I don’t remember anyone mentioning this when prescribing Prozac…

Having made such great progress taking myself off lithium, I keenly decided Prozac (fluoxetine) was the next to go (after six years, most of it at 60mg a day) – and why not right now?

= mistake. Oh boy.

I went from 60mg daily to 40mg, stayed there for two days, then cut down to 20mg. That was early last week.

On Sunday the nausea kicked in – I thought I’d caught a stomach bug. Except it was more than that. It was like having a cold too with sniffles etc, and maybe flu because my joints ached and it hurt to move. Yesterday the nausea subsided, to be replaced by all-mighty brain-zaps. It feels like there is WAY too much electricity in my brain. Every movement seems exaggerated, like I might fall. I can feel my pulse in my head. I’m sure that I’m physically twitching, although my housemate is assuring me she hasn’t noticed.

Venlafaxine withdrawals were hard for this reason, but they were intense and over in a couple of days. This seems really drawn out, and I can’t keep taking time off work. At the same time, I’m not safe to drive. I’m not really that safe to walk!!

I’ll post again in a few days when hopefully my brain has settled down, but in the mean time I just had to wave a flag to say Prozac withdrawals can be a real *****. I found ‘SSRI Discontinuation Syndrome’ on the interweb, read the symptoms and yelled ‘THAT’S EXACTLY WHAT I’M GOING THROUGH.’

Given the really long half life of fluoxetine, I was under the impression it would be really easy to come off, especially if I didn’t go cold turkey. If I had known it could hurt like this, I’m not sure I would have stayed on it for six years.

 

Slow and steady wins the race, but does she have the patience?

Since Wednesday I’ve gone from 700mg lithium daily to 500mg. I haven’t noticed any withdrawals, but I think the flush out takes a good 48h plus, so early days.

Its killing me to go this slowly. Every night when I pop open my pill box I have to fight the urge to remove some more. Get this over with. But the responsibilities of a full time job win over – last time I went cold turkey and had a hard time, I could stay at home and keep out of sight. I can’t now. Especially given the recent…screw up.

On that note it’s been okay at work – I had to talk to a couple of heads of division to explain myself which was a bit nerve racking, but my co-workers have been very supportive and laughed it off like nothing. It’s amazing how quickly the pessimist in me can take over – when I realised my mistake last week I was immediately thinking through the consequences if I resigned, and where else I might look for work. I feel pretty pathetic for crying, but hey, I felt terrible.

I wonder how I’ll feel post-lithium. For me it’s a buffer, numbing everything a little – which was perfect when I was suicidally depressed because it took the heat out of my worst moods. The thought of feeling those achingly bad moods again scares me a little, but I don’t think I’ll be able to forgive myself if I don’t give my all in therapy, now that time is limited. I need to be sharper. I need to feel my anger, sadness, and fear in order for them to pass. I think losing lithium could really help.

I just need to not rush the withdrawal and end up dealing with some stupid med drama that detracts from the real work.

Waking up

The last few days have felt horrendous, but they’ve been worth it. I forced myself to keep reading my old journals, and cringing aside, something stirred inside me. I know who I am. Where my head is. I know I’ve been sleep walking through the last two years, hiding from anything that might cause anxiety. I chose blissful ignorance, the easy life, avoiding problems by not actually doing anything. 

Today I wrote a new journal entry, and it felt like clasping hands with an old friend. 

I told Dr T that I can’t coast through the six months of therapy we have left to work with. I’ve been going to him for five years now and I STILL struggle to be open with him despite the trust we’ve built – I don’t think I’ll ever have that level of trust again, so if I don’t somehow beat my depression now I’m really scared I never will. And he listened. Asked the things I wished he wouldn’t. It’s hard, harder than running 5k, but it’s right. Now the low mood has a twist of hope, and that makes it bearable.

