I see the light, and it isn’t an oncoming train.

I went to go see a new shrink on Tuesday and for the first time in a long time, I see a little light at the end of the tunnel. I haven’t been speaking about it because really, how many times do you want to hear that I am struggling with the depression and anxiety thing. Blah blah fishpaste.

Anyway, to backtrack a little. I was first diagnosed with depression in 2002. It was all understandable and it made sense etc. The infertility stuff was terrible. I was depressed. Understandable. I then went on and off AD’s while I kept getting pregnant and then losing it again. The last time I was on them, I decided that staying on them while pregnant was far less risky than stopping and starting them. So I stayed on from Jan ’04 (just after Ben died) until July ’05 when the twins were 6m old. I don’t know why I went off and in hindsight; it was a stupid stupid idea. But I felt fine, I thought I was fine and I thought my depression was totally infertility related. I had my babies so I should be fine, right? Wrong.

I was actually ok for a year. But July ’06 I could feel the depression come back. It took me 3 months to figure out it was depression and not anything wrong my marriage / my future / my kids / life etc. A bit slow on the uptake there.

Around Nov ’06 my rollercoaster ride started with trying to find an AD that worked. First the Fluoxetine for 6 weeks, which nearly killed me. Then the Wellbutrin, then the Cymbalta, then the Molipaxin. Those 5 months were terrible. Those pills nearly finished me off.

Then I got pregnant in March and went off all medication. Then lost the pregnancy, and decided to do the FET two months later. All the while being off all meds. That didn’t work so well either. I thought I would try and do this on my own. No AD’s. I didn’t think there was an AD out there that would work anyway, they were all killing me.

About a month ago I realized that I can’t do this anymore. Living like this is no way to live at all. I had become increasingly anxious to the point where I was becoming almost overwhelmed by it. By my life. So much to do and achieving absolutely nothing.  Spinning around and spinning out.

I eventually went to see my therapist and asked her to refer to me to someone who specializes in the chemical stuff. I had to wait six (!) weeks to get an appointment (and you know I am used to getting appointments almost straight away) and eventually on Tuesday I got to see her.

She is fabulous. I feel so much more hopeful now. We spoke about how the long term effects of drug usage (ecstasy, cocaine etc) are often felt in the form of late onset anxiety and depression, we spoke about the genetic connection. She explained things so well. I really like her approach: very thorough (for the first time ever, I got tested for thyroid function etc. No one has ever tested that before. Results on Tues), very logical and very scientific. That appeals to me. I don’t do touchy-feely, incense-burning, crystal loving stuff. I don’t have time to go through everything we spoke about but she had reasons! (reasons why I am feeling the way I am) And explanations! (explanations why the drugs didn’t work) And best of all, A Plan!

The plan is to start v v slowly. An eighth of a pill (Cipramil / Celexa*) a day for a week and build up that way. She explained that when one’s (mine) serotonin is so severely depleted, any amount of serotonin into the system causes a large and disproportionate response in the body, leading to massive spikes in anxiety. Which in some cases causes pain and spasms in the large muscle groups. Exactly what happened to me in the five months I tried the four different pills. Every time I started a new pill my anxiety would spike so badly that I was on anti anxiety pills during the day, sleeping pills at night and in constant pain. And then I would stop that pill and try another one. Same thing again. So we are going to go very low and very slow and build up slowly so that the body has enough time to adjust to the serotonin.

It’s funny how you can carry on going and going and then when there is finally an end in sight, everything suddenly seems to become almost unbearable. I have been feeling SO anxious this last week. Terrible. Which is why I have not been able to post much. Too anxious. When I got to the psychiatrists rooms, I was so wound up I couldn’t complete the forms. I thought my bloody head was going to explode.

I am glad we are doing this slowly, but it is also hard for me, because I just want to be fixed. Now! This instant! Take a whole handful of pills and be better! But having burnt myself so badly with the last experiences on the pills, I know that this is the only way to go. Low and slow.

I had a good laugh though, when I was cutting my little pill up into 8 equal pieces. Firstly, because she warned me. She said “it doesn’t matter if the pieces are equal. They won’t be and you will feel all sorts of anxiety about the fact that you don’t have 8 equal pieces. Don’t. It’s fine. I don’t care if you get crumbs in the beginning. We need to do this really slowly”. But the real reason I had a laugh was that I had such a strong flashback to my druggie days, when we used to share an E. The precision with which we dissected that pill! It wasn’t about fairness as much as wanting to make damn sure you didn’t get the tiny piece. And here I am cutting up a pill into pieces 10 years later, licking my finger and cleaning up the left over powder on the table, hoping to treat what was probably caused by those pills in the first place.

