SNRI discontinuation laugh riot

...all your brain are belong to us sprach die möwen. "My brain hurt like a warehouse," sang Bowie.

Depression is the single most expensive disorder faced by Western societies and antidepressants are among the best selling drugs; yet modern antidepressants are no more effective than the first generation and electroconvulsive shock treatment remains the most effective treatment for turning that frown upside-down. *

Pinocchio! So this is where I find you! How do you ever expect to be a real boy? Look at yourself. Smoking! Playing pool!

– Jiminy Cricket

Sex during SNRI discontinuation is like the first time – if you lost your virginity concussed, held up against an electric fence in a rainstorm. During the relationships, flings and longer first dates of the last six years I’d gotten used to the numb pounding of dutiful copulation; I knew I should have been enjoying it more, and sometimes a girl would go the extra mile, but more often than not sex was there just to remind me what a worthless bloated addict I’d become.

So this recent withdrawal was fortunate, at least for me – my partner was forced to witness the gross see-saw between agoraphobia and mania while I was still inside her. I mean, Jesus, what’s the good of being cored out and numb enough to face your pals and the world around them if your malfunctioning ape brain can’t feel joy in the driving force behind our survivability as a species. Does this sound like the life of a man on ‘happy pills’?

Yeah, but this is more black bile about bad medicine, right? If you’re sick of my rhetoric but invested in the subject then skip to the bottom for useful links – you won’t hurt my feelings.

When I started writing this it was week one of the mindfuck carousel and it felt important, like my experience was a matter of psychology and pharmacology that could help others like me. I had more energy – albeit the filthy kind you’d get hitting a dog speeding in a rented car – but that turned out to be just the first of several stages, 7-10 days each in length, each with distinct and separate themes – the familiar dressed differently – like Disneyland only with mania instead of a monorail.

Well welcome to month two since I quit Venlafaxine. The truly refreshing creative compulsions have been replaced with humdrum depression – a lack of joy or good feeling about absolutely everything. Despair isn’t a word I throw about lightly, but I get that feeling watching the news and I get that feeling when I’m frozen still, staring off into the walls; I’ve forced myself to finish this guff with an uninspiring cocktail of pills and drinks because I want it out of me and away although I don’t feel I deserve to make the grand sweeping statements I’ve prepared. There are lots of other people out there searching the internet for answers so I hope if I can’t offer some kind of empathy then at the very least someone will get a laugh. I want the mania to come back, I hope this is just a low ebb, I’m certain of it, somehow.

Why stop the poison? Haven’t I stopped before? Well I did write about tapering off Zoloft in 2012 after my Nan passed and I moved back to Scotland but what I kept quiet about was how, a month or so later, something dark twisted in and around me and I was daft enough to tell my GP. Yes, dear reader, I’m a big fat fucking faker; weak and weird and deceitful; a loser of proportions so gargantuan they are trumped only by my irrelevance. Sorry, but I did include a disclaimer that time – there was an asterisk and everything.

Anyway, eighteen months or so later and I decided that I would rather, now and again, have a phantom grip run a tanto blade across my arms than make another lover feel useless for dealing with the paradoxical side effects of my antidepressants. It’s been six years of different doctors putting me on a plethora of psychotropic poison; the last one recommended I try SNRIs this time around. N is for Norepinephrine(US)/Noradrenaline(UK) – same substance but with Greek/Latin origins respectively. Useful to know when reading up.

This is where my understanding breaks down – SNRIs recycle that neurotransmitter much as SSRIs did with serotonin but then beta-blockers – prescribed for anxiety – block its action. I don’t get it – I would later ask my GP and she didn’t seem sure either. But anyway, stopping the metabolism of neurotransmitters to keep my mood up works briefly for each different drug until the body adjusts and requires a higher dose. The higher the dose, often the higher the severity of the side-effects and eventual toxicity. The recycling felt like the neurological version of drinking my own piss, and not in a good way, like on a mission to Mars, but on a life raft with a slow leak drifting away from major shipping channels.

Stop me if you think you’ve heard this one before but I was initially offered antidepressants in Denmark five months after my first knee operation. I do wonder at the correlation between the figures for usage over there and the regular articles in the British press about how awesome life is there. They must be keeping the good shit for the natives.

So I was caught up in a world where everything was medicalised. You go under the knife and there’s pills for the pain and pills for the sadness, but depression is a stigma so you get pills to make your friends stick around then when the wheat gets sorted from the chaff and you find out who your real buddies are, that reckoning rarely helps your mood, but hey, pal – there’s pills for that.

