25th Annual International OCD Foundation Conference

I’ll get to non-OCD blogging shortly, but I don’t think I’ve mentioned this and it’s important and I want to brag: in a couple weeks I’m speaking at the 25th annual International OCD Foundation Conference in Washington DC. I made submitting a proposal to talk at the IOCDF conference a 37 for 37 item, but didn’t give much thought to the proposal being accepted…until it was. I’m co-presenting with Doc Awesome and a fellow sufferer (and therapist-in-training) from New Jersey. Our topic is as follows:

It takes approximately 14 to 17 years for people to obtain appropriate treatment for OCD. Exposure and Response Prevention (ERP) is an effective, yet demanding treatment for OCD. This panel consists of an OCD specialist therapist and two OCD sufferers who struggled and are now successfully living with OCD. First, the clinician will present the clinical applications of ERP and how to use it effectively, and then attendees will hear the personal reflections of ERP treatment from the two clients, including the unique perspective of an OCD sufferer who is studying to be a therapist. Their personal stories of ERP treatment as they journeyed from severe OCD to life beyond will be shared followed by Q and A.

This feels like a big deal. It is a big deal, isn’t it? I can’t think of a better way of getting one over OCD (short of living my best life right in OCD’s fat, ugly face) than speaking at a conference attended by some of the world’s leading OCD experts. Sam and I are tacking the conference onto the end of our trip to New Mexico and Arizona, for which we depart this Saturday. I can’t wait, either for the road trip component (we’re driving Route 66 from Santa Fe to the Grand Canyon) or for the talk. Muy updates to follow.

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A Bit More Math

Let’s do a bit more basic math, along with some even more basic doctoring.

Today is Tuesday, June 26th. I stopped taking Trintellix, my antidepressant, on Tuesday, June 12. Trintellix has a half-life of anywhere between 57 and 66 hours depending on (among other things) a person’s age, metabolism and overall health. It takes five times as long for the drug to fully exit a person’s system. 5 x 57 = 285, 5 x 66 = 330; 285/24 = 11.875, 330/24 = 13.75. In other words, 11-4/5 and 13-3/4 days.

Which means at some point between the early hours of Sunday and Tuesday mornings my body secreted the last lingering vestiges of Trintellix.

I am officially antidepressant-free.

And I think it’s gonna stick. I feel good. The withdrawal symptoms that were the bane of my existence from February till May were practically non-existent during Phase Four of the Trintellix Taper (which I’m comfortable referring to in the past tense). The lingering tiredness, dizziness and intrusive thoughts disappeared last week, never to resurface. I’ve learned, through brutal experience, that I don’t need antidepressants as mood enhancers and should focus instead on healthier lifestyle choices. And earlier this morning I went to Rexall and disposed of the last remaining pills:

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Let’s see what tomorrow brings. Thanks to each and every one of you for you support.

Now can we please talk about something else?

Withdrawal

Today, Sunday, is my fifth day antidepressant-free, and so far withdrawal’s been relatively smooth. Sure, I’ve been tired and lightheaded and irritable and had a mild surge of intrusive thoughts, but these are all perfectly normal withdrawal symptoms. Besides, the last time I did this I had a much different experience:

Day one was fine. Day two was okay. Day three was bad; day four was hellish. Day four was when the withdrawal symptoms really kicked in. Strangely enough I hadn’t really anticipated the possibility of negative side effects, yet they were myriad and surprisingly aggressive. I figured insomnia would be one of them, since one of my antidepressants was a sleeping aid, and it was. But what I didn’t reckon for was the nausea, dizziness, obsessive thoughts, or general sense of dread (not to mention some of the weirder side effects, like the inability to eat dairy or an itchy scalp).

Almost none of that’s happened this time, the dizziness and the obsessive thoughts aside – and even then the obsessions, while sometimes persistent and usually unpleasant, are mostly white noise (I could never have said that the last time, when obsessions still had the capacity to paralyze me). I suppose I should qualify that by mentioning I was going off both an antidepressant and an off-label antipsychotic the last time – but still, so far the difference between the two experiences has been night and day.

Ultimately, withdrawal symptoms are nothing more than the miserable, short-term consequences of tapering. Unfortunately, given that they oftentimes mirror the initial disorder, they’re easily confused with a return to symptoms; this is one of the many reasons it’s crucial to taper under supervision. The term “antidepressant” is a misnomer, by the way, because they’re used to treat any number of different things. Having OCD doesn’t mean having depression, too, even though there’s significant comorbidity (or overlap) between the two disorders. In the case of OCD, antidepressants don’t eliminate obsessions or compulsions but rather lower a sufferer’s anxiety so that they’re better able to do Exposure and Response Prevention, or ERP, which is the lone evidence-based treatment for OCD. Once I’d mastered ERP I stopped needing antidepressants – hence the decision to stop taking them.

