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.

 

Mentally Stable

Newsflash: MQ has graduated from psych land! Or in other words, I’ve finally been discharged from the psychiatric hospital (outpatient).

Mentally Questionable has become a little less ‘Mentally Questionable’, and more stable.

It was weird walking out of there for what was hopefully the last time on Thursday. Unsurprisingly that place is full of memories; the rooms of the day-hospital that opened my eyes to other patients and problems, the clinic where I let them jack me up with ketamine, the wall that moved when my CPN quit, the crisis team…etc etc.

And I don’t need any of it any more.

After two years of experimenting with all sorts of drugs, my awesome psychiatrist found the right combo to keep me moving, and keep me safe. Applause for her, and applause for:

  • 60mg fluoxetine
  • 600mg lithium
  • 45mg mirtazapine
  • 80/160mg propranolol

She suggested I continue taking these for at least the next two years, and then if I’m feeling stable come down very, very slowly, one drug at a time. I was hoping not to be on lithium for that long (I’ve already been on it a year, and I know it can be damaging long-term), but perhaps I’ll review in a year’s time and see how I’m doing.

Now I’m off the psych books, the main sources of change for me have to be therapy, and obviously myself. I’m not sure how I feel about this. I’m certainly not brimming with confidence. But I’ll deal with that later. For now, I’m just going to celebrate a significant step in the right direction 🙂

When the heart wants change, at any cost

I had an appointment with my psychiatrist today up at the psych hospital, and it’s made me realise that I need to have a really good think about meds – about my expectations of them, and expectations of my psychiatrist, and how I can end up working against myself.

Let me rewind a little bit. For a few days now I’ve been stuck in a sad/low-funk, reminiscent of really bad phases I thought I’d left behind. Naturally, it scares me to be back in this position, and I encounter a fresh sense of injustice at having to feel like this, when most people couldn’t even imagine it.

I see my psychiatrist every 2/3 months, so she is really just getting a snapshot of how I’m doing at any given time. When I realised this appointment was coming up, I knew there was a danger here. If I told my psychiatrist how I feel right now, it could undermine the impressively stable period that came before it, and discredit the combo of meds responsible.

Because the truth is, I think that after years of experimenting, we’ve finally found a combination of pills and dosages that works for me; 60mg fluoxetine keeps me functioning, 600mg lithium numbs the suicidal urges, 45mg mirtazapine beats insomnia, and 80mg propranolol takes the edge off anxiety.

But I realised that despite this, I wanted my psychiatrist to add something, or take away something, or change the dose of something. Because I was feeling crap (and regardless of that being short-term so far), I wanted her to DO SOMETHING. Even if it would be a massive mistake.

I didn’t want her to do something because it might make me feel better. I wanted her to do something because it would mean someone acknowledges how horrible and unfair this situation is. That’s the naked truth here; I was prepared to sabotage years of side effects, withdrawals and other crap just to have my psychiatrist say ‘this really doesn’t sound alright; I think we’d better change something’.

I knew all of this when I went into my appointment today, and I still found myself having to be really honest about what the last few days have been like. Thankfully, my psychiatrist didn’t make any changes to my prescription (she said she’s wary of adding anything else to the cocktail I’m already on), and I’m grateful to her for this. I also suspect I’m not the only person to have this problem, because my psychiatrist even said ‘I know that doesn’t sound very satisfactory…’.

I wish I could have been stronger, but I can’t deny that if I’d walked out of the hospital with an altered prescription I’d have been pleased.

Distractions

I’m back in that place where answering ‘how are you?’ is difficult, because I have to decide whether or not to really engage my brain. If I leave myself in ‘cruise control’, where I mindlessly kill time with hobbies, the answer is that I’m fine. If I switch back to manual I sit here hating that cruise control, but also hating all the alternatives, so instead of honestly answering I settle for ‘everything sucks’.

Yesterday brought the first therapy session after a break of about three weeks, and initially I was pleased that I could present myself as being a lot brighter than I was pre-Christmas. Depression really was less prominent, as I had become better at passing the time that would otherwise have festered negative thinking.

But in that session I realised that I couldn’t draw, knit, and video-game forever; I need a proper job to replace the childminding, I need to find somewhere else to live etc…There is a massive question mark hanging over most aspects of my future, and I had a nasty feeling that my recent stability might only exist in my previous (willing) ignorance of this. I knew the full-blown nastiness of depression was waiting in the wings, but I wasn’t quite touching it.

And then last night the missing link hit me: it’s there when I ask myself if I want any of this (‘this’ being life and it’s opportunities etc)…let the broken record play.

I just don’t know if there’s a fix for that. Can you get your drive for life back if you’ve lost it? Meds won’t give it to me; I think my current combo (fluoxetine 60mg/d, lithium 600mg/d, mirtazapine 45mg/d) is the best one we’ve found in two years of trying, but I’m not sure it does a whole lot more than aid the aforementioned cruise-control (+ cure insomnia, albeit with a shed load of intense dreams each night).

I don’t know if therapy really has the answers for me, for two reasons. One is that I have this nasty feeling I’m too…broken/weird/out-of-sync…to be able to change as Dr T expects me to. The second is more logistic; money’s tight, so I can see therapy ending soon for financial reasons.

