Flashbacks

Trigger warning - This writing contains some graphic content which may be upsetting to some. Please read with care.

“No one knows the pain you carry. Everyone hides it… and when it’s bad enough you either come through it or you don’t. The world keeps turning just the same, blue sky and all.”

Now that I'm past the induction period of ketamine (2x a week for a month), the flashbacks have come back with a vengeance. In depression and long-term trauma, certain brain circuits become very fixed. The brain keeps running the same emotional pathways over and over. Ketamine reduces the dominance of those networks for a while. When that happens, the brain can revisit stored material that normally stays compartmentalized.

So instead of the brain keeping things neatly boxed away, connections between memories, emotions, and body sensations become more fluid. Emotional memories surfacing, sudden grief or anger, vivid recollections, and flashbacks.

I'm having all of this. The brain is actively processing material that used to stay tightly contained and it fucking sucks. If I'm not sobbing, I'm holding back tears. I hear the younger me screaming, "Why me!? Why did these things happen to me!?" There will never be an answer to this other than I just wasn't dealt a nice deck of cards in this life. 

The sadness is overtaking me again. The thoughts have grown increasingly dark. I won't do anything, yet I feel so much anger that I have to keep living. The pain is indescribable. The worst of it all is the isolation. Trying so hard for someone to see me but they just don't, and likely wouldn't be able to. I'm told "you can call me at any time", but this isn't reality. I can't wake a friend up at 2am because I had a panic attack remembering the first time I was raped as a virgin. I can't text someone saying how I am having vaginal pains recalling being abused as a child. And what would you say to me anyway? It happened to me and I wouldn't know what to say. But screaming and sobbing alone is a loneliness like no other. 

People genuinely want to help, but there is often a strange disconnect between intention and impact. Sometimes the words meant to comfort land sideways. Not out of cruelty, but because suffering makes people uncomfortable and they reach for the nearest phrase that sounds supportive. And as I’ve said so many times before, the perfect words don’t exist. You can’t tell me it’s going to work out, because it might not. You can’t tell me things will get better, because they can get worse… much worse. The truth is that when you’re in the middle of something like this, there are no reassuring sentences that can carry the weight of it. Sometimes it feels like I’m standing on a stage with everyone watching, quietly waiting for the moment when I’m finally “better.” There are times I sit holding my head, swaying back and forth, trying to will all of this away, and the only thing that comes is more tears.

I feel one of my deepest neural pathways, that possibly the ketamine is loosening, is the constant fear something bad is about to happen. Because horrible things did keep happening and I couldn't tell anyone. How do you explain to your friends at 16 as they go to prom and plan for college, that you have knives hidden all over the living room to kill your mother's boyfriend for how he was terrorizing us? How do you explain that every time you tried to hope it was blown up in front of you? Most people don't know what it feels like to have been on your own since you were a teenager with no safety net; no family to give you some money if you're going under, no partner to have your back, knowing the entirety of your survival is up to you. 

I'm told this is the resurfacing phase. For people with trauma histories especially, the brain reactivates stored emotional networks and accesses material that used to be locked away. My brain has attempted to numb and push it all down. It’s not healing; it’s containment so you can function. The brain is bringing the memory network into awareness where it can be reorganized. It's incredibly lonely and destabilizing to do this by myself. But there is no other choice. 

As we're so often told "it gets worse before it gets better". The next phase would be reprocessing and integration. Yet I'm barely breathing.

"No one can tell what goes on in between the person you were and the person you become. No one can chart that blue and lonely section of hell. There are no maps of the change. You just come out the other side. Or you don't." Stephen King (2008). “The Stand”

Reprocessing

Processing. I'm so sick of the word processing, along with trauma, healing, and so many other therapy buzz words. But apparently this is the stage I'm at in my journey. There is a lot of misconception with ketamine treatments that they in itself will "make you better". (Note: I didn't use the word healing. Let's just lose that word entirely when it comes to CPTSD and treatment resistant depression. Not helpful. In fact, it's hurtful.) 

