I’m looking forward to Christmas. Most of my extended family members will be coming to our house for Christmas dinner tommorrow, so hopefully I’ll be able to enjoy it without being too anxious. Christmas can be a particularly stressful time for SA sufferers, but hopefully it won’t be too bad.

I’ve been on Fluoxetine for almost two weeks now, and it’s going fairly well. I have had quite a few side effects (twitching, yawning more often, an upest stomach, feeling sick when I eat, and a weird feeling like a jolt going through my whole body at times) but nothing to be too concerned about. I’ve been feeling much happier lately, I’m looking forward to Christmas and have been enjoying myself in the snow.

Here’s wishing a Merry Christmas and a very happy New year to fellow SA sufferers in particular.

I’m back in work!! I am an officially functioning member of society once again. I get up, go to work, do my thing and get paid….MONEY, ACTUAL MONEY!!

Please don’t make the mistake of prematurely congratulating my achievement, it’s a god damned nightmare.

So let me tell you what’s going on…

I work for a fairly big food retail company in England (Not maccas or burger king). The benefit of working for a large company is being privileged enough to indulge in a mental illness with 28 weeks of some sort of benefit. My 28 weeks ended at the beginning of October therefore forcing me back in to employment. I was assured many times that i would be looked after and ‘eased in’ to this difficult change in my life. So I relaxed a little, safe in the knowledge that I would be watched over by my superiors, etc.

Never did I realise that being ‘eased in’ would involve being placed in the busiest shop in the city working for a manager that can only be described (politely) as unreasonable. See I’ve been placed in a shop where every single member of staff has a transfer pending due to the intolerable manager.

Is it wrong of me to see it as unreasonable placing someone who has been suffering depression and severe anxiety in this environment?

It’s true, I am just another robot contributing to the financial gain of the company on a minimum wage, I expect nothing less in such a job. Though surely if they wanted any kind of progress and lack of absence from me they would have placed me in a more stable environment, not somewhere the aged, stable and world-weary staff are driven to tears on a daily basis?

And that is the least of it.

I phoned my aunt on Monday night and what she told me did help me a little bit. From what she has told me, I believe it’s very likely that she suffered from social anxiety when she was about my age, although perhaps not quite to the same severity as me. She told me that she remembers worrying about other people judging her, feeling inferior to others, and feeling nervous and overly self-concious around people. If you met her nowadays, you’d find it hard to believe that she could ever have felt anxious around people. She is very outgoing, has many friends and seems confident and assertive. Her job (nursing) also means that she has to talk to many different people every day.

She told me that she went on medication (antidepressants, but she couldn’t remeber which type) for a couple of months when she was about sixteen, but felt that it didn’t really help, and that she wanted to overcome her depression and low self-esteem on her own. In terms of side effects, she remembers suffering from headaches, her mouth feeling dry, and feeling a bit peculiar at times, but nothing too serious. She also told me that she felt that Cognitive Behavioural Therapy helped her more than the medication did. She remebers seeing a nurse for CBT, and feeling much better afterwards (despite the fact she only saw the nurse three or four times), due to the fact that it changed her thinking pattern and helped her to see things from a more positive point of view.

After splitting up with her long-term boyfriend in her thirties, she went on Fluoxetine, and felt that it really helped her, and that sides effects were minimal. I’m feeling more and more like I will give Fluoxetine a try, but I still wonder if it can help me if anxiety is the underlying cause of my depression. As I suffer from bouts of depression, I also worry that the medication will make me feel worse during the times I would usually be feeling happier.

From what my aunt told me over the phone, it would appear that Social Anxiety (or at least feeling very shy) is something which runs in my dad’s side of the family. She told me that her aunt (my grandad’s sister) also went through a time when she felt overly self-concious and anxious around people, during her teenage years. That was many years ago, but from the times I have met her, I can see that she too has become a much more confident and outgoing person. My uncle (also on my dad’s side of the family) has also been described as “not really the life and soul of the party”, and still seems kind of shy around people, but he doesn’t avoid social situations or anything. Even my dad (who again, is very outgoing now) was very shy when he was younger, and told me that he when through a phase of feeling like all the passengers where staring at him whenever he walked past a bus.

My mum managed to find me a book on overcoming anxiety disorders and on depression at the library. I read parts of them after tea last night, and feel like the book on anxiety disorders in particular, will be very useful. My aunt also visited us today, and brought down the self-help books she has on depression. As luck would have it, she recently did a course on depression, so she brought a massive pile of books with her (including one on shyness and social anxiety). She also told me that I can phone or e-mail her any time to talk to her about her experiences with depression and low self-esteem.

For now, I suppose it’s happy reading… =]

Fucking psychiatrist I saw on Tuesday put me on Fluoxetine, and I told him there was a reason I shouldn’t be on it. Only I couldn’t remember why at the time. Oh yeah! It’s because I’m on Lunesta! And cyclobenzaprine! And the fucker knew it, as he had my whole medication list in FRONT OF HIM THE WHOLE TIME. And I specifically said to him I had reservations about it, but no. I’m there trying to get therapy, so that automatically makes me incredibly stupid and insane. I am neither. I am SICK NOT STUPID.

