The Short Short Version:
Medications and Alternatives:
Cipralex – Put me to sleep. Not any happier.
Wellbutrin SR – Made me crazy hyper, but euphorically hopeful. Also unfortunately promptly gave me big red itchy hives.
Effexor – The bane of my existence. Not any happier. In fact, brought on depressive symptoms WAY more extreme than anything I was having naturally. Extreme enough that suicide became a real concern. Also put me through hell trying to get off it.
Prozac – Made me progressively more anxious, and then more depressed, as the dose increased. Was eventually so anxious that dialing the phone became difficult because my hand was shaking so much. Didn’t seem to help much if at all with the mood. Also put me to sleep for hours and hours every day and had me fighting just to keep my eyes open the rest of the time. Oh, and my stomach inflated like I was pregnant after eating. Good times.
Luvox – Put me to sleep in a similar way to the prozac. Didn’t seem to do anything else beyond that. Took forever to get off of, as I kept having intolerable withdrawal symptoms.
Ritalin – Made me high as a kite for an hour or two, then left me a drained out husk for the rest of the day. Fun for those couple of hours, though.
Wellbutrin XL – May or may not have done anything at all. Might have increased anxiety slightly. Might have increased mood very slightly.
SAMe – Seems to have improved energy and mood dramatically. Side effects were tolerable, and actually went away over time.
Mindfulness meditation – May have helped dramatically. May not have done much at all. Hard to tell due to timing of other changes, but I’m still doing it just in case.
Have also dabbled in many, many other treatments, but haven’t engaged in any one thoroughly or consistently enough to list it here.
The Slightly Less Short Version:
This is a brief timeline of this particular bout of depression, particularly as it relates to the major stressors leading up to it and the medications I’ve taken. In retrospect, this is something I had been dealing with for many years prior so it’s tough to label a real “start” to it, but these were the most significant dates that I can think of this time around. I learned fairly early on that people were going to routinely ask me for specific details of my medication history, so I started keeping pretty accurate track of it. That part I am sure of. With everything else I’m sure I’m leaving out a lot, but at least it’s got the basics. Once upon a time, there was a sense of emotional flatness…
My boyfriend of two years and I, having graduated from our respective post-secondary institutions, move closer to the nearest major city to make it more likely that we will be able to find career employment. We sleep on a futon in a friend’s walk-in storage closet, and spend almost every day job hunting. Neither one of us has any savings, so we are living off the credit card.
Neither one of us has found a career job yet. Beginning to realize that we could be at this much longer than we thought, we move out of the closet so as not to impose too much, and apply to every retail, fast food, and any other job we can find. My boyfriend eventually gets hired at minimum wage. No one seems to want me.
Near the end of the month, we both get hired for full time career positions, within a week of each other. We have to quickly purchase a car, as it is a requirement of his job that he has access to one if needed, and my job is about a 45 minute drive in a direction that the local transit doesn’t go.
I start my first real job. It is stressful, and overwhelming, and almost unbearably awful. Coworkers tell me that I happened to be assigned to something all of them would be totally overwhelmed by too, even with the experience under their belt. I am drowning, and lonely, and still trying to do a 100% perfect job at all times. The job is somewhat open-ended, so I end up constantly bringing work home with me. I work almost every evening and weekend.
The boyfriend’s job is just as bad. His company is tiny, and demanding, and judgmental, and antiquated, and infuriating, and completely and blatantly misogynistic. He sometimes works so late and gets so little sleep that the company assumes he just won’t come home. He is also grossly underpaid, and continues to get increasingly more responsibility with no additional compensation. It is in his nature to be a superstar at work as well.
We are still sharing the one car, so I drive him down to the subway every morning (an hour), then drive myself to work and pick him up at the end of the night (often in the wee hours of the morning). On the rare days that he needs the car, he drives me to work for around 6 am, and I wait an hour for them to open the building. I wait at work until 9 or 10 at night for him to pick me up so that I can go home. The cleaning staff glares at me often.
