If only....

So we have reached an impasse - 1.50ml (6mg)

So it was our youngest son’s 13th birthday this week, which also marks the 13th anniversary of my being on and off (mostly on obviously) Lustral/Zoloft or Prozac.

So anyway, I, or we’ve reached a bit of an impasse with my withdrawal plan. I’ve been tapering slowly and steadily every 5 or 6 weeks for the past 3+ years. I am now stuck at 1.5ml.

1.50mls!! have you thought about how teeny tiny that dose is every morning? At this stage of the game it would be SO easy and tempting for me to just stop dead, but I know from past experience that that way madness truly lies (and I don’t mean “The House of Fun”) and my current healthy mental state would unravel with the withdrawal. I proved countless times in the past that I am obviously very sensitive to SSRI reductions. It’s crazy how powerful this tiny drop of liquid is.

In many ways I am amazed that I ever got as far as I have, a few years ago I thought I was on Prozac for life, I thought that it wasn’t physically possible for me to cope with life without it, but deep down I could never truly accept that I would be on it for life, because of the side effects I’ve always had a very strong inner drive or compulsion to get myself off this stuff, it refused to go away no matter how much I tried to convince myself to stay on it. Some inner voice I couldn’t ignore kept telling me I needed to get off the pills and kept driving me on, and still does. I like to think I could be happy sticking with a low low dose but deep down I know I’m not really.

So anyway, after 3 months at this dose I am feeling that I would like to now proceed with another reduction, I am now very stable. Peter is very ambivalent about this and I think it’s the first time we’ve disagreed on this issue. I understand his point of view, we have been and still are under financial pressure and both working hard. He also has the pressure/burden of an industry exam to pass. He is also the one who has to cope with me when a withdrawal hits. The last time it happened I am embarrassed to admit I burst into tears in his office and I couldn’t stop, and there was no obvious reason, it was a withdrawal pure and simple, but I just couldn’t stop crying.

So there we are....an impasse.

Any comments welcome.

Prozac reduction timeline

Silent Tuesday ;)

Confessions of an RX Drug Pusher

I just finished this book:

Before I read it though I had to google "rx" because although I'd seen the term I wasn't sure what it meant. This was the definition I found: Rx: A medical prescription. The symbol "Rx" is usually said to stand for the Latin word "recipe" meaning "to take." It is customarily part of the superscription (heading) of a prescription.

Gwen Olsen has had an amazingly interesting life. She spent more than a decade as a sales rep in the pharmaceutical industry, the whole book is fascinating but her insight into the decadence, power and corruption of the drugs giants, the political shenanigans and her own experience as one of those reps who wined and dined doctors and showered them with freebies in order to sell the drugs and up the prescriptions, and the hard sell was the part I found most interesting. What a brave woman to whistle blow on the industry she had worked for.

Gwen also has personal insight into mental illness and the "catastrophic consequences that lurk in medicine cabinets", with a family background of mental health problems and a 19 year old niece who committed suicide as a result of being a victim of the adverse affects of prescription drugs.

Gwen Olsen's web site

Marketing antipsychotics.

I won't go into the politics too much of Big Pharma because there are other blogs and web sites who do that far better than I ever could, it is something that interests me and I have a list of books on my hit list:

Anatomy of an Epidemic - Robert Whitaker

Mad in America - Robert Whitaker

Prozac: Panacea or Pandora - Ann Blake Tracy.

The one I'm reading next though is We Need to Talk About Kevin - Lionel Shriver

Some sights that go into the politics in depth:

Seroxat Sufferers Stand Up and Be Counted

Psychiatry, It's a Killing

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

World Mental Health Day

Something plopped into my mailbox today that reminded me that 10th October is World Mental Health Day. In reality we should be aware of mental health issues every day, not just one day a year. The idea though is to raise public awareness of mental health issues and promote discussion. Apparently 1 in 4 of us are affected at some point in our life.
I am no longer ashamed to admit that I have suffered with depression and anxiety and that I had post natal depression twice, I am still occaisionally chased by the black dog.  I have felt the stigma and still do, and in my own small way I hope this blog will help contribute to bringing the subject out in the open. It's not a very sexy subject but it is part of the human condition for many people.

Chill Pill

A conversation with a friend who is in exactly the same boat as me tapering off prozac, made me realise that yes I am feeling a consistent low level anxiety (bordering on depression) the past few weeks. The big positive thing about being on Prozac full dose is that it really is like taking a chill pill, it makes you so you really don’t give a damn. That was the only thing I DID like about it, and it’s STILL not enough to make me ever want to go back to the full dose because I don’t want the unwanted side effects that go with the “don’t give a damn feeling.

Lately however I have been noticing like I said this consistent low level anxiety which is sometimes hard to shake, we are under a lot of pressure in our life at the moment and so it is hard for me to unravel this feeling, is it the “real me” how I am anyway without Prozac? Is it purely circumstantial and if the pressures we’re under at the moment disappear in time will my low level anxiety also disappear? This is the really confusing thing about having been on Prozac so long, you never really know what the “real you” is, you forget and you never know if what you are feeling is “you” or “Prozac you” or a mixture of both. I suppose the only way I may ever find out is when I eventually get off it completely, but even then my brain chemistry may have altered from years of Prozac so that I never know what the “real me” ever was or is. Confused? So am I LOL

I’m finding it really hard because I feel like I am constantly chasing my tail, never quite on top of things, and like I am doing lots of things “ok” and in a bodgy way when I’d rather be doing less things but doing them well and completing them, I sometimes feel like the boys are being short changed because I don’t give them as much undivided attention as I’d like, and I wish there was more time to cook decent healthy meals. Housework gets me down, that’s the thing I find hard to keep on top of, so I just concentrate on laundry and food and the rest I have to try and let go, but I find it really really hard to turn a blind eye to dust piling up and a bathroom that needs cleaning. That’s when I really wish I could take a chill pill and just not give a damn. That’s maybe one of the reasons why I was prone to depression/anxiety in the first place because I find it hard to “chill” and let things go. I’m always having to tick that list off.

So any tips on how to chill and not sweat the small stuff will be gratefully received.

Perhaps I should just not wear my contact lenses anymore then I won’t “see” the dust!



Prozac Reduction Timeline

Struggling with the Elephant in the Room

David guest posted my essay about Bob Fiddamans book "The Evidence However is Clear" on his blog:
Struggling with the Elephant in the Room
It will be interesting to see if it raises some debate. I enjoy David's eloquent writing about his situation.