I could have fucking DIED last night. I blacked out an hour after taking all my meds, and today was a complete loss. I could barely get to the bathroom and feed myself. And now I’m having an asthma attack.

I ALMOST FUCKING DIED.

Thank gods I didn’t. I suppose I should have gone to the doctor or ER today, but what’s the use? They’d just shoot me up with more drugs, and my symptoms are a lot better now. I’ve had Serotonin Syndrome before, and it sucks, but usually I’m straightened out in a couple of days.

I have no idea what to do. Do I storm in there with my lawyer next week and throw the prescription bottle at him? Do I simply ask for another psychiatrist? Do I say fuck it and never go back at all and just pursue seeing a fribromyalgia doc, because I know I’ll be treated better?

He swore up and down that the Lexapro was obviously not working for me (even though we really have no proof of that, as my anxiety seems to be way down since I started on the Neurontin), and he looked at me like I was a total idiot when I told him I was hesitant to try it. I cannot believe he saw my whole list of meds, and the only thing useful he could tell me was to not take the Lexapro and Fluoxetine together. No fucking duh, asshole! Pharmacist did the same thing! Neither of them had ANYTHING else to tell me! Not how or when to take it, or what not to take at the same time.

Fuckers. FUCKERS.

I’m not taking it again. Ever. Fuck him. Waste of a medication.

I think I’m starting to get over my parent’s divorce, but I think it will only seem real if and when my dad moves out.

My parents and I had another meeting with the psychiatrist last week, who invited along a guy who is supposed to be a specialist in anxiety disorders. He basically told me that medication is my only option at this point, and if I decide I don’t want to take it then there is nothing more that they can do for me. He recommended that I take Fluoxetine for twelve months to help with anxiety and depression, and that they would meet with me every few weeks to make sure that I was not suffering any serious side effects. I’m not really sure about what to do at the moment, as I’ve never taken any antidepressants or anything before, and I don’t like the thought of chemicals messing with my brain (or the side effects, for that matter). Both my mum and I have researched it, and my gut feeling is that I should not take it, although I’m not entirely sure. My aunt was apparently a lot like me she was a teenager, and was put on antidepresants when she was about sixteen, so I will probably phone her tommorrow and ask her what she thinks.

Of course this leaves me wondering what on earth I will do if I decide not to take the medication. The anxiety disorder guy didn’t seem very nice, and I feel that he is more or less forcing me to take meds. He was nice at first, but after my dad left (he had to leave the meeting early to see about getting a council house) he started talking about Fluoxetine like it’s the greatest thing since sliced bread, and how I’d hardly notice the side effects. It’s the first time I’ve gotten really angry at one of the meetings with them, which he probably noticed, as he acted as if I wasn’t there for the last twenty minutes of my appointment, and continued talking to my mum as if me taking meds was her desicion to make.

If my current psychiatrist signs me off, I will be back to square one again, letting my mental health deteriorate rather than improve. Although when I think about it, she hasn’t really helped me at all, in fact she hasn’t even diagnosed me yet. Despite me telling her that I am 110% sure I have Social Anxiety, she still seems to want to believe that I may have Asperger’s Syndrome (which I am 100% sure I do not have). Since June, all she has done is say that I probably have either SA or AS and that medication may help (I could have told her that and much, much more), and I have sunk to a new low after every session with her, wondering why I continue to live if she nor anyone else can do anything to help me. I will just have to hope that I can get reffered to someone else, as I feel that I can’t get out of this on my own.

On a positive note, my parents have been very supportive of me lately, especially my mum. She always helps me to focus on the positive things I have done, rather than the negatives, even if it’s just making eye contact with someone, or responding to someone if they are trying to make conversation with me. She has also told me that she’s seen self-help books for Social Anxiety at the library (something which amazes me, as few people have ever even heard of it), so I might ask her to get them for me and give them a try.

Lately I’ve found that exercise has really helped to alleviate my depression, and have been going cycling with my mum every weekend. I felt the happiest I’ve felt in ages (in fact, I almost felt as if I was high or something) on Monday after going cycling the day before. It’s very difficult to find the energy to exercise when you are depressed, but it’s been proven that regular exercise helps depression just as much as antidepressants do, and I always feel a lot happier (and fitter) afterwards. Cycling is something that I enjoy, so I will see if I can find the time and energy to do it more often.

I love Halloween.  In the southern hemisphere, it’s actually springtime, and the days are getting longer and warmer.  In our neighbourhood, kids go trick or treating, even though it’s a USA tradition, and they’re all excited.  We always make sure we have lots of treats.  SO and I actually were out weeding the front lawn this afternoon, so we got to see all the kids go past, which was great fun.  Plus, it made the time pass a bit quicker.  Weeding the lawn is up there with ironing; it’s a boring task that has to be done.  We’re about halfway there, which is good, as SO’s dad is going to spray the lawn on Monday.

I always make a special dinner for Halloween.  For us it’s Beltane, so we always have a celebration of the season.  Tonight I did roast beef striploin, which had been marinaded, for one and a half hours at 180 degrees C, with roast vegies.  It was absolutely spot on, the meat was pink and tender and delicious.  SO cleared his plate without saying a word, always a good sign.  It’s nice when everything all seems to work when you’re cooking.  Roasts of any description are a bit hit and miss with me, I did a lamb roast the other week and SO was not happy with how pink the lamb was.  It was fine, but he didn’t like it, and I hate having to convince people to eat my food. 

