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Serotonin Sickness

Have you heard of this?

I have just had the strange misfortune to find out a little about it.  It makes me wonder, why, when I have been on SSRIs for the better part of the time since 1993 (Wow.  Nearly 20 years.) noone has felt the need to discuss this with me previously.

So the story goes something like this.  I was in the stage that I term my pre-crash “euphoria”, for want of a better term.  It is this stage that has made me wonder about whether I might have a low level bi-polar illness.  I was upset, because I know that there is a crash coming, even ‘though there appears to be nothing wrong, and there is nothing I can do about it.

I had an appointment with my new psychologist during this time.  (When I say “new” I mean she is new on the team this year.  8 months is new when compared to 19 years.)

She asked me to describe what happens.

Firstly, I start to get more energy.  This is a good thing, because I spend so much time flat.  This extra energy and the things that I can achieve with it give me an excitement, a renewed vigour.

The next stage, the energy starts to get out of hand.  I start to stay up late at night (typically to 1 or 2am) doing stuff.  At first this is great because I get so much done.  Sometimes even housework!

But then the insomnia hits.  I am tired.  Exhausted.  And yet, I still cannot go to bed.  If I do, then I can’t sleep.  I am no longer excited and energetic, I am just plain agitated.  And cranky.  In the past I have generally blamed the insomnia for this.

During this stage, it also becomes increasingly difficult to take my medication.  I will go for weeks only taking it sporadically, if at all.

Finally, I crash.  I edge closer and closer to that cliff until finally over I go down into the whirlpool.  I hit the depression spiral, and well, you know about that, I am sure.

It has taken me a long time to figure a lot of this out.  The cycle is so long, it is hard to remember details from time to time.  This time, I was able to talk about it with someone who could ask probing questions.  This was her take on events:

I get a build up of SSRI in my system.  The side-effects get out of hand.  Being well in tune with my body, I am unable to take my meds (my body wants to avoid any more of the “poison”).  However, while I am detoxing from the side-effects, I am not getting the therapeutic benefits that I do need, and therefore end up crashing.

I had never heard of this concept of the build-up in the system causing negative side-effects over time.  (Fortunately for me, my psychologist has worked in hospital teams for many years and has been part of the medication programme.)

So I had to head back to the GP for a med-review.  My psych had suggested getting a referral to a psychiatrist for this, but to be honest, I didn’t know if I could cope with the multiple doctors (and the babysitting required), so I was happy when my GP decided to do it himself.

Sort of happy, anyway.

He has prescribed an SNRI for me.  I am really not sure about it.  My concerns about the new medication are a whole separate post.

Back to the serotonin sickness.

As I read through the PIS for the new medication (Cymbalta), amongst all the other alarm bells ringing, I notice this:

If you have some or all of the following symptoms you may have something called serotonin syndrome: feeling confused, feeling restless, sweating, shaking, shivering, hallucinations, sudden jerks in your muscles or a fast heartbeat.

It then continues with the following symptoms; the poor punctuation left me unsure if they are also symptoms of serotonin syndrome or not.

  • stick neck or jaw muscles (lockjaw)
  • fits or seizures
  • mood of excitement, over-activity and uninhibited behaviour
  • aggression or anger especially after starting or stopping taking this medicine.

You may need urgent medical attention.

Now, I looked at that list and thought for about thirty seconds.  Then I read the list more slowly.

  • feeling confused – well that is part of depression and anxiety, isn’t it?  It certainly is for me when I am suffering insomnia.
  • feeling restless – well that is certainly part of the pre-crash euphoria
  • sweating – yes, well.  The night-sweats of late have been awful.
  • shivering – just figured that this combined with the sweating meant I was feverish and fighting a bug
  • shaking – uh-huh, uh-huh.  Thought I was tired from the insomnia
  • hallucinations – well not terribly; just that seeing things move out of the corner of your eye thing.  Doesn’t everyone get that when they are over-tired?
  • sudden jerks in your muscles – not often, but I get a bit tic-y occasionally.  Like last Saturday.  And then there is the restless leg syndrome…
  • fast heartbeat – oh, again, like Saturday.
  • stiff neck and jaw – Here’s the thing.  I was in a car accident in 1993 and did considerable soft-tissue damage to my neck.  It flares up from time to time.  Like recently…
  • lock-jaw – well, not lately.  But I spent a fair bit of time being treated for it – since I have been on Lexapro.
  • fits and seizures – you mean there is something on here that I haven’t had lately?
  • excitement, over-activity and uninhibited behaviour – um, excitement and over-activity… isn’t that how I described the euphoria?  (Not uninhibited behaviour, ‘though.  Apparently, that is how we know I am not bipolar.)
  • aggression or anger – and I thought it was just progesterone!