Chased by the Black Dog

A good friend who reads this calls it “being chased by the black dog”. I think Winston Churchill used the expression “black dog” to describe his depression. I’ve had a mahusive mother of all anxiety attacks, luckily it doesn’t happen often and as I look back over my blog archive it really isn’t too often, but I wouldn’t wish it on anyone. I think lots of different stressers in my life at the moment culminated in triggering something big in me, I spent about the past week feeling really quite depressed and anxious generally and just not myself. The last couple of days I felt pretty bad, and I could feel adrenaline pumping and stomach tightening. It finally culminated in not being able to sleep last night, and we all know how everything seems far worse in the middle of the night when you can’t sleep than in the cold light of day. I spent all day today feeling shattered, exhausted but all the anxiety slowly subsiding and flowing away from me, like a fever had broken. I know I’m on the mend now (apart from a cold)

I don’t know if it’s some kind of withdrawal, or the “real me” surfacing and I have to learn how to deal with the” real me” when this happens. At least I know it passes.

All this resulted in a conversation with P in which we went through all these things and neither of us could conclude what caused it specifically, Prozac withdrawal or real me, but I did realise again what an absolutely fantastic, supportive and encouraging husband I have and appreciated how lucky I am.

Some phrases that help me through the nasty patches:

This too will pass.

If you’re going through hell, keep going – (Winston Churchill (also a friends blog title))

Ships in safe harbour are safe, but that’s not what ships are built for

The best way out is always through (Helen Keller)

I’m not a failure if I don’t make it...I’m a success because I tried

A Mums Madness

Why are more women depressed? Is this a real epidemic - or the result of cynical marketing by drug giants?

This was in the Daily Mail newspaper and website today (don't normally read the Mail I prefer The Sun & Dear Deidre early in the morning but it was already taken)

Link to the article in Daily Mail

Why are more women depressed? Is this a real epidemic - or the result of cynical marketing by drug giants?


By John Naish

One in three of women polled had taken antidepressants during her lifetime
More women than ever are reaching for the happy pills, it was revealed last week. New research suggests there has been a massive increase in the number of women with depression.
Women are twice as likely to suffer from the illness than they were 40 years ago, and as many as one in seven will be affected by the condition at some point in their lives — more than double the number of men, according to a study published in the journal European Neuropsychopharmacology.
And the result of these soaring depression levels is becoming all too clear — a massive rise in prescriptions for antidepressant drugs.
Newly released figures from the Office for National Statistics show that more than four times as many prescriptions for drugs such as Prozac and Cipramil were dispensed in England in 2009 than 18 years before.
Women are twice as likely to be prescribed antidepressants than men — around two-thirds of all NHS antidepressant drugs are prescribed to women. The scale of these increases, over a comparatively short period of time, is breathtaking. So what’s behind the rise?
The German researchers for the European study blame one factor: modern life. Professor Hans-Ulrich Wittchen, in charge of the research, says the pressure of trying to cope with having a family and pursuing a career is leaving women with a ‘tremendous burden’.
More...Kathleen thought she had the flu. In fact, it was meningitis - and it cost her both legs
Why take your backache to the doctor when you can relieve your pain at home?
But is it really so simple? Go back 40 years and British women were hardly basking in leisure. They had grown up during the Blitz, suffered severe rationing, shortages and poverty wages. They were the victims of demoralisingly blatant sex discrimination and still had to haul in the coal.
Meanwhile, modern-day men are suffering unprecedented job losses, their role as the head of the family is disappearing and their lives are also getting more hectic and harried. But men’s depression rates have not climbed nearly so high.
In fact, one of the main reasons behind this astonishing rise in antidepressant use is that women are increasingly being parked on these powerful and potentially dangerous drugs for want of anything else to help them with the emotional distress that led them to visit their doctor.
This was echoed in a poll of 2,000 women released in June by the women’s campaign group Platform 51 (formerly the Young Women’s Christian Association, YWCA).
Women are twice as likely to be prescribed antidepressants than men
One in three of the women polled had taken antidepressants during her lifetime. More than half of these were not offered any alternatives to drugs. And a quarter were left on the drugs for more than a year without having their prescriptions reviewed.
This is despite the fact that guidelines from the health watchdog NICE say that ‘talking therapies’ such as cognitive behavioural therapy (CBT) should be the first-line therapy for patients with mild depression.
Treatment for patients who have moderate to severe depression should be a combination of talking therapy and antidepressants.
‘Women and girls don’t want to take these drugs for a long time and would prefer GPs to discuss with them why they are down in the first place,’ says Platform 51’s director of policy, Rebecca Gill. ‘They can feel no one is interested in their story.’
But many GPs say they feel forced to prescribe women antidepressants because it is difficult to organise alternative support such as psychotherapy.
Dr Peter Kandela, a former correspondent for The Lancet and a GP with a special interest in depression, says: ‘Theoretically, it would be better to give many of them counselling or CBT than antidepressants.
‘I would love to do it. But you have to fill in so many forms and contact so many people.’
Dr Kandela, who has a practice in Ashford, Middlesex, adds: ‘When the appointment finally comes, it is often too late to be of help.’ He says that arranging therapy can take three months.
‘This happened recently with a distressed patient. She gave up waiting and went to another doctor, who put her on antidepressants.’
The drugs carry the potential risk of serious side-effects, ranging from anxiety and loss of appetite and libido to convulsions and mania.
For this reason, the Royal College of General Practitioners advises that antidepressants be prescribed for only limited periods, up to a few months.
However, there is another factor affecting the judgment of hard-pressed doctors: women who are having emotional problems are far easier to spot than depressed men.
‘Men might not have their symptoms recognised so easily as women,’ says Bridget O’Connell, head of information at mental health charity Mind.
‘Evidence from our survey that compares 1,000 men and 1,000 women shows women may describe classic symptoms such as feeling down, tearful or anxious.
‘Men are more likely to act out their distress through drinking too much or being hostile and withdrawn, or they may have physical symptoms such as feeling nauseous or suffering from headaches.’
On top of that, there is the oft-quoted fact that men are much less likely than women to visit a doctor about emotional issues. This has traditionally been put down to the fact that men are too scared or incapable to describe their feelings of anxiety, depression or loneliness.
But a new study of nearly 2,000 children and adolescents has found a rather different answer — many males simply can’t be bothered with such thoughts.
‘When we asked young people how talking about their problems would make them feel, boys didn’t express angst or distress about discussing problems any more than girls,’ says Amanda Rose, a psychology professor at the University of Missouri, who was in charge of the research.
‘Instead, the boys’ responses suggest they just don’t see talking about problems to be particularly useful. It would make them feel as if they were wasting time.’
Antidepressants carry the potential risk of serious side-effects, ranging from anxiety and loss of appetite and libido to convulsions and mania
That still leaves us with the question: Are women really more depressed than ever?
Professor David Healey, director of psychological medicine at Cardiff University, thinks this is unlikely. Instead, he says, the leap in prescriptions for antidepressants may be seen as a triumph for drug company sales departments.
Professor Healey, the author of Let Them Eat Prozac, has argued that antidepressants are today’s ‘mother’s little helpers’ — the new incarnation of tranquillising drugs such as Valium.
‘In the Sixties and through to the end of the Eighties, companies marketed tranquillisers and had to persuade people they were anxious,’ he says.
When Valium-type drugs fell from favour in the Eighties because of their addictiveness, drug companies developed a different class of drugs: antidepressants.
‘In order to market antidepressants you have to persuade people they are depressed,’ says Professor Healey.
‘It is a case of labelling. People are as stressed as they were. The reason they view the problem as depression is down to marketing.’
Drug companies certainly do continue to push antidepressants on to women — even if the women are not suffering from a mood disorder.
Pharmaceutical firms are always keen to find new uses for their existing drugs because they do not have to take them through another highly expensive round of trials to prove they are considered safe enough for human consumption.
Furthermore, it may well be that so many women take antidepressants that it seems normal and acceptable to be given them — for whatever use.
For example, an American study in June declared that the antidepressant drug escitalopram can ease hot flushes in healthy, non-depressed women.
The study concluded that 55 per cent of women who took the drug, which acts on the brain’s feelgood chemical serotonin, had at least 50 per cent fewer hot flushes. But since when were hot flushes a problem to be medicalised and drugged?
Antidepressants have also frequently been prescribed to women with menstrual problems. The practice has been criticised by Claudine Domoney, a consultant gynaecologist at Chelsea and Westminster Hospital in London.
‘Doctors should always explore other avenues before handing out antidepressants for premenstrual syndrome.
‘It shouldn’t be first-line treatment,’ she says. ‘Why give a young woman a drug with potentially serious side-effects when it might not be necessary?’
Meanwhile, there is a dearth of well-funded research or support for alternative forms of treatment for women suffering from emotional problems.

