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Posts tagged ‘trigger warning’

What I Learned About Ketamine and Depression

Trigger Warning – Meds

Note that I’m not a doctor or a pharmacist or any kind of medical personnel. Do not consider this post to be advice on what you should do. If the subject interests you, ask a licensed physician for more information.

What did I know about ketamine before I started doing some research?

Not much.

I knew that as a street and “club” drug it was known as “Special K.”

Then I heard that it was being used for treatment-resistant depression. Here’s what I found.

First, you can’t just go down to Brown Street and buy a few pills. That’s illegal. And what you get may include other substances that you didn’t intend to take.

So, you need a prescription for it. Once you get that prescription, usually after a consult with a psychiatrist, you need to find a treatment center that will administer the drug. Clinic operators may be anesthesiologists, as ketamine is primarily used as an anesthetic.

The treatment is delivered via IV or injections. No simple pills to take. It’s a course of treatments, each lasting 45 minutes to an hour, with a rest of an hour afterward. The treatment may be delivered for as many as six doses over the course of 12 days. (There may also be a nasal spray option, but the IV version seems more typical.)

You have to have someone who can drive you. The possible side effects include confusion and blurry vision. You can’t drive for 24 hours after the treatment, which basically means you can’t drive for two weeks, since the treatments are roughly every other day.

They don’t know how it works. I don’t find this surprising, since every time I’ve asked my psychiatrist how a medication works, I’ve been told, “They don’t really know, blah blah blah, neurotransmitters, blah blah blah, serotonin, blah blah blah.”

It’s expensive. The initial treatment may cost $500–$1,000, and a full course of treatments may cost as much as $3,800, which insurance won’t cover. These are estimated costs, based on treatment in various regions of the country. (The wholesale cost is approximately $.32 per dose, by the way.)

The results don’t last. They give relief for as little as a few hours to as much as nine months, after which a $600 booster shot is required.

You may still need regular antidepressants and psychotherapy. Ketamine may get you “over the hump” until your regular antidepressant kicks in, but is not a stand-alone treatment.

There are side effects. Confusion, hallucinations, and high blood pressure are among them, along with something called “lucid daydreaming.”

More research is needed. Duh.

The FDA has also approved trials of MDMA (Ecstasy) for treating PTSD. It is also being researched for effects on OCD, depression, and other conditions.

So, assuming that I could afford it, would I try ketamine? There’s not one easy answer to that.

Back in the days when my depression was drug-resistant, when I had spent years trying different combinations of psychotropics, when I was considering electroshock, I might well have seen ketamine as something to consider before I took that step. It should be noted that, at the time, my psychiatrist did not recommend or even mention it, so it might not have been appropriate for me whether I wanted to try it or not. And anyway, a combination of meds and therapy finally kicked in and made the subject moot.

Nowadays, I would not try ketamine (or MDMA, for that matter). My bipolar depression has moved from drug-resistant to drug-alleviated, at least for the most part. And that “most part” is enough for me. I have no need to be driven 45 minutes to the nearest clinic or to try to find a psychiatrist and anesthesiologist willing to go off-label. I am satisfied as I am.

As always, Your Mileage May Vary.

Sources

http://www.webmd.com/depression/news/20140923/ketamine-depression#1

http://www.ketaminetherapy.com/Depression.html

http://uchealth.com/intranasal-ketamine-infusion/

https://psychcentral.com/blog/archives/2012/12/01/should-you-try-ketamine-for-depression/

https://en.wikipedia.org/wiki/Ketamine

http://www.webmd.com/depression/news/20161130/fda-ecstasy-ptsd-treatment#1

Support and Non-Support Groups

My family has never been big on support groups. When my father had multiple myeloma (which killed him after 15 years), he turned down any opportunities he was given to join cancer support groups with names like Make Today Count. He preferred to go it alone. He was stubborn.

So am I.

I have actually been to support groups for mental illness once or twice, but they were never a success or, I guess, just never right for me.

The first one was when I was in college. That one was a bust because I wasn’t really ready to address my problems and because I had the ability to appear “normal” for an hour at a time while sitting cross-legged on the floor. I couldn’t do that now. (The floor-sitting part.)

The second time was after I saw a brochure for a group called High Flyers and Low Landers, which met in the church I was going to at the time. (I don’t think the organization still exists. The church is still there.)

It was a very odd experience. Everyone had a book, many with needlepoint covers. It was their bible, though not the Bible, which I know many people needlepoint covers for, or at least did back then.

