Choosing medication to fight my depression was not part of the plan. In fact only 24 hours before, I was dead set against pursuing any treatment involving medication. I had my own prejudices working against me too, cultivated by the same common denominator of any prejudice – ignorance. When you are looking for a path out of the depths of depression it pays not to be too narrow-minded about the choice. It’s not a case of any path will do, more so that all options should be considered. You owe it to yourself to be informed about any decision, especially one that can give you back control of your life. Like anyone in this scenario I wasn’t of sound mind, not even close, but luckily I didn’t have to face the decision alone.
The day before I went to see a Doctor to finally get professional help, I was messaging one of my closest friends. It was a conversation he and I had repeated over many months when I had first realised I was having problems. He and my wife had both been through the ringer with me at my lowest ebb, trying to push me in the right direction of professional help, without cracking what fragile shell I had left. He had seen the positive effects medication could have, and understood why it had worked for another close friend of his. He broached the subject carefully, being mindful of my track record of shutting down the option without discussion. Maybe his persistence had paid off, or maybe I was too exhausted to counter, but for some reason his argument resonated with me this time.
The trigger for my spiral into depression was an isolated incident, but part of a greater problem. I didn’t have the frame of mind to see it straight on but it was there, slithering in and out of my peripheral vision. I didn’t want to talk about it, I just wanted to take a breath. To me depression is the mental equal of drowning. Slowly being pulled under, unaware of the danger. The water appears calm and still, until you slip beneath – betrayed by a weight you didn’t even know you carried. If you know you are going underwater, you always take a deep breath. When that moment comes unawares, you run out of air and panic sets in. Forget rational thought and common sense, your mind goes into survival mode screaming for relief. I just wanted to breath, the most basic of desires.
The doctor was more understanding than I had imagined. He didn’t seem surprised by what I had told him, and he was reassuring. He offered three options as a starting point:
- Exercise and diet
I was already on a fitness kick so that box was ticked. I had experienced some relief from exercise but it wasn’t enough. The counseling hadn’t felt right for me, and I had given it plenty of consideration. I felt I knew what the problem was, it was trying to think straight long enough to find a way out. So he gave me a rundown of my medication options and how it would all work. His recommended drug to use was Lexapro, which I knew nothing about. I will tell you what he told me, which was informative but incomplete.
What he told me was the brain is not hard-wired. A chemical substance called Serotonin acts as a neurotransmitter, relaying signals from one area of the brain to another. There is a school of thought that a Serotonin shortage, or imbalance, can influence moods and lead to depression. Thoughts effectively get ‘short circuited’, hence why they go round in circles in your head. Lexapro is an antidepressant belonging to the SSRI (Selective Serotonin Reuptake Inhibitors) group which is designed to boost Serotonin levels, producing more brain cells, and allowing the depression to lift. It basically ensures you have enough Serotonin to allow the normal thought process to be completed.
Deciding on the Dosage
Lexapro had it’s own particular challenges and side effects – like most mental health medication it seems. The first task was to choose a dosage. This was arrived at by mutual agreement between myself and the doctor and we decided to start lower than I probably needed. This was to allow me to gauge the effects and also to lessen the side effects at first. I also wanted to avoid being numb to my situation. I needed to have that edge, both to drive me to fix what was wrong, and to ensure I didn’t get comfortable on the medication any more than necessary. It also takes four weeks for the drug to become effective. During that time I would experience most of the side effects and also – get this – feel more depressed. Short term pain for long-term gain, that’s how I approached it.
There may be Side Effects
I read up on the side effects (after I had started on the drug I have to admit) and this was the list:
– Dry mouth
– Increased sweating
– Abdominal pain
– Upset stomach
– Decreased sex drive
– Decreased appetite
– Involuntary clenching of the jaw (seriously)
In the first four weeks I had almost all of the above. After that initial period it whittled down to just a few, but they stayed with me for the full course of the medication. Reading that list it doesn’t appear too bad but during those first weeks they hit harder than you think. On higher dosages they are even worse. If I got any particularly undesirable side effects that could affect my work e.g. dizziness the plan was to try another drug until I found one that fit. I was lucky in that sense, as they leveled out to bearable levels and I only had fleeting days were work was affected. I was left with 4/5 constant side effects in the end.