Women are twice as likely to be prescribed antidepressants than men

Research by five mental health charities found depressed patients were having to wait for six to 18 months for an appointment with an NHS counsellor, with many being forced to go private.
Other alternatives which show promise in small-scale trials include acupuncture and light therapy.
A study of 27 depressed mothers-to-be in the Journal of Clinical Psychiatry in April found that after five weeks of full- spectrum light therapy, of the type given to people with seasonal affective disorder, 13 of the women had at least a 50 per cent improvement in their symptoms and 11 were no longer depressed.
Clearly, we do need alternative forms of support and treatment for women who experience emotional problems.
It may be true that life is more hurried, but it is also true that women have always experienced mood problems as part of the natural highs and lows of life.
In the past, they would have been supported by large, close families. Nowadays, they may need to turn to their family doctors for help.
But the answer, surely, cannot be to prescribe ever more mind-numbing antidepressant pills.

Syndicating to Facebook

I’ve been wrestling with myself for ages about whether to syndicate this blog to facebook. It’s been out there on the internet for years, and now it’s linked up to various other sites, and I’ve loved how it’s helped some people and I’ve made new friends through it, and yet it’s somehow been a bit anonymous. But facebook.....that’s really close to home and I’ve really agonised about it. One or two friends and most of my family have seen my blog and know my “ishoos” already. Most haven’t.


I think there is a silent epidemic of people “stuck” on SSRI medication, unable to stop taking them and suffering side effects. There is still so much stigma around depression/anxiety, it’s easier to go to the doctor and pop pills than seek any other therapies or help. If we break down the stigma of depression & anxiety hopefully, in the long run people will seek other ways to help themselves and SSRI’s will be the LAST resort and not the FIRST resort, So this is my little contribution to breaking down the stigma and “coming out”.

Prozac Withdrawal Timeline

The Evidence, However, Is Clear - The Seroxat Scandal - Bob Fiddaman

I’ve been following Seroxat Sufferers - Stand Up and Be Counted For a little while and I cottoned onto the fact that the author, Bob had written the book "The Evidence, However, Is Clear" so I sent off for it and read it in one day, that’s pretty fast for me nowadays.


Bob was prescribed Seroxat (an SSRI in the same family as Prozac/Lustral) for depression due to work related problems, what followed was a journey that took him through a tapering process of, what he believes to be, a highly addictive antidepressant. Following almost two years of withdrawal, Fiddaman’s new battle with the manufacturer of the drug (GlaxoSmithKline) and the UK Medicines Regulator (MHRA) took him on a more frustrating journey than he could ever have imagined. (This bit is from the blurb on the back of the book). I understand from Bob’s website/blog/book that he is an activist and winner of two Human Rights Awards and lives in a council flat in Birmingham.

I am really so much in awe of Bob and I learned a lot from his book, about how the pharmaceutical industry has cynically marketed SSRI’s, how the MHRA is hand in glove with the manufacturers of SSRI’s (and other drugs) and not detached as it should be. How they have suppressed information that these drugs are extremely difficult to get off of, and kept the medical profession in the dark about how to get people off SSRI’s properly. I learned how the drug companies peddled the myth of a “Chemical Imbalance in the Brain” which I fell for and believed myself until the penny slowly dropped after 10 years of failure to get myself off Lustral. It’s a shocking read but I wasn’t surprised by anything I read, I’d kind of realised for myself a long while ago that someone must be making a lot money out of all these people who are hooked on and struggle to get off SSRI’s , and believe they have a chemical imbalance. There is a silent epidemic of people who have been put on SSRI’s and haven’t realised they can’t get off them, who think they are on them for life because they have “a chemical imbalance”, and of course I’m horrified that they are increasingly prescribed to children and teenagers around the world with sometimes devastating consequences.

Where I struggle is that I know many people who feel they have benefited from antidepressants as well, and feel they have improved their quality of life, I find myself avoiding discussion forums on mental health on certain web sites now for fear of upsetting people who are on SSRI’s with what I now know. I don’t want to cause additional depression and anxiety for people who are already depressed and anxious and probably wouldn’t want to listen anyway, and there is a place for SSRI’s in some situations for some people (Bob would disagree I’m sure LOL) but SSRI’s should be the LAST resort of the medical profession and not the FIRST resort.

