A For Antidepressants

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When Silent D And Me was last live, I promised that I would discuss my experiences of antidepressants with my readers. In this blog post, I’ll do just that.

Antidepressants and Me

I was first prescribed anti-depressants when I was 15 years old. I had been struggling with my depression, and had the beginnings of an eating disorder (my psychiatrist disagreed that I had an eating disorder, but I’ll leave that story for another blog post.) Following a suicide attempt, I was admitted to hospital. I was assigned a psychiatrist, who prescribed Fluoxetine AKA Prozac.

When I was discharged from hospital, I remained under their care as an out-patient; and met with my psychiatrist on a weekly basis. At first, the Fluoxetine seemed to work well for me – the suicidal thoughts became less frequent and intense; and I felt less nervous about facing the world. But I still struggled with eating. My psychiatrist was happy to keep prescribing the medication, and combined it with talk therapy.

Out of the blue, I started to experience very strange symptoms. I was back at school, but only in body. I didn’t remember the majority of the day, and the parts I did remember were spent feeling overwhelmingly drowsy.

I would come home from school at around 4.30pm. Almost immediately after I got home, I’d fall into a deep sleep. I slept through to the next morning, and when I woke up, I struggled to stay awake.

Out of The Fog

The crunch came one morning, when I fell asleep face down in my cereal (and I don’t just mean the sound the cereal made, when I passed out and face planted it.)My mother dragged my semi-conscious body back to the hospital, and demanded answers from my psychiatrist. He took blood from me, and fast tracked it through the lab. The results came back that I had a Sodium deficiency, and my psychiatrist put it down to me starving my body of nutrients.

My mother wasn’t having any of it. She insisted that I was having an adverse reaction to the Fluoxetine, and demanded I be taken off it. As I was only 15 at the time, and medically a child; my psychiatrist had to grant my mother’s request. But he advised that just stopping the medication could have more adverse effects on me. He and my mother (reluctantly) came to the agreement that I should be gradually taken off the Fluoxetine.

Things didn’t start to improve, until I’d stepped down to the lowest dosage of medication. It felt like I’d had my head underwater for a long time, and had finally broken the surface. I was more conscious and lucid; but I was still sleeping for long periods of time during the night. I’d wake up the morning feeling groggy and heavy-headed. It was like having a severe hangover. It took a couple of hours, before I could function properly; but at least I was back in the land of the living.

I continued with the talk therapy for a few months, after I’d come off the medication. I was eventually discharged from the hospital, 2 months before my 16th Birthday.

A Medicated 20 – Something

The second time I was prescribed antidepressants, I was 23 and had revealed to my GP, my plans to end my life. I’d been planning my suicide for around 4 months, and a week before my self imposed expiry date, I reached out for help. I’m so glad I did. When I look back at that appointment with the doctor, I feel annoyed with him. I’m annoyed because I’d told him what I was planning to do and when I had planned to do it; yet his first resort wasn’t to refer me for counselling, it was to prescribe me some pills.

This time, I was prescribed Citalopram. Although they were a different drug, they had the same effect on me as Fluoxetine. I was back to being a half conscious spectre, but this time I couldn’t afford to pass out at the breakfast table. I had a toddler and a young baby to care for, and the last thing they needed was a half conscious mother. My husband was working full time, so I had to be lucid and present.

Remembering how I’d been gradually been taken off the Fluoxetine last time, I went back to my GP. He agreed to slowly bring me off the pills and again, I broke the surface of the water I was immersed in. I’ve haven’t taken antidepressants since.

So Who Do They Work For?

Although antidepressants haven’t been a great help to me, I know people who they do help. My Sister is one of them. She has Sleep Apnoea, which causes her to have night terrors and nocturnal panic attacks. She has a very demanding and stressful job, which involves sleeping over at her workplace. She was prescribed Fluoxetine a couple of years ago, and it helps her to keep the panic attacks under control.

