De-mirtazapin-ize me please!

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A lot has come together for me in the past couple of weeks, which culminated in me deciding to make a dr’s appointment for this afternoon to get advice on how to go about tapering off my dose of anti-depressants – currently I’m on 30mg mirtazapine per day.

I didn’t really come up with a good pros/cons list of staying on or going off the medication, but in the end I’m starting to realise how tired I am doing day to day things, to the point that I haven’t really done much at all. I hadn’t really noticed how I’ve been acting or feeling recently, as I thought I was doing fine, but my (dearest) mother keeps on at me for not being more active or enthused or getting out and about. To which all I can say is that I’d love to be active/enthused/out and about, if only I didn’t keep feeling like I could do with another nap or a bit more sleep.

I’ve tried going for runs, but they only make me spend the rest of the day exhausted, I’ve tried eating more to get more energy, but I’m at the point of just putting on more weight, and I’ve tried getting more sleep, but I’m already getting plenty, and the need for sleep keeps eating into and destroying plans for doing other things like meeting up with friends in the evening or going out to photograph sunrise.

The other thing my mother keeps trying to tell me is how I ‘don’t seem happy’. Again, all I can say is that I’m doing my best to ‘seem happy’, but pretending to be happy is really starting to get exhausting, and being properly happy, without the inverted commas, is equally exhausting, and too hard not to be cross when no one can understand me because I’m slurring my words because I’m so tired, and too hard not to be upset at what I’m missing out on with friends when I’m just too tired to make plans, let alone think about actually get myself to town and back again, or being decent company.

I don’t think I’m depressed anymore, not in the depressed way of not being able to bring myself to do anything, or not feeling anything is worth moving for. Rather, it is a pure and simple problem of not doing things because I don’t have the energy. Basically I know I just need to get a grip. Which I feel like I could do if only I wasn’t so tired…and round and round in circles I go, making myself upset as I don’t have the energy to fight the tears either.

I’m not blaming the medication entirely on my tired state, but given that one of its headlining actions is to help insomnia, the mirtazapine is almost certainly not helping me stay alert and energized through the day. While the medication almost certainly helped me through April and May, and the side effects were worth putting up with, now the side effects are outstaying their welcome. I’m imagining myself as a hot air balloon, and while the mirtazapine was a useful safety tether while sorting my supplies and gear out, now I need to cut the anchor and lines so I can rise up and float away.

So I’m now cutting my pills in half, down to 15mg/day, for the next two weeks, and then I’ll take half (15mg/day) every other day for the following two weeks. I  hope I’m ok with that. I think I should be. Through the day today, after I decided on my plan and felt like I was taking decisions into my own hands, I felt excited and lighter in my step, and for the first time in the longest that  I can remember, I felt a slight crackle of electricity coursing through my veins. I’d completely forgotten that feeling, but I like it and am glad to have it back.

Another wonder pill

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Following on from the supposed wonder pill that is Omega-3 rich fish oil, I wanted to give a mention to another wonder drug I’m on at the moment: Mirtazapine. It seems to take a lot of flak, but I’ve just been reading the small print on a new lot of just picked up from the pharmacy (I must be bored!), and found some rather interesting things:

“Mirtazapine is a potent antagonist of histamine (H1) receptors”

I had secretly been noticing, though not wanting to say it aloud for fear of putting a jinx on myself, that since I arrived back home at the beginning of August, I haven’t had a single stuffy or runny nose for the first time in the longest that I can remember! Now reading that factoid, that essentially I am taking a pretty strong antihistamine, I can understand why this is the first trip back that I haven’t felt like divorcing my nose because of the ubiquitous mould and mildew of my warmer clime homeland.

“Mirtapazine is a potent antagonist of 5-HT3 receptors”

When I looked up that receptor, it noted that antagonists are sometimes an anti-emetic. ie to stop nausea. It turns out that is also a ‘side effect’ of histamine antagonists too! At this point I must apologise to my fellow crew members last month when we were sailing: I was happily bumping up and down on the waves telling others (who were getting greener and greener) ‘ah you haven’t seen proper waves! I know I get sea sick, but I haven’t yet, so this must be nothing!’. It seems, that without knowing it, I was on some ‘potent’ anti-seasick tablets already!

Interestingly, according to Wikipedia, that same receptor is also antagonised by a drug called Memantine, which I recognise as the medication my grandfather is current trying in a bid to reverse his Alzheimer’s Disease symptoms. The jury is still out on the usefulness of that medication for that, but it’s interesting to think it is affecting the same thing that my mirtazapine also affects. Though I may be getting a bit ahead of myself to think I could also be staving off the Alzheimer’s that seems the inevitable ending of my family!

On the other hand, I was sorry to read:

“Mirtazapine is a potent antagonist of 5-HTreceptors”

as I just read that psychaedelic drugs like LSD are agonists at this receptor. Shucks! I was still waiting for that trip!