Anyhow, today was a good day.  As well as weeding, I returned a heap of stuff to Ikea, Target, Kmart, Spotlight – all stuff I’d bought at different points which had been the wrong colour, size, shape, you name it.  And I managed to get to Medicare to get some money back from my appt with Dr W, which I then promptly spent on some new tee shirts for me, and a new casual shirt for SO.  I also fit in an afternoon nap, always a priority on the weekend.

I picked up the buspirone tablets on Thursday night and gave them a try on Friday.  While the 5mg helped, I can see I’ll need the 10mg dose.  That’s fine, at least I know now what I’ll need.  And the good thing is it really doesn’t impact on anything else.  No side effects to speak of.  I was still alert and didn’t feel nauseous or anything.  So far, I’m liking them.  I even took one yesterday afternoon before leaving work, as I was feeling sick with stress and wanted to help wind down for the weekend.  It definitely helped.  Today, I feel absolutely fine.  Not stressed at all.  It’s pretty clear that work is the issue, but at least I am able to leave it behind on weekends.

As far as I know, no plans for tomorrow, other than more gardening.  I love getting out there, it’s so satisfying.

I keep thinking that I’m over it, that I’m happy having a great time and have a great life. Then I make myself sick or destroy a razor to get the blade out. I don’t know what’s wrong with me or how to fix it.

Today I actually got re-dressed (I’d put pj’s on when I got in from work) to go to Asda and buy a basket full of sweets just so I could eat them and throw them up. I don’t think I even wanted the sweets. I just wanted to throw up.

And I’m starting to get paranoid about my teeth, I don’t want to rot them with stomach acid I keep meaning to buy chewing gum but keep forgetting. Must get some tomorrow.

This is a bit cryptic for a first post isn’t? sorry, i’ll try and explain myself in a minute. Basically I’m trying to use this blog to help me get better, as my own kind of psycho-therapy. Get all the random thoughts out of my head and stop them spinning around everyday. Finger’s crossed this will work!

I’m keeping this as anonymous as possible because part of my problem is people knowing all about me, i know this is one of my problems but im not quite ready to confront it again. (tried and still haunted)

I’m mostly writing this to help myself but if it helps someone else then thats good at least!

I am in my early 20s, have a job that I love, own my own flat, have a car, finished uni with a 1st class honors degree and I look around at everything I have and think I am really lucky and really happy. But for some reason, against all my stubbornness to be strong and non-stereotypical, I keep falling apart. Falling apart in my own very private, very controlled ways.

Here comes the tough part.

I think a part of me has always been and will always be a little messed up. I was raped when I was 11. I blocked out the memory but through therapy, nightmares, scars and a lot more therapy it all came out when I was about 15. It affected me a lot when i didn’t know what it was though.

I was that kid that every school had; the one that just screamed out ‘me! me! Pick on ME!’ I had a group of friends but i never really fitted into secondary school well. I was quiet, clever and had frizzy hair, perfect bully victim.

When I was 13 I slit my wrists, I had it all planned I even knew what flowers i wanted on my coffin. I didn’t cut deep enough. The next day I took an overdose. I was in hospital for 5 days then put under house arrest when i was released, either my mum or my dad had to be in the same room with me at all times everything that could possible harm me was out under lock and key. I was put on fluoxetine and had to see a psychiatrist once a week.

Only took about a month before someone left the combination on the padlock to the medicine cabinet. From then on I took 2 of each packet every time I could so it wasn’t noticeable. Being careful to put the padlock back and change the numbers. 6 months after my first attempts i took another overdose this time of around 60 assorted tablets and a bottle of tequila (still can’t drink that stuff). I woke up at 4pm the next day lying in my own sick. I realised that my parents were due home from work but i couldnt quite stand up straight I headed for my bike to ride to the woods and die there but i didn’t quite make it.

My mum didnt shout at me this time. By rights i should be dead, they say once paracetamol has been in your system more than 12 hours its irreversible. It had been a good 16 hours before I got treatment. The tequila must have saved me.

Again i was in hospital for a week, then I had to go to a special school at the local psychiatric centre.

I self harmed a lot during all this, I’m covered in scars. Now i think back to the hospital trips I can’t remember much more than how horrible the Doctors and Nurses were. To them i was just an inconvenience, wasting their time when there was real people who needed there help. Which was true but it doesn’t exactly make you glad you survived.

Anyway it took a long time for me to work out why i was so determined to kill myself but once i found out I was even more determined not to be that girl. The one that turns up on Trisha or Jeremy Kyle who has is a drug addict, with 5 abused kids and no job and uses the rape as an excuse for it all. (i know thats a bad stereotype but you know what i mean)

But here I am still messed up, by all accounts i have a great life; i love my job, where i live, all my friends but yet i throw up every meal I make. It takes a lot to wind me up but as soon as I get to that level then its as if i need to do something to relieve it. something that would most likely involve a blade.

