Six Months

I kicked antidepressants six months ago tomorrow.

Six months.

I’ve done a lot of living since then. I’ve grown further into my marriage. I’ve been all over the place: New York, the U.S. Southwest, DC, Chicago, Brazil, Atlanta, Trinidad, Houston, Southeast Asia, Thunder Bay. I’ve knocked off recruitment season #12. I’ve dived head-first into numerous lifestyle changes, in particular with respect to sleep and diet. Meanwhile, on the OCD front, I’ve worked hard to (among other things) remind myself to “treat the OCD” on the odd occasion my symptoms flare up – which means, in other words, not to go content dumpster diving, because content, in the words of Dr. Reid Wilson, is trash.

And somewhere in late August, about a week after we saw Pearl Jam in Chicago, something clicked.

I started feeling normal.

And freedom lies here in normality, as Pete Townshend once put it. Shoot, Pete Townshend wrote this entry for me in 1992*:

I’m free
I’m free
And freedom tastes of reality

I’m free
I’m free
And freedom lies here in normality

I could tell you what it takes to reach the highest high
You’d laugh and say, “Nothing’s that simple”
But you’ve been down this path before
While I was waiting at the door
This place is sacred as a temple

(* – I am aware, of course, that Pete Townshend wrote Tommy well before 1992; these are the lyrics to “I’m Free” that appear in the stage version which, as I might’ve mentioned, has had a profound impact on my life)

How to describe what it means to feel “normal”? Or at least, how to describe what it means to feel “normal” without falling down a philosophical rabbit hole? It’s not as though I felt abnormal while I was medicated – I just lived a life in which I sacrificed those highest highs in order to avoid the depths of OCD despair. I guess in this case “normal” means I stopped obsessing about how I was feeling from one moment to the next (for the most part, anyway: I still do this every so often, and it’s one of the few remaining compulsions I have to eliminate). The intrusive thoughts – the same ones that’d been bothering me since 2012 and that’d spiked last year – became quieter, and I stopped wondering whether withdrawal had been a mistake. My mind felt free. I felt free.

That’s how “normal” felt in late August.

Recovery remains a work in progress. I still have to eliminate a few compulsions. I still have to do a better job of accepting that I’ve got OCD to begin with. Above all, I have to remember to “treat the OCD,” which remains a challenging proposition (involving, in essence, having to enthusiastically agree with your intrusive thoughts; the “enthusiastically” bit is key). But six months following that last dose of antidepressant I’m confident I made the right decision in withdrawing. The standard caveats apply, but I feel as though it’s going to be permanent, and an important landmark on my journey.

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Caribbean Lapse

I’m at the tail end of a moderate OCD lapse. Firstly, thanks. Secondly, yeah, it does suck. Thirdly, though, it is what it is: since OCD’s chronic I’m susceptible to flare-ups even when things are going great.

And things are going great! Like, “completely symptom-free” great. Things were so good I was able to listen to and enjoy a Soundgarden album (King Animal) for the first time since Chris Cornell’s death. And that’s what makes this lapse tolerable: the knowledge that I was there as recently as last week and that I’ll be there again shortly.

So does this: knowing exactly why it occurred. I spent last weekend in Trinidad. I know what you’re thinking: “The Caribbean! You get paid to travel! Suck it up!” But consider the itinerary:

  • Thursday: up at 4:20 a.m., followed by 17 hours in transit
  • Friday: 6-hour recruitment visit which included three presentations
  • Saturday and Sunday: two 6-hour recruitment fairs, during which my partner and I spoke with over 1,200 students; the fair was in a windowless ballroom, so while I was in the Caribbean I could’ve literally been anywhere for all the sun and sand I saw
  • Monday: evening information session

In other words, I had to be on the entire weekend (and yes, I’m aware it’s what I’m paid to do – I’m explaining, not complaining). Sam joined me, which was wonderful, but we spent most of our free time with colleagues. Between the work schedule, the “being on” and the lack of personal space, a lapse was inevitable. The lapse began Friday, intensified through Sunday and began diminishing – not surprisingly – on the cab ride to Piarco International Airport. But then I spiked again Thursday night: I was still tired from the trip and, as I’ve mentioned before, sleep deprivation activates the amygdala, the almond-sized part of the brain which, among other things, churns out the mental flotsam which comprises the “O” in OCD. My OCD symptoms only tend to manifest when I’m sleep deprived, and in this instance that’s certainly true (Sam and I also had an awful night’s sleep Thursday, the result of a malfunctioning thermostat…but that’s for another time). How tired was I following the weekend? I don’t tend to sleep on planes. Monday, I fell asleep while we were taxiing (we went straight from the information session to the airport). At some point during the flight I became aware of a medical situation happening on board. Next thing I knew we’d begun our descent into Houston, which was our destination. I’d slept the entire flight; that’s how tired I was (the medical situation was taken care of prior to landing).

