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.

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Maybe discussing dreams isn’t all that random/boring. Maybe it’s useful

Talking about dreams is boring, right? That’s the message I received growing up – no matter how exciting/weird/personally interesting (or even potentially-interesting-to-others) your dream is, if you mention it to someone they’re sure to be privately wishing you hadn’t bothered. That sounds a little strong as I type it, but that is definitely what I had been led to believe.

Imagine my confusion when my therapist actually encourages me to share my dreams with him. I’ve done it a few times, and on every occasion I can’t help but hold back (…more than usual, ha ha…) in case I’m boring him. But he insists that I’m not, and says he’s interested because the figures we see in dreams are parts of ourselves. If I tell him what I dream, he gets a little ‘update from the unconscious’ on how I’m doing. Here’s an example: I dream I watch helplessly as my brother falls into a river and dies. Imagine the boy in need of help is actually me, and it’s also noteworthy that the dream wasn’t me falling in the river. I didn’t dream I was the one needing help, which is perhaps unsurprising given that I’ve needed a lot of convincing in the waking world that I need things from other people.

I’ve been meaning to write about dreams for a while, but posting this makes me uneasy because it wasn’t long ago that I firmly believed that almost all dreams are meaningless. That the brains makes up stories, plucks characters from recent thoughts/encounters, and voila. When I studied psychology at sixth form college we were taught that ‘dream analysis’ (introduced when studying Freud/psychodynamics) was laughable as an approach to investigating psychopathology, compared to say, CBT. But I don’t laugh at it anymore – coincidence can’t explain the amount of correct information my therapist has pulled from what I’ve described.

Anyway, the reason I’m typing-out-loud about dreams is because since I quit venlafaxine a few days ago I’ve been having strong dreams every night. I know I dream a lot, but most of it is little anxiety dreams, or bits and pieces about what’s going on in my life (e.g. dreaming about an upcoming event). Currently every night brings a long, dark dream. There’s always something going wrong – I’m in trouble, I’m arrested, I’m chased, I’m forced to do something etc etc. I’m hoping they’re only dark because they’re a symptom of withdrawal, as opposed to there being something dark in my head.

Venlafaxine withdrawal: The horror stories are TRUE

It’s day two of going cold turkey from the 300mg daily dose of venlafaxine XR (/Effexor), and despite the reassurances from my GP on Friday I can confirm the horror stories are turning out to be true.

Last night was strange – I had lots of strong dreams, and at one point during the night I woke up shaking pretty violently. I also felt sick so I emptied my bin and placed it next to my bed just in case. Today I’ve had relatives over for lunch so I’ve had to put on a bit of a show of being fine, but I had to take a few minutes to sneak away and keep my head between my knees, waiting for some dizziness to fade. I’ve also been close to crying on a couple of occasions, which is weird for me. At first I thought it was because I feel so strange, but I now reckon it has more to do with withdrawal-related emotional instability.

Rather than posting loads on the same topic, I’ll update this post semi-regularly over the next few days with how I’m getting on. Fingers crossed the worst will be over by Christmas…

Update: 23/12 – Today has been better and worse – better in that I feel more emotionally stable, but worse because I’ve been shaking non-stop all day, regardless of temperature. I’m more than happy to live with it though; I’d much rather shake like I’m sitting in a bath filled with ice than mooch around feeling sick and miserable. I’m not worried about how this might affect Christmas, and I’m hopeful that I’m over the worst of the withdrawal.

Update: 25/12 – The shakes stuck with me for most of yesterday, but they seemed to have vanished for Christmas! I’ve actually felt pretty much normal for most of today, and it’s only as the evening has drawn in that I’ve started feeling buzzy again. My coordination is back to standard, which means I’ve been able to drive today for the first time in a little while.

Update: 30/12 – I’ve been off venlafaxine for over a week now, and I think I’m clear of withdrawal symptoms. I haven’t had any brain zaps in a while, and I think I can safely sign off on any shaking being more cold-related than anything else now.

A bit of a medication mess

I saw my GP this afternoon, and we agreed that venlafaxine (Effexor) isn’t working out for me. I’ve been on it for over three months now, on a high dose of 300mg daily for at least a third of that time, and yet I still end up feeling low and self-harming etc.

The big question was what to try next; if you’ve seen my ‘about’ page you’ll know I’ve tried quite a number of different meds with little success. Last time I saw my psychiatrist he said the next step would be to either add mirtazapine into the mix (a combo worryingly known as ‘Californian Rocket Fuel’), or switch to a different AD altogether. My GP opted for the first and cut me down to 150mg venlafaxine each morning, with 15mg of mirtazapine to be taken each night. He also assured me that I shouldn’t take the horror stories I’ve read online about venlafaxine withdrawal too seriously (we shall see…)

However, when I arrived at the pharmacy a little later and actually read the prescription my GP had given me, I realised he wasn’t giving me any more venlafaxine, and I only have a couple of 150mg tablets left. My mistake; I shouldn’t have assumed he’d know to give me more (although he usually does. Never mind). It would have been a hassle to go back, so I’ve rather bravely (?) decided to collect up whatever pills I have left (a couple of 150s, some 225s and some 75s) and wean myself off completely over the course of the next week or two. I hope my GP was right about the withdrawal symptoms horror stories being exaggerated because otherwise Christmas isn’t going to be a lot of fun.

