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.
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).
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.
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.
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.
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.
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.
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.