Depression treatment - questions about esketamine. Hope needed.
December 9, 2023 12:41 AM Subscribe
Got my first dose of Spravato two weeks ago. Didn't do much. I had high hopes, am now really disappointed, and would love to hear from others who have been through this.
I got a 28mg dose for the first two times, and then a 56mg one last Monday and yesterday. I definitely felt loopy and dizzy while still at the doctor's office. Double vision and a bit of nausea, plus a headache. No horrible side effects. I was exhausted after each of the treatments and enjoyed listening to music and just "watching" imaginary patterns during.
I only really noticed an effect on my psychological state for the first dose. I felt giddy and had this sensation of my thoughts being wrapped in cotton, individually, instead of all intertwined in a flaming ball of barbed wire. It made thinking more pleasant.
During the second treatment, I had the powerful thought that nothing I do is really that bad, in comparison to murderers or dictators. It took away some of the shame that I'm carrying. So that was good.
Apart from that, I noticed absolutely nothing. I still can't summon up the motivation to do anything. Nothing feels good for more than a split-second (nothing). I watch a lot of TV and take care of my pets. I also keep up with social expectations to some extent (like, I got my dad a birthday present and will deliver that). But apart from that, I don't do anything. It's very difficult to eat and sleep. I think about suicide whenever I'm stressed (in a passive, detached, and probably pretty safe manner, so don't worry). I think about being a burden for the world and I've withdrawn from my friends because they just don't understand. Even my husband, who has been depressed forever, doesn't really believe me and thinks I can power through.
So, I'm already taking Bupropion (Wellbutrin) and Lithium Carbonate. I don't want to put my body through even more medication. If Spravato hasn't done anything yet, does it really make sense to keep trying? I don't want to give up what seems like my last chance to be happy again, but it feels like so much effort and discomfort for very little gain.
In online reviews, people keep saying that the first dose of Spravato changed their life and suddenly, things felt easy. Even my own psychiatrist said that I should be feeling something after the third dose, at the latest. This probably just doesn't work for me, right?
I know I should talk to my doctor about this, and I've tried, but he's extremely busy and only has a few minutes when I'm there. So if you can help me narrow down what to ask him about, that would also be helpful.
I got a 28mg dose for the first two times, and then a 56mg one last Monday and yesterday. I definitely felt loopy and dizzy while still at the doctor's office. Double vision and a bit of nausea, plus a headache. No horrible side effects. I was exhausted after each of the treatments and enjoyed listening to music and just "watching" imaginary patterns during.
I only really noticed an effect on my psychological state for the first dose. I felt giddy and had this sensation of my thoughts being wrapped in cotton, individually, instead of all intertwined in a flaming ball of barbed wire. It made thinking more pleasant.
During the second treatment, I had the powerful thought that nothing I do is really that bad, in comparison to murderers or dictators. It took away some of the shame that I'm carrying. So that was good.
Apart from that, I noticed absolutely nothing. I still can't summon up the motivation to do anything. Nothing feels good for more than a split-second (nothing). I watch a lot of TV and take care of my pets. I also keep up with social expectations to some extent (like, I got my dad a birthday present and will deliver that). But apart from that, I don't do anything. It's very difficult to eat and sleep. I think about suicide whenever I'm stressed (in a passive, detached, and probably pretty safe manner, so don't worry). I think about being a burden for the world and I've withdrawn from my friends because they just don't understand. Even my husband, who has been depressed forever, doesn't really believe me and thinks I can power through.
So, I'm already taking Bupropion (Wellbutrin) and Lithium Carbonate. I don't want to put my body through even more medication. If Spravato hasn't done anything yet, does it really make sense to keep trying? I don't want to give up what seems like my last chance to be happy again, but it feels like so much effort and discomfort for very little gain.
In online reviews, people keep saying that the first dose of Spravato changed their life and suddenly, things felt easy. Even my own psychiatrist said that I should be feeling something after the third dose, at the latest. This probably just doesn't work for me, right?
I know I should talk to my doctor about this, and I've tried, but he's extremely busy and only has a few minutes when I'm there. So if you can help me narrow down what to ask him about, that would also be helpful.
I have serious depression but haven't tried Ketamine yet, but have had similar "is that it?" reactions to other psychedelics. Based on my own experience and the research I've done, I believe that expectations have a big impact on the effects of drugs like this. I have felt that "last chance to be happy" feeling before and I think that is probably too high of an expectation to have for any drug. I don't really believe that anything can make me magically happy suddenly, and that belief makes it harder for drugs to work. But that is not the same as saying treatment is pointless as they can actually make me happier in small but important ways.
The two experiences you describe are definitely not "nothing" as you said it helped you feel less shame and thinking felt more pleasant in a new way. Those are not nothing! So there is probably a way you can build on those experiences with a larger dose next time. You're experienced with the feelings now, so maybe you can use your next time to try and work on changing some negative beliefs. That's much easier to do on psychedelics, and seems to happen spontaneously for some people which is why they say it instantly works.
