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!

Sunday, 16 December 2012

A Little Knowledge Can Be a Dangerous Thing!


1ml Syringe
Yesterday, my friend who is a specialist nurse called round and we talked syringes. (I really need to get a life). This friend is the only health professional me and P know who has taken on board and taken an interest in my issues. I happened to mention in the course of the conversation that I'd started flushing the syringe in water and drinking the water to make sure I got all the medicine out. I'd read that this was a good idea. She pointed out to me that if I had just started doing this, I had inadvertently been updosing another .05ml so I had gone up from 0.85ml to most likely 1.10ml which was a bigger jump than I had intended. I was flusing the Prozac out of the nub at the bottom and that nub is quite big. 
 
Everyone close to me has had a different opinion on what I should do, but I decided to go with my gut feeling and go to 1ml. Six days later I think this gut feeling is begining to pay off, this week end the awful gut churning anxiety/dread/doom feelings seem to have just melted away, I'm sleeping better, not quite as well as previously but noticably better and today I feel a definate shift towards feeling more "normal" self again. I have also been practising a mindfulness meditation everyday and of course that may have helped as well.
 

Saturday, 15 December 2012

1ml (4mg) - Who Needs Red Bull!

So after nearly a month at 1.05ml I honestly wasn’t feeling any improvement, in fact I think I was beginning to feel worse again, the main problem was feeling “wired” or like I’d drunk a jug of Red Bull and unable to sleep, this in turn was making me feel really depressed. 
I would really like to thank Alto Strata at http://survivingantidepressants.org/ who asked a knowledgeable doctor about what was happening to me and the conclusion was that by going to 1.05ml I may have overshot my bolt, and the Prozac was becoming too activating, it is a stimulating drug and I seem to be very sensitive. When we studied it I was beginning to feel better shortly after I went to 1.05ml but since Prozac takes a lot of days to reach “high tide” it was probably the effect of going up to 1ml beginning to take effect and then I ramped it up by going up further to 1.05ml and got worse again. So I’m going to see how back to 1ml goes.

In my real life I seem to be surrounded by people who just “stopped” their drug or had no problems, I am so thankful for the internet and finding that I’m so NOT alone with this and I'm not mad.
In the meantime I have begun to practise mindfulness, and can thoroughly recommend a book called “The Mindful Way Through Depression”, it has a CD with it and I’ve begun to do about half an hour practise a day, and if I can find the right dose to get my nervous system back on the right track I’ll stick there because I’ve had enough of this crap for now.
My Prozac Reduction Timeline

Saturday, 17 November 2012

1.05ml - Arresting the Spiral


So I’ve  found myself spiralling down in a way that I hadn’t felt for 5-6 years, after years of fairly benign withdrawals because I’ve been tapering so slow, I was shocked to find myself getting all the old symptoms from years back. A bad withdrawal seems to take your most negative emotion like anxiety and ramp it up or amplify it to a spirit crushing level. Mind you depression does that as well?!?!
 As I’ve documented in the posts below the worst things I was getting and still getting on and off, was insomnia, deep despair, dread and adrenaline/anxiety. I actually, maybe naively, thought I’d left those things behind years ago in the bad old days. It’s impacting on my life again recently in ways I hate; I’ve been too exhausted to go into work for a few days during October/November, and I’m struggling to get myself back on an even keel again. Insomnia is the most debilitating symptom and just aggravates everything else and is classic in drug withdrawal.
So having taken guidance from the eminently knowledgeable and wise Alto Strata, (who I probably should have listened to months ago when she suggested a micro taper to me) I’m going to go up a tiny bit more to 1.05ml in an extra bid to clear my current issues, as she explained it .05 is 5% of 1ml and it could well be that I am sensitive to tiny amounts now, and Prozac is a stimulating drug, if I’m sensitive I don’t want to aggravate things further but need to find the right balance and stabilise myself at that point.
So I suppose the lesson here is never get blasé and underestimate the power of these drugs, for good or bad depending on how you view them.
The other lesson is that recovery and progress doesn’t always happen in a straight line.
 

Saturday, 10 November 2012

1ml (4mg) - A Small Reinstatement

So on Wednesday I had to updose a tiny bit back to 1ml, the received wisdom from those who have trod this path before me is that if you start unravelling it's best to go back to the dose where you last felt well, so this is what I've done,  I will write more fully about it hopefully in the next week, right now I'm just totally drained.

Prozac Reduction Timeline

Monday, 29 October 2012

C'mon Inner Peace I Don't Have All Day!!

The people who mentioned it gets hard near the end, they were not wrong!!  Anyway I realised this blog was turning into a right misery pity fest so I want to turn it around again into a more positive story of recovery and celebrate the fact that I have in fact come a long long way even if there is still a bit or work to do.

I’m getting the adrenaline surges I used to get years ago when I did cold turkey but not as severe, it becomes a bit of a downward spiral because adrenaline surges means it’s hard to relax/sleep and in turn the tiredness/exhaustion makes the surges feel worse and more desperate; the one positive thing about adrenaline surges is that they appear to eat calories and I can now eat cake and lose weight.!!Has to be some benefit doesn’t there? Yesterday I had a couple of strong coffees in the morning and couldn’t help but notice how very on edge I felt an hour or so later, so I guess that’s something I’ll have to cut down or eliminate, hopefully temporarily. I have taken some advice and this is the positive action I am taking:

       Out with the bungee jumping


       Out with the trips to Alton Towers, no more Oblivion for me, at least for the time being

Cut down on tea and coffee

 
And:

       Replace tea and coffee with chamomile, green and rosehip tea (boring but soothing)

Eat healthy

Magnesium citrate (was already taking magnesium but apparently magnesium citrate is much better absorbed and is good for the nervous system and muscles)

Melatonin (good for sleep)

Learn about Mindfulness, “Wherever You Go There You Are” on order.

Keep up with the exercise, sadly weather for cycling is not good but I still have the X trainer.

Continue to appreciate my caring and supportive husband who worries about me, and my funny affectionate sons.

 I’ve been trying to unravel whether this is “withdrawal” or mind and body rebelling against the crutch I’ve had for so many years now disappearing, and even whether I ought to up dose a bit or tough this out. At the moment I’m going to stay at this dose, take positive action as above and mull over how to proceed in the future.


