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.
Now that Christmas is over and I have time to breathe I can
finally catch up on this neglected blog. It's more than three months since I
started taking an antidepressant for the first time in ten years – and probably
the first time that I was capable of handling the side effects and waiting for
the worst ones to stop. It's high time for a progress report!
I'm taking only 25 mg of Luvox a day, a miserly dose
compared with the allowed daily maximum of 300 mg. Being incredibly sensitive
to anything I put into my system, I can't imagine what I'd be like on the full
dose, apart from comatose – I'd probably make a zombie look like an ADHD
sufferer. So even on my tiny 25 mg I'm declaring the experiment a success. This amount is enough to take the edge off my fears and obsessions, to
the extent that I can perform certain social feats, and I've totted up a few triumphs
that are improving my quality of life. Then there's the relative freedom from
obsessional thinking that was becoming more and more debilitating.
On the minus side, there are continuing side effects that
won't go away. I consider the trade-off worthwhile but they are significant
enough to warn me off a higher dose. As well, despite my progress, the basic
structure of my social anxiety is still intact.
The graces
When I started taking Luvox, I was amazed at how quickly I
noticed positive change (I know what you're thinking – the placebo effect!) and
how quickly life itself seemed to respond to my improved resilience.
Reduction in OCD
The most quick-acting and lasting effect of the Luvox has
been a reduction in obsessional thinking – a low-level form of OCD, I'm now
convinced. My obsessional fears about people and groups have been par for the
course for decades, and in recent years I'd developed a mild body dysmorphia
that had me examining various body parts in the mirror in an attempt at reassurance
that instead led to horror whenever I discovered some shocking new flaw. But I
hadn't realised just how debilitating my OCD had become until my latest
periodic fixation reared its head yet again – stains on clothes.
Every now and then, an incident in which a piece of clothing
was ruined by an irremovable stain – oil is a common culprit – would spark an
obsessional fear that all my clothes, as well as sheets, doona covers and so
on, were or would become irrevocably stained. Everything else shrank in the face
of that possibility and I would wonder how civilisation was at all possible
with this ever-present threat, and how people with children managed to afford
to clothe them, when surely the little blighters would be routinely ruining
everything they wore (I'm still amazed at the temerity of anyone who wears
white, including brides!). I'd had a couple of these attacks when I started to
realise they might actually signal the OCD that I'd been wondering if I had.
The strength of this fear in me is a good measure of my obsessional
thinking in general, and Luvox has quietened these fears. When a loved piece of
clothing stains, I still get upset but it no longer signals the arrival of the four
horsemen of the apocalypse. I still obsess about people and social situations, too,
but less so.
Reduction in social
anxiety
Work has been an area of giant strides. Two days in a row –
try to imagine the angst – I had to drive out to different locations to meet
clients I'd never met before (well, I didn't have to – but with the drug in my system I was willing to give it a
burl). Both of these involved long drives to locations of varying familiarity
with all sorts of fears of doom and dark forebodings going on beforehand.
Having the two meetings in the same week created an
accidental curve of therapeutic exposure. Upping the ante even further, both happened
to be male clients, which I find far more anxiety-provoking than female. The
second one was far harder than the first, connected as it was to my main
copywriting client.
To top it off, I actually went into the workplace of a
long-standing publisher client and worked in-house for three days – three whole
days! While this was a triumph, there's no way I could have sustained it – or would
even have wanted to. But to be able to actually achieve some work while in the
company of others, and to say hello and interact with people I hadn't seen for
a couple of years and had communicated with mostly by email was a huge boost to
my confidence.
In all these scenarios the drug didn't take away the fear
but it took away the worst of the physical symptoms. Having fear is strange on
an SSRI like Luvox. To an extent your body and mind still perform their usual, rusted-on
routine (mind conjuring up social catastrophes while stomach churns and
somersaults) but there's a numbness there too, a sense of detachment, as if you
know you're bluffing and there's a fair chance you might actually be alright.
The first time around on Luvox in 2001, I remember telling a friend it was like
having a platform underneath me for the first time, whereas before in social
situations I was always falling into the cellar of my unconscious terrors. This
time around it sometimes feels as if the drug is holding me, keeping me steady.
It's like a good fairy or a guardian angel.
