Following this latest development, I went back to the GP. We discussed my options (limited as they were, as GP’s have a much shorter list of drugs at their disposal than a specialist) and we settled upon Duloxetine. Duloxetine is an SNRI (Serotonin-Noradrenalne Reuptake Inhibitor). An SNRI is basically the same as an SSRI, with the added benefit of supposedly increasing Noradrenaline levels as well as Serotonin. I’ve been unable to find a decent explanation of Noradrenaline (also known as Norepinephrine), so I’ll provide a brief synopsis of what I’ve learnt. Noradrenaline is a hormone and neurotransmitter produced by the adrenal gland. It is normally produced in times of stress and is the trigger that gets your blood pumping and your heart pounding. It is effectively the fight or flight mechanism that prepares your body to respond to stress.
My GP had dealt with a person similar to myself in the past and found that Duloxetine had been very beneficial for him, with regards to his anxiety and irritable bowel. Sign me up, I said. It has to be better than Sertraline. Before I continue, I’m going to take you back and remind you of something that I said earlier, you know, about how transitioning drugs was “the WORST”. Well this is the point point at which I made this discovery.
Ordinarily in this situation, you would be tapered from one drug and onto the other. In this case, that didn’t apply. The GP’s computer said that it was fine to completely stop Sertraline and go straight onto Duloxetine, so that’s what I did. And I was a mess. I won’t go too much into detail right now, save to say that my self harming went through the roof. I became completely irrational and ended up trying to strangle myself with my own t-shirt, having ripped it pro-wrestler style straight off my body. It was the WORST. There are several reasons for this; many anti-depressants have severe withdrawal symptoms if stopped incorrectly, it can take several weeks for the new medication to work, your body is awash with different drugs. So, you are effectively swimming in chemicals, none of which are actually working for you and combatting your depression/anxiety.
This WORST-ness went on for several weeks. It was hell. Literal hell. I didn’t know if I was coming or going. When I thought I was being completely rational and seeing things clearly, I was actually being nuts. So I didn’t know what was what. I never knew if I was feeling rational and normal because I was rational and normal, or because I simply believed that I was. I was permanently on edge, bordering on the brink of breaking down and freaking out. All day, every day. It was exhausting (having researched Duloxetine further for this blog, it’s now quite obvious to me why this was occurring, I was in permanent fight or flight mode AND I’ve also seen that recent studies have shown that SNRIs may have pain relieving properties, which is not so great for self harming!). Things got so bad that my GP made an urgent referral to the local mental health crisis team, with a request that I be seen within 24 hours. Several weeks – and multiple calls from the GP, myself and Frankie – later (don’t let them tell you the NHS isn’t up shit creek), I finally had my urgent appointment with a psychiatric doctor.
For the first time, I found myself talking to somebody who had a detailed knowledge of the medications available to treat my conditions (but for only 30 of my scheduled 60 mins, as they’d double booked the second half of my appointment). The GP had done his best, but now it was time to brush aside his puny list and access the good stuff.
The psych Doctor recommended that I come off of Duloxetine and onto a combination of Pregabalin and Mirtazapine. Pregabalin is used mainly to treat epilepsy and certain types of pain, but it is also used for generalised anxiety disorder. To put it very, very, very simply (I am neither a doctor or scientist), Pregabalin is believed to work within your body to calm the damaged or overactive nerves that cause pain. It does this by binding to “over-excited” pre-synaptic neurones, reducing the release of excitatory neurotransmitters (those neurotransmitters again!). Mirtazapine is used in partnership to provide the anti-depressant element and was a must according to the doc. It works in a similar way to other antidepressants (affecting both Serotonin and Noradrenaline), but differs slightly in so much as it only stimulates one type of Serotonin receptor. It is also prescribed to people with insomnia as the “sedative effects lessen the hyperarousal which prevents people getting to sleep, whilst increasing the stages of slow wave, restorative sleep”.
This time around, I got to taper. Therefore whilst lowering my dose of Duloxetine, I was building my dose of Pregabalin and Mirtazapine. Once again, I was awash with chemicals and a mess. But a different kind of mess. A sleepy, dozey, dopey mess. This seemed very much tied to the Mirtazapine, and it’s sleep inducing properties. Like most anxious people, I struggle with sleep. My brain simply will not stop ticking over, it never gets tired, never stops thinking about what could have been and what might be. As I mentioned earlier, I hate not being in control and in particular the feeling of anaesthesia. So, something that was forcing me to go to sleep, was never going to go down too well. I fought it, got up, paced around, smacked myself in the face. Anything to avoid the induced sleep!
After a few days, this issue ceased to become relevant. I was such a mindless zombie, I had no bloody idea I was even being put to sleep, let alone an ability to fight it. I also aided the cause by taking the tablets last thing at night – literally in bed. After 10 days (just as the zombie effect was wearing off), I was fully off Duloxetine and had Pregabalin and Mirtazapine upped to a therapeutic dose. Once again I was part of the walking dead, waking to a fog that hung around till late afternoon. I was completely incapable of moving quickly or standing up, let alone driving. My co-ordination was off, any minor movement causing my head to spin. Putting the dog on the lead was a monumental task that required a good sit down when completed (sorry Lyla for all the times you were ready for a walk and I sat back down again).
Things got dark again. I woke up every morning dreading the day ahead. Questioning why I would bother to put myself through life as a zombie. I wholeheartedly convinced myself I was better off dead. Fully, fully convinced myself that I’d finally worked it all out, life was a cycle that lead nowhere and I wanted to break that cycle. Once again, timely intervention was all that came between me and a Viking burial (I’m being serious by the way, put me in a boat with a sword, push it out to sea/river/lake/any bit of water you can find and fire flaming arrows at it). The erratic behaviour returned, as did the panic attacks. I couldn’t be trusted to make the most basic decisions for myself and began to self harm again. All of this lasted for around ten days in total.
After this time, with each passing day the dizziness abated a little further. The self harm and thoughts of killing myself became less frequent (although I did come very close to throwing myself out of a moving car) whilst the feeling like a zombie completely disappeared (trust me, I’m sat here writing this at 2am with no obvious sleep in sight), only to be replaced with a hair trigger temper and an overwhelming sense of irritability. And that’s pretty much where we stand right now, a couple of weeks into my therapeutic dose. Wide awake, freshly scarred and with my brain ticking over like crazy as I question myself about the whole experience…
Have I found a magic cure? No. Do I feel better? Well, I feel better than two weeks ago, but I’m not sure I’m better than when I started taking the meds. Have I stopped feeling anxious? No. Depressed? No. Suicidal? No. Have I stopped self harming? No. Do I know which thoughts are my own? No. Can I tell when I’m being rational/irrational? No. Can I trust myself? No. DO THE DRUGS WORK, DAMN IT? No idea.
My end goal remains the same though; to conquer this with more than medication. I’m certainly not trying any other meds, not transitioning onto anything else ever again. I’ve given it a good shot and if the current lot don’t work, so be it, cos I ain’t trying anything else.
Once again, I’m not sure if this is helpful, but I’m hopeful that it is. Maybe as a warning that you aren’t just going to begin medication and feel suddenly better, or as a comfort that you aren’t the only one struggling. As ever, please feel free to contact me if you’re experiencing similar – or have a loved one going through this, I’m happy to share experiences, provide advice where I can and just have a general chit chat if that’s all you want.