The meetings consisted of a little ritual. One person read a passage from the book. Then each person in the circle had to tell an event that happened to them in the past week. The recital had to be in a specific format: what happened, what symptoms the person experienced (dry mouth, racing thoughts – there was a list), how the person would have handled it before reading the book, and how the person did handle it. There was much quoting of the book and certain specific phrases that everyone had to use.

Some of the quotations were helpful, or at least true. (People do things that annoy us, not to annoy us.) But as I recall, those were the only sorts of comments the people in the circle were allowed to make. Not “How did that work out?” or “What did your mother do next?” or “I hate when people get passive-aggressive.”

It was just too weird and formulaic for me, so I never went back. (As I was leaving, I offered someone a mint. Everyone laughed and said, “Dry mouth!”)

Since I don’t seem to do so well in actual support groups, I recently thought I would check out some virtual ones. I’m not going to name the groups I joined or where I found them, because all of them stressed privacy and confidentiality.

What I found was both support and non-support.

Some of the groups were associated with national organizations or publications, and they pretty much stuck to sharing articles about scientific research or political news about mental illness, along with lists of resources, hotlines, and the like.

So far, so good.

Other groups were more like traditional support groups, with members asking questions or relating accounts of what had happened or how they felt. There were administrators who tried to keep the members to more or less stick to the topic and rules of the group (give trigger warnings, no suicide threats, or whatever).

Some of the groups were peaceful. People asked standard questions (Who’s on this med? Should I take something else too?) and received fairly standard answers (Worked for me. Didn’t work for me. Ask your doctor.) People related similar events and how they handled them, or asked for more specifics so they could understand the situation better. People posted assorted uplifting memes and affirmations.

Then there was the other sort. People did not know how to use trigger warnings or simply didn’t bother. Others shared people’s posts without removing identifying information. Some posted truly vulgar jokes that had nothing whatsoever to do with bipolar disorder. Negativity overflowed. Arguments raged. (Some of the topics were “Bipolar is not an excuse for bad behavior” and “Don’t buy into the drug companies’ propaganda by taking meds.”) There was the online equivalent of name-calling and shouting. People reported other people to the admins. People accused people of reporting people to the admins.

The administrators did try to keep a handle on these groups, but couldn’t always, most likely because they were busy with their own lives and issues and difficulties.

It got so bad that I took to lurking instead of participating. Every week or so I would go back to take a peek and check on the drama llamas. Mostly they were still running around spitting. I think I had helpful things to add to the discussions and times when I needed help with feelings, but I just couldn’t trust enough to jump back in. I know other people left these groups for similar reasons, and some were blocked or banned or given warnings about their behavior.

In general, I have this to say about online support groups. You’d do well to sit back and watch their interactions before you try participating on anything but a “Congratulations! You got a job!” level. If the group seems truly helpful – supportive – then dive in. You may be able to give and receive help.

But non-support is exhausting. And I’m too stubborn to put up with it.

Trigger Warning: Trigger Warnings

What is a trigger warning?

Let’s start with a more basic question. What is a trigger?

Just as a literal trigger activates a gun, a figurative trigger activates your mental disorder. It’s a stimulus that sets off either a manic or depressive phase, or a bout of PTSD.

Triggers are usually unique to the individual. What sets you off may not affect me at all.

Over the years I’ve learned what my triggers are, and so do most bipolar or PTSD sufferers. Loud noises and large crowds trigger my anxiety, which is why I could never work at a Chuck E. Cheese. My depressive phases don’t often have triggers except for bad dreams about an ex-boyfriend. Most of my depressive episodes just happen without a trigger.

Generally, one avoids triggers, because who needs more manic or depressive phases in addition to those that occur naturally, with no prompting?

A trigger warning is something else. It is a notice that someone puts at the beginning of a piece of writing to warn readers that the subject matter may be intense. Ordinarily, trigger warnings are given for major life events that have caused trauma and may cause flashbacks, severe stress  or other extreme reactions.

Some of the most common trigger warnings are for graphic depictions of rape, suicide, self harm, or physical or sexual abuse. The trigger warning says to a potential reader: If you don’t want to encounter this material, if you think it will make your illness worse, or cause you undue stress, don’t read any further.

Although we call relatively minor stimuli triggers, they usually do not require trigger warnings. If you’re going to write about having a fight with your mother, you probably don’t need to put a trigger warning on it. If your mother hit you in the face with a frying pan and sent you to the ER, you might need to place a trigger warning on your post about it.

Online, the standard form for trigger warnings is first to state, often in all caps, TRIGGER WARNING and state the type of trigger it is – TRIGGER WARNING: SELF-HARM, TRIGGER WARNING: SUICIDAL THOUGHTS, etc. To be extra sensitive, the writer leaves a number of blank spaces or a few dots before beginning to write the difficult material. This gives the reader the choice of whether to scroll down and read it or not.

