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.

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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!

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.

11th March: An awkward meeting

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This morning I eventually went to a meeting with one of my module tutors and Enise (uni mental health advisor), at the uni med centre. I felt really ridiculous that I’ve let my stress over uni work reach that stage. But I know that I haven’t chosen for it to get that bad, and the meeting itself was probably useful. I walked to the med centre with the uni tutor, and it was a nice opportunity to chat a bit. He normally sees me around my work, when I am almost always stressed, so it was a chance to talk about something else for a bit. I really want to get across that I really hate the way I’m letting uni work get to me so much, and that fact is stressing myself equally as much as the work itself. Not sure I made my point as all I can think about at the moment is work stress!

I can’t remember what we actually talked about in Enise’s office. It’s all a bit of a blur. I know there were some tears, but I’m beyond feeling embarrassed about that now, in front of anyone. If I felt fine then we wouldn’t be in that awkward situation in Enise room!

I know at some point Enise asked me about me coming off the sertralines. I’d seen the dr earlier in the week and told him I didn’t want to be on them anymore, so he gave me advice on how to taper off them. I was half expecting him to protest, but I guess there isn’t anything he can say. Enise made it clear that she didn’t think it was a good idea, right now, but she couldn’t argue either that they were doing me any good! It was slightly awkward discussing that with my tutor in the room, though I think he found it more awkward than me! He definitely saw me taking my pills one morning, after I’d slept over night in the studio so was looking pretty rough, and he questioned if they were ProPlus pills. I gave him a good roll of the eyes and he shut up after that. If he didn’t know what they were then, I’m sure he made the connection  after Enise questioned me about the sertralines.

At the end my tutor asked if he could have ‘a private word’ with Enise. I was fine about that, though I haven’t a clue what he could have thought up that was so ‘private’, especially after the sorts of things Enise had been asking me in front of him. After he finished talking to her, Enise called me back in, mostly to make sure I was utterly clear that she thought it was the worst time for me to think of coming off sertraline, and that I must be crazy. Um yah… She also reported that my tutor had told her that he thought I could still be heading for an A/distinction overall, if only I’d believe in myself and have confidence. Either that comment was meant to be top secret and he told her that ‘in private’, or else she made that up anyway. He’s never told me that I could ever reach those grades, and that comment has only piled on the pressure. I thought that Enise at least knew me well enough by now to know that a comment like that isn’t going to boost my confidence at all, and only confirms that since I’ve lost confidence (it seems easier to work with that fact than to exhaust myself trying to fight it), I’m bound not to do well.

Sometime later this afternoon after I was back at university, Enise phoned me again, again reiterating that it was a bad idea to come off antidepressants (yah okay, I’m get the message!), but how about trying mirtazapine? I had to agree with her that my concerns were mainly specifically to do with the sertraline/Zoloft, rather than antidepressants in general. She said let my dr know I’d agreed to try it. Right. Okay, I guess I have done in that case? Hmm.

I’m going to research a bit about mirtazapine before I blindly swallow the pills.