I slept better last night. I should sleep well tonight, as well. That means tomorrow I should – should – be well and truly out of the woods. Lapses suck, but they’re ultimately opportunities to get better; they serve as checkpoints along the road to recovery and ensure I don’t get complacent. I’ve got a couple more trips this fall – a day trip to Houston, followed by six nights in Southeast Asia – that’ll provide even more opportunities to put my cognitive skills to the test. Today, however, I’m enjoying a lazy afternoon and, with luck, putting this lapse behind me. I’m better for having had it.

Terminated Again

Ze Good Doctor fired me. It’s a good thing! Let me explain – but first, some Who:

I’m free
I’m free
And freedom tastes of reality

Where were we? Right: with me getting fired by another treatment provider and, once again, this being a good thing. Most of you know I withdrew from antidepressants four months ago. Mine and Ze Good Doctor’s most recent meeting was in early July; then, he seemed pleased by my progress and told me to come back in three months. But when I walked into his office this morning I wasn’t sure what would happen. I had a mild OCD lapse last week and, as tends to happen, I overreacted – which, given the timing, included me seriously contemplating whether or not I should go back on medication despite overwhelming evidence that I shouldn’t.

I made this for Ze Good Doctor:

THE PROS AND CONS OF WITHDRAWING

PROS

CONS

  • Medication helped me get better, but the skills I learned through Exposure with Response Prevention are going to keep me better
  • I have more energy
  • I have more motivation
  • The lingering tiredness that’s been affecting me since as long as I can remember has begun lifting
  • My mood is great
  • REDACTED FOR PUBLIC CONSUMPTION
  • Medication has, in the past, caused a spike in my obsessive thoughts
  • I like the idea of being medication-free (which is a minor point, but it’s not an insignificant consideration)
  • I’ve made several significant lifestyle changes – in particular with regard to sleep – that are having a much bigger impact on my day-to-day well-being than antidepressants
  • I feel as though there’s been an increase in obsessive thoughts since I’ve withdrawn. The thoughts are mostly white noise, but they’re also persistent and occasionally upsetting.

As I said: overwhelming. But I tend to overreact to even the tiniest lapse, and I walked into this morning’s meeting willing to at least discuss going back on medication somewhere down the road.

Ze Good Doctor nipped that talk in the bud within about 30 seconds. He reminded me (since apparently I need the occasional reminder) that these intrusive thoughts, despite being persistent and oftentimes unpleasant, are symptoms of OCD and, indeed, are universal; that I needed to work on accepting their continued presence; that it’s okay if every day isn’t a 10/10; and at the end of the appointment, that he’d see me in one or two years.

Not months. Years. And then he said he was formally discharging me.

I honestly never thought I’d get to this point; I certainly wouldn’t have dared to imagine it last May after my experiment with tapering went south. Now that I’m here, now that I’ve scored this massive personal achievement, I’m going to celebrate – then learn how to stop overreacting to minor lapses and how to love my brain, warts and all.

Thanks to every single one of you for helping me get here.

Three Months

I’ve been off antidepressants exactly three months, and so far, so good. So really good, for the most part.

At the risk of belabouring this point: I am not against antidepressants. They helped me get better; I’d start taking them again tomorrow if it were necessary. For now, though, it isn’t, and I’m hopefully done with them for a good, long while.

The end of the withdrawal was, somewhat surprisingly, easier than the previous stage (during which I’d gone from a therapeutic to a non-therapeutic dose). The worst withdrawal symptom wasn’t increased intrusive thoughts, but rather fatigue. I was exhausted. Sam was away at a conference that first weekend, and I spent most of it crashed on my parents’ couch with Ed crashed on top of me. The physical withdrawal symptoms went away after a couple weeks, never to return. The mental withdrawal symptoms took a bit longer to manifest, although those, too, quickly went away.