Sunday, 28 October 2012

Peter Hitchens writing in the Daily Mail about Felicia Boots

Peter Hitchens often writes on this topic in the Daily Mail. I have actually been avoiding this story because it's really so painful, but it is actually really important to share this, as most people will be missing the point entirely and blaming the post natal depression, the real story is that she stopped taking her pills cold turkey. Thank you thank you Peter Hitchens.


Investigate the evil of these pills

I bit my tongue when I first read of the tragedy of Felicia Boots, her life now a desolation of unbearable grief.
As soon as I learned that she had killed her own children and then tried to do away with herself, I was sure that I would find she had been taking ‘antidepressants’. And so it proves.
Our courts let many people off because of spurious claims that they could not control themselves.
Probe: Peter Hitchens wants an inquiry into the usage of antidepressants following the tragic story of Felicia Boots, right
Probe: Peter Hitchens wants an inquiry into the usage of antidepressants following the tragic story of Felicia Boots, right
But I believe that in her case the judge was right to say that this unhappy woman was in the grip of ‘forces that were beyond her control’.
It will be pointed out that she had recently ceased taking these pills, because of a perfectly reasonable fear of passing on the drugs to her children through her breast milk.
To anyone who has studied the matter, the fact that Mrs Boots became unhinged after ceasing to take her ‘antidepressants’ will be no surprise.
Normal human beings become abnormal, possibly for ever, as soon as they first ingest these powerful, poorly-researched chemicals, often prescribed by doctors shamefully ignorant of the growing body of expert criticism of them.
The effects of coming off them can be even worse than the effects of starting to take them. I have absolutely no personal stake in this argument. I have simply observed what seems to me to be a pattern, both among several people known to me and in a growing number of news reports.
I will be told this is ‘anecdotal’. Very well, then. Let us have a proper, fully-funded inquiry that will settle the matter once and for all. It is very urgent. Prescriptions of ‘antidepressants’ grow all the time.
If there is the slightest risk that they make good, kind mothers lose their minds and kill their own babies, I can imagine few more pressing matters on the agenda of any government than to establish the truth and act on it. Please, somebody listen.

Link to the article (scroll down)

Saturday, 20 October 2012

Cutting Up Rough


Just had one of the worst few days in a long while, since I embarked on this taper in 2008 my withdrawals have been fairly benign and I’ve been pretty much able to work through them. This time however I’ve had a few days that have felt much more crippling in intensity, I’m wondering if it’s because now I’m below 1ml each cut I make is more than 10% of previous dose. At this point I could make micro cuts, which could be endless, or just leave even longer between cuts and accepting that the withdrawals will be more debilitating when they do hit. At the moment I am thinking the latter; whatever, it’s just really frustrating to be so near and yet so far to the end. It’s so tempting to just think to hell with it and just drop this last bit dead but I just know Prozac and my brain won’t like it and will cut up very rough.

These past few days I’ve had the following:


·        Wired/caffeinated feeling

·        Insomnia (one night I got so fed up I went downstairs and made a packed lunch and sorted laundry, went back to bed and still couldn’t sleep)

·        Free floating anxiety

·        Crying

·        Despair
At my lowest point I nearly deleted my page off Facebook and this blog, until P talked me out of it, and now I’m so glad I didn’t, I would have missed the page and all the wonderful people out there. This time I even had to take a couple of days off my local authority job and I felt really bad about that, I’m so used to rarely being off sick. The plus side is that I work with a great team of people, and I felt able to tell the truth about why I was off sick and even had a lengthy chat about it with a colleague when I did get back and it was all positive.

Today I feel like I’m definitely coming out the other side and I’m just left feeling like I’ve been through the wringer and feeling a bit spaced out.
I do just want to address something that I know people think but are too polite to say or ask, everyone who goes on these drugs went on them for a reason, depression, anxiety (and nowadays PMT, ADD, ADHD, physical pain or any number of different ailments). How do I know I’m not just depressed still? Of course I’m not naive enough to think depression will leave my life forever, of course I will always be someone prone to depression/anxiety as part of my makeup and I am ever mindful of that fact. Having had depression I know that with no drugs involved it just doesn’t shift that quickly, it’s a longer haul. When doing a slow taper off a drug the depressions are mercifully time limited and do shift in a way that depression wouldn’t.

My youngest son is 14 this coming week, this means its 14 years since this story started.

I just want to end this post with a picture made by a good friend Paul:
My Prozac Reduction Timeline

Wednesday, 10 October 2012

Today is World Mental Health Day

P is in a lot business networking groups on Facebook, and he received an invitation to an "Afternoon tea and talk" event at Arlingtons Brasserie in Ipswich this afternoon, it's a mental health awareness event with interesting things going on,  at first I thought I wouldn't be able to go and then I realised I had in fact swapped my work days for a staff meeting so I could in fact go.

 A portion of the proceeds of the event are going to Suffolk Mind and The Mind Sanctuary in Suffolk. This was too good an event for us to miss as it combines business networking for P and mental health awareness which is of interest to us both.

The Mind Sanctuary

Suffolk Mind

Saturday, 6 October 2012

Antidepressant Withdrawal is Hell!

When I shared this picture on my Facebook page a while back I was shocked by how much response it got, so many related to it or had something to say about it.

I could tick at least half the things on that list and many people I know could tick nearly all.

Monday, 1 October 2012

It's.just.a.drag



So a week into my tiny cut this is how I've been feeling, my sleep pattern has temporarily gone to pot and I've been dragging my weary ass through the days, it's. just. a. drag. On saturday I'd had a good nights sleep but despite that I just felt like someone had pulled my plug out, I felt drained like when you have flu.  No emotionals this time, just tiredness,  I know it will pass. I really was hoping to speed up the last bit of the taper now, but P, very sensibly said what does it matter? who cares if the last bit takes another load of months? enjoy the stability in between the drops? I know he's right darn it!!

I'm married to someone who can sleep on a clothes line at the drop of a hat, I however have to go to bed the same time every night and no matter what time I go to bed, I always wake early, I never sleep the clock round, and I daytime sleep just doesn't come easy, and if it does I get a thumping headache, so routine is important to me, I've found talking to other members of my family that they are much the same, and I think it's to do with being brought up in a farming family.

