the id, the ego, & the single misfiring brain cell

and what the doctor didn't say

I realize I've been on a tear lately. I also realize that I never provided follow-up for my posts. Apologies. I've been distracted and when I wasn't, genuinely busy. (School's back in session, donchaknow.)

Again, thanks to my many friends who posted to Facebook or emailed/PM'd me with thoughts/suggestions/concerns. I left y'all hanging with the understanding that I submitted to the indignity of going to the ER a day late to ascertain my heart's health, then said I had a follow-up appointment last Wednesday. I've been going down several rabbit holes since then. Now I owe you a follow-up.

***

So here's the timeline:

25 August: the attack that provoked the my time to see the doc again post. I immediately scheduled a visit with my new doctor as I was told a year ago that this was just a panic attack. I assumed I'd just had another and it was time for a med change.

26 August: a visit to the ER, just in case I was underestimating my problem, but it wasn't a heart attack

29 August: realization which led to my quitting my meds--Celexa (for depression) and Elavil (for insomnia)--altogether

30 August: new woman

1 September: met with my new doctor and told her all; got new meds

3 September: wait...what's happening?!

Let's start with the realization....

I realized that I was not me anymore. Furthermore, I couldn't remember when I stopped being me. The medications seemed like a godsend (heh) at first, a year ago. I wasn't angry; I was happy and focused and felt...normal. (I guess. I mean, how do you know when you feel "normal" or not?) There was a certain emotional flattening, but I was willing to accept the tradeoff.

When I went in after six months, I still felt fine. My (other) doc extended my prescription. But I wasn't all that fine, really. I was already growing apathetic and indolent, but I was boiling a frog. The changes were so gradual, like growing up or gaining weight, that I didn't notice.

I'd also gone back to drinking, only my drinking was FAR worse. Over this summer, I realized this. I mean, I could see myself, but I didn't care. I didn't care about my health, my weight (which has grown beyond any point I've been in my life), my lack of motivation, my lack of any real interest in activities or exercise or occasionally stepping out of the house into the sunshine. The things I love to do--read and engage in online discussions--even ceased to be interesting to me. I got bored in the middle of movies and good TV shows.

At the same time, I was groggy all the time. I suspected I might be overdoing the Elavil, so I cut my dosage in half. So I wasn't groggy, my insomnia hit immediately, as though I'd taken nothing at all. So I resumed my excessive Elavil dosage. I slept all the time--when I wasn't somewhat awake but still groggy, and when I wasn't drinking.

I didn't even want to drink. That's the weird thing. But I did, day after day and excessively. We're talking about two bottles of wine a night or so. I didn't ever measure, but I knew I was putting it away and just not caring. My weight blossomed to almost 160 pounds, and I still didn't care. I no longer fit into any of my jeans, even the oversized ones I've kept around for doing yard work (although I can still squeeze those on).

I guess we all have our breaking points, and mine came on Monday. It was the first day of school. As I drove through Castle Rock on my way to Boulder, I thought I'd just stop at the outlet stores on the way home the next afternoon and buy bigger jeans. The hell with it.

Having made peace, I thought, with my weight, I was happy to be back in school. Even though I was still on meds, I felt something that day. This may be linked to the fact that I'm taking two excellent and interesting classes. Or that this is my favorite time of year in Colorado. Or that I got to see my Boulder friends again. I don't know what made this click in my brain, but click it did: I'm not me anymore. I don't know who this is living in my body. For that matter, I don't even know whose body this is. The only way to end it is to stop taking the medications.

So I did. That day. That night, I drank several beers, but went to bed sober (I have a truly frightening tolerance). I didn't sleep well, but I didn't sleep poorly, either. I woke a couple of times, but was able to slip back into sleep.

The next morning, I awoke. Just so you understand and appreciate my meaning, here is the appropriate emphasis: The next morning, I awoke. I was working on my homework around 7:30am--with no alarm needed--and I was not groggy. My homework was interesting and fun. The sun was shining, the breeze blew, and the leaves were a perfect hue of green.