I did a little snooping on the internet.  I don’t like to self-diagnose, or use the internet as a doctor, but there is enough to make me think. Enough to make me cross that no medical professional has told me about it, especially when I have discussed and questioned the way I was feeling.

You know, people die from this?

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Chronic

Have you ever thought about the difference between a chronic illness and an acute illness?  I think the main difference is that the novelty wears off a chronic illness.

I would classify my depression and anxiety as chronic.  It is true that it is episodic, and I do not have symptoms every single day – well I do NOW, but not always (or do I?).  I have spent more of my life suffering from or dealing with depression and anxiety than not – more of my life in an episode than not.  (Actually, that in itself is quite depressing!)

This chain of thought was started the other day as I was driving along to the shopping centre with S3 talking non stop in the back of the car, and F1 along from the ride, plotting her next bit of mischief.  I could not help but think how much easier it would be to do the shopping run alone.  To do anything alone.  Anything.  I couldn’t help think how badly I need a break and how hard it is to get it.  How totally emotionally and physically exhausted I am.

I have a friend who lives in a country town.  After the birth of her first child she had a bad bout of PND and had to be hospitalised in a specialist hospital in the city.  When she did return home, she was rallied around and given the support she needed.  When her second child was born, she had all the support networks sorted well in advance.

Now,I don’t know if I have PND.  The psychiatrist treating me up until HJ6 was born explained to me that the definition of PND was any episode of depression occurring within 12 months of the baby’s birth.  By that definition, I certainly have.  However, each time it is identified it is usually brushed aside because of my history.  And that is by the medical professionals, so how much more so for family?

This is time for a little aside for family attitudes to depression.  I was originally diagnosed because my mother insisted  go to the doctor with a list of symptoms that she had noticed.  When I came home with a diagnosis, she was shamed and horrified.  I was not to take my medicine in the kitchen or bathroom – I had to take it in my room where no one would see.  I was not to mention it to anyone and I was not to speak of it in the house.  Things changed slowly over time as she realised it was a real illness, but many others do not.  (The irony?  Her mother suffered from depression most of her life, as has my mother.  Also, many of my cousins on my Mum’s side are sufferers of depression and related illnesses.). My in-law are a mixed bag.  My MIL has no idea.  I have heard her talk about people to whom she has ministered, I have tried to explain the nature of these kind of mental illnesses, but she cannot grasp it.  Cannot believe that an illness can effect your mind like that.  Most of the family is the same.  However, my BIL is a psychiatrist, and totally understands.  He and his family, while lovely, live in a different city to us.

Anyway, the point is, the help is not there.  Despite being one of eight kids and DH being one of five, we have virtually no support.  We have six siblings, plus spouses, and countless grown-up nieces and nephews living in our city.  Only one will babysit (and she is a full time carer as well as working two jobs, so you can imagine how much free time she has.). We can’t ask her all the time – she has her own life – but we use her in emergencies.

But what, if like my friend, I hadn’t had a lifetime battle with this illness?  What if I was first diagnosed during this time?  Honestly, I think help would have been forthcoming.  Somehow, because this is ongoing, I am supposed to have it all worked out by now.  Somehow I do not need the assistance other women with PND would require.  Sure it is true, I have a pretty good understanding of how the illness works and how it often works in me.  However, I am unable to look after myself the way I need to, the way other women with PND need to, without help.  I still have all these kids to look after.  I still parent night and day – I don’t get unbroken sleep.  I still have to feed a family, wash their clothes, wipe bottoms, clean a house (not very well), entertain, ferry, care for…. well you get the idea.  So why can’t I get help with all that?

Apparently I shouldn’t whinge.  I get more help than most (I do?  I doubt it.). I don’t whinge, except for here.  I suck it up.  I be stoic.  And I seethe with jealousy on occasion, but internally.

In those darker moments I can’t help but think that if this was a single, acute episode, eventually I would recover – really recover, not just until next time.

