Ketamine starts Monday and DBT soon, wish me lucK...

[Momofadultbpd]

My adult daughter is a very high functioning professional most of the time. But it takes constant medication , therapy, and attentiveness to her every need from myself and her dad to keep her going. She’s a very “good girl” who does everything that she is told to do to help manage her illness (diet exercise hobbies friends etc). It takes every ounce of her energy and mine to keep it together.

Her engagement (after a 4 year relationship) ended abruptly about 6 months ago. Since then all her usual coping mechanisms are not enough and she threatens suicide daily. She was hospitalized only once recently but she threatens daily. She had one almost successful attempt (pills) about 15 years ago.

She is too sick to work now which is the first time in her life she couldn’t keep up with school or work. She is getting ready to start DBT and a series of ketamine infusions. Her therapist of the past 15 years is supportive of the DBT but not of the ketamine. She (and her dad and I) feel so desperate for relief that she is going to start the ketamine next week despite her psychoatrist’s desire to just try another drug (Latuda and lamictal). She has been on every drug in the past and it’s fair to say they probably helped with all her accomplishments but she will say they have never done anything with her obsessive thoughts of suicide.

I am hopeful that the DBT (via a new therapist) and the ketamine will be a godsend. She can be the  most loving daughter and the most evil villain back and forth in a day.

I don’t believe in miracles but I could use some encouragement that the DBT and/or the ketamine can make a difference in the suicidality. When she is not thinking about killing herself she is an extraordinary woman.

I’m coping. But I’m losing hope. She has almost convinced me that her pain is so severe on a daily basis that only the cruelest of mothers would insist on her continuing to stay alive. She wants my validation of her reasons to kill herself. I’ve come close several times under unrelenting pressure of verbal and emotional abuse.

I never fight back because I cannot match her strength and energy when she is all revived up and fighting for the “right to die”. She always fights me to the point that I am curled up in a ball hiding in my closet begging her to stop assaulting me (verbally and emotionally). It usually ends when she finally takes enough tranquilizers to put her to sleep. A typical episode lasts 8-12 hours and occasionally lasts until the next day.

She’s always sorry. But then she will do it again soon after.

Now that’s she’s 30 I am trying to limit myself to an hour of this kind of confrontation. But it hasn’t been successful. I get sucked in because she starts the suicide talk. As long as I am in the room she’s alive.

But this can’t keep happening. It’s no better now than when she was 15. I am desperate for the DBT and ketamine to do something.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Hyacinth Bucket]

Hi MomofadultBPD,

I almost don't have words, that sounds unbearable. I'm so sorry that this is still happening after so many years.

My best friend, while not BPD, did go through ketamine treatment and it definitely saved her life. She was extremely suicidal.  The big thing with ketamine is keeping up with the boosters. She waited too long for a booster and relapsed, but she's doing well now.

I'm glad you got her in so quickly. There is a good chance it will help. dbt is also by far the most effective therapy for suicidal patients.

Do you have support for yourself? Therapist, friends?

I hope for your sake and hers that things improve rapidly. Please keep posting and let us know how you're doing.

[Hyacinth Bucket]

Has she considered residential treatment?

[Only Human]

Hi MomofadultBPD and welcome to BPD Family.

I can only imagine what it must be like to endure hours long emotional abuse, to the point you're curled up in a ball in your closet. This is heartbreaking.

I don't know anything about Ketamine, sorry. I'm glad you found us, this is a very supportive and safe place.

~ OH

[Momofadultbpd]

I do have a therapist and take medication to sleep and control my anxiety. I take very good care of myself.  I have strong support around me.

Residential treatment is an option at Some point. Until recently she was working and doing well at a high paying professional job. She kept it together for her job and she and her therapists thought it was an important part of keeping her on track.

She would just fall apart on the weekends and go to work on Monday.

Now that she is not working she has nothing to keep her on track so she is worse. But she starts DBT and ketamine next week and that will be her “job” for a while.