What I really have a problem with is how lightly they are dished out with no warnings. The first time I had Post Natal Depression I soldiered on without drugs, I really struggled, because I didn’t tell anyone, the stigma and shame was crippling in itself, and it took me a good year to really come out the other side, I’m glad I did though and I’m glad I didn’t go into a second pregnancy on SSRI’s and the worry about the effect of SSRI’s on my second baby. After I gave birth the second time I thought I had got away with it, but then I felt the blackness wash over me a couple of weeks after, worse than the first time. This time I decided I wasn’t going to keep it to myself, I was going to fess up, I told Peter and my health visitor, together we went to talk to the doctor, the doctor suggested antidepressants, I was desperate to feel “normal” but my overriding concern was that I would become addicted like the people I’d vaguely heard about who got addicted to valium, and that was the first question I asked, I was reassured that no these were a new class of drug and they were not addictive, I could take them for six months to a year and then come off them..........the rest is history.

I often wonder, if my doctor had said, there is a drug that can help you feel better, but they do have side effects; they can make you feel numb, if you stop them suddenly or come off too fast they can make you feel sick, desperate, and suicidal, they can be extremely difficult to get off, and worse case scenario it could take you as long as 3-5 years to taper off them, I wonder what I would have decided then? If I hadn’t felt the stigma and shame of being depressed and had felt able to ask for support from others instead of running to the doctor as the first port of call I wonder how it would have turned out.




Prozac Withdrawal Timeline

I have to admit to really struggling this week

Yes I have to admit this week has been quite testing for me. We have had a really bad week, P was involved in a car collision with our neighbours, which I won't go into the details, but it turned pretty nasty with the neighbours, and there is nothing worse than falling out with neighbours. I am pretty piss poor at confrontation and it's something I tend to run a mile from, but I was really proud of myself because I was assertive and calm and I stuck to my guns with the neighbours, while P was really wound up/angry, the neighbours wife was wound up, and the neighbour was displaying a very distinct nervous twitch, I was pleased to note.

As well I can't go into details but we are awaiting a big decision that will mean a lot to our business about how we proceed with it, and the waiting is killing us.

It's my line managers last day today, I have worked with her for 20 years, she is taking redundancy/early retirement, I'm really going to miss her.

The result is that  all in all I have been feeling very flat, blah and mildly depressed this week, and it's a timely warning to me to be ever mindful and protective of my mental health and never take it for granted.



Prozac Reduction Timeline

The reduction that didn't happen

I had set my heart on going down to 1.40ml today, but after discussion with P, we decided to hold off a bit, work issues which we hope to have resolved soon mean that he is feeling stressed to the hilt, and me having a withdrawal meltdown could be too much for him to cope with, fair comment, so I reluctantly decided to hold off for another week or fortnight.
My prozac Reduction Timeline

A Mum's Madness - Sharing the Blog Love

Thank you to Amy for mentioning me on her blog this week, I am following her blog as well.
Mum's Madness - Sharing the Blog Love
So many blogs, so little time (sigh)

My Prozac Reduction Timeline

Occaisional Wallflower - August Blog Carnival Mental Health Personal Journey

My blog was included in Occaisional Wallflowers Aug blog carnival about journeys in mental health. I was thrilled to be included, although my story is nowhere near as profound or powerful as the others, it's still been a journey of sorts.
Occaisional Wallflowers Blog Carnival




My Prozac Reduction Timeline (my journey)

Addiction, how was it for me? (aka "Antidepressant Discontinuation Syndrome")

I wanted to put on here how withdrawal felt for me; partly just to remind myself of just how dire it could be so I could remind myself of how far I’ve come and how much better things are now.


When I used to withdraw by the alternate day method, on the doctor’s advice, after a few days I would become aware that I felt really dizzy and fuzzy headed, sort of like having water sloshing round your head sometimes, other times you would turn your head and it was as though it took a few seconds for your eyes to catch up with your head turning, then after a while I would get a feeling of sadness which would increase in intensity as the days passed, almost like grieving for something but not knowing what, then eventually a difficult situation would act as a trigger to tip me into intense anxiety as well as the intense sadness. As time went on I would find in the mornings I would wake up early with excruciating anxiety, if I still persevered with getting off the drugs for weeks and months the anxiety would increase in unbearable intensity so I wouldn’t know where to put myself and couldn't escape it, it would eventually became all consuming, it would become 24/7 adrenaline pumping through my system and I would become unable to sleep as well for nights at a time, if I kept on long enough I would almost feel suicidal just to escape the torture of the crushing all consuming sadness and anxiety, and I would become more and more reclusive and not socialize because it was just too damned hard to disguise. It was like being tortured by a monster inside my head that I couldn’t defeat. The longest I ever kept this up for was a whole year in 2003.

Eli Lilly who manufacture Prozac call it “Antidepressant Discontinuation Syndrome”

Sooner or later I would always have to give it up and go back on the drug. Now try and tell me that’s not addiction?


My Prozac Reduction Timeline

NOT feeling like the Duracell bunny

The past three days I have been so tired, drained and tired, like my battery has gone flat. I actually could have fallen asleep quite easily at my desk, even though I had seeminly had a good night sleep on Monday.  I never know whether this is linked to withdrawal or just part of the human condition, it's so easy to blame everything on Prozac withdrawal. I've also been feeling a bit flat, I think it's the time of year, summer drawing to a close and boys back to school.

My Prozac withdrawal timeline

The Numb Documentary - Here are the Trailers

I mailed Phil Lawrence and he very kindly let me post the trailers on here, it's all positive publicity for the documentary.


The Numb Documentary

Hell yeah I've felt all those things in the trailers :(

The Numb Documentary

I stumbled on this Numb Documentary last night, and saw a trailer on another blog, I was so moved by the trailer I have e mailed them and asked if I can post a link to said trailer on my blog. It's amazing that someone has made a film about this subject, and I can't wait to see it. It made me realise that although my blog seems quite lighthearted, lots of cartoons etc, it is actually a very grim subject and it reminded me of just how grim it is when you withdraw too fast or go cold turkey, it reminded me of how I felt so grim I didn't know where to put myself and how close I felt to jumping off a bridge because I couldn't cope with how I was feeling. It's hard to put into words and Phil is much more articulate in his trailer than I am. The way he describes the numbness of being on the drug as well. Pink Floyd - Comfortably Numb


My Prozac Reduction Timeline

Forgot to take my Prozac!!

Standards are definately slipping since I discovered the world of blogs and Twatter Twitter, I actually forgot to take my Prozac early this morning!


Prozac Reduction Timeline

The Real SuperMum Blog

A big thanks to Emma who guest blogged one of my posts on her blog The Real Supermum, got loads of comments and I'm really chuffed to get my blog out there at last, the whole point of my blog is I hope to help enlighten other people stuck on the bewildering antidepressant catch 22.
The Real SuperMum Blog Suddenly Stopping Antidepressants
Go and take a look at the link and Emma's brilliant blog as well.