Trigger warnings have become controversial, particularly in schools and colleges. Many pieces of literature and even textbooks on history or sociology discuss difficult topics that may be triggering. For example, a novel might feature a rape as a plot point, or a history text might discuss slavery.

Some people believe that a trigger warning will help a prospective reader know whether reading further will provoke a strong reaction. Other people believe that trigger warnings are a way of coddling the weak and letting students avoid challenging material that is necessary for the class.

My own opinion is that a trigger warning is like chicken soup: It won’t hurt and might help. It may mean that a student asks for an alternative reading or assignment, but it also may mean that the student simply wants to be in a safe space – not surrounded by strangers, for example – before reading the material.

People that believe trigger warnings should not be given have usually not experienced the kind of emotional breakdown that can result from unexpectedly confronting a traumatic topic. Very likely they have never even been in the presence of someone who has had such an extreme reaction.

I suppose that ideally, we could all read any material and simply brush it off if we found it troubling. Unfortunately, for those of us with mental disorders such as bipolar illness, PTSD, and anxiety disorders, this is simply not possible. A trigger warning may prevent someone from having a public meltdown and others from having to witness one.

I don’t know why that should be controversial. It seems like simple courtesy to me.

Self-Harm Revisited

If that title isn’t enough of a TRIGGER WARNING for you, I don’t know what is.

Not long ago I saw on the web a video with the title “Is scratching self-harm?” Well, of course it is, I thought. The video agreed with me.

It seems like the low end of the spectrum, not as extreme as as what most people think of as self-harm, but a form of it nonetheless. Scratching, pinching, hair pulling, and the like are probably considered subclinical next to cutting and burning. But they are still problems. They can escalate into worse self-harm.

In another article (http://www.upworthy.com/this-researcher-who-studies-self-injury-explains-why-people-do-it-and-why-he-did-it?c=ufb1) I saw this definition for self-harm:

“Self-injury is intentional damage to body tissue (that doesn’t include body modifications like piercings, tattoos, and scarification) without suicidal intent.”

So, yes, scratching is self-harm. It is intentional. It is damage to body tissue. and it does not indicate suicidal intent.

Scratching sounds so minor. We scratch ourselves all the time when we have an itch or an insect bite. We scratch ourselves accidentally on protruding nails. Occasionally we draw blood. We wash it off, slap on a band-aid, and that’s that.

But when scratching escalates to self-harm, it can indeed be serious. For one thing, scratches have a tendency to become infected, infection of the sort can lead to further tissue damage – and if untreated, to more serious complications.

There is also the potential for further harm because the scratching will scab over. Then the desire to scratch off the scabs kicks in. When this happens, the scratches never heal. And yes, that’s both a fact and a metaphor.

My own experience with scratching came when I was working at a job that required me to monitor burglar alarms. The alarms tended to go off – whether there was a burglary or not – during thunderstorms. When a storm hit, a dozen or more alarms could go off simultaneously, or at least in rapid succession. I had to call the owners of the businesses, or emergency services as required.

One night during a particularly bad storm, I missed one of the alarms. I did not call the owners until I looked back at the record. When I called, it was 45 minutes since the alarm. I knew I had made a mistake, and a bad one. The owners of the business would not be happy. My boss would not be happy. I was not happy.

I sat alone by the monitors and imagined the trouble I was in. I started scratching my right arm – long slow strokes from nearly the wrist to nearly the elbow. Repetitively. Obsessively. Painfully. I believe I was punishing myself for making a bad mistake. Perhaps there was some thought that if I inflicted the pain, I would escape further consequences of my mistake.

Of course that makes no sense. It’s an example of the irrational thinking that goes with self-harm.

I don’t cut anymore, as I discussed in a previous post (http://wp.me/s4e9Hv-cutters). I also don’t scratch the way I did that night. I still have a tendency to pick scabs. Occasionally if I have an insect bite, I will scratch it to blood and then pick the scabs on that. I try not to. My husband helps me by reminding me not to pick at scabs or to put band-aids on them. I try to rub instead of scratch, or use lotion.

Jenny Lawson (aka the Bloggess) has admitted in her most recent book, Furiously Happy, that she scratches past the point of bleeding and pulls her hair enough to create bald spots. It’s clear that she considers this self-harm. Her husband tries to help her with it too.

But self-harm is basically a private thing – something we do and hide from the world. Some people are able to hide it even from their most intimate family and loved ones. I know I wore long sleeves to cover the dreadful scratch on my right arm. It healed from a scratch to a pink scar and then to a white scar. Now I can’t even see it anymore through the freckles.

