what is ethical here - antidepressants?

March 15, 2020 7:11 PM

I get ketamine infusions, every two weeks, to keep my suicidal depression at bay. How can I not view this as frivolous at this time?

I get ketamine infusions every two weeks to keep me from diving into a (sometimes actively) suicidal, anxious, traumatized hole. Recently, I underwent a new induction series of six in two weeks to get them working better again. To maintain their effectiveness I need to get boosters every two weeks (yes, we've tried longer, and that's why the new induction was needed...it was too long).

I've spoken about this on Mefi at length, they keep me functional and they're great. However, they're also optional, technically. I COULD white-knuckle it through the depression and panic attacks I'll get if I stop taking them, until Covid is over. It wouldn't be easy, but I would survive. With all the talk about elective surgery and optional medical things being canceled, I can't justify these treatments anymore in my mind. Yes, they allow me a life, but I won't actually physically DIE right away. They're not like, chemo. I'm willing to sacrifice the progress I've made over two years if it keeps myself and loved ones and strangers and the world safe. What if me getting my ketamine inadvertently causes death for another?

My "clinic" is actually just a lab inside of Columbia University. It is a mental health research building so there's no inpatients immediately around me, but it's still a medical center and the doctors walk all around. My doctor says he'll take whatever precautions are needed, and he's a good dude who I trust, but that feels like it isn't enough....

If people are holding off surgery, how can I not hold off this? How can I live with myself knowing I'm not Flattening the Curve?

posted by colorblock sock to Health & Fitness (27 answers total)

I think these are easily justified, and you should feel no guilt about keeping up with them, provided you take care with your transportation. Treatments to keep you from becoming suicidal are absolutely medically necessary, while a surgery that can wait a few months is not.

Also, at the lab/clinic you go to, would they conceivably be treating Covid patients if not you? It doesn't sound like it, so you are not pulling resources from more needy people.
posted by ktkt at 7:15 PM on March 15, 2020 [34 favorites]

For what it's worth, your psychiatrists aren't going to be drafted into service to treat COVID19 patients until (and unless) things get so terrible you don't want to go to the hospital at all, ever. And at that point, your clinic will likely close anyway. Go, have the front desk txt you when your appointment time is due so you can wait in your car and not in the waiting room. Don't let anyone touch you unless they wash first. Wash thoroughly after. Sit 6 feet apart. But go. The world needs all of us mentally healthy right now.
posted by shadygrove at 7:16 PM on March 15, 2020 [24 favorites]

If your depression reaches suicidal level, these treatments are like chemo. You could die otherwise. And this is just the kind of situation to aggravate your condition. Go get your treatments.

There's a lot of surgery that's truly elective. I had something done in December to treat a condition that was seriously messing with my quality of life and would've only gotten worse over time in a way that's not exactly fixable, but I wasn't going to die of it. That's elective, and postponable, even if it would be unpleasant not to get treated. If your illness can kill or incapacitate you, you need to keep getting treatment.
posted by praemunire at 7:21 PM on March 15, 2020 [42 favorites]

This sounds like depression talking. You need what you need to stay healthy and functional, whether it's ketamine or Suboxone or Truvada or insulin.
posted by arrmatie at 7:23 PM on March 15, 2020 [34 favorites]

Please go.
posted by purpleclover at 7:26 PM on March 15, 2020 [12 favorites]

It's not frivolous and it doesn't sound optional to me. This also doesn't seem like a high-risk scenario.

In my unprofessional opinion, not going is more likely to put a bigger burden on the healthcare system than going would.

Maybe see if the doctors can let you take a month supply home or something?