I am desperately lonely, and feel like a horrible failure at work. I am sick one week out of every four. I cry almost every night, and often in the car on the drive in. Sometimes I drive with a maniacal grin plastered on my face because I have learned that smiling can trigger happy chemicals in your brain. I cry while I do it.
Even with two “real” salaries, we are far from able to afford the rent on an apartment. We live in my aunt’s spare bedroom and pay her rent for it. We eat, sleep, work, and play all in that room.
Wondering if the depth of what I’m feeling is normal, I make an appointment through the anonymous counseling service provided by my workplace. I cry during the session. She is a total judgmental bitch to me. I do not go back.
We finally get our own apartment. We can’t entirely afford it, but we can make it work and are going batty without any space.
I am trying not to do work on Saturdays (though I still work evenings and Sundays). The boyfriend’s job is still crazy.
Boyfriend musters up the courage to leave and gets a different job. For a while it is like there are actual angels singing for us every day. Boyfriend wonders what took him so long. He is home by 6:30 some nights. This is remarkable to us.
We decide that if we wait for our finances to catch up with us we are going to be retired before we’re married, and get engaged. I spend countless hours making our wedding experience special and unique. I stop working (on non-wedding things at least) most weekends.
I start developing a previously nonexistent phobia of high places (apartment buildings, balconies, etc.). This seemingly comes out of nowhere and confuses the heck out of me. It gets bad enough that my doctor refers me to a psychologist.
I continue to see the psychologist, as it is clear that there are more issues there than just the phobia (which actually pretty much goes away fairly promptly). I wonder if it was my psyche’s way of forcing me to get help. The psychologist is really good. I like her a lot and generally find the sessions helpful, though I have a difficult time explaining the extent of my problems to her. I try to convey the situation as clearly as I can. Generally she focuses on supportive listening and helping to gently guide me to give myself more of what I need.
After much effort and more powerpoint and spreadsheets than I’ve used in my life, we are married. It is lovely. I almost killed myself putting it all together, but don’t actually regret a minute of that time spent.
I have an especially difficult six months ahead at work. Incredibly stressful. Again, I am working harder than I have in my life and am still left feeling like a complete failure. I begin to take sick days sometimes because I just can’t bring myself to go in, and feel often like I am clinging on by my fingernails.
I hit black ice on the highway and my car spins out. It gets smashed. Thankfully I am physically okay, but driving in the snowy weather puts me into a complete panic for a while.
My mother moves to San Diego and remarries my step-father. They promise to visit often, but I know they won’t actually have the money for it (they do not, in fact, make it up for Christmas this year despite assurances to the contrary). I feel like I’m losing my mom.
February 21, 2009
I send an e-mail to my psychologist asking if we could schedule a session that week. Usually I have been seeing her once a month or so, but I am having a “down” period and think that it would be helpful for her to see me in that state. If I wait, I may have things mostly under control again, and she won’t be able to gauge the extent of the problem. My e-mail is fairly well put together. My husband (with my permission) adds a note at the bottom to tell her that, by the way, I was sobbing my eyes out while writing it. The psychologist schedules me in.
February 27, 2009
I tell work that I have “a specialist’s appointment” and leave early to make the session with my psychologist. She tells me that she thinks I am depressed. I fill out some checklists and answer some questions. They indicate that I am most definitely struggling with significant depression. I cry a lot during the process. She suggests that I may want to make an appointment with my family doctor to discuss medications. They tell me that if I need to take some time off work, they can make that happen.
I leave feeling more relieved than I have in ages. I feel like this is a new beginning for me, and that finally I have answers, and help. It is amazing to me to think that with treatment everything won’t have to be so hard anymore. Finding out that things aren’t supposed to be that hard almost makes me want to cry, but in a good way. I call my husband. I go get most of my hair cut off. I feel crazy hopeful, and happier than I have in ages.
