Am I hooked on happy pills?

‘Well I’m happy for you to stay on them…’ My GP peered thoughtfully at me over the rim of his glasses. ‘I’m also perfectly fine with you coming off them. I’ll set our review for a year’s time shall I?’

And thus passed the annual antidepressant prescription review, like so many of its predecessors, proving about as useful as a chocolate teapot – and that although it’s so very easy to start taking happy pills, getting off them is another story.

Happy pills. antidepressants, SSRI’s – whatever you call them – used to be the preserve of those teetering on the edge of psychosis. These days everyone’s on them. There’s no doubting that some people in the throes of serious clinical depression really need support from medication – and drugs like paroxetine, citalopram and zoloft provide a chemical lifeline to those nosediving into a serotonin-deprived abyss. However there seems to be a worrying trend towards over-prescription. Medication being handed out like smarties for the mildest cases of the blues – and patients consigning themselves to years of pill popping.

The NHS prescribed record numbers of antidepressants in the UK last year and a recent study by women’s campaign group Platform 51 found that nearly half of those using antidepressants have taken them for at least five years, while a quarter have used them for ten years or more. The statistics are frightening, but actually being part of these numbers scares me even more. I’m eight years and counting.

I have been on and off antidepressants three times now. Having never been able to tolerate more than the lowest possible dose of my particular brand of synaptic rocket fuel, I still have absolutely no idea if they help me at all. Literally none. However the emphatic explaining away of my anxiety, depression and fatigue symptoms with ‘serotonin deficiency’ has consistently led me back to a GP-endorsed SSRI prescription.

I do know that the first two weeks of cranium electrics, nausea, sandpaper mouth and night sweats feel like a grenade has been dropped into my soul. And that once these side effects have tapered off it’s impossible to benchmark what effect the antidepressants are really having. I’m just thankful to have survived. I’m told the ‘therapeutic benefits’ of my medication can be expected to kick in after six weeks or so – but at this point I’ve usually been working so hard at getting better through exercise, meditation, healthy diet and general avoidance of stress that any number of things could be bringing me back to wellness. Drugs have always been just one aspect of a very holistic treatment plan for me and I’ve never been sure of the part they’ve really played in my wider recovery story.

My uncertainty has always sat in stark contrast to the certainty with which medical professionals have recommended drug therapy to me. All roads lead back to chemical imbalance, it seems. That knowing nod in the GP room when it’s discovered that depression reared it’s ugly head again a year after ditching my medication, the inferred conclusion that being drug free was the chip in the metaphorical mental health windscreen that led to a whole world of shattered glass. Serotonin, you see. And my counter-argument that we’re all still utterly clueless around whether or not the pills actually help me? ‘Well they really can’t hurt…’

Except for some people it seems they can. Hurt, that is. Particularly for those on high dosage antidepressants, withdrawal can be vicious. Dizzy spells, migraines, aches and pains, insomnia. If you’ve watched Leo Di Caprio sweating and whimpering his way through heroine withdrawal in The Basketball Diaries think of SSRI comedown as a vanilla version. Pretty, it is not. Six months easily turns into six years on these pills when kicking the habit is this hard. Then there’s psychological dependency. Even if you’re not chemically hooked, mustering up the confidence to throw out the blister-pack-shaped safety net is terrifying.

At this stage I have no idea what to do and neither, it seems, does my doctor. It’s definitely the easier option to keep mindlessly slipping a small blue pill under my tongue after breakfast everyday. But time’s marching on and with it the ever decreasing likelihood of a chemically unaltered future. Do I really want to remain a slave to lab-manufactured serotonin? Can I put up with the tedium and inconvenience of monthly trips to the pharmacy coupled with the expense of prescription charges? It’s a sensitive subject – a decision worthy of careful, contemplative thought with due consideration for what support might be needed further down the road – and it’s going to take more than ‘come back and see me in a year’ to get there.