Impact of the Medication
On the medication I had a marked improvement in the clarity of my thought process. Small problems didn’t snowball, and I felt like I was no longer drowning. I became more proactive and began to research how to resolve my problems and actually look forward to a future. I will be honest about that last point and say there were times I didn’t see one. I will leave it at that, but that is not an exaggeration. I had a dramatic lift in energy levels, and I slept well for the first time in 18 months. I was more social and felt comfortable in the company of others again.
Let me be clear though, it is no miracle cure. I did feel like my old self again but the problems were still there, the medication just enabled me to meet them head on. It also allowed me to compartmentalise when I needed to, leave a problem where it was and walk away to try again the next day. I still had bad days, days were I wished I had chosen a higher dose but everyone has them. The idea is not to make every day golden, it is to give you the strength to tackle the days that are from it. Life is always going to be tough and full of challenges, the medication just helped me learn how to tackle those problems again. Problems that I would recognise for what they were, not problems I weaved into enormous dragons I couldn’t slay.
Coming off the Medication
In conversations with my Doctor he wanted to target a 12 month duration for being on the medication. I thought this seemed reasonable. It would take a month for the impact to be in full effect and resolving the problems was not a quick process – in fact I am still in that process – so a year was sensible. Around 8 months in I decided that I needed to feel a bit more, and that I had the mental strength to take the next step of facing it all without medication. I did a bit of research about people’s experiences coming off medication and how it had been for them. I decided of my own accord to halve my dose, for 2 weeks at first, but only on the my own proviso that I meet up with my Doctor after those two weeks.
I went to see him expecting a minor telling off, but he was happy I had made the choice to come off Lexapro of my own accord, and that cutting the dose was the right course of action too. He wished me luck with it and said to come off completely over the next week or so. I was told I might get some side effects, but not to worry.
Well that was an understatement. A lot of the same symptoms I mentioned from the first four-week period came back with a vengeance, worse than before. I also became depressed for 6-8 weeks after with the only solace being I knew it wouldn’t last this time, not at that level of severity. Finally, I got a little excited and had my first night of drinks since I had been on medication. What I didn’t know was the drug stays in your systems for several weeks afterwards. The alcohol hit me like a freight train and I have no memory of the night. Nothing bad happened but it freaked me out and just added to the misery. Coming off the medication takes you to a place you were trying to avoid in the first place, albeit for a finite period of time.
Make an Informed Choice
What I have spoken about above is not a recommendation to pursue medication as a solution. Nor does it advocate following my path for a resolution to depression, or any mental illness. It is me sharing my experience in the hope that you will consider all options, and that you understand there is no easy way.
I have something I say on a regular basis, it is ‘I am broken’. My wife hates to hear me say it because it makes her worry. It sounds negative and defeatist. I don’t mean it in that way, I mean it as an acknowledgment that there is no complete fix to what this experience has done to me. But in admitting that, it allows me to be free. I can concentrate on trying to live with it and not stumble along looking for a miracle cure. There is no going back, but why would I want to? Everyone has their own crucible in life, it can be anything but it is yours. I write this understanding I am not alone in this experience, but if sharing it helps even one person than it has been worthwhile.
Please remember, professional help is the number one step no matter what your situation is. I cannot stress that enough,and no amount of research or self-help can replace that. If you are drowning in depression and can’t breathe, look for help. As I have said before you are not weak. To have endured what you have takes a herculean effort, but everyone needs help at some stage. If you have read this because you need answers, go to a professional and get them. Take this for what it was meant to be – a nudge and remember, you are never alone.
I discuss my experiences with depression further in this post Positivity from Depression.