The pills are not the only answer though. Unfortunately. Because I am all about the instant fix, but there are other aspects she wants me to work on. I know I should do all of that anyway. Exercise is a must. She takes a holistic approach to treatment and says things like diet, exercise and therapy go hand in hand with the chemical stuff. So I need to find a new therapist (my last one moved), I must start Pilates or Yoga and I must stop drinking so often. The last part is going to be the hardest bit. I know I must though.

Another really interesting thing she pointed me to was a piece that appeared in the Harvard Business Review, 2005 edition entitled “Overloaded Circuits: Why Smart People Underperform”. She said I would be able to relate and oh how I do. It is a great article. See below for a brief overview and link to the HBR site.

You know what I liked most of all? She said I was a text book case. A classic case of women my age, who had done the drug thing in their youth, who had a genetic component linked to depression. High achievers who are suddenly drowning with their overloaded, hyper-kinetic lives.  After being an (infertility) anomaly for so long, I know what it is like be a statistical oddity. It sucks. I want to be a text book case. Text book cases have researched, proven solutions. Anomalies don’t. I nearly wept with relief when she said those words, ‘text book case’. 

I really like her. I like the way she thinks, I like that she is very ‘no nonsense’. I need that. I have to say that I am feeling hopeful for the first time in the long time. There is light at the end of the tunnel and this time it is not the headlights of an oncoming freight train.

* Please please do not tell me any horror stories about Cipramil / Celexa. If you tell me about a negative side effect, I will instantly get it too. I’ve decided not to google it, or read up whether it causes weight gain / insomnia / etc etc. Because if I read it, I’ll get it. And I so badly want this pill to work. I can’t go through another round of multi drug testing. This one has to work. It just has to.

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HBR Article: Overloaded Circuits: Why Smart People Underperform

Frenzied executives who fidget through meetings, lose track of their appointments, and jab at the "door close" button on the elevator aren't crazy--just crazed. They suffer from a newly recognized neurological phenomenon that the author, a psychiatrist, calls attention deficit trait, or ADT. It isn't an illness; it's purely a response to the hyperkinetic environment in which we live. But it has become epidemic in today's organizations. When a manager is desperately trying to deal with more input than he possibly can, the brain and body get locked into a reverberating circuit while the brain's frontal lobes lose their sophistication, as if vinegar were added to wine. The result is black-and-white thinking; perspective and shades of gray disappear. People with ADT have difficulty staying organized, setting priorities, and managing time, and they feel a constant low level of panic and guilt. (me me ME!!!)

Read more here

Comments

[Heike]

Hi there

I had a severe episode of PND, and I was put onto Cipralex. It is almost the same as Cipromil, also made by Lundbeck. What a winner!!! It is one of the leading AD's on the market in SA. I had absolutely no side effects at all.

I hope you will have the same experience than me!

Good luck

Cheers
Heike

PS - Say hi to Tanja from me when you see her.

[Cara]

I am on Cipralex (next generation) as well and have NOTHING but good things to say about it. I've been on it for three years and I can honestly say it saved my life. And I started feeling the effects immediately, the very first day, because I was so happy I had finally done something for myself after years of depression. You should too; congratulations for taking care of yourself and GOOD LUCK!

[Cara]

I am on Cipralex (next generation) as well and have NOTHING but good things to say about it. I've been on it for three years and I can honestly say it saved my life. And I started feeling the effects immediately, the very first day, because I was so happy I had finally done something for myself after years of depression. You should too; congratulations for taking care of yourself and GOOD LUCK!

[anna v]

I really like her slow buildup approach and have seen it work.

Do you have compounding chemists in SA? They can compound the meds so that you can have really small dosages accurately. It's made a big difference in my household to have that option.

[Geohde]

Oh god, this is so totally superficial of me after your so serious post about how terrible you've been feeling and your wonderful new therapist, but I can't help it.

*Share* an E? Man, they must make 'em stronger in SA than they do here.

Not that I'm admitting any firsthand knowledge of such substances in my misspent youth, by any means. Of course.

[Sister Mel]

So glad for u! I was actually thinking about recreational drugs long term effects this morning cos we can never play remember when...
Tersh remember when we played with Suzie in the cave....NO.
How about when we went camping....NO.
The time we were kidnapped..... NOPE
Just like flippin Gary!

[Jo in Boston]

Celexa saved me, It even helped with the migranes and no side effects. My doc combined it with Klonopin for the first two months to reduce the anxiety spike. Good luck!

[carosgram]

It sounds like you found a great doctor. I am glad you are getting help and that this dr seems to understand. I like that she is up on the current information. Hope you feel better soon.

