communication has been the weakest link in the marriage. I'm self absorbed by self pity. My focus is strained. Concentration is lost. It compounds all the problems and bleeds over into the marriage. I don't know how the marriage can be repaired when I can barely keep myself afloat. I have to muster the energy to keep everything together but things couldn't be more daunting right now. One day at a time I suppose.

"I've Not Seen This"

As promised, I made good on a follow-up visit to my psychiatrist post Ketamine infusion for the first time in two years. She had moved her practice to a new building and had a new staff. Not the friendliest bunch but I've found that to be the norm with these doctors.

I reported to her that the Ketamine was very disappointing. She hadn't worked with it at all so couldn't really comment on it too much. I'm the only patient she had that's tried it. I then bluntly asked her if it's possible I'm really not clinically depressed because of a chemical imbalance since no chemicals have yet to correct the situation. Is this just how I am? She replied absolutely not. This isn't normal and it can't be traced to a character flaw. There has to be a medication that will help. The obvious reply from me was.....(sigh).....what's new out there that may hold promise? She listed a couple drugs I'd never heard of. I told her what I was currently taking (Lexapro) and the dosage. She asked if it was helping and I said it has a numbing effect at best but doesn't really lift the depression to any degree. She then asked why I was taking it if it really wasn't helping. I reiterated how the numbing properties took a slight edge off the depression and anxiety and Lexapro has the least amount of side effects for me. I basically just settled on it as the best of the worst.

She asked if I'd had any recent blood work done. I had had a physical a couple years previous and the blood work was normal. Several years before I went to my regular doctor to have specific blood work done to possibly pinpoint a medical problem causing the depression like thyroid or hormone levels that might be off kilter but everything was fine. Regardless, she wanted to see blood work so wrote up a referral to a lab.

I brought up the issue of having shortness of breath which I've been experiencing for about 3-4 years now. I thought it was related to my sleep apnea but several doctors said no, that's not how the body works. I'm physically very healthy so I can't imagine that it's a medical issue so I dismissed it as a symptom of anxiety. She asked how often I experience it. I told her it's constant. She said that can't be from anxiety. It wouldn't be constant. Shortness of breath from anxiety is intermittent, not constant. She highly recommended I get it checked by my doctor.

Next, she said I should try something called Brintellix. I don't really know what it is but it works on things in the brain that Lexapro doesn't. Side effects are minimal.

I really didn't care. I just agreed to try it.

She had free samples and a brochure. Like all other drugs, Brintellix had a slick campaign complete with a fancy logo, tagline and eye catching graphics. The plan was to wean off the Lexapro and start the new drug. I asked if this one doesn't work, then what....knowing exactly what her answer would be. On to the next one.

At one point during the conversation she said, "I've not seen this" referring to my treatment resistance. Again she repeated, "I've not seen this." She had said something similar a few years earlier that I documented in this blog. I was hands down her most challenging case but I didn't detect that she was eager to meet the challenge. Though I like her, she exudes a quasi-exasperation with me. She's stumped and not proud of it. Neither am I to say the least.

I took the little brown bag with the samples and left the office feeling worse than when I had arrived. Deflated. Defeated. Numb. Exhausted. Indifferent.

More pills.

The next day I went online to research the drug a bit. I found a testimonial page that I skimmed over. Many raved about this medication, others panned it. I no longer hold stock in anyone's opinion any more. Only I can find out for myself because everyone's different. I admittedly have a terrible attitude towards these meds. I "know" this one will fail like the others. I realize I sabotage myself with that thinking but that's my harsh reality. I could try to view it positively but I really don't have the ability to candy coat it. This drug will either work or it won't and then on to the next one.

Ketamine IV

Deeply disappointed in the previous day's lack of results, I begrudgingly went back to the hospital the next day for one last blood draw and MRI scan. This time at 8:00am. Traffic was tougher and more irritating at that hour but I expected that. This time I could drive myself.

Upon arrival, one of the assistants met me in the lobby and took me back to the MRI room. The other assistant was there with another patient from a different study. He was noticeably hesitant about having an MRI. He muttered something about "if" he can stay in there for an hour. I wanted to tell him it was a breeze and to just try and doze off but I chose to be silent.

Another nurse I had not met before arrived to take my blood. We went to the other side of the room out of view of the hesitant patient. While my blood was being taken, I could hear what sounded like goodbyes so apparently the poor guy was too spooked to proceed into the MRI tube so my place in line advanced to now.

It was now 24 hours since the administering of Ketamine and still no signs of improvement. I didn't sleep well the night before. I was taken aback by the absolute nothingness this drug displayed. Not even a lone side effect. Not what I expected. I was within the 72 hour window of possibly noticing a change so I latched onto that—loosely.

