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:
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.
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.
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.
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.)
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.
I wasn’t sleeping. My obsessive thoughts were spiraling. I needed to get off this stuff.
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.
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.
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!
I switched from Celexa to Trintellix after a friend told me that it’d reduced certain…shall we say “unwanted” side effects.
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).
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.