To medicate, or not to medicate? That is the question.
I get asked a lot about medication. If I take it, what I take, my reasons for starting it or not starting it. Choosing whether or not to take medication is a hugely personal decision and I’m very happy to write about my experiences here, but please don’t let this sway you one way or another. I’ve learnt the hard way that taking matters into your own hands where medication is concerned is not a good idea. So please make sure you talk to your medical professional about anything medication related. It’s so, so important.
Alright, here we go…
Throughout my twenties, I was offered medication a few times for anxiety and depression, but I never took my prescription to the pharmacy. There were a number of reasons for this:
I’d started feeling better and didn’t think I needed them anymore
I’d be too frightened to take them
I didn’t want the fact I’d received the medication to go on my medical record
I was worried about side effects and permanent damage
I believed I should be able to deal with the problem myself
During one particularly awful patch - when I was living with daily debilitating panic attacks that were threatening the outcome of my teaching qualification - I did actually take my prescription to the pharmacy and receive the medication. You won't believe what happened next. I’d been prescribed Seroxat and that VERY night there was a BBC Horizon documentary on that highlighted the alleged dangers of taking Seroxat, particularly in the young. People my age. It was the first mental health-based documentary I’d ever seen, and I was terrified. I watched it with my mum who was equally concerned, and the medication went straight into the bin. Was it fate? Some might say ‘Yes! Blimey that was a close call, learn from that. No more drugs for you!’. Others would say ‘No! Get them out again, you’ll feel so much after you take them’. That’s the interesting thing about medication. Everyone has a view and it’s almost impossible to get a definite answer about the effects they’ll have on you.
Well versed in magical thinking I was very much in the ‘that was a close call’ camp and I refused to take medication from then on…
… that is, until I reached crisis point after having my son in 2012 (roughly eight years after the above incident).
Taking medication at the time was a no-brainer for me. By that point I would have taken anything to make my symptoms go away. I was in crisis, I had severe OCD symptoms and was experiencing terrifying intrusive thoughts about harming my son. I was barely functioning, semi delusional through lack of food and sleep, and I was desperate.
My Dr, thank goodness, recognised anxiety and I was prescribed Citalopram and a few Diazepam to take to help for when I was really suffering, just until the anti-depressants kicked in.
Although they turned me into a bit of a zombie for the first few weeks, after that the clouds parted, and I began to function enough to get up and about. I was by no means back to my old self, following the latest setback I was terrified of a relapse, my self-esteem was at rock bottom and I needed to regain my weight and physical health. I also had quite a bit of explaining to do to close family and friends who wondered what on earth was happening to me and were more than a little worried.
Jumping ahead to now and looking back over the five years since first agreeing to take anti-depressants, I can see clearly the love/hate, on/off relationship I've had with them and because I don’t want this to turn into the type of article that terrified me 'back-in-the-day', I’m going to start with the positive side.
The positive side of taking medication for me
Medication gave me my life back and I can’t help but admit it probably saved it too. I look back at my decision to take medication as one of the best I have made during the management of my OCD, anxiety and depression. Five years of living a life hand in hand with Citalopram has helped me to experience things I would never have experienced without it. It has given me so many memories, a cognitive photo album full of amazing days out, conversations with friends, hugs, laughs, risks, education… I could go on and on.
I'm pretty sure that without medication, I would have had a very different five years behind me. A lower dose of anti-depressant allowed me to grieve the passing of my parents and my beloved cat and best friend, Archer - prior to that OCD was destroying my ability to do that.
Medication has helped me access the recovery work that was so badly needed. It helped me to gain the courage to do more, and take more chances. I have had the chance to give my little boy the mum he deserves. His life has been full of things we’ve done together and moments we’ve shared, I sometimes wonder how many there would have been without medication helping me to take those first baby steps into recovery.
It hasn’t been all plain sailing however, I’ll share what I’ve learnt and the mistakes I’ve made in the hope it helps you too.
Ok, here goes….
What I’ve learnt about anti-depressants
Trial and error
Trying to find the correct medication and dosage can be a huge pain in the backside. Most of the drugs take a while to build up in your system so a commitment needs to be made for a while before the dosage and type of medication can even be assessed. If you feel awful and suffer side effects you must go through a process of elimination and experimentation to see if it is down to a particular drug, a particular dosage or even a particular combination if you’re taking more than one type of medication.
Speaking from my own experience, I find this process frustrating, and at times totally depressing, but as soon as it works properly and the clouds part a little I look back and believe every second to have be worth it.
