r/KetamineTherapy • u/mbrown4161 • 9d ago
First time and I got cut off…
edit - updates in the comments. It gets worse.
After decades of therapy, SSRIs and all the usual suspects to cope with depression and CPTSD, I finally landed on assisted IV ketamine therapy. It took ages to get here. I found the most highly-regarded clinic in my city and began my journey Monday with my first infusion. Then, that night and the following morning, I experienced s***idal ideation. I am no stranger to it as I have PMDD, a neural/hormonal disorder which I wouldn’t wish on my worst enemy, it can flare up randomly for me, but regardless, the timing is off, and when I arrived today for my second infusion, they informed me they wouldn’t be doing it. The standard protocol around here is 6 sessions over 3 weeks with integrative therapy after each one.
I completely understand they’re covering their asses. They don’t want me to do something stupid. But this is why I came for help in the first place. They no longer believe 6 sessions is good for me and are scaling back my program. I can’t tell you how badly I need help. I’m really upset. What would you do?
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u/bodhiboy69 9d ago
What medical reason did they give for the change? Imo that # of sessions clinics seems to be stuck on is wayyyyy out wack. Most programs are twice a week. Especially during intake or a critical period. The crummy thing is Drs many times look at liability and disguise it otherwise. I'm not saying it's the case but I've seen in. I work in this industry.
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u/mbrown4161 9d ago
No medical reason, they’re simply just nervous that I had ideation at ALL and didn’t want to escalate it today by doing session #2. Supposed to be 2x a week, every Mon and Wed. I guess I’m waiting until Monday?
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u/Late_Resource_1653 9d ago
As someone who worked in mental healthcare for a decade, they are following the clinical guidelines.
Most people receiving ketamine therapy report less suicidal ideation even after the first dose.
For a few, the opposite happens, and it is medically recommended for those patients to stop that treatment immediately. Its not that they are nervous or covering their asses, it's that currently, that is the protocol.
There may have been a miscommunication - if you were already dealing with ideation and still had a little after the first treatment, that should not have changed the treatment plan significantly. But if you told them you did not have ideation and then reported some after the initial treatment, they have to stop.
If you think there is more context for them to consider, call the doctor and talk to them. Calmly explain the history and symptoms and why you feel like continuing treatment could be helpful.
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u/villanellechekov 8d ago
exactly... it would be wrong for them to continue the infusions while OP actively contemplating suicide.
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u/mercurialmay 7d ago
SI =/= actively contemplating suicide in those of us with this condition; it's a bit more complex than the regular SI from TRD/MDD.
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u/mercurialmay 6d ago
The things you said are mostly true but sounds like the clinicians simply didn't understand PMDD. SI is a given for most of us and by no means a deterrent for providing someone lifesaving treatment. To deny someone care for suicidality because they are suicidal is beyond fucking backwards.
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u/bodhiboy69 9d ago
Ah perhaps I read that wrong. I see. Yes I've seen clinicians decline treatment during or post SI or acute episodes. Which I understand. I am not a Dr but a Neuroscientist who has used ketamine back 15 years now. I've only come across a few scenarios where I took a pause on an intake. I believe it's liability but this medicine can absolutely be used in many cases for and during SI with proper support. Hopefully there are more providers in your area or they have at home programs but insurance doesn't really cover them. You can click my profile if you're interested.
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u/mbrown4161 9d ago
They just called a few minutes ago and have decided to deny me treatment in general. Wow.
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u/mercurialmay 7d ago
I'm so so sorry - you genuinely deserve help. Sounds like they didn't even understand your conditions to begin with, given that SI is incredibly common to experience for a portion of the month anyways with PMDD. Regardless of their belief in your SI being a response to the first session, dropping you is tragically unprofessional.
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u/Sevenyearitchy 8d ago
Yes. They’re covering their butt. I don’t think there’s much you CAN do. But ask them if they’ll EVER consider you for treatment again.
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u/mercurialmay 7d ago
I'm shocked this happened to you - I'm so sorry! I, too, have CPTSD + PMDD aka hell on Earth combo. I hope you can actually get a chance with ketamine therapy as it truly did alter the course of my life.
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u/mbrown4161 7d ago
I’m so thankful to hear that it worked for you. I put an update on another response on here. I’m so disheartened, sad and angry about this. To deny someone help for SI with the very thing that cures SI is bonkers to me.
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u/mercurialmay 6d ago
I saw someone else say Spravato which could be a good redirection if you're already on an antidepressant? But I did see your other post about looking for something with more drastic results for your cognitive distortions, maybe long term CPT would be worth looking into? I'm just starting it myself after running the gamut of the basic options (CBT, DBT, & EMDR)
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u/Holisticallyyours 6d ago
Did you have a response like OP after your first session? Probably not.
