My journey of self rediscovery with mirtazapine, as dissected below, was not to last. Although I had the side-effects of this potent tricyclic – drowsiness, dizziness, very loud dreams – I was experiencing none of the benefits. Unfortunately, one of the problems with antidepressants is that they can enhance your mood – that is, make you even more depressed and/or anxious – before you get better.
A month down the road and I was back to violent mood swings, paranoia, even some mild self-harm (there, I said it.) The problem was that the local shaman seemed unable to comprehend that I needed some extra help to get through this mire, and it took a six-hour stake-out of the local Accident and Emergency ward (that’s the ER, for readers in the colonies) for me to attract the notice of the Mental Health Professionals.
So, a month down the line, and – at last! – I get phone and personal support from people who don’t look like nurses, but regular blokes with whom you’d happily share a pint of the old Thunderjugs down the Dog and Ferret – and I see an actual psychiatrist, who (huzzah!) didn’t waffle on about behavioural cognitive bollocks, or respond with my utterances of Proposition X with responses such as ‘So, you feel that Proposition X?’ notwithstanding inasmuch as which I had made it quite clear that those who went down that road with me shouldn’t be surprised to get a smack in the gob. No, my psych eschewed such woolly-minded ether-bothering and got straight down to business – there are no such things as thoughts and feelings, there are only drugs, and my problem was simply getting the right ones.
So, this is what happened – the psych said that the mirtazapine in which I had been placing such hope for a month obviously wasn’t my thing, and I had to go back to serotonin reuptake inhibitor similar to my old tried and trusted citalopram.
A month of my life I’ll never see again (not that I’d want to, it was mostly horrible.)
Back to square one.
So now I’m on 50mg sertraline:
A sertraline molecule, recently.
As you can see from the picture this looks reassuringly unlike a tricyclic and rather different from the citalopram that kept me going for years or the serotonin whose reuptake it is meant to inhibit. I have had precisely one (1) dose so far (I’ve counted … and if you were in my current state, you’d appreciate how difficult it is to count up to one, rather than the three or possibly five that is typical for palaeontologists.)
But wait, there’s more. I also have a side order of lorazepam to curb the anxiety attacks … and some zopiclone to help me sleep. I haven’t had sleep, what you’re really call sleep … for … goodness. Ages.
Let’s hope it works this time. I am a little irked that (a) my shaman prescribed mirtazapine and then effectively left me to get on with it; (b) he didn’t tell me of the support services that existed to keep me on the straight and narrow, and to reassure my family that I will get better.
Eventually.
If they can only decide on which pills I should take. The red ones? Or the blue ones? Both at once? Neither? Something else instead? I’m so tired I can hardly twitch galvanically in response.
Anything that I write here seems so empty and meaning-less. Still, I want you to know that I hope and wish with all my heart that things get better for you.
Thanks mgg – I’m getting a flood of support from people I don’t even know, and some I do, and the amazing thing is how many people have suffered depression. Most people I know are currently (or have recently come off) citalopram, mirtazapine, Prozac, and so on and forth. I have a feeling that we are suffering a collective reaction against the overstimulation of modern life, with all its comings and goings and hopes and dreams and expectations.
I feel that after age 30, every 5 years or so we should take 2 weeks off for reflection and some compulsory calming time, where we unhook from our daily grind and take time off to cherish all the good stuff and all the wonderful people that we know. And also kind of reorient ourselves so that we stay true to whoever we want to be.Some compulsory mental rejuvenation time, by a mountain or by the sea or in some relaxed non-crowded place. I guess this could go a long way in helping us stay in harmony with ourselves.
Perhaps we also need to teach our children to do the same, because “this overstimulation of modern life” is only going to get worse and our children will be even less adept than us in dealing with it.
There are some studies to show that some SSRI will bmcoee part of the body can start to adapt to them and then they’re not active anymore after longer periods of use (some even after 6-12 months). Then you can switch to similar one, similar yet different , and then after a while go back again Anyway, I’m sure you know about those papers so I won’t repeat stuff.As for my spontanaous reaction 50 mg isn’t especially high dose and if you don’t feel an effect (as to more than the initial one where you know you’ve taken something since you feel better) after two-three weeks there is plenty room for dosage study, as to which dose you feel the best on.There are some sideeffects shaking of hands and arms and then for some there are outbursts of aggression (angry rants and explosive burst of angry),. The latter ones are also an indicator that you’re getting better’ from the depression since you feel something (albeit not happy but something) and for some (like me) there was a time when I was happy feeling anything over that blasted numbness. Anyway, maybe TMI ? Hope you feel a change to your old self soon. All the best!
That sound like a horrid month, Henry… glad to hear you’re out of the end of it and here’s hoping the sertraline does what it should. Plenty of clinical and real-world experience with that drug, anyway.
One can but hope. Right now I feel rather as deflated punchbags scattered around a boxing gym after Muhammad Ali and Joe Frazier had been sparring. It’ll be another two weeks before I’m any way coherent.