I don’t understand. I really want to be well. I have tried everything. So why am i still ruining myself?? I don’t want to be like this for ever but every time i get to a point which i think i am doing great i mess it up. Am I really going to be crazy forever?

So, saw my psychiatrist today.  I’ve worked out why he’s always so happy to see me – he knows he’ll be getting $240 per visit from me.  Crap, I could’ve bought so much stuff with that money…still, it wouldn’t sort out my mental health issues.

Dr W and I agreed that the fluoxetine seems to be working reasonably well.  However, my anxiety is getting out of control.  I know exactly why, it’s because my manager is coming back from leave.  I’ve only had limited contact with her so far, but that’s been enough to send my anxiety levels skyrocketing.  I explained the situation, and asked Dr W if upping the fluoxetine dose would help at all.   He said that it wouldn’t make a difference, but he said that buspirone would sort out the anxiety.

Apparently there are a number of good things about buspirone.  It’s non-addictive.  It works quickly – almost like panadol – and you can take it up to three times a day, depending on how your anxiety is going.  It doesn’t need to be taken every day, just as needed.  And as a bonus, Dr W said that he prescribes it as the preferred anxiolytic (anxiety-reducing) drug for professionals, as it doesn’t alter cognitive function.  So it won’t turn me into a drooling, sleepy paperweight at work, which is ideal for me.  By this point in the discussion, I was jumping out of my chair to get some.  Well maybe not exactly jumping, but I’d stopped crying, which had to be a good sign.

Anyhow, I have the script in my hot little hand, and I’ve got my local pharmacy to order it in.  Apparently it’s a reasonably rare drug, only prescribed by psychiatrists, so pharmacies don’t normally stock it.  And it is expensive – even after my private health rebate, it’s $40 a month.  Still, as I said to Dr W, what price mental health?  I’d pay three times that if it worked and helped me to function like a normal human being again.

My appointment was early and I went straight home afterwards, so I decided to be a good wife and actually cook dinner for a change.  When SO got home I was making spaghetti bolognese (yes, again).  He asked me how it went with Dr W, so I told him everything that happened.  He didn’t say anything but he came up behind me and hugged me as I stirred the pasta.  Poor darling, he’s worried about me.

Okay, I’ve been neglectful again.  I’m sure this comes as no surprise to regular readers.

I’m going okay on the meds.  Up to 30mgs, as of last Monday, so six days now.  Haven’t noticed the increased dosage has made much of a difference, though.  Maybe I need to up it to 40mgs?  Who knows.  In any case, I’m seeing my pdoc on Wednesday, so I can check with a medical professional, rather than guesstimate it myself. 

I’m noticing that while I do still get stressed on fluoxetine, more so than escitalopram, I do have more energy.  I’m not needing a sleep after work every day, or at lunch time.  I’m not needing a nap on weekends.  Today, for example, I was up at 7am, spent all morning running around doing shopping etc, then gardened all afternoon.  I did have a nap, but only for an hour, and I got up and cooked a real dinner (spaghetti bolognese) afterwards.  This is waaaay more energetic than I ever was on the escitalopram.  So yes, my need for sleep has quietened to a dull roar.  While it may still sound like I still need too much sleep, I should point out that I’ve always, always loved my naps, and needed lots of sleep.  With the fluoxetine my need for sleep is about right for me, pre-depression.  So I’m guessing that’s a good thing.

So yes, we spent some time in the garden today.  SO’s stepmum and I planted out a front garden bed, while SO and his dad got some mulch and spread it over the rest of the front garden beds.  It’s amazing how much better the place is looking!  We’ve spent at least one day for the last four or five weekends out there, weeding, planting, fertilising, and hacking back plants.  It’s starting to show - everything looks great.  It makes me really happy to see the gardens looking respectable. 

Things are generally going well, I guess.  While my moods are smoothed out, I’m functioning at a higher level on a daily basis, which is good.  And who knows, an increase in my fluoxetine dose might be just enough to really hit the spot.

What a change a few days can bring.  On Wednesday, I was feeling more crap than I had in over a year.  Today, I feel fairly normal.  I say ‘fairly’ because there was some knotted stomach stuff earlier today; but in terms of my capacity to think, and to do stuff, I’m about a thousand percent better.

Who knows.   Maybe prozac is the one.  I was saying to my work friend P yesterday that finding the right antidepressant is kind of like finding the right guy, but harder.  He agreed.  And as he added, sometimes it can appear to be the one, but over time you work out that it’s not.  Which sucks.

Still, I’m feeling heaps better.  It’s hard for me to believe that things can change in such a short period of time.

I also had a win today.  SO’s dad has recently been diagnosed as having coeliac (that is, he’s gluten intolerant).  As a result, his diet has radically changed.  It seems that most of the food available for coeliacs is pretty nasty tasting, and he’s been miserable.  His favourite recipe that I make is a date loaf, and I decided to try a gluten-free version today.  He came around this afternoon and we had a taste of it.  Well, it tastes great, and he was so appreciative, poor love.  And the changes were easy, too.  I’ll have to post the amended recipe at some stage. 