Pimping my Blog

    I've had some annual leave and in that time I've been exploring the world of blogs as well as pimping my own blog, something I've been meaning to do for a long time, I've had a lot of fun looking it other blogs and getting ideas, and now I've tarted this one up and put it on some blogger networks. Bit like Pimp my ride. I've even added twatter twitter!
Seriously though, I wish all this internet lark had been around when I had my first baby, I've been thinking a lot about the isolation of post natal depression and mean to write about my experience of that when I'm ready. But I wish the internet, blogs and parenting forums had been available to me 1994 living in an isolated village, trapped, lonely, isolated, depressed and struggling with a newborn etc. Oh I went to the NCT coffee mornings but everyone else seemed to have perfect babies and coping beautifuly (competitive parenting?), there were lots of little Alfie's, Hugo's, Arthur's, Maximillians, Theodore's, and then there was me and Alex, don't think we quite fitted in.


Prozac Withdrawal Timeline

Pushing a boulder up a hill

P was right, a few days after reducing my prozac, I go a bit hyper, then he knows I'm going to have a bit of a crash, I tell him that he blames me/the prozac for any little mood change as it suits him, but we had quite an in depth discussion about it in which he said that he has been a very close observer of me and knows me inside out, and he gets fed up when I accuse him of blaming a mood change on a prozac reduction.

It's Sunday now and I'm feeling a lot better now, I now have two weeks off my SCC job, still working odd days with P but I'll have a bit of time off with the boys.

Prozac reduction timeline

Therapeutic bike ride

I love the Suffolk countryside!


Prozac reduction timeline

The New Middle Ages Self Nonmedication

A friend sent me this article about withdrawal in the New York Times which I thought was beautifully well written.