I quit taking antidepressants for two main reasons. One, I realized they didn’t actually stop my intrusive thoughts from happening, but rather diminished their intensity and facilitated the exposure therapy I no longer needed to do on a regular basis. Two, in January I embarked on a vaguely Quixotic adventure to figure out why I was always so tired, and after touching on diet, exercise and sleep – I was actually tested for sleep apnea in March; the results were inconclusive – I decided to examine my antidepressant usage. My energy soared after each of the first two tapers, while the snoring and teeth grinding which led to the sleep study in the first place disappeared. It seems obvious what the culprit was.

Onward and upward we go, then. My next appointment with Ze Good Doctor’s in early October, at which point I expect he’ll wish me well and say to get in touch should the need arise. Tonight, however, sitting in my São Paulo hotel’s lobby and climbing down the hours till I fly home tomorrow, I don’t imagine that happening anytime soon.

My Recovery

A few weeks ago I took the Yale-Brown Obsessive Compulsive Scale and scored myself as generously as my symptoms might allow. I got a 7 out of 40. A 7 is subclinical, but this wasn’t a true 7: it could’ve easily been a 2 or a 3. In other words, if I walked into a psychologist’s office tomorrow they wouldn’t be able to diagnose me with OCD. Yet I do have OCD – and, what’s more, I’ll have it forever. I’m okay with that. And with Doc Awesome ordering me to “let go right now” I figured I should explain what recovery from OCD actually means – and, more importantly, how I’m going to stay recovered despite having this chronic mental disorder.

Firstly, and most importantly, recovery doesn’t mean the absence of intrusive thoughts. I still get them on a daily basis, although they’re a lot less frequent and a lot less intense than they used to be. They tend to be loudest when I’m travelling. Secondly, it requires accepting that I’ll sometimes have these unwanted thoughts. They’re a symptom of OCD, as unremarkable in that sense as a sneeze is to a cold. I can’t control them; no one can control their thoughts (and if you don’t believe me, try not thinking about pink elephants). No one can control the arrival of feelings or urges, either; both are similarly symptomatic of OCD. Accepting the ongoing presence of these thoughts, feelings and urges is hard. As evidence, look no further than…well, me: I still struggle with acceptance almost six years into treatment. My intrusive thoughts may not be as loud as they once were, but I still get bogged down in their content sometimes, which is a common OCD trap. Content is trash where OCD’s concerned – it’s trash. That’s not me talking, by the way: that’s a direct quote from Dr. Reid Wilson, one of the world’s foremost authorities on anxiety disorders. (I don’t know if there’s such a thing as OCD treatment provider acolytes, but if there is then I’m a Dr. Wilson acolyte: he’s the best.) But recognizing content as trash is easier said than done. OCD preys on your deepest fears, then keeps them running through your mind on an endless loop. I’m impressed by my OCD’s intractability, and as much as I wished it’d bugger off it’s sometimes an oddly endearing adversary, like a pathetic younger sibling who’s desperate for my attention. Sometimes, though, the younger sibling bites.

Hence the importance of acceptance in OCD recovery. For me, things started getting better when I was able to accept, albeit reluctantly, that flare-ups were going to happen, as well as to anticipate when I should expect them. Two weeks ago, for example, I had an OCD spike, but instead of overreacting as I would’ve done in the past I recognized it for what it was (a symptom of OCD and a predictable result of both travel and poor sleep), responded to the intrusive thoughts using cognitive techniques and let the spike float away on its own. I was fine after a couple good nights’ sleep. Another crucial step was learning to ask OCD to keep sending me the unwanted thoughts. It sounds counterintuitive – much about OCD recovery is – but literally every single intrusive thought’s an opportunity to practice my coping skills. Usually I simply ignore the thoughts; if they get a bit sticky I’ll agree with them, either vaguely or aggressively, in a game of mental rope-a-dope in which the odds are somehow stacked in my favour.

This point underscores a critical aspect of recovery: thoughts, feelings and urges can’t be controlled, but your response can be. The goal of Exposure with Response Prevention, or ERP, isn’t disproving the content of your obsessive thoughts, but rather giving them space inside your head – in other words, changing your natural tendency to perform compulsions. The better you’re able to do it, the less the thoughts bother you.