Therapy isn’t the only arena of change – I’ve decided it’s time to lose the lithium. I’m not bipolar – I’m on lithium to boost the fluoxetine – so I don’t think it’s a dangerous move. For now I’ve gone from 700mg to 600 – I don’t know if I have the patience to go this slowly. Surely the withdrawals if I go cold turkey can’t be worse than they were for venlafaxine? 

If anyone reading this has come off lithium, I’d be very interested to hear your experience.

ECT? Ketamine infusions??

I saw my psychiatrist this morning, and it turned out to be quite an…interesting…half an hour.

She realised the lithium dilemma without me having to explain it, and the upshot is that we’re reducing my dose from 800mg to 600mg nightly in order to reduce the side effects I’m experiencing. This means we definitely won’t be hitting our original target of a lithium level between 0.55-0.7, but she says that target is more relevant to bipolar patients than patients with depression. Hopefully 600mg will still be useful to me.

We’re also adding in another antidepressant to try and boost my serotonin levels: welcome back mirtazapine (/Remeron). I have to admit, I’m a bit nervous about this – I’ve taken it before to help me sleep (which is another reason my psychiatrist wants me to take it now), and in December I wrote myself a warning before discontinuing this med for being too strong. I’ve been told to cut the pills in half and see if a lower dose is tolerable, and then increase in a fortnight. 

The whole medication vs insomnia battle really sucks; the meds are either so strong that I’m barely conscious in the daylight hours, or so weak I might as well be swallowing chalk pills. The only med that hit the right spot in the middle was zopiclone (/Imovane/Zimovane), but I’m not trusted with it in case I overdose. Grrr.

With this all established, my psychiatrist sat back and said we should think about what the next step is. When I see her in two months time, if the mirtazapine hasn’t helped much she wants to add in aripriprazole (/Abilify), an antipsychotic. After my bad experiences of olanzapine (/Zyprexa), quetiapine (/Seroquel) and risperidone (Risperdal) I had sworn I never wanted to touch an antipsychotic again, so we’ll see how I feel if it is decided this med is necessary.

And then my psychiatrist said she wanted to say something that might horrify me…that I should consider ECT. I’ve read enough blogs on WordPress to know that for all the scary assumptions we hold about it, it can have it’s good points, and my doc was quite encouraged when I didn’t immediately say no. She reckons it’s really underused, especially with patients like me who are managing to function, but are having a miserable time of it. 

Apparently I should also consider ketamine infusion therapy, because a UK trial has just finished and found some patients respond really well, so it’s opening up to referrals. And yes, that’s ketamine as in the horse tranquilliser/Class B drug, but used at a much smaller dose. 

I was a bit shocked by these suggestions – I’d thought that ECT especially was for very severe cases of depression, but now I know that’s not true (..and I’ve been reminded that my diagnosis is ‘severe depression’). I’m not exactly shut against the suggestion of having ECT, but the memory loss bothers me. I’d also have to have it as an outpatient because the hospital is really short on beds, but I’d need to have someone to care for me for 24 hours, and that’s not an option. 

With the ketamine infusion idea, I was pretty skeptical, but having looked up the details of the study etc I’m actually kind of intrigued. But, hopefully none of this will be necessary because the mirtazapine will help. Or the aripriprazole if it comes to that.

All in all, it wasn’t a bad meeting. I really like this psychiatrist (and yes, I realise that means she’ll be next on the list to disappear off somewhere else), because she is nice, but not too nice, and she clearly knows her stuff (not surprising given she’s a consultant psychiatrist). The loss of Nurse L was mentioned in passing – as I suspected there will be no replacement, and I have no interest in asking for one. My GP won’t be happy because she specifically told me to ask about it because she thinks it makes me safer (true), but letting someone else in is also dangerous in it’s own way.

We’re already rocking the med boat, so lets leave the rest alone, at least for now.

