Live in the moment. It's advice so prevalent you could drown in it.
But if you're in the middle of a depressive episode, you don't have a choice.
All sense of history vanishes: you can't believe you've ever felt differently than you do right now. Any sense of future disappears, too. Hopelessness stops all clocks.
I'd been suffering with treatment-resistant depression for almost 10 years when I first heard about ketamine therapy. I'd tried a half-dozen antidepressants with careful guidance from my psychiatrist.
Some worked for a short time, a few months each, before their effects faded away. Some had side effects too harsh to bear: sleep interrupted by what felt like electric shocks, or a brain fog so severe it made any creative work impossible.
But ketamine, typically used as an anaesthetic or recreationally as a party drug, is thought to work differently to traditional antidepressants. It increases the activity of glutamate, a neurotransmitter in the brain's frontal cortex.
Research shows ketamine works faster than medication that targets serotonin — for some people, almost immediately. Depression can cause you to lose some synaptic connections, too, and ketamine helps those lost connections to regrow.
I found a small clinic in the outer suburbs of Melbourne conducting a clinical trial into ketamine and depression. After a battery of tests — blood, urine, heart rate and more — I was given the opportunity to try it.
It ran for two months, and I was in the control group for month one, which meant I received a placebo. (How did I know? Believe me, it's not hard to tell.)
In month two, though, I was in the intervention group and would go to the clinic twice a week for someone to pinch my stomach and inject me with ketamine.
The feeling of being on ketamine is hard to explain. As my psychiatrist says, "it's a very strange drug."
It's a dream-like experience that changes your relationship with both your body and your mind. Your hands can seem very far away, your fingers as big as tree trunks. Sometimes I could see each of my thoughts arriving like trains at a station.
Nothing happened for a few weeks, and then, suddenly, light grew brighter. Colours more vivid. I realised I didn't feel depression's gravity flattening me.
"Is this how normal people feel all the time?" I said to a friend, incredulously.
The euphoria slowly turned into something less dramatic, but just as profound: a kind of emotional resilience I hadn't felt in years. A personal force field that stopped the slightest hint of bad news from sending me back to bed to stare at the ceiling. Time was moving again.
It lasted about six weeks.
The trial was over, with no hint as to the future of ketamine as a depression treatment.
I went back to my old survival tactics: various antidepressants with limited effectiveness.
Meanwhile, I googled for any news of ketamine being legalised in Australia. To this day, my news feed remembers, and throws up every pharmaceutical story it can find.
I tried to tell myself that I just had to hold on. How could a treatment this effective not be made available?
The fact ketamine is known as a party drug was one strike against it; the fact it required you to be monitored by a medical professional for an hour or so after taking it was another.
It also doesn't work for everyone, and is not without its risks — including the potential for addiction.
Mostly, though, it's that ketamine is an old, cheap drug, and therefore hard to make any money from. But if you adjust its molecular structure, just a little, you can patent it. Study it. Sell it.
That's how ketamine became esketamine, a slightly different drug (sold under the brand name Spravato) with supposedly the same antidepressant effects.
After months of looking, I finally found another clinic offering another trial. Six months this time. The esketamine comes in a nasal spray, taken in a dimly lit room.
I heard some in the program say they hated the experience. It made them feel dizzy, sick to their stomach. The trick, I think, is the right kind of music. Nothing too heavy, but textured enough to keep your attention as you drift away.
The treatment was twice a week at first, then once a week, then eventually every fortnight. Every time the dose dropped, I panicked that I'd slip back to how I felt before. But every time, my emotions held steady.
I wouldn't say that it made me happy – more that it made me hopeful. Like everything wasn't as bad as it seemed. Things could get better, and maybe even stay better.
But I was counting the weeks until this program ended, too.
On the day of my last session, I was told that the government had chosen not to put esketamine on the Pharmaceutical Benefits Scheme (PBS).
Mental health in your inbox
Get a selection of the best mental health content from across the ABC by subscribing to our monthly newsletter
The drug was approved by Australia's medical regulator last year, but is ludicrously expensive without a PBS listing. The monitoring afterwards just adds to the cost.
I could continue if I wanted to, but each individual session would cost at least $700. I can't afford it. Most people couldn't. It's inevitably what drives patients to the black market.
While cheaper, this comes with obvious risks: breaking the law, for one, but also interruption of supply, and purity of the product that's out of your control.
The doctor told me they hoped the six months of treatment would have a "long tail".
Theoretically, it would act more like electro-shock therapy than a regular antidepressant.
You'd finish a course and you'd feel the effects for months, even years — but no-one knows for sure.
There's a lot that researchers are still to learn about how many treatments are needed, and for how long.
I tell myself that I have to hold on. The government will eventually make this treatment available for those that need it — either for their first treatment, or to return for boosters as required.
But I can't help but think that every bad mood, no matter how fleeting, is the beginning of something much worse.
So I — and many others like me — are left waiting for the clocks to stop.
This is one person's experience only and is not intended as medical advice. You should see a qualified medical practitioner who knows your medical history.
Martyn Pedler is a writer and academic who's completing a PhD on superhero stories. He's also a screenwriter with several projects in development in the US. His work has appeared in Meanjin, Overland, Comics Journal, and Time Out Melbourne.