So yes, that was great, and it was so nice to see SO’s dad smile while he chowed down.  First time in a couple of months that it looked like he was enjoying eating something.

Well, this sucks.

I’ve been doing okay with the med changes.  Some physical stuff, the nausea, the visual stuff, but okay.  However both last night and today, some of the emotional/mood stuff is rearing its head.  I’m getting vaguer, not remembering words for common things, and I have the horrible knotted stomach thing happening again.  And no matter what I do, I can’t relax it.  It really is a physical symptom, but I know it’s a manifestation of anxiety, which is a mood thing.  Ugh.  It sucks.

So I’m not at work today.  Great, my boss must be delighted.  I hate letting her down, she’s so fantastic to work for, and just a great person.  So yes, the self-esteem isn’t the best either.

On another note, we were sitting at the dining table this morning when I noticed a baby magpie in our backyard.  I could tell he was a baby as his black feathers are still grey.  He was wandering around, and not doing much flying (another indicator he’s only young).  Anyhow, when SO and I went outside, he ran over to us.  SO groaned – ‘God, he’s tame.  That doesn’t bode well for his long term survival!’  The dopey bugger was looking for some food, or some attention I guess.  Anyhow, I watered the front garden, and when I came back he was still waiting.  I had a chat with him while he looked at me hopefully, but I didn’t feed him.

He’s still out there, sitting on the washing line.  I think I’ll call him Dopey.

It amazes me how many articles on the internet discuss the impact of antidepressant meds during pregnancy and breastfeeding.  Not that it surprises me that expectant mothers get depressed; this seems a perfectly normal reaction.  (Does that make me weird?)  I understand succumbing to depression while pregnant.  What I struggle with, is people with a history of depression, who choose to go on to have children.

Okay, I admit here that I’m not the most maternal of females.  I suspect if I had my own children, that I would very well end up eating my young, for all the maternal feelings I have.  But truly, the thought of choosing to be pregnant and risking coming off/not being able to take antidepressants, and go through depression without that option, scares me.  I struggle to cope on meds; I can’t begin to imagine what life is like off them, especially when pregnant.

And then, you have the baby.  I would definitely need meds to deal with a crying, helpless little baby who can’t let you know what it needs.  Plus the interrupted sleep.  Oh god, just the thought of the bad sleep is enough to scare me off forever.  Tiredness is the number one trigger for me. 

It’s fine if the only real impact is on yourself.  I can be suicidal and know that my darling SO can still feed himself and go to work, and do everything he needs to.  A baby, on the other hand, needs a competent parent to survive.  And when I’m badly depressed, I can’t look after myself, let alone a poor little baby that didn’t ask to be born into this world to a suicidal mother.

Please don’t misunderstand me.  I’m not criticising women with a history of depression who choose to have children.  I actually think they’re about as brave as anyone I can think of.  It’s just I couldn’t do it, myself.  I’m just not strong enough.

I suppose the reason I’m thinking about this is because all my friends are pregnant at the moment.  I look at them and marvel.  And in the back of my head is a little voice that says, even if you wanted to go there and try it, you’re a good two years away from even being stable on your new drugs.  Thinking about having kids has been pharmaceutically pushed out by a significant time frame.  This doesn’t particularly worry me, but SO may well find it difficult to cope with when it occurs to him.  Poor darling, he loves kids.

So, yes.  Something else to ponder on.

Another day where I didn’t accomplish much.  Did some more laundry (washing and ironing) and some dishes, and I made SO lunch, but that was about it.  Felt very crook this afternoon at around 4pm, so I crashed for a couple of hours.  Woke up and felt considerably better.

My little brother called me in the morning and asked if I could have a look at a property with him, to which I said yes (of course).  We went along and looked at a nice little three bedroom, two toilet stand alone unit in an inner-city suburb.  We both agreed that it looked good, and A’s decided he’ll put in an offer on it tomorrow.  Poor love, he’s a bit nervous about it, but I told him that I’d help him out and it’ll all be fine.  Hopefully, it will be.

Struggling today.  I woke up early and did a few things (some laundry, cleaned one bathroom and toilet) but then fizzled into a lump of stress and ambivalence.  I spent most of the day wandering around, confused, and not getting much done.  I slept for three hours in the afternoon, and woke up unrefreshed.

I’m holding onto the fact that in a few days’ time, I’ll be starting my full dose of prozac, and will be nearly weaned off the lexapro.  Surely once I’m up to 20mg prozac, things will start being a bit easier to face.  Meanwhile, I’m sleeping lots and very grumpy, and SO is fully aware of how things are progressing.  As a result, he did the food shopping today, and organised dinner.  He’s a darling.

Well, I wouldn’t say I’m sailing through my med changeover, but I’m getting there.  I’ve been okay this week, although I went home early on Wednesday as I was feeling pretty nauseous.  In fact I’m feeling pretty nauseous now too, but I’ve worked out I’m not going to throw up, so it’s going to be okay.

I also decided I’d speed up the changeover a bit.  Instead of altering the dosage every seven days, I moved it to every five.  This will just get me to the end of the process that much quicker, and I couldn’t see how two days would make that much of a difference, so thought I’d give it a go.  Seems to be going okay so far, so all good. 