But I don’t need the visible reminder. I remember how it felt to do it, how it felt after I did it, and how I felt as I watch the scars slowly fade. its nothing I’m proud of, except for the fact that I survived it and no longer do it.

As most cutters and other people who self-harm do, I feel shame in recalling the act, and almost never speak of it. The reason I’m sharing the story in such a public forum is to let people know that not all self-harm consists of big dramatic gestures. It can start with a tiny scratch. But it is not something to be ignored. We need to talk about self-harm, educate about it, bring it out in the open, and let others know that it doesn’t have to continue.

And that it can start with something as small as a scratch.

What Was I Thinking?

When I was a kid, I had irrational thoughts all the time. I think most kids do. They were harmless – even amusing.

It’s when you’re older that they become problems, or even dangers.

My younger self wouldn’t eat rhubarb because I knew that some part of the plant was poisonous and I didn’t want to take a chance. (I still don’t eat rhubarb. Any vegetable that needs that much sugar to make it palatable hardly seems worth it.) I suppose that could be considered an early OCD-type thought, since it was about potentially toxic food.

Another paranoid idea I had was that when someone threw a cigarette out of a car window, it could cause a major fireball explosion if it just happened to land underneath another car that just happened to have a leaking gas tank. I always looked around and braced for disaster when I saw someone fling a death-stick onto the road. It might as well have been dynamite, as far as I was concerned. (And I was very concerned.)

Yet another irrational fear (looking back, my irrational thoughts were almost all fears) was based on the fact that I had no idea how plumbing really worked. I was afraid that if I flushed the toilet right before I brushed my teeth, the waste water somehow flowed past the tap and could end up on my toothbrush.

(Another plumbing-related misconception dealt with sex (though not conception), but we won’t go into that now. Let’s just say that they never covered it in health class back then. For all I know, they still don’t. I had my mother buy me a copy of Everything You Always Wanted to Know About Sex But Were Afraid to Ask so I could find the answer.)

In my teen years, my irrational thoughts became more delusional, and more related to my by-then-shaky mental health. At some point it was recommended (I think by the high school, though I don’t remember the circumstances) that I should visit a counselor. And they were right. I certainly should have, although in retrospect, child psychiatry in those days was fairly primitive and I most likely wouldn’t have received a correct diagnosis or treatment. I don’t think bipolar type 2 even existed.

I’ll say this for my parents: They consulted me on whether I wanted to go or not, which was not what I would have expected. I declined.

My “reason”? I somehow thought that having such a thing on my permanent record would keep me from getting into a good – or perhaps any – college. (When I started applying, of course, no one even asked.)

And once I was in college and knew that my sanity was truly on shaky ground, my life goal was to graduate, and then work enough quarters (at pretty much anything) until I qualified for Social Security before I was put away. I was convinced that was likely to be my fate. I’m not sure why I thought that having Social Security would have helped.

None of those irrational fears were ever addressed in a timely manner. Except the sex one. Yay, me! for finding some accurate information on that one and Yay, Mom! for facilitating my enlightenment.

If you’ve noticed a trend of increasing irrationality and increasing potential for sabotaging my own life, you’re not wrong.

*** TRIGGER WARNING ***

The rest of this is tough stuff. You know what’s coming, so stop now if you’re not ready to hear about it.

When I had my major meltdown ten or so years ago, I had the worst irrational thought of all. My mother had just died, so my thought processes were pretty scrambled anyway.

Then my husband did something that I thought was unethical and likely illegal as well. Then he said he’d do it again. I managed to talk our way out of the first instance as a simple mistake, but his statement that he might do it again haunted me.

I catastrophized, of course. This time, however, the potential catastrophe loomed large and to me very real. If he did repeat his actions. there would be no possibility of smoothing things over. He would be culpable. And I would be in the position of needing to report it.

Then he would lose his job – at the very least – which was at the time loosely related to the legal system. They wouldn’t be able to overlook it.

I was unable to work at the time, trying to get disability, and we were barely staying afloat. Without his job, we would sink.

So I thought that, if he did it again, and I reported it, and he lost his job, the only thing left for me to do was kill myself.

Like I said, pretty irrational.

I had a plan, though. In fact, I had three or four different plans and I couldn’t decide among them. Indecision is part of what kept me alive.

As it turns out, my husband did not choose to repeat his actions, and I was spared the necessity of choosing among mine.

Soon thereafter, I got help. I never mentioned the suicidal thoughts till they were long gone, so I never even had to fear the dreaded lock-up that I had anticipated all those years before.

I kept one of the intended means of exit for a while, though. Just in case.

It was a major day in my healing when I finally let that go. That irrational thought had been dismissed and conquered.

 

 

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