Time is a One Way Street

I take the brain pills, I’ve been on various brain pills since 2006. I’ve tried a lot of brain pills with varying results. Everybody’s brain chemistry and wiring is different and the sad fact is that no one really knows what those differences are or why they occur. To find the correct antidepressant and dosage it seems that a person will have to try a few different drugs and will have to vary the dosage. So, in 2006 we started down the path of finding the right drug.
I’d taken prozac as a teenager and the results were horrid. Prozac made me sleepless and paranoid, so we knew we could take that off the list. I had also taken Nortriptyline when I was 18 and the results were all around positive. We started out with Zoloft. I felt nothing, no effect at all. We raised the dose a few times and still, nothing. So we moved on to Celexa. Celexa was awful. It made me so anxious that I was becoming physically ill at even the thought of being around other people. We decided to take SSRIs off the list completely. I had asked about the Nortriptyline, it was something that had worked. Nortriptyline is pretty old school as far as antidepressants go and the side effects can be problematic. There was a newer drug, Effexor, that also worked on inhibiting the re-uptake of norepinephrine, but with easier to monitor side effects. Thus, at the beginning of 2007 I started Effexor.
Effexor is a hell of a drug. The side effects are phenomenal, brain zaps, weird dreams, weak muscles, dry mouth, dizziness, and the most insidious, apathy. Most of the side effects waned over time and over time we continued to increase the dose until, finally, I was taking 375mg a day. That is a pretty substantial dose. It did lift me out of the very bottom of my depressive slump, it brought light to the very darkest corners of my mind. It was a life jacket tossed to me at the very last moment. I grabbed it hard and held on.
But then that was it. The Effexor was acting as a stabilizer, it was keeping my head above water but it was not getting me out of the ocean, just preventing my drowning. And though I could remain calm as I surveyed my situation, I was seeing that I was not making any progress towards getting better. We continued to raise the dose and eventually we added Welbutrin to the mix. The Welbutrin was a dopamine reuptake inhibitor as well as a norepinephrine reuptake inhibitor. The idea was that it would enhance the anti-depressive qualities of the Effexor while adding more dopamine to the mix. Dopamine works on motivation and pleasure. It’s the ‘reward’ chemical that gives you that bit of a high when you do well at something, seeking out that dopamine high is what motivates people to continue to do well. There are some strong indications that many drug addictions are linked to the seeking out of that dopamine reward.
And so we kept marching forward adding more and more Effexor and Welbutrin to the mix. Effexor is a drug that requires a very long term commitment. Dosage increases have to happen very slowly and over long periods of time. You start at the lowest dose, 37.5mg and work your way up from there. Also, it does not start affecting the norepinephrine until you get up to 225mg. It could be months before you start feeling positive effects, making it a commitment not to be taken lightly. Once I got up to 225mg and beyond I patiently waited to feel better.
A few times I asked about Nortriptyline. It had the distinction of being the only antidepressant that I had tried that had very real and noticeable results. How was it different from Effexor? Why was Effexor seen as a better choice when the results so far have been not so spectacular? Remember the side effects I mentioned before? Remember the apathy? Yeah, that never went away. The apathy was huge. It was a catch-22 of amazing proportions. I was not getting better, Effexor was not helping me, many very important things in my life were falling apart and I surveyed all of that through a barrier of disconnect.
Should I have pushed harder to switch from Effexor to Nortiptyline? That’s the $64,000 question, isn’t it? I am not a doctor, I am not a trained medical professional, I am in no way an expert on neurobiology. I am just me, a sort of a goof of a dooflerumpus trying to navigate the world with a brain that seems determined to confound me at every step. I’m not an expert, and as much as I would like to buy into or believe in that new agey ideal of “it’s your body, you know what’s best” I just can’t. It isn’t true. I’ve known far too many people who have taken that sort of logic to its worst extreme and ignored sound medical and scientific evidence to the siren song of “alternative” treatments that were nothing more than sugar and hope. Add to that a pharmaceutical industry that advertises prescription meds on prime time TV and eventually you have an army of people who base their treatment plans on 30 second sound bites and a misbegotten notion of “natural = better”.