Prozac Reduction Timeline

Sunday, 23 September 2012

0.85ml and Surviving Antidepressants

It's been a long time since my last reduction, I decided to hold it steady over the summer as I did feel the last cut for a while, and it took me a bit by surprise. Now I'm on the home stretch I decided to make smaller cuts as the last bit is allegedly the hardest. Partly at the suggestion of Alto Strata on the Surviving Antidepressants web site and partly because my husband worries :)
Speaking of Surviving Antidepressants I was hugely flattered a few weeks ago when I got a message from Alto Strata at Surviving Antidepressants asking me if I would like to help admin/moderate the forums and in particular the "Tapering" forum. I was impressed with my "staff" badge on the site,  but at first I wondered what I let myself in for, not because I was worried about talking/helping people on the forums, I do that a lot anyway, it was more all the techy bits I now have access to behind the web site. I also wondered if I would be able to do it justice and visit the site enough to keep up with people, but it's been absolutely fine and the tapering forum doesn't move as fast as some of the others forums on the site.

Link to Surviving Antidepressants for Anyone Seeking Support

Friday, 10 August 2012

Prozac Taper Progress Report

So here I am still at 0.90ml since mid June. It’s not been an easy ride this time; I had a feeling from things I’ve heard from other people that it can get tricky when you get near the end. I’ve been waking up with low level depression, waves of sadness most mornings, sometimes it hangs around like a bad smell for best part of the day, but mostly it does dissipate mid morning. That’s it, it’s just low level and niggling, not crippling. It has crossed my mind that either I could get stuck at this low dose, permanently, or the last 1ml of the taper could just take an awful long time. It’s the sheer subtlety of it now, the not knowing what it is that’s really annoying, is it withdrawal or “me”? I do know that I am always going to be one of those people who will be “prone” to depression and anxiety and therefore I need to be mindful.

This happened to a fellow taperer/friend (I hope she doesn’t mind me mentioning) and she reluctantly chose to stay at the very low dose permanently because every time she dipped below that level depression kicked in. As she said “it is what it is”. It’s great to compare notes with someone else from a completely different country and different walk of life but going through the exact same thing.
In the meantime, I am helping a lady in New Zealand to admin her support group on Facebook, there are about 90 people in the group, not all active, I think some just like to sit quietly and read things. It's a brilliant supportive and friendly group so if anyone reading this and needs help/advice and would like to join please contact me and I'll add you, it is a closed group, not visible unless you search for it, and therefore no one outside the group can read anything in it.
Today is a good day though, the sun is shining, I now have 2 weeks off from my part time job (not from helping Peter with the business though sadly), we are going to a Newmarket Race Night this evening with some very good friends, Tom Jones will be performing at the end of the races, and over the next two weeks I’ll get to spend more time with my youngest and catching up with friends before the new school term starts.

Prozac reduction timeline

Saturday, 21 July 2012

School Shootings, SSRI Nightmares, Suicide and Violence

I don't normally dwell TOO much on the dark side on my blog, partly because I want it to be a story of recovery, but there is a massive dark side which can't be ignored. Back in 1999, 2000, 2001 I would have dismissed it as scaremongering bollox as well.
Until I experienced it myself I never would have believed it. Cold turkey sent me to a very very dark place, by end of 2003, I knew I couldn't go on much longer, it was harder and harder to keep a front up, at work and at home, the only person who really knew what was going on was my husband, I couldn't eat properly, I couldn't sleep, I couldn't stop the adrenaline surges day and night, I couldn't stop the dark dark thoughts and feelings. The adrenaline surges were the hardest thing to deal with. If you can imagine the gut churning fight or flight response never switching itself off. I couldn't tell anyone, people talk about "losing the plot" but I really had lost the plot and was lost in my own inner torment that no one could see, let alone understand. Hell I didn't understand it myself so how would anyone else? I did get to a point where images of the Orwell Bridge entered my head, it was just a thought but it was there. I've since met people who've had similar experiences with coming off too fast, severe agitation, distressing thoughts of violence towards other people and themselves, which cleared with reinstatement of the drug. This happened again to me in 2005, 2006 and 2007 but to a much lesser degree as I reinstated the drug more rapidly when I realised what was happening.

If I had perservered without reinstating Lustral for another month or so into 2004, I think the internal agitation, desperation and despair would have driven me to something dreadful to end the misery. Fortunately with my husbands encouragment I reinstated Lustral and fairly swiftly my symptoms subsided.  This was my insight into the dark side of SSRI's.

No one told me this could happen.

Since writing this blog I've met many others with similar experiences and I've read a lot. Really I do need to get a life, but knowing the medical establishment are either genuinely ignorant or totally in denial and there is so little help out there, I am prepared to talk about it here knowing that others stumble on it and find they are not alone.

Sometimes even now when I drop my dose I get a flavour of that "dark side" again for a few days, and then it just suddenly disappears as my brain/body gets used to the new slightly lower level of Prozac. My husband is so finely tuned into me, he knows, he said to me the other week I looked like I had the weight of the world on my shoulders, and then almost overnight it just went as my metabolism adjusted to the new lower dose.

In recent years as I've done a lot more research into SSRI's I've discovered my experience wasn't unique, but many many people when it happens don't know the inner agitation/adrenaline surges is a side effect of dropping a drug too fast. Suicide and violence are now recognised in many circles as side effects of dropping Prozac/Lustral/Seroxat etc too fast, or starting it too fast.
Like I said, I would never have believed it years ago, and most people who are settled and comfortable on SSRI's don't believe it either. If you're one of those people reading this, I can hopefully save you ever having to find out by telling you that when you do decide to come off your drug, don't do it cold turkey, don't do the alternate day thing and do it extremely slowly, there is no such thing as too slow for some of us.

SSRI stories This is a really interesting data base of reported SSRI related violence/suicide, there is even a celebrity section.

Many many stories of random violence or suicide that you read in the media have an underlying hidden story of prescription medication behind them that the media generally don't pick up on, unless it's a celebrity, maybe. Unless you've experienced it yourself it just doesn't cross your mind.

Hmm I can hear some people I know reading this and thinking, yes, but how do you know it's the drug? you might be a sandwich short of a picnic and the drug might be nothing to do with it, how do you know it's not the mental illness? well that's the head f*** because it can always be blamed on the original illness and big pharmaceutical companies hide behind this.
But don't just take my word for it, look at SSRI stories and Dr David Healy, professor of psychiatry in Wales.