Literally overnight, I transformed from the drugged, indolent and apathetic zombie I had become. I walked the mile to the bus stop, in love with the world. I smiled at people. There was a bounce in my step. I could feel the breeze on my skin. I sipped maybe three beers that night, at most. I poured the last one down the drain and went to bed.

I felt even better on Wednesday when I went in to see my doctor.

I have a new doc. That is, this is not the one who put me on these meds a year ago. (I didn't ask for a new doc, but military transfers ensure we all get a second opinion occasionally, so that's good.)

I'd originally made the appointment because I assumed I had had panic attacks again (but...weird ones, including intense pain in chest and shoulders), so I ostensibly went in to get a new prescription. Once I got there, I told my new doc about my recent "panic attack" and emergency room visit. I also explained as succinctly as I could* that I'd quit my meds a couple of days before and exactly why.

* I know. Y'all don't think I'm capable of succinct communication. You'll just have to push the "I believe" button here, I'm afraid.

My doc said, "I normally would caution anyone against quitting antidepressant medications cold turkey like that without medical supervision. I understand that you'd just had it, but in the future, contact me."

OK. Sounds reasonable.

She said, "It could be panic attacks that you experienced. It's hard to tell. Everyone reacts differently to them. However...let's talk about your blood pressure." I'm really liking this doctor. "I don't know if you have rising blood pressure because it's hereditary, or because you're stressed. The fact is, your blood pressure is up, and it is consistently so. Normally, we'd run a five day test to get a good view of your blood pressure, but"--she gazed meaningfully at the electronic records of me for the past few years--"your blood pressure is consistently high. I want to put you on blood pressure control medications."

Yes. A doctor who didn't (1) give me another "your blood pressure is high because you're in the doctor's office/sick/stressed/excited" line of bollocks, and who didn't (2) instantly dismiss my "panic attacks" or whatever they are as Hysterical Lady Syndrome. She cancelled my other prescriptions because my marks for intense depression were, as you might imagine, off the charts. She prescribed a low dosage of Wellbutrin and a low dosage of Trazodone (for my insomnia), as well as Zestril for my blood pressure.

I asked her if I could still exercise while I'm in the probationary blood pressure med period, keeping in mind that my idea of exercise is most people's idea of prolongued intense exertion. She said, "Absolutely no intense exertion until our follow-up in two weeks. You can walk, but no racewalking."

That day, I took a Zestril, but decided to give my body some time to come off the old depression drugs before I went on the new ones. Besides...I felt like myself again, and frankly, I was enjoying it. I felt so great that the next day, I spent 3.5 hours sawing down trees and adding to my wood pile.

Friday, I went to a massage appointment in the morning, then drove to Bicycle Village and bought a new road bike and had it sized and outfitted with accessories. I felt...great. I've lived so long without motivation that I'm literally wallowing in all the energy and interest I now have.

And oh yeah.... Suddenly, without any resolution or effort whatsoever, I want little more than a beer or a glass of wine a day. I haven't tried to stop drinking. I just suddenly don't want it.

If you've ever wondered how much excessive drinking is mental and how much is chemical, I can't answer that for everyone. For me, though? It's undeniably chemical. I now understand all sorts of strange behaviors I never "got" before. All my life, I've helped people develop exercise programs and stick to them. I never understood why people wouldn't want to exercise, frankly. On a day to day basis, sure, but every day all the time? No. The concept was completely foreign to me. Now, I get it.

Also, I know people make themselves stop drinking. Most need support groups, and sometimes need to meet with their group more than once a day at first, but they can make themselves stop drinking. I guess. (Well, no. When the problem is complete lack of interest or motivation, how and why would you bother?)

When I came home Friday afternoon, I took the new wheels out for a spin, planning to do an easy 20 or so (I know...don't tell my doc), but I made it less than two miles before two things turned me around: (1) I realized that the default seat for my new wheels, while undeniably softer than your average manufacturer's seat, was not going to work, and (2) I felt suddenly dizzy and...odd. I had the unmistakable sensation that jolts of electricity were occasionally going through my body and brain. It was surreal. I felt high, but not pleasantly so. I took a Trazadone, and slept well.

I didn't have a clue what was going on.

