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.

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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 York. 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 its 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.

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.

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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.

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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.

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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.

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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 for what it’s worth: as something that’s very much my experience. Above all, when it comes to brain candy, make sure you work with a doctor – preferably a psychiatrist. These are powerful things, not to be fucked with: they work, but they will profoundly affect you both mentally and physically.

This blog’s been written with the benefit of 20/20 hindsight. It reveals the extent to which antidepressants, in addition to helping my OCD, also hindered my recovery between 2015 and 2018. To that end, it further justifies my decision to withdraw.

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Remember Dr. No? He’s the therapist I saw for a couple months in 2012 whose treatment protocols included running a magnet down my back. I’ve begun transcribing some of my old OCD journals, and yesterday, as I was going back through our session notes, I googled his name to see if he’d been up to anything lately.

As it turns out, he’s been up to quite a bit.

(Holy $&@^$%# *#&$!)

Just so we’re clear, Dr. No didn’t do anything inappropriate to me: I stopped seeing him because he didn’t know how to treat OCD. I knew it was the right decision at the time. I didn’t know just how right till yesterday.

The Antidepressant Solution

Thus we enter Week Three of Phase Three, and once again I don’t have much to report. The withdrawal symptoms have been mild: some obsessive thoughts, a lingering tiredness, but not much else. In his book entitled The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and “Addiction” Joseph Glenmullen lists six criteria for determining if a person’s ready to start tapering off antidepressants. They are:

  1. The patient’s original condition has improved substantially.
  2. The patient is in a relatively stable, calm period in life.
  3. The patient has grown, or changed, psychologically in ways that make her less vulnerable to the condition the drug was used to treat.
  4. The patient’s life circumstances have changed so significantly that the circumstances originally making him depressed, anxious, or otherwise symptomatic are no longer present.
  5. The patient has significant side effects that contribute to the desire to go off the medication or that necessitate going off.
  6. The patient wants to go off the antidepressant rather than stay on it indefinitely because of concerns about long-term, largely unknown, side effects and risks, especially if she no longer needs the drug.

I meet at least five, if not all six of those criteria:

My OCD has improved substantially, especially since I went after my biggest fear and especially since making the conscious choice to stop caring so damn much about the disorder in the first place. (At the risk of belabouring the point, Dr. Steve Phillipson’s article about choice is an invaluable resource.)

I’m in as stable and calm a period in life as I have been in ages. I can’t stress this enough: my new, more relaxed travel schedule has had an incredibly positive effect on my mental health. Meanwhile, having Sam in the same house instead of on the opposite side of the world’s second-largest country has had a bigger impact than any antidepressant.

I’ve grown psychologically in ways that make me less vulnerable to the condition the drug was used to treat. Antidepressants certainly helped, but Exposure and Response Prevention – ERP – is what really got me where I am and what’ll keep me there long-term. By January, when the Great Trintellix Taper of 2018 started, antidepressants had become almost redundant. I didn’t need them to help me with ERP, and while antidepressants do, to a certain extent, quiet intrusive thoughts I’m no longer willing to sacrifice my vitality for that mild reduction (ERP does it as well, but more permanently).

My life circumstances have changed so significantly that the circumstances originally making him symptomatic are no longer present. This one’s tougher to quantify since OCD’s a chronic condition. Again, though, moving back to Toronto and travelling less frequently have had a sizable impact.

I have significant side effects that contribute to the desire to go off the medication or that necessitate going off. Among other things, I’ve had a lot more energy since I started tapering – despite the current lethargy. And my mood’s been great. I feel like I’m getting closer to becoming the Real Me.

I want to go off the antidepressant rather than stay on it indefinitely because of concerns about long-term, largely unknown, side effects and risks, especially if she no longer needs the drug. Firstly, and like I’ve said before, I feel as though anyone would rather take less medication if given the option (although I’m told that’s not the case – which baffles me, but there you go). Secondly, in general I’m worried about long-term side effects, yeah.

I guess that makes me 6/6.

Roll on, June 20. And roll on to when I can start blogging about the Minnesota Vikings and Pearl Jam concerts (August 18 and 20 at Wrigley, baby!) and Hamilton instead of antidepressant withdrawal symptoms. I love having this platform for sharing my journey, but there’s a lot more I’d rather be writing about. We’ll be one step closer in six weeks.