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.

Advertisements

WD Day

Dear Reader:

All being well, in two weeks – Wednesday, June 13 – I’ll be antidepressant-free. WD Day was bumped forward again.

As you were.

Dr. WHOA

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

And so 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 with 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 keep my anxiety in check because ERP was doing that already. And while antidepressants quiet my obsessive thoughts it’s at the expense of my vitality. I’m no longer willing to make that trade (and besides, ERP quiets them as well by rewiring the brain’s circuitry).

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 sizeable 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 six-for-six.

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.

Update

Phase Three of the Great Trintellix Taper of 2018 is nearing the end of its second week and…there still isn’t much to say, actually. Except this: two weeks ago I wrote, “I’m sure I’ll eventually have withdrawal symptoms to complain about, but based on previous experience I won’t start having them till the weekend.” I was wrong: I didn’t start having them till this past Saturday, eleven days after lowering my dosage from 10mg to 5. I can’t explain why. Maybe the drug’s efficacy’s wearing off. Or maybe all the spite riding’s turned me into a serotonin-producing machine.

Either way, we’ve got a new end date: Wednesday, June 20. I’m seeing The Phantom of the Opera that night to celebrate.

Phase Three

5mgIt’s hard finding much to say about the start of Phase Three of the Great Trintellix Taper of 2018 other than, “It’s started.” Today my dosage went down by 50%, from 10 mg to 5. I’m sure I’ll eventually have withdrawal symptoms to complain about, but based on previous experience I won’t start having them till the weekend. Inevitably my brain’s already scanning for issues, as though it understands it’s about to go through withdrawal again and it’s eager to get the party started. Poor guy: he’s been through a lot in 2018.

So we have a start date, April 25, and now, we have an end date: if all goes well I’ll be free of antidepressants on Wednesday, July 4. Stay tuned.

This Bites

An apple a day keep the doctor away, they say. Bullsh*t, I say! Because this afternoon an apple actually brought me to a doctor – or a dentist, rather. I explain!

I had an apple at 3pm. Also, I got braces 25-and-a-half years ago like pretty much everyone else I know. They were taken off in 1994; I’ve had a wire on my bottom teeth ever since. I’ve literally never had a problem with that wire; this is what the kids refer to as “foreshadowing.” I bit into the apple (as one does) and felt a piece of it stick inside the wire. I tried prodding it loose with my tongue and realized, hey, that’s a pretty hard piece of apple! Turns out it wasn’t a hard piece of apple but a hard piece of wire that’d broken loose and was now jabbing into the bottom of my tongue. Which is how I ended up at an emergency dentist’s office in Little Portugal having orthodontic work done for the first time in over two decades.

I don’t know what the takeaway here is, folks. I do know it was an unexpected way to end my last day in the office before April 24 – and that if anyone needs a great dentist in the west end of the city, drop me a line.