Enter: lithium

I start taking lithium tonight (400mg), and I’m nervous about it. The Crazy Meds site is my medication Bible, and the lithium page isn’t exactly encouraging in terms of side effects. Those aside, I know it can do great things for bipolar disorders, but there seems to be less info about lithium and treatment-resistant depression. I would say ‘I guess I’m about to find out…’, but my psychiatrist said lithium can take up to SIX MONTHS for it to take effect.  Ouch. I’m worried about how it’s going to affect my GI tract, and I already have issues with drinking enough water which I’m told will be exacerbated.

But I will try it. I don’t like being dependent on meds, but I think the time has come to hold my hands up and admit I need their help. As of today I’m also back up to 60mg fluoxetine (Prozac). Let’s hope there aren’t any interactions.

There’s not much to say about how this weekend went; weekends are just two days of ‘dead time’. Nothing really useful done, nothing very exciting achieved. To be honest that’s mostly true of the weekdays too at the moment, med-appointments aside, but given the state of my mental health recently I think that’s acceptable if it means I don’t rock the boat and risk my safety. I did decide though that half-watching TV is not occupying enough, so I’ve reinstalled a computer game I used to enjoy. I don’t really want to be that person who sits around playing a game, but it’s more absorbing than TV if I can’t concentrate well enough to read or sketch.

I think overall my mood has improved since my last CBT ‘reasons not to Check out Early’ session at the hospital on Friday. I’m not miserable anymore. I’m not happy, but I’m not on the verge of tears either. I’m functional. There’s been a bit of a dip today following my GP appointment this morning; I think it’s because as I got up to leave my GP asked me if I’m ‘safe’, and looked anxious about it. The guilt I carry from worrying him has found it’s way to the surface again, and leaves me feeling sad. But at least I can recognise and understand this mood, and I suppose that’s what therapy has been teaching me to do. If I’m not in touch with my feelings, they tend to fester and grow into much darker forms of the emotions they started out as.

I’m not sure

Today I just want to air a quick thought that’s been bugging me – is my recent low mood connected to being off meds? I don’t mean withdrawals, because I’m pretty sure those were over at least a week ago. I’m wondering if generally, despite me claiming the opposite, the meds were doing something useful, and that it isn’t all that safe for me to be off them.

I don’t know, and it’s never going to be a straight answer because there’s a lot of stress around my daily life at the moment (although I think if you went back in time and stopped me at any point over the last couple of years I’d say I was stressed). All I do know is that I haven’t been so obsessed with suicide and self harm in a while.

I really hope meds aren’t playing a role in this. I’d hate to have to admit I need them.

I’m not sure I can be trusted with meds

Last night wasn’t brilliant, but it could have been worse. It turns out Nytol and trazodone (Desyrel) don’t make for a great combo; some internet research warned me that the two would interact, but it wasn’t the way I expected. I was hoping to be knocked out, but actually that didn’t happen at all. It took hours to get to sleep, which is unusual when I OD on Nytol.

Now I don’t know what to do. I want the Nytol to work, and for that to happen I would have to skip the trazodone. But at the same time I know I’m really meant to be giving the trazodone a proper try, so my doctor would say to skip the Nytol instead. My head is going ‘no. no, no...’ because the less sleep I get, the stronger the destructive urges get. And I guess also because I’m sick of insomnia, and when Nytol works it’s a nice change. If I’m being honest there’s a part of my brain telling me to take all the trazodone in one go and see what that does, but since that’s a promise-breaker I’m doing a good job of ignoring it.

You know what makes me feel pretty sad at the moment? I don’t think I can be trusted with meds. I was so pleased to be allowed weekly prescriptions again this week, but perhaps my GP was right to hesitate. I haven’t abused the trazodone so far, but it’s come pretty close. And now I think that even if we dropped back to twice-weekly prescriptions, the urges would be there all the same.

I don’t know what the answer to any of this is, but part of me wonders if I shouldn’t be given meds at all. That wouldn’t improve the Nytol-related problems, but it would make me safer in one sense at least.

I don’t know