After the MRI, one more question and answer session. She said she was sorry there were no positive results. Of course there was no guarantee and there were disclaimers aplenty stating it would possibly not work at all. I asked her if I could participate in future Ketamine studies with the thought that maybe the dosage was too low, or too brief. She couldn't give me that info as she was not a doctor and had no way of knowing. I did hear that the doctors were approved to do a study of "serial" Ketamine infusions which means a series of multiple injections as opposed to the single one I experienced.

My fear that it wouldn't work came to fruition. Maybe it was a self fulfilling prophecy. Maybe I willed it away with my negative expectations or maybe the drug simply didn't fulfill its promise. I'll never know. Yet again, I shook someone's hand for the last time, thanked her for her time, told her it was nice meeting her as we parted in opposite directions.

I hadn't had breakfast or coffee yet so I thought I'd venture into the cafeteria to grab a bite. After purchasing my items I found an outside dining area adjacent to the cafeteria. The building's A/C gave me a chill so I found a table in a sunny spot. As I nursed my coffee, the realization of another failed treatment gripped me. I really didn't want my hopes too high for this one but I couldn't help it based on all the fuss around this "breakthrough." I simply couldn't believe that yet another medication couldn't make the slightest dent. At the very least I was hopeful to experience just a small taste of relief. Just a slight glimpse. A tiny morsel of happy. How could this possibly keep happening? I wanted to cry but I couldn't. I didn't want to go back home. I didn't want to stay there. I was lost in numbness.

I pondered the thought that I was possibly NOT clinically depressed, that there was NO chemical imbalance that was the cause. If there was a chemical problem, why wouldn't all the chemicals I've been prescribed change things for the better even remotely? Maybe this was just who I am. and what I've become. It's just the fiber I'm made of.

The weather was clear, warm and breezy. I did take note of what a beautiful day it was.

Into the "K-hole"

On the day of the infusion, my wife and I arose around 4:00am in order to get ready to make the trek to the hospital by 6. Luckily traffic wasn't too heavy at that hour so we arrived on time.

We met with one of the assistants who escorted us to an admittance office to fill out more paper work. After that, we made our way to a hospital room where we would spend most of the day. The room was very nice. Large and comfortable with a window overlooking the city from the 6th floor. A flatscreen TV faced the bed and broadcast serene landscape scenes accompanied by relaxing music.

We were introduced to the head nurse who would be one of three that would be overseeing the procedure. I was quickly weighed and asked to lie on the bed. Shortly thereafter, the other two nurses appeared with some equipment and the Ketamine dosage. It was in what looked like a large, transparent syringe minus the needle. I later learned it was called a barrel. The actual appearance of Ketamine could have been water, vodka, rubbing alcohol or any other number of unassuming, clear liquids. It would be diluted with saline which looked exactly the same. I'm not sure of the exact dosage.

The head nurse set up the central line where the drug would enter my system. The other nurses attached  heart electrodes and a blood pressure collar so my vitals would be closely monitored.

Things began happening fast. The doctor I had the initial consult with popped in wearing a very official looking white lab coat. After I introduced him to my wife he began explaining what I was in for and made sure everything was correctly set up. The barrel was loaded onto the IV drip along with the saline. I later told my wife I felt as though I looked like a sick patient all wired in a hospital bed.

The drip was started as the nurses noted the time and recorded it in their paperwork. It would be about a 30-40 minute process. About 7-10 minutes in, I could start to feel its effects. At first a slight dizzy feeling like any other drug. As time went on it began to intensify. Things moved more slowly. I became disoriented. There was no euphoric feeling or mood lift. I was asked how I felt and I simply said I felt drugged. That was the best way to describe it. I could hear the music from the TV and intermittently saw colorful fields of wildflowers, waterfalls, mountain scapes, rivers and creeks on the screen. The relaxing music competed with the voices of everyone in the room. Sounds and images became compartmentalized. Music from the TV remote at my feet on the bed; the nurses at my left, the doctor at my right, my wife at far left. I strived to pay attention to what was being said. I didn't want to appear drunken or slurred. At one point I asked my wife how I sounded and she reassured me I sounded normal.

As the infusion continued I felt the need to catch my breath a few times. Things became dream-like although there was no euphoria or "high." I simply felt intoxicated, drugged. I had the realization that I was the center of attention as three nurses, a doctor and my wife all stood around the bed talking to each other and observing me but also felt slightly removed as if I was the observer. Two or three times the doctor quizzed me to check my overall mental alertness asking where are you? What day is it? Wiggle your toes. Wiggle your thumb, etc. Before the infusion ended, the doctor, satisfied with my "rock solid" vitals, said his goodbyes to everyone. I thanked him wondering if I'd see him again.

