Saturday, February 16, 2013

brain chemicals: why i take medication, part two of two.

aberdeen, early morning haar-fog, may 2012

By this point in my life, I have gone over these events exhaustively, and I can’t seem to figure out what triggered this period in my life that made me decide to try medication. No one stress seemed so monumental that it could do this to me, it was everything and nothing. And it was something that I simply could not seem to muster up the will or strength to do anything about, and after nearly four months of it, it did not seem like it was simply a season in my brain, like other intense periods had been.  And now I could not do anything, and I wanted to not exist any more, which also catalysed further anxiety, and that was what made me decide that psychotropic drugs were probably no worse than what I currently was feeling. I was in the strange state of not wanting to exist, but not wanting to not want to exist; I felt like I had nothing to lose.

Again, at this stage, I was lucky. Lucky to have such an understanding psychologist, and a doctor who was patient with me, and warned me that I might have to try a few different medications to find one that helped. And I did try a different drug, before I tried the one I still take; it was one that made me quite ill right from the beginning. It made my frenetic thoughts slow down, but to the point where I couldn’t think at all. I went from highly anxious to strangely dulled, depressed. I remember one day when it seemed to only allow me to think about how I could hear the blood in my veins, and that the raindrops on the windows sounded like they were amplified and slowed down. I was nauseous constantly, and this was simply not feasible. So we tried something else, and I was tremendously lucky in that this one just fit. The first week was rough, but all in all, it happened quite quickly. There were side effects, but they were better than how I currently felt, perhaps even a welcome distraction, and so I continued.

Over the next two months, my thoughts slowly returned to something more normal for me: I could think clearly again, precisely enough to replace my incessant mantras with more sustainable CBT. I could better tell when my thoughts were  I stopped shaking, and panic attacks dropped off and I could do things, venture out, do healthy things. I could distract myself not with sharp things but with productive things to do with my hands. In essence, it simply allowed me to finally properly do the work I needed to do in order to deal with the anxiety I was feeling, before it got so bad I could no longer even think about doing anything. It allowed me to be clear and functional again, enough to cope. 

It was not perfect. It still isn't. Most of the side effects have faded, but some linger at times. I am afraid of running out, losing my pills; I can't forget to take one or I feel it immediately. But this is still many orders of magnitude better than what I was feeling before, and so I deal with it. Through a lot of experimentation I've found the dose and the timing that seems to be optimal for me, and I go with it, while trying as much as I can to do all the non-pharmaceutical things I can to stay healthy. 

Because I still get anxious, as I said; I still feel depressed. I have bad periods, very helpless-feeling, unproductive, waves that I have to get through. But these, while trying and unpleasant, are things I feel that I can deal with. They are something different than the pure terror, the neuronal storms of nonsense and inability to think. They arise from things I understand, most of the time, so they feel like something else. And I know that it could be argued that my brain with its faulty substrata predisposes me to have certain kinds of reactions to things in the world. This is not unlikely. However, I feel there is such a distinction between feeling depressed and anxious due to the state of the world and my place in it, the forces acting against me that I ultimately cannot alter, and feeling anxious because I am having paranoid, terrifying, irrational thoughts that I still recognize have no basis in reality. I am not trying to artificially separate the kinds of anxiety and depression I feel into purely chemical and purely situational; I am not trying to uphold the harmful Cartesian duality of mind and body that I think is one of the sources of the denigration of mental illness. That the medication seems to help one strain of anxiety though, and not others, though, suggests to my non-neurologist self that perhaps  there are different (but connected) kinds; the kind that stems from my brain structure, and the kind that starts from outside of it but I experience and process (of course) through my neuronal set-up. Maybe they are far too entwined to fully separate, and interdependent in myriad subtle ways; my reactions to the OCD-like thoughts certain do shape my reactions to situation-based anxiety too. I don't fully understand it yet, but I keep trying to. For now, I just want to acknowledge that some of what I feel is traceable and comprehensible to me, and some of it arose without such triggers; and the latter is what I find the medication helps.