Sunday, 8 July 2012

The best way out is always through

Following on from last weeks post, I am now coming out the other side, I've had about 10 days to 2 weeks of:

  • Low level depression/anxiety, worse first thing, better as day goes on
  • Poor sleep
  • Fuzzy head, worse when tired, which has been a lot
Normally I just get the poor sleep and fuzzy head but I've had a triple whammy this time. I can feel it's distinctly lifted this week end and I am mightily relieved, it's always hard to keep the faith that it's a withdrawal, and shake the fear that it has in fact set in permanently.

My Prozac reduction timeline

Sunday, 1 July 2012

Going through a withdrawal

That's it, I know I'm going through a withdrawal, my head has been a bit spaced out all week, I've been up and down and just "not quite right", anxiety has kicked in, I've had those feelings of fear that it won't go away, but I've done this so many times before now, I know it will go away again. This too will pass.

Saturday, 16 June 2012

0.90ml - and Low blood sugar

So now I've broken the 1ml barrier!  I've always suffered with low blood sugar, even before I went on Sertraline, but I know it is also aggravated by SSRI's, I wonder if this is the reason why many people gain weight and it's a known side effect of these drugs. Lately it just seems to be really bad, mornings are worst for me, half way throught he morning I'm already hungry and my mid day I'm ravenous and if I don't get my lunch I am all those things in the picture to the right! and if lunch is not adequate enough by mid afternoon I have a real thumping headache. I am experimenting now with cutting out  sweets, biscuits, cakes, puddings to see if that helps, not that I eat a lot of cakes but I naturally crave sweet stuff when I see it. I thought about cutting out tea/coffee as caffeine is known to aggravate it, but that lasted all of about two days!! I manage to keep my weight in the range it should be but it's a struggle. Hence the bike rides/exercise. Anyway, I am curious to know if this is an issue for anyone else? and how you deal with it?    

But anyway! 0.90ml!!!! A friend on facebook said there would be a party on facebook when I make it to 0. No pressure then!                  



Friday, 15 June 2012

Mind - Making sense of coming off psychiatric drugs

I discovered last week that Mind, the mental health charity in the UK, have a really really good page on their web site about coming off psychiatric drugs. You can either read it on line and print it off or you can send off for it as a booklet for £2. Perhaps it would be a good idea for people to print off and give to their doctors!  There is also another booklet called "Coping with coming off" which is £2 but no idea what it's like, you have to send off for that one to read it.
Mind - Making sense of coming off psychiatric drugs

Monday, 4 June 2012

Hanging in There

I had really hoped that I would be going to 0.90ml this week end, but, I went down with tonsillitus, been feeling generally really run down physically, ear ache, head ache and as well my head is feeling just so, how can I describe it? just kind of dizzy which I know is a side effect of withdrawal. So, my mentor (Peter) has told me sensibly to hold off another week or maybe two.

Saturday, 26 May 2012

4th Anniversary

Today is the 4th anniversary of my taper, I made my first timid reduction to 4.90ml on 25th May 2008, I'd switched to liquid Prozac in the February and in fact Peter wanted me to wait until about August before starting my taper because we were rennovating the house and it was in chaos, but I was a bit impatient and in fact that first reduction was me allowing a little air bubble in the syringe as a cautious experiment. In fact it was more like 4.95 than 4.90, that's how scared and phobic you get about it. Now I WAS going to go down to 0.90ml today, but, this week my sleep pattern has been shot to bits and I am decidedly cranky so I'm going to leave it another week.
One thing I have been getting is a lot more of the dizzy head feeling, I think because up to recently I have never dropped more than 10% of previous dose but now I am so low, if you do the maths the drops as a percentage of the previous dose get steeper so I think my head is feeling it now. I never had the brain zaps that other people describe, more of a dizzyness and waterlogged fuzz inside my head.
Oh and this week Bobby Fiddaman asked me and another person to write guest blogs on SEROXAT SUFFERERS - STAND UP AND BE COUNTED about sertraline (zoloft), I said yes but I don't know what to write, how mad is that?!?! I've been blathering on here about it for four years and found enough to say!!

Anyway, as it's my 4th anniversary here's my timeline for the past four years, just in case you haven't already seen it ;)

I think by this time next year I'll be done.

25th May 2008 4.90ml

10th June 2008 4.80ml

14th July 2008 4.70ml

14th Aug 2008 4.60ml

14th Oct 2008 4.50ml

25th Nov 2008 6 months

3rd Dec 2008 4.40ml

24th Jan 2009 4.25ml

11th April 2009 4.10ml

18th April 2009 3.90ml

17th May 2009 3.80ml

25th May 2009 1 Year

6th July 2009 3.60ml

22nd Aug 2009 3.50ml

2nd Oct 2009 3.30ml

14th Nov 2009 3.20ml

25th Nov 2009 18 Months

24th Dec 2009 3.10ml

31st Jan 2010 2.90ml

6th March 2010 2.70ml

10th April 2010 2.60ml

25th May 2010 2 Years

5th June 2010 2.50ml

3rd July 2010 2.40ml

7th Aug 2010 2.30ml

18th Sep 2010 2.20ml

23rd Oct 2010 2.00ml

25th Nov 2010 2 Years 6 months

18th Dec 2010 1.90ml

2nd March 2011 1.80ml

28th April 2011 1.70ml

25th May 2011 3 Years

10th June 2011 1.60ml

23rd July 2011 1.50ml

10th Nov 2011 1.40ml

25th Nov 2011 3 Years 6 Months

18th Dec 2011 1.30ml

17th Feb 2012 1.20ml

26th March 2012 1.10ml

28th April 2012 1.00ml

25th May      4 Years

1ml syringe



Tuesday, 1 May 2012

It's not where you are in life, it's who you have by your side that matters

So I've definately been getting this effect today. Earlier when I was looking at a book or a screen I felt like there was a wodge of cotton wool between my brain and what I was trying to take in, hard to describe, but nowadays it's not too bad compared to how it used to be a few years ago, I guess it's the brain adapting to firing on it's cylinders with less of the drug.

In fact I commented to P today on how transient the withdrawals are now, that sometimes I forget how rubbish it was a few years ago and feel a bit of a fraud now with my blog and facebook page, his response; you're not a fraud, you may forget sometimes but I bloody don't!!  
                
It reminds me how dreadful it was for him as well, scary for him living with me slowly cracking up and neither of us talking to anyone outside of us about it, and while I was preoccupied with struggling with waives and waives of sadness and anxiety washing over me with the occaisional glimmer of light which I held out for, but which was always dashed with more waives of sadness, he was also struggling, with his own confusion and fears. Depression/SSRI withdrawal can make a person appear pretty damned selfish and preoccupied and frustrating and hard for partners to deal with, not sure I could have dealt with it had the boot been on the other foot, I married a real gem.