[loveandcare]

HI!
Our DD is 18 and BPD. I had suspected it for years, since about 11/12 or so, but nobody would diagnose her before 18. So frustrating because we wasted so much time and energy on pointless therapies that simply DO NOT work for someone with borderline. They need specialized help, as you know. Anyway - our DD has the common co-morbidities of depression and anxiety. She is emotionally numb/empty. She turned to smoking drugs just to "feel" something. It's been awful. Long story short, we were referred to try Ketamine infusions with the idea that if we could at least lift the depression then she would be more open to trying to help herself. As is often the way with BPD - they self-sabotage, so our goal was to get her feeling better enough she could start to address the issues.

Anyway - she's on treatment 4, and I would say there has been a slight improvement, but not a great deal. I am not sure if we will continue at this point. We are paying out of pocket, and it is $500 a treatment, so we've dropped $2K so far, and we haven't seen the results we so hoped for.

Having said that, I would still encourage you to try it. From everything I've read, it really can help. I just wonder if the BPD somehow makes treating the depression almost impossible. At least, that's how it feels to us. We have tried every med out there over the last 6 years, and every treatment style going.

So - we're kind of in limbo right now. Not sure if it's worked or not, and not sure if we'll continue. I'll keep you posted.

[wendydarling]

Hi MomofadultBPD  

I join others here welcoming you to the community.  I'm sorry what brings you here and what you're going through with your daughter is heart breaking, I'm so glad you've come here for support, you are not alone.  

I don't have any experience of Ketamine to share with you, I do have experience of DBT. My 30DD had 14 months weekly DBT and in time it did address her self harm, suicidal thoughts, acting on. She came to realise she wanted to live and that she had to work using the skills she was learning. She gave up work (Creative Director) half way through to concentrate on DBT, give it her 100% best, she removed all external stressors, that was Dec 2016. She applied herself to DBT.  She's been out of DBT/therapy for 12 months, doing well, joined another DBT group a month ago. She advocates for DBT, the value of it to others suffering BPD.

DD did have a crisis 2 weeks ago (shock), first in two years, her meds were halved 3 weeks prior and she was experiencing dissociative states, there were a number of stressful issues which likely  prompted the dissociation. That's what we are working through to understand right now.

DBT and getting her meds right were the game changer for her. I got my girl back. I've come to realise she'd likely benefit from other therapies to compliment DBT. Schema has been mentioned to her, so she'll be going down that road at some point I think.

DD's not back to work, she won't be going back to her previous career, she's past that now. What she will do I don't know, she's not quite there. My approach has been to support her concentrating on recovery by just giving her the space to do what she needs to do. What I have learnt recently, that means back to back on going treatment for her, for now.

I hope my share helps, gives you some comfort things can improve, it's been small steps and lots of patience on my part.

Are you familiar with the tools and lessons to your right, many are DBT based  

I'm glad to hear you've a solid support network in place and you can add family here to that. It really helps to talk!

WDx

[Momofadultbpd]

Much thanks to everyone who is sharing heirbstories. You get it and that validates me and it makes me feel better.

So, yes, I’m using the TOOLS on the website and I especially liked the talk by Dr Fuzzenatti on Validstong. It was spot on

I was not validating my daughters feelings (big mistake I know now) but in my defense, her feeling was that she felt like she had the right to die , to kill herself. I had been told by therapists never to “give her permission” Or empathisize with suicidal ideation. After watching the validating talk , I see how I can split hairs and validate how my daughter feels about wanting to kill herself without actually condoning or giving her permission to do so.

She had another meltdown last night so currently is ignoring me. It gives me a break , but that doesn’t really help because I have no way of knowing if she is alive much less okay.

When I do see her I plan to carefully validate her feelings of thinking that lo life is
To painful to live without condoning suicide

Wish me luck.

She starts ketamine on Monday and hopefully DBT soon. I’ll keep you posted.

Thank you all for your input. It is much appreciated.

[wendydarling]

Hi MomofadultBPD  

Yey! Wishing you bundles of luck.   Gee, we have to keep our spirits up, we're in the trenches together.

Isn't the talk by Dr Fuzzenatti just brilliant, I'm glad you found it helpful to see how we can validate feelings, split hairs as you say. The resources here are world class, as are the parents!  

