KETAMINE TREATEMENT FOR MAJOR DEPRESSIVE DISORDER.

What exactly is ketamine ? Well, it  was once used mainly as an anesthetic on battlefields and in operating rooms. Unlike other anesthetics, ketamine doesn’t slow breathing or heart rate, so patients don’t need to be on a ventilator to receive it. In recent years Ketamine has been proven to have significant effects it can rapidly reduce suicidality (life-threatening thoughts and acts) and relieve other serious symptoms of depression. Ketamine also can be effective for treating depression combined with anxiety. Major depressive illness is a debilitating condition which is matter of concern worldwide affecting millions of people causing a considerable burden on health and socioeconomic status. As per the World Health Organization, depression is third among global disease burden.

Single dose of ketamine has rapid action on depressive symptoms, and this action persists even for a week, which suggests its possible role in neuroplasticity. Many studies showed remission of depressive symptoms 1-week postinfusion. A recent meta-analysis showed antidepressant efficacy from day 1 in patients of unipolar and bipolar depression. The neuropsychiatric effect of subanesthetic dose of ketamine helps in the management of suicidal ideation and reduces self-harm or suicide in addition to the reduction in depressive symptoms. Open-label studies have shown that one-time intravenous (i.v) ketamine led to rapid improvement of treatment-resistant depression and the quickest significant antidepressant response was noted within 2 h and slowest within 4 h. Another study done in India on 27 patients of treatment-resistant depression (TRD) with single i.v dose of ketamine infusion showed short-lasting improvement in suicidal ideation and depression. No significant adverse physical effects are reported in with low-dose ketamine and S-ketamine in antidepressant trials till date.

Ketamine is a new and effective option in future with rapid onset of action, but studies are limited with multiple doses of ketamine which have assessed depressive and anxiety symptoms comprehensively. There are limited studies which have used i.v ketamine in bolus dose as most of the studies used it as slow i.v infusion. Hence, index study aimed to assess the efficacy of bolus i.v ketamine in patients with severe depression.

2021 was by far one of the worst years mentally, emotionally and physically. I had sunk into the worst depression I think I have ever experienced, mind you I’ve been suffering from manic depression for  years and been on and off medication for years as well. However this time it was worse I could feel myself slipping into the ‘darkness’ as I’d like to call it, my anxiety has never really been that bad but then it got so bad my chest would constantly be in pain. I’d feel like it was ripping out and I couldn’t breathe. I’d have up to about five panic attacks a day and breakdown multiple times, especially when I would look in the mirror or leave the house. I barely had the strength to get out of bed.

This time I could not fight it. I tried, I had been on my medication religiously, had set a fixed sleeping schedule to help with my insomnia and at the same time trouble leaving the bed. I also started the gym but nothing seemed to be working and I was fill with so much pain, so much hurt, so much hopelessness and hate especially to myself. I had fallen so deep into this stage of manic depression and anxiety and I had honestly reached my breaking point. I had lost all my strength and was so so emotionally and physically drained. I just wanted to die, just  die I was so exhausted and I felt like I deserved everything that was happening to me. I believed that I deserved to surfer and I had no meaning neither did I matter to anyone….. be it friends or family, I felt like an imposter that I didn’t deserve anyone or anything. It was like I wasn’t living just passing through the days. 

I had honestly lost it, I felt like such a waste, a fraud, pathetic ….I HATED MYSELF SO DAMN MUCH, I could barely look at myself in the mirror without bursting out in tears.  I had made up my mind I was really ready to end it all. I had a date and a plan and I was so calm and content, also strangely at peace. 

I had gone to see my psychiatrist for what I knew in my head to be the last time. He strongly suggested the Ketamine treatment like he had so many times before but my father had always refused. I was not expecting this time to be different but my father agreed straight away, even my Doctor was a bit surprised. Then just like that I was being admitted. The treatments were meant to be administered each morning via muscle injections (they use this instead of infusions these days). The first day I was honestly panicking because I didn’t know what to expect and I had a this dreadful feeling that the treatment wouldn’t work. “What if I was too much of a gone case” I kept on thinking. With Ketamine normally by the third dose the treatment takes effect, and the doctors are able to know if its a success or not. Ketamine has a high success rate and rarely ever fails. It’s been known to cure people suffering from depression and suicidal thoughts for over 30 years.

 

Anyway, after the first dose of ketamine I really didn’t feel anything I was more of really drowsy an tired so nothing much of note really. The second day however everything went downhill. I was okay in the morning an I went to receive my dose which went normally but around lunch time it happened. I had a horrible breakdown I could barely breathe and I could not stop crying. I spent almost 5 hours straight just crying . My heart was broken and i was so done, the treatment was a flop cause this was the second dose and here I was crying uncontrollably. That’s how I fell asleep on that second day, crying, broken….. I was below rock bottom. The next day when my doctor came to check up on me and my progress I didn’t know say I felt defeated and ashamed.

After I received the third dose I went back and rested for a while, when I woke up I felt strangely weird, I felt light for lack of a better word. There was no heaviness in my chest and my body felt rejuvenated, when i went to go take a shower I looked in the mirror and for the first time in a long time I didn’t hate the person saw. I wasn’t in love with her but I didn’t hate her. I was so confused and conflicted because I hadn’t felt this way in almost forever. I went through the rest of the Third day without  any breakdown or panic attack which hadn’t happened in such a long time.

The forth day was my last day of treatment. They can normally go from 3 to 6 doses I was doing $ for a couple of reasons that I won’t go into now. Fast forward to now I feel like a whole new person.

It’s such a weird feeling. I feel so light and relived like the biggest burdern has just been lited off of me. I can from this really dark and ugly place to now this. It took me a while to put this out because I was finding it really Hard to put all the emotions I felt into words.  Right now I am taking it one day at a time embracing the moments and changes, living for me. I know tey are some people I hurt by not letting them know how bad things had gotten but at that time I was so lost, broken and drained I gad no idea how to. I really thought it was over for me. Now the place I’m at emotionally and mentally is a work in progress I won’t say I’m 100% but I’m getting there. I am slowly learning who I am, what do I like and dislike, what do I want in life e.t.c. For so long I was lost to the point i no longer knew  myself but that’s changing, I know this sounds hella cliche but Ketamine actually saved me.

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