My Prozac Reduction Timeline

Friday, 27 April 2012

1ml of Prozac and the man from Pakistan

Now down to just 1ml, so glad to get rid of that pesky .1 of a ml

 I am part of a really nice group on facebook about 50 of us, different stages of tapering off SSRI's mostly Seroxat but one or two others like me.  Most of us are from US, UK and New Zealand, the group had been pretty quiet and not a lot going on, but recently Adnan Abid from Pakistan burst on the scene joined our group, his English is pretty good, he had so much to learn about how to come off Seroxat and the group really came into it's own with the help and moral support, and humour, it was like he was the catalyst to really get the group talking, and what a nice group it's turned out to be, just a shame we're all so far flung and can't all meet up.

I don't normally mention people by name on here, to protect their privacy, but Adnan was so thrilled I'd mentioned him he asked me to edit this and mention him properly by name, so here it is Adnan!

My Prozac Reduction Timeline

Sunday, 15 April 2012

I Like to Know Things!

This is a 10 minute clip, and Shannon really amuses me. I think my tongue is in my cheek posting this one, you have to get past the very short skirt, the cliche sexy librarian look, and the Texan accent (sorry American friends) and if you really close your eyes and actually listen to what Shannon is saying about critical thinking with particular reference to antidepressants and the chemical imbalance theory, you get a basic lesson in how to look at advertising and think critically about how things are worded.

This Youtube clip is from Psychetruth website and here Psychetruth on Facebook.

They do a whole series of Youtube clips on lots of different health topics but I really don't know what their credentials are, whether they are doctors, scientists or everyday people doing research?

 Prozac Reduction Timeline

Thursday, 5 April 2012

2 Weeks? Try 12 years!!!!


Normally I do my repeat prescription for the Prozac on line and just go and collect. This time however my prescription request was requested and I was called into the surgery, I wondered if this was because Peter had recently shared my blog with them, although we'd had no comment or response. I couldn't see my regular doctor so I saw a new one who I had never seen before, he didn't know why my request had been rejected but he was very puzzled about my being on liquid Prozac, so I explained. I'm not sure he got it, I always feel like doctors think I've walked in off a spaceship from another planet when I talk about it.

Anyway, I got my prescription, and when I got in the car I looked at the patient info leaflet for the first time in a long long time, and I just had to photograph it and put it on here, can you see?? it tells you a few side effects if you stop taking this medicine suddenly, but then it tells you to talk to your doctor if you want to stop taking Prozep (the Prozac I have is called Prozep for some reason) and your doctor will explain how to reduce your dose slowly over 1 to 2 weeks!!!!!!!!!!

At the start of Jan 2007 I was on 5ml Prozac and I started reducing by 0.10ml a week, by February half term week the bottom was well and truly dropping out of my world again, adrenaline surges, insomnia, extreme restlessness, profound sadness/depression, and no this wasn't the depression returning, it was much more physical than that.

If this is the information patients and doctors are getting is it any wonder so many people including doctors are so confused??!!??


Prozac Reduction Timeline

Sunday, 25 March 2012

1.10ml

Going down to 1.10ml today. I keep being asked if I'm noticing it getting any harder now I'm right down low on the dose, and I have to say the only thing I'm noticing I'm getting a lot more of is the dizzy head, sometimes it's like my head is packed with cotton wool and it's hard to get a handle on a particular thought, it's only a minor thing and I suspect it will just come and go with time, so if you ask me a question and I give you a blank look it might be that I'm processing it through the cotton wool (that's my excuse anyway!).

I've had some lovley e mails from people who've read my blog, I've said it loads of times before but it really does make my day when someone takes the trouble to write to me and tell me they got something out of reading my waffle on here!




Prozac Reduction Timeline

Saturday, 24 March 2012

Liebster Award

I've had a really nice surprise,  I got nominated for a Liebster blog award by The Highly Unlikely Housewife, first time I've had a blog award, so thank you! I have no idea what Liebster means, but anyway here are the rules of engagement for this award:


  • Thank the person that nominated you on your blog and link back to them.

  • Nominate up to five other blogs for the award.

  • Let them know via a comment on their blog.

  • Post the award on your blog.'


As I understand it this award is for blogs with less than 200 followers, so here are my nominations:

No Spend Days because I love reading her thrifty blog and I aspire to be more thrifty myself but don't always suceed.

Maithancailin because she is my best friend, she writes brilliant poetry and is naturally a much better writer than I could ever hope to be,  and I hope she puts some poetry on her blog soon.

Crazy People Music because I like his music, and because he has been really supportive of my blog/taper and he is good company on facebook.

Everyones Gran because she is funny and entertaining and been a great support as well.

Struggling With the Elephant in the Room Manic Depressive Blog because David has written a really eloquent blog about his personal struggles with mental health issues, but he has been really very unwell lately and I miss his blog posts, and I'm kind of hoping this might help him get back to his writing, but if nothing else just to let him know that people do care.


Sunday, 26 February 2012

Numb Documentary - Watched at Last


Numb website - order the documentary here

I watched this last night, that was a big mistake, my sleep pattern has been a bit shot lately and watching this before bed didn't help!

It was absolutely spot on and I related to ALL of it. I've written about what it feels like to stop taking your antidepressant and what happens Akathisia as have many others, but Phil has gone a step further and actually filmed what happened when he halved his antidepressant. There's no way I wanted anyone to see me in that state and I actively hid myself and "it" when the withdrawals kicked in. Big kudos to Phil for doing this.

The excerpt with his very supportive wife was exactly how Peter was with me, especially where she said she didn't want Phil reading the worst case scenarios on the internet, it was obvious to me Phil was reading the Paxil Progress web site, exactly as I had when desperately searching for the answers. The impact on marriage and family life was an exact mirror image of ours when I was trying to stop taking my antidepressant. Peter on the outside trying to understand what was going on but feeling pretty helpless. Phil tried everything I tried, diet, exercise, alternative remedies, all to no avail. In the end he did what I had to done so many times, he restarted the antidepressant, after much angst and wrestling with whether to persevere with his withdrawals or give in and go back to the drug.  I was interested to see he switched to Prozac, just as I did, and I wonder if it was with a view to attempting to taper off liquid Prozac in the future.