[Heather]

I used to take Celexa and liked it. I spent several years without meds and just recently went back on them. My doctor just put me on a new pill called Pexeva. This is the best thing to ever happen to me as far as ADs are concerned. It's wonderful. Apparently it's very new. My therapist hadn't even heard of it.

[blackbird]

I have been taking Celexa for just over a month - I think you'll be pleased.

[Amy]

Celexa is fantastic! It'll make you lose weight, your skin will be shiny and your hair will be full. Your nails will grow twice as fast as they do, and you'll have to shave your legs half as often. It will keep your bathrooms clean and your kitchen cleaner. Your kids will be immune from colds and flu. Your husband will begin to look more and more like Brad Pitt. Your dog will not get fleas. Your bills will be paid by a mysterious philanthropist who expects nothing in return. Your blog will get 10 times as many hits. Your work will be rewarding and fulfilling. Your book will end up on Oprah. (In fact, I hear that Celexa is what made Oprah so successful to begin with). Your car will get better gas mileage. People will stop you on the street to ask you what, exactly, the key to your success is, and you will say:

CELEXA!!!

(Just trying to help! If you're going to get side effects from reading about them, they might as well be fabulous!)

[Rose]

Your new doctor sounds like a good match.
I suffer from depression as well and I remember bursting into tears in my doctor's office when I realized that FINALLY someone understood and then didn't sympathize so much as GIVE ME A PLAN. It was such a relief.
Take care of yourself Tertia!

[M]

While I've never commented before I've lurked, oh, forever.

Good for you for not googling. Google is, after all, the devil when it comes to things like AD's.

Now...for the good news? I'm jumping on the Celexa is king bandwagon! I started very very crazy low and worked up to a dose that is still really low in the AD world and it's working WONDERS. I mean super spectacular WONDERS. I've been going around pushing the drug it's so good (okay, not quite, but seriously the amount of depressed anxious should be medicated folk I know is high and I keep insisting they try the stuff.)

And, FYI, Celexa is one of the best tolerated lowest side effects AD's on the market. So really it should be fantastic for you. ESPECIALLY starting slow (I'm so happy you have a dr who doesn't believe in just pop the pills a handful at a time. THAT is why ad's get such a bad wrap. They aren't utilized correctly!)

Best of luck! (And did the dr mention how incredibly fast these suckers work? Within a week I started feeling somewhat sane. It was DIVINE.)

[ksmaybe]

I'm so happy for you! This sounds like such a good fit in a doctor/patient relationship. The explanations for the drugs being so hard on you before makes so much sense. Goof luck!

[Gillie]

Long time lurker-first time comment. :)
What a great entry! My doctor recently told me similar things and also mentioned the "recreational" drug use in my 20's could be a factor in some of my anxiety.
Keep me posted on how the meds work for you. :)

Love your blog!!!
Gillie in Nebraska

[Ute]

Hang on, let me get this straight: You lost umpteen pregnancies and no-one ever tested your TSH, FT3, FT4 and/or antibodies??? You've got to be joking!!!

[Andrea]

Before I even reached the end of your post, I thought to myself: "textbook case!" and then you said she said that! Tertia, stick with the treatment in the long run this time. I have seen too many cases of people ceasing treatment (drug, therapy, etc.) because they felt like they were better. Typically, they are better because the treatment is helping! As for the drugs, I know it can be very frustrating. People's bodies react so differently, and sometimes it is really difficult trying to establish which will work best for which person.

Don't worry too much about your medication though. Think about the positive side effects instead!

[alchemilla]

Just wanted to say how pleased I am for you, T. Good for you, what a terrific series of steps you are taking. I'm hovering on the edge of taking loving self-control of my own life, too, and you are very encouraging to read.

[Louise]

So pleased for you. It's nice to be "textbook" once in a while!

[cathy]

Awesome news, T.

If I can add just one little postscript, can it be this: If I were you, I wouldn't take on any new "projects," especially those involving general anesthaesa (eg breast surgery), until you've got this problem well in hand.

First off, no sense mucking with the circuits! Secondly, who knows how you'll feel about the chest when the anxiety/depression is gone?

Which hopefully will be nice and soon. Since we're ALL ABOUT IDG (intolerance of delayed gratification).

Excellent news, again. Thanks for posting.

Cath

[artemisia]

I'm so happy for you! I totally relate to so much of what you posted today. I hope you feel better very quickly and more importantly, I hope it's ongoing.

[Amy]

Sounds like a great appointment and plan! Let us know how it goes and take care.

[Simonne]

Hey T,

Cipramil is marketed under the name Citolapram (spelling possibly up the sh*t) here in NZ, and a very good Dr prescribed those for me when I had a very bad patch at the start of this IF thing. Anyway - she started me on a tiny dose because I had had very bad reactions to a number of other ADs, and I started to respond, really well, even to the small dose - she was amazed! I had no side effects to that AD, and they really helped.