The next day, it was worse. I thought it was just light-headedness from the new blood pressure meds, but the doc hadn't mentioned the electricity and disorientation part. I developed some, ahem, gastrointestinal distress. All day Saturday, I felt weak and disoriented. And I kept having that electrical feeling, which was worse when I didn't sit or lie still. I'd occasionally lose my balance. I was awake all night, too. I just wasn't sleepy. I went to bed around 5:30am.

Sunday morning, I mentioned to Travis that despite this, I still felt tons better after quitting my antidepressants. He said, "Wait. You stopped taking your antidepressants?" Yeah. "When?" Monday. "And they're SSRI's?" Yeah. "Um...I don't think the blood pressure medicine is your problem. You probably have SSRI Discontinuation Syndrome."

My reaction: wot.

I've never heard of this. Also, I told my doctor I'd quit (and the new drugs she gave me are not SSRIs), and she didn't mention it.

And in an uncharacteristic move, I didn't instantly go look it up.

Sunday night, I was again awake until about 2:30. Around 4am, I woke on my hands and knees (on my bed) staring in horror at my pillow. I'd had a strange dream in which I was climbing some monkey-bar-ish things to escape a bull (of all things), and when I looked down, the bull had jumped, hooked its front hooves on the lowest rung, and was drawing itself up toward me. As I stared at it, it morphed into a huge snake with prickly nettles all over its head (????), and it continued to rise toward me. This is where I woke, I think, but my pillow--which has a white pillowcase--was covered with huge black paisley patterns, and as I stared at it, the patterns would shift and snake heads would lift, look at me, then lie back down. In a few seconds I was fully awake, at which point the pillow returned to its harmless white self.

That morning, I looked up SSRI Discontinuation Syndrome. Common symptoms include:

Antidepressant discontinuation syndrome occurs in approximately 20 percent of patients after abrupt discontinuation of an antidepressant medication that was taken for at least six weeks. Typical symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. These symptoms usually are mild, last one to two weeks, and are rapidly extinguished with reinstitution of antidepressant medication. Antidepressant discontinuation syndrome is more likely with a longer duration of treatment and a shorter half-life of the treatment drug.

That's the Celexa, but this adds to the fun, no doubt:

...tricyclic antidepressants also affect the cholinergic system, so rapid discontinuation may cause signs of parkinsonism and problems with balance

Elavil is a tricyclic.

So then...now I understand the brain zaps, trembling, weakness, gastric upset, exacerbated insomnia, nightmares, and really...everything. So why didn't I know about this?

As it turns out, pharmaceutical companys they don't want you to realize how addictive these drugs really are:

SSRIs are not addictive in the conventional medical use of the word (i.e. animals given free access to the drug do not actively seek it out and do not seek to increase the dose), but discontinuing their use can produce both somatic and psychological symptoms.

Critics argue that the pharmaceutical industry has a vested interest in creating a distinction between addiction to recreational or illegal drugs and dependence on antidepressants. Arguments against the use of the term 'withdrawal' are primarily predicated on not frightening patients or alienating potential customers who may or may not need the medication. According to the consensus definition by the American Academy of Pain Medicine, withdrawal is a symptom of "Physical Dependence", not of "Addiction" and thus arguments against SSRIs being "addictive" do not clearly make the use of the term "withdrawal" inappropriate to the symptoms caused by ceasing an SSRI.

Right. Mice don't automatically choose it over food, so it isn't "addictive." (Is it just me, or does that strike you as grossly misleading, at best?)

Travis said he finds SSRI discontinuation syndrome intolerable. He's tried to quit, but has been forced back on them. I understand what he means, but for me, going back on them is simply not an option. Being on them is itself intolerable.

So...what I've been experiencing since Friday are colloquially known as "brain zaps." I'll often get them so intensely that I can hear the air pressure change in my ears (sounds like a brief, intense wind) and my body will go through a Parkinsonian shiver. This morning, I was hit with one that made me tremble so violently that I sloshed coffee on the kitchen floor.

I have another week of this, tops. Or so says the literature.

Yeah, I can just start the Wellbutrin, and I may break down and do it, but I want to give this a chance to even out first.

And honestly? I'm just enjoying remember what it feels like to be me right now, even if I am in a higher hyper-bitch mode than usual.

d