When Anti-Depressants Don’t Quite Work (Or, Work Too Well)

So, it turns out that keeping track of medication and changes is a useful thing to do. Lately I’ve been feeling somewhat low; kinda-almost-but-not-quite depressed. I was chalking it up to being just one of those things but then the keeper of the medication (aka the husband) reminded me that until about two weeks ago I’d been taking 100mg Sertraline – sorry Doc P, we know you dropped it to 50mg a while back but we forgot to change it down. Sertraline, for the uninitiated, is an SSRI anti-depressant which is known as Zoloft in the US. Like many anti-depressants, it has magical powers that are sometimes too magical – sometimes, for people like me, it sends a person too far ‘the other way’ and triggers hypomania or even full-blown mania.

For me it was somewhere on the spectrum of low-to-mid range hypomania. Not awful, but definitely noticeable. So that’s why Doc P decided to bring it down when we added a mood stabiliser to the equation in the hopes the lower dose would work out better. Probably worth mentioning that when I first started sertraline I was tried on 50mg and it simply wasn’t enough to be therapeutic, so that’s why we bumped up to 100mg. Gosh, this whole meds thing is so confusing and delicate; not made easier by my hyper-sensitivity to weird but not wonderful side effects (yes, I am the girl who was knocked out by a single dose of aripiprazole on the way up the stairs to bed. Also, risperidone gave me incredibly high levels of prolactin and my body reacted as if I were pregnant. Weird.)

When we realised that I was still taking the higher dose a couple of weeks ago we immediately switched to 50mg. To be honest, the 100mg was working but we’re following the Doc’s advice here. We’re not experts on the whole medication malarkey! The lesson here is that I need to be closely paying attention to the changes that happen in my mood and symptoms when meds get changed. It’s taken two or three weeks to realise that this current slump in mood could well be directly related to the reduced dosage.

Of course, this happens whilst my CPN is on leave, but I’m not so bad that I need to call the office and speak to my Pdoc. It can reasonably wait till she’s back (and that’s only tomorrow, so definitely no panic). I don’t know if it’s worth asking to try 100mg again when I know I’ll most likely swing back into the hypo range of moods. Maybe a different anti-depressant? Citalopram is the only other one I’ve been on and wow was that a bad experience – back to the weird side effects; everything I ate tasted greasy and (less weird) it spun me into an extreme mania.

Going forwards from here I know I’ve learnt something; I know I need to be more on top of things when bits and bobs change. Things like going back to diarising moods and meds and various other factors sounds like a good idea. Hopefully next time we change something it’ll finally be the last piece of the puzzle and I can get back to functioning properly!

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When Anti-Depressants Don’t Quite Work (Or, Work Too Well)

Becoming Stable

It is hard, after so many years of being ‘not myself’ to know who I really am. I think I’m coming back to something resembling my ‘old’ self but I feel like I still have a long way to go. There are so many positives in the last six or so months that I try to focus on. I have spent too long tallying up my so-called failings. I seem to have lost any frame of reference to help me judge what is normal and what is of concern. It all comes down to self-awareness. I am getting better at being self-aware.

I want to keep on top of being well; I’ve really enjoyed being stable and not wildly swinging from high to low and back again. I like being more out-going too and getting to know people around town. Getting into conversations with the baristas at Starbucks, or getting a hug from the security guard at Tesco; it’s the little human interactions that I would’ve felt unable to handle not too long ago that are making me realise that I am actually worth a chat and a smile. The people who get paid to do a job but go out of their way to be nice to me make such a huge difference in my daily goings-on. I hope they realise the good they’re doing. I hope their bosses realise it too.

A little while ago my CPN and Luke helped me write out a relapse indicators list. Looking at it now it shows me how far I’ve come since we wrote it in September 2013. It is heavily based around delusions that haven’t been in my mind for a long while; things like suspecting the neighbours of trying to poison us, thinking they’re aliens, going to church to listen to the voice of God are all just memories now.

And I think it’s easy to discount how much progress I’ve made in the last two years. Once we got the psychotic aspects of the disorder under control the mood features came to the fore and became the next challenge. Now I’m finally on a good mood stabiliser the moods are settled and I feel somewhere around the middle ground on what was previously a binary scale of ‘off’ or ‘on’.