I’ll try again: if you ask me how I am, I’ll answer ‘I’m generally doing better, because the right combination of meds and hobbies have made it easier for me to function during the day, but ultimately they’re only distracting me from the darkness hiding underneath, which paints these distractions as pointless.’

Ugh I really hate my head sometimes.

I won’t let you hurt me

Stop telling me you’ll be there for me.

I don’t need to hear that you’re around every day

Don’t look at me, don’t use that gentle tone.

I won’t let you hurt me.

Maybe that’s a little strong, but I’m feeling super-defensive after the demise of my treatment-trinity. Today I had a GP appointment, with a doc I used to see on occasion when my regular GP was on holiday. She is very friendly. Very softly spoken. She’s always running late because she takes time with every patient to find out exactly how they’re doing, medically and otherwise, and then writes up their notes in detail.

This scares me, so when my original GP left I chose to see locums instead of switching to her, but today I didn’t have a choice.

I haven’t seen her since Easter time when I rather desperately asked for an extension on my dissertation. She remembers that, and noted that I looked pretty ‘flaky’ today compared to last time. But I was not going to play this game. Every time she asked how I was or anything like that I’d say ‘fine’ and immediately ask about my prescription/lithium level results/ANYTHING. 

I could almost feel bad, because she was trying really hard, and I must have come across as pretty stubborn, but I don’t feel like I have a choice anymore. She kept reassuring me that she was going to be working every day so I could talk to her any time etc…and I just had to get out of there. 

Aaaaah.

My lithium level came back at 0.5 after taking 800mg nightly, which is still a little below target. In fact, I think it’s the same reading we got at 700mg. I’m seeing my psychiatrist tomorrow, so she’ll decide if I should keep taking it or not. If I keep taking it, I have to deal with worsening side effects like this tremor. If I stop taking it, I risk losing the suicide-protection it seems to have given me (unless that has more to do with the fluoxetine). 

We’ll see.

Check in: Being social/The right meds

I spent today with a friend of mine from uni; he’s a year below me doing the same course, and he wanted some ideas on his dissertation. This was a bit of a break in my anti-social pattern, and I could feel old habits tugging at me after about an hour.

Make excuses and leave. You could be at home on your own. Tell him you need to go. 

I’m pleased to say that I didn’t give in; I stuck with him until he suggested we head off. And it was really nice to catch up with him – I think if I were capable of missing friends, I’d really miss him. He gave me such amazing support when I was facing my final exams, and when I had to take a year out due to my mental health. I owe him a lot.

My tremor is back today, which may be the result of boosting the lithium to 800mg. I REALLY hope it goes away before I see my psychiatrist, because lowering the dose would take me out of the therapeutic range (i.e. why even take it?), and I don’t want to stop and try something else – that list is already far, far too long.

Side effects aside, I think the lithium/fluoxetine combo is really working for me. It eases the low periods – in my worst times I used to physically feel my depression, and often be overwhelmed with negative thoughts and emotions that would push me to impulsively do something stupid. I am really grateful that my meds seem to be blocking that, which is the big reason for wanting to keep lithium on my prescriptions.

That’s it for today. Happy Wednesday folks!

Check in: Job hunting & fun with lithium

Word of the day: ‘busy’. Getting such a positive degree result yesterday motivated me to immediately start job hunting, which is both terrifying and exciting. Both my psychiatrist and my GP agree that I need to find some part time work, at least initially, and worry about full-time careers etc later. For now I need something that pays the bills, and gives me the time I need for therapy/doctors appointments/babysitting.

With my background in biology and psychology I’ve decided I’d enjoy working in a medical setting, so I’ve applied for a couple of administrative jobs at a local hospital. I already feel super-excited, which tells me I’ve identified the right area to work in, but I’m trying to be mindful that I have almost zero relevant experience so it might take a few applications before I’m successful. Fingers crossed! I’m also feeling some low-grade anxiety about interviews/fitting in/learning new systems quickly enough, but the sensible part of my brain is firmly saying ‘One thing at a time‘. If these hospital jobs don’t work out I’ve got enough local babysitting on the calendar that either way I’m covered for rent, so there’s no pressure on that front.

The other news regards lithium – last time I saw my GP he told me 400mg gave me a lithium level of 0.3 (needs to be 0.5-0.8), so he upped my dosage to 600mg. I started taking the new dose, and saw my psychiatrist the next day, presenting with an impressive tremor. 60mg fluoxetine (Prozac) used to make me slightly shaky, but this was a whole other level that left me unable to write/made it hard for me to accurately use my touchscreen phone, so the psychiatrist gave me a prescription for 500mg lithium.

Unfortunately, she gave me a prescription I couldn’t fill. I tried at two pharmacies but they both rejected it, because apparently lithium carbonate doesn’t come in doses other than 200mg or 400mg (= no way to make 500mg), and they said the prescription was too vague anyway. This left me with a bit of a dilemma: stick at 600mg and cope with the tremor, or go back down to 400mg even though it’s not really a therapeutic dose? I went for the 600mg, but I’ve switched it around – I was taking 200mg in the morning and 400mg in the evening, and now I’m taking the full 600mg in the evening. I’ll report back tomorrow on whether or not that works. Ideally I’ll stick with 600mg until I have my next blood test on Monday, and see if we’ve hit the right lithium level.