Link to this article

May 6, 2007


The New Middle AgesSelf-Nonmedication By BRUCE STUTZ

Seven years ago, not long after my father died, with my editing job lost, my finances frail, my 26-year marriage failing, a child in college and a mortgage to pay, my brain seemed to lose its way. Sometimes it could barely think at all. Sometimes it tortured a single thought for hours. And sometimes, in desperation and without aim, it released a barrage of anger upon itself.
I could come up with a hundred descriptions of how I felt — as if the train I’d been riding had gone off track, as if the ground beneath me had given way and swallowed me up, as if I were in a black hole being compressed to nothingness — none of them very original, I suppose, because this was not, for a man just past 50, a very extraordinary midlife situation. But it was mine, and I saw no way out of it. Immobilized by indecision or agitated to the point of exhaustion, I could enumerate every stressful circumstance, but I was simply unable or unwilling to resolve any of them. Instead, I dithered miserably while I staved off creditors, struggled to write, sparred with marriage counselors and rued the emotional havoc I was wreaking on myself and everyone around me. Frustrated, I felt angered and at times utterly hopeless. I needed help.
At our first meeting, I told the psychiatrist that what I thought I needed was something to enable me to focus my thinking, something like the amphetamines I used to take in college to study. He demurred but said that an antidepressant might prove worthwhile and accomplish the same thing. He prescribed Prozac, but after only a few days on it, I began having nightmares that verged on the hallucinatory. So he suggested a switch to Effexor, and without much thought as to what this was or how it worked, I took the prescription and the handful of blister-packed capsules he offered (I had, when I was younger, tried many things given me by far lesser authorities) and agreed that we should meet regularly. The medication, he said, would begin working after a few weeks of gradually increasing dosage. I had no adverse reaction to it.
We met weekly and, like engineers examining a weakening structure, began to analyze each point of stress and how I might deal with it. This was not easy since, in the course of living, working and rearing children, I had developed many ways of specifically not dealing with many things — especially those that involved determining who I was and what I thought without reference to my being son, father, husband, lover or friend. I was not breaking new psychoanalytic ground here, but if one of the characteristics of depression —as it has been said of insanity — is thinking the same thing over and over and expecting to get different results, then I was depressed. I found little pleasure in anything; I couldn’t sleep. Each day seemed to drag on forever, and yet I never seemed to have enough time to accomplish even the simplest tasks.
After several weeks of sessions, my brain began to clear. Whether this was because of the drug or from just taking the time to consider my circumstances, I don’t know. Still, it took nearly three years of therapy before I began to lose my fear of thinking about things differently and accepting the fact that change held possibility along with uncertainty. But change was still hard — on everyone. My marriage did not make it through. I was living alone in a 17-by-6-foot below-ground studio in Brooklyn that my kids called “the Batcave,” still challenged by money and work. But the siege had lifted, the panic had vanished and I felt older, wiser and abler.
My last session with my psychiatrist lacked drama. I thanked him. We shook hands. He wished me luck. There was no mention of going off my antidepressant, and satisfied with the way things were going, I continued to take my 150 milligrams once a day. I still struggled with work and money, but I stayed focused. Over the next several months, I wrote a proposal for a book that would, in examining the nature of spring, consider the nature of change. In March of the following year I began my travels, heading north across the country for four months, following the increasing hours of daylight, seeking to reach spring’s climax and complete my spiritual renewal when I reached the Arctic at the summer solstice. But there, I also came to another realization: exhilarated by the 24 hours of Arctic daylight, hoping for a transformative escape from time, I had removed my watch. I was watching the timeless sight of caribou herds crossing the vast Arctic plain — and found myself worrying that I had no way of knowing when I should take my next dose of antidepressant.
In the past I experienced what happened if I didn’t take it on time. When I missed my morning dose, by 2 p.m. I would begin to space out. A prickliness in my neck would give way to a restless agitation that left me edging toward panic. All I would be able to think of was how far away I was from home, my pill, relief. Within 20 minutes of taking the pill, I would feel better. I would feel better just knowing I’d taken it.
But what I was experiencing 4,000 miles away from New York felt absurd. Why, more than two years after leaving therapy, feeling fine, able to work, write and face setbacks and frustrations without panic or depression, was I still taking an antidepressant? I decided that being in the middle of writing the book was no time to stop, and stayed on for another two years. But once the book was published, I began to wonder again whether I needed to keep taking this pill.
Since the time I had stopped seeing my psychiatrist, other doctors had, with no questions asked, written prescriptions. My G.P. was the prescriber of the moment.
“I was thinking of getting off Effexor,” I told him.
“Do you feel O.K. on it?” he asked.
I said I did.
“Then why go off it?”
Well, for one thing, this fear of forgetting my pills. And for another, I was beginning to suffer some undesirable sexual side effects.
“There are other drugs with fewer sexual side effects,” he offered. “And there’s always Viagra.”
Didn’t it seem strange to have to counteract the effects of one drug with another drug? Why not just get off the antidepressant?
“In my experience,” he said, “most people who go off eventually go back on.”
Somehow I couldn’t believe I had to take this pill for the rest of my life. I was feeling fine. At least I thought I was feeling fine. The image that came to mind was of Dumbo the elephant believing that what allowed him to fly was the feather the crows had given him. Only when he drops the feather does he realize that he truly has the gift of flight. Could I let go?
Friends had plenty of stories of trying to go off antidepressants. One said her medication made her lose interest in sex, so that soon after she began taking it she quit but felt guilty telling her therapist, who went on thinking she was on it. Another said she kept trying to get off because she couldn’t deal with the amount of weight she’d gained. But she kept returning to it. One said that within two weeks of quitting, she and her husband both found her unbearable, and she went back on.
All of them questioned my decision to go off. Didn’t I understand that depression was caused by a chemical imbalance? It was a disease, they insisted, like diabetes, and antidepressants were like insulin. But a diabetic knows what will happen if he goes off his insulin. I was in a psychopharmacological Catch-22: the only way to know whether my depression would return if I went off of my antidepressant was to go off my antidepressant and risk depression.
My friends and I are children of the modern drug age; we never knew a time before antibiotics or antipsychotics, so our working assumption is that every disease has its cure. Sooner or later, as in the movies, an Erlich, a Pasteur or a Salk, working late in the lab, has a eureka moment, and the magic bullet is found.
When it came to depression, serotonin was deemed that magic bullet. One of life’s most venerable chemicals — plants were making use of it long before humans evolved — serotonin is one of several chemicals, including norepinephrine and dopamine, called neurotransmitters, which nerve cells release into the tiny gaps among themselves and their neighbors to allow signals to pass among them. Once a message has been sent and received, the sending cell absorbs (“reuptakes” is the scientific term) the leftover neurotransmitter.
During the 1960s and 1970s, researchers recognized that some drugs that improved patients’ moods had the ability to inhibit the sending cell’s reuptake process, thereby leaving more neurotransmitter lingering in the synapses. Inductive reasoning led them to conclude that what must have caused these patients’ mood disorders in the first place was an insufficiency of these same chemical neurotransmitters. Restore the brain’s “chemical balance,” the thinking went, and depression could be alleviated. The antidepressant age was born.
Early antidepressants worked on a number of neurotransmitters. In 1987, Prozac became the first selective serotonin reuptake inhibitor (S.S.R.I.) introduced in America, followed by Paxil and Zoloft. Effexor (generically, venlafaxine hydrochloride), the drug I was taking, focused on both serotonin and norepinephrine (and so is referred to as an S.N.R.I), inhibiting their reuptake, increasing the amounts in my synapses and thereby presumably enabling my brain to keep depression at bay.
It has long been known that the body’s chemistry responds to stress. Recent studies suggest that when stress becomes chronic, the persistence of the chemicals that respond to it may damage or reduce the number of serotonin receptors, inhibit the production of proteins that mobilize serotonin receptors and even shrink neurons in the hippocampus, the part of the brain involved most with memory. How the chemistry of chronic stress results in depression is uncertain. It’s also uncertain whether a deficiency of serotonin might lead to chronic stress. But the presumption is that antidepressants, by increasing serotonin, reduce the effects of chronic stress and thereby arrest depression.