She recently looked at the possibility of coming away from antidepressants and with the help of her GP, she began the process of decreasing her dosage. This had disastrous consequences. Where I broke the surface of the water at the lowest dosage of Fluoxetine, my sister sank to the bottom.

She went on holiday with her partner, and after a series of phone calls from her employer (badgering her to cut her holiday short, to cover a sick colleague’s shifts), she spent one night in the grip of a ferocious panic attack. Her partner was horrified. My sister was half asleep, running around the apartment, frantically trying to escape. After what must have felt like an age, my sister’s partner managed to persuade her to go back to sleep.

When she woke up the next morning, she didn’t have any recollection of her Somnambulant panic attack. When her partner told her what had happened, she decided she should go back to her GP and have her Fluoxetine dosage increased.

The other person I know who’s on antidepressants long term, is my husband. He’s takes Amitriptyline to ease the symptoms of Chronic Fatigue Syndrome. Because his brain doesn’t produce enough of the hormone which enables him to progress into the REM sleep stage,the Amitriptyline helps him to go into a deep sleep.

When he wakes in the morning, my husband feels fuzzy headed, and heavy limbed. This is due to the mild tranquilizer contained in the medication. This is actually the lesser of the two evils. If he doesn’t take the Amitriptyline before he goes to bed, his joints are incredibly stiff and painful in the morning.

So the sedative effect of antidepressants can be useful to people with medical conditions, such as Chronic Fatigue Syndrome and Sleep Apnoea.

What’s the bottom line?

Whether or not anti depressants are effective in treating mental illness, is largely subjective and depends on the individual patient and their circumstances.

Anti depressants such as Fluoxetine are usually used alongside a form of talk therapy, such as Cognitive Behavioual Therapy (CBT). This is because the medical world acknowledges that conditions like depression aren’t solely caused by a chemical imbalance in the brain. There are usually external factors at play in the development of depression. The combined therapy is designed to address both causes of the patient’s condition.

I personally haven’t had the best experiences with anti-depressants, but that doesn’t mean they don’t work or they’re not helping people. Every individual is different, and people living with a mental health issue should find a treatment that works for them – even if it means they’re on anti-depressants for the rest of their lives.

I’d rather hear of someone using anti-depressants until they die of old age, than hear of someone not taking them (if they work for them) and dying by their own hands, well before Mother Nature got to have her say.

 

 

 

 

 

 

 

 

 

 

 

 

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A For Addiction

….In despair or incoherent, nothing in between.

China white, my bride tonight, smiling on the tiles.

Bring that minute back, we never get so close as when the sun ward flight begins.

I share it all with you, powder blue……….

–  Elbow, Powder Blue 2001

The above song was written by Elbow’s Guy Garvey,after he saw a withdrawing couple in Dry Bar in Manchester. He said of his muses: “….I noticed a tenderness between the two, despite them being strung out; it was a very romantic, but a rather dark, situation.”

A Deadly Romance

And that’s addiction isn’t it? Romantically dark and deadly. A love-hate relationship with the thing that simultaneously takes your pain away, and brings you new waves of pain.

Addiction comes in many forms: alcoholism, drug addiction, gambling addiction, sex addiction, nicotine addiction, food addiction, to name but a few.

What Causes Addiction?

To get a better understanding of the causes of addiction, I took to YouTube as part of my research. A TED Talks video made by Johann Hari, entitled “Everything You Think You Know About Addiction Is Wrong” focuses on the causes of drug addiction, and whether current drug policies are effective in fighting the war on drug addiction.

In the video, Jonathan challenges the scientific theory that drug addiction is a result of the chemical hooks contained in the drugs.

Jonathan references the studies and research of Prof. Bruce Alexander, a Professor of Psychology in Vancouver, Canada. In the 1970s, Prof. Alexander analysed drug experiments conducted in the early 20th Century, which were carried out on lab rats. The scientists gave the rats two types of drinking water – one bottle contained plain water, and the other contained water laced with either Heroin, or Cocaine.