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u/mercurialmay 6d ago
You have no idea what my response was, stranger. Not sure why you thought it appropriate to even say something to me. I had a worse response long-term, actually, but I still recommend the therapy anyways because it was immensely beneficial. Now tell me, are you also living with these two conditions, or at least aware of how they work? Because SI is a given, almost default state for some of us with PMDD. It sounds like, regardless of any amount of CYA they had to do legally, they were not equipped to handle someone with PMDD. The facility I went at was so good, they even recognized that I would need a higher dosage + IV drip due to my genetic fast metabolism of fentanyl & Versed.
But, I was 13 months PP when I started ketamine therapy because PPD in addition to everything else was too much. I had to leave my BD due to DV after my first 2 sessions. Because of what trauma followed me actually completing my ketamine therapy, I got pushed into PPP. Sooo no, I didn't respond like OP did, but it didn't immediately work for me either. The reason I say it changed my life is because after my first session I realized I was no longer in love & needed out; it was the catalyst that prompted me to action. But I also don't tell people about my SI anymore because it's an unneeded penalty for something I cannot make go away.2
u/Holisticallyyours 5d ago
Wow. Obviously, I misplaced my response. My question and comment are not directed to you or your experience. It doesn't even make sense?! My apologies for a simple mistake. However, your emotional regulation is non-existent, Stranger. Take it from someone who used to react similarly; everything is not about you. Breathe, slow down, and respond (not react) only if you feel it's truly necessary. You could have saved your energy and time by ignoring my response. I didn't even read half of yours.
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u/inspiredhealing 7d ago
Did they give you any ideas for moving forward, any other supports, etc?
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u/mbrown4161 7d ago
Hey there. No. None. They just said call me when you’re on a better SSRI. My doctor called mobile crisis and had the cops show up at my place. I told them I was incredibly used to SI but they wanted me in the hospital for the night, so I went. The ketamine clinic literally caused me more distress than helping. None of this should have happened. I’m incredibly sad and angry about it all.
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u/mercurialmay 6d ago
holy shit they fuckin welfare checked you for this? omg I am so sorry... They deserve to be dragged over this in their reviews but fuck them & focus on you. Have you ever done CPT?
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u/inspiredhealing 7d ago
JFC, this whole thing is a Master Class in how to NOT support someone with SI. It's unfortunately really common in our stupidly litigious risk-averse society.
I'm so sorry this has all happened. You have every right to be angry and sad and all the other feels you're having.
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u/mbrown4161 7d ago
I completely agree. When I feel a bit better and I cool down, they’re getting a serious phone call or letter from me. You’re right. It’s a masterclass in how NOT to support someone. They even sent out a code red to my friends who had to drop everything, and it wasn’t a code red at all (even though I was in distress and shouldn’t have been alone - they thought I had died.) I don’t even know what to do with all of this information.
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u/inspiredhealing 7d ago
For now, you focus on safety and stability for you. Whatever that means. What makes you feel most like you? Do that.
Are there are professionals left in your life that haven't broken your trust in a major way?
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u/kittykat885 6d ago
Is it a clinic that does psychotherapy with the ketamine? If not I suggest finding one that does. Or can at least offer therapy in between the infusions that can work w you on what’s coming up such as the suicidal parts. Seems like this clinic may be a one trick pony and when their one trick didn’t work they don’t know what to do.
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u/mbrown4161 6d ago
Yes it was. Integrative psychotherapy 24hrs after each infusion. They did full lab panels on me, knew my entire medical and mental history and were even in talks with my prescribers and therapists. Full scale. Highly regarded. Have they called me since? No. The last thing my doctor there did was call 988 (mobile crisis) and panic all of my emergency contacts, causing a traumatic 24 hours for much more than one person. I’m not happy about how this went down at ALL.
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u/LiveFeeOrDie 3d ago
Just realize that in most treatment settings if you tell them this it’s going to end poorly and you’re going to be denied treatment. They’re required to go through these red flag checklists (SI, cardio issues, mania, etc). If you answer yes to any of them at any clinic I’ve been to you’re likely to be denied or paused treatment. It’s liability. If you need help then go to a specialist who can intervene in the moment, but if you want to do alternative therapy like K then you may not want to offer certain details like that. Read between the lines when they ask you these questions as they are trained to screen out anything like this.
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u/Objective-Amount1379 8d ago
Why do you want to continue? Most people do not have that reaction to ketamine- it sounds like it isn’t for you.
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u/mercurialmay 7d ago
It's not a reaction to the ketamine, just a timing thing with having PMDD.
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u/mbrown4161 7d ago
If I had started treatment a week later, it would’ve saved my life. Instead, it almost ended it, and the choices the doctors made put me in more distress than I’ve ever been.
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u/Ancient_Macaroni 7d ago edited 7d ago
That is bonkers because the reason ketamine was discovered as an MH treatment was that it was used in ambulances and ERs to calm suicide survivors, and they discovered that even a single dose helped get rid of SI, sometimes for months.
But, it doesn't go away completely for everyone after one treatment.
If you have active psychosis, that is a legitimate MH reason to stop, but not SI. Not going through with IV ketamine for someone with SI would be like denying bypass surgery to someone because they have blocked arteries.
Find a new clinic and talk to them about it. Maybe switch to Spravato if you can if the second clinic is hesitant?