## On drugs (and off them)

Posted in Mental Health with tags , , , , , , on July 11, 2017 by telescoper

I came across an interesting piece in the Guardian the other day written by Deborah Orr, who had just taken antidepressants for the first time (with unpleasant consequences). This was followed by an explanatory article by blogger and author Dean Burnett who explains that nobody really knows how anti-depressants work, and why it is not surprising that they can have unexpected side effects. I hope that the articles I mentioned above help make it clearer what is involved being on medication of this sort. These drugs are in widespread use, but ignorance about them is spread even wider.

I remember a while ago, when I was working at the University of Sussex, sitting on a bus in Brighton with two people behind me talking – in a very unhelpful and ill-informed way – about depression, and how anti-depressant drugs were a soft option’. It made me quite angry listening to some of the comments they made but I didn’t intervene. I toyed with the idea of writing a blog then but I didn’t get round to it, partly because I didn’t really want all the staff and students in the School of which I was Head to know I was taking heavy medication for much of the time I was working there.  I only told a handful of people at the time. Now I am no longer in that job I think it’s safe to be a bit more open, and add a little bit here from my own experience to the articles mentioned above.

The most widespread anti-depressant drugs currently available are called Selective Serotonin Reuptake Inhibitors (the best-known of which, Fluoxetine, is known by the trade name Prozac). Deborah Orr’s article concerned her experience with an SSRI called Citalopram, which I was using about five years years ago. More recently, for much of the time I was at Sussex I was taking Paroxetine (trade name: Seroxat). The latter is not available on the National Health Service through a General Practioner, but must instead be prescribed by a consultant psychiatrist.

Anti-depressants are not only prescribed for the treatment of clinical depression but also for, e.g., anxiety disorder, panic disorder, and post-traumatic stress disorder. Nobody really knows why anti-depressants work against depression (although there is clinical evidence that they do), and there is even less understanding why (and, in some cases, evidence that) they are effective for these other conditions. Like many treatments they seem to have been discovered empirically, by trial and error.

As Dean Burnett explains in his article, SSRIs work by increasing the level of Serotonin (a monoamine neurotransmitter). However, taking an SSRI increases the level of Serotonin almost immediately whereas the effect on depression takes weeks to register. While low Serotonin levels may play a part in depressive illness, they’re clearly not the whole story.

My experience contrasts a bit with Deborah Orr’s, in that I have never experienced significant problems going onto this sort of medication – the worst by far has been when I’ve tried to quit. I had awful problems in the summer of 2012 largely as a result of trying to come off the medication I had been on since the previous autumn. The withdrawal symptoms then included shaking fits, insomnia, visual and auditory hallucinations, nausea, and hypervigilance.

The effect of this extreme collection of withdrawal symptoms was that I didn’t eat or sleep for a couple of weeks, and ended up in a high-dependency unit at a psychiatric hospital under sedation while they figured out what to do with me. Fortunately, I recovered well enough to return to work after a couple of months.

At the end of the summer of 2012, I was offered the job of Head of the School of Mathematical and Physical Sciences at Sussex University. I moved from Cardiff to Brighton in early 2013 to take up this new position. I hadn’t been there for long when my old problem returned. The stress of the job obviously played a role in this, and I soon realised that I couldn’t keep going without help from medication. It was then that I was tried out on Paroxetine, the dose being gradually increased until I was at the maximum recommended level (60mg daily).

While this medication was effective in controlling the panic disorder, it had some unpleasant side-effects, including: digestive problems; dizziness; difficulty in concentrating; fatigue; and the weirdest of all, a thing called depersonalisation. Deborah Orr describes the latter very well in her piece but she seems to have experienced it as soon as she started taking medication, whereas in my case it came on  gradually.

I found myself living a kind of half-life, functioning reasonably well at work but not having the energy or enthusiasm to do very much else outside of working hours. Eventually I got fed up with it.  I felt I had to choose between staying in my job as Head of School (which meant carrying on taking the drugs indefinitely) or leaving to do something else (which would mean I might be able to quit the drugs). I picked the latter. The desire to come off medication wasn’t the only factor behind my decision to stand down from my job, but it played a big part.

I knew however that Paroxetine  is associated with notoriously difficult withdrawal symptoms so, mindful of my previous experience in 2012, I followed the medical instructions to the letter, gradually cutting down my dose over a couple of months during the course of the Autumn in 2016. I still had significant withdrawal symptoms, especially the insomnia, but not as bad as five years ago. I’m hoping that my current (part-time) job allows me to manage for the foreseeable future without the need for any medication – apart, perhaps, from the odd glass of fine wine!

So those are my experiences. All I can say that I hope I’ve convinced you that anti-depressants are not a soft option’!

## Breaking down a breakdown

Posted in Biographical, The Universe and Stuff with tags , , , , , on April 25, 2013 by telescoper

A blog piece by Dean Burnett  I read on on the Grauniad website yesterday set me thinking about whether I should post a personal comment in reaction to it. I never know what is the appropriate way to draw the line between the private and the public on In the Dark but since having a blog is clearly an exercise in self-indulgence anyway I thought I’d go ahead and write a piece.

Dean’s piece is about nervous breakdowns, but it’s really about why “nervous breakdown” is not a very good name for what it purports to describe. Regular readers of this blog  (both of them) will know that I went through one last year, and one thing I do remember is the disapproval that the term “nervous breakdown” provoked when I used it during my subsequent course of therapy. Apparently it’s a bit frowned-upon among professionals in the field.