It didn't magically restore my self-esteem, make me fearless, a better writer, make me love myself unconditionally, flood me with optimism. But it also didn't erase my personality and turn me into a mask-wearing zombie with stunted, inappropriate emotions, nor a shallow, uncritical consumer. It did let me feel more than constant anxiety and panic, though. That was all, and that is what I wanted.


I know, though, for some people, these kinds of medication make them feel horrible. They do feel like blank, stumbling automatons, just as clouded and fuzzy as they do while depressed, numbed and dulled. We know that for whatever reason, these medications are temperamental and finicky and quite unpredictable (just like people’s brains).  For some reason, what helps one person’s anxiety or depression does little to nothing for (or seriously worsens) another’s condition:  I’ve heard both just as many completely terrifying horror stories as accounts of neutrality or ineffectualness as I have successes. And I wish I knew why this was, wish we were at that point with neurology to have an explanation, but we aren’t. We still can’t always discern the messenger from the message, the excess from the essential; why some people’s brain waves look really different from other people’s even while in very similar states, why this drug I take that they thought would be good for epilepsy (but wasn't) might be good for depression (sometimes, it seems) would end up helping more people with generalized anxiety and obsessive-compulsive disorder (it did for me, anyway). 

Perhaps all this speaks to is the incredibly individual natures of our brains, perhaps more so than any other part of the body.  One issue with allopathic medicine is that it wants to assume that all human bodies are essentially the same, rather than specific systems, I feel; and perhaps the fact that not all anti-depression and anti-anxiolytic medications work on every person’s issues  I would hazard a guess that my brain chemicals were perhaps quite responsive to psychotropic medication because I seem to be pretty sensitive in general to any kind of chemical interference; sleuthing out the triggers of my migraines has made me realize that the foods I put in my body have a massive and often immediate effect on how I feel. Therefore, by fastidiously avoiding those foods and supplementing my diet with a concoction of vitamins does a lot toward making my migraines less frequent, because I seem to be pretty chemically suggestible.

I suppose it would be wonderful if I could find a vitamin-potion/food combination that did the same for my anxiety and depression. I’ve tried a lot of different combinations, both through my own research and seeing a naturopath, too, and I continue to try things even though I take pharmaceuticals. But unlike with my migraines, I wasn’t able to find anything that could stave off two breaking points. And that was when I decided (both times) to initially go on my medication, and to continue it after a hiatus. I was doing all the good things that they tell you to do with mental illness: to eat properly, to take the vitamins, to exercise. And that helps a great deal, but not enough for the worst bits, unfortunately.

Now, I did manage to get through a number of difficult stretches without any medication; the OCD-like periods, some of the self-harm. Sometimes I wonder if I could have handled my most serious breakdown that way, if I could have pulled through it too. I realize that many people do go through very similar things without it. And well – I didn’t. I did what I felt was best for me at the time, the only thing I felt I could manage. If that makes me weak, then I suppose I’m weak, but I’m alive, and I can deal with the periods of depression and anxiety that I still go through because at least I am not contending with that terror I could not will away on my own. I still struggle with doing a number of things, but I am far more productive than I ever could have been without it, I feel. This leaves me with the extra energy I need to deal with what the drugs do not touch.

Everything that I’ve written may just read like elaborate and desperate justification for my medication; so be it. For me, it is a potent reminder for when I start to criticize myself, for when I start to think that I am wrong to have started the drugs in the first place. I completely understand and respect why someone would never want to touch a psychotropic medication, as I've been there. I just happened to eventually change my mind. And if that makes me just another brainwashed, ‘addicted’, misguided consumer who will take this medication for the rest of her life, I suppose that is how it will be. I just want to be fine with that, to openly acknowledge and explain why I did it, and through I may always struggle with it, I also want to be able to freely acknowledge that I’m grateful that there was this option available to me. I'll settle for being weak, but functioning; for whatever the anti-psychiatry movement wants to call me, but alive.