Since I was no longer feeling depressed, the experiment I was about to embark upon would test whether without the drug to keep my serotonin up, my depression would return. A risky proposition, considering all I’d gone through to get well, but if I really was well, perhaps my serotonin levels might adjust on their own. Or perhaps I was well enough to live with a chemical imbalance, if that’s what I had.
Drug-company brochures and Web sites reported that the symptoms of going off antidepressants were usually mild and short-lived — a week or two. They all recommended tapering off, preferably by half-steps, in consultation with a doctor. I thought about calling my psychiatrist, but it had been four years, and I didn’t want to return to the place, physically or mentally, where I had gone through so much pain. I also knew my psychiatrist well enough to know that he didn’t take his job lightly and would have most likely asked me to come in. But I couldn’t afford more sessions.
While I was still undecided whether or when to begin, serendipity came into play. Instead of prescribing a month’s worth of 150-milligram capsules to be taken once a day, my doctor mistakenly prescribed 75-milligram capsules to be taken twice a day. I took it as an omen. This would make it easy for me to halve my dose. So I began.
I expected that for the first couple of days I would feel the muscle-twitching anxiety that came when I missed a dose, but it was not so bad, and I had hopes that I might taper off quickly. On the third day, however, I began to find it difficult to focus and was unable to sit at my desk for more than a half-hour at a time. I was agitated, restless and hyperaware of sounds. When I read, sentences seemed to run into one another on the page, and I realized that this was not just because of difficulty focusing my mind but also my eyes. By early evening on that day, I felt so jittery and anxious that I decided I needed more medication. Somewhere, I recalled, a couple of years earlier I stashed a blister pack of 37.5-milligram capsules, a sample my doctor had passed on to me. But where? Although I could have split open a 75-milligram capsule, in my anxious state I became bent on finding those 37.5’s. An hour or more later, after manically scavenging through everything in the apartment, I found them — six remaining in the blister pack. I took one and felt as if I could now go on. I felt relieved to have them. I would stay with my reduced dosage as long as I could, but they would be my backup if I found that I absolutely needed them.
Over the next several days they came in handy, especially at night, when I would wake up feeling dizzy, almost seasick, disoriented and in a heavy sweat, the pillow soaked. One night, awake and not eager to go back to lying restlessly in bed, I went online, typed in “Effexor withdrawal” and found bulletin boards full of pained, plaintive and sometimes angry posters who had quit taking their medication and were suffering a broad but surprisingly consistent range of symptoms: dry mouth, muscle twitching, sleeplessness, fatigue, dizziness, stomach cramps, nightmares, blurred vision, tinnitus, anxiety and, weirdest of all, what were referred to as “brain zaps” or “brain shivers.” While there were those who went off with few or no symptoms at all, others reported taking months to feel physically readjusted. In the face of those symptoms, many despaired, gave up and returned to the drugs.
By the end of the second week, I felt confident that I could continue on 75 milligrams a day. But then my symptoms became more physical: the chills at night and the cold sweats continued. I felt tingling in my shoulders and hands, spasms in my legs. These came and went, seemingly with no reason. And then one night as I lay back to go to sleep, I felt a quick spasm in my head as if an electrical current had suddenly been sent through a circuit somewhere inside my brain. Two more followed in quick succession. With each came a wave of nausea. I sat up. They seemed to disappear. They returned. I realized these were the brain zaps, and over the next few weeks they would come, with no distinguishable pattern, several times a day.
Coping with the ever-changing and seemingly capricious symptoms was beginning to exhaust me. I couldn’t stick to any sleep schedule. I couldn’t think clearly. I was becoming unfocused, agitated and unable to sit long enough to read or work. The stress of anxiety and sleeplessness that I’d almost forgotten seemed to be returning. And that scared me.
Was my depression returning, or could getting off this drug actually cause so many and various symptoms? I spoke with neuroscientists, research psychiatrists and practicing therapists. All of them knew of the difficulties some people had in getting off not only Effexor but other antidepressants as well. They also all agreed that most of these symptoms were caused by a deficiency of serotonin.
What was happening was this: When I started taking Effexor, the drug began inhibiting my brain cells’ process of reabsorbing “excess” serotonin — that is, the serotonin that had gone unused in sending signals across the synapses from one neuron to another. This was the purpose of taking the drug — to increase the amount of serotonin my cells had to work with and therefore, in theory, enable me to cope with my stress and depression. I say “in theory” because even 20 years since the introduction of drugs like these, every researcher with whom I spoke was cautious about presuming a direct relationship between increased serotonin levels in neural synapses and a decrease in depression. First, no one has ever measured the amount of serotonin in the synapses between anyone’s brain cells. No one knows what constitutes a low, high or even standard level. Second, for reasons unknown, only a little better than half the people treated with antidepressants respond to them. Third, studies have shown that placebos have only a slightly lesser rate of effectiveness than the drugs. Fourth, serotonin levels are affected by many things — exercise, light, sleep, diet and even time of day. And finally, serotonin has so much influence on chemistry and functions in so many places in the body and brain relating to mood, sleep, sexual desire, appetite and body temperature that to say that it acts in any one particular way is impossible.
Research suggests that as the effects of the drug set in, my cells became more receptive to serotonin and the brain compensated to ensure that there wasn’t a serotonin overflow. This function is important, because an excess of serotonin can not only cause severe psychological effects but can also, in rare cases, be fatal. During the first weeks of taking an antidepressant, then, until the drug’s ability to inhibit reuptake of serotonin matches the brain’s ability to withhold it, the brain apparently has less serotonin to work with than it had before. During this period patients can suffer a range of uncomfortable side effects, from sleeplessness to anxiety, that make many patients quit taking the drug before they ever reach an effective dose. It’s also the period during which some patients suffer such severe agitation that the chances that they will attempt suicide increase significantly enough that the F.D.A. requires what is known as a “black box” warning on the labels of S.S.R.I.’s for pediatric patients and is considering extending this warning to adults.
What I was doing now by decreasing my dose of Effexor was essentially reversing the process that I went through when I began taking it. As the amount of the drug in my system declined, my neurons once again began to take up the excess serotonin. But while the reuptake mechanism may respond quickly, the serotonin system can take weeks or months to readjust. In the meantime I was going to be short on serotonin and would have to suffer the effects. And because serotonin is so ubiquitous in the nervous system, the effects might be almost anything. They might even feel like depression. Or worse, they might even be depression.
None of these symptoms would come as news to most researchers. In 1996, nearly a decade after the introduction of Prozac, its manufacturer, Eli Lilly, sponsored a research symposium to address the increasing number of reports of patients who had difficult symptoms after going off their antidepressants. By then it had become clear that drug-company estimates that at most a few percent of those who took antidepressants would have a hard time getting off were far too low. Jerrold Rosenbaum and Maurizio Fava, researchers at Massachusetts General Hospital, found that among people getting off antidepressants, anywhere from 20 percent to 80 percent (depending on the drug) suffered what was being called antidepressant withdrawal (but which, after the symposium, was renamed “discontinuation syndrome”).
They also found that the withdrawal effects depend on a given antidepressant’s half-life — that is, the amount of time it takes for half the medication to be washed out of the body. Since this is a measure of the length of time the drug is effective, you will more quickly feel the effects of missing a dose of an antidepressant with a short half-life than of one with a long half-life. If you’re taking your full medication daily, this isn’t relevant. But when, say, you reduce the dosage of a short-half-life drug by half, that half is, by the nature of the drug, quickly halved again. In their studies, Rosenbaum and Fava found that Paxil and Zoloft, with half-lives of one day, proved more difficult to get off than Prozac, with a half-life of four to six days. Effexor, the drug I was on, has the shortest half-life of all: five or six hours. That explained why, if I forgot to take my medication in the morning, by afternoon I was facing a panic attack. It was also why, Rosenbaum and Fava told me, when a patient is having trouble getting off Effexor they might recommend switching to Prozac to ease the transition.