One thing I'd like to share. My DD spent so much time in her room, recluse, it worried me until I realised she was practising her skills, to help her regulate, keep calm, sooth. She needed quiet. And I had to trust her. While you may not see progress externally, I came to realise the progress internally was happening. My DD is a quiet pwBPD, hard to read.

Does your DD practise self soothing?

WDx

[SunBreeze]

My DD18, with uBPD, but certainly with diagnosed “traits” and behaviours, and comorbities of depression and anxiety started ketamine in the spring 2018.  She has been treatment resistant with several classes of anti-depression medications. She went for an intensive 2 week protocol of 6 ketamine infusions, the recommended method of infusions.  It is reported that 70-75% of persons will respond to ketamine and I was so hopeful that she be in that percentage.  Prior to treatment, two written tests were conducted to measure the level of her depression and anxiety.  Both were in the high range.  After the first infusion, and by the evening hours, her depression dropped dramatically, and by the next morning, she was a changed person.  After the third infusion, at the end of the first week, they redid the tests and her written test levels and self reporting put her in remission from depression.  It was amazing to witness.  Be mindful that she admitted that she said that she didn’t know how to be this new person, and so it’s not like all her behaviours disappeared but said she couldn’t locate her depression inside herself even by trying. This itself was so important to lift and see her happy again.  She still needs to learn more tools for self care and monitoring.  She does need ongoing booster infusions for maintenance and these are timed by my observance of her, her communication to me, and through an app registering her mood / written retests that connects electronically to the Dr’s office. She also continues with DBT. Good luck on Monday.

[Momofadultbpd]

Thank you both for sharing. Each of you make important points.

I can see how even feeling better internally may not manifest externally until the internal change can take hold and life-long behaviors developed while “sick” have to be “unlearned”. And I see how this can take time and will need a lot of space and practice. Thank you!

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[SunBreeze]

Also,further to my earlier post, be aware that the Lamictal, which you say is being recommended for your daughter, can be one contraindication for the success of ketamine infusions.  It can be taken, but only to a certain mg amount.  Make sure if your DD does start Lamictal to discuss with the ketamine practitioner.  I'm sure they will go over medications with you/her. 

[Momofadultbpd]

Thanks for the info on lamictal and ketamine. Damn. Didn’t know about that!

Also, please send me link about self-soothing. That is clearly a serious problem with my daughter. She blows up so easily and
Cannot self-soothe. Her go-to plan is to call me and expect
Me To sumpathize and empathize with the pain that she is feeling because of ________(something usually trivial).

I can’t imagone wanting to die because I missed my furniture delivery. Yes, I do feel frustrated and it puts me in a bad mood, but I don’t call up my mother and expect her to feel the same degree of pain and explain that that’s a good enough reason to commit suicide... .I also don’t expect for my mom or anyone  else to soothe me.

She has had years of therapy so she knows about taking a hot lavender bath, turning on music, having some herbal tea, etc. she does that kind of self-soothing. Is there more?

In the past I would try and put whatever happened in perspective—the sofa will come tomorrow, nobody is sick or hurt, it didn’t cost you any money , etc (use logic and reasoning) but that only INFURIATES her even more. I realize now that when I do that it INVALIDATES her feelings. I’m working on validating her feelings, sympathizing and empathizing more rather  than “problem solving”. She’s perfectly capable of problem solving herself. She just wants her feelings validated.  So that’s what I’m working on.

BTW—she missed her sofa delivery this morning. So back to suicide talk again today.

[loveandcare]

So - we completed session4, with very little improvement. That night there was a melt down, and then she has been gone for close to 48 hours. Long story short, we think it is highly possible she was smoking oxy (opioid) during treatment. Since ketamine targets the same receptors, that would obviously negate all the benefits of the ketamine. I actually think it would really help her if she wasn't doing the drugs, so I would definitely encourage you to try it.

[Momofadultbpd]

I feel lucky that my daughter has never self medicated with alcohol or other unprescriobed medications. But I feel like none of the prescribed meds she has ever been on has helped with her suicidal ideation. So I’m using a lot of wishful thinking In hoping that her treatment resistant suicidal ideation will respond to something completely different—ketamine

Since unlike most meds used to treat BPD ketamine seems to work quickly maybe you can get your daughter to refrain from opiates and other substances and give ketamine a chance—emphasizing that she may feel some rapid relief?