I am looking forward to getting to the end of the changeover.  My mood seems pretty good, generally; I haven’t sunk into the depths of despair, and I’m still functioning pretty well at work and at home.  Work has actually been full on this week, lots of stuff happening, and I’ve handled it well, which is a great relief, both to me and my boss.  It’s mostly the visual disturbance and nausea that’s giving me the hump.

Another study (this time in the BMJ) finds an increased risk in heart defects, the severity of the risk depending on which SSRI you took. I see no mention of Paxil, which is curious in and of itself. (See: Paxil more powerful teratogen than Cocaine, court documents from the first Paxil birth defect trial, and other related articles concerning this trial on the Seroxat Sufferers blog. By the way, thanks to Fiddy for embedding our @pledgie “Stop Preventable Infant Deaths and Birth Defects” link!)

Also they seem anxious to let other birth defects off the hook and to regard not using SSRIs as not getting treatment. That’s ridiculous considering antidepressants can barely be considered to work at all and that they can actually make you worse and induce violence. How well do they work when your baby dies because of them? Are you supposed to feel happy if you keep taking your drugs?

This study seems to indicate that “about two” babies per 250 women who took an SSRI were born with a heart defect. I assume (though I haven’t read the study yet) that nobody looked at the heart defects leading to abortions or that they were not thinking about the babies who had so many other defects that they died in utero or after birth from some sort of “syndrome.” Probably like in other studies they would have excluded those babies with genetic problems that were linked to heart defects and multiple other defects, without considering if the rate of genetic defects was higher in the SSRI exposed group. If you don’t count all the miscarried babies either and you try to look at each individual type of heart defect and birth defect separately you can pretend the risk is small. But if you group all the risks together the supposed benefit pales in comparison to the risk. We know that antidepressants usually work about as well as a placebo (about one third of people showing mild improvement). But we also know that one third of women who expose their babies to antidepressants have a baby who is born early or underweight, who has seizures, or who dies (“women who take SSRIs have an increased risk of giving birth to a fetus who dies, having a premature delivery, giving birth to an underweight baby, and delivering babies who experience seizures. According to the study almost one-third of women on SSRIs experienced at least one of the complications”). So think about all the risks you would be exposing your baby to and then ask yourself if that’s depressing.

According to just this study, on average about two out of every 250 women taking SSRIs had a baby with a heart defect, compared to about one out of 250 who did not take SSRIs. But the same study said that the risk was more than three times higher with Zoloft than the non-exposed group, more than doubled with Celexa, and almost five times higher with more than one SSRI.

“Sertraline more than tripled the risk, while citalopram more than doubled it. Using more than one SSRI nearly quintupled the risk of the heart defect.”

According to the drug label, 1/100 to 1/1000 is an “infrequent” event, and fewer than 1/1000 is a “rare” event. “Frequent” means it occurs in at least 1/100 patients or more.

Two out of 250 is the same as .8 people per 100, or .008. That’s pretty close to bordering on the drug companies’ version of “frequent.” It’s definitely not in the rare category. But with Sertraline (Zoloft) it would be .012 or 1.2 babies per 100 babies, well into the frequent reaction zone. This is just one study and it’s hard to say without having read the whole thing how they came up with their results or what type of heart defect they looked at. I will update more later as I have time to do more research.

To see reports to the FDA of birth defects and deaths with psychiatric drug exposure go here: http://www.cchrint.org/psychdrugdangers/MothersAct.html

See Dr. Tracy’s commentary on the drugawareness.org website here.

http://www.reuters.com/article/healthNews/idUSTRE58O39F20090925

Antidepressants in pregnancy up heart defect risk

Fri Sep 25, 2009 9:58am EDT

By Anthony J. Brown, MD

NEW YORK (Reuters Health) – If you take antidepressants such as fluoxetine (marketed as Prozac) early in your pregnancy, you may be doubling the risk that your newborn will be born with a heart defect, according to a new study.

However, the vast majority of children born to women who take such antidepressants – known as selective serotonin reuptake inhibitors (SSRIs) – do not have such defects, the researchers are quick to note.

Earlier studies have tied SSRIs during pregnancy to heart defects, but also to even more serious birth defects. According to the new study of nearly half a million children born in Denmark between 1996 and 2003, however, only heart defects are likely to be associated with the antidepressants, note co-author Dr. Lars Henning Pedersen, from Aarhus University, Denmark, and colleagues.

Along with fluoxetine, sertraline (marketed as Zoloft) and citalopram (marketed as Celexa) seemed to increase the risk more than others, as did using more than one antidepressant at a time, according to the report in the September 25th Online First issue of BMJ.

Overall, SSRI use in early pregnancy, defined as 28 days before to 112 days after conception, doubled the risk of a particular kind of heart defect involving a piece of tissue that separates parts of the heart.

Sertraline more than tripled the risk, while citalopram more than doubled it. Using more than one SSRI nearly quintupled the risk of the heart defect.

However, the number of children born with such defects was still quite small: For about every 250 pregnant women who did not take SSRIs, one infant was born with the defect, while about two were born with the defect for every 250 women who took one SSRI, and four for every 200 mothers who took more than one.