Now, I am hoping for my referral to the personality disorders unit to come through; I don’t want to be reliant on meds forever to keep things controlled, plus there are certain things they can’t help with that I want to learn to deal with myself.  Hopefully that’ll happen soon. It’s the next step in my road to recovery.

Becoming Stable

Medication Hangovers

I am sitting on the bus and my brain is in slow-motion; it’s nice to get a break from the incessant mind-chatter of yesterday. This morning I woke up – grudgingly – at 5:30 and felt the effects of the night before. I’d not been out and gotten drunk though; I’d had a medication increase.

The worst hangover I ever had was from quetiapine. That was the time I passed out half way up the stairs because I literally couldn’t keep myself awake. My husband tells me he put me back in bed, and when I woke some hours later I felt like death warmed up. A mouth like the bottom of a bird cage, a raging headache and some serious nausea – it wasn’t much fun.

Today’s discomfort is no match for that previous experience. I feel like I stayed out drinking wine till gone midnight, but it was nothing close to that much fun. A little queasy, a slight headache; just mildly unpleasant.

Fatigue and drowsiness are pretty common side effects of a lot of anti-psychotic medications. The list on drugs.com lists a whole host of adverse effects as ‘common’ when on olanzapine:

  • Slowed movements,
  • Loss of balance control,
  • Slurred speech,
  • Trembling or shaking of the fingers, hands, feet, legs, or arms,
  • Blurred vision.

Which all sounds a lot like the effects of alcohol to my mind – perhaps it’s little wonder a hangover awaits me on the other side of sleep.

I’m hoping the increase in dosage will settle into my system pretty soon and start working its magic. Until then, I’ll stick with it and tolerate these drowsy mornings; and of course, speak to my psychiatrist if it gets any worse.

Medication Hangovers

Sertraline Dreams

Anyone who has taken psychiatric medication will be familiar with the meds-go-round – that process of trial and error whereby you start a medication, realise the side effects are not worth it, switch medication again and hope the side effects on the new one aren’t as bad.

I have been on sertraline (Zoloft) for around two years now and thankfully it has been a good match for me. It slightly elevates my mood, but not in any detrimental way. In truth, I think I’ve only had one major side effect on this medication – and it’s been kind of fun!

Sertraline gives me incredible dreams. Drugs.com reports that abnormal dreams as a side effect has an incidence rate of 0.1% – 1%, making it rather uncommon. Having Googled for others’ experiences of dreaming on sertraline I realise I’m not the only one having these night-time adventures.

Sometimes the dreams stay with me after I’ve woken up, and I can recount them in the same way I can tell my husband about my day at work. Other times they leave my head upon waking and it isn’t until something reminds me of them during the course of waking life that they come flooding back, as though they are memories of real things that have happened.

The ones I remember fully are totally vivid and real; right down to being able to feel things and smell things within the dream. I have been on the battlefield in World War 1 (totally terrifying) and I’ve climbed Mount Everest. There are still bizarre elements to them; especially the ones involving sexual encounters.

Other dreams don’t leave such a conscious impression. I remember one occasion in which I was surprised that my hair was still long when I looked in the mirror; I had a distinct memory of having it cut to chin-length. I’ve also been mad at my husband because of rows we’ve ‘had’. It isn’t until I talk to him about it that I realise the memory of the argument is actually a remnant of a dream.

One of the more upsetting incidents was when I spent a morning distraught over the loss of my Nanny Noo. For about four hours I mourned her, until something made me doubt myself and I asked my husband if it was real. The relief I felt when he told me that I had dreamed it was unbelievable.

I’ve had the whole Inception experience too. I’ve woken up into another dream a few times, and it isn’t until something truly bizarre happens that I either realise it’s a dream or wake up for real.

The dreams don’t really bother me too much anymore. It is weird and unsettling, sure, but as side effects go I’ll happily take this one over anything physical. I’ve come to enjoy most of the dreams, and have recurring characters within them now that I actually look forward to seeing, as though they’re old friends.