Now if I could just find something that will make me a bit less sweet to mosquitoes, I will be a very happy bunny!

Fish Oils

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So my mother came into my room a couple of days ago, proudly announcing she had consulted Dr Google (since saw her search: “depression””crying”) and had found the solution to all evils: Omega 3 fish oil.

A while ago I’d looked up health supplements and noticed that Omega 3 sounded possibly helpful. But all the the different acronymns of EHS, ALA, DHA (probably got those wrong) were confusing, as well as the discussion between Omega-3, -6, 88 and 101’s (or whatever) was too much for me to follow a few months ago. I’d thought I’d pop into Holland & Barrett to take a look at what they had, but never managed to get into town at the same time as having on me, my scrappy little note of abbreviations and random symbols.

I was also a bit pleased that my mother had at least vaguely understood and accepted my explanation that I completed agreed that whatever I was upset over was a silly thing to be upset over, except that being upset at it upset me more for being upset at something so silly!

So I took her up on her offer of trying the fish oil capsules full of omega-3 goodness, and she duly rushed out to buy me a bottle of them.

I am really not into the homeo-herby stuff, but I’m willing to try something that might help. I’ll see how I get on.

(also found this fun little graphic: http://www.informationisbeautiful.net/play/snake-oil-supplements/. The bubble for fish oil/omega 3 regarding ‘depression/mental health’ is floating next to ‘conflicting evidence’, just below the ‘worth it’ line. )

Coping & Maintenance

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The second to last section on the worksheet I’ve been working on:
‘WHAT HELPS ME COPE’
Helpful                                    Unhelpful
Helpful:
I’ve begun by just copying over the list I have under the ‘Weapons’ tab. I’ve been trying to build up my arsenal to attack my problems from various angles, including medication, various talking therapies and generally trying to take care of myself and put fun leisure in wherever I can.
  • Mirtazapine: 30mg/day (around bed time. Zonks me for about three hours)
  • Diazepam: 2mg PRN (works out to be about 1-2x2mg once or twice a week, more around deadlines)
  • Talking Therapy: 1hr/week (more or less) with Celine, an NHS CBT therapist who comes to my university
  • University Advisor: a meeting with Enise every now and again (every few months)
  • Making a conscious effort to get 7 or 8 hours sleep/night, eating 3 proper meals a day
  • Making a conscious decision to “put fun in wherever I can”, especially when I feel anxiety rising
Also:
  • Art – lots of sketching, especially botanical illustration. I think that helps slow me down and I can focus on fine detail which actually produces something. Helps especially when I’m getting really frustrated. (most recently a series of ‘Zentangles‘)
  • Walking, photograph – though these things only help before I’m wound up!
  • Generally trying to persevere, not give up and get through problems, reminding myself that if I can get through a particular bump, I will come out the other side (although this can lead to exhaustion and can be Unhelpful too…)

Some less helpful things:

  • NOT yoga (tried. failed. miserably)
  • Staying up too late and missing meals trying to push myself too hard to get work done = physical exhaustion.
  • Pushing myself to get things done when I’d rather be doing fun things = resentment.
  • Getting distracted with fun things and not getting the goal achieved = guilt.
The final section is:
‘WHAT MAINTAINS THE PROBLEM NOW’
Thoughts
|
Physical  – + – Emotions
|
Behaviours
I’ve done this ‘hot cross bun’ thing before in my sessions with Celine. It’s become fairly clear as I’ve been listing my ‘rules I live by’ and ‘what helps me cope’ is that everything is a vicious circle. Now that I’m in it, the more I push myself to get through a problem, the more I feel its a problem that I have to push myself. With the physical (exhaustion) and mental problems (guilt, resentment) as well as cloudy thinking, lack of focus and general frustration that come with it.
Therefore, my maintenance pattern boils down to:
“I’m not good enough”
|
                Exhaustion – + – Frustration, worry
|
Push myself, be upset
I think I knew all this already. Which is why I’ve become so irritated with myself because I can see how silly it is, but it’s still happening. I have been trying to build my resilience so that I can make the effort to either challenge the initial thought, or if that is too difficult or too believable, then at least I will have the energy to not be such a slave to my emotions and stop myself from doing the behaviours that result in a bad physical state with low resilience.
Here are links to my entries for the rest of the worksheet: Intro | Early Things | Core Beliefs | Rules | Current Problem & Triggers |

Resilience

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I mentioned in my previous post, a report on my CBT session with Celine yesterday, about her mentioning ‘resilience’ and that striking a cord with me. I think it deserves a proper post of its own as well.

As I said before, ‘resilience’ is common when talking about catching colds. I’ve also come across in it in my landscape architecture uni work, to do with adapting to climate change and a movement called ‘resilient communities’. I probably sound like a man (I’m not!) now likening health stuff to towns and cities. But it’s true, I’m familiar with the term, but for completely unrelated reasons, so it has felt a bit of a break through to see it applied to my own mental health.