Pedersen told Reuters Health that the results surprised the team.

Still, in an accompanying editorial, Dr. Christina Chambers, from the University of California, San Diego, comments that doctors and patients “need to balance the small risks associated with SSRIs against those associated with undertreatment or no treatment.”

SOURCE: BMJ, online September 25, 2009.

Today was a public holiday, and we put it to good use.  SO and his dad did a fair bit of weeding in our front garden yesterday, so today we followed up by planting new plants (all free, courtesy of the in-laws’ prolific garden), throwing some wettasoil about the place, and fertilizing with sheep poo.  SO and his dad did most of the hard work, while I weeded the lawn and supervised.  SO’s stepmum was also there, giving advice and deadheading various plants that needed it.  After a busy day, the front garden now looks respectable, and hopefully our neighbours will start speaking to us again now that we’re not dragging down the suburb’s property values.

I also visited my mother this morning.  It was all a bit stressful as her fiance J was moving all his stuff in today, so there were family members all over the place helping out, as well as various boxes and furniture, and Mum was not happy.  I find it awfully tough dealing with her when she’s like that as she gets so shrill, it hurts my ears.  And my head.  The good news was, my brother was there, and the moving finished up shortly after I arrived, so we sat down and Mum finally started to calm down.  It took a while, though.  She runs on sheer nervous energy.  However she and my brother are both well (as is J) and it was good to see them.

I’m doing better on the drug switch today.  No nausea or visual disturbances, and I’m still feeling okay (ie. not sinking into the black hole of incapacity to move or think).  I’m also not too short-tempered, which is good.

 Back to work tomorrow.  I’m kind of looking forward to it, and kind of not.

It’s hard to believe that, even at nearly 33, firsts still happen.  Like the first time visiting Melbourne; the first time eating Korean food……the first time switching between SSRIs. 

Today I began my reduced dose of escitalopram (Lexapro) – down to 30mg - and started on the fluoxetine (Prozac) dose of 5mg.  Didn’t feel any different for about three hours, then some nausea and visual disturbance set in.  I dealt with it by having a nap which seemed to help.  Not sure what I’ll do if it continues into the work week, but for now it seems manageable.  Thank god.

I’ve switched from venlafaxine (Effexor) onto Lexapro before, in January 2008.  This was a very long process as I was going from an SNRI to an SSRI, so I had to be almost completely off the Effexor before starting the Lexapro.  This time is different – there’s a lot more overlap between the Lexapro and Prozac.  Also, I’m nowhere nearly as bad in terms of my depression as I was in early 2008.  Thank god, not suicidal this time.

So yes, we’ll see how we go.  I’m still scared, though.

A little less agitated than yesterday evening at the moment, but I’ve had a terrible night’s sleep. I was very wound up all night and couldn’t keep still. My head was flying all over the place. Every time I drifted into sleep I had busy, fast, vivid, strange dreams. I was waking up from them every 30 minutes or so and wondering why I wasn’t doing all the things I was dreaming about and then I couldn’t get back to sleep because my mind was flying off on all these tangents inspired by the dreams. Things eventually seemed to calm down a little around 6-7am, so I did get a couple hours of sleep, but even then my sleep was littered with more dreams.

Part of this agitation may have been exacerbated by the argument I had with my partner last night. The night before I am due to go for an ESA medical, testing whether or not I am fit for work, he tells me I should just go back to work and implies that I am lazy, a skiver and not ill at all. This isn’t helpful.

He was telling me that I should just go back because unless I do, I’ll never be ready. He thinks I am just putting it off forever. He thinks I need to go back and try to work because until I do I can’t be sure if I am ready or not. This is of course true, but I think I need to be showing more signs of being ready before I try it.

There are of course a lot of things to lose by going back too soon and then having to stop working. The loss of my permanent health insurance income being one. I’d have to apply again for it, which is a lengthy process. The loss of ESA will be another factor, if of course they ever give me it. As I am claiming under youth rules I’d have to be off sick for another 6 months before I can claim again.

I suspect that he may in part be pushing me back for selfish reasons. He has of course given up a lot to look after me, but I think it is wearing thin and he doesn’t want to stay at home and care for me any more. I pointed out to him that if I am ready enough to go back to work then he shouldn’t need to care for me anyway and should just go out and get himself another job, but he didn’t seem to agree. The fact he still thinks I can’t be left on my own must tell him I can’t be expected to work. I would likely be on my own a lot in the office and there’s also the matter of getting to and from work. It would be easy to abscond.

My social worker seems to have a strange attitude to my employment. She was asking me if my goal for recovery is to get back to work. For me, the ultimate goal is being well enough to work again and more importantly for me, to go back to the job I loved doing. She seemed disappointed with this and almost surprised. It really felt as if she thought I shouldn’t expect to work again because of my mental health. Maybe she just feels I shouldn’t be working in a high-pressure, highly competitive environment, but for me, working in a simpler job wouldn’t be recovery. It would seem like a poor compromise.

To me her attitude to work seems bizarre. Surely her goal should be for me to return to a normal life, or at least as normal life as possible? I don’t think it should be expected that I will remain disabled and a full-time mental for life? I really fear that will happen and need as much help as possible to stop it happening. I know I have to face the fact that this illness isn’t going to go away and I will have to learn to live with it, but I hope that I will be living a fuller life than this sometime soon.