It’s always quicker for a Doctor to write a prescription than not to. You’re looking for help, this could be the first time they’ve met you and you’re vulnerable, you’ve been conditioned to trust authority so you’ll take what they say as Gospel, or at least I did.

Don’t think I’m saying GPs are all fools and monsters – the vast majority I’ve known have been kind, patient and done everything in their power to help me. I’ve just moved around a lot so it’s hard for them to make a proper judgement not knowing my history. In my experience it’s dentistry that attracts psychopathy – general practice can create that in time but you’ll often spot those dinosaurs long before they get their cold hands on you.

Reverie aside, over these past six years I’ve worked my way through the available SSRIs yet remained a miserable prick. Fortunately during this I’ve been passed back and forth between a few shrinks so the consensus is that Cognitive Behavioural Therapy (CBT) will save me the trouble of lugging a rifle up to the top of a clock tower. Six weeks ago I had my first appointment and although I’d wager most are never as truly mental as their responses to PHQ-9, GAD-7, CORE and LSAS questionnaires suggest, I still felt that arrogant stubborn me would be an uphill struggle for any psychotherapist.

Honestly: Tick clearly within the boxes: Depressed mood; Irritability; Low self esteem; Feelings of hopelessness, worthlessness, but not guilt, if that’s part of that tick box trinity does it mean I’m a sociopath to not feel guilt? But what should I feel guilt for? Oh Christ, there it is. Decreased ability to concentrate and think, Insomnia, agitation, mania ( all presenting itself in this blog) Luckily, no recurrent thoughts of death or suicide, not ‘recurrent’ anyway just idle consideration.

Due to the pair of us having seasonal colds, I’ve so far only met my CBT therapist for three one-hour sessions, but funnily enough it was our initial meeting that flicked a switch in me and made me realise what was happening, and why it needed to stop. It wasn’t what he said, but more what his listening alluded to: Venlafaxine had stuck me in a rut, I was ‘low mood’ but complacent in my stoicism, sharing a converted hill-top hospice with miscreants and poltergeists. If I was a superstitious person I’d say the spirits there that couldn’t move on wouldn’t let me either – after all this was by bizarre unbelievable coincidence where my great-grandmother gasped her last breath. Regulars will remember how I enjoyed the bunnies and the squirrels; it’d felt like George and me had finally got that place for me to tend the rabbits.

Hugs not Drugs, right Kids?!

But no, there was always a revolver to the back of my head, and if I’d gone to my GP she would have recommended I taper my doses down to lessen the severe withdrawal. Venlafaxine is an SNRI with a half-life of only 10 hours, which is why if you even forget one dose you’ll start to get the shivering zaps. When tapering it’s suggested to take a lower dose of an antidepressant with a higher half-life, like fluoxetine, but that junk turns me into a Romero Zombie (although it did stop me biting my nails) so call me a stubborn bastard but I chose just to quit.

They call it discontinuation syndrome only because protracted skullfuck  is unsuitable for the information leaflet. No drug comedown ever tore back the curtain the way SNRI discontinuation has; at least with LSD or MDMA you’re never away that long; at least with a sensible dose of narcotics I always knew that whatever happened, it wouldn’t be permanent.

When I tried to sleep in any condition other than exhaustion, loved ones who’ve passed away would return to me, smile tenderly, then disintegrate into hellfire demons clambering to drag me down into the inferno. For my own sanity I was forced to experiment with sleep deprivation; the most I could manage was 48 hours, but Christ I felt alive. If I hadn’t been making notes I doubt I’d remember much. Thinking back it’s like a strange dream, jumpy and staggered with the grey-green rectangle splashes of bad encoding, like a movie recorded from the side of a cinema with a camera phone and a disruptive audience.

There is good news: relief from the muscle twitches which just disappeared along with the death of bruxism – that teeth grinding and chewing of the inside of my mouth, those inverse Joker scars that scared even the worst of dentists. That mess grows back real quick, don’t worry.

But while the flesh heals the neurons must realign, with underwater shocks and unstoppable yawns like bad influenza with a nose stuffed with bus exhaust . Fear was stopping me accepting the world, it was fight or flight in the supermarket, the blind panic of the lunatic; hippocampus shrivelled, socially retarded. Loud rock music brought my thoughts to the surface and shut the noise out leaving the one steady line of inner dialogue that I could deal with without all the rats, bats and gibbering cats of hysteria.