What else can I do to ensure I stay recovered? Glad you asked:

Maintenance work. I’m finished with ERP, but that doesn’t mean I’m finished with ERP…if that makes sense. I still have to confront my obsessive thoughts whenever they happen; I can’t give them an inch or OCD will take a foot. Learning how to respond to the occasional obsessive thought is a crucial skill (here’s a great article on doing just that). Another is doing the opposite of what OCD dictates – like not avoiding people, places or things. If OCD tells me to avoid a certain situation, you can rest assured I’ll go towards it instead.

Exercise. I’m up to three times a week and headed towards six. Being married to a fitness zealot helps.

Diet. I’m creating a new diet that focuses on increasing my energy, strength and mental well-being. Happily, that particular Venn Diagram’s basically a circle.

Medication. I withdrew from antidepressants on June 12, and things are still going well. I need the occasional reminder that antidepressants won’t stop intrusive thoughts from happening, but otherwise I remain cautiously optimistic that I’m done with them forever (standard disclaimers apply). For me, the benefits of withdrawal vastly outweigh the negatives. Take sleep, for instance: I’ve stopped snoring and grinding my teeth, and while I’m still slightly fatigued I’m no longer perpetually exhausted. Hey, speaking of sleep…

Sleep. If there’s a magic bullet, it’s sleep.

I can’t stress this enough: sleep is critical, not just in recovery but to every facet of personal wellness. One of my overarching goals for the coming year is a relatively non-negotiable 8-1/2 to 9 hours of sleep opportunity every night. But that goal encompasses more than simply being in bed by quarter to ten: it includes limiting late nights, curbing my fluid intake during the afternoon (I have one kidney – you do the math!) and establishing a consistent bedtime routine. And again, it’s critical. Obsessive thoughts originate in the amygdala, which is part of the brain’s fight-or-flight system. Did you know that your amygdala’s activity increases by 60% after one night of bad sleep? (I learned this – among many, many, many other things – in Why We Sleep by Matthew Walker, which is a genuinely transformative read.)

Letting go. Doctor’s orders.

So here we are: three months post-withdrawal, nine months since Doc Awesome declared me “recovered” and heading into the great wide open. First stop: Brazil, for which I leave tomorrow. Travel’s usually a good test for my recovery; solo travel’s an even better one. A few months ago this trip might’ve made me a bit nervous. As it stands, I haven’t been this excited for recruitment travel in years.

Scratch that: I haven’t been this excited for life in years. I can’t wait to see where this crazy adventure leads next.

Terminated

Doc Awesome fired me. It’s a good thing! Let me explain.

Firstly, our joint talk at the IOCDF Conference went really well. I’d been bracing myself for a sea of empty chairs. In the event, 100 people showed up and the response was universally positive. I’d experienced an uptick in my obsessive thoughts during mine and Sam’s trip to the US Southwest (a common occurrence when I travel), but the conference invigorated me and I left Washington wanting to dive right back into ERP. Once I got home I made a list of eleven different imagine scenarios I wanted to do, then began writing. I finished five, sent one to Doc Awesome for input…and got a muted response. “Let’s talk about this at our appointment next week,” it said.

I knew what that meant: Doc Awesome could tell I was becoming obsessive about my recovery. I did the same thing last year, to the point where it actually set my recovery back. Sam recognized it as well: that same night she flat-out told me I needed to back off, if not for my sake then for hers. And here’s the thing: I knew it, too. Obsessive thoughts are not, in and of themselves, the problem with OCD: they’re symptoms. I’ve known this for ages. But I was still fighting the thoughts, which was sending me down an unproductive path.

I needed to let go. Doc Awesome knew it. Sam knew it. I knew it. I just had to start doing it.

Which brings us to my and Doc Awesome’s appointment. The notes are wonderfully succinct:

  • I think we’re done here.
  • No more planned ERP. No more preventative ERP. Live your life!
    • You don’t need to keep retraining your brain!
    • Only do ERP if the thoughts start getting sticky or you notice yourself doing compulsions that you’re not able to catch. As long as you continually respond to intrusive thoughts the way you’ve been taught your brain is not going to revert back.
    • Don’t write those imagine scenarios. This is the obsessive part!
  • Accept that you’re a person with OCD; accept the thoughts when they come, rather than causing this big upset
  • “I think it’s important that you just let go right now.”