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Shades of Kefalonia and the reality of recovery

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A restless butterfly whirls about the pine trees; flashes of yellow and white amidst fir-clad branches. Perched atop a rocky outcrop overlooking the Ionian Sea I hear the distant murmur of surf tickling the sandy shores below. My eyes blink closed and, for the first time in what must be years, I feel completely at peace. Everything is OK.

Except it wasn’t OK.

At the apex of my sickness if someone had announced that in three years time I would happily hop on a flight to Kefalonia, by myself, to spend a week at a Greek yoga retreat with a throng of complete strangers, I’d have punched them in the nose. I truly would have believed myself a likelier candidate for space travel and being taunted with such a delicious but unrealistic dream would have infuriated me.

But I made it. Several hundred miles on from a bleary-eyed and anxious morning at Gatwick Airport I’d boarded a plane solo for the first time in years, thrown off the shackles of bad health and opened myself up to a whole seven days of new experiences, growth and, well, just good old fashioned…fun. Nestled in the idyllic paradise of Vigla Village I started to realise what recovery looks like. I allowed myself to languish in the acceptance that illness doesn’t rule my life anymore.

But I got cocky. I came home feeling invincible. I stopped bothering to do any of the things that keep me on the straight and narrow – my healthy diet degenerated, I drank more, rested less. And guess what – I wasn’t, in fact, bullet proof. A few hiccoughs at work, a disastrous romantic encounter and one house move later found me feeling less than fighting fit. Fatigue crept in. A dark cloud swept over my head. I felt awful. Not to mention incredibly foolish for daring to entertain the prospect of a new, symptom-free reality.

I pulled through. A month on as I sit tapping away at this blog, I’m feeling much better having focused on eating well, getting the right balance of rest and exercise and just giving myself time to digest various recent life events. Nourishing myself – body and mind. And simultaneously feeling pretty damn sheepish – at how naive I had been to think that chronic illness can simply vanish into the night.

My health is something I have to manage. It’s not perfect and sometimes I live alongside some pretty unpleasant ailments, aches, pains and difficulties. The ever-present spectre of tinnitus buzzes gently between my ears, intensifying in times of stress and acting as a strange sort of barometer for how well I’m looking after myself. It’s a constant work in progress and never, ever again will I allow arrogance to shake my commitment to staying well.

Fatigue and depression are dual forces of torment and destruction that can ruin lives – but they’re not unmanageable. I can honestly say that despite my struggles, I’m generally in a happy place now.

Joy finds me on a far more regular basis than gloom – and if that sparks hope for even just one reader out there walking their own dark path, I’ll be a very happy lady today.

Photographic memories

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Anyone with clinical depression who has been told to ‘think positive’ and ‘remember the good times’ will know the creepy, forced smile you offer the purveyor of said well meaning sentiments. Because trying to explain to anyone that actually has access to the happy part of their brain that you don’t really want to be miserable, you’ve just lost the ability to feel good, is like being repeatedly slapped in the face with a trout.

Depression is a negativity dump truck, unloading its toxic cargo of sad thoughts, self doubt and unpleasant memories into your cranium every hour of the day. The reason sufferers can’t just focus on happy thoughts is that, temporarily, they don’t exist. All that was once joyful and light has been squirrelled away deep in the annals of your consciousness, to be uncovered once depression’s done playing it’s sick and twisted game. Sometimes it’s impossible to comprehend that happiness was once physically possible.

Enter photography. Photos are genuine, bona fide happiness EVIDENCE. Even when you can’t remember what it’s like to feel joy, you can certainly look at an old photo that captures a moment of happiness and know that it really happened. Is that me grinning like a deranged meerkat as I jumped out of a plane in New Zealand? Yes. Am I actually laughing in that surfing shot? Looking calm and relaxed on holiday with my family? Yes and yes. It happened. Was I on mind bending drugs or under the spell of a magical unicorn? Nope, just enjoying myself.