During these experiments, the rats almost always preferred the spiked water, to the plain water. The result was that the rats drank so much of the spiked water, they eventually overdosed and died. This proved the theory that chemical hooks are responsible for addiction. The scientists came to the conclusion that the rats were hooked on the spiked water, therefore compulsively drank it to feed their addiction.

When Prof. Bruce Alexander studied the records from these experiments, he noted that the cages the rats were kept in were empty, and contained no sources of stimuli.

Based on his findings, Prof. Bruce Alexander carried out his own experiments, using a custom built cage, which he named “Rat Park”. He placed more than one rat inside the cage, and the cage contained sources of stimuli, such as toys and exercise equipment. Just like the experiments conducted in the early 20th Century, Prof. Bruce Alexander gave the rats two water bottles, one containing plain water and the other laced with narcotics.

During these experiments, the rats in Rat Park preferred the plain water to the spiked water. None of the rats died of an overdose from the drugged water. Prof. Alexander concluded that the rats in Rat Park didn’t use the spiked water, because they were happy and entertained. They had other rats to interact with, and toys to keep them occupied. So this put paid to the idea that drug addiction is solely a result of the chemical hooks contained in the drugs.

Addiction As A Form of Connection

Based on his experiment, Prof. Alexander felt that the term “addiction” doesn’t come close to describing the psychological mechanics of the condition. He felt that the term “bonding” would be a better fit.

During my research into addiction, I found that the general consensus of current addicts, recovered addicts and professionals such as addiction counsellors, is that people become addicted to substances or habits (drugs and alcohol especially), because they have suffered some kind of social disconnection in their lives.

Although the abuse of substances disconnects you from reality, it provides users with a connection of sorts. If you’ve ever met someone who’s addicted to a substance, you will, on at least one occasion, hear them say the words: “drugs/drink is always there for me. It’s never let me down.” This phrase is demonstrative of the bond between substance, and user. Users see their substance of choice as their friend.

Social Connection = Survival

Humans are essentially pack animals, and our main primal instinct is to form connections with our pack, in order to be safe from potential predators. Staying connected with our pack gives us a better chance of survival. When we observe pack animals in the wild, we find that when a pack member is disconnected from their group, it inevitably dies; either by being eaten by a predator, or their health rapidly deteriorates.

Because we no longer have predators around us (the kind who will eat us), we don’t need to form connections for basic survival, right?

Wrong. No matter what has happened to us through the evolutionary process, we are still fundamentally pack animals. We suffer terrible loneliness when we are disconnected, and we also suffer boredom, just like our drug addicted rats in the lab suffered boredom and loneliness.

This is where addiction comes into play. If there are no opportunities available in a person’s life to be connected to other people, and be challenged and stimulated, they are at a greater risk of turning to a substance or habit, to simulate the feelings of purpose and connection.

Trauma’s Role in Addiction

In many cases, people with addictions have experienced either an isolated traumatic event, or a series of traumatic incidents. These traumatic events provide the catalyst for future disconnection.

Childhood abuse is one of the main causes of people turning to substances and other addictive habits. The secrecy that underpins abusive environments, and the fear and terror of the consequences of revealing their abuse to others, automatically disconnects the victim from society and sources of help.

Another form of compulsory disconnection, is bereavement. The loss of someone who provides support, particularly emotional support to you leaves you vulnerable and wide open to attack. We then search for ways to reconnect to the emotions we experienced when we were with this person. This can then lead to addiction. Some people even turn to alcohol or drugs as a method of ending their lives, so that they can be reunited with their deceased loved one.

The Role of Stress in Addiction

During my research, I watched a documentary by Russell Brand, entitled: Russell Brand – From Addiction To Recovery. In the documentary, he spoke with a doctor who gave a list of risk factors to developing an addiction. One of the risk factors was stress.

People who have stressful lives, tend to turn to alcohol or another substance, as a way of “letting off steam.” I think we’re all guilty of that, aren’t we? Stressful week at work? Let’s have a few glasses of wine on a Friday night to unwind. Your children are re enacting the Battle of Hastings in your front room, over who ate the last fruit pastille? Take yourself outside for a coffee and a cigarette.