So we’re off to a good start, but we’re also well-positioned for long-term success. I redid the basic withdrawal math and determined that the Trintellix will be completely out of my body June 24 or 25. In the meantime, I’ve made a withdrawal to-do and to-don’t list. Check it out! (These symptoms could linger beyond the end of June.)

DO:

  • Sleep 7-½ or 9 hours a night.
  • Drink more water than usual. Keep starting every day with a glass of water – and then drink nine more, for a total of 2-½ litres a day.
  • Continue to develop your brain healthy diet.
  • Exercise regularly.
  • Write about your recovery.
  • Start making medium- and long-term goals. Goals help with recovery.

DO NOT:

  • Give your withdrawal symptoms (or your OCD, for that matter) more attention than necessary. The rest of these items flow from this overarching point.
  • Read about withdrawal symptoms. You already know everything you need to know.
  • Read your own blog entries about withdrawal.
  • Rate yourself on the Yale-Brown Obsessive Compulsive Scale. Every time you do you will donate $20 to the provincial Progressive Conservatives.
  • Seek reassurance. Perspective is fine; reassurance is not.
  • Overcommit.
  • Become obsessive about withdrawal.

ONE MORE DO:

  • CELEBRATE THIS MASSIVE ACCOMPLISHMENT.

The Final Phase

At eight this morning Ze Good Doctor approved my full withdrawal from antidepressants.

Thus, the taper that started four-and-a-half months ago enters its final phase. We’re not quite finished. The drug’s still in my system. Trintellix has up to a 66-hour half-life, which means there’ll still be traces left in me till next weekend. But I’m done taking it: my last dose was yesterday at 7:09 in the morning, which means this is the first day in three years where I deliberately haven’t taken an antidepressant. I wasn’t sure whether complete withdrawal was even feasible when I started tapering back in February. At the time I wrote: “I still don’t know the end goal of this latest experiment. I don’t know if it’s complete withdrawal – but I’m allowing myself to entertain that possibility. I’m in a much better place than the last time I tried it; in fact, this might be the perfect opportunity to give it another go. Or, it might not be! I accepted the possibility that I’ll be on antidepressants for the rest of my life a long time ago.” Turns out it was the perfect opportunity.

So now we wait. Joseph Glenmullen, author of The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and “Addiction,” says people sometimes experience worse withdrawal symptoms when the drug’s being fully flushed from their bodies. On the other hand, my family doctor thinks the worst of them will have occurred when I went from 10mg down to 5 – from a therapeutic to a non-therapeutic dose. Ze Good Doctor equivocated as Ze Good Doctor tends to do, saying I might have worse symptoms, similar symptoms or no symptoms whatsoever. I’ve been on antidepressants since the second Bush Administration; I’d be surprised if I didn’t experience at least some discomfort, whether it’s real or a placebo effect or whatever. Ultimately, I couldn’t care less if I do: any withdrawal symptoms will be gone within a few weeks and I’ll be done with them forever.

(Or, well, “forever.” The standard disclaimer applies: I may have to take antidepressants again somewhere down the road. I’ll cross that bridge if and when I get to it.)

Taking that last pill felt big, like I was done scaling a peak on my way to an even higher summit. It’s as though all the work I’ve been doing – with sleep, exercise, a more conscientious diet that emphasizes brain healthy foods – is coming together. I feel alive – more alive than I’ve felt in ages. I don’t think I’m at risk of becoming complacent: I want to keep this momentum going. Like Bono, I’m ready for what’s next. But first I’m going to savour this major personal victory.

Ativan

It’s Ride to Conquer Cancer weekend, and because I remember these sorts of things that means it’s exactly a year to the day since I last took Ativan. I’d been using it regularly following Chris Cornell’s death. Once we got to Hamilton on Saturday I was so exhausted from the biking, the heat and Ambassador Gordo’s godmother pumping us full of lasagna and roast beef and charcuterie that I passed out before taking my dose – and then realizing I had an opportunity to kick it completely, fought through a bit of discomfort on Sunday while the the last lingering vestiges exited my body.

I haven’t touched Ativan since. But I still had a bottle of it lying around, and in March (after disposing of the pills at Rexall) Sam and I went for a walk so I could get rid of it.

Here’s how I did it. It only took two tries! (The container had a narrow opening, hence the sidearm.)

T-minus four days to go. This time next week the last of the Trintellix will be outta my system.

Math

Let’s do some basic math! (I can only do basic math.)