As ketamine changes the brain's neuroplasticity it also loosens the brain's filtering system. When ketamine loosens the brain's defenses, older parts of your life can start to surface. When the brain becomes more flexible, the protective walls you built to keep painful material contained can loosen. So things you pushed down can surface. Memories, grief, anger, shame, sadness, and flashes of the past all hitting at once.

I thought the incessant crying was over but it's back. I'm told this is processing crying instead of collapse. It feels the same. I broke down the other day in front of friends. I was doing everything in me to hold it together and then one asked about my ketamine treatments and I fell apart. It was humiliating. Everyone was kind and said they loved me but now it's been over a day and no one has reached out. Not a surprise to me as this has happened my entire life. You are told you are safe and to open up, you do it and then silence. No one looked back to see if I was still standing. I get it though as there are no good words to say. If you hit me with some toxic positivity shit then I'll push back hard, but then if nothing is said I'm just as sad. There's no way for anyone to win here. 

Yesterday was brutal. I spent a good 6 hours crying from afternoon to night until I passed out on the couch from the exhaustion of it all. Woke up still crying. My cats were jumping on me and meowing as they knew I wasn't OK. Passed out in another crying fit this afternoon. I don't want to detail my thoughts as they'd land me in inpatient and if that were to happen it would be the literal end of me. I guess there must be some hope left to have the strength to refuse. 

Doing this alone is rough. There is no one to hug you and say they won't leave you. (Well, there never was anyone anyway) I have no safety net. People care about me but at the end of the day it's me holding everything. 

I am just so sick of being this person. It's always me. The sad one, the one alone, the one making bad choices. I have another appointment tomorrow. I'm still trying, but right now I don't know how much I have left.

The Crying is Back

I started crying again. I felt like things were better, less triggered, no recollection of panic attacks since starting ketamine treatments. Then the tears came back and I feared I was regressing. Yet neurologically and physiologically these are two different states. Prior to ketamine I was in a collapsed state, dorsal vagal shutdown, where the nervous system believes survival is threatened and escape or repair isn’t possible. In this state the crying was uncontrollable and got to be constant. The hopelessness felt absolute and permanent. I am told I'm in a nervous system that is still wounded, still grieving, but no longer trapped in the same physiological prison. Ketamine restores flexibility to neural networks. That means emotions that were previously frozen or buried can move.

"Doesn't that sound nice? Now you can cry and let it out and heal!" No one said these exact words to me, but I've heard many versions of it. I don't have any expectation of "healing", as I don't believe we can heal from everything. There feels like an expectation of those looking on from the outside, that "healing" is an actual achievable goal, and if you don't then it's your fault. Though the intentions are good, it's not helpful. 

Since things appeared to be going well, when the tears came back I was crushed and scared. My mother had sent a picture of a snowfall through a family text chain. My brother replied with a picture from the ocean saying he had a better view. This brother is also a therapist, who I reached out to when I was trying to get into intensive outpatient. He knew I was suicidal and going down hard. He doesn't know I'm now doing ketamine as he hasn't reached out at all to see how I am doing. He also got engaged over Christmas and is traveling the world with his fiancé. I am still unemployed, alone, and my one big goal when I got divorced was to travel and just an hour before this text I'd downgraded my Sky Miles Amex as I've lost flight status and can't afford to go anywhere. The comparison, looking at what I want yet just never happens for me, seeing a life I'd long for, it all just took me out. 

First thoughts were that I couldn't go through this again. I thought of the months in collapse where I'd be screaming and sobbing, and it nearly ended me. But the crying did stop this time. I saw that though painful, I got back to my level set depression state and kept going. 

I've wiped the tears once again. And I'll go on. But I'm so fucking tired of trying and living in this pain.

Tips & Tricks from the Psychedelic Trenches

Author's note: this post will speak directly to my personal experience. Yours might be different. Do what is right for you.

Going into my 5th ketamine session today. Might be at a higher dose, and doing this two days back-to-back, so I'm expecting to be decently out of it and that my experience will likely change from the previous ones. 

These are the steps I take that worked for me, some from advice from others, and some just knowing how my body reacts.