But what happens if those few glasses of wine on a Friday night, turn into a bottle every night? Or a few glasses of wine over lunch, followed by a couple of bottles over dinner?

The doctor in Russell Brand’s documentary explained that although the majority of the population drink alcohol recreationally, 10% go on to become alcoholics. The reason? He said the key to stress related addiction lies in the Amygdala.

The Amygdala And Addiction

 

The amygdala is located within the temporal lobe of our brains. We have two amygdalae (one on each side of the brain), and they are in charge of our emotions, survival instincts and memory.

When an external source of stress occurs, the amygdala sends a distress signal to the hypothalmus. The hypothalmus is the control room of the brain, and is the link between the brain and the rest of the body. Once the hypothalmus receives a distress signal from the amygdala, it sends a message to the adrenal glands, which respond by secreting adrenaline into the bloodstream. The presence of adrenaline in the bloodstream brings about certain physiological changes in your body. Your heart beats faster, your blood pressure rises, and you breathe faster to enable your brain to receive extra oxygen. The effect of this, is your senses become sharper. You now have the burst of energy you need to either fight the perceived danger, or take flight away from it.

Once the danger has passed, your adrenal glands stop secreting adrenaline into your bloodstream and you start to calm down. Your heart rate slows back down to its regular pace, and your breathing starts to regulate itself once more. This “come down” has more physiological effects on your body. I personally feel very nauseous after a stressful situation.

The doctor in Russell Brand’s documentary said that the reasons some people reach for a substance during a stressful situation, can either be to counter the physiological effects of the adrenaline rush during the stressful event, or to replicate it afterwards. Which could explain why people often offer you a strong alcoholic drink to “calm your nerves”, before delivering some distressing news to you.

Aside from the fight or flight element, the amygdala is responsible for your emotional memory. Have you noticed that certain smells or pieces of music induce certain emotions in you? Your Grandmother’s perfume may induce happy emotions, whereas the music which was played at her funeral induces feelings of deep sadness. That’s the work of your amygdala.

This emotional memory plays a key part in addiction. A reminder or trigger of a deeply emotional event in your past, forces your amygdala to identify the thing which made you feel better. If that thing happens to be drinking alcohol, or taking drugs, your amygdala tells your hypothalmus to send a message to the rest of your body that this substance is required.

The Amygdala’s Role in Compulsivity

The amygdala also remembers withdrawal, and the physical and emotional experiences associated with it. Because your amygdala is in charge of your survival instincts, it will work hard to steer you away from things which threaten your survival. For example: the physical effects of Heroin withdrawal threaten your body’s wellbeing, so the amygdala will use your memory to point you in the direction of something which prevents withdrawal. And that something is usually Heroin itself. This explains why people who’ve recovered from their addictions, are never far away from relapse.

With this in mind, we can draw the conclusion that the amygdala is responsible for the compulsive side to addiction. The addict themselves aren’t consciously responsible for the habits they’ve developed. It’s more of a subconscious process.

Impulses and Addiction

Another factor the doctor identified in Russell Brand’s documentary, is how impulsive an individual is. He said that those who are most likely to develop addictions, are less in control of their impulses than those who don’t go on to be addicts.

He referenced an experiment which was conducted, again, using rats as their subjects. Each rat was given a lever or button to push, and the reward for doing so was a treat. The length of time each rat could go between lever pushes was measured, and it was found that some rats couldn’t wait longer than a few seconds, before pushing the lever again. Other rats could wait longer than a few seconds between lever pushes.

This experiment goes back to the rats’ desire or need for external stimuli. Some rats could quite happily sit for long periods, before boredom set in; and others craved constant stimulation.

Anyone who has ever owned a dog, has unwittingly conducted this experiment. When our dogs were puppies, we put them through training. We would order them to sit for 10 seconds, before rewarding them with a treat. If the puppy wandered off before the 10 seconds were up, they wouldn’t receive the treat. Gradually, the puppy learned that there was more to gain from controlling their impulses; and they would become what we call more “obedient.”

