Tag Archives: antidepressants

Why I’m Phasing Out My Antidepressants

So, I’m finally going to do it. I’m going to talk to my doctor about tapering down my medication. I’ve been on one antidepressant or another for 11 years. For the last five or so, I’ve been on 225 grams of Effexor. It’s time to taper them down.

Why? For one, I’m just tired of having to take a pill three times a day. 225 grams is also a really high dose, and I don’t need it. I’m not in a stressful environment, I have a strong support system, and I’m an expert at self-care. Also, while Effexor doesn’t have obvious side effects like headaches or brain zaps, I do believe it has a numbing effect on my emotions and sexual drive. I’m trying to connect to my emotions more since I’ve been seeing my spiritual director, and I just feel like the medication is blocking some channels.

I’ve been reading Lost Connections by Johann Hari and it’s blowing my mind. I had no idea how relatively ineffective antidepressants are when it comes to treating depression and anxiety. I’m not saying they’re worthless, they’re just not as effective as Big Pharma would have us believe, and there are other treatments that could be as effective or more effective that aren’t getting researched. It was also really troubling to learn that pharmaceutical companies aren’t required to release all the information they have on their pills, so they only release the most positive. The studies are also known to frequently be biased and funded by the company itself. I feel like I shouldn’t be so surprised. Money drives everything and pharmaceutical companies stand to make billions by hawking their drugs.

It’s time for me to taper down or stop the medication completely. I’m much less worried than I was before, because now I’m not sure how much the drug by itself is responsible for my better mental health. I think back to the worst depression relapses and they all happened in really chaotic times : being in, then ending an emotionally-draining relationship/feeling isolated at a high school where I didn’t fit in/being at a college where I didn’t fit in with very few friends/engaging in a really destructive spiritual environment/switching to a radically-different college/unearthing childhood trauma. Of course I reacted the way I did and a pill wasn’t going to fix everything, even as my doctor raised the dose. Now, I don’t anticipate having the kind of relapses I did before because my environment is so different. My worst fear was going off medication and just completely shattering. That’s not going to happen, because that’s just not how my mind works. The withdrawal won’t be fun, those symptoms usually resemble depression relapses, but once those are over, I don’t see myself emotionally-teleporting back to my 19-year old self.

I’m not saying that I wish I had never started taking antidepressants or that they’re always bad in every case. However, I’m starting to grasp more fully just how little we actually know about depression and anxiety. We’ve been fed this line about how it’s a brain imbalance and if we get the balance of chemicals right, we’ll be fine, but if that was the case, so many people wouldn’t still be depressed. Focusing so much on the biological aspect of depression and anxiety ignores the effect of our environment, social lives, family, work, etc. It’s been weird to read Lost Connections and experience so many “duh” moments simultaneously with “whaaat” moments.

I see my doctor next week. I have no idea what she’s going to say (this is also my first time seeing her, so she might not be as gung-ho about tapering down as I am), but I’m going to stand my ground. I know me better than anyone, I know that it’s time. I’m basically just asking her to write a new prescription if necessary and what kind of reduction schedule I need to follow to prevent withdrawal as much as possible. It will be really nice to not have to set so many alarms and always carry pill supplies around everywhere.

 

Advertisement

when fear asks the wrong question

The greatest disagreement Chris and I have had in our relationship is children. He’s always wanted kids, and when we got married, he knew I wasn’t too keen on the idea, but I was very young, and we both assumed I would gradually come around to the idea. I haven’t. In fact, I’ve become more resistant to it.

We’ve had a lot of tough conversations. There have been lots of tears. It seemed like the question we both had to face was, “Do I have to choose between the person I love or the life I always imagined having?” For Chris, that life meant children. For me, it meant not having children. We reached an impasse.

I knew something was wrong with the question we were asking. I’ve always been very analytical and self-aware, and any question that seemed designed for heartbreak made me suspicious. I fully believe that there is no fear in love, and to be so fearful meant there was something going on.

I’ve had to ask myself a million times, why don’t I want children? It always comes back to my mental illness. The idea of pregnancy terrifies me. The medication I’m on has such a bad rap that there’s a thing called “Effexor babies,” where women have sued after being on high doses while pregnant, and having children with birth defects or who died. Of course, the healthcare system insists the risk isn’t too bad, but they have a horse in the race. Reading stories from actual women has convinced me that any kind of strong antidepressant is going to mess with the natural development of a child. However, the other option, going off medication, is just as scary and risky. Severe depression can affect a fetus’ growth just as much as a drug.

My fears don’t stop there, though. No matter what route I go, that’s just 9-10 months. It’s doable. But, then the baby is born, and it’s here for the rest of my life. It’s overwhelming. I’m at a point where I can just care for my own mental state, how on earth can I be expected to take care of a kid? Another human being, who is essentially a sponge? And then there’s the increased risk of the child also developing a mental illness, so that’s another layer of responsibility.