Your therapist does sound wonderful - sometimes having a basis for a relationship (eg. 'clicking') other than illness helps a lot.

xoxo

[Kathy]

It must be such a relief to find someone in whom you have so much confidence and trust. I have a few experiences with depression and it is an ugly, ugly thing. I am crossing all bits and peces for this to be THE plan, the one that gives you some peace.

Best wishes.

[Suzie-Q.]

Am feeling v. happy for you right now, my friend. :)

[Jessica]

Tertia,

I am so happy for you. When I went back on AD's my Dr. had me do the same, started out very low and worked my way up. I'm now on 2 different meds and I cant remember the last time I felt this good. GOOD LUCK from sunny San Diego.

['wishIknew']

Tertia,

She sounds great! I think the going on slowly is a fabulous idea - wish I had done that when I first tried ADs. I used Lexapro (which is a newer version of Celexa - basically same thing but with less of the the non-active ingredients so supposedly has even lower side effect profile but Celexa's is low to begin with). I found myself wondering why she didn't pick the newer version (Lexapro) but she sounds very smart so I'm sure she had her reasons.
It will really help with the anxiety a lot. So glad for you.
I ended up starting mine for PPD summer of 2005 and have just weaned off 2 years later - I got off very very slowly and so far so good. So again, getting on slowly is SO smart!
All the best!
'wishIknew'

[Wobs]

Best of luck, Tertia!

[heathersak]

Yay T! Light-at-end-of-tunnel is so important. Sometimes the light fades on me, but when it's rediscovered, it's almost as sweet as the first time i saw it (the day i learned what was wrong with me was depression/anxiety, reassuringly common, and i was so relieved i ate 3/4 a bbq chicken!).

anyway, i've been on celexa for ... since oct 03. and i feel good that you're trying it, because i know it has worked for me, especially in the areas of Being Able To Function On A Daily Basis: Eating And Sleeping Are Fun.

There is indeed a light at the end of the tunnel, T, and you're headed straight toward it. Peace sista! :)

[Ann Johannesburg, South Africa]

There is a light at the end of the tunnel - and it's NOT the train!
xxx

[Heather]

I'm so glad you are so honest here. You don't know how many people you will help from being so honest. Your new doctor sounds fantastic. Love her already! That article is terrific. I see so much of myself there too. Good luck on the slow and steady plan.

I do also admit that exercising does help. We bought an elliptical machine and if I can get a half hour on it before everyone wakes up, it gives me endorphins to get through my work day.

[Kristin]

YAY! Tertia, I'm excited for you! I hope that this is your 'answer'.

I know you from your blog, yet, as many of us do, we develop a connection to the author.. and often I find myself wondering "How's she holding up today?" with respect to you. I know that your family is probably looking forward to the day when you're out of the tunnel.

Until then, keep plugging away and I too like the plan your therapist has in place and I have my appendages crossed (and my eyes too), that this is what works!

[Suzi in NC]

Hey girl - I'm on Lexapro (newer version of your new supa-Pill) and I started on it for anxiety that was aggravating my Irritable Bowel Syndrome, which I've had cause me problems for 20 years now. (What? You want to go out to eat? Fine, but we'll have to stay an extra 20 minutes after or you'll need to find me a restroom on the way home.)

OH. MY. GOD. I love this pill. I'm so less anxious, the IBS has become completely managable, and its like living my life, just not in fast forward. Its like I have this distance now from everything that protects me from over reacting and freaking out and now instead of saying WTF??? HOW AM I SUPPOSED TO DEAL WITH THIS?? I'm all, Hmmm. This sucks. OK. Worst thing? I do nothing. Not a big deal. Now, what should I do about it?

Still stressed, still engaged, but man - as I told my gastro doc (who prescribed it to me) - YOU CAN'T HAVE IT BACK!!!!

:)

Good luck, m'dear!

[BG]

Hi Tertia,

I went on Zoloft 6 months ago and it has changed my life. However, the first week of zoloft was an anxiety ridden nightmare that was terrifying. AFter that, I felt GREAT. Think the tiny sections of pills (at first) sounds great. I wish my shrink had suggested that!

[Leslie]

I love doctors like that. Sounds like such a reasonable plan. Best of luck with it!

[Amy]

I hope that the light at the end just keeps getting bigger and bigger. You deserve it. Way to go!

[angel]

FANTASTIC post t- as always- but especially interesting for me! i've been on ADs for about 2 years- my depression is mild- but i SO feel it if i skip a prescription for a few weeks... i know i won't be able to go without them no matter how good i feel, and i have to keep reminding myself of that!