Going off SSRI Medication – Pros and Cons

The following is my personal experience. Please make decisions regarding SSRIs with your doctor and any other trusted helpers. If you are tapering off antidepressants, please do it slowly.

I took the SSRI antidepressant Luvox (very imperfectly) between October 2012 and November 2013. I wanted to write some thoughts about this experience, and how I've been feeling since going off it.

Drugs are powerful things that change the workings of the brain and involve significant psychological risk. Depending on your condition it may be risky not to take them, and it may be risky to go it alone during the period when you first start taking them or when you are tapering off. This article gives no recommendations or advice. It is simply my experience. But it seems fraught to even write about that experience; drugs, for all their nuisances and imperfections, can save lives in the short and medium term, and sometimes the long haul.

For some people being on drugs, despite the side effects, turns out to be inevitable if they are to have any long-term peace or sanity. I may yet turn out to be one of those people. Then again I may not. For me at the moment, the process is important. I need to add that some of what appears to be recklessness (taking myself off Luvox last December) is partly because I had had previous experience with it and knew it was a drug I could safely wean myself from. Other drugs (and physiologies) may not be so forgiving. Also the dose I was on was very low, so it was never a case of having to wean myself off a high dosage.

Trying Luvox for the second time in 2012–13, I was a lot more self-aware; I don’t remember many of my reactions the first time around about a decade earlier. Adjusting to the drug the second time around was difficult, and ideally I should have been ‘babysat’ for the first few weeks of the new regime. This is something doctors seem unforgivably ignorant about. People going on SSRIs should be told to expect to feel very strange for a couple of weeks and to have a support system in place, even if it’s just someone to check in with by phone on a daily or twice-daily basis.

Doctors would also do their patients a real service if they checked for a history, say, of impulsive behaviour. Someone with such a history might need very close monitoring if going on a new SSRI.

First impressions

I was in the worst throes of OCD when I first started taking the drug, and the relief of those first few weeks is still sweet in my memory. What Luvox seemed to do for me was get rid of my obsession with embarrassing social interactions and mulling over possible interpretations of what I had said, done and thought. Everything was suddenly in perspective again. My brain grew still, and what a wonderful stillness it was.

But only weeks after my system had adjusted to the drug, difficulties emerged. There’s no doubt in my mind that it affected my work adversely. The silence in my brain seemed to result in a reduced ability to ‘take in’ the outside world, to grasp facts, and my memory was also affected. Now, that’s not to say it would do the same for most people; I have multiple food intolerance, low blood sugar and an incredibly sensitive system. As well, I’ve always been a bit slow on the uptake, and obsessively aware of this tendency.

My job as a freelance editor meant it was absolutely vital to be alert. I developed an elaborate system of moderating the dose if I was doing a particularly demanding job. I wouldn’t recommend this; it worked up to a point because my intuition is very finely tuned (I’ve spent years developing it) and because the jobs were short term. But it was a very unhealthy way to be, playing havoc with my moods – risk-taking behaviour for the sake of my work. I began to wonder what my brain would be like without the drug.

Deciding to quit

After about 11 months on Luvox, I noticed something that made my heart sink – it wasn’t helping with the OCD as much as it had been. In my newly quietened brain, the scary thoughts were starting to reassert themselves. One option was to increase the dose, but I was scared of turning into a zombie. Without really consciously deciding, I tapered the drug in November and December and by January was completely off it, and it began to leave my system entirely. As I was doing this I researched other SSRIs and found a new one, Lexapro, that seemed to have far fewer side effects. Early in January I was notified of a three-week full time job that would take place about mid-February. I decided to do the job drug-free, and to try Lexapro afterwards.

Without the drug in my system, my OCD was almost unbearable for a few weeks. This suggests I was taking a significant risk not switching straight to another drug. The only thing that kept me going was the thought that in a few weeks or months I would be trying Lexapro.

Having said that, I had time to work through some of my OCD issues. I did a bit of research and got a much better understanding of what I was up against. I gradually developed a more detached approach – no longer identifying with the OCD thoughts as much. Some of the fears and dreads that had banked up while I was on Luvox were gradually reduced, though never dispelled completely.

I have come to understand the difference between OCD ‘spikes’ when the thoughts come, and the ruminations that follow. I now have some post-it reminders near my computer screen about how to deal with the OCD. One of them says to accept the thought-spikes, and go on calmly without reacting to them; but to avoid the ruminations, which are much more voluntary than the spikes and more of a habit (the compulsive part of OCD).

But if I had had less of a long-range view I could have been in a serious situation. I am fifty now (it sounds so ancient!) and the brain as it gets older can take a very long-range view. So I consider what I did not to be recommended.

Back to the future?

One thing that was important to say was that some of the brain changes that took place while on the SSRI seem to have remained, to some extent. This suggests that short-term use of SSRIs could allow for behavioural changes (for example taking social risks) that, through brain plasticity, could remain do-able after the drug is no longer taken. For example, I am still able to sit through a two-hour Grow meeting, even though I only went to my first Grow meeting when I was already on SSRIs.