In my experience, GP’s tend to prescribe a smaller dosage at first before asking you to increase a week or two in. This is so your body can adjust to taking the medication. If, like me, you have left it until you feel very unwell, having relied on other coping strategies first as a way of avoiding taking medication, then they may choose to put you on a higher dose to start with. If that’s the case, expect to find the side effects to have more of an impact on you for a while.
Taking matters into my own hands
In the early days of taking medication I took it upon myself to lower my dose without talking to my Dr. HUGE mistake!!! I was a mess, it felt as if my body had stopped working properly, worse than any flu I’d ever had, I couldn’t think straight – it was seriously frightening, and it took weeks to get back to my ‘normal’ medicated self. These were in the days before I’d learned anything about the drugs involved or the effects they can have when altered suddenly. I thought it wouldn’t hurt. Man, was I wrong!
So make sure you discuss a change in dose with your medical professional first that way they can monitor your health.
What works for me
As time goes by you will learn how sensitive you are to medication as a whole, and to your particular brand. You will learn what works well for you, but a good idea is to increase and decrease slowly. I’m very sensitive to medication so in my particular case it’s essential to decrease slowly. I can’t handle any more than a 5mg decrease of Citalopram and if tapering off to totally come off the medication, I keep halving my dose until it's next to nothing before taking the last step.
I’ve learnt to ensure that whatever my dose, I get the same amount every day. So for example if decreasing from 20mg to 10mg (I used to do this jump in my early medication days) I would take be 10mg per day rather than 20mg every other day. If I go from 10mg to 5mg I use my pill cutter and take 5mg a day rather than 10mg every other day.
Yo-yoing my dose
Ok, hands up, in the past I have been guilty of increasing and decreasing my dosages way-hay-ay too much. There were two main reasons for this:
I still wanted to be able to heal naturally without the use of medication and
I wanted to have another baby and I wanted to do it medication free.
Looking back now, this was such an upsetting time and I put way too much pressure on myself. I kept tapering off, using a pill cutter to slice off ever decreasing pieces of pill, feeling awful so upping the dose again, feeling better, tapering off, feeling awful and so… the… cycle… continued…
Every time I had to go back on medication it was a huge blow for me and the pressure to feel well enough to conceive a baby and manage throughout pregnancy without medication became too much almost every time. I got myself in such a tangle of thoughts about this, I’d eventually have some form of setback, and given the fact a lot of my worries concerned a second baby, it was usually the harm OCD intrusive thoughts that would return and I’d be off to the Dr’s as soon as I got desperate enough.
Rapidly increasing and decreasing your dosages stops you feeling the peace you could have on a stable dose of medication. It stops you from building up your strength again. It also creates almost a constant state of battling side effects from either upping or lowering your doses.
Be regimental about taking your tablets
Once you’ve found the correct, drug, dosage, combination, time of day to take it etc, stick with it. Try not to let your relief from the worse symptoms make you blasé. Citalopram works best for me if I take it at night before bed. I try to take it at the same time every day, without missing a day.
Store it carefully
I once stored a packet of 20mg tablets and one of 10mg tablets in the same box. I mixed the tablet doses on and off for a week before realising what I’d done. I felt awful as a result of that mistake and it was one I won’t make again.
Stigma of medication
Most of the people I talk to about medication are hugely supportive. It’s a shame if you finally make the difficult choice to start taking them only for others to weigh in on whether they think it’s a good choice or not, but if this happens, I always try to remember these people are trying to ensure my well-being and safety. Do all the research you need to but ultimately, this needs to be your choice.
Some people hate anti-depressants with a passion
Sadly, anti-depressants don’t work for everyone. Sometimes they cause truly awful side effects - including in some cases, tragically, a loss of life. There are campaigns, blogs, posts, you name it, about people whose experiences and stories suggest that antidepressants have the potential to destroy lives. I remind myself that adverse reactions can happen with any medication, but I don’t ignore these stories. It’s important I stay informed. That’s the way I choose to deal with it. Research everything you can, get as much advice as you can, then make the choice that you hope is right for you.
Medication and pregnancy
If you become poorly whilst pregnant your GP will discuss the support available to you. There should be perinatal mental health support in your local area that you can be referred to although I realise that the kind of support you get is hugely dependent on where you live.
Talking to a Dr before getting pregnant is a great way of finding out about the support available out there for you. Us folks don’t always have the luxury of having time to prepare beforehand and if that’s the case a chat with your Dr during your first pregnancy appointment (or before if you would like one) will give you the opportunity to be referred for assessment and to have a network of support put into place for you. Again, everywhere is different so check your local area first.
Remember OCD charities and the internet. There is a tonne of support out there that can tide you over while you wait for medical appointments. Many of which have an advocacy service also, so can provide you with someone to help you talk to professionals if you feel that would be beneficial. Use them, it’s what they’re there for.