Friday, February 15, 2013

brain chemicals: why i take medication, part one of two.

raven on a chimney, early morning Aberdeen, May 2012


I have never liked taking medication. As a young child I had to be bribed into it, because early experiences with penicillin made all medicine have pretty unpleasant associations, as did bad reactions to decongestants and cough suppressants. I remember tolerating the one penicillin that didn't  wreak havoc on my system, the infamous 'banana medicine', but that was it. I learned to accept that ibuprofen could do fine things for a tension headache, and take a few hours off a migraine even if it did nothing for the pain. Half a dimenhydrinate makes nausea evaporate. But I was always (and continue to be wary) of what was going into my body because of the element of the unexpected, the understanding of their power, and I still am. I remember learning in biology about the load many medicinal substances place on the liver and the kidneys, and I worried about my body's ability to handle these substances; I understood that it should be fine if drugs are taken sparingly, but what about something you take every day?

I do agree with many opponents of psychotropic medications; I think it is terrifying that you can walk into a doctor’s office and blithely ask for an anti-depressant or anti-anxiolytic of your choice; this has happened to me and a number of others. I want these drugs to be available, but I am concerned that many doctors really know little about them, because from my experience and stories I've heard, patients are rarely told about the trials and hazards of going on and off medication (or that their concerns are explicitly dismissed or downplayed). They can have very serious side effects and consequences and should never be taken lightly or without a lot of consideration, because they cannot be discontinued abruptly. And most definitely they can be worse than reasons why you're taking them; I have no doubt about that. But that doesn’t mean they’re worthless and should all be condemned, as they can be very effective.

I thought about providing links to medical studies and articles both for and against anti-depressants, but frankly, it's pretty easy to find these sorts of back-and-forths everywhere online, by psychiatrists and other clinicians as well as those who have experienced the drugs. Yes, it's true that we know very little about the brain as a whole, and also only a very small bit about what causes mental illness and about the mechanisms of these drugs we use to treat it. However, I just can't understand how anyone can make the leap to 'these drugs are no better than placebos' just because it is not precisely known at this point in time how and why they work. Some brain chemical imbalance theories may be outdated or (partially) debunked, but we do know that somehow these medications, these chemicals, can bring relief to symptoms by affecting the function of neurons. They did something for me.

I feel awkward writing this, because I really don't want to dismiss the fact that others have been miserable on them, and have found their conditions to worsen and become more debilitating. But I am also tired of having to downplay or deny my own experiences-- especially since it was not an easy decision for me to make, to take these drugs in the first place. I am tired of the subtle but insidious judgment that comes from taking them; the misunderstanding that it's a cheap and easy way to 'happiness' makes me seethe. I have done a fuckload of work to be able to function, before and after starting this medication. This is not the easy way out. I do not take these to be happy. These do not make you happy. I am not happy all the time. I sought out this treatment because I could not feel anything but pure terror and I wanted to have other feelings. I still get anxious. I still have periods of depression. But now I can have more than one feeling. Now I can deal with these things, most of the time. 

I don't know where my anxiety comes from. I don't really know if this predisposition comes from brain chemicals, even though I use other chemicals to help fix it. I think a lot of it comes from my brain, though, and I have memories of anxiety and panic for nearly as long as I have memories at all. It's been with me for a rather long time. I had a very un-tumultuous early childhood, with attentive and supportive parents, but I could really having a full-blown, hyperventilating panic attacks that came out of nowhere. When my dad found me crying and shaking on my bedroom floor, I didn’t know what to tell him. Even then, I realized that if you were upset, there had to be a good reason to be so upset – and it terrified me that I had no such reason. I made up stories; I told him that the girl next door had been mean to me. (That happened sometimes, and made me anxious too.  And I knew it was okay, it was normal to be upset about that, because that was a thing that happened. It was real.)

