Ketamine Therapy: Understanding Ketamine Maintenance Programs

Hello all.  This is Susan from myketaminestory.com.  

I am a blogger that suffers with Treatment Resistant Depression (TRD), Anxiety and Obsessive Compulsive Disorder (OCD).  I was introduced to Ketamine for TRD in January 2015. I am forever grateful that I was. I spent the first two years focused on my recovery.  I now have an excellent treatment plan in place but that does not clear me from obstacles or pitfalls. I journal regularly. I educate and advocate for Ketamine Therapy to help treat depression.

I have a long history with treatment resistant depression and anxiety disorders.  My mental health has been my primary focus; often without my permission. Ketamine changed all of that.

In this blog, I will discuss the maintenance regimen of Ketamine therapy.  I want to explore this topic because it has been something I have experimented with and often get emails asking me, “what is the perfect timeline for getting Ketamine booster treatments?”  It is because of the questions being asked, and my experimenting with length or time and dosages of Ketamine, that I would like to address this issue and share what I have discovered to be true for me, as well as, what others have shared with me over the past four plus years.  

The answer in short form, I believe, is that it is different for everyone.  

I feel that awareness of the return of our symptoms and fluctuations in our moods are paramount in figuring out when it is time to get a Ketamine treatment.  It is vital to pay attention to the filter that depression puts on us. What I mean by that is, for me, watching my inner dialogue. When I experience the arrival of fleeting suicidal thoughts, negativity that I can’t escape no matter which psychological tools I use, heaviness that burdens me, issues with the ability to breathe properly,  slight paranoid thinking, lack of motivation or desire to engage in life, wanting to isolate, being angry towards others and self, clouded thinking, the absence of ease in processing information or the clarity of mind that Ketamine gifts me with, and a general feeling that life is now a struggle… I know that when I need Ketamine therapy I feel off in multiple ways.  My world is tainted with depressive thoughts and I can no longer make sense of the cause. Life is challenging under ideal circumstances, but once the depression wants to run the show I know I have limited time before I spiral and need Ketamine again. That instance when I start to believe the ugly truth depression wants me to sink into, and it robs me of the knowledge that depression is in fact a lying bastard, I know I must seek treatment.

I don’t want to discourage anyone with my next statement.  It is important to remind those suffering with treatment resistant depression, those like me, that it takes time to figure out how often we may be required to get Ketamine therapy.  We suffer with the same illness, however, our chemistry and history may differ.

I have learned many difficult lessons in my journey to stay stable and symptom free.  I want to share what I have learned in hopes of potentially helping another. My discoveries have been painful and frustrating.  I find myself typically in a good space now, at least for two weeks at a time, and I have a deep appreciation for what I have cultivated from my stumbles and spirals into that familiar terrain known to me as chemical imbalance depression.  I skate on thin ice when I mislabel exhaustion and situational struggles as chronic depression. I am a work in progress.  The changes in my behaviors and adjustments in my default settings are slower than I would like them to be, but I can recognize the growth and healing that is taking shape.  It has been challenging for me to struggle with the return of the unexplainable symptoms of resistant depression.  

Acceptance has been my nemesis.  

I want to be allies.  

In the beginning, back in 2015, when I was introduced to Ketamine as a therapy or antidepressant for helping elevate my timeless depressive episodes, constant obsession with wanting death by suicide and neverending panic at having to awaken to another day in battle with the beast, I fought madly with the injustices I felt when the symptoms would resurface.  Why and how were these characteristic traits of depression able to push past the walls the Ketamine seemed to be building?  

It took many attempts and failures to figure out how long I could go between appointments with my doctor for Ketamine therapy.  I wanted it to be on my schedule. I was determined to go as long as possible between treatments for convenience and financial reasons.  I wanted control of my illness. I didn’t want to concede. I didn’t want to be a slave to the depression. I didn’t want to acknowledge the fact that my chemical makeup was going to dictate the guidelines for me.  If I was told by a fellow sufferer that they could maintain their mood and felt stable for a month at a time I automatically went into competitive mode and assured myself I could do the same. I failed time and time again trying to obtain standards held by other Ketamine providers or the people that were sharing their story with me.  