And you don't have to sacrifice yourself here. Go. You're worth it.
posted by Jacen at 7:27 PM on March 15, 2020 [5 favorites]

I COULD white-knuckle it through the depression and panic attacks I'll get if I stop taking them,

Oh honey no. I don't see where this is a problem for anybody else, like you're taking space that would be used to save another patient. Your life is not an extravagance! Physical medicine uses completely different resources than mental treatment, and that's what the distinction with postponing elective surgery is.
posted by rhizome at 7:28 PM on March 15, 2020 [14 favorites]

This sounds like a critical therapy to me. Please don’t feel bad about continuing. You need to take care of your health. Living on a panicky anxious depressed whiteknuckled condition is not all right. You need the treatment. Take it.
posted by SLC Mom at 7:30 PM on March 15, 2020 [2 favorites]

Call them. Many clinics are putting protocols into place that will allow them to continue to offer services as expected. But they may also ask that you review your own health prior to going or review it with you prior to entry: no fever, no cough, no runny nose, no shortness of breath, no high risk exposures.
posted by beaning at 7:32 PM on March 15, 2020

Depression, esp. severe treatment-resistant depression, is a real disease that requires real treatment. They always say chemical imbalance in the brain, but in my experience, it's a whole-body illness and it has a significant mortality rate; suicide is a leading cause of death. You require treatment for your serious illness. Stay home the rest of the time if you can. You and your mental health deserve treatment as much as any patient with any serious, life-threatening illness. Be especially good to health-care workers, who are at high risk and be well.
posted by theora55 at 7:32 PM on March 15, 2020 [8 favorites]

We all make choices about what activities, while technically risky, are worth it to us. There is no need to become a hermit and prioritize complete and utter safety above everything else. If *everyone* were as conscientious about their activities as you are, we'd flatten the curve in no time. You have this internet stranger's permission to take care of yourself in the best way you know how.
posted by DrGail at 7:33 PM on March 15, 2020 [4 favorites]

Please go! We’re staying home in part so people can get the medical treatment they need; yours is absolutely the right kind.
posted by chesty_a_arthur at 7:37 PM on March 15, 2020 [24 favorites]

This sounds like depression talking.

I second. This is *exactly* the sort of thinking I indulge in when I'm depressed, and I've had to learn to keep an eye out for it. Leave it up to your doctor and the clinic to make this decision.
posted by pullayup at 7:42 PM on March 15, 2020 [1 favorite]

Please continue to get these treatments for as long as they are available to you. This is not an extravagance.
posted by bilabial at 8:04 PM on March 15, 2020 [1 favorite]

My friend spent ten days on a ventilator after a (fortunately failed) suicide attempt in February. She was using all of the many mental health tools available to her but for a moment even that wasn't enough. I'm grateful that she's recovering, and I'd hate to think how that situation would go during a pandemic.

Taking care of your mental health by getting the ketamine infusions you need also protects your physical health. It's a wise choice, IMO.
posted by needs more cowbell at 8:09 PM on March 15, 2020 [2 favorites]

Hey, I've dealt with depression and suicidal ideation pretty much my whole life, so I absolutely understand a lot of what you feel. This really sounds like the depression talking, using the free floating anxiety all around us right now to claw its way up to the forefront of your experience. You have to fight it. Get your treatments. You are worth it and your mental well-being is worth it and as long as your doctor is saying he can do it you should take him at his word.

You can live with yourself because by maintaining your mental wellness and not plunging yourself into the depths during this time you are Flattening the Curve by not needing more constant hands on medical care later. You are keeping yourself functional so the people you love can not worry so much about you and get on with the hard work of changing habits to help their community elsewhere. Stay strong now so you can pull through later.
posted by Mizu at 8:27 PM on March 15, 2020 [4 favorites]

This is essential medical care. nthing all of the above. If you have seen a lot of the other advice on similar threads where people have been advised to stay home, then I hope you understand just how strongly we mefites believe that you need to go and get this care.

Sending love
posted by acidnova at 8:38 PM on March 15, 2020

I would definitely err on the side of doing treatment, but give them a call and ask.
posted by Tell Me No Lies at 8:46 PM on March 15, 2020

We are cancelling elective surgery so the ventilators that would otherwise have been used to anaesthetise surgical patients can be used to set up overspill ICU beds. Not because there is something extravagant and sinful about having elective surgery during a national health crisis. Local anaesthetic/daycase procedures are still continuing as per usual. I have two lists this week. Routine clinic appointments are still happening (maybe over the phone! But I am still ordering blood work, prescribing, writing referrals etc).