It doesn't sound like you had horrible side effects so I wouldn't stop yet. I would ask your psychiatrist for ideas about specific things to work on, if they have experience with the ideas behind psychedelic therapy or might have a referral to someone who does. I would recommend thinking about it as an opportunity to experience something interesting and new, instead of thinking about it as a "last chance". My brain expects all last chances to fail, so I need to think about things in a different way
posted by JZig at 8:47 AM on December 9, 2023 [4 favorites]
The two experiences you describe are definitely not "nothing" as you said it helped you feel less shame and thinking felt more pleasant in a new way. Those are not nothing! So there is probably a way you can build on those experiences with a larger dose next time. You're experienced with the feelings now, so maybe you can use your next time to try and work on changing some negative beliefs. That's much easier to do on psychedelics, and seems to happen spontaneously for some people which is why they say it instantly works.
It doesn't sound like you had horrible side effects so I wouldn't stop yet. I would ask your psychiatrist for ideas about specific things to work on, if they have experience with the ideas behind psychedelic therapy or might have a referral to someone who does. I would recommend thinking about it as an opportunity to experience something interesting and new, instead of thinking about it as a "last chance". My brain expects all last chances to fail, so I need to think about things in a different way
posted by JZig at 8:47 AM on December 9, 2023 [4 favorites]
You had some response to the treatment. The above suggestions to increase dose are spot on.
I wanted to challenge your assumptions that this is your last chance at treatment. That is your depression talking. You could try psilocybin, ketamine infusions, rTMS, ECT. There is more out there for you.
Since you can keep up a few social obligations, try therapy or exercise programs. There are therapists now that offer walk-and-talk therapy, so you could do both at once. You won’t be motivated, and maybe you won’t feel better, but it might very well beat the status quo and be worth a shot. Even 5 minutes with a resistance band from your bed counts.
Hang in there
posted by shock muppet at 10:52 AM on December 9, 2023 [4 favorites]
I wanted to challenge your assumptions that this is your last chance at treatment. That is your depression talking. You could try psilocybin, ketamine infusions, rTMS, ECT. There is more out there for you.
Since you can keep up a few social obligations, try therapy or exercise programs. There are therapists now that offer walk-and-talk therapy, so you could do both at once. You won’t be motivated, and maybe you won’t feel better, but it might very well beat the status quo and be worth a shot. Even 5 minutes with a resistance band from your bed counts.
Hang in there
posted by shock muppet at 10:52 AM on December 9, 2023 [4 favorites]
I've been receiving treatment for major depression with IV ketamine infusions for a couple of years now. From what I understand, esketamine is a very different experience so I'm sorry if my experience doesn't exactly translate. In any event, during my infusions I've found that my self judgment is suspended and I can work through difficult things in my life while in that state that I had difficulty working through otherwise. Doing this seems to require going into the infusion with a specifically chosen intention either to work on a particular difficulty or the intention to allow what comes up to come up without fighting it. Both of these approaches have allowed me to arrive at insights that meaningfully changed my perspective and helped lift me out of deep depression and suicidality.
I will also say that I didn't find even ketamine infusions (which would be equivalent to a much higher dose of esketamine) to be an "oh my god this changed my life" experience. Rather, I've found that having the infusions provides a floor that keeps me from sinking too far into the basement of depression.
Music also has a significant effect on the experience of an infusion. I've had good luck with Jon Hopkins 2021 record "Music for Pschedelic Therapy" and East Forest's 2021 record "In: A Soundtrack For The Psychedelic Practitioner, Vol. II." Neither one is something I'd generally listen to outside an infusion but they feel like helpful support. I also like Arthur Rubenstein's 1967 recording of Chopin's Nocturnes.
posted by davybyrne at 2:30 PM on December 9, 2023 [6 favorites]
I will also say that I didn't find even ketamine infusions (which would be equivalent to a much higher dose of esketamine) to be an "oh my god this changed my life" experience. Rather, I've found that having the infusions provides a floor that keeps me from sinking too far into the basement of depression.
Music also has a significant effect on the experience of an infusion. I've had good luck with Jon Hopkins 2021 record "Music for Pschedelic Therapy" and East Forest's 2021 record "In: A Soundtrack For The Psychedelic Practitioner, Vol. II." Neither one is something I'd generally listen to outside an infusion but they feel like helpful support. I also like Arthur Rubenstein's 1967 recording of Chopin's Nocturnes.
posted by davybyrne at 2:30 PM on December 9, 2023 [6 favorites]
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"The recommended dosage of Spravato is 56 mg on day 1, 56 or 84 mg twice per week during weeks 1 to 4, 56 or 84 mg once per week during weeks 5 to 8, and 56 or 84 mg every 2 weeks or once weekly during week 9 and thereafter."
The source of the dosing information is the National Library of Medicine DailyMed.
You could ask your doctor about the clinical reasoning behind the dose you've received and what to expect and when.
Regarding online reviews, it is likely a very biased sample - it's possible that people are more likely to report online if it changed their life suddenly (and in a good way) or made them extremely miserable; the people for whom it worked modestly, over time, and without side effects might just out there slowly getting on with things.
Not a doctor, not a pharmacist, etc etc.
posted by lulu68 at 3:02 AM on December 9, 2023 [1 favorite]