As I got older, I developed many more persistent anxieties. Some of these things were because of things that actually existed in the world, things that make many children anxious (being harassed in elementary school, etc.) and others, were not so rational, and definitely not so external. This duality that I could see developing in hindsight tells me something, too -- that in some ways, my anxiety and depression is Janus-faced: some of stems from my responses to my social and environmental factors, and yet some of it arises within my own mind, for reasons that cannot be traced (despite years of therapy). Many people, like Ann Cvetkovich, write that depression is 'the symptoms of a response to a fucked up world or a fucked up life' (see Depression: A Public Feeling, p. 15) and I do agree. I still get anxious, I still get depressed, even after a decade on psychotropic medication. However, when I look to the causes of this anxiety and depression, I can generally always link it to something in the world, in my life, that is shitty. Because there are awful things, both great catastrophes and daily microaggressions that build up and weigh us down. (And honestly, I find people who do not react to kyriarchal oppression as a little suspect, because things are pretty dire). I think anxiety and depression are completely normal responses, to certain things.

But then there are these other things, things inside my head. They can be exacerbated by less ideal conditions in the world, but they feel so internal, so idiosyncratic that they seem to come from my brain. Like my migraines can be triggered by things I ingest or by conditions in my environment, but also can just spring up from no traceable cause, so can my anxiety. And this is the kind that led me to not be able to function. The symptoms of this kind is what I like to remind myself about when I want to stop taking my medication.

The panic attacks that came on in class suddenly, that sent me running for the washroom often at school to hide there, because I often couldn’t explain what brought them on. And even if I could, it was a thoroughly awkward thing to do. And when not feeling that dizzy wash of fear, the accelerating breathing, the crush in my chest, I felt a constant tightness in my shoulders, a constricting mass in my throat, a vague nausea nearly every morning. When I was 10 and 11, there were times when I could hardly eat anything, terrified I would choke on each bite I took. I was underweight, my blood pressure was low, and my resting heart rate sometimes spiked up like a terrified rabbit until I thought I would black out.

There was the kind of anxiety that made me feel as if I was going crazy. It crept up for no reason. I deeply feared  losing my mind, forgetting who I was, saying and doing horrible things. I don’t know where those thoughts came from, what they arose from, what brought them on, but they definitely felt different than the other things that triggered anxiety, the people, the situations, my fears about things actually happening in the world outside of my thoughts. In high school, when I began seeing a psychologist, she helped me understand I probably had a mild form of obsessive-compulsive disorder (my sister and uncle have been diagnosed with a severe form of this), because I created rituals to assuage the anxiety: I washed my hands often, til they bled, not because of germs but contamination by frightening thoughts. I repeated phrases to myself over and over, mantras before I slept each night, a certain number of times, to make it so that everything would be okay. Looking over notebooks I kept at the time, I see pencilmarks in the margins tearing through the pages, fervently underlining the magical words I needed to write to prevent these awful thoughts, to straighten them out, to keep them in check.

As I got older, some of these rituals fell away. But when the tension in my body was too much, or I had a panic attack where I couldn’t stop crying, I learned to dig my fingernails hard into my palms. This sudden pain caused my focus to shift, and provided a momentary release from this internal intensity; it led to me scratching harder, and eventually cutting my skin – little vents for the anxiety, sort of like trepanning but for my flesh instead of my skull.  It helped at first, but eventually caused me greater anxiety for doing it, especially when I confessed it to others and received little empathy or support. This is when I started seeing my psychologist, because I was at a loss as to how to deal with this (I once had believed everyone dealt with anxiety like this, but trying to explain my feelings to others had come to understand this most likely wasn’t true) and was becoming afraid of myself in a way I could not handle.

With my psychologist, I engaged in Cognitive-Behavioural therapy, to help me deal with the moments of intense anxiety and the panic attacks. And so they still came, but I learned to manage them better, to fend them off as best I could without resorting to cutting or burning. She always told me that medication could be an option if I decided I’d like to try it, but we would work without it unless I asked, and I was still very much against it.  And I was doing fairly well managing with the CBT for awhile, but then things started cropping up again. Near the end of my first year of university,    I wasn’t particularly stressed about things in the world, external things; I was managing the new routines and workloads fairly well.

