Imagine that you find yourself in a snowstorm. You look around and you can tell you are in a forest but there is no clear sign of shelter or a way out. It’s getting colder, near white-out conditions and the snow is four feet deep. What would you do? Most of us would look for a few moments to see if there was any quick way out, a person, a cabin, a road. But if those aren’t visible, we would probably do what we could to find or make a shelter. We must get away from the elements as much as possible to survive. We might dig a snow cave or break some limbs to create some refuge from the full force of the weather. This storm and the rudimentary shelter built are a metaphor for the way many of us survive the storms of life. What if you had access to something insulating? Maybe a hat, coat, gloves, or boots? What might this alter for you?
These insulators are similar to the medications that we typically use for depression, anxiety, and other issues. Not all insulators are created equally. Taking the wrong medication is like having an over or undersized coat. Taking the wrong dose is like having a light jacket when you need a heavy parka or vice versa. Stopping the medication suddenly is like saying “well I feel warm now maybe I don’t need the coat.”
If used correctly the insulators will provide the protection necessary to make the next move. The next move usually consists of finding a way out of the storm. Now we can go much further in our search for a solution before feeling overwhelmed. The insulators may be needed for only a short time, or for a long period of time depending on how strong the storm is and how long it is likely to last. We don’t always know the cause of the storm. It may be a genetic predisposition or current social or environmental stressors. Some of these can be changed, while others cannot.
A guide is available in this storm. They know the mountain, the way through the storm, where the best shelters are, and how to make snowshoes and other tools. This guide is the equivalent of having a good therapist on your side. They cannot carry you from the storm, but they can teach you how to work within the current situation and how to use the correct tools to escape. Often this is enough to make the full difference, but sometimes it is not.
What if there was a tool that could stop the storm temporarily? What if it could lift you above the trees to give a clear view of the possible outcomes, and then clear the deep snow for several days? What kind of progress could you make then?
This is what ketamine and esketamine (Spravato) can do. They immediately quiet the noise, reduce the crippling fear and help you see past the obstacles that feel so insurmountable. Then it causes a release of Brain Derived Neurotrophic Factor, which creates millions of new pathways in the brain, quite literally creating new neural connections around the roadblocks that are present along the old worn in neural paths that continue to lead us to pain and frustration.
With these new pathways the world can begin to seem a bit brighter and it loses the feeling of heaviness and hopelessness. That hopelessness can be replaced with a sense of possibility and potential for growth.
These newly-opened pathways will only stay open on their own for one to two weeks, that is unless you take advantage of them. When these connections are used regularly the supporting glial cells in the brain will nourish them and encourage them to grow. As a result, they will be stronger and better pathways than the old, wide, and worn ones that keep us stuck in repeating patterns. Eventually these old pathways can close in and become secondary or tertiary pathways that take more effort to use than before. These enhanced pathways are better equipped to lead to motivation, joy, connection, and achievement, but more importantly, to peace.
Dr. Landon Moyers, DNP, APRN, PMHNP-BC