Comfort:
I need complete and absolute comfort in my sessions. Tried having my hair in a ponytail but that small pull on the hair was too intense. Changed underwear prior to a session as it was creeping up my butt a bit too much and I knew it would bother me. Soft clothes, nothing tight or binding, not even the slightest bit of irritation. 

Warmth & Weight:
I need to be extra warm. Not hot, but no amount of chill. I used a weighted blanket my last session and it comforted and grounded me in a way that I felt completely secure.

Food:
My first session I was nervous and didn't eat much. I had a 1/2 of an apple, small amount of almond butter, and a few hours later one slice of toast with a little almond butter. This was fine, but I have issues with low blood sugar so I don't think it was enough, especially as my session went over lunch so I wasn't able to eat again until midafternoon. The next session I had what is my go-to breakfast: I call it a protein pancake. Basically, a small amount of protein pancake mix, 1egg, cinnamon, stevia and a little almond milk to moisten. I eat it with berries. My blood sugar felt more even with this or maybe it's just what my body likes, so I've been sticking with it. Maybe it's because my sessions have been over lunchtime, but by the time I get home I'm shaky and struggling, so I need food that I can grab and go right to the couch. Tried to cook something after one session and it was too much effort.

Home prep:
I need to have everything in my home comfortable and ready to go, so when I get home from a session there is nothing for me to do but rest. Everything clean and orderly, food stocked, candles, lighting...I sort of make my own home spa setting.

Music:
I was advised to use ear buds and play music without lyrics. I played Ambient Deep Sleep (though there are many Ketamine playlists on Spotify). I can see how any music with lyrics, or even instrumental that brings up recall memory, might be triggering. 

During treatment:
In the clinic I go to there are lounge chairs, a little table with barf bags (amazing I didn't need one), mints (for the chemical taste of ketamine going down your throat), kleenex, and a call button in case you need anything. I get situated by making sure my blanket is all the way up to my neck, laying way back, earbuds in and then stillness. The first session I don't think I moved at all but the ones after I did switch positions to my side later in the session. I did see one patient sitting up looking at his phone during his session. I can't imagine this, and struggle to even do this after the session at home, but again each experience appears to be individual.

Vitals:
Your vitals are checked before, during, and at the end of your session. It's typical for people's blood pressure to go up during a treatment. Mine goes down, but doing the opposite is typical for my body, which is all the more reason I'm relieved and amazed that I haven't had side effects from this.

Bottom line advice:
Tune into you. Listen to the advice of others, but your body is your best teacher (my yoga teacher voice coming out now). Your body knows what to do, don't fight it, just be there and let the drugs work for you.

He didn't love you

"He didn't love you." Said to me so matter of fact, as if I'd shrug my shoulders and say, "True!" then skip on down the lane. Always said to me in a way that assumes I didn't know this, and this knowledge would somehow change my feelings. Change my hurt. Change my heartbreak.

I loved his voice. His looks came and went. Sometimes looking so attractive and other times like a pudgy old man lying about his height. Though he'd always tell me how good looking he was. Soothing voice. A voice with conviction that you believed. Even when I knew he was wrong he would say things in such a way that my mind would question even with all proof before my eyes.

He didn't love you.

As I was crumbling, he said, "So have you cried yet today?" with a laugh and smirk in the undertone. He held me as we lay together on the beanbag that night. I was drunk, high, crying quietly as I plummeted further under. I never felt he cared, yet I clung to his arms with the distant hope that if he felt my pain he'd return to those early days of claiming he loved me. He saw and acknowledged I was breaking, even said he knew I was suicidal, yet offered nothing.

He didn't love you.

I drove drunk and high with him. Opening a bottle of wine and chugging it from the bottle while going down the road in broad daylight. Flying to Vegas to meet up with him and not telling anyone, where we agreed to play like we were in love and nothing in the past had happened for the time we were there. It was dangerous, and toxic, and I should really regret it but I don't.

He didn't love you.