Then one day I had a very severe panic attack that coincided with a migraine that sent me to the hospital, and I was convinced I would die. The headache and panic attack subsided, and then a few days later I woke up with another one. And another one, and then suddenly every moment felt like constant anxiety, more continuous than it had ever been before; panic attacks were mere spikes on a high plateau of frantic unease.

It felt like my thoughts had aphasia; they came out in chunks that raced around and I felt nauseous trying to round them up. I felt lost in my own head, unsure of how I would ever make sense of anything again. The OCD-like fears returned, mantras were needed, but sometimes they were not even enough, and my mood began to sink when I realized that I really could not even trust my own thoughts anymore. I wanted to practice my CBT techniques, but I could not slow my thoughts enough to do so, could not even begin to do it no matter how hard I tried. Walking around the block, let alone running, was too terrifying, so I could not clear my head that way, feed myself the endorphins I hoped might help. Eating became difficult again, and I lost 15 pounds in three weeks. I would wake up shaking, convinced I was going crazy and/or was going to die. Nothing could convince me that I actually wasn’t.

I would have panic attacks that seemed to only subside when my body was too tired to keep shaking, too dehydrated to cry any longer; I then became afraid of always having a panic attack. When I wasn’t awake and worrying, I often had terrible nightmares, chaotic and violent; in the moments when I would wake from them I had the most scrambled thoughts, and it took all my energy to sort things out in my head enough so that I could get out of bed.

School term was over, I was working but kept having to miss shifts or leave early because I could not focus. Functioning was a little difficult though I tried so hard to not let on what was happening inside my head, and then I would feel worse because I could not function. But one day in the moments before waking I had by far the worst dream of my life, and I thought it was real, and I woke up and a cascade of thoughts started and I can’t even begin to explain it, can’t even type it out, could never even speak a word of it to anyone, but suffice to say that my shaky traitorous brain took about three seconds to convince me that it would come true and I would do a horrible thing and I was so fatigued and so tired that I had no energy to even summon up one of my spells to compensate for that hideous thought that I had another massive panic attack and decided that I needed to die, to not exist, to not be anymore.

I can’t express these thoughts very eloquently. I wish I could. I write them out and they feel suitably frenzied, but I do not know how to convey the terror and sickness I feel when I think of them, remember them; I can’t seem to capture it on the page. But this is why I decided to take medication. I can’t do justice to the lows I felt that day, I could not even calm down enough to speak until later that day when I went in to see my psychologist, and that was when I told her that perhaps I would like to try something, because at this point I was willing to try pretty much anything, frankly, that could even possibly make these particular feelings stop, because they were not really compatible with living anymore, and I thought I still wanted that.

So that, in a hastily explained, incomplete nutshell, is why I take medication for my anxiety. Not for the kind that comes from living in a problematic world and having feelings about it. Not the kind that is linked to my self-esteem and my place in the aforementioned world, but from living with a brain that antagonizes me and is uncooperative for reasons I may never quite discern, but seem to lie within it.

Wednesday, February 13, 2013

brain chemicals: why i take medication, prologue.

 On Broad hill, 5 a.m., Aberdeen last May, after a night of no sleep
On the way to the beach, that same early morning, one of those times the landscape reflects the inside of the mind so precisely


As with my last post from a few months ago, where my running alleviates my anxiety and depression due to both its chemical effect (dopamine, serotonin, and their cohorts) and also for its emotional influence (catalysed by feeling strong and reclaiming space), this next series of posts is also a story about the two-sided nature of my brain’s condition: something that is both chemical and emotional, something that is partially helped by psychotropic medication and something that these drugs still cannot touch.

