Sunday, 4 March 2012

"Keith Richards and Me"

Years ago I watched a comedian on TV speaking about child birth. She couldn't imagine a drug-free birth - she was all about reducing the pain as much as she could. To illustrate her point she said, "I want drugs. And get Keith Richards to bring them so that I know they are good!"

Mental health issues are riddled with stigmas. A big one has to do with medication. Some people think that drugs are the answer. Others refuse to even consider medication. So let's talk about drugs.

When I was first diagnosed with depression twenty years ago my doctor prescribed an antidepressant. I didn't question or doubt it because my doctor is not one to quickly hand out a prescription for anything - he has always been a big proponent of a healthy lifestyle, including a balanced diet and regular exercise. For both of us the medication was just a piece of the overall care plan to treat my illness, a care plan that we discussed together. Fairly soon after starting the medication I began to see positive changes. I went from high highs and low lows to a much more even keel. I still felt emotions, just not in such an extreme way. Getting my emotions under control to a large extent then allowed me to work on the other aspects of getting well - it allowed me to catch my breath.

For many years the meds, coupled with a fairly healthy lifestyle, were enough to keep me well. In 2003 when I suffered my first major depressive episode, my doctor and I adjusted my medication dosages and added a psychologist into the mix for a brief period of time. After about a year of putting one foot in front of the other on a daily basis, I was mostly well again. Life carried on and it wasn't until 2010 that I fell into another deep depression. This time I felt different. This time I felt like nothing was helping. I felt almost hopeless. Could it be that the drugs that had helped me through years of difficult times weren't working anymore? That's what I thought.

So I sought alternatives. My doctor and I spoke about working with the University of British Columbia Mood Disorder Clinic. A respected and prominent psychiatrist there (let's call him Dr. Smith) was working on a study of the impact of light therapy and negative ION therapy on patients with severe depression. Here was an opportunity to help others with this illness and perhaps find an alternative treatment. The catch? I had to stop taking my medication in order to participate. The meds weren't working anyway, right? Sign me up! What did I have to lose? Turns out, a lot.

I began visiting UBC on a weekly basis. I worked mostly with Dr. Smith's research assistant who was lovely - she repeatedly assessed the state of my depression as I slowly reduced my medication and she added a compassionate touch to what was a fairly clinical research project. Here's a brief time line that perhaps best illustrates my experience withdrawing from medication:

May 27: After a gradual reduction of dosage and under medical supervision, I am no longer taking medication.
May 29: I am starting to experience withdrawal side effects: extreme irritability, restlessness, hysteria, anger, vomiting, headaches. I am also experiencing what I can only describe as "brain zaps" - continual, irritating short circuits in my brain.
June 1: Dr. Smith prescribes an anti-anxiety medication to help with the extreme irritability that I have been experiencing. The pills make me very foggy so I only take them in extreme situations (see below).
June 5: I suffer a panic attack in a store - I am so irritated by a woman playing with a child's tambourine (she thinks she's amusing her grandchild but she has no idea that she may soon be wearing her ass for a hat) that I have to leave the store and wait for my mom and niece outside. Once outside I breathe deeply and try to regain some sense of calm.
June 7: Withdrawal symptoms seem to be dissipating - I have only experienced a slight headache, tears, and body aches.
June 9: Extreme sadness and constant tears but none of the withdrawal symptoms. Even the ever present "brain zaps" are gone.
June 14: Surprise! Dr. Smith says that I no longer qualify to participate in the study - I am not depressed enough. Seems that I have shifted from major depression to moderate. Woo-hoo!
June 21: Turns out that the surprise is on Dr. Smith, after all. I am so depressed by this date that I am having suicidal thoughts again. Immediately I am back in my psychiatrist's office and we resume my course of medication, this time adding a supplemental antidepressant, coupled with continued cognitive behavioural therapy (CBT).

So here's what I learnt on my great adventure: you don't need to go to an amusement park to ride a roller coaster. OK, I learnt a lot more than that. I also learnt to have a healthy respect for drugs.

In retrospect, my decision to participate in the UBC study might not have been the best. But it's hard to regret it - I was open to trying new things to become well and I was working with a team of doctors. I will be hesitant in the future, however, to mess with my medication. I have first hand experience as to the strength of antidepressant medication. And you could argue that having something so strong in your body isn't healthy. That may be true - 20 or 40 years from now we may discover that these medications are harmful. But my experience has been that they have kept me alive and for that I am grateful.

It's very important to me that I stress a few things. First of all, any decisions to start or stop medication should be discussed with your doctor. And if you don't feel comfortable with medical advice that you have been given, seek alternative opinions and educate yourself. Every person is different and what works for one person might not work for another. It is generally accepted, however, that medication works best when combined with CBT. I feel strongly that the cognitive behavioural therapy is what gave me the edge in getting well. Today, I am still on medication but my dosage is lower and at a steady level. I balance this with a generally healthy, balanced lifestyle.

If you are suffering from depression, whether you choose medication or not, here are some suggestions from Christiane Northrup, MD to support your treatment:

* Stop Drinking: alcohol is a depressant and can make depression itself particularly persistent.
* Engage in Regular Exercise: exercise changes brain chemistry and exercising 20-30 minutes a day four to five days per week can have a significant positive impact on your mood.
* Get Outside in the Natural Light: This raises serotonin levels in your brain. In the winter you may want to consider a light box or full-spectrum light bulbs to get enough light.
* Take a Multivitamin and Make an Effort to Eat Well: Avoid refined carbohydrates, eat protein at least three times a day, and be sure to include a source of omega-3 fat in your diet regularly.

Finally, if you do decide to take an antidepressant, allow time for it to work. Per Dr. Northrup, "half of those who stop their medication within three months of starting get depressed again."

Did I forget to mention that I also experienced a hallucination while withdrawing from my meds? Yup - I giant hummingbird in my bedroom one night. I know that I wasn't sleeping because I said to myself, "Oh, that's a giant hummingbird and I am not dreaming." A drug-induced hallucination - so that's probably one thing that Keith Richards and I have in common.

KB xo

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