Your infusions aren’t even in the same hospital as the ICU. There’s no reason whatsoever not to go for them. Not having them won’t help fight Covid any more than stopping your blood pressure tablets would help. Really, you becoming mentally unwell is likely to use far more healthcare resources than just turning up and having your treatment with the minimum of fuss.
posted by tinkletown at 8:58 PM on March 15, 2020 [16 favorites]

Medical care is for people who suffer, physically or mentally (and the two are often hard to separate!) no matter whether the cause is ongoing or new.

I will still see a gynecologist if my current pain won't subsist, and I still need to go and get my other prescriptions, because they allow me to be functional. I would postpone anything like an annual checkup right now, but treatments I need are treatments I can and should get. At least, the doctors are still operating and not turning me away - my thyroid clinic closing won't suddenly make corona better anyway.

Other people deserving care doesn't mean you don't.
posted by LoonyLovegood at 9:07 PM on March 15, 2020 [1 favorite]

You won't make anybody else less sick by making yourself more so, and a dose of white knuckle mental suffering for you won't improve anybody else's ability to drain their festering lungs. So, what everybody else said. The best thing you can do for the community right now is stay as well as you know how to.
posted by flabdablet at 9:21 PM on March 15, 2020 [1 favorite]

What tinkletown said. IV infusions aren't interfering with COVID care in any way. Please get what you need.
posted by AlexiaSky at 2:17 AM on March 16, 2020

Nthing all the other advice. Do not be a martyr for no good reason. Your community needs you to be as healthy as possible. Please continue your treatments. As described, they are not optional. They are keeping you alive. That is a good thing and an important thing. We are rooting for you. Please keep going.
posted by Bella Donna at 2:46 AM on March 16, 2020

You absolutely should keep up this treatment. It helps you live! I absolutely see it as important as chemo. Your life isn't less valuable than someone else's and you'll take all the reasonable precautions and have no reason to feel guilty. Please keep going. Besides helping you (which is very important) you're also modeling good management of mental health.

I am someone with a messed up knee and a messed up uterus and I was expecting to have surgery one one or both this year. That's going to be delayed now. So I'll limp a bit longer and have ongoing discomfort but do not in any way consider it near the kind of sacrifice you would be making if you stopped treatment. I have bipolar disorder. I can relate to that black hole. Don't go there unnecessarily. Please look after yourself, you matter too.
posted by kitten magic at 3:15 AM on March 16, 2020 [3 favorites]

We all should be practicing social distancing by reducing our exposure to others to a minimum so that essential things can be taken care of with less risk.

Your health care is one of the essential things.

Please take care of yourself. Your medical condition requires treatment. If you have an acute health crisis, you will involve more people, more contacts and may require hospital space, etc. Please go.
posted by jclarkin at 9:58 AM on March 16, 2020 [3 favorites]

Response by poster: Hi, all. I decided to go. My doctor had taken EXTREME precaution with sanitation as did I (his included an n95 mask), I was the only one in the office, gloves, things stored in clean plastic bags, travel via disinfected vehicle door-to-door etc. He seemed very sure both of us were very safe and I'd be fine. It was an incredibly stressful situation and might not be something I can reasonably continue if I can find an easier way but thank you for at least letting me know it's morally acceptable and isn't hurting anyone else.
posted by colorblock sock at 2:45 PM on March 19, 2020 [6 favorites]

Response by poster: As a follow-up to this in case anyone comes to this question later (hopefully no one will need to!!!!) I was able to get a form of at-home ketamine prescribed due to the lockdown measures currently in place. This is an uncommon and remarkable privilege, but I wanted to make myself available as a resource if anyone finds themselves in that situation or has questions about it. So far, it's been a huge improvement over the current alternative, and it may be worth asking about especially if you're dealing with other health issues that make you vulnerable/living with people who do.
posted by colorblock sock at 10:13 PM on April 17, 2020 [5 favorites]