The bad idea is to give a slightly detailed update regarding my medical/mental/existential shit on the absurd presumption that it might be of some interest or service to do so. I am not entirely sure what brings such a presumption into being in my mind, and speculation is error-prone. I'd best just get on with it. (The first typo I caught while writing this was kind of funny. I wrote "one" instead of "on" in the sentence previous to this parenthetical note.)
The sweeping and misleading statement I am likely to use when sharing a link to this is "I'm off my meds!" More accurately, over the past month or so I have been gradually reducing the dosage of one of my psych meds, Sertraline (generic for Zoloft, broadly classified as an SSRI), and as of this writing I have been on dosage of zero for one week. The general "rule of thumb" (stupid, to me, sounding euphemism, of which I do not know the etymology, yet I am using it) my psychiatrist gave me was that with each reduction in dosage, I should know what that feels like after a week. I have decided to err my expectations more cautiously, so I don't expect to know for another week. Similarly, each increment of dosage reduction along the way to zero was at two-week intervals.
How do I actually feel? Similar to my own expectations, I feel not very different from how I felt when on my highest dosage (150mg/day). There seem to be differences, but I am cautious about trusting and reporting such perceptions and life is subjectively a chaotic bombardment of unpredictable variables that can skew my perceptions. Life might be solidly deterministic, but since I don't believe that it is possible for me to know this with certainty, the subjective experience of chaos and choices is all I have. How I may feel differently is better prefaced by an explanation of why I did this.
Why did I do this? I am not confident that anyone fully knows the mechanisms of the brain, not the mechanisms by which introducing specific chemical compounds may effect change. There are some fairly simple-sounding explanations of how and SSRI works and what it does, but I am among many who find that the subjective experience does not match the expectations implied by such explanations. There is a remarkable consistency between my experience, and those anecdotally reported by many others being treated by this, and similar, drugs.
I should avoid undue drama in my report of SSRI use, mostly because the primary effect I seem to notice is a distinct lack of drama. The drug that is intended to make me feel less bad, maybe even more good, made me feel less everything. In many ways, this was a tremendous relief. There are many emotions of which I was content to be free. Anger, irritability, rage. These I do not need or want, and the bargain of losing everything else seemed fair enough, for awhile. Even the complete loss of libido was freeing. People do some of the most silly, dangerous and hurtful things when enslaved to the drive to procreate. From the outside, the whole thing looks like a tragic/comic opera of foolishness.
Over time, while on the higher dosages, two things happened. First, I began to notice that I had less love, the hard-to-define unselfish non-sexual kind of love, the existence of which is subject to debate, but in which I personally believe. Perhaps a better word would be "kindness". Oddly, in my dull way, I also began to miss sadness. Things happened that would once have made me cry only elicited an intellectual acknowledgement that something sad had happened. Worst of all, for me, the urge to sing was gone. I did not sing along with songs, nor sing extemporaneously as I once often had. My interest in music was still strong, but I found myself gravitating towards music more intellectual than emotional, appreciating the cleverness of the construction and the precision of the performance. I have always had that kind of appreciation of that kind of music, but to me, there seems to have been something more that was no longer accessible to me. Also, hopelessness was as present as ever, it just felt more normal, like a simple acknowledgement of the true nature of existence. No delusions remained to dissuade me from grim resignation, yet it also had no edge, it did not hurt. It was like I was already essentially dead, just running out the clock, and was scarcely concerned about it.
The other thing that happened was that all of the above gradually happened less, but in a peculiar way I found to be uncomfortable. I regained some access to some emotions, but only some of the ones I least wanted, such as irritability or any number of other imperfect near-synonyms to that word. Hopelessness regained some of it's ability to inflict pain and panic. The strangely comfortable peace of disassociation degraded into a dull yet pervasive and persistent sadness. But my voice did not come back, not even tears came back, just an increasing desire to be done with it all.