I’ve often tried to think about what benefits I’ve had from antidepressants. The best I’ve been able to describe it is that they help make tears a bit deeper and further away. When I’m not awash in tears, its easier to think things through more clearly or have a sensible conversation with someone to work through problems and find solutions. When I can see a solution and a clear plan that will lead me towards it, then I get less anxious and am more likely to be able to keep to the plan and sort out a particular problem. Conversely, when I’m in tears, then everything is backwards: I can’t think clearly, I can’t get help, I can’t identify a solution, I can’t formulate a plan  to get me there, and then I feel even worse off, with anxiety thrown in as I watch myself going even further backwards. I suppose that anti depressants have been giving me resilience, in the same way vitamin C tablets help stave off a cold.

I’m excited that Celine has pointed out how there are things I can do to improve my mental resilience, even as simple as making sure I get enough sleep, eating three proper meals a day, and thinking to myself that ‘I can do it, it’s only because I doubt myself that then I have trouble’. I’m excited that with these concrete things (which I’ve been able to learn because I haven’t been in floods of tears, thanks probably to both mirtazapine and Celine’s calm, un-upsetting attitude), I can make a conscious effort now to build my own resilience and hopefully eventually no longer have to rely on mirtazapine!

I feel a bit ridiculous that it’s taken five sessions with an NHS therapist to help me see such a simple thing. I feel like I must have been totally wasting her time/their money. Yet  I need to remind myself that that shows how badly I needed help: I’d reached such a state that I couldn’t see such simple things for myself. Hopefully it’s been money well spent in the long run.

Or maybe I’m just feeling overoptimistic again. I hope not though!

25 March: Mirtazapined

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So I went to my dr, being a good little Zee following Enise’s instructions. I’d made my list of things I wanted to ask him, so I may have stretched my appointment to a mammoth 32 seconds.

At first I tried to explain that I really didn’t want to be on anything (said through tears, which didn’t help make a strong argument), with my main concern being about side effects:

Sleepiness: I said I was worried that if I was sleepy, it would really mess up trying to meet uni deadlines, especially with them fast approaching. To which he just said, ‘well we can sort out more extensions. That’s easy. And you look like you could do with the sleep anyway’. Gee thanks, I must look terrible. And the whole point is I don’t want to have more extensions, which will just prove I’m incapable of coping with deadlines.

Appetite increase: I tried telling him I was concerned that  I couldn’t manage to organise and eat proper meals as it was, so what was I meant to do if the pills gave me an even bigger appetite? But he gave me a look to shut me up, just saying that he thought it would be a good thing if I improved my appeitite.

Weight gain: I didn’t bother to raise that issue after his previous comment.

Alcohol: Dr assured me it would be ok to drink with it. Yay! And now I’m just ignoring that sticker on the box warning ‘DO NOT DRINK alcoholic beverages when taking this medication’. At least I don’t swig the pill down with a shot of vodka.

So I am now £7.20 lighter (but luckily haven’t noticed extra physical pounds yet), have a little med certificate for uni, and have been taking the mirtazapines (15mg/day) for a week.

For the first couple of days (I’ve been taking them for a week now), I took them religiously at 6pm, had an early supper, went for a little walk in my neighbourhood and then went to sleep at 8pm. Maybe just getting those longer hours of sleep helped, but the honeymoon period lasted all of two days and now I’ve had to get back to doing my uni work and can’t afford to sleep for 12 or 16 hours or whatever my body would like to do. Things aren’t better…yet…I guess I need to give them a chance…but omg I just feel like my blood is simmering away the entire time. That irritating icecream van with its blood curdling tune was too much this evening.

13th March: I’m just like…a fungi ridden field

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One of the things Enise (uni mental health advisor) said to me in trying to convince me to reconsider antidepressents, and it’s something I’m coming round to agreeing with, is that there is not reason I should be unhappy. So I ought to change something to let me enjoy myself more and be happy. Perhaps, as I say it isn’t the uni work itself that is upsetting me (evidence against: everyone else can cope, I’m not normally dumb, I’m already doing as much as I can to keep up with it), and I’ve been doing my best with SG’s guided CBT, I need to look at something else to change, like chemicals. And that means a change in medication.

I made up the analogy to help me figure out what I feel like. As I’m studying landscape architecture, it seems apt to think about problems with vegetable crops (and yes I’m weird):

I feel like I’m a field of soil with a fungal problem: if the crop were being damaged by caterpillars, then you can see them and could go out and kill off the caterpillars. But if you have a fungal disease in the soil, the crop will die off even though there is nothing visibly wrong with it. And for a fungal disease, you can’t go out and manually pick it off, you have to go after it with horrible fungicidal chemicals. aka anti-depressants. Similarly, if you have a fungal disease in the soil, if you trashed the affected crop and replant the following year, you’d end up with just the same problem in the next crop as you haven’t dealt with the root of the problem. aka if I deferred the modules I am taking this year, I would still be just as stressed by them next year, unless I change how I am feeling now.

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