But there was always one puppy you owned, who wouldn’t play the game wasn’t there? If that puppy were a human being, they would be deemed more likely to develop an addiction, based on the highly impulsive behaviours they displayed.

Russell Brand put himself in the same category as the rats who couldn’t wait longer than a few seconds, before pulling the lever. You can tell from his overall demeanour and often scatty behaviour, that he is very much driven by his impulses. People like Russell are on the constant look out for variety and adventure, and this can unfortunately, lead them into the clutches of addiction.

Addiction And Pleasure

We would be naive if we thought that addicts don’t derive pleasure from the substances they abuse. After all, how can you become addicted to something if it didn’t bring you pleasure in the first place?

Take alcoholics for example: the majority of alcoholics started out as social drinkers. One minute, they’re having a good time in a pub or bar, surrounded by their friends; and the next minute the good times ended and everyone had to go back to their lives. But they didn’t want to go back to boring old real life, with their boring jobs and mundane routines. Why did the party have to end?

So we go back to the Amygdala, and emotional memory. Alcoholics started out by associating alcohol with good times. So what’s the best way to prolong the good times? By drinking. Everything’s great, lots of drunken fun is to be had. And before you know it, you’re knocking back a few vodkas just so you can face the mundane aspects of real life.

This is how my Dad’s best friend became an alcoholic. What started out as a few pints down the local with the lads, became an all – consuming devil on his shoulder. He didn’t want the party to end, so he tried to turn his life into one long party. Two failed marriages, two estranged children, a drink – drive ban and a string of lost jobs later; and my Dad’s best friend of nearly 50 years passed away from alcohol – related illness, in 2008. He was 56 years old.

So What’s The Solution To Beating Addiction?

In short, I don’t have a specific answer to this. But my research into addiction has thrown up some interesting arguments and theories on beating addiction.

In his documentary, Russell Brand said that addicts have a hole somewhere inside them, and use drugs or alcohol to fill the void. He’s against the Methadone programme, because he feels that abstinence therapy is a better solution to beating addiction. He has a point. Why is it that when a person is addicted to a substance, they are placed onto another substance to “wean them off?” This method is merely replacing one addiction with another.

It isn’t getting to the root of the addiction, it’s just stabilising the addict. And how many addicts out there take substances to “get stable?” Well, maybe some alcoholics drink to “get stable” in terms of calming their panic responses; but even then, we would recommend they replace the alcohol with caffeine, which is just another drug.

Take cigarette smokers as another example. I’m a smoker, and I have been since the age of 14. Peer pressure was a major factor in my decision to take up smoking. My school friends were all smokers, and some of them still are. But some of them aren’t. As soon as we left school, and the peer pressure wasn’t present anymore; they quit. And stayed quit. They’d been smoking for the same amount of time the rest of us had, therefore were exposed to the same levels of nicotine, yet they could just stop. This further proves the argument of Prof. Alexander, that addiction is not a result of the chemical hooks inside the substance. There has to be more to it than that.

So, say a smoker like me wants to quit. What do they do? They replace the cigarettes with a form of nicotine replacement therapy. Then what? Do they use the nicotine therapy for a short period of time, before quitting it cold turkey? No. They use the nicotine replacement therapy on a long – term basis. Or they go back on the fags. Why? Because the initial cause of the addiction hasn’t been addressed or resolved.

The majority of the arguments against placing addicts on another substance to overcome their addiction, point to the psychological and emotional causes of the addiction not being given enough emphasis. Health professionals in the field of addiction, tend to focus more on the physiology of addiction and not the psychology. The Methadone programme proves this.

In his documentary, Russell Brand said that he’s against the Methadone programme, because he feels that it doesn’t fill the hole that Heroin seems to fill – it doesn’t get you high. So in order to derive the same euphoria or escape from reality that Heroin provides, he said that Methadone users often abuse other substances, such as alcohol. Some of them even continue to use Heroin.