And THAT is what I believe to be the main difference between a chronic illness and an acute one.

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Me and My Highly Sensitive Child

Possum is 6 years and 1 month

As you know, possum and I both have big problems with anxiety.  Not a bit shy, but really functionally damaging anxiety.

Possum is on the waiting list for the Emotional Health Clinic at one of the local universities, one that is a leading researcher into childhood anxiety.  It seems like forever since I managed to take action on this one, waiting for his name to come up.  Maybe it is a little bit of time for me to find some headspace of my own, as well as find out more about his situation.

One thing that I am looking into is “The Highly Sensitive Child” (and “The Highly Sensitive Person” for me…).  It was recommended to me by my psychologist.  I haven’t read the whole book about the HSC (an acronym with which I struggle, so ingrained in me is its use for the coming-of-age, trial-by-fire in these here parts- the Higher School Certificate).  I did read the age relevant bits and some other selected bits.  I had to rush as Possum’s teacher wanted to borrow it for the school holidays, which start today.

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It is so good.  It is so true.  I cried.  How I wish that someone had read this when I was a child.

According to Arons, approximately 15-20% of all species are classified as highly sensitive.  Reading this book it is obvious to me that not only do Possum and I both fit into the more rare highly-sensitive with anxiety and/or depression, but we are at the highly sensitive end of the highly sensitive spectrum.

Now his teacher is lovely.  She has heaps of experience.  She says that she has never had such an anxious child in her classroom and is beside herself trying to find out what to do.

It is hard for me to explain that her classroom is overwhelming and I am only not completely intimidated by her vivacious personality because I have done 20 years of therapy.  Really, she is lovely and friendly, loves her kids, loves to inspire and really does.  She helps kids work at their level, but helps them to keep moving up, not get stuck.  But the room is bright, there is “literary overload” (stuff written on the walls) and lots of action.  Fantastic for most….

Actually, I think the room is much more soothing now that they have started doing big displays of their work on the walls.  They are doing a thing about bugs at the moment and all the kids made these cute little insects.  There is a single large sheet of coloured paper down one panel and all the bugs are buzzing in front of it.  So much better than all the posters and things with writing.  For me, anyway, and I assume for Possum, too.

I will be interested to see if she finds the book helpful.  I hope so.

Another book that I had previously started, and have picked up again is, “Raising Your Spirited Child“.  I am pretty sure that I have at least two of those.

Next I need to look into “The Highly Sensitive Person”.  To be honest, I am a bit scared.  What will I find?  What will it make me do?  Will it provide comfort and safety in this dangerous world, or will it leave me feeling more vulnerable and exposed?

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My Front Door

As you know, I have been feeling a bit grim lately.

One of the things that has been really getting me down is my front door.  Since F1 came along, and especially since this bout of depression, housework is pretty much on a survival basis (as is everything else.)  Even at the best of times, a lot of housework doesn’t inspire me.

However, it has really been bothering me that when I arrive home, I go to the front door and it is dirty.  I put my key into a dirty door.  Yuck.

I am already feeling bad, and I know my house is a comparative bombsite, but to have it greet me before I even get inside – well it is just awful.

So this morning, I cleaned my front door.

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As you can see, our front door is a very cheery colour.  I love coloured front doors.  I grew up in a house with a green front door (number 32, just like Paddington Bear).  When we were house hunting I completely fell in love with a house with a red front door.  The house was totally inappropriate for our needs, but I still think about that house because of it’s door.

And now, I can see our lovely, coloured front door.

It just gives me a little buzz inside.

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Blood

Warning:  This post contains discussion of bodily fluids

I hate having periods.  I reckon most females do.  I hate the inconvenience.  I hate the mess.  I hate the pain.  I hate the dirty feeling that comes with it.  I hate the smell.

But these days, I see blood and I feel a wave of relief.

I know my hormone levels are starting to change.  I have survived this round.  In about a week’s time I will be back, to normal (whatever that is).

Ever since ovulation I have been starting to go haywire.  I have been growing more and more wild.  My temper has been getting worse, my fuse shorter.  I fly off the handle in a scary way, snapping without notice.  It is like I have no control, and, well, I don’t.  It frightens me as much as anyone else.  I have the persona I have kindly dubbed, ‘psychotic bitch from hell’.