The meetings are harder though, and my social fears can produce some nasty spikes. Some of the ability to stay in the meeting is because I am very familiar with the majority of members. But I now have to make concessions to my fears; for example, I have been known to change seats if I felt where I was sitting was too prominent.

It became clear to me as the drug completely left my system that my general shyness was returning; Luvox had remained more effective in dealing with that than it did with the OCD. I find it hard to look other people in the eye and my OCD fears are worse.

The low-level depression I’ve gradually developed in the last 15 years has also returned. It’s certainly not the kind of depression that makes it a struggle to get out of bed, but the kind that means I’m always just on the verge of tears. And if I’m not sad I’m angry and having mini-tantrums where I throw my pillow to the floor and silently curse the great god of Destiny or Fate, the inescapability of Things As They Are. I can’t decide if this depression is the result of my lifestyle or something I’d have anyway – possibly a bit of both.

Here are the things I’m doing to counter all this:

• a few minutes mindfulness meditation as soon as I get up
• abdominal breathing exercises in front of telly every day
• free tai chi class in the park once a week
• dancing to some music with the blinds down in the lounge room most days
• about three times a week, some yoga stretches and muscle-building exercises
• University of the Third Age courses
• writing lots of poetry!

 What’s dropped out is the walking around the oval of my local park – must get into this again.

At this point, I'm not as desperate as I was before about trying out the Lexapro after the Big Job. I am basically monitoring the situation. A friend of mine who recently went off Lexapro said that he believed one of the side effects of antidepressants was 'an inability to love'. I smiled wryly at this, because while that kind of numbness could be incredibly frustrating – I couldn't always cry when I needed to, for example – in social situations it could be wonderfully freeing for me, supersensitive as I am to every tiny perception that passes through me.

So, I'm not sure what I'll do ultimately – the situation is fluid. In the meantime I am enjoying my greater brain power, trying to look after myself, and keeping a watching brief.

Tweet

Silver Linings Not All They're Cracked Up to Be

I finally got around to watching the comedy-drama Silver Linings Playbook the other night. The film’s hero, Patrick Solitano, is a sufferer of bipolar whose problems stem from his initial refusal to take medication. I’m not exactly the first person to watch it through the lens of mental illness, and to be judging it poorly on its portrayal. Yet it’s been critically acclaimed and has received a huge number of accolades, won Jennifer Lawrence an Oscar for Best Actress and and has a 92 per cent critics rating on Rotten Tomatoes.

Actually, the parts of the film that did deal with mental illness weren’t uniformly terrible. If the humour is done in the right way (ie laughing with, not laughing at) the travails of trying different drugs and putting up with the side effects until the right drug is found can have a funny side. The ability to laugh at difficulties is an essential tool for getting through any chronic illness, and also a way of educating non-sufferers.

However, while Patrick and his potential romantic partner, Tiffany, initially toss drug names and their side effects at each other in a humorous way, once Patrick is resigned to taking his meds the film as a whole simply forgets that both of them are on drugs. There are no more side effects, no having to get off one drug and try another, just two people trying to be human. Which is fair enough, but the loss of drugs from the narrative, which implied that both characters were on stable regimes that enabled them to enjoy complete sanity, made me wonder whether the film had been funded by a drug company.

But I don’t want to give the impression that this was the sole thing wrong with Silver Linings. I wish. No, it was the script and the characters. There is a certain kind of Hollywood humour that consists of people starting off on a high register of emotional conflict, and staying there. Part of the humour in these films consists of people being rude and abusive to each other. This is the style of Judd Apatow, who directed and cowrote films like The 40-Year-Old Virgin and Knocked Up. It has been hugely successful, so much so that other writers have adopted it (traces of this style can also be found in The United States of Tara).

This, sadly, is the style that dominates Silver Linings Playbook, courtesy of writer-director David O. Russell. Robbie Collin of the Daily Telegraph said there was ‘a tiring fruitlessness to the mayhem’ of the film, and I couldn’t agree more.

I didn’t entirely dislike the characters – there is something brooding and interesting behind Jennifer Lawrence’s Tiffany and she’s such a good actress she gives every character resonance – but the script makes her a lonely bad girl in a way that is cliched and boring.

But no movie experience is a complete waste of time. It was actually quite timely – well, spookily timely – sitting there and watching the hero deny his need for meds. I have just been going through the same thing – coming off Luvox because it had stopped working, trying to exercise to compensate. Then my back gave in on me and my mean sister told me that she had noticed I wouldn’t look at her.

So I did some googling and found an SSRI called Lexapro that seems to have fewer side effects than other SSRIs. I am seeing my doctor and hopefully getting a prescription when the surgery gets back from holidays next week. (Art imitates life, or is it the other way around?) I wish I could be confident of ending up as functional as Patrick is by the end of the film, but I fear that my experience with Luvox will be repeated with Lexapro and I’ll have to switch again. Watch this space ...

Tweet

A Pill Popper's Progress

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.

Tweet

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.

Tweet