Tricyclics suck. My partner was given them, stayed on for several years. All they did, especially as prescribed, was zonk her out so that she didn’t have the wherewithal to get bad/mad. Just as bad, it also stunted what good stuff there was, and (as far as I could tell) reduced her REM sleep to near zero — she slept like a drunk, basically; just physical rest, but no processing of memories.
I have to disagree with the drug route. I don’t doubt that there are people with congenital or other issues whose machinery is genuinely messed up, but it seems to me that in most cases there just isn’t an easy answer. Drugs as an ‘answer’ seems like a kind of continuous quantitative easing — the underlying economy is still fucked; it’s just on life support.
I also think it is too easy to dismiss cognitive therapy as pretending that everything is okay. I concur that the bulk of the non-drug-em-and-bag-em approaches seem to be broadly useless unless you genuinely have no idea why you’re in a mess but it should be obvious (bad parenting etc.) — shouting at chairs, play-doh modelling — just no way I could do that. Like group hugs.
But… I believe in niches, and I believe that a spoken thought is more impactful on the thinker. In a nutshell, I think that cognitive therapy used to encourage positive thinking (icky, but not as bad as shouting at chairs) and to avoid aggravating hurts, is of value and can allow a mind more space to heal. And on that, I reckon that 99% of getting over depression is about getting totally bored of being depressed. Just as (waaay more trivially), talking through a stress can help, so rehearsing (perceived) sources of depression reduces their potency. I’ve also seen a concerted campaign against voicing complaints actually work to an extent.
As for causes, it seems almost simpler to me if it is a ‘big’ thing (horrors, stress, neglect, bereavement). Then it seems that drugs can help short term; talking over the longer term; the goal being acceptance. Worse in a sense is something like anomie. Without meaning to trivialise anything: few of us made it to the moon; human progress is halting; most people are wankers and natural justice is a myth, as expected; lifespans are unlikely to be extended and there’s no comfort for atheists (so we burn brighter).
It’s (for me, to the extent that I have issues in this regard) reminiscent of that ‘James’ line (probably from some ancient root): ‘If I hadn’t seen such riches I could live with being poor’, or of the way I imagine some drugs distort one’s idea of a really good time to a degree unachievable without those drugs. Except I imagined rather than saw, yet I still feel disappointed. Don’t get me wrong I know I’ve had lots of fun and I’m really lucky with my kids. I may even get a job after this one, despite being an object lesson in why you should stick to a trade. I’ve relationship issues going back years, and a dead dad (you can tell I was 8 because that’s the age I revert to under stress — emotional development stalled lol).
I don’t know. Maybe you’re coping with something horrific, in which case I apologise for intruding. That said, you’re a witty and therefore jolly bright chap (which is it’s own burden of course, but your happiness is [if you believe the hype] higher quality).
If you want my prescription, lose the drugs, pick up some cognitive tricks to replace them, and make a gamma-ray-burster of a change in your life, ideally so that it includes something both to increase your self esteem and to re-frame your experience (and I don’t mean to ‘shock you out of it’ — I mean to open yourself up through new social interaction — disturb that mental ecosystem, basically, with new models of people and the world). Anyway I almost want you to tell me where to shove my thoughts, so convinced am I that this is inappropriate. But you seem like such a great bloke :\
Well, Chris, everyone is different, but I have many good reasons to suspect that I have a congenital and perhaps also genetic disposition towards lower-than-healthy serotonin concentrations in the brain, so in my case it’s all – ALL – about the drugs. When citalopram, my SRI of choice, began to fail me after many happy years together, I needed a new drug. Mirtazapine turns out to have been the wrong choice. Let’s hope sertraline is better.
The question is raised therefore of why the citalopram began to fail, and that might be sought not in any particular bad life events, but simply because my life is too busy and too stressful. In fact, given that the proportion of people whom I know who’ve had interaction with depression of some kind, I suspect that the real culprit is modern life and the pace at which we are expected to live it.
Fair enough. I’d want to be bloody sure of that though, before giving up on the possibility of things you can hope to change rather than just endure — to me ‘faulty brain’ feels like a catch-all, but I don’t know of course. Maybe you have evidence. I’m not sure even ‘running in families’ is necessarily proof. It may be, but but but…
In the end, if all I’ve said is wrong and this is just like diabetes to be treated with insulin, then fine, but even then there’s more than one way to treat a cat. You need something about which even from the bottom of the well you can still feel strongly. Something bigger than you, and new.
One last shot: have you ever considered voluntarily counselling or supporting others through treatment? Could be good to use your experience to help other people and you might stumble on something that helps you too. Even if not, that kind of pseudo-altruistic buzz can’t be bad for the old 5-HT. Change is good. Same is how you got here.
I really should shut up and go away but I can’t help myself.
Counselling has its place, and at the moment I am being helped by trained mental health professionals who look in on me every few days, really just to chat. I really appreciate having a knowledgeable person I can discuss things with.
glad you got the right support -even if after a long ass time – fight the good fight Henry – I am rootin’ for you ( as we say in the colonies
) for what is is worth
Thanks Sylvia – it’s not over yet. When I’m done I think I might swap careers and become a drug dealer, like the character Danny in Withnail and I. I’ll certainly have the knowledge, and I’ll be able to go around holding up little pills and saying things like “In the lab, (1S,4S)-4-(3,4-dichlorophenyl)-N-methyl-1,2,3,4-tetrahydronaphthalen-1-amine. On the street, The Embalmer.”