I’ve wanted to write this for the past year, really, because it occurred to me that I had been taking medication for anxiety for a whole decade.  That it has taken me nearly another year to sit down and write it speaks rather emphatically about my continued ambivalence about said medication.

Or really, perhaps I am not ambivalent about my medication anymore. If I ask myself honestly, I can frankly say that I’m grateful for it. I am deeply thankful for what it has allowed me to do and writing the long piece that follows is a way of reminding myself why, despite the currents of unease that still run through me.  I am indeed still afraid of being judged for taking it, for having positive feelings toward it, and for now being unwilling to stop, for accepting that I will probably take it for the rest of my life, and I need to keep making peace with this, for now.

I felt I had to write this now because I was reading a piece recently where the writer was describing her tapering-off period on an SSRI (not one I have experience with) that was fairly heinous. And it was almost funny how  I could have predicted the four camps the responses fell into: the voices encouraging her and sharing their own tips and stories with difficult drugs very neutrally; those who mentioned that they hated how they felt on SSRIs and also faced a difficult withdrawal and would never touch one again; those who had experienced depression or anxiety but had not medicated, and mentioned  their wariness; and then those who smugly informed the commentariat that they would NEVER put such POISON in their bodies.

I get it, those first three responses.  And I completely respect those who do suffer anxiety and depression and choose not to go on medication or not to stay on medication because of how awful or wrong it makes them feel either because they tried it or it simply feels like the wrong choice for them. I have felt those things and they made sense to me at certain points in my life; I just personally reached a point where they were no longer true for me at all. In writing this, the absolute last thing I want to do is condemn others for doing what they needed to do in terms of medication or the lack thereof. But  I just get so tired of hearing people who have never been depressed, never had constant anxiety or recurrent panic attacks say things like ‘Oh, I would never take an anti-depressant, I could never put that in my body, I heard they don’t work,’ and all manner of things like that. I feel the bile rise in me when people continue to conflate taking psychotropic medication to function is 'taking pills to find cheap happiness'.  And I cringe when I remember how at one time in my life I'd be nodding along and agreeing, something I don’t do outright anymore, but oh, I did when I was younger, all the time.

I did the nod-and-agree thing when I met a boy who I would later date. We were both involved in a number of activist causes at the time, and one day we were chatting about something, and something about pharmaceuticals came up, and of course all good lefties are anti-pharmaceutical, and I agreed with him on the dastardliness of such things, and he (who had never been depressed, or anxious, I would later learn) said, ‘If I were depressed, I’d NEVER put something like that in my body’, and I mumbled some assent, oh yes, how could anyone do that, etc.  Because I wanted to be his friend. And I felt ashamed, and guilty, impure, and weak; I had absorbed so many narratives about how these medications made your feelings inauthentic, or made you into a pliant and unfeeling zombie under the control of the capitalist market, took your most unpredictable individuality and tempered it into something palatable and controllable. ‘I’m so glad you agree with me, so many people just don’t understand how BAD it is, etc,’ he said, and oh, off I slunk, because it was just after dinner, and I needed to take my second dose of the day.

And we became friends, and then we dated for over a year, and that whole time I surreptitiously slipped my pills, always hidden in the internal pocket of my purse. I told him a bit about my anxiety, my panic (I had to, because he witnessed it) but I never, ever told him about the medication.  Not until a year or so later, when we were not in a romantic relationship any longer, and I had been off the drugs for a few months, but then had another breakdown and started again. I told him then I was taking them, but not that I had before. Maybe he was already tired of dealing with me, but we started drifting even further apart then, and I’ll now never know what he thought of that.

I’ve told people bits and pieces of this, but perhaps never all of it at once, or in sequence. I suppose, though, that this story is really for myself, right now, as a reminder to remember why I am taking the medication when I start to resent it, or feel guilty, or weak for doing so. To remind myself that this a choice I made after a lot of hardship and a lot of consideration; thinking back to the times where I could do nothing at all is helpful whenever I am presently too hard on myself (which is most of the time).