March 6, 2009
My doctor prescribes 10 mg of Cipralex, since it was successfully helping my sister. I start with 5 mg and have horrible, completely overwhelming side effects for the first couple of days (thankfully a weekend). I sleep, and sweat, and yawn, and want to vomit.
March 16, 2009
I have a week of vacation time off work. My dosage of the Cipralex is increased to 20 mg. I am semi-comatose for the week, vividly constipated, and have lost my orgasm, but I am still very hopeful. I make a trip to the bookstore and buy every book I can get my hands on that looks like it might be helpful for my situation. I read several of them. I relax, and learn, and try to take care of myself. I start investigating things like yoga and qigong. Occasionally I find myself sitting in the hallway crying, and am unable to tell if the Cipralex is affecting me, or if I am just more in touch with the sadness I was already feeling.
March 23, 2009
I return to work. My husband has to drive me, as I am still too comatose to operate a vehicle. I am a zombie at work, can’t think straight, and have trouble putting sentences together. I feel completely disconnected from my work. It is kind of surreal. I also fall back into my normal pattern of stress. I feel once again like I am barely hanging on. I lost the energy to read, or do yoga, or do anything more than hide on the couch most of the time. I do not feel like I am able to both work and get better at the same time.
March 27, 2009
I have a previously scheduled appointment with my family doctor to check in on how I am doing with the medication. In noting my condition, she stresses again that it would likely be a good idea for me to take a little time off work. I decline, and then agonize about it for the rest of the weekend. She increases my dosage of Cipralex to 40 mg.
March 30, 2009
I cannot bring myself to go into work again if there is another alternative. I call in sick and visit my doctor. She provides medical documentation to put me on medical leave for a month.
March 31, 2009
I go into work anyway to tie up lose ends. I feel horribly guilty and anxious about leaving. I am still unsure about whether I am doing the right thing or making a terrible mistake. I feel totally surreal in going about my regular activities. I tell people that my doctor is putting me on medical leave, but do not provide details. I’ve had issues with my potassium levels and everyone knows that, so most people just assume it’s related. I stay late putting together information for my temporary replacement. One department I work with wishes me all the best, worries for me, and tells me to just leave the work there and go home. After telling the members of the other department I work with, they call to ask if I could stay extra late that evening to help with something they’re doing. I suddenly and very vividly realize that department is full of douchebags.
I begin seeing my psychologist weekly. I read a lot of self-help books and learn a great deal about depression, and the brain, and various coping strategies. I do yoga and tai chi and qigong. I try acupressure and aromatherapy. I walk a lot. I dabble in meditation. I do cognitive exercises. Like everything else, I am bound and determined to EXCEL at recovery. I am still extremely stressed about being off work. I feel very guilty for taking the time off, and worry often about what judgments and assumptions my coworkers are making about me. Sometimes I actually stress myself out to the point of inaction over the decision of whether to do yoga or tai chi in that moment. I do not in any way feel ready to return to work at the end of the month, and am officially put off for another stretch of time.
May 1, 2009
At the suggestion of my psychologist, I enroll in a meditation course that administers the MBSR (mindfulness based stress reduction) program. I have my first intake session with the most relaxed woman I have ever met. The travel to get there is somewhat stressful, but I am still determined to do everything I possibly can to help myself get better.
May 23, 2009
Since the Cipralex seems not to be doing anything but making me really tired, my doctor adds 100mg of Wellbutrin in an attempt to kick start its effectiveness.
June 1, 2009
The Wellbutrin seems to be starting to make a positive difference in my mood, energy level, and capabilities. My psychologist has suggested that I write a book about my experiences. I start a blog instead.
June 2, 2009
I begin my ten sessions of meditation practice. We are to do 45 – 60 minutes of home practice every day in order to firmly make permanent changes in our mental pathways. As my meditation teacher tells us, we can “hate it, put it off, rail against it, swear about it, and then do it anyway.” I commit to doing the full practice, as if I am going to go to the trouble and expense of taking the course, I want to do it right. At the intro session, we are introduced to a group of around 25 other people who are suffering from various physical and mental conditions. I admit to them that I am struggling with depression. This is the first group of people I have done this with.