In going over my reasons, I noticed that Chris was entirely absent from my thought process. And then I realized that the reason I’m so overwhelmed is because I imagine dealing with all the complexities of parenting + mental illness by myself. I don’t have confidence that Chris would know how to deal. I’ve never imagined my life with kids because I’ve never known my life free from the ever-looming presence of mental illness, and I’ve never known what having a real partner in the fight is like. That doesn’t mean that Chris doesn’t support me or is unhelpful. It’s just that depression/anxiety has always been my “thing” that he comes in and out of, it isn’t something he lives with like I live with it. If we’re going to be a real team, we both have to live with it. If we were truly united, I wouldn’t feel so overwhelmed about the idea of kids.

The real question isn’t choosing between us or a kid. It is, “How do we get on the same team when it comes to mental illness?” That’s something a counselor can help us with, and has lots of solutions both practically and spiritually. It’s a question we can tackle without feeling like we’re just butting heads. Fear always likes to ask the question that only has one, usually horrible answer, but that’s not how love works.

God of the Tar Pits (Part 2)

While seeing depression as a result of spiritual frailty or sin has become outdated, there’s still some odd Christian teachings about it. Depression is viewed as a season and something that – with time and prayer – can be overcome. All my life people have told me to be patient, that they were praying for me, and that I would one day know the freedom and joy that only Jesus can bring. The longer the depression stayed, the less people talked about it. They got tired of telling me they were praying, and I got tired of hearing about it. Believing that depression is a sign of spiritual weakness is not popular, but if you suffer from prolonged depression, people start to wonder.

Depression “success” stories are remarkably popular. Christians devour personal tales of fellow believers suffering from crippling anxiety and depression who have been transformed by God and grace, whose marriages have been saved, who have found peace, who have overcome brain chemistry and been “freed” from medication. They were lifted from the tar pits by Jesus and as one of those Christians who have depression, I was encouraged to pray for similar redemption. At a conference, a friend told a story about a young man who went to be prayed for and was healed from depression in that moment.

“How did he know?” I asked, confused.

“He just…knew,” she replied.

“That sounds like bull crap.”

“Do you not believe that God can do miracles?” she probed.

I didn’t know how to explain to her that that wasn’t the issue. It wasn’t that I didn’t believe God could heal me from depression, it was just that I knew if it happened, it wouldn’t be with just the snap of a finger. I had never seen God work that way. He didn’t seem to really be into that whole instant gratification thing. When I had that conversation, I was at the point in my life where I didn’t even want to be healed from depression. I was beginning to learn that it was just something I would have to live with, like a scar. Sometimes it would act up and interfere with my life, while other times I could almost forget it was there. I didn’t want to overcome; I wanted to persevere.

When I recognized that depression was going to a permanent fixture, I stopped struggling. The discovery came in stages, but was punctuated by the end of my second year of college, where things were going so well that I stopped taking my medication. From the outside, my life looked perfect. I had gotten into my dream school, was doing well, and making friends. I was also part of a faith community that emphasized spiritual warfare, and I believed that I had successfully conquered all my demons. Then a childhood memory rushed brutally to the surface and my brain broke. I locked myself in my room for three days straight and didn’t move. People had to bring me food so I wouldn’t starve. It was finals’ week and all my hard work seemed wasted. It seemed like I had won against depression, but it came back with a vengeance, like it had never left, or like it had been gathering strength. When summer came, I went back to my psychiatrist and was put on the highest dose of a new medication. For the first time, I accepted it gladly.

Antidepressants are notoriously tricky. The most prescribed class of medication for people like me with major depressive disorder and anxiety are SSRIs (selective serotonin re-uptake inhibitors). These were created based on the belief that depression and a host of other mental illnesses like anxiety is caused by a lack of serotonin – a neurotransmitter responsible for feelings of happiness- in the brain. The reason they are controversial is because of the nearly limitless side effects that have been reported, like loss of sexual interest, vomiting, headaches, dizziness, and insomnia. They are also labeled with a “black box,” which means a side effect of taking the medication might increase suicidal thoughts and tendencies. When I first started taking medication in high school, I was required to see a psychiatrist once every two weeks and tell her if I was experiencing this side effect. I can’t say if these sorts of thoughts increased because of medication, but many of them did little to reduce my depression while also gracing me with flu-like symptoms, severe exhaustion, and muscle pains. On particular medication I took over a summer made me sick every morning for two weeks.