I’m also learning that there is a lot of overlap between bipolar disorder and borderline personality. I think that’s most likely what my daughter is dealing with. She has aspects of both and doesn’t fit that well with either of them alone.

It is complicated. But over time patients and caregivers can learn and things can get better. I definitely feel your pain and frustration and fear. I don’t have a solution for you or for me. But your situation is not unique and maybe knowing that you are a loving and caring parent who is doing your best will make you feel better and keep you going.

Just me saying that to you shows that I have taken the VALIDATING lesson by Dr Fuzzenatti to heart. I am sympathizing and empathizing with you (validating your feelings) rather than rushing through your emotions and trying to solve your problem. I can feel for you but I can’t fix it. That’s supposed to help. Does it?  I hope so because that’s how I’m teying to manage
My daughter. So far it seems to be making a difference and she hasn’t even started the ketamine or the DBT yet

My validating how she feels (rather than trying to talk her out of how she is feeling) is so far making  a huge difference in our interaction. Turns out that’s what she mostly wanted. She didn’t need help problem-solving. She is better at that than I am. What she wanted was validation. And I was refusing to validate her suicidal ideation.

It’s only been One day. But for that I’m appreciative.

[loveandcare]

Where did you find the VALIDATING lesson by Dr Fuzzenatti ? Is that on here, or Youtube, or someplace else?
Thanks!

[wendydarling]

Here, loveandcare ~ in our video library

  VIDEO | Validation and Invalidation 

[wendydarling]

She has had years of therapy so she knows about taking a hot lavender bath, turning on music, having some herbal tea, etc. she does that kind of self-soothing. Is there more?

Yes, that is what I was referring to, Taste, Smell, See, Hear, Touch, helped my DD when she was suffering extreme anxiety, panic attacks, psychosis. This was before she joined DBT.  Self soothing is part of the Distress Tolerance module, so using all the skills together will hopefully help your DD.

Distress tolerance module ….

Using Crisis Survival: Distraction with Wise Mind Accepts
     A Activities
     C Contributing
     C Comparisons
     E Emotions - use opposite
     P Pushing Away
     T Thoughts
     S Sensations
Using Self Soothe with five senses:
     Using Improve the moment:
     I Imagery
     M Meaning
     P Prayer
     R Relaxation
     O One thing at a time
     V Vacation
     E Encouragement
Using Pros and Cons
Guidelines for Accepting Reality:
     Observing your Breath
     Half Smiling
     Awareness
Willingness
Radical Acceptance
Turning your mind (Distract)

Treating depression definitely helped my DD be able to focus on getting better, on DBT. I hope the Ketamine works for your DD as SunBreeze explains.  They'll treat the suicidal thoughts early on in DBT, they did with my DD who was also self harming. DD said it was the work with the therapist combined with the skills learning she recognised she did not want to die, she wanted to live.

You are right there a overlap between bipolar disorder and borderline personality. My DD was dx BPD 2015 and treated for that, depression, anxiety, psychosis …… DD has felt there is more than BPD and last time she spoke with her psychiatrist he agreed, BPD, bilpolar, schizoaffective ~ I think they're been treating this all along and perhaps did not want to add to the load of NAMES    Anyhow she's doing beautifully now and I wish that for your DD.

[wendydarling]

Hi again MomofadultBPD

I though this may be helpful for you, what do you think? 
9.01 Supporting a Child in Therapy  This five part guide for supporting a loved one is based on recommendations from McLean's Hospital, a national center of excellence for Borderline Personality Disorder treatment affiliated with Harvard University.

WDx

[Momofadultbpd]

Thank you for helpful advice on supporting a child in therapy.

I have been so wrong in quickly shutting down, invalidating, “nipping in the bud” any talk my daughter wanted to have about what I considered to be an INVALID thought or
Feeling. I thought i was doing the right thing by shutting down talk about suicide or refusing to talk about whether I loved her or not. I honestly felt that my strong reaction would convince her how wrong her thought and feelings were. I see now that that was exactly the wrong thing for me to do.

