I was prescribed Sertraline (Zoloft) in 1998 when I had postnatal depression. I was told to take it for a year to 18 months. I went from deep depression/anxiety to euphoria in the space of about two weeks, I felt pretty damned fantastic, there was nothing I couldn’t handle. As time went on I continued to feel well but my emotions were dampened down, so I was functioning well, no depression, but no “joy” either. After a few months of feeling well I decided I didn’t want to be on Sertraline anymore, didn’t read the patient information leaflet or talk to a doctor, not that that would have helped anyway. I just stopped taking them. My head felt terrible, it began to feel water logged, if I turned my head there was a time lag between my eye balls catching up with the fact that my head had turned, so dizzy, gradually intense sadness would kick in, really really intense sadness and anxiety, oh the anxiety, pumping adrenaline and nerves shot to bits. I went back on the Sertraline.
The doctor told me to do the alternate day thing, alternate days for a fortnight,then every third day for a fortnight, then one tablet a week, I did this various times over the next few years to no avail. I tried a pill cutter and halving the tablet, it wouldn’t break down easily without crumbling so that was unsuccessful. Every time I tried something, I ended up in worse shape than the time before, it was all getting steadily worse. I tried meditation, healing, exercise, cognitive behavioural therapy, counselling, fish oil capsules, NOTHING touched it. I pressured my surgery to refer me to a psychiatrist for advice,but the psychiatrist had no clue and could only recommend switching to another drug. I did switch to Citalopram for a while, and Mirtzapine, I felt constant fatigue on Mirtzapine, and then back to Sertraline. Yet another psychiatrist recommended halving my dose of Sertraline and taking diazepam to mitigate the withdrawals, so replace one powerful drug with an even more powerful addictive drug.
This is my description of how withdrawal felt from my blog, I only recently found out that what was happening had a name,akathisia:

“5am and for about the 3rd night in a row I’ve barely slept, I can’t stop the adrenaline pumping round my body, my stomach is tightly knotted, I’ve barely been able to eat properly it makes me feel sick. I’m clammy, sweating and crying and P is trying to reassure me, but he has to go to work. I get up and drag myself through all the motions of the day and making sure boys get to school, I feel like the living dead, I make sure they get fed and make sure they and no one else is aware of what’s going on, I don’t hang around at the school gates. Oh I do kind of tell a few people I’m not really feeling right but I play it down.
The constant adrenaline is tormenting me on the inside and I can’t stop it.It’s been building up over a period of months and I’ve been fighting and fighting the feelings but it seems to have reached a peak of exquisite torture.It’s like being at the top of a roller coaster that never stops. Someone else mentioned birdsong, and it was a funny thing, the torture was worse in the mornings and over the summer months while it was slowly building, birdsong in the morning outside the window had become a kind of torture as well. I had to go to work only 2 days a week and God only knows how I managed it. I had taken
my last Sertraline tablet months ago, and come off it as per the doctors instructions, and now my depression/anxiety was back tenfold to punish me for daring to presume I could stop taking it. I must be wired up wrong, no one else feels like this do they? What is wrong with me? Maybe I really am insane, maybe I just can’t cope with life without my tablets, how come everyone else can cope with life, and I can’t? There must be something fundamentally wrong with me. By now the Orwell Bridge was beginning to look a bit attractive and I just wanted to escape the adrenaline surges torturing me, my nerves were in shreds”.
This was 2003,at the end of 2003 I gave in and went back on the sertraline.