I confess.  I thought that I was inferior.  I was obviously a tragedy because I could go two weeks without Ketamine.  I would come up with creative explanations to nullify my fears that I was abnormal and freakish.  I now believe I was missing the point. I needed to stop comparing my treatment to others and begin to pay attention the the subtle shifts and signs that my mind and body were offering me if I would stop having expectations based on other peoples’ treatment plans. 

Ketamine is incredibly new in terms of treating resistant depression.  There isn’t decades of research compiled and readily accessible to its users.  As the years have grown and passed, there is definitely more being discovered and written about Ketamine and how and why it works, but it often remains a mystery to many of the patients being treated with Ketamine.  I suppose I should clarify and not make generalized statements. It has been a guessing game for me.

I work very closely with my doctor.  I kept diligent mental notes on my experiences.  I have a journal and have written articles on my journey with Ketamine.  I want to educate others as well as get a better understanding for myself.  

It was obstacle after obstacle in the early years of treatment with Ketamine.  

I would attempt to make appointments three weeks out and find myself suicidal after twelve days.  I would usually feel really uplifted and motivated during the first week after my Ketamine therapy and I would plan everything I wanted to get done before my next treatment in those first seven or eight days.  I was working from a fear based mentality as the second or third week were very inconsistent. I couldn’t count on being symptom free. I was resentful of the return of my depressive state and how it was disrupting my life.  I would advance ahead and see accomplishments and growth only to fall flat on my face and spiral down the rabbit hole.

What was I doing wrong?  Why wasn’t the Ketamine patching up all the holes and keeping the flood waters back?  I felt like a tightrope walker crossing dental floss instead of tensioned wires. I could never figure out how to balance myself.

I remember in the first year the confusion I felt with all the new emotions and lacking coping skills to address and manage my life without depression.  It was very new for me; feeling. As much as I detested the devil that is depression, we were intimate partners. I found ways, unhealthy ways, to cope or survive the darkness.  Ketamine allowed and continuously allows the sunshine in. I needed to locate the shades in order to function without being blinded.

Eventually, I  settled on Ketamine therapy every two weeks and began to feel stable in my moods only to think I could change it up again.  “If I am making it solidly from appointment to appointment without the depression resurfacing maybe I no longer need it every two weeks.” I discuss these thoughts with my doctor and quickly change strategies.  I tried going three weeks between treatments and initially I would be ecstatic that I was faltering only slightly before my appointments. I found that after a couple of months I was struggling and having suicidal thoughts.  I called my doctor numerous times for emergency appointments for Ketamine and later agreed to go back to biweekly.  

I was disappointed.  I felt if I was getting healthier that I should be able to make it three weeks without incident.  I didn’t want to lower my expectations because I was using how often I received Ketamine as a measuring stick of my healing success.  I don’t advise this approach. It is not a valid assessment. The brain is going to need the antidepressant properties of Ketamine when it needs it.  It is not about will or ability to cope. Managing one’s life is a separate issue.

I continued to get Ketamine every two weeks for months.  I was grounded and repairing the psychological effects decades of clinical depression bestowed on me.  

It would be in another attempt to prove how well as was doing that my doctor and I would experiment with dosage.  We decreased the amount I was getting to gauge whether limiting the amount given at each appointment was beneficial.  I think I was constantly trying to use Ketamine as a barometer of my success. If less is better, then receiving a lower dose would signal to me that my brain was repairing itself and I would one day be able to have the perfect cells and chemistry to stop needing Ketamine at all.  The problem I faced was accepting that I have mental illnesses and I won’t be able to change that.  

Acceptance.

Grrrrr……

I am sure you can predict the outcome.

Over time, the change in dosage and results were not immediate.  It took several sessions at a new dose before I found myself in darkness and wanting it all to end.  I would reach out to my doctor, again blaming myself for failing to be able to stay symptom free with the change in dosage.

It was always my fault in my mind.

“I should” was a common mantra and one I still find trips me up more than I care to admit.

I suppose my writing on the subject of dosage and length of time between Ketamine sessions is to point out that there is no clear guideline; at least there doesn’t seem to be from the experimentation I have had over the last several years.  It is important to me to share my experience in hopes of helping others avoid many of the mistakes and misconceptions I have had in my journey with Ketamine.