There were no feelings of joy or happiness. No overwhelming relief or hope. Slowly the initial effects began to wear off. I felt more coherent and lucid with just some residual dizziness. That was it. The infusion was complete. The show was over. Both the doctor and the paperwork stated that I could possibly feel the "peak" effects within 24-72 hours after the infusion. I rested my hopes on that.

Next, the assistant returned to check on me and ask follow up questions. These were questions I've answered before and would answer after every test. Unfortunately, I couldn't report any improvement.

From then on it was lots of waiting in the room as I was scheduled for a blood draw and another MRI later in the day. An hour or two after all the action, it was quiet in the room with the same zen-like music coming from the speaker. Disappointment settled in. There were so many reports and testimonials of people feeling relief within hours. After the initial "trip" into the K-hole, as its referred to,  I returned to the exact same place I started. Not even the slightest side effect.

As mid day approached, my wife went downstairs to the cafeteria to bring back some lunch paid for by the study. I sat on a couch by the window gazing at the buildings and people below. I uttered a makeshift prayer pleading with God to please see that this medication kicks in within the next 24 hours. Please.

After a pleasant lunch it was time for the blood draw. A couple of hours later the MRI. I wasn't allowed to walk so a wheelchair was brought in. A precaution, though not needed. Ironically I felt fine enough to drive home if permitted—all effects of the drug were gone. My despondence progressed.

Both assistants returned and wheeled me to the MRI lab. I wondered what differences the trained eye would see in the before and after scans but figured I'd probably never know. The scan went smoothly and it was back to the room to wait a few more hours for one more scan for that day.

Another round of questioning. Same questions. Same answers.

Before the last MRI, the other doctor that was spearheading the study dropped by to introduce herself and check in. She was very nice and knowledgable. She reiterated the 24-72 hour "peak" effect time after I told her there was no remission. She then escorted us to the MRI room, this time sans the wheelchair.

Last MRI of the day goes smoothly. We're done for the day.

Ketamine II

It's now the next day and I've received a call from the doctor himself who is spearheading the study. He wants to get me in quickly because he will be vacationing out of the country. If I don't schedule now, I'll have to wait several months. We worked out a tentative appointment for Monday of the next week. When Monday arrived I made the drive to the facility which is a lengthy, trafficy, mind-numbing venture both to and from.

I have to say, all the people that I dealt with that day were extremely kind and informative. The doctor was pleasant if not a bit mechanical. He had me fill out the necessary paperwork and consent forms. An interview ensued for a good amount of time with the usual questions. Then two young assistants took me on a long walk through the medical center's various buildings to get blood work and an EKG done. After that, we ventured to another building to get an MRI scan of my troubled brain. This would be the first of three scans, each of which would take almost an hour. Luckily I don't have any claustrophobic issues. I learned there were ten people in this study and I was #10. I was there for about four hours just in time to rejoin the snarled freeways during the early evening rush hour for the long, congested commute home.

Three days later I received a call from the other doctor in charge informing me that all the tests looked fine and I qualified for the infusion. I was scheduled to be there the following Thursday at 6:00am for an all-day visit which would include additional brain scans and more blood work in addition to the infusion. I'm not allowed to drive home that day so my amazing wife will be joining me for support and to chauffeur me home.

At this point I just feel numbness. I can't allow my hopes to heighten. I don't want to be set up for another fall. It's quite a literally a "one shot" opportunity with this drug. I've been reading about it and relying on its promise for several years. Now, suddenly, I'm a qualified candidate. It's a bit surreal. Even if it should transform me for a few days or hours, it's not FDA approved for depression and may not be for years so I won't be leaving with a long-term prescription. I won't be leaving with anything— except the experience. The only thing to look forward to is an ever so brief and possible taste of what relief might be like if it does what it's supposed to do, but I must be cautious and realistic. This could go either way as all other options have.

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At this writing, it's exactly four days before the Ketamine infusion. I'm compelled to put my thoughts in writing having mixed emotions about the whole thing. Of course, I fear it won't work and will be another dismal disappointment. I'm trying to prepare for this so as not to be so devastated. Then again, I fear it will work but I won't have any access to the medication so it will be a futile tease. I'm questioning why I'm even taking part in this at all because it will be so open ended.

The only benefit I can justify this with is the hope that the medication will give me a brief respite from the heavy sorrow and darkness that I've grown so accustomed to. Maybe the slightest glint of hope will renew my faith in life itself. I suppose this is why I'm doing it.