Something else jumped out at me, one commentator in the documentary talked about whether these drugs are "addictive" or not, and this is a question that I have wrestled with. The commentator (I can't remember who it was, perhaps someone will remind me) made the point that the drug companies tell you they are not addictive because you don't see people selling them on street corners and people craving them, but that's because it's so easy to get your prescription filled from the doctor. I have sat in the surgery and heard someone begging for a doctors appointment because they hadn't realised they'd run out of their seroxat and if they didn't get it they would be in a terrible state the next day.

If anyone around me wants to borrow it and watch please feel free to ask me, but I won't post it to anyone because I don't want to risk losing it!



Tuesday, 14 February 2012

1.20ml - New Reduction

It's been two months since I last reduced, I think I'm deliberately taking it slower over the winter.

I've said it before and I'll say it again but I'm at a stage where it would be so easy to just stop taking the Prozac, I'm on such a stupidly low dose, but on the other hand I'm scared of all my hard work and patience unravelling at the end. So I'm keeping in mind what I read that I shouldn't ever reduce more than 10% of the last dose I was on, and when you think about the maths, the lower I go, the steeper the % drops.
So I'm really not sure how this will work when I hit 1ml, I think I may have to consider when my jumping off point will be.
 NEVER underestimate how this class of drug can screw you up. I'll carry on being the tortoise and not the hare for the time being.

My tortoise Prozac reduction timeline!

Monday, 13 February 2012

Psychiatric Drug Withdrawal: Why Taper by 10% of your Dosage?

I found this today and thought it was an excellent article, I have also put it as a page on the side for reference. It's more or less the method I've been following. Just been wondering where my "jump off" point will be....

By AltoStrata

AltoStrata's Surviving Antidepressants Web Site


Why taper by 10% of my dosage?

We believe that, for a minority, the risk of severe withdrawal is so great, a very conservative approach to tapering to protect everyone is called for.

Many people seem to be able to taper off psychiatric medications in a couple of weeks or even cold-turkey with minor withdrawal symptoms perhaps for a month or so. Doctors therefore expect everyone can do this. However, it seems a minority suffer severe symptoms for much longer.

It is unknown how large or small this minority is. You may very well be in it. You cannot know how your nervous system will respond to a decrease in medication until you try it.
Withdrawal symptoms represent neurological dysfunction. Severe symptoms can be distressing, debilitating, or even disabling. If you get prolonged withdrawal syndrome, there is no known treatment or cure. You will have to cope with it until it goes away.

Some guides will suggest a trial decrease of 25% to start. If you get withdrawal symptoms, it is recommended to reinstate the original full dosage and taper more slowly from there.

That is reasonable, except that it can take weeks to feel the full brunt of withdrawal symptoms from an initial drop. If you have already made two reductions from your original dosage, you will have reduced by about 50% — and your symptoms may indicate substantial neurological damage.

(NEVER ALTERNATE DOSAGES TO TAPER. IF YOU ARE SENSITIVE, THIS IS SURE TO SET OFF WITHDRAWAL SYMPTOMS.)

If you are a person who is sensitive to fluctuations in your dosage, you may be suffering quite a bit, and for these people, even if the original dosage is reinstated at this point, withdrawal symptoms may continue to be severe.

To save wear and tear on your nervous system, we recommend an initial drop of 10% and staying at that level for a month to see if withdrawal symptoms develop. If they do, you may wish to reinstate and make smaller decreases at intervals of about a month. If you are sensitive, this can protect you from a great deal of pain and discomfort.

If are not sensitive to a 10% drop, by listening to your body, you may be able to make 10% drops more often than every month.

In this way, the 10% method protects everyone and you have the option of tapering faster if you can tolerate it.

From the Icarus Project Mind UK Document


If you find you have to withdraw very slowly, it can be difficult to make small enough reductions in your dose, especially if your drug comes in capsule form. Sometimes it’s possible to break open the capsule and remove some of the content to lower the dose. You should always take care doing this, though, as the contents (for instance, fluoxetine) are sometimes irritating to the skin or the eyes. A pharmacist should be able to tell you if it’s safe to do so.
Some drugs are obtainable in liquid form, which can be diluted to make small reductions in dosage. It may be worth asking whether you can change to one of these. You would then need to be very sure what the concentration of the liquid is, and how much water to add to achieve the dose you wish. You may want to ask a pharmacist to help you with this….
Allow enough time for your body to readjust to the lower dosage at each stage. You could start by reducing the dose by 10 percent, and see how you feel. If you get withdrawal effects, wait for these to settle before you try the next reduction. Then reduce it by another 10 percent of the original dose. As the dose gets smaller, you may find this rate more difficult to cope with, and reducing by 10 percent of the reduced dose may be a better idea. If you started with 400mg of your drug, for example, you could first reduce the dose by 10 percent (40mg), to 360mg. The next 40mg reduction would take you down to 320mg, then 280mg, 240mg, and so on. If you got to 200mg and then found that a further drop of 40mg drop was too difficult, you could reduce by 10 percent of 200mg (20mg), and go down to 180mg, and so on. At each stage, if you find the reduction too difficult to cope with, you can increase the dose slightly (not necessarily back to the previous dose) and stabilise on that before you continue.

Also see Dr.Peter Breggin's 10% taper method

Please note that the 10% reduction method we recommend is a 10% reduction on the already reduced dose.

- If you started at 10mg, the first reduction would be 10% of 10mg, or 1mg, for a reduced dose of 9mg.

- Your second reduction would be 10% of 9mg, or .9mg, for a reduced dose of 8.1mg.

- Your third reduction would be 10% of 8.1mg, or .81mg, for a reduced dose of 7.29mg.

And so on.

This ensures that your nervous system is eased down a gentle 10% slope at every step of the process. It’s important that drops become smaller, not larger, as you go. Once you find the rate at which you can comfortably taper, you don’t want to jolt your nervous system with a larger drop than it can handle.

Mathematics whizzes may recognize that the 10% reduction formula is a geometric progression approaching but never equaling zero. At a very small dosage, likely less than 1mg, when reductions no longer cause any withdrawal symptoms, you will want to simply stop.

You will need to use your own judgment about your jumping-off point. Some people have found that the final steps require reductions so tiny they cannot measure them, employing methods such as dipping a toothpick in a liquid solution to ease off in the final stages.