If the only memories I had were what’s locked inside my head, I’d be in trouble right now. But these glossy, dog-eared snapshots represent a time when I knew what it was like to be happy, and they’re playing a critical role in keeping me hopeful at the moment. The camera doesn’t lie.

So when I’m feeling hopeless, my mind is clouded with ‘I can’ts’ and ‘you’ll nevers’ and I’m convinced the depressed version of me is the only person I’ll ever be, I leaf through some old photos to remind myself of who I was before the big D. A girl who travelled, socialised, danced, laughed, lived and who had fear but jumped anyway. And I tell myself that if I was her once, then I can be her again.

Doctor doctor

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Having been snuffling around in the pigsty of poor mental health for several years now, I’m learning to be more demanding when it comes to getting help.

A recent trip to the doctor’s more resembled a perilous voyage into Mordor than an innocent check up – I was battle-ready and prepared not to leave with just a pill prescription, but rather a more concrete and sustainable plan to wobble my way back to better mental health. Fight the power.

Except that ten minutes after shaking the doctor’s hand, I had a psychotherapy referral underway, a blood test booked and a sincere request from my GP to please come back if I felt in any way overwhelmed over the next few days. It all went so well I didn’t really know what to do with myself.

It’s not my intention to badmouth the NHS, but my experience of GPs is that they’re perpetually reluctant to make referrals to see a specialist unless you’re so far gone that your brain’s seeping out your ears like a soft, steaming mass of spaghetti. ‘Come back in six weeks’ and ‘I’m certain we can sort this out here’ are all too familiar platitudes to me. Not to mention that bloody depression questionnaire they make you fill out. Sometimes, I’ve felt like doctors are clueless when it comes to mental health.

Which is why my recent experience was so refreshing, and also why it’s so great that the campaign against mental illness stigma, Time to Change, has implemented a new project to make GPs more mental health friendly. Since October last year project workers have been leading one-to-one sessions with frontline health staff, to help them better understand mental health service users’ experiences. The results have been positive with 64% of GPs saying they were better equipped to make adjustments so that people with mental health difficulties could access their practice, as opposed to just 41% before the project began.

In times of ill health your doctor is the lifeboat you cling to and the way they react to those that reach out for help with depression and anxiety, can be life changing. So if this project has made even a shred of progress in doctors surgeries nationwide, for some people that could literally mean the difference between life and death.

Coming out of the depression closet

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“You should be writing about your experiences in the Guardian or something. You know, show people it’s nothing to be ashamed of…” a friend said to me recently.

I nodded. “Yeah. Maybe in a few months. Think I’ll just do the anonymous blogging thing for now though.”

Putting your name to an illness like depression is brave, courageous and generally bloody awesome. It shouldn’t have to be, but thanks to prevailing bad attitudes and stigma towards mental health, it is. Considering the Victorians thought depression in women was down to the ‘wandering womb‘, we’ve certainly come a long way in terms of how society views the depressed and anxious. If only curing my affliction was as simple as shrieking ‘Wench! Back in your box!’ at my nomadic uterus.

Campaigns like Time to Change and the wealth of celebrities speaking out about their experience of mental illness are doing brilliant things to oil the wheels of change when it comes to stigma. But there’s still a lot of work to do.

It’s definitely important not to hide your illness in the shadows. Talking about it helps and self shame and stigma only serve to reinforce society’s misunderstanding of depression. I do believe that those who have experienced a walk with the black dog are the ones who can truly debunk and stamp out unhelpful depression myths.

But often while we’re fighting the good fight we forget about the people behind the illnesses. And that reluctance to go public with your problems isn’t always indicative of shame. Depression and anxiety are physiological conditions in the same way heart disease and broken bones are. But they’re more personal. 