At the moment I don’t think I’m ready to go back to work. This sudden swing into agitation is a suggestion of that. Last time I tried to return to work I became very hypomanic, very quickly, probably aided by the fluoxetine I was on at the time. Work is likely to fuel this mood and send me up and up. Maybe that would be nice, but I’m not sure I’d be a productive employee.

Even if I hadn’t have entered this mood yesterday, I don’t think I’m ready yet. I am still battling suicidal thoughts almost constantly. Stress would only make these thoughts more urgent and amplify the need to escape this world.

There is also the matter of anger management. I’m not there yet. I have calmed down on a month or two ago, but I am still struggling with bubbling agitation. The smallest thing can send me into rage, wanting to hurt both myself and the cause of the anger. I have to admit I can’t take criticism. It was something I found hard before, but I usually turned it on myself mentally. Lately I’ve been literally hitting back and that is not suitable behaviour for work. I don’t want to be violent and I certainly don’t want to display that in the workplace. It would do nothing for reducing the stigma that mentally ill people are dangerous.

It is these things that I’ll be talking about today at the medical. I need to convince them I shouldn’t be working, yet I’m doubting this myself. I hate being hypocritical. I guess if I do get through the medical it is proof that I shouldn’t be working. If I can convince the DWP, who are notoriously bad at trying to get people back to work before they are ready, then I really must be ill. We will see. I don’t hold my breath.

There is a voice that tells me I am a fraud and I should just go back to work. I feel lazy, sitting around having nothing to do all day. I am trying to occupy myself, but I am not a productive member of society.

I am getting stuff done, but this only makes me think I should be working. Over the past couple of days I’ve embarked on a project to sort out all of my photos and to get them online. I used to have a photo gallery on my website, but I took it down when the domain was up to expire and since uni I’ve been very lazy about my photography. I have literally thousands of images, over 40gb worth. A lot of these are utter rubbish, but I want to find the ones that aren’t and get them out in the open. Anyway, the point of this is I’ve been sitting on my computer sorting this photos out and generally I’ve been able to concentrate on the task in hand. Considering a vast amount of my job is sitting at a computer then maybe I should be doing that and not just sorting out my photos.

I’ve been baking more recently and on Tuesday, I also made a load of home-made chocolates. I managed to do it successfully this time after a recent attempt involved me using semolina instead of sugar. Unsurprisingly the mixture had to go in the bin. They were popular at creative remedies yesterday, with many suggestions of having to sell them or give them as christmas presents.

I had even ventured back into the world of books and reading over the past month or so. I haven’t picked up a book for a couple of weeks, but I was getting there. I was reading stuff and even starting to enjoy it a little. I sometimes had to read paragraphs multiple times or forgot what I had been reading the previous day, but I was getting through the pages.

I also worry about this blog. The fact I can sit here and read and write. Does that mean I should be working instead of just writing about the fact I’m not? If people found this, would they use it against me to tell me I should be working?

This desire to work has of course has been amplified by my mood since yesterday. I have all these ideas of things I could be doing at work. I will not be on a project at first so need to find some internal work I could be doing. I can think of so many ways to improve our company. So many things that could be done and I want to be the person to do them.

There are barriers to returning. My doctors tell me I’m not ready. My social worker tells me I’m not ready. I need to go to occupational health before they will let me go back to work and they may well tell me I’m not ready. When will I know if I’m ready? How can they know?

I saw my lovely psychiatrist, Dr W, yesterday.  (He is lovely, I’m not being sarcastic.)  Long story short, he wants me to go a fortnight on my current drugs as they are, and if I haven’t picked up by then, I have to switch from Lexapro to Prozac (fluoxetine), going up to 20mg per day by the end of the tapering.

Of course, this is what I expected and dreaded.  One of the unfortunate things about mental health drugs is that there’s no specific cure.  If you get an infection, there are antibiotics you can take.  If you have a mental illness, there’s a whole range of potential drug based solutions, and no way to tell what will or won’t work for you.  Even biology and genetics do not act as predictors.  So for example, my mother responded well to Effexor for her depression; it didn’t work for me.  My brother responded well to Lexapro; it apparently doesn’t work sufficiently for me over the medium to long term.

I’m scared.  Dr W outlined a number of different future scenarios with me.  Best case, the Prozac might be ‘the one’ – kind of  like finding your true love, but harder to achieve.  Alternatively, Prozac may not be ‘the one’, but another SSRI might be.  Other options include switching between SSRIs when the conking out process begins.  That is, when the edges of life blur, colours change to grey, and life is an indifferent affair altogether.  Past switching lies the murky ground of augmenting an SSRI with another drug.  I know enough about mental health drug therapy to know that if we get to that point, I will be in a very small group of sufferers for whom there is no really effective solution.

So yes, I’m nervous.  And scared.

Well, of some sort. Don't they look like candy? I think these may be the prettiest pills I've had to take. They're fluoxetine 20mg, more affectionately known as Prozac. I'm so fascinated by this light blue/turquoise color that I had to take a picture.

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