Thursday, 9 February 2012

A Prozac Withdrawal Story - This is Short..


..but I bet the long term withdrawal isn't. This is less than a minute but puts it in a nutshell, I had forgotten about this video until a friend shared it with me.




And after I posted this the other day, a friend shared with a video he had made about his own experience after cold turkey from 40mg Prozac (which is double the dose I was on) and sadly he is still reaping the whirlwind and now coming off Prozac a lot slower.





Prozac Reduction Timeline

Thursday, 2 February 2012

Akathisia - a Side Effect of SSRI's, Withdrawing Too Fast off SSRI's, or Cold Turkeying off SSRI's

Summer 1994

Coming back from a gathering of mums and babies, post natal NCT support group, in reality the group wasn’t very supportive, there was rather a lot of competitive mumdom going on, other babies seemed to be sleeping through contentedly, learning the alphabet, names put down for private school already, ok I’m exaggerating a bit.


The mum I was getting a lift home with, our two babies in their seats in the back, I had more of an affinity with, our babies were not so easy and we didn’t pretend otherwise, and neither of us was finding new motherhood a breeze, and we both had money worries. In hindsight I know I was depressed and living with my emotions very raw and close to the surface but for me this was a very closely guarded secret but I think the other Mum sensed it. She was more open about her feelings, at least to me anyway, on that drive home she suddenly let rip, it all came tumbling out, how depressed she felt, her resentment towards the other Mums in the group, the medication she was on, how life was a constant uphill battle managing the baby, her dog, her husband, anxiety about going back to work and the sleepless nights, and the medication she was on. She told me that she often had thoughts when she was driving of just ramming her car into a lorry or car in front deliberately to escape her life.

December 2003 and Feb 2007

5am and for about the 3rd night in a row I’ve barely slept a wink, 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 Lustral 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 totally 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.



Broken, exhausted and shaken I reluctantly started taking the Lustral again and gradually started to feel more “normal”. Obviously there was something wrong with me and I needed Lustral to help me function. How come though I hadn’t needed Lustral to function before 1998?

Nowadays my withdrawals are almost but not quite non existent, the tsunami that is akathisia has long since washed away leaving me just a bit more nervy and more vulnerable to stress, much calmer but aware that adrenaline is always not far from the surface, and still trying to hide it and not always succeeding.

I’ve just finished reading Ann Blake Tracey’s book “Prozac Panacea or Pandora?”, I’ve heard the word akathisia in relation to antidepressants in recent years but I had never been quite sure what it was or that it applied to me. This book included loads and loads of anecdotes from people and information about akathisia and I actually felt emotional reading it, there was a name for it and I never knew at the time and I’m absolutely certain my doctor didn’t know either.

Prozac Reduction Timeline

Tuesday, 24 January 2012

Psychiatry's Grand Confession


Link to Original article -Mad in America - Psychiatry's Grand Confession


Psychiatry’s Grand Confession
The psychiatry profession has finally come clean and confessed on a national media outlet that there is no evidence to support the Serotonin Theory of Depression. Today, on NPR’s Morning Edition there is a segment about the chemical imbalance theory, and virtually all the psychiatrists who are interviewed acknowledge that the there was never any evidence in support of the idea that low serotonin causes depression. But then, amazingly, they go on to say that it is perfectly fine to tell patients that serotonin imbalance causes depression even though they know this isn’t the case.
Several years ago in PLoS Medicine we wrote a long piece about the serotonin theory and the disconnect between what research psychiatrists say in professional journals and textbooks and what the advertisements say. While the advertisements presented the theory as scientific fact, the scientific sources clearly did not. Given the enormous marketing programs that pushed this theory combined with the media’s lack of skepticism, we were sympathetic to the general public who could hardly be faulted for thinking that theory had some foundation in fact. Following the publication of our piece a reporter contacted us and suggested that we were attacking a well accepted theory. We pointed out to the reporter that we weren’t attacking a sacred cow but that instead we were pointing out the mainstream psychiatry didn’t even accept this theory. We urged the reporter to contact the FDA, NIMH, APA, etc and ask them about the science behind the advertisements. He did, and as expected, an expert from the FDA explained that the theory was really just a metaphor. The problem is that patients who heard their physician explain the serotonin theory thought they were hearing real science. They weren’t told it was a metaphor and hence thought it was a fact. When a doctor talks about high cholesterol, diabetes, or hypothyroidism, they are talking about scientific measurement, not a metaphor. How is a patient with high cholesterol and depression who listens to their doctor’s explanation of their conditions supposed to know when the doctor has moved from science to metaphor?
Several months ago Ronald Pies published an interesting article in Psychiatric Times entitled, “Psychiatry’s New Brain-Mind and the Legend of the Chemical Imbalance.” Pies, just like the experts on NPR, acknowledges that the Chemical Imbalance theory is not true. However, according to Pies, it was the pharmaceutical companies who espoused the theory, and not well-informed, practicing clinicians, because the psychiatry community has known all along that the theory is not true.
But if the Psychiatry Community knew all along that the theory was not true, then why did they not clarify this issue for the general public? Shouldn’t they have pointed out to the general public and patients that what the pharmaceutical companies were saying about psychological stress was not true? Why did the professional societies not publicly set the record straight?
There are many angry comments on the NPR website. These comments are interesting, because apparently many patients who were told that depression is caused by a chemical imbalance never understood that were hearing a metaphor and not science. Since the chemical imbalance theory is often presented as a rationale for taking SSRIs, such patients now understandably feel lied to by their clinicians.
Perhaps the most interesting part about the NPR piece is that the reporter seems to not understand that the idea of telling a falsehood to patients because you think it is good for them is a serious violation of informed consent. Shouldn’t the reporter have asked the obvious questions, such as:
1) Do you feel it is acceptable to present a scientific theory as fact even though you know it is false?
2) Is it okay for psychiatrists to tell patients stories about their conditions that psychiatrists know are false?
3) Is there not an ethical issue when a psychiatrist informs their patient that they have a serotonin imbalance, when the medical textbooks on the shelf clearly say this is a falsified theory?
In general, we are fans of NPR, but hopefully the next news outlet that covers this topic will be more investigative in their approach.