Today is Thursday. On Tuesday, five days from now, I’ll be taking my last dose of Trintellix. Trintellix has a half-life of 66 hours, which means it takes 66 hours to fully leave your body…and so assuming I take that final dose at around 7am on Tuesday I’ll be antidepressant-free at about 1am on Friday, June 15 it takes five times that length of time to fully leave your system…and so assuming I take that final dose on Tuesday my body will be antidepressant-free on or around Sunday, June 24.

That’s about 180 hours from now I suck at math.

Speaking of 180s, I still feel a sense of bewilderment when I think back to the summer of 2015 and then look at where I am now. I feel like a different person; heck, I sort of am a different person. And yet I wouldn’t trade that experience for anything, because it helped make me the man I am now. And I sorta like that guy. A lot.

I can’t wait for next week.

The War On Drugs

First, a disclaimer: I’m not a doctor. (You know this.) I’m one person describing his experience with antidepressants and other, similar medicines. Take it with a grain of salt: it’s very much my experience. Yours will almost certainly be different. Above all, when it comes to brain medication, make sure you work with a doctor – preferably a psychiatrist. These are powerful drugs. They work, but they will have a profound effect on you both mentally and physically.

This blog’s been written with the benefit of 20/20 hindsight. It reveals the extent to which medication, in addition to helping my OCD, triggered multiple spikes between 2015 and 2018. To that effect, it further justifies my decision to withdraw from antidepressants.

But first, a brief overview:

2006/07
I began taking an antidepressant – a selective serotonin reuptake inhibitor, or SSRI – called Celexa in 2007. I was also given Ativan – a benzodiazepine, which is a fancy way of saying anti-anxiety medication – with no further instructions beyond, “Here: take this.” I used Celexa, supplementing it with Ativan as necessary, for the next 5+ years.

April 2012
A former GP gave me Seroquel as a sleeping aid, which in retrospect was very cavalier: Seroquel’s off-label for OCD (it’s primarily used to treat schizophrenia and bipolar disorder) and comes with brutal side effects. I used to refer to it as “my knockout pill,” because within minutes of taking it I’d be sound asleep. Cumulatively, the medications lowered the intensity of my obsessive thoughts and enabled me to start exposure therapy, which forms the bedrock of OCD treatment. But there just wasn’t any sort of long-term strategy: I was simply “on meds.”

Later in 2012
Celexa turned into Cipralex.

October 2014
I withdrew for the first time. I’d been tapering for months, and figured I’d finish the job and deal with any withdrawal symptoms during a long weekend in Toronto. Oh, how naive: the worst of those symptoms lasted two weeks and were surprisingly aggressive. Once they abated I felt fine, but not great. Looking back I wasn’t doing enough of “the other stuff,” specifically the dieting and exercising, that I needed to be doing. This would come back to bite me a few months later. (In my defense regarding exercise, I’d had three ACL reconstructions between March 2013-June 2014.)

*

Thus we arrive at June 2015. This is where things get interesting.

June 2015
I went back on antidepressants. I hadn’t felt “right” since going off them and identified the lack of medication in my body as the primary culprit. My former psychiatrist had retired, and in late June I met with an absolute asshole of a doctor. Let’s call him Dr. Angel; I wish I could use his real name because he deserves to be fucking dragged. Dr. Angel gave me a prescription for 20mg of Celexa, which is high for an initial dose. And so I started taking it, then flew to the United Kingdom for vacation. Once I arrived I began experiencing side effects that grew increasingly intolerable as the trip continued. A week later I stopped the medication cold turkey and the side effects abated.

I need to stress this: I should never have gone back on antidepressants. I was seeing them as mood enhancers…which they are, except I didn’t (and indeed don’t) have a mood disorder. I have an anxiety disorder; I needed to learn how to live with my (mild) anxiety. And I needed to make lifestyle changes: I needed to eat better and exercise harder and travel less (by July of 2015 I’d been to the Middle East for three weeks, Europe for two and China for a long weekend, not to mention regular trips to Toronto and visits to Vancouver and DC). Dr. Angel should’ve recognized this, and while I appreciate it’s his job to dispense medication I feel as though in this instance he should’ve recognized I didn’t need it. (I won’t be making this mistake again, obviously.)

July 2015
Once I returned to Calgary I told Dr. Angel what’d happened. He got mad, as though my stopping Celexa was some sort of personal affront. He then prescribed me a different antidepressant, called Luvox. Again, he didn’t mention side effects; once again they arrived almost immediately, except this time the intrusive thoughts came served with a side order of insomnia. I was sleeping two hours on a good night, all the while experiencing hellish obsessions. I ended up meeting with Doc Awesome, terrified I was having a relapse. (This, as it turns out, became a common development: I’d adjust my medication, I’d have obsessive thoughts and I’d run to Doc Awesome.)