June 12, 2009
My dose of Wellbutrin is increased to 150mg. It still seems to be helping, and although I am feeling some side effects (tensed muscles, jitters, poor sleep, loss of appetite, etc.), they are well worth it if the meds really work. I begin looking towards my return to work. I get some bad advice from a case worker from my employer and end up losing out on thousands of dollars in pay, sick pay, and benefits, although I don’t know this yet. I continue with my explorations of alternative therapies and develop a strange sense of euphoric hope at times. I feel like this could be a powerful changing moment in my life. I later recognize that this was probably the increased dopamine.
June 13, 2009
I begin to get a mild itching sensation on the soles of my feet and palms of my hands. This progresses over the next few days to the crease where my legs connect to my torso, and then all over my body. It becomes extremely strong. It begins to create large red itchy welts wherever anything makes contact with my body.
June 22, 2009
I see the doctor. She puts me back on the lower dose of Wellbutrin to see what happens, and prescribes a strong antihistamine as well.
June 27, 2009
I come rather forcefully to the conclusion that my skin is still reacting poorly. I spend the weekend covered in calamine lotion.
June 30, 2009
Back to the doctor. She pulls me off the Wellbutrin, as expected. I am crushed. I begin to cry in her office.
July 1, 2009
I begin taking 37.5 mg of Effexor, while gradually weaning off of the Cipralex. I occasionally do not take my antihistamine for a day or two to see if my skin has calmed down yet. It hasn’t. It actually continues to flare up for months to come. I am an emotional mess, so my dose of Effexor gets raised. Eventually I become fairly sure that it’s the Effexor itself that is making me worse. My doctor raises my dose again. Over time it gets up to 150 mg a day.
My psychologist moves to a different office this month, and I move into my first house in the opposite direction. It now takes hours for me make the trip to see her. I continue to go anyway, although I can’t do it weekly. My insurance coverage for my sessions with her has run out long ago anyway. I contact the local Mental Health Association to see if they have any supports that I could make use of.
August 5, 2009
I see a drug safety specialist my doctor referred me to at a nearby hospital to discuss the possibility of doing an extremely gradual reintroduction of the Wellbutrin in an attempt to prevent my body from reacting. She suggests that I get myself off of the Effexor, and wait for my skin to calm down fully.
I begin very gradually weaning down my dose of Effexor, as instructed by my doctor, spending two weeks at each intermediate dosage. I am now so depressed that I sometimes just lie face down on my kitchen floor because I don’t know what else to do with myself. I am having suicidal and self-harm urges, and begin to wonder whether I will still be able to recognize that I need help if they get strong enough that I would act on them. I debate whether or not I should be turning myself into the hospital or something. I try to make lists of “healthy” activities for me to do every day (exercise, go outside, meditate, read a self-help book, etc.), but am unable to complete them. I feel like I should be able to do the things that I was doing in June. I feel like since I am off work I should be doing more around the house. I am miserable and very frustrated.
August 27, 2009
I try a local support group. For the first few visits, it is immensely satisfying to be exposed to people who sincerely understand what I am going through. I have not yet really talked with anyone else who is depressed. After a while I begin to find that I am more depressed after the meetings, as some of the people there make me sad and less hopeful. I stop attending after a while and feel guilty about not having said goodbye.
I continue to experience increasingly vivid mood swings that are heightened every time the dose of Effexor goes down. I become extremely volatile, sensitive, and generally emotional. I routinely sob for hours like my soul is dying. I also have intense cravings for sweets and occasionally violent thoughts towards others. I feel the overwhelming urge to violently cause damage to myself. It is almost unbearable.
Trying desperately to pull my life back together, I sign up for weekly yoga and ballet classes, and try to start forcing myself to walk outside again.