In 2006 I attempted another withdrawal, but at the same time we found ourselves going through a stressful life event, I tried to tough it out but ended up back on the Sertraline again.
So here I was, several years later and no further forward, and not for wont of trying! Everytime I went in a book shop or library I would try and find anything I could about antidepressants and depression, but nothing really enlightened me. I rummaged around on the internet but couldn’t find the answers. Until one day, I was browsing around Waterstones, and “Coming off Antidepressants” by Joseph Glenmullen jumped out at me, I read it avidly, and discovered TAPERING!!! But, all the examples in the book referred to liquid Seroxat or Prozac, I was really upset to find Sertraline was not available in liquid form. Armed with my new information about the simple concept of tapering, further digging led me to Dr Healy’s protocol of switching to the equivalent dose of liquid Prozac. These two pieces of information became my secret hope, I latched onto them. I decided to take a leap of faith and switch to liquid Prozac. At the beginning of 2007 I marked up my calendar with a schedule, I was going to go down from 5ml to 4.90ml the first week, 4.80ml the next week and so on, as my sons would say “epic fail”. By about mid February the nightmare was unfolding again and I had to give in and go back to the top of my Prozac dose, I was devastated.
Still I hadn’t given up hope, P was sympathetic but he couldn’t understand why I didn’t just give it up and accept I “needed” the drugs like a diabetic needs insulin. After lots more research, and P having interesting and enlightening conversations with a client who was a pharmacist about my problem, I started my taper again in May 2008, this time much much slower and here I am four years later down to 1ml liquid Prozac and still sucessfully tapering. It has needed a lot of self-discipline. I kept this blog/diary of my progress; I’ve been amazed to meet a few others who have been tapering longer than me. Nowadays my withdrawals are fairly benign, but I still feel a bit scarred from the experience,the akathisia has left me still feeling like my nerves are quite raw and very close to the surface but I can live with that now.
There is a huge assumption that these drugs are benign and harmless, they are not; they can cause extreme agitation and internal torture. They are dished out like smarties and people left to deal with the results. Starting them is like playing a game of Russian Roulette, you might be a lucky one who can take them and come off them with ease, or you might not. My understanding was that they were meant to be taken for only a year or so after you feel “well” but many many people are stuck on them for years or forever, I know many people who’ve given up hope of coming off SSRI’s and I hear many people say “oh I’ll be on these the rest of my life”. There is NO support or advice in place through doctors or psychiatrists on how to taper safely off the drugs.....if anyone does find any help in the UK, please let me know, although it’s a bit too late for me now as I’ve almost done it myself, but I know a lot of other people who might like to know!

Saturday, 15 October 2011

Antidepressants and sex: A doomed romance?

A great article sent to me by a friend.
Link to this article
Antidepressants and sex: A doomed romance?

As a libido-friendly "happy pill" gets FDA approval, we talk to people who've endured other drugs' bad side effects.