Many years ago I went to my GP with my insomnia issue. I’d been struggling with insomnia since I was a teen (keeping in mind, of course, that when a teen suffers from insomnia the only response they get is a condescending recommendation to go to bed earlier or some such nonsense). This isn’t just “a hard time getting to sleep” this was night after night of no sleep that would last 5-7 days and then I would sleep for a night or two and then no more sleep. When I asked my doctor about this she asked me which sleeping pill I wanted to try. What? Seriously? I’m not a fucking doctor, why would I know which sleeping pill was best for me? Well, this was at a time when Ambien and Lunestra were advertising pretty heavily on TV. Since I don’t watch TV I never saw those commercials. What was instantly clear to me was that doctors were willing to prescribe medication to people who were armed with nothing more than a preference for an advertising campaign.
As a patient I have to try to strike a balance between the knowledge that I do have (Nortriptyline has worked in the past) and the professional opinion of a person who is educated in that arena (Effexor has a higher success rate and fewer side effects than Nortriptyline). Once I was on the Effexor, however, it became harder and harder to find that balance. The Effexor was not working but I was apathetic. The Welbutrin should have helped with the apathy, but did not.
Then I lost my job and that should have been a great big giant sign that said, “HOLY CRAP! THIS ISN’T WORKING!!!” in flashing red neon letters. Instead we just bumped up the Effexor and Welbutrin.
Finally, at the beginning of 2009 I had a moment of clarity. It happened in the psychiatrist’s office. She’d been playing the role a therapist for me as well as psychiatrist and she was failing at both. Her therapy method was to take my larger issues (fear of making a big mistake keeps me from doing even the simplest of tasks, like grocery shopping) tease out the overriding logic (it’s pretty difficult to make a big mistake when grocery shopping, and whatever little mistakes there might be did not make a difference at all) and then say, “well, if you know this to be logically true then why are you still having a problem?”
Yes, indeed, how on earth could I still be having a problem if the logical answer was so clearly laid out in front of me? That’s why I’m in therapy you dipwad! If I were capable of being logical about these emotional issues I wouldn’t be in this big mess. My moment of clarity involved some yelling and some crying and an unfocused sense of determination. I stopped my sessions with her (which was inevitable anyway, I didn’t have insurance and the bills were piling up fast), I wrote a letter to the clinic describing my issues (which I’m sure just got pitched into the crazy lady bin) and I started weaning myself off the Effexor.
The next thing we know it’s September and things had gone all to hell. Time continued its relentless march, December happened and things got ugly. Finally, I got in to see a new psychiatrist. First we talked about what was happening in my head, we talked about my symptoms and my concerns. David came in as well to give his insight into the situation. We discussed the various meds that I had used over the years. Then he asked the most important question ever, “What medications HAVE worked for you?”. Nortriptyline! We talked about my experiences with Nortriptyline (i really hate typing the word Nortriptyline, it’s very difficult to type). As an added benefit, it was a medication on the Target $4 list! So we went over the possible side effects and the way it works and I got me a prescription for Nortriptyline!
I started slow, 25mg to start, 25mg bumps over 7 day intervals. Initially, I was a bit disappointed. I could feel no positive difference but I was feeling some very definite apathy coming back. Then about 4 weeks in it was like a vice grip had been released from my brain. The apathy was slowly burning away like fog in the morning light. More importantly, I was feeling motivation. I had not felt much in the way of motivation for years.
I take 100mg of Nortriptyline every day. I am not ‘healed’ or ‘better’, my depression has not been magically zapped away. It doesn’t work like that. What has happened is that I have looked down and finally saw the path that could lead me out of the forest. I still have months and months of hard work in front of me, but now I am able to face that work without the constant self defeating actions of my brain.
And what happens if I turn and try to look back? I see frustration back there. There is a part of me that feels angry over losing 3 years of my life to ineffectual medications. It is not hard to imagine where my life would be if only I’d spoken up or insisted on getting Nortriptyline. I’d probably still have my job, David and I would have bought a house. I’ve lost a lot of friends over these past 3 years because of my inability to maintain contact. Mostly, however, it pains me to think that David has had to live with this, that many of his plans had to be compromised because of my depression.
Time is a one way street. I can look back, but I can only watch it recede out of sight. Part of me is angry, part of me is sad. A greater part of me, however, knows that this life is truly finite and that the only thing I can control is what I choose to do next. If I could go back in time and change things, I would, absolutely, but I cannot. I will instead, try to be kind to my own self, to be forgiving and charitable to myself. My goals in life were never big, they were never along the lines of “be a big success” or “be famous”. My goals were always tempered with “do the best you can with what you have”. I am a journey oriented person, I revel more in the “now” of life than in the “long term”, perhaps this is why I love dogs so much, they only know right now and they love the hell out of every right now that they experience.
