Friday, September 14, 2012

New and Improved Version? Or Slightly Nutty Does Drugs




Please note: the following is my experience only and is not advice about whether or not to take antidepressants. If you are experiencing any serious side effects from pharmaceutical drugs, including suicidal thoughts, contact your doctor or a close family member immediately.

I am 49 years old, and it sometimes feels as if my evolution as a human has consisted of removing one inadequate story to explain my life – one veil over my eyes – and replacing it with another. The replacement story is never completely accurate but gets closer to the truth each time.

My latest revelation is this: not that it would be beneficial for me to be on medication, or that I would do better on it, but that I should not be let out of the house without being drugged to the eyeballs; and that this has probably been the case for my entire adult life (except they didn’t have SSRI antidepressants when I was 19, so I and the entire universe are excused from responsibility for my mental health until the creation and dissemination of Luvox).

Having been on ‘drugs’ for a grand total of six days I realise that this is just another story to explain where I’m at right now; whether relatively accurate or not, it’s too early to judge.

Crunch time

I had a crisis on a recent weekend. I’d come to a total halt. Just about everything had become hard, apart from buying groceries at the supermarket using the self-serve checkouts, and browsing in clothes stores. Hairdressers too hard, didn’t like the close contact, podiatrists too hard, what if you have a panic attack while they’re literally holding onto your feet? Dates too difficult, how not to hyperventilate when the date is sitting opposite you and you don’t even trust yourself to pick up the glass of mineral water, carry it to your lips and sip from it? Family gatherings increasingly too hard: this has been all too easy to be in denial about and to dismiss as a symptom because I don’t get on with my family – it’s their fault I feel so uncomfortable, not the fact that I suffer from a virulent combination of social anxiety, OCD and panic disorder undergirded by affect phobia and hypervigilance.

And even – get this – too hard to sit in the audience – not in the podium, but in the audience – at an author talk or discussion forum. What if I catch the eye of one of the speakers and there are not enough tall, big-headed people to hide behind? It feels as if the person on the platform can see right through me. Yes, folks, this is how bad my whatever-it-is actually is these days, how controlling it’s become. Extreme, but in a quiet, polite, implosive kind of way. I can’t even have a conversation with an uncle or male cousin at a family do without a panic attack hovering in the background.

How did I take so long to reach this conclusion? There have been so many warning signs. It’s amazing how many books you can read about people coming to terms with being on medication and not think it applies to you in the slightest.

I did make some progress when I saw a psychologist for a period in 2010-11, but when I stopped seeing her I started to slip backwards again.

My physical difficulties are the reason why I’ve been (mostly) undrugged for most of my adult life (along with my attitude towards them). If you already suffer from brain fog from food intolerance and low blood sugar, and an eating disorder that makes it difficult to stick to a restricted diet, and you live in a cold, mouldy old house with a gas heater that sends you to sleep whenever you lounge in front of it, why would you further compromise your precious grey matter?

Because you have almost nothing to lose.

Because there’s no other option.

Because you are almost two-thirds of the way through your expected lifespan, and suddenly it makes no sense to preserve future cognitive ability for some mythical perfect self, rather than make life better in the present moment.

Because you are curious.

What I’m hoping is that there’s a pay-off: the drugs will get me out of the house, especially at night, so that the mould and the cold won’t matter so much.

My not-so-hidden agenda is to be able to sit in meetings. Social meetings, support meetings at this point. Later, political meetings (a very big ask). I want to start off with a mental health meeting and take it from there.

My hidden agenda is that I’ll actually make some new friends. This has been a huge sticking point with me all my adult life, but especially in recent years. I made my last new friend way back in 2004, and no-one I’ve met since then in the world of internet dating has stuck, yet I’m haemorrhaging old friends. It’s time to go out in the world to find people with common interests.

Never have the words ‘easier said than done’ been more applicable. Some days I am confident that I am on the way to becoming the most socially phobic person in Australia. I have no confidence in my ability to sit in a circle with a group of people with the slightest degree of equanimity for, oh I don’t know, two minutes. This hurts to write, because I can chart how I’ve gone downhill in the last 12 years: it was never easy, but some one-off workshops and ongoing classes and meetings were once manageable, depending on where I was sitting and the combination of people.

So last Thursday I finally came to the end of my tether and made an appointment with my GP, whom I hadn’t seen in 13 months.

‘I want to go back on Luvox.’

‘What’s going on?’

‘I’m the kind of person ...’ I said, repeating my dramatic ‘drugged to the eyeballs’ line.