When it Comes to Depression Serotonin isn't the Whole Story


Yesterday, I was lucky to have three interesting articles shared with me, thanks Bobby Fiddaman and Carolyn Anderson. I think I've only got time to get one out this morning, the other two will have to wait til this evening. I like this article because it covers everything I've been banging on about for ages, particularly this : "Frazer says it's probably because it has had, and continues to have, important cultural uses. For one, he says, by initially framing the problem as a deficiency — something that needed to be returned to normal — patients felt more comfortable taking a drug.

"If there was this biological reason for them being depressed, some deficiency that the drug was correcting," Frazer says, then taking a drug was OK. "They had a chemical imbalance and the drug was correcting that imbalance." In fact, he says, the story enables many people to come out of the closet about being depressed, which he views as a good thing."
The chemical imbalance theory is absolutely rife, I see it and hear it everywhere, it's more socially acceptable than "I feel really rubbish/depressed/overwelmingly anxious".


When it comes to depression serotonin isn't the whole story




The antidepressant Prozac selectively targets the chemical serotonin.

When I was 17 years old, I got so depressed that what felt like an enormous black hole appeared in my chest. Everywhere I went, the black hole went, too.

So to address the black-hole issue, my parents took me to a psychiatrist at Johns Hopkins Hospital. She did an evaluation and then told me this story:

"The problem with you," she explained, "is that you have a chemical imbalance. It's biological, just like diabetes, but it's in your brain. This chemical in your brain called serotonin is too, too low. There's not enough of it, and that's what's causing the chemical imbalance. We need to give you medication to correct that."

Then she handed my mother a prescription for Prozac.

That was the late '80s, but this story of a chemical imbalance brought on by low serotonin has remained very popular.

"I don't know of any story that has supplanted it," says Alan Frazer, a researcher who studies how antidepressant medications work. He is also chairman of the pharmacology department at the University of Texas Health Science Center at San Antonio.

"It definitely continues to live — absolutely," agrees his colleague Pedro Delgado, the chair of the psychiatry department at UT. "If you go to your community doctor, you're likely to hear some version of that."

But for many scientists who research depression, this explanation is no longer satisfying.

"Chemical imbalance is sort of last-century thinking. It's much more complicated than that," says Dr. Joseph Coyle, a professor of neuroscience at Harvard Medical School. "It's really an outmoded way of thinking."

Coyle, who is also the editor of the journal Archives of General Psychiatry, says that though serotonin plays a role in depression, low serotonin is likely not the cause of depression. Scientific thinking has clearly shifted, he says.

Still, the story of serotonin remains. Why does it continue to have such a powerful grip on the popular imagination?

The Link

According to Frazer, to understand how the story of low serotonin came to dominate our understanding of what causes depression, you need to go back to the late '50s, to a psychiatric hospital in Switzerland.

That's where psychiatrist Roland Kuhn gave a newly developed drug to 10 patients who had been paralyzed by depression for years. Over the course of three weeks, he watched a near-miracle occur.

"There was this lightening of their mood," Frazer says. "They became more energized, more interested in things around them."

This was the birth of the very first antidepressants, called tricyclics. And with that birth came a question: How could these drugs possibly be working? Researchers had some ideas, but it really wasn't until the mid '60s, when the cause of Parkinson's disease was discovered, that a real narrative began to take shape.

It turned out that Parkinson's — a brain disorder — was caused by a deficiency of a chemical in the brain called dopamine. This discovery influenced the way scientists thought about depression.

"There is no doubt in my mind that the Parkinson's story had a strong impact on the way that people were thinking about depression," Frazer says. "It became easy to speculate that depression was due to a deficiency."

The question, of course, was what was deficient? Which chemical was too low? For decades researchers argued this question, but no one candidate took the lead. And then came Prozac.

Prozac's Pull

Almost as soon as it was introduced in 1987, the antidepressant Prozac, which selectively targets the chemical serotonin, became a blockbuster. "Prozac just blew everything else out of the water," Frazer says.

This had less to do with the efficacy of Prozac (it is not better at treating depression than tricyclics, the earlier generation of antidepressants) than with the fact that the drug had relatively few side effects.

"It was very free of side effects," says Pedro Delgado. "And so it began to be used very widely, and there was a lot of enthusiasm for it."

That understates the case. In a very short time, Prozac became wildly popular, and again, Prozac worked on just one chemical in the brain: serotonin.

And really, it is because of the popularity of Prozac that the low-serotonin story took hold, even though, Frazer argues, the scientific research has not borne that out.

"I don't think there's any convincing body of data that anybody has ever found that depression is associated to a significant extent with a loss of serotonin," he says.

Delgado also makes this argument. In the 1990s, he carried out a study that showed that if you take a normal person and deplete them of serotonin, they will not become depressed. He says he feels this demonstrates that low serotonin doesn't cause depression.

Coyle is less absolute in his dismissal of the evidence on serotonin. His take is that while low serotonin probably doesn't cause depression, some abnormality in the serotonin system clearly plays a role. But most researchers have moved on, he says, and are looking at more fundamental issues like identifying the genes that might put people at risk for developing depression.

"What's being looked at are processes that are much more fundamental than just serotonin levels," he says. "We need to move beyond serotonin, and I think the field is."

Serotonin Sticking Around

So why are so many people still talking about low serotonin causing depression?

Frazer says it's probably because it has had, and continues to have, important cultural uses. For one, he says, by initially framing the problem as a deficiency — something that needed to be returned to normal — patients felt more comfortable taking a drug.

"If there was this biological reason for them being depressed, some deficiency that the drug was correcting," Frazer says, then taking a drug was OK. "They had a chemical imbalance and the drug was correcting that imbalance." In fact, he says, the story enables many people to come out of the closet about being depressed, which he views as a good thing.

Still, there's no question that the story also has downsides. Describing the problem exclusively in biological terms has convinced many people to take antidepressants when other therapies — like talk therapy — can work just as well.

One critic I talked to said the serotonin story distracted researchers from looking for other causes of depression. But Delgado agrees with Frazer and says the story has some benefits. He points out that years of research have demonstrated that uncertainty itself can be harmful to people — which is why, he says, clear, simple explanations are so very important.

"When you feel that you understand it, a lot of the stress levels dramatically are reduced," he says. "So stress, hormones and a lot of biological factors change."

Unfortunately, the real story is complicated and, in a way, not all that reassuring. Researchers don't really know what causes depression. They're making progress, but they don't know. That's the real story.

It's not exactly a blockbuster.


When it comes to depression serotonin isn't the whole story