It is not easy, but I am turning away from what I have lost and will focus my energies on what I can be.

The Masterful Myth of Free Will

Part One: How I Spent My Winter Vacation.
So where have I been? Not been writing much, not been able to, that’s for sure. What happened?
By the time winter rolled around I had weaned myself completely off the Effexor. Effexor is not a bad drug, per se, but it was not the correct drug for me. I appreciated that it lifted me from the absolute dregs of depression, that it evened out my mood swings, that was awesome. The problem with the Effexor is that it made complacent with my depression. I knew things were not going well, but meh, I had a hard time caring about it.
Winter rolls around and I am completely off any meds at all. Let’s just take this moment to contemplate the idea of facing the holidays (and all the stressful nuggetry they entail) sans brain meds! I don’t even recommend that my healthy friends do this. Holidays should…nay MUST! be endured with some form of artificial fortification. To do otherwise is to mock the entire institution of holidays with the family! Suffice to say, things went from tolerable to not okay to entirely fucked in a few short weeks.
It happened mid December. The best way I can describe it is that my mind split into two parts. One mind was sick, very sick. That part of my brain was a whirlwind of anger, paranoia, hurt, suspicion, irritability and generalized craziness. While you might be tempted to say, “but, Heather, how is this different from normal?” and I would respond with a hearty, “suck it”. Seriously, though, it was pretty awful. My mind was thinking thoughts that I did not want to think, it was believing things that were completely untrue. My mind was suspicious of everything everyone said. The worst part of all this was that it was constant, it was uncontrollable and it was pervasive.
The other part of my mind stayed rational and mostly reacted in horror at the thoughts and ideas in the crazy part of my head. I was lucky, very very lucky. I imagine I was on a precipice looking over the edge at the abyss of mental illness and I almost fell. The fact that I managed to maintain that slice of rational mind is a miracle, nothing less. I stared into the face of true mental illness and it scared the holy hell out of me.
Unless you have experienced it, I’m not sure you can quite appreciate it. We tend to see our minds as an ineffable, unquantifiable part of our physical brains. We separate them, our brains are corporeal but our minds are non-corporeal. The mind is the essence of you. So what happens when your mind starts doing things that you don’t want it to do? How do you control the thing that you need to use to control itself…what? How do you use your mind to control your own mind and thoughts? What do you do when you cannot control your mind? What exactly does that mean about you?
There were so many horrid thoughts in my head, so many awful conclusions reached. It took a grand force of will during every interaction to not blow up at people, to not scream in anger, to not accuse people of secretly hating me, of conspiring against me. And even when I did limit my interactions with people these thoughts would not stop. They were like a hurricane in my skull, an unceasing force in my mind. At one point it got so bad that I found myself in the bathtub knocking my head against the edge of the tub. One good thump of the tub would give me 3 or 4 minutes of relief, would provide enough external stimulus to distract my from my mind.
My little slice of rational brain was screaming! I knew this wasn’t right, I knew this was unhealthy. Most importantly, however, I knew that I could lose that slice of rational brain. I told people, I called for help. I was losing this battle and I was sinking fast. And help was what I got. We bumped my therapy up to twice a week, I got a couple county social workers (which is a completely different post), my friends and family grabbed me by my hair and pulled me to the surface and they held me aloft until I was able to tread on my own.
What is free will? What does it mean if the choices you make are tainted by depression? mental illness? poor ‘wiring’ in the brain? The fact that the small slice of rational brain remained is the exception, not the rule. It was wholly terrifying to see how easy it was for my mind to become that black and oily snakepit. If I’d lost that bit of rational brain and fell off the edge there, would I still be operating within the parameters of ‘free will’? How free is your will? how many of the things you choose or act on or react to every day are truly free will? How many of your emotions and reactions are free and how many are the result of baser instinct? or brain chemistry?
The thing that scared me the most was knowing that if I lost that bit of rational brain I’d never know it, that there would be no way to recognize the loss of rational mind without the rational mind there to analyze the situation.
The good news is that I climbed out of that morass. I survived. I got new meds, I’m taking Nortriptyline and it’s working. It is really truly working. It is like a vice grip of fog has been removed from my brain. I went to therapy twice a week as needed and as the fog lifted I was able to bring it back down to once a week. I’m calling this ‘My Cautiously Optimistic Phase” as it’s true that I am feeling good but I know that it might be temporary, that it’s not enough to just want to feel better.
And while this won’t mean much to most people, it will mean something to those who have been close to me during this crisis: I cleaned my kitchen.