She was great. Scrutinised me in her no-nonsense, non-judgemental way, curious as to why, after briefly flirting with Luvox in 2010, I’d suddenly come to this decision. I mentioned the crisis but didn’t go into much detail.

Loving and leaving Luvox

I have a history with this drug that made the flirtation in 2010 possible. I first started on Luvox in around 2001, when I began a writing and editing diploma. It was a low dose, but it helped me sit in my classes more comfortably in the first year, and perhaps, towards the beginning, took the edge off my social anxiety.

Luvox is one of the SSRIs used to treat OCD as well as social anxiety. My psyche at the time, an elderly Freudian with compassion and wisdom, had chosen Luvox for me instead of a host of other SSRIs, so he perceived I was obsessive. But I regret that he chose not to suggest to me that I might have some low-level form of OCD, and that this might be affecting my ability to handle my social anxiety. To his credit he wanted me to increase the dose to 50 mg (which is still low: the maximum is 300 mg) but I was too paranoid about brain fog to comply.

But – and this is an indication of how all-over-the-shop I was in those days – I have no idea how long I stayed on it beyond the months in which classes were held in 2001. Whatever the length of time, and whether it stretched into the second year of my course, I must have at some point stopped monitoring its effects on my social life or believing it made much difference to my social anxiety, because when I did decide to stop it in early 2003, I was very blase (surely I must have noticed, though, its ability to reduce my obsessiveness?). Whatever the time period I was on the Luvox, I took only 25 mg a day. I feared a higher dose would turn me into a zombie.

I'm now curious as to whether I stayed on the drug continuously the following year, 2002, the second year of my editing course, but I marvel at my stupidity either way. If I did stay on it, I should have upped the dose: it was a year of accumulating social and emotional disasters. I remember being very phobic in a couple of classes; sabotaging some emerging acquaintanceships; starting a doomed fling with a randy right-wing barrister; and moving out of my Carlton cottage, which was in the centre of everything, to a lonely and undersized one-bedroom flat further north of the city that I eventually flooded. Towards the end of 2002 I embarked on a course of useless homeopathics, which just made my blood sugar problems worse because the only active ingredient in a homeopathy solution is the alcohol. If I was still on the Luvox then, I evidently put no thought into what the combination of Luvox and the alcohol solution would have been but I soon realised how spaced out I was becoming.

I finally went off the drug completely some time early in 2003 because I remember writing that it was making everything ‘white and exhausting like a snow storm’ and I wanted my brain to be as clear as possible for the editing business I was in the process of establishing. As I’ve said, I have no idea if my use had been continuous throughout 2002.

What I wanted then, and would still choose now in the best possible world, would be some kind of perfect non-drug therapy that involved a return to an infantilised state and reparenting. I have read about this kind of therapy and often thought it sounded perfect for me; I’ve also had the sense that given a strong, resilient enough therapeutic community that could deal with the acting out of my symptoms I would over time heal.

But in a perfect world.

First days on the drug

So now I’m back on Luvox again, starting with a low dose of 25 mg. Once I’ve adjusted to this dose, I am hoping to increase the amount to 50 mg.

The adjustment period is impossible to describe. I have felt very odd things that are difficult to put into words. None has been unbearable, but some are turning out to be pretty hellish. If these feelings persist beyond a month I’ll stop the drug but I want to give my system time to get used to it before I make a decision.

Last Saturday afternoon at the local mall: a horrible jumping sensation when I lift my self-conscious feet as I prepare for the escalator. I feel that I must focus on my feet in order to walk normally, but I notice that already I am less self-conscious about the rest of me. People aren’t staring at me all of a sudden; they’re not that interested in me. We are in our separate worlds.

Tiny beads of sweat like powder on my skin.

I am in an awful mental brace. Back at home, I go online and find other people complaining of things like ‘feeling medicated’ and a sensation, apparently common, of having two brains.

Hmmm. I can sort of understand what they mean. One brain feeling all the feelings, the other brain containing the feelings and stopping them from spilling out? Are two brains better than one?

Or two heads? Back in 2002, someone in my 12-step program said, of her battle with depression and her firm belief that drugs, however difficult to get right, were essential to her wellbeing: I don’t care if they give me three heads, at least I can function.

Once you can’t function any more, side effects and future risks become moot.

Saturday night: awful. I ring up one of the few friends I have left who is as usual too tired to go out, as she had promised. (If any of my friends are reading this: it is not a complaint. I’ve somehow set it up that way.) As we talk an unutterable, mildly suicidal depression kicks in along with that medicated feeling. A sort of terminal gloominess, like an extreme version of boredom. But I am bored, terribly bored, and I’ve been bored for ages.