Mood swings and shame, frustrated social embarrassment, sensitivity to ordinary banter, limited concentration and sorry, what was I saying? Faced with ‘guess that smell’ and dried botulism ejaculate in the shared microwave I came close to throwing that wretched fucking box across the kitchen – that level of irritability isn’t right, is it?

Oscar season is an emotional time for discontinuation. Anything designed to pull at your heart strings will tear you to weeping pieces or break ribs laughing. Be careful reading about teen suicide on the bus or any of the heartbreaking knee-jerk headlines regarding racism, homophobia and paedophilia – which is all the British seem to do these days – all will foam up that microwave rage.

And the lucid dreams and fevered sweating night terrors are something to behold. Don’t fall asleep during a documentary about superluminal space travel if you don’t want Lovecraft skullfucking your REM sleep. The terror, like the microwave anger, is palpable. Realignment of neurons is like pieces of Lego littered across a dark staircase and the father that never raised you is drunk, barefoot and terrifyingly erect.

This is why I walked, as soon as the sun came up, if I’d slept or not, as long as I knew there would be people out there – other humans going places before some swine came along and ruined their day. Together with the crawling things out the corner of my eye, I had those brain zaps to contend with, like the pressure of soaring blood when your plane lands heavy, when you’ve been travelling for a day or two, breathing in recycled air, eating recycled food, meeting recycled people. Like if you held a shell up to your ear during a riot.

When I did pass out I woke up at 5something but it’s dark outside so there’s no way to tell if it’s morning or evening. The dark thoughts were like quicksand and not my own, the alien concerns, responses and passions were a virus, my brain kept jabbing my consciousness: “You’re lucky to hit the far wall of the range but that wouldn’t matter with your tongue on the barrel…”

I took a copy of the Watchtower from a guy on the street that week, he had a death grip on it like he wanted to talk, I felt his stare but I didn’t want to see how delusion can put more spark in a man’s eyes than self appraisal and despair.

I became addicted to incremental reward based first-person shooters – just thirty more headshots and you’ll get a laser sight for the 9mm – stabbing a member of the opposing force through the heart with a bowie knife thus botching their C4 tank ambush will raise the adrenalin just enough to stop you hating yourself. For everything else there’s Wild Turkey and painkillers.

Week Three and I’m losing my fucking mind; every now and then I quantum leapt into someone else’s diseased brain without actually solving the last one’s problems. I needed to get out, the paranoia was back, everyone was staring, I didn’t deserve to be anywhere. I walked around Glasgow in the rain, grinning at the old memories, better for the change, but should have gone to the Lego shop after the War and Conflict exhibition at the MoMA. Later I had a frustrated breakdown at the till machine in Tesco, manic and on a knife edge. I went home and drank the wine.

Another ten days passed and much of the physical side effects had abated. I continued scanning drug forums and research papers for information and support but the trouble with that approach was I kept reading until someone told me what I wanted to hear: “Diazepam, Codeine and Single Malt? Sure, fill your boots, Son!” Promising results with ketamine and MDMA in double-blind depression trials? Well hook me the fuck up, Pablo.

OECD figures put levels of antidepressant usage pretty damn high, raising concerns about appropriateness.  I came to the conclusion that in many cases the medicalisation of melancholia is often a bad thing. If our doctors aren’t on the ball with big pharma withholding or distorting trial results then through no real fault of their own they could be relaying propaganda to patients, therefore prescribing psychotropic poison that in many instances may be completely unnecessary when what most people need is just another human being to talk to.

“The idea that depression is caused by low serotonin levels in the brain is now deeply embedded in popular folklore, and people with no neuroscience background at all will routinely incorporate phrases about it into everyday discussion of their mood.”

Bad Pharma author Ben Goldacre says that this theory is wrong, that the serotonin hypothesis for depression is shaky and the evidence for it contradictory. I can’t recommend that book enough, nor the preceding Bad Science. He’s done a great job of making medical science accessible to dumb shits like me.

So I have trouble talking to people and making friends, but only because I’m shy, manic, inhibited and kind of a dick but depressed? Shit. Personally, I never knew depression before I began SSRI treatment. I’m an only child and like my parents before me I had a fucked up childhood – there was medication in the home but it didn’t seem to be helping anyone.

Five weeks into cessation and I felt I had to make a doctor’s appointment. Aghast that I’d simply flat-out stopped taking Venlafaxine she prescribed a week’s worth of diazepam to take the edge off the tail end of withdrawal. Thankfully the veil had been pickaxed away and Edinburgh felt like a new town, one that felt like a good place to be. I took the script anyway, sometimes I feel too much, and I don’t know if that’s the withdrawal or simply normal me.