The following are all the ways that I determined my timeline and when I needed Ketamine.  It is my hope that by sharing my experiences and pitfalls that someone may be able to understand their situation better. Every single time my doctor and I tried to investigate a new approach to my treatment, it would take roughly six to eight weeks before I observed myself faltering and struggling to make it to my next appointment.  I would find myself fighting suicidal thoughts. My thoughts became obsessive. I couldn’t process information or events clearly. It was as if a switch had been flipped and everything was overwhelming for me. I felt irrational and self defeated. I was like two different people. It was bizarre for me. My world was confusing and everyone was against me it seemed.  I had a deep appreciation for Jekyll and Hyde. I related to the feeling of being two very opposite people.  

I would be floored once I got my Ketamine therapy and the clarity and hopefulness reemerged.  It was like a rebirth. I could even see the change occurring during my treatment. I’d check in with my doctor and would be moaning about my desire to give up.  I shared my utter lack of ability to function properly and my heaviness that makes me feel as though I am swimming underwater wearing sandbags and looking up through the slime at the life I was leading.  In mid sentence I start to disbelieve the feelings and thoughts I was explaining to my doctor as mine, and begin to correct myself. I couldn’t believe the words I was expressing. They were no longer true.  The Ketamine switched off the depression and I am once again shaking my head and correcting my thoughts and feelings. They were no longer true. How odd. It was as though I was telling a story about a friend.   

Gone.  

Returned.

When Ketamine is acting like an antidepressant,I am free from the demons that try to distort my view of myself and the world around me.  I have grown to be grateful and optimistic and a complete opposite of the wounded and frightened being I am when the depression filter is on.  

Years later, I can tolerate the symptoms better than I used to in the beginning of my journey with Ketamine.  The tools that would help me sort through my thoughts were disabled and I would quickly sink into a pit of depression that felt all encompassing and I couldn’t change it.  It would take several visits to my Ketamine doctor before I felt stable again.

It was at a recent appointment after several months of feeling stable and grounded.  I am managing my emotions and engaged in my life. I feel semi healthy. My doctor suggested we reduce the dose again and I adamantly refused and cited all the reasons why I felt I needed to remain at the same dose and time frame.  I will not allow any further experimenting. New studies may be written and suggestions made about how to treat patients with Ketamine. I know this fact about my recovery: I am not willing to have these new findings wreak havoc on my life.  I have documented my experiences with Ketamine and know what works for me. Our brains, our chemistry and our history vary, and I have found my “perfect window and dose”. I am thoroughly convinced that trying to manipulate the window only causes me setbacks and frustrations.  

I knew that I needed to write on the subject of maintenance schedules and open up about the various ways that I discovered that the guidelines for how often Ketamine should be administered, and how much Ketamine should be used, may in fact be individualized.  

My doctor has increased the dose of Ketamine because I read that higher levels were beneficial.  My experience proved this was not true for me. It may be significant for others, but it wasn’t for me.  I continued to need Ketamine every two weeks despite the increase. My moods were not necessarily better either.  

My doctor has decreased the dose of my Ketamine because he read studies that indicated lower levels of Ketamine were showing that maybe less was best.  I wouldn’t notice any effect for weeks, but eventually found myself in an intensely dark place and needing to return after one week. It typically would mean, for me, receiving Ketamine every seven days for several weeks before I could achieve the results I was used to having and remain stable for two weeks.  I would always come back to 50-55 mgs of Ketamine injected intramuscularly. 

My doctor and I have discussed lengthening the time between my Ketamine shots.  It was often at my request. I was gauging my mental health success on how often and how much Ketamine I was given.  I was struggling to accept my diagnosis and detested the fact that depression would always resurface for me, and I had no control or will over my mental illnesses.  I have gone three weeks, four weeks, eight weeks but always returned to my two weeks schedule when my world would fall around me.

I work on acceptance.  

I can see progress.  

I am finally writing an article about Ketamine maintenance programs.  It has been on my mind for several months. I suppose I needed one last attempt at testing my theories.  It was another botched effort and now I am convinced that I can’t control my illness or “will” the depression symptoms away.  

The facts: Ketamine is my antidepressant.  I am grateful to have found a medication that suppresses or controls the symptoms so I can participate in life.  If I consistently get the dose I need, when I am scheduled to get it, my life and outlook tends to feel stable. That equates to a successful drug therapy in my book.

In closing I will share how I have evaluated my mental health and well being, and how I discovered what my threshold was, and when and how much Ketamine is needed.   

The key to figuring out how long to go between treatments is observation.