Constantly adjusting medications that didn’t seem to help much, but succeeded in making me ill was frustrating, but when I had that breakdown sophomore year, I knew I needed medication. No amount of prayer alone could fix brain chemistry. I was arguably in the best place I had ever been spiritually, I knew I wasn’t possessed, but still my head reeled and I couldn’t will my body to move. That experience taught me that I can’t pretend my depression is gone just because I feel okay. I have to anticipate it, plan for it, accommodate it. That’s what medication is for. Finding one with minimal side effects was worth it and when things are going well, I may be tempted to stop taking it, but when the other shoe falls, medication is there to balance out any craziness the body throws at me.

Once I realized that depression was going to be a part of my life in varying degrees, my expectations changed. Instead of trying to match everyone’s achievements, I came to terms with the fact that I wasn’t like “everyone else.” Certain things will never be easy, like making a phone call, getting to class every day, or hanging out in a large group. There are things I will never do, like travel alone, go completely off medication, or hold down a high-pressure job. It’s a good week if I get out of bed every day. And that’s okay. That is just who I am.

There are also things I know that other people don’t because of the depression. I understand hopelessness. When people ask why anyone would commit suicide, I have the answer. I don’t have a neat, happy success story, but I have a story that says, “Depression never goes away, but it doesn’t have to control or define you.” I can see where traditional mental health services failed people, especially religious ones, because it has failed me. What I learned most from depression is that it’s the place where I met God. He wasn’t in a counselor’s office, where I was given lists of mood-boosting activities, or in a required chapel where I felt completely alone while surrounded by other Christians. He wasn’t in books or sermons.  He was- and still is – in the tar pit.

It would be understandable if I had abandoned my faith at some point during my struggles, but something kept drawing me back. Some of it was fear, yes, fear of venturing off into the unknown, but most of it was because I could see the marked difference between how my fellow Christians saw mental illness, and how God seemed to see it. The Bible is so full of references to persistent, bone-crushing sorrow that it can be overwhelming and triggering to read. People are constantly weeping, renting their clothes, pouring ashes on their heads, and lying on the ground, unmoving, for days. Jesus himself prayed with such agony before His death, that his sweat had blood in it. He is described as “a man of sorrows and acquainted with grief.” The one verse that has stuck with me most is from Psalm 34: “The Lord is close to the brokenhearted and saves those who are crushed in spirit.” I used to be frustrated with this. I understood the first part, but what about the second? Where was the “saving me” bit? When I accepted my depression as something that was just with me, my definition of “salvation” changed. It didn’t involve being pulled up from the tar in a bright beam of light and suddenly “knowing” I was “cured.” It didn’t involve some big success where I suddenly become someone I’m not. It’s the little things, like being loved. It’s having insurance for medication. It’s graduating from college, no matter how long it took. It’s finding people who understand. God had been saving me every day, bit by bit, keeping my head above the tar.

I should make it clear that not all of life is being in the tar pit. Good medication and healthy choices help keep me grounded and productive. It’s just that no matter how good things are going, that tar pit is never too far away. There’s no real rhyme or reason to why I fall in. Sometimes it makes sense, like the death of a family member. Other times it’s random, like the wind changed directions. I used to be terrified of that movement when I felt the tar rising up my legs, pulling me down. I would struggle and berate myself.

“How could you be so stupid?”

“Why did you let your hopes get up?”

“You know you can’t push yourself too far; why did you try?”

The voices are quiet now. The tar pit doesn’t frighten me as much. I just keep breathing and let it happen. Eventually, the tar thins out and I’m free from it for a while, with renewed focus and gratitude. Life goes on, and I have two choices: look back with regret, or keep moving forward with hope. I choose hope.

Disturbance in the Force

Image

A new study from the University of Maryland School of Medicine suggests that depression results from a disturbance in the ability of brain cells to communicate with each other. The study indicates a major shift in our understanding of how depression is caused and how it should be treated. Instead of focusing on the levels of hormone-like chemicals in the brain, such as serotonin, the scientists found that the transmission of excitatory signals between cells becomes abnormal in depression.

This research is from 2013 and was definitely news to me. The first revelation was that antidepressants (most of them) don’t actually increase serotonin in the brain, they stop the brain cells from absorbing it, so the concentration of serotonin goes up. Good to know what those frustrating little pills are doing all up in my mind space.

Serotonin is the buzzword for people who have depression, but apparently increasing serotonin only makes some depressed people feel better. The article described it as being at a party where lots of people are talking, and you’re trying to have a conversation. Serotonin enables you to talk louder so the other person can hear, but it doesn’t necessarily help the other person understand what you’re saying. The article concludes by saying researchers need to figure out how to make antidepressants deal with this miscommunication issue.

And so once again, another problem is caused by a lack of good communication. Poor little brain cells. They should go to counseling.

University of Maryland Medical Center. “Depression stems from miscommunication between brain cells; Study challenges role of serotonin in depression.” ScienceDaily. ScienceDaily, 18 March 2013. <www.sciencedaily.com/releases/2013/03/130318105329.htm>.