The chances are the internet is full of stories by women and men who have been through, or are going through, the same thing as you. Reaching out to those people, reading about their stories and what they did to help themselves keep healthy, might help you feel more positive and less alone.
Medication and Alcohol
I cannot drink alcohol when taking Citalopram, I feel like I’m going to crash after a couple of sips. It’s been really handy for me as it’s encouraged me to stop drinking. In the past alcohol has made my OCD symptoms much worse and it’s no fun dealing with OCD when sober let alone when incoherent. I’ve been pretty much tee-total for around 5 years and I’m pretty sure I’ll be that way for life. I see it as a small price to pay (I also get a lot more weekend now I wake up without a hangover).
From what I’ve seen, all of my medicines have carried warnings about mixing with alcohol. It can cause serious side effects and loss of life. So please be careful!
Question your medical team
I have an amazing gp and feel very lucky that I can discuss things in an open and honest way. This relationship has made a big difference to my recovery. If you don’t feel the same about your own gp, see if you can ask for another one. In an ideal world, if you are unsure about anything, you should be able to ask and get a clear, informative answer. It is you who is taking these tablets, if you are worried about something, say it. If you want to know more, ask it. We are central to our own recovery.
Also, under this vein, be prepared to be assertive. I know me, and I know that when I take a certain brand of Citalopram, I get horrible side effects. They are bad enough for me to not want to take it, so I always request a brand that I know works well for me. One that my body is used to. Note this is still Citalopram, it’s just a different brand. I cannot tell you the times I’ve had to ‘argue’ this with pharmacists who, despite this being on my records, still try to give me other brands and look at me like I have five heads if I request a specific one. This used to crush me and confirm my old belief that I couldn’t trust my own findings. But not anymore, I know my body, and you know you. If you're not happy with something, or you want something done in a particular way – ask for it.
Know your support and advice options
I know that if I can’t get an emergency appointment at my gp’s, I can ring and request a triage appointment over the phone. I have never been in the situation where I haven’t been able to get in touch with my dr’s in some way on the day I’ve needed to – I know, I’m seriously lucky. I do, however, have the numbers for my local crisis team should I need it. I have a page in my journal with numbers on it should I need to ring a charity for advice or for someone to listen (I spoke about this a little under Medication and Pregnancy above). I’ve used Samaritans in this way too. And I know also, that if the worst comes to the worst, if I can’t get support in any other way, or if I’m frightened and can’t wait, I can take myself to my local A and E.
Make sure you know your options, and the details about them too. This could be for general mental health support or anything to do with taking medication. I’ve added my list of these contacts to the files that also carry my recovery blueprint. It helps to have all my information in one place.
You can read about the blueprint in the post entitled The Relapse Series: Part One.
In the weeks following a dose increase I wake up drenched every morning. I mean seriously soaked. It’s a side effect. I also develop issues with my sinuses and I sleep – a lot.
If I take too big a decrease in my medication, I get very dizzy and struggle to do very much because my head’s spinning and my vision is affected. I’ve also experienced a little of the ‘head zaps’ people talk about when tapering off their medication. The list of possible side effects is terrifying and covers pretty much everything you could think of, and although it's pretty tempting not to look at them it pays to make sure you’re familiar, so you can notice the symptoms in you.
Everyone is different
Ultimately, everyone is different and everyone’s journey with medication, if it’s a route you choose to take, will be different. Different people have different reactions to different things and that’s why its almost impossible to know exactly what any outcome involving them will be.
I’m currently on 10mg of Citalopram and have been on it for my longest stretch yet, about 14 months. I feel fantastic. I think I need a little more sleep than I used to, although that could be due to other factors, and I sometimes feel like my memory is affected but I honestly think that choosing to take medication was the correct choice for me.
I’m not sure what the future holds for me in terms of my relationship with Citalopram. I think I’ll wait a few months and have another little drop, see how I get on. If it doesn’t work out, I’ll go up again. One thing I do know is that for as long as I continue to take Citalopram I will respect it, because I know the minute I stop respecting it, it knocks me off my feet!
Okay, I think that’s about it….
I’m sure I’ve forgotten some important things (my memory, haha!). If I remember them later I'll add them.
Just as a quick reminder, I’ve written this post so that you have the chance to hear about someone else’s journey with medication – the up, the downs, and the lessons learnt. Whether or not to try medication is a big choice. Please don’t make it based on what you’ve seen in this post. This is just my story with a few helpful hints. Speak to a professional, get advice and make an informed choice. You deserve that!
When it comes to recovery, every choice we make is made with the very best of intentions. If you make a choice and it’s not the right one for you, no worries, you can change it again 😊.
Until the next time…