He discussed his opinions with a GP, who has patients in her care on the Methadone programme. For the most part, she dismissed Russell’s arguments; because the statistics show that the Methadone programme has a high success rate. Russell argued that the statistics aren’t a true reflection of its success, because the Methadone programme was devised; not as a tool to overcome addiction, but a tool to reduce crime rates and the number of Heroin addicts contracting HIV through needle sharing.

After his meeting with the GP, Russell met a very drunk woman; who was swigging from a can of strong lager. She was on the Methadone programme. She said that the reason she was drinking on top of her Methadone, was because the Methadone wasn’t an effective substitute for Heroin – it wasn’t getting her high. She was also occasionally using crack cocaine on top of the Methadone and alcohol. Her addictions had multiplied since being placed on the Methadone programme.

The points raised by the GP bring me onto the subject of stigma.

The Stigma Of Addiction

If what Russell said about the objectives of the Methadone programme is true, then this means that its initial development was motivated by stigma.

Another professor in Russell Brand’s documentary said that through his work in drug rehabilitation, he met an advocate of the Methadone programme who said that if one of his relatives developed a drug addiction, he wouldn’t treat them with Methadone; he would get them into a residential rehab facility instead.

The professor said he was angry at this statement, because here was this person – an advocate for the Methadone programme, saying that they wouldn’t use it if someone close to them became hooked on Heroin. He said he felt that this person was saying “I don’t care about the other addicts out there, because they’re just drug addicts.” And if that is what this person meant, what an irresponsible attitude to have, as an advocate for an addiction treatment programme.

I understand the motives for the Methadone programme, but I don’t agree with how it is used. Yes, if a drug addict is committing criminal offences to fund their drug habit, then they should be taken through the legal system. But then they shouldn’t be kicked out of the system, once they’ve fulfilled their punishment. If the drug addiction isn’t addressed properly, then the users will almost certainly go on to re offend. Criminals under the influence of drugs or alcohol should be given a compulsory detention in a residential rehab programme, instead of a custodial sentence in prison.

Those who say it isn’t possible, and we don’t have the resources to do it; need to answer this question: we have the resources to detain some of the most dangerous criminals in secure units, or hospitals; yet we don’t seem to have the resources to put drug related offenders in rehab facilities. Why? The dangerous criminals, and the criminals who offend to fund their habits have one thing in common: they have diminished responsibility. Yet why is it that someone who has committed a heinous crime, can plead insanity and receive a “get out of jail free card,” but someone who’s burgled a house or stolen a car for drug money, can’t use their mitigating circumstances to get access to the treatment they need?

I think back on the withdrawing couple who inspired Guy Garvey’s hauntingly beautiful song. Do I think they recovered? I used to. After doing the research for this blog post, I’m not very optimistic. Had they been withdrawing in the street, or in a supermarket; then maybe there’d be more hope for them of getting and staying clean. But they were withdrawing in a bar. They were replacing one drug with another. The odds were stacked against Powder Blue and her love.

Like I said, I don’t have the end-all answer to the issue of addiction. But what I can say is: the war on addiction will never be won, unless attitudes to people with addictions change.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A-Z Of Mental Health Blog Challenge

 

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Hi Everyone,

I’ve set myself a challenge, to hopefully drag myself out of my writing rut.

Over the next 26 weeks, I will be writing blog posts on the A-Z of mental health.

Each week, I aim to write at least 2 blog posts on mental health topics which begin with the letter of the week. For example, this coming week, I’ll be focusing on mental health subjects that start with the letter A. Next week, I’ll focus on the letter B, and so on.

Strap yourselves in, put the kettle on and stay tuned. I’ll be asking questions at the end.

See you soon.

Caroline xx

 

Edit: Due to time constraints, my Letter of The Week will now be the Letter of The Fortnight. I was a little too ambitious with this challenge, and found I couldn’t cover all the topics I wanted to in just a week.