Meanwhile, I saw a second psychiatrist – I’d gotten two simultaneous referrals – who misdiagnosed Pure O as delusion disorder. I never saw him again.

August 2015
I wasn’t sleeping. My obsessive thoughts were spiraling. I needed to get off this stuff.

September 2015
And so I called Dr. Angel and left him a message. He returned the call, and after I told him what was happening he said: “I can’t talk right now: I’m about to see a patient. If you’re having problems, go to emergency.” That’s an exact quote, by the way. Instead, I saw my family doctor, who told me to stop taking the Luvox. I absolutely should not have done that, but I don’t think either of us realized the drug had now fully entered my system. Meanwhile, I got on a plane and flew to Toronto so I could detox. I fired Dr. Angel via voicemail.

(Writing this almost three years later I can’t believe I’m the same person. For the record, my medical team now consists of my family doctor and psychiatrist in Toronto and Doc Awesome in Calgary. She and I do phone appointments roughly every other month; I rarely see the other two.)

The detox lasted a lot longer than anticipated. September sucked. I was solo travelling – to New York, Houston, New Mexico – while experiencing brutal withdrawal symptoms. My anxiety made me feel as though I couldn’t breathe. Three things kept me sane: Sam, the X album More Fun in the New World and the Blue Jays’ first successful pennant drive since 1993.

October 2015
Back in Toronto, this time for work, I made an appointment with my family doctor (or, well, my Toronto family doctor – I lead a complicated life). He listened to me explain what’d been happening, then calmly told me what was going to happen next: we were going to start me on a low dose of Celexa, I was going to have 2-3 rough weeks and I was going to be fine. He told me to take Ativan as I saw fit and that it’d help bridge the gap during the initial uptake. And he was right: I did have a few rough weeks, compounded no doubt by the Blue Jays’ playoff run (imagine being at the bat flip game in my state? Well, I was). I also went to the Middle East for a week. I felt awful and contemplated flying home early, but fought through the anxiety and (as it turns out) finished my University of Calgary career in style.

Late 2015
I leveled off once I got back to Canada. On November 9 I quit U of C, and two-and-a-half weeks later moved to Toronto. I experienced three months of “genuine” OCD that disappeared once I got hired at U of T (OCD tends to thrive during times of transition). Things were good!

2016
I switched from Celexa to Trintellix after a friend told me that it’d reduced certain…shall we say “unwanted” side effects.

January 2017
I’d been on 20mg of Trintellix – but I was feeling good, and so I went down to 15mg. Nothing dramatic occurred; I continued to feel good, did a couple major international trips and continued adjusting to my new role as “fiancé” (Sam and I got engaged on Canada Day 2016).

May 2017
I’d been on 15mg of Trintellix – but I was feeling good, and so I went down to 10mg.

May 17, 2017
I felt sluggish at work. Later, I went for a bike ride. On my way home I passed the Molson Amphitheatre, thought about the time I saw Soundgarden there and wondered if they were playing Detroit that night (I’d looked into getting tickets but balked at the idea of driving back from Detroit on a weeknight; in retrospect this was one of the best decisions I’ll ever make).

May 18, 2017
Chris Cornell died by suicide. I was devastated, and gussed an OCD spike was imminent. And I was right – sort of. I did have a spike – but as we’ve seen I’m prone to withdrawal symptoms, and the fact Chris Cornell’s death coincided with a taper made me more vulnerable than usual. I struggled along for a week, then went back up to 15mg (which led to its own set of problems). By July I was back on my original dose of Trintellix. Again, speaking with the clarity of 20/20 hindsight, I shouldn’t have gone back up. I should’ve fought through a bit longer; I was almost certainly experiencing heightened withdrawal symptoms, no more and no less.

Let’s say, then, that my reaction to Chris Cornell’s death wasn’t an OCD spike but rather an adverse reaction to medication. That would mean I haven’t had a non-meds-related OCD lapse since late 2015 – and prior to that, 2012! That would suggest I’m doing a helluva lot better than I’m giving myself credit for. That would mean I’m living – thriving, even – with OCD. It suggests I know how and when to use my OCD toolkit. And it suggests medication, rather than helping my progress, might actually be hindering it. Indeed, as I’ve been tapering down, the biggest withdrawal symptom has been (you guessed it) obsessive thoughts.

And so we’ll continue tapering. I’m going to finish this, and then we’ll see what happens. I’m optimistic it won’t be much. I’m guessing I’ll feel a bit more anxious; the thoughts might come back a bit louder. I’m guessing I can handle both these things. I’m guessing I’ll emerge stronger than ever. I’m guessing we’ll find out soon.