September 1, 2009
Remember how I mentioned before about getting kind of screwed out of thousands of dollars? Yeah. I find that out now. The poor woman on the phone responds extremely awkwardly when I burst into tears on her. She is still inflexible about it. I kick myself a lot for having trusted them, and feel horribly guilty about what my absence from work is doing to our finances. We have no income at all this month from my end. I have insurance coverage through work, but they are still “considering my application” and deciding whether to believe me, and the benefits wouldn’t begin for almost another two months anyway. I fill out many, many forms for various people who want information about my condition, and my limitations, and why I am not mentally capable of filling out large quantities of forms.
September 19, 2009
After having been back down to the 37.5 mg Effexor dose for two weeks, I enter into the “every other day” phase of the weaning process that my doctor laid out. I spend the day having horrible brain zaps, dizziness, and nausea. I promptly decide that maybe every other day right now is a little too fast for my system. I do some research, and decide to try gradually reducing the number of “balls” of medication inside the 37.5 mg caplets over the course of the next week instead.
I firmly consider this week the most hellish of my life.
September 25, 2009
The attempt to reduce the dosage has left me such a disoriented, dizzy, electrocuted, nauseous mess that not only am I avoiding getting up to go to the bathroom unless absolutely necessary and doing nothing but lying as still as possible all day, but I am also now violently vomiting in my living room. I see the doctor, but she does not offer any help or even sympathy. A little research tells me that for some people this can last for MONTHS. I cannot fathom enduring another day. In desperation, I go back to taking the Effexor.
October 1, 2009
Having read it as a suggestion to help the process of getting off of Effexor, I begin taking a small dose of Prozac (10 mg). I get the prescription from a walk-in clinic, as in my current state I am unable to make the drive to my doctor’s office.
October 4, 2009
I am still desperately nauseous, but stop taking the Effexor and increase the dose of Prozac to 20 mg. The Prozac makes my stomach inflate like I am pregnant all the time. I can no longer wear my normal clothing.
I continue to be very nauseous, muddled and tired. I kick myself for having signed up for those classes, since I only managed to attend a few weeks of each before becoming too medication-sick to go. I continue to try to get myself to do more.
October 5, 2009
I have my first session with a MSW therapist through the mental health association. She is much more technique-focused than my psychologist was, but that is not necessarily a bad thing. She does not yet understand me at all when I tell her that pushing myself to do more is the opposite of my problem. It takes several sessions before she begins to get me at all.
October 6, 2009
I have my first appointment with a psychiatrist. It is brief. He is the “pill” kind of psychiatrist, not the therapy kind. He says that he would have suggested Prozac for me, so to continue taking it.
October 9, 2009
I make one last trip to see my psychologist, and cry unexpectedly in the car afterwards. I feel a little empty without anyone looking out for me like she did.
October 11, 2009
I begin to feel somewhat less nauseous, but continue to be extremely tired. I begin sleeping a full night, requiring a three hour nap during the day, and even still am having a very difficult time fighting to stay conscious. This continues through the month. I feel much more positive than I did while on the Effexor, but that isn’t saying much. I am beginning to feel much more limited by anxiety issues than I ever was before – a side effect of the Prozac.
October 20, 2009
The mandatory unpaid waiting period for my long term disability insurance from work finally runs out, and I start receiving payments. Not nearly what I was making while I was working, but significant enough to make a big difference for us. The financial situation is still very tight, but not quite as grim.
November 3, 2009
I see the psychiatrist again, and since it doesn’t seem to be doing much for my mood yet, he raises my Prozac dose to 40 mg.
I continue to see my new therapist weekly, mostly focused on CBT (cognitive and behavioural therapy) techniques. She seems shocked by the number of books I have read on the topic of depression treatment, as apparently most of her patients are not so proactive. I do not feel like it is particularly a lot.
December 1, 2009
The psychiatrist raises my Prozac to 60 mg a day. I am now so anxious that I am shaking uncontrollably in the waiting room. I am apparently completely unable to explain the severity of my side effects to him in a way that is understandable to him. I also have the mistaken impression that severe side effects are expected and normal due to some unfortunate experiences with my family doctor when I discussed my previous side effects with her.