The other triumph is that I'm now attending a mental health
group that meets on a weekly basis. We sit in a circle in the front room of a forties
Tudor-style house converted to the group's office in a middlebrow suburb about
fifteen minutes' drive from my place. I can't say I go every week – sometimes
work forbids it – but the exposure has been incredible. The meetings go for two
hours, way too long for someone like me, and my usual habit of homing in on 'scary'
people is still there, but the Luvox allows me to stay put and work through
this (touch wood – as I become more familiar with the group members, it
actually becomes harder for me).
Better sleep
I'm also sleeping better. Nothing seems that pressing any
more that I can't eventually get to sleep. My dreams are clearer too, vivid and
fun to interpret in the morning, although they fade quickly after I wake.
The curses
Here are the side effects of Luvox that have continued into
my third month on the drug. I can't speak for others – I suspect some of my
symptoms are to do with have a dodgy immune system and a sensitivity to common
food chemicals rather than being typical side effects of the drug, but I could
be wrong.
Memory
My memory isn't as good on Luvox. For example, I struggle to
remember what is on telly that evening after checking the guide online (the
litmus test for me of good working memory). The other thing is reading.
Depending on the level of detail, I struggle to recall much of what I've read
even after a few paragraphs. Non-fiction, with its endless new names of players
and organisations, is much worse than fiction. Part of this, I tell myself, is
low blood sugar. There's no doubt the drug makes me even more susceptible to
blood sugar fluctuations than I was previously.
Being more careful with my diet would definitely help. My weekend treats, mild as they are (rice cakes, tomato and hummus; cashews) result in greater tiredness, even exhaustion. So I
need to indulge less, and this is difficult.
However, it not's all bad where memory's concerned. Having a
quieter mind in some ways increases my ability to focus (although I can be a
bit slow on the uptake), so I suspect in some ways I might be retaining some
information better, especially the kind that occurs in conversation.
Digestion
There is evidence that SSRIs can disrupt the workings of the
digestive system. I don't know
whether this is related, but I have a permanently bloated stomach. (I've heard
people complain of putting on weight while on anti-depressants, although I haven't
put on a pound, probably because I'm on such a strict anti-allergy diet.) On the
other hand my body image issues are reduced on Luvox, so the slightly distended
tummy isn't such a terrible thing now I've got used to it.
Numbness
Unlike many on SSRIs, I mostly enjoy the relative emotional numbness
I feel on Luvox. It's preferable to the combination of disassociation and depression
I used to feel. I still feel just as concerned about the fate of the world, and
the suffering of humans and animals, but the concern doesn't make me feel as
unhappy and unsettled as it did in the past.
However, the reduced sexual response that is a common effect
of SSRIs is also my experience, and this is where numbness (not just sexual but
emotional) can become a burden.
Future possibilities
While Luvox alone is helping me, combining it with therapy
would enable me to get the maximum benefits.
As I've said, Luvox blunts rather than removes my social
anxiety. For me there are two aspects: the performance itself and then the
replay at home afterwards. Common to this is an 'oh no!' reaction as I relive one
or two incidents where I feel I've made a terrible fool of myself. I torment
myself by going over the incidents again and again, and cursing myself for
whatever I said or did. (I'm aware that the 'oh no!' is something my brain has
built into it, and then finds a memory to attach itself to, but awareness doesn't
seem to make much difference to the angst.)
The Luvox doesn't actually stop this process, but it blunts
the pain and shortens the length of the remorseful period. Therapy could be a
useful adjunct: someone to hold my hand as I expose myself to the
horrific social possibilities my mind conjures. In theory I could do much of
this exposure work alone, but in practice I need a skilled and knowledgeable
psychologist who can parent me through the worst. 'So what if you acted strangely
in front of aunty X and cousin Y the other night. What if you're right, and
they do think you're weird – so what?' the skilled psychologist might say.
Or as I face my mental health group and try not to blush and
look self-conscious, I could be doing something more useful: not simply allowing
myself to think disallowed thoughts but actually making myself think them. My imaginary psychologist might encourage
me to picture myself in bed with half the meeting as they sit opposite me – so
that I'd gradually become more accustomed to, and less fearful of, such 'scary'
thoughts.