But the sign of blood means that this is subsiding.  It is over for another few weeks.  In a day or two I can move into damage limitation mode.  It is a huge relief to know that the crescendo is over.

It is not much fun only having a week to ten days in a month where I am not fighting to control my emotions.

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Keeping Body and Soul Together

Sometimes I think about my body.  Ponder might be a better word.  And mourn.

I remember being 19.  I was young, I was fit, I was active, I was healthy.  I guess I was 19.

These days I am not.  I am flabby and droopy and stiff and tired and, well, cushioned.  I will not use the ‘f’ word or the ‘o’ word, although they would probably apply.  But I don’t think that of me.  I really still think of myself as that skinny, toned girl, and I get a shock when I see my reflection.

It really feels like that skinny girl is me and I am wearing one of those fancy dress sumo suits that I am not able, or not quite prepared to take off just yet.

And I think there is some truth in that.

Technically losing weight and getting back in shape is easy.  A few steps: eat more veg, go to bed earlier, eat less junk, be more active.  Boot camp it or little steps, whatever works, it all helps.

Right?

Or not.

Not so easy.  Yes, that is how I should look after my body.  I would like to look after my body.  I guess I want it to last, and I am getting to an age where I need to seriously think about that kind of thing.  I want to look good.  People treat you differently when you are large and frumpy.  You feel different, too.  Well, I do.  And of course there is also all that stuff in Corinthians about respecting your body and that your body is a gift from God.

Guilt…should, should, should…guilt,guilt.

Pass the chocolate.  And the cream, too, please.

The truth is that I just can’t do that at the moment.  I need to stop feeling bad about it.

What I have realised is that I truly believe that the world is a dangerous place.  People are demanding.  I am scared.  For me, anyway, this is true.

I know that I am no good at setting boundaries.  This is a major problem for me.  I have realised, recently, that I have set up an insulation system for myself.  I feel like the true me is buried deep inside, curled up inside a shell like a shiny, little macadamia.  (Funny, I always visualise the shell like that, but do you know how tender the flesh of a macadamia is?  Maybe the analogy is more appropriate than I had realised.). Around my little real me I see layers of protection, like the view across the countryside from a dun.  Way off in the distance is my skin.

Yes, my skin is part of me.  Some would say the edge of me.  Some would even, quite sensibly, suggest that my boundaries should be further afield than my skin.  But there you have it, it is my horizon.  And in order to protect myself a little more, I make my skin further afield.

I have come to understand that it isn’t a disrespect for my body, that has me in this physical condition.  It isn’t neglect.  It is USE.  At this point of time I do not have the skills to protect my emotional self, not in any healthy way, at any rate.  I am working on this – it is quite a project and that is why I have medical and religious professionals on board – but I am not there at all.  In the mean time, my body has protected me.  It is true that this has caused much wear and tear that would not have otherwise occurred, but it has protected me, none the less.

Has it been successful?  Well, yes, I guess it has.  It has kept me going, albeit, not always very well, but I HAVE survived thus far.

I need to go easy on myself.  Not as an excuse, but in empathy.

I do not have the skills to look after myself emotionally.  Some people do, but I don’t.  And that’s okay.  It is okay that I have been getting by the best I can.  I am learning how now, but I am at the beginning.  No one thinks a baby is useless for crawling, even though walking is more efficient.  So I need to accept that in me, too.

Maybe one day the world will be safe – or at least parts of it will be.  Maybe one day I will drop back into a healthy weight range.  Maybe one day that skinny, young girl will come out for a run again.

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2 Hours

Two hours sleep is not enough.

I am really struggling today.  Thank goodness the kids are being unusually good.  It might have been something to do with the talk I gave them this morning.  It went something like, “I have only had two hours sleep.  I am tired and cranky.  Your (insert behaviour) will not be tolerated today.”. Or it might be luck.  God giving me a small break.  A small miracle for us all.

So how come I only had two hours sleep?

My depression is getting worse.  I know the signs.  I have had that burst of energy, that keeps me up at night doing stuff.  I’ve been building through the insomnia that becomes less and less fun.  I’ve got to the point where it is almost impossible to take my meds.  My numbing drug of choice this time has been solitaire on my tablet (computer, not meds). I’m heading for a crash and I’m not sure where to cry for help.  Today I caught myself on online bookshops.  Soon I will be living off Cheezels.