I see now that Letting her talk about what she was thinking and feeling was the best therapy for her no matter how painful it was for me to hear. But shutting her down always led to hours and hours of increasing hostility on both sides so that was not good either. Since I have told my daughter that I now see the error of my ways by shutting her down and I vowed to let her talk in the  future about all her thoughts and feelings (no matter how “stupid” they are—we actually had a laugh there).   she seems full of hope for her recovery. All she wanted was to be validated. We shall see... .

I will keep reading all the very helpful advice on supporting a child in therapy. And soon I hope she starts DBT and learns more self soothing skills and distress tolerance.

I feel so much more hopeful since talking to my new friends on this website.

[Momofadultbpd]

She got ketamine on Monday. When she woke up she was a little irritable for a few minutes, her hands, feet, and lips were tingly and she stumbled a little when she first got up. But within  10 minutes she seemed normal except for she was pleasantly talkative about her experience on the ketamine. She remembered everything the doctor told her before the ketamine started, and she was able to describe what she “saw” during the experience and that it was very weird (bright colors, kaleidoscope, maze, warm, fuzzy) but very comfortable. She wasn’t afraid. She just as in a different reality but it was a comfortable place to be and was okay with it

She was smiling and animated as she spoke. She seemed happy like a normal person would be happy. There was cheer in her voice and she even walked in a happier way. I clearly noticed that the ketamine had lifted her spirits.

I didn’t ask her how she felt and just let her volunteer whatever she wanted to say. She was pleasant and NICE all day and it was unbelievable how improved she was. But it was true. She was also ravenously hungry. She ate 2 Big meals in the 4-5 hours after the ketamine. We were warned she would be hungry so I encouraged her to eat. (She weighs 110 pounds).   Turns out that was bad because that evening she threw up for 3 hours all the food she had eaten. That’s the bad part. The good news is 3 hours of toilet hugging didn’t spoil her good mood.

The next day she kept up her good cheer and I was really starting to be optimistic that ketamine is a miracle drug.

Wednesday was a repeat of the good experience on Monday minus the vomiting because she only drank a smoothie afterwards and ate a light dinner. So my optimism continued.

Then today happened.

She has a long history (almost all bad) with her sister who is only a year and a half younger. Because of the BPD and closeness in age their relationship has been a mine field especially when they were young and I had no idea that I was raising a BPD child. Her sister understands she is mentally ill, but she can only take so much BPD abuse from her and then she fights back. I always get stuck in between and it becomes a 3 way war.

So today a minor trivial thing happened between the two of them and my BPD daughter went ballistic. It was all via text and her sister was at work. It was a typical kind of episode between those two so I can say that 2 doses of ketamine did not lessen the explosion.  My BPD daughter called me to rant and rave at the highest level possible. I used all my might to validate
Her feelings of outrage at her sister but I refused
To become Outraged at her sister because her sister had done nothing wrong. My old pattern was To throw her sister under the bus to stop the tantrum—I expected her sister to “understand” because she was normal and her sister was mentally ill. I realize now how unfair that was to the normal one.

Today I just validated the BPD daughter but would not allow her to force me to be outraged at her sister. She turned on me with with all her vengeance and it was almost as bad as it ever gets. What was surprising is that there was no mention of suicide. That is actually quite shocking because she usually talks about suicide  everyday. So I credit the ketamine for that.

She DID say she wasn’t going to do anymore ketamine. I didn’t argue with her. I felt that she was using that to manipulate
Me and get me to agree that her sister is evil. So this time rather than threaten suicide  she threatened not doing the ketamine.

Her dad (we are amicably divorced and equally caring for you our daughter) was Going to be taking her tomorrow to the ketamine. I filled him in on today’s events. He has watched the Dr Fruzzetti video (EXCELLENT) on Validating also. He called her and validated the day’s events and she finally calmed
Down (about 5 hours after it all started) and agreed to let him take her tomorrow. thank you Dr Fruzzetti for guidance on dealing with BPD. Dad was fresh and BPD daughter was exhausted at that point and dad was able to calm her down with validating techniques.

Presumably she is still mad at me for not telling her that her sister is evil.