Ketamine I

Back in August of 2010, I created a post called "Psychedelics." It dealt with scientists revisiting hallucinogenic drugs long abandoned from the ’60s and ’70s due to their abuse and stigma. Some of the base chemicals in these drugs have been shown to be effective in treating depression. One of them has been around a long time. Primarily used as an animal tranquilizer by veterinarians, Ketamine made its way into the recreational arena and became known as "Special K." It's still around in the streets and used as a party drug like Ecstasy.

When I first mentioned it in this blog almost four years ago, it was making headlines as a "breakthrough" treatment for depression that quite literally showed positive results in hours instead of days or weeks. Now Ketamine is really gaining steam and being tested by more and more scientists, doctors and clinics. I just read about Ketamine being administered in a nasal spray form. There are similar drugs in the same family being tested with the same results. The only problem for me was there was no testing or clinical trials in my area. Most were being conducted in the midwest and northeast. I'm in California which you would think would be on the cutting edge of this type of research. For several years I've been checking clinical trial sites, emailing clinics and doctors trying to find out where and when Ketamine would be coming to a theater near me.

Finally today, I happened upon a link that had the attached flier.

At this point in my miserable journey, I don't get excited about potential "breakthroughs" or even remotely get my hopes high. I read the flier, studied the website it originated from and then decided to make the call—full well knowing I would be diving back into the red tape ladened bureaucracy that is the medical field.

There are two doctors listed on the flier. I actually got a human on the other end and asked for the first doctor. That doctor was not at that location which was confounding. I then asked about the second doctor which of course I could only leave a voicemail for. As each hoop was placed in front of me I jumped through them like a trained circus animal.

Surprisingly, two days later I got a call back from the secretary of the doctor I left the message for. She asked if I was under current psychiatric care. I replied not at this time. She then told me it's mandatory that I have a referral from a psychiatrist. I told her nowhere is that information anywhere on their website or on the flier. She said she would ask the doctor if an exception could be made and would call back in a couple of hours. Hours later, after not hearing back, I called and managed to contact the same lady. She reiterated that it was mandatory to be under psychiatric care for follow up reasons. Perplexed, I asked what the role of the doctors were in this trial if they're not following up on the results. She said there would be a short visit with the doctor "after the infusion" but the main follow up would be with MY doctor. This now means I have to either find a new psychiatrist or contact the previous one I had in order to participate in this study.

This is why I loathe the psychiatric machine. It's cold, demeaning and bureaucratic. These people are in the profession to help the downtrodden and yet one can literally be driven crazy by the process itself. It stinks and should be changed.

After the weekend, on a Monday I left a voicemail with my former psychiatrist. Amazingly, she called me at day's end and was happy to help in any way she could. She gave me her email address to send her the details of the study so she could transmit a written referral. The next day, I got in contact with the trial doctor's assistant and told her the referral would be faxed to them in the next couple of days. That was good enough to prompt a pre-screening on the phone which I apparently passed. The next step after they received the referral was to make an appointment. I'll be damned if this wasn't speeding along fairly quickly.

As I thought, a little hiccup had developed. I must be under current psychiatric care in order to participate but understandably, my ex psychiatrist won't fib about that. I asked her to state in the referral that she'd be willing to follow up with me after the trial. She obliged and sent her referral to the doctor. That was good enough to clinch an appointment for a consultation for the trial. So far I've been surprised at how quickly this process has progressed.

Succumbing

I've discontinued seeing my therapist. After a year or so we were just covering the same ground repeatedly. I hadn't shown or experienced any improvement and I've learned that I'm either unable or more realistically unwilling to help myself. I felt I was wasting her time as well as mine. Counseling has never helped. I blame myself because therapists offer endless tools I can use to chip away at the destructive thought process that I've subjected myself to most of my life but I just can't seem to commit. It's laziness, complacency, fatigue and a crippling heaviness that prevents me from helping myself. I know it's only ME that can help ME but I've come to realize I really don't want to do the work. I want it to happen FOR me. I've reached some sort of point-of-no-return.

This latest therapist made the suggestion to try to accept my situation and stop fighting but I'm not even sure how to do that. It's tantamount to finding comfort on a bed of nails. You're always going to toss and turn until you find the slightest shred of comfort.

I don't know what to say anymore. I might wrap up this blog. I'm sure I'm just typing to myself instead of any readers. There hasn't been any comments in a long time. In any case, until some miracle happens or I just fade away, I hope I've made a connection with someone out there. Forgive my hopeless tone.

Today

Today was nothing more than a dark, narrow bridge linking yesterday with tomorrow.