In the following week, I am so anxious that I have difficulty making phone calls because my hand is shaking too badly to dial the number, even with my husband beside me for moral support. I also become more irritable, disconnected, and easily upset. I find myself lying on the floor again, and realize that something is not right with this picture. I phone the psychiatrist and my dose is reduced to 40 mg again.
December 29, 2009
My Prozac dose is lowered to 20 mg. I am to wean off of it and then start taking Luvox.
I am moody, irritable, and have overwhelming cravings during the process, but I get through it. I only have to get down to 10 mg, and then I can start taking the Luvox instead.
January 13, 2010
I take my first 50 mg dose of Luvox. I am still dysfunctionally exhausted at all times, sleep twelve hours or more per day even when I am trying to force myself to stay awake as much as possible, and am also now occasionally dizzy. I am still having digestive issues, and I still cannot wear my regular wardrobe due to the over-inflation of my stomach after I eat. I have now stopped doing almost anything at all. Sometimes I watch T.V., or play methodical video games that do not require much thought. I have difficulty holding complex concepts in my head, and get frustrated by activities that involve too much emotional thought, following a plot, or character development. I stop bothering to get out of my pajamas some days.
February 10, 2010
To combat the fatigue caused by the Luvox, my psychiatrist prescribes Ritalin. I begin taking 10 mg twice a day.
The Ritalin helps me to function for an hour or two each day, but I feel even more hollow and drained out the rest of the day.
February 17, 2010
I continue taking the Ritalin, and as directed by my psychiatrist, begin to wean myself off of the Luvox. Having learned my lesson previously, I try to make the transition as gradual as possible by cutting off a tiny bit more from my pills each day.
It is still too sudden for my body. I get extreme emotional instability and some thoughts of self harm followed by nausea, brain zaps, etc, although thankfully not as severe as the ones the Effexor withdrawal inspired. I am forced to increase my dose again, and the weaning process goes on for more than six weeks before I am clear.
March 4, 2010
My psychiatrist suggests that it may have been something in the generic brand bupropion (Wellbutrin) that I was allergic to, and not the name brand Wellbutrin. I had read the same thing when I first experienced the reaction. We decide to give it another shot. I stop taking the Ritalin and start on 150 mg of name brand Wellbutrin XR. I do not erupt into itchy hives.
Either the Wellbutrin of the absence of the other pills seems to make a subtle but positive difference. I begin to feel able to do non-stressful activities during the day (take a walk, for example). I tackle some overdue paperwork. I organize part of our basement. I start getting grand ambitions of starting an exercise or meditation regime again. I start into more self-help books. I still feel frustrated and trapped and sad, and I still melt down over nothing sometimes, but at least it is a little bit better. Once the Luvox is reduced, I stop sleeping all day too, which helps.
After an unfortunately long battle and many revised timelines, am finally free of the Luvox (and vowing to never, ever, ever go near another SSRI ever again). Had some crazy emotional withdrawal symptoms, particularly near the end, but made it through regardless. Internal chemistry seems out of whack, and not yet back to where it was before all of the medications. Have sunk into a pretty deep pit, and am unsure whether it’s the result of all the ups and downs my chemistry has been through over the past year trying to readjust themselves. Am trying to be as patient as I can.
Discontinued use of my hormonal birth control pills, which have always made me more moody and reactive. I’ll take any help I can get at this point.
Began taking a SAM-e supplement (and the extra B vitamins needed to process it). Having side effects similar to swollen glands in my neck and armpit, and occasional sharp pains in stomach or head. Random internal muscles sometimes do a little tap dance for a while as well. Started out at 200mg, which seems to be the commonly recommended “introductory dose,” but quickly lowered to 100mg and then to 50mg (quarter of a pill) when side effects were pronounced. Supposedly it’s about a week or two before improvements should begin to manifest.
SAM-e seems to bring a little renewed energy with it