I've lost two years of my life to this man. Longer. But even with the devaluation, the cruelty, the abuse...God we were so fucking great in some ways! He lied (yet said I did), said some of the most hurtful words ever spoken to me, broke me...but there was also a connection I have never had, and don't expect to again. 

He didn't love you.

The Magical Mystery Tour of my Brain

Author's note: I am documenting my ketamine experiences from my point of view. This is to share for anyone considering it, doing it, or supporting someone through this. I also believe, as with everything in life, our experiences are unique, so please take it from that view.

Two more ketamine sessions in and each one has had its own nuances. The day prior to my third session I had a brutal, but good, EMDR session with my therapist and was emotionally raw. I've also been told the third session can be rough as the novelty has worn off a bit, you know what you are in for, and likely wanting results. My mind raced during the third session, and I couldn't shut it off. Even after I got home, I was agitated though exhausted. Yet my fourth session was amazing! Back to being trippy (which I enjoy) and I was able to tell my mind when troubling images appeared "I'm thinking". No forced changed, no getting upset, just a reminder that my mind was thinking and didn't need my effort. On this session I also used a weighted blanket which gave me the containment and security, I think, to ease and calm into it.

Next week I am being moved to the higher dose (if it gets approved in time) and doing sessions 2 days in a row. I'm assuming I will be completely out of it for 2 whole days, and am making preparations to where I have food, house is clean, all boxes checked and nothing to worry about. 

How ketamine works in plain terms (And maybe it's just because I feel my brain changing or that I've struggled my whole life, that this fascinates me to no end. I underlined parts that really stuck out to me, adding some commentary in parenthesis that hit me.):

How ketamine works chemically in the brain

Ketamine works primarily by affecting the brain’s glutamate system, which is the main system responsible for learning, adaptation, and neural communication.

Most traditional antidepressants work on serotonin or dopamine and take weeks to gradually adjust levels. Ketamine works differently. It acts upstream, at the level of neural connectivity itself.

1. Ketamine temporarily blocks NMDA receptors

NMDA receptors normally regulate glutamate activity. Ketamine blocks these receptors briefly, which creates a controlled disruption in the brain’s usual signaling patterns.

This interruption prevents the brain from running its habitual loops in the same rigid way. (I'm a hard ruminator. Even when having a good time, in conversation, doing anything, the thoughts are incessant.)

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2. This causes a surge of glutamate release

Because NMDA receptors are blocked, the brain releases more glutamate through other pathways, particularly AMPA receptors.

Glutamate is not a “mood chemical.” It’s a plasticity chemical.

It tells the brain:

“Pay attention. Something new is happening. Adapt.”

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3. This activates repair and growth mechanisms

The glutamate surge triggers downstream processes, including the release of a protein called BDNF (brain-derived neurotrophic factor).

BDNF supports:

• growth of new synaptic connections

• strengthening of healthy neural pathways

• repair of stress-damaged circuits

Chronic depression and trauma tend to weaken and prune neural connections. Ketamine temporarily reverses that pattern. (Temporarily. I just had my gut clench in fear of what happens when this ends. I wonder if you do enough of these sessions that it actually allows for repair.)

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4. The brain becomes more flexible

For a period of hours to days after treatment, the brain enters a state of increased neuroplasticity.

This means neural pathways are less rigid and more capable of reorganizing.

Thought patterns that previously felt automatic and inescapable may loosen. Emotional responses may no longer trigger the same intensity of physiological alarm.

This flexibility allows the brain to update itself.

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Why effort is not required

This process is chemical and cellular. It does not depend on conscious effort. (This is a hard one for me. I've been told for so long that my mental state is from my lack of effort while I'm always trying.)

You cannot “force” neuroplasticity through concentration or willpower during a session.

The beneficial effects come from the biological cascade:

• NMDA receptor blockade

• glutamate release

• BDNF activation

• synaptic remodeling

These processes occur regardless of whether your mind is quiet, busy, creative, or distracted.

Trying to control your thoughts does not enhance the effect. In fact, excessive effort activates control networks that can interfere with the nervous system’s ability to settle.