I’d be interested to know if any of you have experienced anything like this on sertraline or other SSRIs. Connect with me on Twitter (@dontsayimcrazy) or in the comments below.

Sertraline Dreams

Spotlight on Bipolar

Bipolar is the modern diagnosis of ‘manic depression’. There are people out there who prefer the old way of saying it. The bipolar label just isn’t as descriptive of the issues faced by those diagnosed with it.

Bipolar disorder is characterised by extremes of mood. There are varying degrees of it; from cyclothymia (more chronic but less extreme), bipolar I and bipolar II. All forms feature a mix of depressive and manic episodes, but the severity of the episodes can vary between diagnosis.

Bipolar I is a disorder in which the person experiences full manic or mixed episodes. They only need to have experienced one manic episode for diagnosis to be made, the severity of which causes impairment to everyday activities. The manic state is characterised by extravagance, grandeur, elation, pressured speech, irritability, reduced need to sleep, along with potential risk-seeking behaviours. There should also be, during a depressive episode, at least three characteristics of major depression.

Bipolar II is differentiated from BPI by the absence of full mania. Instead, the person can experience hypomania that lasts at least four days. The depressive state can be the more common and the intervals of well-being are generally shorter.

The risk of self-harm and suicide is increased in those with BPII, and especially those in a mixed-mood state. This can be due to an increased motivation to engage in risk-taking behaviour, coupled with depressive hopelessness. Substance abuse disorders have high co-morbidity with the bipolar disorders.

Treatment for bipolar disorder involves the use of medication. Mood stabilisers act to suppress the swings between highs and lows. In addition, an anti-depressant can be used to combat the depressive episodes, especially in those with BPII. Some atypical anti-psychotics also have a mood stabilising effect.

Talk therapies such as cognitive behavioural therapy can be used to support well-being and help the sufferer with learning skills to cope, triggers and help with awareness of early warning signs of an episode.

Living with bipolar can be a challenge. Episodes of depression and mania effect the ability to conduct everyday life.

Spotlight on Bipolar

Spotlight On Depression

So often in life I hear the phrase ‘I’m so depressed.’ Around the office, in public, with friends; depression has come to be the buzz-word of choice for emphasising just how sad a person is. The fact is real depression is not just sadness. Whoever decided to call it depression rather missed the point.

A huge number of people are affected by depression worldwide. The stats are something like 1 in 4 people will either suffer depression or support someone who does in the course of a year. But depression is a mixed-bag diagnosis just like other mental health problems and it doesn’t affect everyone in the same way.

Most of us have experienced situational depression at some point in our lives. This can be linked to life events such as the breakdown of a relationship, loss of a job or bereavement. It is short-term and usually has an onset within three months of the event that triggers it.

The DSM (Diagnostic and Statistical Manual of Mental Disorders) outlines the criteria for Major Depression. The symptoms can be the same for situational and clinical depression – the difference lies in the impact it has on normal life. For a diagnosis of major depression the person will have at least five symptoms simultaneously, and those symptoms will be severe enough to prevent their engagement with regular living.

The symptoms can vary depending on the individual and includes sadness, hopelessness, anxiety and worry, lack of concentration and lack of pleasure (anhedonia). There is usually a withdrawal from normal work, leisure and social activities. For some people, suicidal ideation is present.

Treatment for depression can include the use of anti-depressants and talk-therapies such as CBT (cognitive behavioural therapy). In very severe cases ECT (electroconvulsive therapy) can be used. This treatment uses electrical stimulation to induce seizures and is administered under general anaesthetic. It has proven to be very effective (mind.org.uk suggests that 74% of people treated with ECT responded positively), but is a last-resort option.

My own experience with depression started when I was 13. In the last few years I’ve battled with mixed mood episodes that have landed me in crisis care twice. A mixed episode for me is characterised by rage, restlessness, agitation, hopelessness and suicidal ideation. Commonly I have experienced a total inability to see past the present; a feeling of no hope and no future.

I read somewhere (Matt Haig possibly?) that depressives do not wish for happiness, they just wish for nothingness. Happiness is a luxury. A good day can mean a day in which symptoms are mostly absent. A bad day is the kind where the symptoms are overwhelming and feel endless.