(This feeling returns in the evenings of the following week from around 8.30 pm, seemingly when the drug starts to wear off and when the hormonal changes caused by nightfall have well and truly kicked in.)

Sunday is drastic. I wake with unutterable relief that the drug has started to leave my system and my intuition screams at me not to take it. I listen to it and don’t take the Luvox, wondering if this will be the end of my drug experiment; but I end up taking it every day of the following week – Sunday’s refusal turns out to be just my body telling me to ease into the new regime.

It’s a sunny afternoon and after going back to bed and nursing a need for an extra hour’s sleep I have plenty of energy to get out of the house and even brave Melbourne public transport’s new and fairly disastrous ticketing system (worth a blog entry on its own). And go to the National Gallery of Victoria (oddly named as it’s actually a state gallery with ideas above its station).

While the punters pay twenty bucks to see a blockbuster on Napoleon, I swan through the almost deserted eighteenth century art rooms, and my memory being shit, am pleasantly surprised at how good and interesting the collection is even though I’ve seen it before (the drug still lingers in my system, a positive offshoot of my sensitivity to drugs).

On that entire visit, not so much a sense of having two brains as two contradictory feelings: unutterable, yet low-level depression and a sense of meaningless and lack of being rooted in the world (I often get this in public spaces, as if I don’t belong in my society any more, but this is more intense) and an awareness of a new social ease.

Galleries are hard for me these days, yet today actually isn’t too bad, apart from the extreme aloneness that the drug seems to highlight rather than mask.

Things pan out a bit as the week progresses. I feel a bit hyped up and spacey in the mornings. At the same time, because of the increased energy, I have a sense of urgency about getting things done. There’s also a sense of my energy feeling scattered. These last two are both unwelcome, in the case of the former because I already experience obsession about getting things done, but it has seemed to dissipate as the week has progressed. I am still feeling shy, but on the other hand my brain is far quieter in ways that are impossible to explain.

Something else is happening that I did predict, because it occurred the previous time. Because I am less depressed and frightened on Luvox, some of the more objectionable parts of my personality, normally repressed by the depression, are coming out to play. The desperately competitive, ambitious girl who gave it up because she was too ambitious and didn’t want to be cut down. The narcissist who dreams of fame.

It’s not such a terrible thing, these personality factors coming up for air. They may make me painful but at least if they’re showing themselves they can be dealt with.

The drugs aren’t doing my blood sugar much good. I want to collapse at around 3 in the afternoon but this effect reduces as the week goes on.

Thursday: I brave a mental health group. The drug holds me like a mother, although I make a couple of inappropriate comments. I see my GP afterwards and she asks me about my OCD and remarks on how cheerful I am. I tell her it’s the drugs – they are making me a bit hyper. But at night, as the drug wears off, that guttering sense of angst that borders on despair.

On Friday night I have a terrible sleeplessness combined with a vivid sense of my brain being so alive it is playing, constructing nonsense sentences just because it can (as a wordy person, I’m used to this happening as I drop off to sleep, but this is occurring at an earlier stage and is quite disturbing). I wait it out and eventually get to sleep.

One other thing I’m noticing: in a minor way, my brain is more acute, especially in conversation; it’s as if the anti-depressant effects of the drug make it easier to make connections, be less self-conscious and think laterally. On the other hand the drug is definitely affecting my memory adversely and even more so my concentration: when I read, I have to sometimes focus on slowing down so that I retain the information my mind wants to skim over. Sometimes I find that I’ve stopped reading and started ruminating, and I have to jog myself into starting again. Still, early days.

Warnings

Information about Luvox available on the internet suggests that it is not suitable for children, adolescents and young adults as it can create suicidal feelings when first taken. It also seems to create that feeling in smaller percentages of people in the older age groups. The information expresses uncertainty about whether these feelings are caused by the drug or are simply a symptom of the depression for which the drug has been prescribed. My experience: it’s the drug!

I have no recommendation about whether or not anyone should take a particular anti-depressant – each person must use their own judgement. But I would suggest arranging to be ‘babysat’ by someone when you first start to take a drug such as a Luvox, at least for the first week. If that’s not possible, have someone you can check in with regularly. These drugs can have very strange effects on our brains, even if some of these effects are short term. I’d also suggest making an effort to eat sensibly and keep your blood sugar levels steady while on such drugs.

Onward and upward, with Luvox in my system and a song(?) in my heart(?)

If you enjoyed this blog entry, you might like The Dilemmas of Therapy.

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