Still, the symptoms of discontinuation syndrome could be fierce. Fava, in a 2006 paper, cited “agitation, anxiety, akathesia, panic attacks, irritability, aggressiveness, worsening of mood, dysphoria, crying spells or mood lability, overactivity or hyperactivity, depersonalization, decreased concentration, slowed thinking, confusion and memory/concentration difficulties.”
So I decided to stick with 75 milligrams a day for a while to give my serotonin system time to catch up. But in my third week, I still felt constantly uncomfortable and often irritable. The brain zaps were sometimes blinding. No one seemed to know what caused them. I even went to an ear, nose and throat specialist to see if I was suffering from some sinus problem, but he found nothing. One day, trying to repair a cabinet drawer, I ruined the glide and, suddenly and blindly angered, began pounding my head with my fist. Worse was that my failure at something so trivial triggered more general, undefinable feelings of failure similar to those I suffered when I was depressed.
Ron Duman, a researcher at the Yale University School of Medicine in the psychiatry department, told me recently that there was no specific mechanism that would explain my symptoms, but that my system was trying to readapt.
“Your neurons,” he said, “are literally sensing the lack of serotonin.” That was the bad news. The good news: “That the brain is able to adapt to stress, to environmental impact or pharmacological stimuli and change over time is really a key concept of how the brain works.”
My choice then, as I saw it, was either to go back to taking the medication or find another way to try and raise my serotonin levels, or at least help the process along. Duman, an athletic-looking guy himself, told me that studies have shown that exercise can improve the serotonin system as much as antidepressants can. So I began a serotonin-boosting regimen — getting out and taking daily walks around Prospect Park, near my home in Brooklyn. No jogger, I completed the three-mile loop in 45 minutes to an hour. After a few days, I noticed that these walks relieved my restlessness. I began to sleep better.
Sleep, Efrain C. Azmitia of the biology department and the Center for Neural Science of New York University, told me, increases serotonin levels, too. Azmitia, who has conducted research on the serotonin system for four decades, said that light and good nutrition can also increase serotonin. Anything, in fact, that relieves severe stress, which, he has found, is disruptive to the serotonin system. It’s why therapy might work just as well as medication, why placebos may work. The stress is relieved, and the system recovers.
I was feeling so much better by the end of the fourth week that I decided to cut back on my dosage again. At the bottom of my computer bag I’d found more blister packs of 37.5-milligram capsules, part of my hidden caches of medication. The first day went fine. But that night I screamed so loudly in my sleep that it seemed to echo in the room long after I sat up awake. It was 4 a.m. I was having brain zaps. I decided to take another 37.5 milligrams but then to try to make it last me through the next day. It did.
Around this time, I began to feel sensations, smells and sounds more intensely. Had the drug, in keeping me focused, also lowered my response to life’s pleasures? When I asked Rosenbaum, the researcher at Mass General, about this, he insisted that there was no evidence that antidepressants have what he called “a dulling effect.” But others disagree. Joseph Glenmullen, a clinical instructor in psychiatry at Harvard Medical School, says he has had many patients describe it. I know that I felt it.
One evening, sitting in the movie theater and watching “Little Miss Sunshine,” I suddenly found myself welling up with tears. I put my head back and closed my eyes, but the tears came. I wondered for a moment whether it was a sign of depression but realized that I never cried when I was depressed. I didn’t have the focus for it. Over the next weeks, when out walking or listening to music (Count Basie’s “Li’l Darlin’,” in particular), I found myself weeping for no reason at all.
What I was gradually beginning to feel was the difference between clicking on a book on Amazon.com and wandering through library shelves, allowing my gaze to wander from spine to spine. I imagined that when I allowed myself such pleasures, I was disarming stress and that my serotonin responded accordingly.
I was now down to 37.5 milligrams a day. It had been two full months since I began getting off Effexor. I decided to see if I could go without. I felt a bit panicked that morning but by noon was still fine. Perhaps, I thought, this was it. But the brain zaps increased throughout the day. Feeling disoriented that night, I took another 37.5 milligrams. I put off taking another dose for 24 hours and then decided to try to make it through the night. By morning I’d gone 36 hours. Should I try to keep going? But the blister pack held another capsule. Maybe just half of it, I thought. I opened the capsule, poured out the tiny white granules, took half into my palm and swallowed it with a glass of water. When I looked down at the counter with the open capsule, the remaining grains of medicine, and the trail of white power where I’d scraped the rest into my hand, I realized that it was time to move on.
In the months since going off, withdrawing, discontinuing, whatever you want to call it, I’ve been through life’s usual stresses (and some extraordinary ones), felt good, bad, sad, unhappy, glad, even hopeless and helpless. But I’ve yet to feel again the chronic, painful and perspectiveless despair that characterizes major depression and that first brought me to seek help.
Will I become depressed again? Rosenbaum told me that the answer to that question may depend on the severity of the earlier depression — a major depressive episode as opposed to feeling very down or stressed — and the length of time the symptoms lasted. Sometimes, he said, patients feel better but have residual symptoms. “If you have residual symptoms, you’re at risk for relapse. If you’ve had multiple severe episodes, if you’ve had chronic depression, you’re at risk for relapse.” Studies show that people who go through one bout with severe depression have a one-in-four chance of having another. Two bouts, and your chances double of having a third. Three bouts, and it’s nearly certain you’ll have another.
I wondered what my future held, since studies show that those who go through long-term therapy in conjunction with antidepressants have less of a chance of their depression returning than those who only take an antidepressant. “I believe that sometimes people can grow while on antidepressants and free up depression in a way that might buffer them to take advantage of psychosocial treatments they couldn’t have taken advantage of when they were depressed,” Rosenbaum told me recently. “But I’ve also seen people who have done hard work in cognitive therapy, but they just can’t sustain it when depression returns.”
What got me back on my feet? Was it the medicine, the therapy or both? Was it just the passage of time? I’m certain that there was much chemistry involved, since our capacities to think, feel and imagine all come out of the chemical makeups of our brains.
But did I need the drug to alter that chemistry? If my psychiatrist had told me, “I think you can do this without taking any drugs,” would I have done just as well? If I had been told how difficult it would be to get off the drug, would I have so readily started on it? Even the doctors and researchers who most believe in the effectiveness of antidepressants acknowledge that the “chemical balance” paradigm, the magic-bullet paradigm, makes things seem simpler than they actually are. For some, these drugs may be a lifesaving treatment. But for most of us troubled or even temporarily anguished by life’s difficulties, does our long-term reliance on these drugs become more of a convenience than a cure, allowing us to simply keep going in the midst of very difficult circumstances? And once we start taking them, how do we find the wherewithal to stop?
Ron Duman told me about one way that scientists try to test the effectiveness of a given antidepressant in the lab. Put a laboratory rat into a beaker of water and see how long it struggles to get out. When it stops, remove it from the beaker and treat it with the drug. Repeat the test. If it struggles for a significantly longer time than before, the drug is considered to have antidepressant potential.
Is this ability to keep us going altogether good? As Rosenbaum pointed out to me, people under stress can do great harm not only to themselves but also to those around them parents to their children, couples to each other. But when does reliance on a drug keep us from seeking ways to resolve the causes of stress? General practitioners, not mental-health specialists, write most of the prescriptions for antidepressants. For most doctors and psychiatrists, drugs, not therapy, have become the first line of defense. Only some 20 percent of people prescribed an antidepressant ever have even a single follow-up appointment.
Perhaps it was the difficult time I had getting off my antidepressant, but I never think about going back on. I’m enjoying this revitalized view of my emotional and physical worlds. Having finally dropped the feather that I believed allowed me to fly, I face life’s difficulties without much fear of falling back into depression. I have no illusions about having resolved every issue or that all that happened won’t continue to have repercussions on those who went through it with me. I don’t believe in “closure.” Life, like the brain, has too much interconnected circuitry. But it is also always changing.
“The brain has evolved to deal with sadness and grief, and having to deal with them may make the brain more flexible,” Azmitia told me.
Maybe dealing with life’s distresses has its own chemistry. I know I hated every second of it. I don’t know if the medication helped. But I do know that I’m very glad I’m off.


Bruce Stutz writes on science and the environment. His most recent book is “Chasing Spring: An American Journey Through a Changing Season.”