I hate this.  Even after all this time, I don’t know what triggers these downward spirals, nor do I know what to do to stop them.  I know lots of my triggers, as in what causes my general episodes, but these whirlpools, uh-uh.   I know many triggers are in place, I am beginning to realise it is when things are also out of my control (like I can’t seem to get a break from the kids, even though I have been trying for months), but I think there is something else here, something specific.  If only I could figure out what it was.

So, that had me up most of the night.  I was going to go to bed at a semi-decent time last night.  I was.  Really.  But somehow it got to 2:15am, the infomercials were making me yawn and it was difficult to beat the deal on solitaire.  Oops.  So I went to bed.  It was freezing cold.  We have no heater in our room, unlike in the lounge.  And our quilt wriggles inside the cover so that sometimes you pretty much just have two sheets and nothing warm.  Last night was arctic, so it was awful.  I lay teeth chattering, trying to pretend my daughter would re-settle from the intrusion without me feeding her, yet again (ha! As if!). Eventually I drifted off – until about 4am, when the little banshee started up.

She was inconsolable.  I don’t know what happened, she doesn’t seem ill or anything.  She was probably just cold.  Whatever it was she stayed awake, screaming until morning.  Demanding milk continuously (I didn’t have the supply, so let’s add pain, guilt and inadequacy to those feelings of exhaustion and frustration, shall we?)

By morning I was shattered.  So was DH.  It was an unpleasant morning after an unpleasant night before an unpleasant day.

Unfortunately, she has had some good sleep today.  I hope tonight is not a repeat.

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Meds

So, just out of interest, what meds am I on?

Lately I seem to rattle.  This is what the daily regime looks like:
Multi-vitamin that includes various B vitamins, plus vitamins C and D, manganese, magnesium, zinc.  This is to supplement my tragic diet as well as targeting restless legs, anxiety and depression
Fish Oil 4000mg – this is for anxiety.
Glucosamine 1500mg – arthritis in my feet
Fenugreek 5000mg – increase breast milk
Lexapro 20mg – anxiety and depression.  I need this dose reviewed, but getting the energy to make a doctor’s appointment, and then facing it with the kids in tow, is so difficult.

Every day.

11 pills.

Ridiculous, huh?

And does it work?  Maybe.  A little.  I sleep a little better when I take the Lexapro, and my feet don’t hurt as much with the fish oil (even though that is only a side effect and not what I am taking it for).  Oh, and fenugreek at 4pm increases my supply for the bedtime rush.  So maybe slightly more than maybe. 

I am not sure I would swear by it all, though.

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Home

I have been out all morning.  We had Church, and then what is best described as Sunday school.  Today there was a meeting, so lunch was provided and it went on quite a while.

I was fine while I was out.  Mostly, anyway.  Sound like a weather forecast, don’t I?  “Mostly fine.”

Anyway, there is that nice hopeful feeling that when it is all over, I’ll get to go home.

Then we get in the car and everyone is tired and cross.  The kids are devouring lunchboxes (despite a snack box, morning tea of ice cream and biscuits and a hot lunch.  Then the high pitched screaming starts, someone can’t open something, someone might sprinkle someone else with their water bottle, this person put grated chess in that one’s lunch box, but he only likes cubed cheese… and so on.  Some of it is just random yelling, because apparently that is fun. *sigh*

By the time we get home I am shattered.

I walk into the house and a big shadow forms over me.  All the time I was out, there was the hope of home.  Now I am here, this is it.  There is no magical feeling, no relief. 

It reminds me of being a teenager, when I would lie in my room and cry.  “I just want to go home,” I’d sob.  Yes I was ‘home’, but it didn’t feel like home; it didn’t feel like a safe place, a sanctuary.  And neither does this.

As we have already eaten lunch at Church, I don’t have a job to immediately fly to, to drown out the feelings.  Just the despair of the endless housework, the feeling of being trapped, of drowning, the noise… a heaviness I can’t escape.

I want to hide in my room, throw myself face down on my pillow and sob, just like when I was a teenager.  But I can’t.  I’m a grown up here.  I’m not allowed to have feelings like that; feelings that I don’t belong; feelings that I need to get away.  Besides, two other people share my bed, so I have no place of my own.  Two other people feed off my body, too, so even that is not mine.  The boundary of me is very small, no wonder I need a sanctuary, a safe house.

But I don’t.

I want to go home.