Are you depressed? Here’s how it went for me.

Gunther, emotional supporter.

October 24, 2018

Two days after my mother’s birthday.  She would have been 106.  

Domestic front:  About two weeks ago my psychiatrist finished tapering me off all my antidepressant medications.  I was on three such meds for several–I don’t know, five?– years. 

I don’t know what happened to make me ill.  Well, maybe I do have a few theories, but I was in a pit of despair for a couple years there.  At the time, one friend told me to “get the fuck in to see someone” about my depressed, suicidal mood.  Gee!  A grandson even phoned me to tell me he would always be available to talk with me if I felt hopeless.

I shared my diagnosis and experience on this blog.

How am I now?  I fear the return of the sadness and anxiety.  Oh yes.  My psych told me to phone him if things got too rough and I felt I needed help.  Yep, I almost phoned him during the first week when I wasn’t taking meds, but hey!  If I can swim through life without water wings, I’d love that.  I’m swimming!  Yeah.  The world still has to cope with a fascist president, global warming, homelessness, racism, but I can still enjoy the fall weather when I walk Gunther, my dog.  This morning I saw a cat drinking from a birdbath.

My memories of that tumultuous time, years ago, of maximum depression are mixed around in my mind like swirling colors of paint in a can, but I recall profoundly hurting, but not the physical kind of pain.  I don’t remember even what I did with my days then.  I wrote in my blog, I walked the dog.  Gunther was a great and enduring comfort to me.  I guess I took more than my share of naps.

I strongly recommend people who even suspect they might be depressed get in to see a medical doctor for anti depression medication and to get a pet.  In either order.  A scrappy, scruffy-looking dog worked for me, but you might need a different species.

A friend brought me over a vest for my dog, Gunther, proclaiming him to be an emotional support animal, or “ESA.”  My psychiatrist wrote me a letter in support, but he stopped short of advocating Gunther accompany me inside a grocery, or even on an airplane.

My oldest son asked me if a blind person needs a dog inside a store, to which I replied yes.  Then he asked me if I needed Gunther in order to go in the store.  You can guess my answer.  No.

In hindsight, I feel fortunate I had topnotch medical care available to me.  Any doctor appointments are hard enough to get, but in Billings, Montana,  psychiatric care is damned near impossible (I’ve heard of people having to wait, like, more than six months for a first appointment), and if my doctor hadn’t referred me to a psychiatrist, I doubt if I’d been able to get in to see one.  He referred me to a psychiatrist because I scared even him.  He said I needed a specialist.  My internist had me on two antidepressants but they didn’t seem to work.

As it was, I got a psych appointment in just a few weeks, although I frequently had to take appointments at odd times, like at 6:30 or 7 a.m.  Those days I stood on the icy steps of the psychiatric center waiting for someone to unlock.  I didn’t dare miss an appointment.  I had heard of people getting fired by their psychiatrist after missing one appointment.

Thanks to my internist I had been on Wellbutrin, an antidepressant, for several years before I went in to see the psychiatrist the first time.  My internist had tried adding first Celexa, then Prozac, to the Wellbutrin, but I felt by turns, no better, then terrible, antsy, nervous, crazy.  My internist referred me out.  He said he didn’t have the experience to tinker.

The psych stopped all but the Wellbutrin, then added Effexor, then had me return in a month.  In many later visits, he adjusted the Effexor, then added Abilify.  

These products are not merely brand names for me, but they have specific properties that work in a variety of ways on the central nervous system.  A lot of it is theoretical and molecular.  The thing is, if a drug has an effect on dopamine, that outcome on dopamine is at most “nice” or “interesting.”  The real outcome of interest, which is hard to gather into data for a study, is if a drug has an effect on whether a person commits suicide.  I call that a compelling outcome.  The nattering about serotonin and whatnot holds little importance for me, but psychiatrists find those concepts useful.

Whenever I talked on the phone about the specifics of my medications, a couple of my family members would chime in about their experiences with their psychiatric meds.  Whoa!  We aren’t talking about whether rhubarb pie is better than apple.  Each person’s experience is bound to be different.  I press home the concept of having a psychiatrist or other qualified practitioner be the coach.  My job (as patient) is to do my best, but the coach is, well, the coach.  Teamwork.

I realize people and the medications they take react together uniquely.  Also, a combination that works well for a person at one time in their life may not work at another juncture.  People change as they age, also the cumulative effects of prescriptions also makes people change.  Ain’t we something?

There are protocols these days for prescribing other kinds of drugs, such as cardiovascular medications, based on data from tens of thousands of people studied for 10-20 years with defensible study endpoints. Like comparison of patient deaths from any cause.  Hard to argue with data like that.  Of course, patient survival isn’t necessarily the most important thing, but if one is taking high blood pressure or cholesterol pills, one can respect an outcome like that.  (Doesn’t address whether the life is tolerable or not.)  Also doesn’t address other aspects of the study.  Are we looking at men? Women? Over age 80? You get the idea.  At least there is scientific evidence to consider with care.

On the other side, psychiatric medicine combinations do not have many large, long, studies, so individual psychiatrists must fly by the seats of their pants.  Well, there are certain pearls of clinical lore, for example:  If one treats the side effect of a medication with another medication, it might (but not always) be a prescription for trouble.  

Depends on their training.  Some psychiatrists believe in dosing a marginally effective prescription up to its maximum before switching to something else.  Medical lore.  A pharmacist I know who has clinical privileges in Billings based some of her choice of med on the effectiveness, as well of the cost to the patient, preferring older generics over newer drugs only available as a patented brand-name product.  An added benefit of her method of using older drugs was the increasing availability of clinical evidence based on many providers’ experiences.  

Back to my experience.  After perhaps a year on the triple antidepressant formula I had gained about 40 lbs, mostly around my belly.  I’ve been skinny most of my life, but psychiatric medications are notorious for weight gain.  The worst for me was the prescription med, Abilify.  Many times I lay awake at 3 a.m. thinking about food before going to the kitchen for a couple bowls of cereal and four packages of ramen noodles.  No, the Abilify is but a tiny, low calorie, pill.  The getting up in the night with a craving for food is a common symptom that I didn’t know how to handle.  Still don’t.  I still have a lot of fat on my belly, but I hope now that I’m not taking psych meds the fat will go away.  I think it will not go away.  

About a year ago my psychiatrist came up with the idea to taper me off all the antidepressants.  I was apprehensive, but he had me return every month while he discontinued first the Rexulti (a brand-name only Abilify-like drug, purportedly causing less appetite increase.  Oh yeah.  Rexulti cost about $15 for a daily pill), then the Wellbutrin, then the Effexor.  He tapered the Effexor over three months.  Like I said, I finished the taper just over two weeks ago.

The good news is I feel well, so far.  I’m thinking that since these antidepressants took more than a month to start working, they may well take that long to stop.  I’ll check myself frequently for the next two weeks, until I visit my psychiatrist again.

He warned me that with each dose decrease of Effexor I’d experience symptoms similar to having a bad cold.  Malaise, mostly.  Sure enough, but those symptoms lasted just a few days, but they were pronounced.

I spoke to my sister Carol yesterday by phone.  I told her about a great opera singer I heard Sunday who sang so magnificently I wept.  To the point where others were thrusting tissues at me as I soaked them one after another.  Carol told me my bladder was too close to my eyes.