Initially I was quite pleased about having mirtazapine again because it should help me sleep, but I’ve remembered that weight gain is a common side effect. Well, I guess if venlafaxine withdrawal has me feeling sick the two might balance each other out!

Feeling dizzy

Recently I’ve found myself repeatedly feeling dizzy and lightheaded, which I’ve previously associated with taking antipsychotics (risperidone and quetiapine lowered my blood pressure). I’m not taking either of those, so I’m wondering if it could be the high dose of venlafaxine (Effexor).

Today I sat on the floor to wrap presents and every time I straightened up from my knees to reach the tags on my bed my vision would darken and everything would spin. Yesterday there were a couple of occasions where I had to hold on to something for a minute and wait for my eyes/brain to behave. This has been going on for a week, and I can’t think of anything that has changed in terms of my routine/diet/exercise etc that could be causing it. I’ll mention it to my doctor on Friday.

It could be worse though; back in the antipsychotic days I learned that if I’m in real danger of passing out/fainting everything will go green first, and that hasn’t happened so far. Fingers crossed that doesn’t change.

Spotlight: Venlafaxine (Effexor)

ImageFor the second instalment of medication reviews I’m jumping forward in time to my most recent prescription – venlafaxine, alternatively known as EffexorAs before please bear in mind that this post is only describing my experience of the drug – it may work differently for other people.

Following the failures of three antipsychotics and fluoxetine to make much of a dent in my depression, my psychiatrist decided I should try venlafaxine, beginning with 75mg a day. At first I noticed feeling quite nauseated, and unfortunately it wasn’t making me sleep any better (not that it was supposed to, but it would have been a bonus!). When I started taking venlafaxine I was in the middle of quite an unstable period mood-wise, and nothing changed in the month we gave it to get working so my GP upped the dose to 150mg (slow release). This was pushed up to 225mg by my psychiatrist at my 6 week review, and as my DSH and suicide ideation persisted I eventually ended up on the dose I take at the moment, 300mg. I’m pleased to say the sickness didn’t last more than a week or so, and apart from that there haven’t been any noticeable side effects. On the other hand, I can’t really say I’ve seen any significant effect on my mood; I have the same ups and downs over time, and can’t imagine feeling worse off without these pills.

However there is something I think anyone considering taking venlafaxine should be aware of: this medication is one of the nastiest I’ve come across in terms of side effects when coming off it. When my psychiatrist first mentioned venlafaxine I did some research and straight away found hundreds comments from patients about the hell they went through when they weaned themselves off it, and with my experience I would bet money that they aren’t exaggerating. Venlafaxine has a short half life which means it leaves your body relatively quickly, and the significance of this is that if you are late taking a dose or miss it, you feel the withdrawal effects faster than you would on say, fluoxetine (Prozac). Being a bit of a curious idiot I decided to go without my meds for a while to see if it was as bad as I’d read, and I can safely say I won’t be doing that again. I lasted 48 hours, during which I had some serious brain zaps, light-headedness, and nausea. Given that venlafaxine doesn’t seem to be doing me many favours I expect my psychiatrist will take me off it after my next review in January, and if I’m honest that’s scaring me a bit given I’m on the highest dose. I plan to come down very slowly, and take some of my leftover fluoxetine to try and dampen the withdrawal symptoms.

Update (30/12/13): After a bit of a prescription mix up I ended up quitting venlafaxine cold turkey, and the week that followed was not fun. I felt sick, my brain buzzed and zapped constantly for two days and then gradually calmed down, I shook violently for quite a long time, and I was very emotionally unstable. That said, it could have been worse – the nausea wore off reasonably fast, and although the shakes and zaps were annoying, I wasn’t bed-ridden. For more detail please see some of my later blog posts.

Summary

Doses (daily): 75mg, 150mg (XR), 225mg (XR), 300mg (XR)

Positive effects: None

Negative effects: Initial nausea, although it wasn’t a big problem because it went away after a week. My real issue with this med is how ill it makes me feel if I forget to take it within a couple of hours of my usual time.

Conclusion: Not the antidepressant for me, and trying it out cost me a lot when the time came to stop taking it. I would seriously recommend having a good think about what you’re potentially committing to if you’re considering starting venlafaxine.

Check in

The last couple of weeks have been pretty hard; a combination of low mood and a little series of unfortunate events. For the sake of anonymity I won’t go into details, but imagine some serious pain when someone I trusted as a good friend suggested my ill health is nothing more than a lie to get ahead at university. Right. Unfortunately that rumour is spreading, so I’m feeling a little low on friends at the moment.

Alongside daily frustrations like this, I’m back to struggling with an internal feeling that I’ve had enough (…of everything…), and that hurts because I can’t seem to do anything about it. I can’t even ‘end it’ for reasons I’ll outline in a later post. In the end I wind up wanting to hit my head against a wall/overdose on sleep meds like the best I can aim for right now is unconsciousness. I’m seeing my therapist tonight so maybe I’ll feel better after that. I can’t say I’m overly optimistic though; I think it would take a lot to make me feel better about:

  • Friends seemingly dropping like flies
  • Not caring about the future, except for the possibility that it will feature mental illness in which case count me out.
  • My current med situation: in brief I want to come off venlafaxine because clearly even at the highest dose it isn’t really doing much except making me eat like crazy, but I’ve heard nasty things about withdrawal and my docs wouldn’t approve.

…to name but a few.

Okay enough moaning. I’m slowly updating the rest of my site with my background info if anyone wants to put my posts in context. Feel free to get in touch and say hi/ask any questions!