People have very different ways of dealing with their emotions – some will reveal their problems to all friends, colleagues, bus drivers and woodlice within a ten mile radius, whereas others (me) are more private and need a bit of time and space to crawl out of the hole and heal first. Explaining what it’s like to go through depression to those that know you can be cathartic, and of course helps dispel mental health misconceptions, but it’s also exhausting.

Which is why the people that matter to me know what I’m going through, but everyone else is none the wiser. It’s why I’ll be writing about my experiences here, but I won’t be revealing my full name.

As long as I’m still in poor health and vulnerable, I plan on burying my head in the sand just a little bit longer. And I think that’s alright. Just as it’s OK to tell the world you have a mental illness, if you’re not ready it’s also OK not to.

An open letter to clinical depression

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I hate you. You’re a thief that’s taken so much from me. The moment you gave me my first panic attack life changed forever and a door opened which can never be shut.

I’m in awe of you. Your relentlessness, your power over me and your ability to instill fear within the most joyful, everyday things. How you ever made the innocent tinkle of an ice cream van bell strike fear into my soul on a balmy summer’s day is beyond me, but seriously, bravo.

I’m grateful for the things you’ve taught me. Self awareness, that being vulnerable is OK, and that all frightening things shrink when you face them head on.

You muted my capacity to love and replaced it with a cocktail of fear, nihilism and apathy. But it’s back stronger than ever now.

You’ve aged me. I’ve confronted things that otherwise may have taken a lifetime of experiences to unearth. I’ve looked my mortality in the face and I’ve come to terms with it. I’m not afraid of dying anymore. I am afraid of not living though.

By taking me to the end of my fear threshold, you showed me there’s nothing to be afraid of.

By forcing me to take time out and recuperate, you taught me to be kind to myself. And now I’m better at being kind to other people.

By showing me that I was living wrong, you forced me to make changes. Living under your crushing weight magnified everything that wasn’t right in my world, and forced me to think about what I could do to make it better. Without you I probably would have just muddled along as I was, accepting things as they were. Now I refuse to live anything but joyfully.

You made me difficult, in fact a complete toss-pot, to be around. But that’s OK because I love those that stood by me all the more for sticking around. You did make me hurt my family when they were trying to help me though, and for that, I still think you’re an ass face.

You’re awful and there have been times you’ve almost destroyed me. But you haven’t crushed my spirit, and you never will.

Once more into the breach

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After over four years of doing battle with depression and anxiety, punctuated with dizzying peaks and catastrophic troughs, I was just starting to feel like I was figuring it out. Back in stable employment, taking a few holidays here and there and even considering dating again, I couldn’t believe my luck. Could the black dog actually be retreating from my world once and for all?

Then spring arrived and with the change of season came a change in mood. For no apparent reason my hormones went beserk, hypomania and anxiety set in and now I find myself, once again, crushed by the weight of my failing nervous system and left cowering under a frightening black cloud. Feeling like there’s an axe wedged in my chest and that the sky is literally pressing down on my head. That creeping chill and a sense of impending doom wherever I turn. Dread. Feeling nervous before doing something as simple as doing the food shopping, or going to the dentist. I even find trees scary. TREES.

It’s disappointing, to say the least. But I’ve done it before and I shall endure it again.

I don’t think there’s anything more frustrating than feeling like your life is passing you by. Seeing all the possibilities before you, trying to grasp at the tendrils of something real but having it escape you. Depression truly is a cage. Your 20s should be a time for fun, frivolity and exploration but unfortunately for many it’s also a very confusing, high pressured and anxiety inducing stage of life. But it’s also a time for growth and if there’s one thing that grappling with mental illness gifts you with, it’s strength of mind as well as a space to grow as a person.

Little comfort to someone in the midst of a black fog, I know. But to anyone else experiencing the quarter-life-crisis, as I like to call it, I’d wager that it really is more common than you think…and if others can crawl their way to the other side, seeing in their 30s with a renewed sense of wellbeing and inner strength, then so can you. And so can I.