The brain repairs itself best when it is not being micromanaged. (I straight up laughed out loud on this one! I absolutely micromanage my brain.)

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What you may notice subjectively

Because the brain becomes less locked into old patterns, people often experience:

• more space between thoughts and reactions

• reduced rumination

• emotional distance from previously overwhelming material

• increased ability to choose responses instead of being driven by reflex (Though mostly responsible, I'm a highly impulsive person. I've been judged harshly "Why would you do that?". I don't fucking know!)

These changes often emerge gradually, not all at once.

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The key point

Ketamine does not insert happiness into the brain.

It restores the brain’s ability to change.

Once flexibility is restored, the nervous system is no longer trapped in fixed survival patterns. New responses become possible.

And importantly, this process happens whether you try to make it happen or not.

Something Amazing

I found this quote I'd forgotten about that was my mantra and focus when I got divorced. "....Okay is not the reason you risk absolutely everything you've got for the smallest chance something absolutely amazing could happen!" I left without a dream or a clue as to what "amazing" would even mean for me. I simply couldn't live another moment trapped in mediocrity and lovelessness. I read it while trying to buy my condo (which my realtor and the closer said was the hardest closing they've ever experienced), I read while sleeping on the couch with a blanket too short to cover my feet because I was starting over with nothing, I read it when flying to Greece alone for the trip I'd always wanted with a partner. Hanging onto the smallest chance something amazing would happen.

Writing this the day after Valentine's day which is a hugely sad and triggering day for me. I'd wanted a wonderful romantic Valentine's my entire life. No boyfriend in Jr High or High school. I watched as the other girls would get sent a rose on Valentine's day and hope, wish, and pray I'd get one but never did. My (ex) husband was the first to ever give me a Valentine's card. The first card, and every card for 24 years, said the same thing "I know I never say it but...". Every card. He'd buy me roses from the gas station that sold a dozen for $9.99. And I'm as happy as anyone for a great deal, but there was zero thought into who I was. He could have spent $5 on pink carnations and that would have shown actual care and thought about me. Even his Facebook posts were about him and not me, showing how he'd bought me roses but nothing about me, his wife. 

When I met my last boyfriend (I struggle to even call him that as it all progressed into such an abusive mess), I was desperate, hopeless, and prime for manipulation. By the time our first and only Valentine's rolled around, I knew who he was but I shoved it all down still clinging to just maybe getting one moment of something amazing. We had a wonderful dinner, beautiful loving card, flowers, presents and the public profession of love on a Facebook post that I'd been dying for saying I had brought him the happiest moments of his life and he loved me more each day. I wiped tears reading it and then I looked at the pictures he posted with it. Alongside adorable pictures of us as a couple he included one of my ass crawling up the stairs drunk and another of me before surgery (that only my closest friends knew about) where I have no makeup, hospital gown, hair net, IV in my arm. The tears changed from elation to hurt. I asked why he'd post those pictures, while being extra careful not to sound mad as I didn't want this moment I'd waited for my whole life to go wrong. He said, "Oh I just quickly grabbed a couple." In the short time we were together we had a massive amount of pictures of us, we dominated the Facebook feed, this was a purposeful cutdown. I smiled and stayed silent as I couldn't accept that this wasn't real.

My 5th ketamine session is tomorrow. One of the biggest things I've noticed is my thoughts are different. The sadness, hurt, and trauma aren't gone but they are distant. I can say, "That was awful and hurt me to my core." without spiraling down the rabbit hole. I saw all the happy couples posting yesterday, and though my mind said "you'll never get that", it didn't make me want to drive into a semi.

Though all signs show my existence will be to die alone, my life is amazing. I have an unbelievable amount of people in my life that love me and have given and shown up for me in ways I could never have fathomed possible. I have pushed through every fear, and self hatred, to do things my little self would never have dared to dream. (I didn't even allow the dream....I just kept going.) For some reason, and I do believe there is a reason, I'm still alive. This is a miracle as I was quite literally hanging from the edge and not telling myself to hold on, but to end it. But maybe, just maybe something amazing will happen.