In the end, GPs can be flawed and biased and ignorant, but they’re often the fastest and best professional contact we’ll get. I would think that there should be regular check-ups for people on meds, and maybe I fell through the woodwork since this new doctor seems firm, fair and invested. But every six months or so, without fail, I’ll get called in for a check up with an asthma nurse; for example, If I’m taking too much Ventolin it can, over time, damage the structure of my lungs – much as psychotropic meds will for the ol’ brain thing. In the world of socialised medicine, there just seems to be way more asthma nurses than shrinks. I wonder why…

Antidepressant use can have permanent detrimental effects long after cessation and the evidence for their efficacy is shaky since, in part, depression is such a motherfucker to pin down. But don’t throw the baby out with the bathwater: SSRIs are a godsend if your depression has you in tears, it will give you a new lease of life. Don’t let me put you off them if you’re a risk to yourself or others, but if we’re talking about depression as a symptom of social anxiety then ask yourself why you’re seeking a chemical cosh in the first place.

Are we throwing pills down our neck due to debilitating depression or simply in order to fit in. Perhaps we’re medicating because we feel like a socially embarrassing threat to others? Then who defines that threat? Is it the others or the others as we see them in our mind’s eye? We can’t always trust our friends, they’re just as flawed as us, and we shouldn’t have to try to appease them by medicalising our moods.

If you do take medication and it makes you feel better, then keep taking it, but if it doesn’t, or it stops making you feel better, well talk to your GP. If you find you’re on the pills for more than a few months then don’t be like me, try to find a professional to talk to, because if they aren’t making you well enough even to approach a shrink, then they aren’t worth shit.

I spoke recently with my ex who told me I was a disrespectful, cold prick when on meds, but that I seemed nicer now. We came to the conclusion that it was the numbing effect that knocked my ability to empathise with others out of me. Then we drank some vodka.

I’m not going to start suggesting exercise and temperance but cod-liver oil and vitamin D seem to help my brain. Look it up, don’t take my word for it. Fruit and veg, sure, that’s what they say, right? Try drinking apple juice with your vodka – the good stuff, not from concentrate, especially if you have a guest over. Don’t laugh, but I found going for a bike ride along the canal and feeding the birds helped me immensely; I even bought proper swan and duck food since bread is bad for them.

I could never bring myself to go to a support group because of the guilt, I mean this is depression, not cancer and I mentioned before the waiting lists, so it felt like I was troubling to ask for even perfunctory help. Is that so fucking English? I know how it can be though if you can’t leave the house, when getting two pizzas delivered and watching a whole season of Boardwalk Empire is preferable to showering, but getting your thoughts together really helps. Write or draw or crank your amp up to 11; move your furniture around if lifting weights feels ridiculous; play with your pet, dig the garden or capture the flag just don’t kill yourself – don’t let the bastards win; don’t give them the satisfaction of watching someone from the council waterblast your blood off the pavement on the evening news.

Drink a mug of strong coffee; eat another disappointing cheeseburger; drink too much whisky in the bar and put your hand on the girl’s arse when you kiss her goodbye at the train station; do a line if some arsehole makes you do overtime – these are all addictions you can deal with tomorrow.  Everything can be dangerous if done properly, but I shouldn’t know the calorie content of my cheeseburger before I buy it then the long term effects of my antidepressants months after starting treatment.

I’m holding out on something else. Love perhaps, or the legalisation of cannabis, MDMA or ketamine so I can follow up on some promising studies I’ve been reading about. Either that or a dealer who isn’t a patsy for big pharma.

If I’m losing my mind, I want it to be on my own terms.

 …

I found the following links interesting. Trust nothing, confirm everything, or just come over to my house – there might still be some Jura left.

* Is mood chemistry? (PDF)

Recognising and managing antidepressant discontinuation symptoms

Antidepressant ‘Withdrawal’ and the Problem of Informed Consent

Venlafaxine and Serious Withdrawal Symptoms

Neurobiology of Depression

The Antidepressant Industry’s Dirty Little Secret 

Psychiatry’s Grand Confession 

Marijuana for depression & bipolar disorder 

Ketamine for Depression: The Most Important Advance in Field in 50 Years? 

Michael Moore: Are SSRI Antidepressant drugs causing School Shootings? 

Serotonin theory of depression may be misleading 

And, how I often feel speaking with shrinks 

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