These are the tips that have helped me and I hope they can assist you too.  I used almost all these suggestions to help me determine if I needed Ketamine, or if I was just experiencing life as others do; having good days and bad days.  If the feelings remained for more than a few days in a row, I examined and assessed many factors before admitting the depression was present and help was needed quickly (as the symptoms tended , for me, to spiral quickly.)  

In the beginning, all emotions were strange, and I oftentimes mislabeled what I was really feeling.  Depression was the one emotion I was intimate with and never realized that there were degrees to the feeling.  I just clumped all my dark feelings into one room so to speak. There are many levels of depression, and I began to choose different words such as blue, down, exhausted, overwhelmed, melancholy, misery, sadness, unhappiness, sorrow, woe, gloom, dejection, downheartedness, despondency, dispiritedness, low spirits, heavy-heartedness, moroseness, discouragement, despair, desolation, moodiness, pessimism, hopelessness, upset and on and on to figure out what was chemical depression and what was perhaps situational depression.  They are all words that can be interchangeable with the word depression and its symptoms but felt slightly differently to me. That difference helped me determine what my mental illness looked like. When I dip, you dip, we all dip, however it is not all chemical.

It was important for me to pay attention to my moods.  I recorded or made mental notes of fluctuations in my abilities to clearly think without the depression filter; what does that look like and how does it change?  I asked myself questions constantly. Does it appear that my thoughts are more negative and self defeating? Are the tools, to cope, in my toolbox working? What is my motivation level?  How am I sleeping? Remarkably, I noticed that it was more difficult to take a full breath, and I used my breathing as an indicator that the depression may be resurfacing.  

I didn’t use only one assessment to gauge whether I needed Ketamine.  I have learned depression likes to mask itself in many ways, and I was clueless at the subtle differences.  I found it helpful to know the variances so I didn’t just assume the depression was present and stir up the anxiety.  I tested myself. It was valuable and empowering. I could challenge myself and learn tolerance levels.  

Am I able to talk to myself as a “cheerleader” or a kind friend?  Can I believe that the negative thoughts may be wrong? Do I see other options?  Is the desire to isolate present? Can I engage in conversations? Do I want to die or do I need sleep?  I needed to introduce myself to so many new emotions and understand what they felt like and how I managed or didn’t handle them.

Get to know yourself without the depression symptoms, as well as, how things change when the depression resurfaces because it usually will; at least that has been my experience.  These assessments and suggestions have been crucial in my healing and recovery. 

If you are interested in educating yourself further on Ketamine therapy for Treatment Resistant Depression, check out the four-part series I wrote answering questions about Ketamine use, based on my experience with Ketamine therapy over the past four years.

My first blog, Ketamine: Addressing Questions & Concerns focused on my early experience with Ketamine Infusions.

In part two of the series, Addressing Questions & Concerns About Ketamine Therapy for Treatment Resistant Depression I addressed questions and concerns about Intramuscular Ketamine versus Ketamine Infusion therapy.

In my third blog, Frequently Asked Questions: Redefining Depression With The Assistance Of Ketamine Therapy, I was a bit more random. I had emails with several questions and themes, and I addressed as many inquiries as I could.

In my final question and answer dialogue, Pondering Concerns & Questions: The Benefits Of Ketamine For Treatment Resistant Depression, I discussed research, clinical studies, and the need for changes to occur within our insurance companies and federal government so that maybe one day Ketamine will not be so difficult to afford or obtain from any qualified professional.

I hope these personal blogs from a patient that suffered for over four decades with treatment resistant depression will be helpful in convincing you why Ketamine could help you or someone you love.

Also, if you would like to become a provider of Ketamine Therapy try enrolling in The Ketamine Academy‘s online Ketamine Infusion Therapy training course; it would be an excellent decision and could be extremely helpful for others like me. The Ketamine Academy online program will surely benefit you and the mental health community.

I have been generating a Ketamine Providers and Locations list and I update it regularly. Please visit my personal website for the full provider list. This list may help you find a clinic in your city or state. I update the provider list regularly. I highly recommend individuals contact me if you administer Ketamine or if you are aware of a Ketamine provider not in my directory; I will happily add new Ketamine clinics.

In conclusion, If you know of anyone suffering with treatment resistant depression, like I do, let them know that Ketamine therapy may be an option worth looking into. It has been and continues to offer me relief from my symptoms.

Originally posted on The Ketamine Academy website.

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