I’m used to this kind of outrage (love you/hate you) but of course I am disappointed that it happened. I know ketamine can change FEELINGS but it takes time and DBT to change patterns of behavior and actions that she has developed over the past 30 years. As I was warned, in times of stress, no matter how trivial the stress (as no stress is ever trivial for BPD) old patterns are more powerful than 2 doses of ketamine. She hasn’t even started the DBT yet

So today was bad. A definite setback. But I’m pretty sure she will do the ketamine with dad tomorrow. And there was no suicide talk. So I’m still hopeful that ketamine and then DBT will change things over time. Change is HARD. And it takes time.

I’ll keep you posted.

Thanks for listening. It’s good for me to think through what happened. And hopefully it helps someone else also.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Hyacinth Bucket]

I'm so glad to hear that it has already seemed to help her suicidal ideation. I hope that ketamine gives her the lift she needs to be able to really absorb and learn from dbt and therefore develop new healthy habits. You're right, change is long and hard. But for your daughter not to be horrifyingly depressed, what a gift. I hope the positive trend continues.

[wendydarling]

Hi MomofadultBPD 

I'm so pleased to hear your good news, you are right change is hard, there are steps to it as you say. It's amazing, something working immediately in chronic situations. Thank you for describing in detail her experience for us and yours, it means so much to the family here.  Suicide ideation/self harm was the first thing they worked on in DBT, so if it comes back you've got that. Re validation in DBT they learn self validation, one day my DD said to me as a sensitive person she needs double the amount of validation than some people. For her to share that, touched my heart as we were finding a very special place, we were connecting our learning.

It's truly wonderful to hear you have the support of your ex on this learning journey. What a star he is diving into the validation lessons. And hopefully your youngest will feel the benefit in time. Have you spoken to her about the new skills, approach, she'd benefit personally from learning them when the time is right for her? It'll give her confidence and peace of mind.

WDx

[Momofadultbpd]

I was Really worried about today’s ketamine dose (third treatment). I understand that it is very important that the BPD patient be in a relatively good “set and setting” in order to optimize the chances for a pleasant ketamine experience.

My daughter had calmed down last night and surprisingly texted me “I love you” before she went to bed. That was unexpected because her last phone conversation with me was still hateful. I’m thinking she actually “self-soothed” which is a first. Usually the only way back from a tantrum is a heavy dose of Seroquel  and exhaustion.

This morning dad picked her up and she was chatty and in good spirits. She told the staff at the clinic that she had had a big fight with her sister the day before. The clinic staff didn’t
Make a big deal out of it at all and just told her to focus on happy thoughts as she went under.

She said today that she had the best experience ever. She was riding on the wings of butterflies and it was colorful and pleasant. Dad took her home and tucked her in bed and I showed up shortly thereafter. She was sleepy but told me it was a good experience but that she wanted to take a nap. So I left

So she is halfway through the ketamine. I’m very optimistic. DBT (5week program) will start the week after she finishes the ketamine. Her dad and I already are using  it on her but we are not “teaching” at this point—we think she needs to hear it from the mental health professionals.

Her sister has a long way to go. She is very hurt from the past. Her dad and I are using validating techniques on her and that seems to be breaking the ice. She isn’t ready to be told that she needs to change to help her sister. Well... .that’s how she would see it. In fact, , it would really just be helping her. But she’s just not ready. Maybe when she sees real change In her sister.

Until next time... .

[wendydarling]

I'm glad things are progressing well. I too practiced the skills, though no teaching as you say. That can lead to feelings of abonnement as can innocent praising how well they are doing. When does the Ketamine complete, your half way through, is it next week. Must be such a relief to see her taking steps forwards.

How are you feeling, are you getting some time for you?

WDx

[Hyacinth Bucket]

I'm so glad to hear you feeling positive!

How often are they recommending she go back for ketamine boosters?

[wendydarling]

First hope in 15 years, a break through moment 

That's a good question HB, on going boosters.

[Momofadultbpd]

No plan at this time for boosters. There has been talk of a ketamine nose spray that may be available in 2019. Until then I expect that more  ketamine IV would be available if she became actovely suicidal again. It’s hard for
Me to believe that she won’t be suicidal ever again—but I’m hopeful that ketamine and DBT can replace suicidal ideation as her go-to solution over time.

[once removed]

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