I think it’s important that you just let go right now.

We left it there.

Alright, fine: Doc Awesome didn’t fire me fire me. But it’s time to follow her advice and let go of OCD. The first step was erasing those imagine scenarios, putting the triggering books I’d left out on the living room tables back on their shelves and deleting hundreds (literally, hundreds) of screenshots, pictures and recordings. And in starting to let go, I’ve noticed that OCD’s begun letting go of me. Look: I’ve worked hard at my recovery. I am, in every way, reaping what I’ve sown. But I’ve reached the point where continuing the work has become counterproductive. I’m giving up on my quest for a perfect recovery, accepting what I’ve done in all its imperfect glory, and moving on with my life.

Come join me, won’t you?

Be Aggressive

Every so often I’ll get an email from Doc Awesome that goes something like this:

Would you be able to write a blurb on aggressively agreeing? I think it would really benefit others with OCD.

Doc Awesome helped drag me from the depths of despair and into the light, so a blog entry seems like the least I can do in exchange. Firstly, though, what does “aggressively agreeing” mean in the context of OCD, or obsessive-compulsive disorder? By now you’ll know that OCD is a mental disorder in which a sufferer’s mind gets filled with all sorts of awful thoughts – obsessions – which he or she attempts to mitigate by performing compulsions, like hand-washing or (as in my case) trying to think them into submission. It’s natural, indeed logical, for an OCD sufferer to try and outrun their obsessions – but that doesn’t work, and in fact it only serves to breathe more life into them. And because ignoring the thoughts is incredibly difficult when you start your recovery, the only way through intrusive thoughts is…well, through them. And that’s where aggressively agreeing comes in.

Let’s say you suddenly have a thought – and let’s say, for argument’s sake, it’s the worst thought you can possibly think. Now imagine that thought gets stuck in your head, and no matter what you do it won’t leave. That’s OCD: the thoughts themselves are perfectly normal, no matter how upsetting, but while most people can simply let go of them it can be an overwhelming challenge when you have the disorder. Let’s say, too, that you’re at a certain level with ERP, or Exposure and Response Prevention, which is the only evidence-based treatment for OCD. You have two choices:

  1. You can perform a compulsion.
  2. You can agree with the thought.

The correct answer is #2.

“Wait a minute,” I hear you say. “I can’t stop thinking the worst thought I can possibly think and you want me to agree with it?!!!” Yes, hypothetical OCD sufferer, I do. I want you to agree with the thought, and the more aggressively you can do it the better. Let’s say your worst thought involves harming a loved one. An ineffective strategy for responding to that thought would be countering it – presenting a counterargument, for instance, or trying to suppress it (one of the many reasons the “STOP!” technique is no longer used in OCD treatment). An effective strategy, on the other hand, would be telling yourself, “Yup! I want to do that!” An even more effective strategy would be adding colour and shape to your agreement – thinking of how you’d harm your loved one, for instance (OCD’s the worst, it really is). And an even more effective strategy would be doubling down: asking OCD if that’s the best it’s got, daring it to send you another thought, literally thanking it for the thought and encouraging more, more, more.

That’s how you get better.

It’s counterintuitive. It’s hard. It’s terrifying the first time you do it – and, what’s more, aggressively agreeing with your obsessive thoughts will make them worse to begin with. I couldn’t do it at first. I needed to build up to it: I started by simply noting the thoughts (“Oh, look! There’s the worst thought I can possibly thing!”), then by vaguely agreeing with them (“I may or may not do that”). It took a while to get comfortable enough that I could aggressively with the thoughts. Once I started, they’d hammer me – absolutely hammer me. I stayed the course, however, and eventually they began to disappear – and then one day they basically went away, seldom to return. So it works – not right away, but eventually, and you’re in this for the long haul anyway. By agreeing with your worst thoughts you’re telling your brain – specifically, the part of your brain called the amygdala – that they don’t warrant the importance OCD places on them.

Aggressively agreeing with your intrusive thoughts helps return them to their “natural” state: thoughts in your head, which may or may not be worth your time or energy. OCD recovery is largely based on doing the opposite of what seems logical, and nowhere is that more evident than using OCD’s bullying tactics against it. Give it a shot!