A simplistic way of putting it would be to say that it felt like the drug was no longer working. It never worked as one might have hoped, but having found acceptance of the way it did change me, I was now gradually losing even that, and gaining nothing I held of value.
A different drug was suggested, based upon some enthusiastic anecdotal reportage from exactly one patient. Both my psychiatrist and I were dubious of the prospect of the long and difficult transition to this other, also much more expensive, treatment.
Ultimately, however, I decided that whatever alternate treatment may or may not follow, there was little to be lost in the experiment of slowly separating myself from my then-current SSRI.
So now I have done that thing. What have I gained? So far, just a few tears and some occasional singing, but only when alone. A lot of the symptoms of "Major Depressive Disorder" have returned, and require constant, exhausting effort to manage. Oddly, I am largely unable to stay asleep or awake continuously for more than two or three hours at a time, so the long hibernations of depression have not returned, but I sure could use some more sleep. Empathy and kindness, I think, have improved. I still have unpredictable bouts of irritability, but not intense or frequent enough to be very alarming, just unfortunate for anyone subjected to it.
What is next? My current state does not seem sustainable for any reasonable amount of time. I am even more averse to pharmacological options that I had been in the years I had resisted before surrendering some years ago. I have a lot of experience with, and doubts about the efficacy of, talk therapy. None of them ever seemed particularly interested in their profession, much less their patients, and I was a particularly discomfiting patient, referred repeatedly from one to another like a barrel of toxic waste. I am open to just about anything else, even ECT or TMS. Both of those are expensive and lengthy processes, difficult to get covered by insurance if at all. ECT offers both a longer clinical history and more certain unpleasant side-effects, while TMS is newer and it's science is less proven, it has thus far been nearly free of negative side-effects. Then there are the largely unproven fringe science electric snake oils of tDCS, tPCS and tRNS. In this particular alphabet soup the "t" is for "trans" or "trans-cranial", and they are all low-current forms of purported brain stimulation applied through electrodes on the head, usually at home with a purchased or home-built device. The simplest and most dubious of these is tDCS, which is essentially plugging a 9-volt battery into your head. All of the others use some form of low-voltage alternating current, in a myriad of special frequencies and wave-forms with a Tower of Babel of claims of efficacy exclusive of one-another. Oh yeah, and there's also currently-experimental and terrifying DBS (electrodes surgically implanted in the brain) and the very unpleasant-sounding VNS (Vagus Nerve Stimulation).
I am likely to try something stupid but relatively harmless such as tPCS/tRNS next. I already burned my temples and gave myself a headache, over a year ago, with a tDCS device I bought through eBay from some former Soviet-Bloc country.
As a bonus anecdote, and speaking of the Vagus Nerve. One week ago my wife suddenly passed out in the middle of dinner at a restaurant, and was pretty out of it for an hour or two after. This resulted in endless hours in the ER and then 24 hours in the peculiar lesser nightmare called the CDU (Clinical Decisions Unit), and many tests resulting in a pseudo-diagnosis of some sort of spontaneous action of the Vagus Nerve, which conveniently cannot be proven or dis-proven by any test, but which also does not very neatly fit the full symptomology presented. Further testing is pending.
One more thing, just to round this out. I am in fact still using another psychoactive prescriptive, known as clonazepam, generic for klonoptin, and just one of many drugs in the class of benzodiazapine tranquilizers. This, as has been repeated in previous blog posts, is an anti-convulsive prescribed off-label for acute anxiety. I continue to take the legal limit of 4mg a day in a series of four equally-spaced, on a good day, doses of 1mg. Halfway through my reduction of my SSRI, I got cocky and tried tapering off of the clonazepam, with absolutely terrible results. This stuff is kind of like Heroin, in that there is no easy and safe way off. Besides, I don't think it has much if any bearing on the issues related to SSRI usage.
Now aren't you glad you skipped to the last line instead of reading all of that shit?