There are some studies to show that some SSRI will become part of the “body can start to adapt to them and then they’re not active anymore” after longer periods of use (some even after 6-12 months). Then you can switch to similar one, “similar yet different”, and then after a while go back again… Anyway, I’m sure you know about those papers so I won’t repeat stuff.
As for my spontanaous reaction 50 mg isn’t especially high dose and if you don’t feel an effect (as to more than the initial one where you know you’ve taken something since you feel better) after two-three weeks there is plenty room for dosage study, as to which dose you feel the best on.
There are some sideeffects… shaking of hands and arms… and then for some there are outbursts of aggression (angry rants and explosive burst of angry),. The latter ones are also an indicator that you’re getting ‘better’ from the depression since you feel something (albeit not happy but something) and for some (like me) there was a time when I was happy feeling anything over that blasted numbness. Anyway, maybe TMI ?
Hope you feel a change to your old self soon. All the best!
Sorry to hear the ‘regime’ still isn’t sorted out, Henry. Sounds like a rough month.
Agree with what you say about depression (and other mental probs, but especially depression) being far more widespread than people commonly perceive. If I had a tenner for every academic I know, or medic, that has taken anti-depressive medication at some point…. well, I would have a decent sized pile of notes, let’s say.
Here’s a question – if I felt I was ‘myself’ on mirtazapine, and that turned out to be the wrong drug, then who is the real me?
Isn’t that a song?
Do you mean that in your gut you felt right, or that your attitudes and behaviour most closely reflected your expectations?
Good question. After my first dose of mirtazapine I woke up and felt immediately in my gut that I was ‘me’ – even before I did anything else, like get out of bed or interact with anyone else. But the subsequent side-effects, with no attenuation of the anxieties so ably dulled in the past by citalopram, were intolerable. I think that what I am saying is that our personalities, and the ways we interact with others, are substantially modulated by our neurochemistry. As I said above – there are no thoughts or feelings, only drugs.
Perhaps it is best to continue with citalopram ?
Henry – by now you might have twigged that I have the insane belief I might be the only person who (by accident of an observation some forty years ago) knows a second mechanism to evolution, which science has missed. – I’ve been writing the book ever since. Some fifteen years ago, after going without sleep for two weeks (the result of an unrelated matter) and after a couple days totally off the planet, I woke up in the local nut house. A friend asked did I need anything bringing in. – Innocently I thought yes – my note pads so I can spend my time writing my book – the one about me knowing something about evolution that nobody else in the entire world knows. – Then I thought hang on a minute there’s a catch – happen I’d be out of here quicker if I said my name was Napoleon. – I asked my friend, bring me a sketch pad and pencils, I’ll do some drawing.
Anyway the whole business left me with a lingering depression and sertraline was the drug that helped – what I found though was that half the prescribed dose did the trick – it dulled the anxiety but did not flatten me completely – but there seems no quick fix.
I called the tablets don’t give shit pills, that was their effect – and that to me seems the best way to mentally handle the problem – practice the art of ‘don’t give a shit’ – about pressures, demands and even depression – it helps some of the time. – But there seems no doubt that ‘your cure’ will be personal to ‘you’ and it’s you who must find it.
Now we get to the joke of the year. – My problem is, having written the evolution book, how do I get it scientifically criticised or assessed by a scientist – a plumber has no credibily in scientific circles – at least not until the heating breaks down.
Years of trying to ‘make scientific contact’ with no obvius result can be extremely depressing to say the least. – Then I find Occum’s typewriter and your fabulous End of the Pier Show – here I found someone very much on the ball about Evolution and with a sense of humour enough even to consider the joke of an evolutionary plumber. – I sensed a slight curiosity, a tolerance, an interest even. I saw a glimmer of hope shining in the distance. Then what happens? – My hero of the rustic tiling and unicycling giraffes goes down like me with depression.
Par for the damned course that’s what I call it.
So – keep taking the pills – take the dogs for walks – deep breathing excercises (force all the spent air out of your lungs till they are empty – then you can’t help but take in an enormous breath of air. -This gets rid of co2 to keep stress and anxiety at bay. – Don’t give a shit about anything or anybody for a while – let the rest of the world look after you for a change – and last but not least – get some top grade MULTIVITAMIN TABLETS. Most foods however ‘green’ are short on vitamins and trace elements these days. (I’m a farmer so I know.) – Remember the bit about fortifying the over forties. (Sorry that’s a depressing thought.)
Of course there might be a serious side effect when you recover. Your wondrously humerous posts undoubtedly have us all in stiches. It is possible though that your depression keeps your humour in check. What worries me is that without this curb, your humour would have free rein – then all your readers might die laughing. Would you please warn us in ample time when you feel you are recovering so that we can take suitable precautions.
John the plumber.