I would love to hear of your experiences with depression. Connect with me on Twitter @dontsayimcrazy – or leave a comment below.

Spotlight On Depression

Sometimes It’s Good To Reflect

I’ve just walked the door after 10 hours away at work. I’m sitting with the laptop, in the recliner chair in front of the fire (mostly because I didn’t wear a coat today and it’s still only March). My husband will be home in around 20 minute and I can’t wait to see his smiling face and have a nice big hug. All in all, I am very content. Sure, there’s things that went wrong today. But instead of being a disaster as I would have seen it three months ago, I am able to shrug it off as just one of those days.

It is when I pause to reflect that I see just how far I’ve come. My care co-ordinator always reminds me to acknowledge my achievements and be proud of myself. So although this post may seem indulgent, or self-congratulatory, I actually don’t care. Today I am in a place where I can sound my own trumpet from the rooftops and I’ll be damned if I don’t do it.

In my eight years of working life I have worn many hats. I have been a minimum wage administrator, and I have been a customer services manager. I’ve spoken to many people, answered millions of emails and worked under lots of bosses. Currently I am working with a tech giant of a company, and although I am a contract worker, I feel good about the job. Compared to some of my permanent positions, I’d still rather be on contract and happy. Maybe that says something about what I have learned to value over the years, especially since I became unwell.

Then-me would have had kittens over a day like today. I thrived in the high-pressure crock pot of the customer services world, and even one slow day would see me climbing the walls with the anxiety of not being active. I needed to go go go to feel like I was earning my keep. Now-me sees things differently. I am a lot more relaxed and value quality over quantity. I work to the beat of my own drum, and I am lucky to have a manager who is only interested in the end-results. Then-me would have needed lots of direction and praise and feedback and management in order to move in the right direction at work, especially in my manic phases where I would start 20 projects all at once, and see none through to fruition. Now-me has a nice, manageable number of spinning plates and hasn’t dropped any (yet! I’m only human, so if I do happen to lose one or two I will learn from it, forgive myself and move on).

It’s not just at work that I’ve changed for the better. I wrote a guest article for Stigma Fighters today and wrote in it that I miss the manic energy. Which is true, except… do I? I miss feeling like I can conquer everything that’s thrown at me, but I’m in no way incapable of doing that whilst I’m stable. In fact, I would wager that although I used to feel that way it would actually be the opposite. I can probably handle more of life now and enjoy it along the way.

Other positive changes include a new interest in actually looking after myself. I mean sleeping enough, eating enough and not abusing alcohol. So really, I am saying that I seem to have remembered the benefits of moderation. Not too little sustenance and not too much booze. Even if I’m in a social situation now I don’t find myself hitting the inhibition lubricant hard. I can go out and enjoy a drink or two without overdoing it.

And this thing called a social life seems to have re-appeared from wherever it was hiding. Up to December 2014 I became something of a social caterpillar (definitely not a butterfly anyway). Since everything has calmed down I feel better equipped to cope with being in a pub, seeing friends and having a nice chat. Funnily enough, it’s a lot easier to hold a conversation with someone when you’re not being distracted by your alter or the voices.

My relationship is on a lovely even keel. The husband has stood by me through some rough times, and has been my carer in so many ways – making sure I take the meds, keeping on top of the housework, listening to many, many incoherent rants and taking the brunt of my rage. I finally feel I am able to repay some small part of what he’s been doing for me for the last few years (he would argue that I don’t owe him anything though). The nice thing is that doing little things to make him feel good also makes me feel good about myself.

I am better connected with my family now that I am trusting them to love me unconditionally – which they always have done, it’s the ‘trusting’ part that’s key here. We have argued, fought and screamed at each other over the years but we’re at a mutual meeting place now as adults and friends. Now I’m no longer ashamed of myself and my struggles to be well, I can see they were never ever ashamed to call me their relation.

So this has been a rather introspective bit of writing – I am sharing it because I want to let the world see how far I’ve come. The changes are down to finally being on the right medication, and having surrounded myself with the right kind of support. Also, it’s partly because I’ve accepted that I don’t have to fight to accept this reality anymore. I am proud to say I am me and this is my life.

Sometimes It’s Good To Reflect