 
It sounds like an absurd deal with the devil, the sort fairy tales are built around: You can get back your zest for life — all you have to do is surrender your desire for sex. Feeling depressed, isolated and lonely? Just take these pills that will make you lose interest in one of the most powerful ways that humans achieve connection and intimacy!
Extreme, perhaps, but that’s a common trade-off made by going on antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). Of course there are other potential side effects, but dry mouth and insomnia are bearable insults compared to sacrificing your libido, erections and orgasms; and these sexual snags are a significant reason people discontinue treatment, according to experts. So when news broke this week that the FDA had approved Viibryd, a so-called sexy-friendly antidepressant, it caused quite a stir. Far too often, people are forced to choose between their mental and sexual health — as though these were entirely separate categories.
A 25-year-old photographer living in Florida tells me that his libido plummeted when he went on antidepressants. “I would have chosen a bowl of ice cream over the sexiest woman alive,” he said. “I stopped taking the medicine because it wasn’t worth the side effects.” It’s an interesting contradiction: He lost his libido but not the strong desire to have a sex drive. Now, he says, “I’m horny 24/7″ — which is just the way he likes it.
A 28-year-old married man tells me that he had trouble getting and staying hard while on Effexor. “I also had trouble reaching climax.” But he didn’t stop taking the medication: “Even though the side effects caused marital problems, not taking it caused the depression to act up, and the mood swings to get really bad. I just couldn’t handle some things without the meds.” A 51-year-old man tells me that he was already struggling with erectile problems when he went on citalopram. “The ED and depression are a chicken and egg thing, don’t know which came first, but each was making the other worse,” he said. “When I was able to get hard enough for sex, I would often not be able to come for a very long time, if at all.” Eventually, his doctor switched him to bupropion, which he says helped with his depression and lessened the sexual side effects.
At least women don’t have to worry about getting and maintaining an erection to have sex, right? Only, it seems they are far more vocal than men about the sexual costs of antidepressants. A 28-year-old woman tells me that before going on Celexa, she would have sex several times a week, and masturbate alone just as often, without any trouble climaxing. “After about a month on Celexa, I stopped masturbating entirely and lost interest in sex with my partner. I couldn’t climax — by hand or vibrator — and I didn’t have the same sexual drive to even try. Looking back, I’m not sure how I made it! It was so frustrating!”
It wasn’t just frustrating for her, either. “My partner complained about my lack of interest and noticed that I was going through the motions of sex, in addition to skipping my personal pleasure time. I couldn’t climax and I rejected a lot of her efforts,” she said. “I was tired of not feeling like myself in and out of the bedroom. My lack of sex drive hurt my self-esteem and my partner’s. We just didn’t feel like we were connecting like we used to.” So, she went off the drug and she reports that she’s “climaxing again and back to my old bedroom ways!” (She isn’t alone: Last year, Ada Calhoun wrote for Salon about how going off Celexa turned her into a bit of a nympho.)
“Jessica,” a 31-year-old living in New York, says she “had plenty of good sex” while on Zoloft, but it took tremendous time and effort for her to climax. “I was emotionally numbed out,” she said. “It was like I couldn’t access that part of me, emotionally, that would allow me to let go. At the time I thought it was trust issues. I’d read about oxytocin and bonding, and I thought maybe I was subconsciously protecting myself from getting hurt, because being in my early 20s, I was getting hurt a lot!” After several years on the drug, she went off and “the orgasms came back almost immediately.” She had harbored suspicions that the Zoloft was to blame for her lack of orgasms, “but it really only all became clear to me once I got off it — they came right back, without any context change.”
When my friend Elissa, 26, went on Lexapro, she “noticed it look at least 45 minutes to get one orgasm, and the orgasm was basically a tiny blip that was more struggle and irritation than anything,” she said. “So I stopped masturbating. I didn’t mind not having orgasms because I was happy.” But then she found someone else was frustrated by her medication: her boyfriend. He wanted to be able to make her climax, so she went off the drug, but, funnily enough, she still couldn’t have an orgasm with the guy (although it was no problem on her own). That’s a reminder that sexual relationships are mysterious and frustrating, even without the obfuscation of medication.
Anyone who decides to go on meds has to wrestle with these riddles all the time: Which part is the drugs, which part is me, which part is the side effects? (For that matter, anyone in a relationship is familiar with that dilemma as well: What’s me and what’s the other person?) Psychiatrists and social critics might cringe at the idea of people going on and off their meds to chase their orgasms, but that clearly happens quite a bit. Michelle, 38, says her libido and her orgasms disappeared on Prozac, but she was terrified that she would “go off the rails” if she stopped taking the medication. Ultimately, she says, “I just could not envision living life with that big piece” — the sex piece — “of the puzzle missing,” she said. As it happens, she didn’t go off the rails.
From all the media hype this week you would think Viibryd had flipped the pharmaceutical industry upside down — but that doesn’t seem to be the expert opinion in the medical community. Andrew Francis Leuchter, a professor at UCLA’s Department of Psychiatry and Biobehavioral Sciences, said the drug’s data looks solid, but he wasn’t ready to call it a game-changer. There are already antidepressants on the market that boast low sexual side effects, and doctors commonly layer drugs to avoid killing a patient’s libido. The problem is that antidepressants aren’t one size fits all. “Whichever medication we pick, it is only going to get patients well about a third of the time,” he said. “We have yet to find a drug that gets most of the patients well right out of the gate.” Better drugs with fewer side effects — sexual and otherwise — are crucial, he says, but it’s important to develop better ways of predicting which drug will work for individual patients to avoid the trial and error approach.
Antidepressants can make life more bearable — they can save lives — but, for many people, a sexless life isn’t much of a life at all. That people are willing to risk this trade speaks to the level of desperation that can lead to antidepressants; and that many find the trade unbearable certainly speaks to the power of sex.

Close.Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory



2 comments:

Carol said...

Aha! Yep! Great blog, really great! Efexor - only side effects for me are NO sex drive, (which could be hilarious due to my age!) and not being able to sleep. Many of the antidepressents are notorious for squashing your sexual feelings, and it is often a case of a trade off. Do you want to be sexy and depressed or t'other way around. hmm xx

SMH said...

Carol you're never too old for a bit of hows your father ;)
Seriously though this was a big issue for me and was a trade off I tried to accept but couldn't.