Here is Dean (who is a neuroscientist in his day job) on the subject:

The term nervous breakdown is actually surprisingly old, and stems from a time when both “nervous” and “breakdown” arguably had different meanings to their modern ones. It seems the “breakdown” element refers to a breakdown in the same way that cars or other machines can break down. And nervous just refers to the nervous tissue. So originally it meant a fault or error in the nervous tissue that controls the body. And suddenly my interpretation doesn’t seem so literal.

But this doesn’t mean it’s an invalid term, it’s just more of a rule-of-thumb or generalisation used to refer to what happens when someone becomes psychologically unable to function as normal. In the simplest sense it could be said that, mentally speaking, a nervous breakdown occurs when an individual finds that the number of things that they are able to cope with is lower than the number of things that they have to cope with.

That seems to me to sum up very sensibly why the term is not very useful for an expert: it’s too vague, in that there are so many quite different things that might cause a person to become “psychologically unable to function as normal”. But it also explains quite well why its usage persists in popular language, in that the state of being “”psychologically unable to function as normal” is not as uncommon you might think. Anyway, if someone says they’ve had a nervous breakdown it gives at least a general idea of what they’ve experienced, although the specifics vary widely from individual to individual.

I hope you’ll bear with me if I illustrate this with some personal observations in the light of my own experiences.

I’ve suffered from a form of panic disorder for many years. Actually even that term has a very broad definition, so that different individuals experience different forms of panic attacks and they can also take very different forms for the same individual. For me, a “typical” panic episode begins with a fairly generalized feeling of apprehension or dread. Sometimes that’s as far as it goes. However, more often, there follows a period of increasingly heightened awareness of things moving  in my peripheral vision that I can’t keep track of. This leads to a sense of being surrounded by threats of various kinds and panic ensues. Usually, at that point, I run.

A typical panic episode lasts only a few minutes, but that’s not the end of it. For a considerable period (hours) afterwards I find myself in a state of hypervigilance during which I’m such a bundle of nerves that the slightest sound or movement can trigger a repeat.

I tend to think of these episodes as being a bit like earthquakes. The milder ones happen fairly frequently, but they’re quite easy to cope with. I have altered my behaviour to avoid places likely to trigger them (see below) and to be aware of appropriate exit strategies. The more severe episodes are much harder to deal with, though, and when one starts there’s nothing I can do apart from try to find somewhere that feels safe, wait for it to pass and then just get through the aftermath, hoping for no aftershocks.

In Dean’s piece he writes about the different stressors that can trigger a breakdown. In my case it was a bit more complicated than that.  Thinking about the milder attacks I find it very difficult to identify specific triggers – they seem to occur more-or-less randomly. However,  I can cope with this low-level “noise” pretty well. I’ve had plenty of time to get used to it, at least.  The more severe attacks seem more likely to be triggered by specific places, especially if they’re crowded with people moving around – although I don’t always have a problem in places like that. To give an example, crossing the main concourse at Victoria Station is, for me, like descending into the abyss; I simply can’t do it, and have to go outside the station to get between the trains and the underground station. Paddington Station, on the other hand, is fine. Weird.

I think the probability of one of these episodes is also influenced by background levels of stress arising from other independent things. Anyway, last year I got into a state in which I was experiencing multiple episodes per day. I couldn’t sleep or eat for over a week, and couldn’t leave the house for fear of experiencing another major problem. I think “nervous breakdown” is a pretty apt description for that period, but my breakdown was caused not by a new problem, but the amplification of an old problem to completely intolerable levels.

The reason for writing about the anatomy of my breakdown in this context is twofold. One part is just to reinforce Dean’s point that a “nervous breakdown” can be triggered by many different circumstances and conditions. Mine is probably an unusual example, but I think everybody else’s  is too.

The other reason is to confess how frustrating it is to be a physicist who has experienced a thing like that. It seems natural that having experienced such an episode I should want or need to try to make sense of it, but I’ve struggled to do that. The way we’re used to thinking about things in physics is to make simple models that capture the relatively simple cause-and-effect relationships between relatively few variables, usually based on the objective analysis of data controlled experiments and/or systematic observations.   This all involves trying to break down a phenomenon into its component parts so as to look at their separate action and thus establish the simple rules (if there are any) that govern the overall behaviour.

The trouble with this analytic approach is that the human brain and its interactions with the external world are far too complicated and non-linear to be approached in the simple-minded way we physicists usually do things. Even if you accept that the brain is basically a collection of atoms communicating with each other using electrical impulses, that doesn’t mean that it’s useful to try to describe its action using atomic physics and electromagnetic theory.

On top of all that, there’s the issue that neuroscience is a subject I know very little about at a technical level. There’s only room in my feeble little brain for my own specialism, so I lack the knowledge needed even to understand the literature.

So although I got over my breakdown, it has left me with a huge number of questions I don’t even know how to begin to answer. What is happening in my brain when a panic episode begins? What is going on with my peripheral vision when it goes awry like it does? Why do some particular places  or circumstances trigger an attack but other, apparently similar, ones don’t?

I don’t suppose anyone out to answer these questions, but if any neuroscientists out there happen to read this piece I would be grateful if they could recommend appropriate literature, as long as it’s simple enough for an astrophysicist to read…

## A blog by any other name..

Posted in The Universe and Stuff with tags , , , on August 8, 2012 by telescoper

While I’m online I thought I’d pass on the following gripe.

\begin{gripe}

Some months ago I saw a message going around on Twitter that the Guardian was looking for new science bloggers to cover a wide range of disciplines for its website. After thinking hard about it, I decided to submit an application basically so I could find out more about what was involved and see if I really wanted to do it. Anyway, I’ve already written a commissioned piece for the Guardian website, so I thought it was an idea worth pursuing.

My idea wasn’t to scrap In the Dark or move it all to the Guardian, but to post less frequent and more sciencey pieces there and keep this as a personal ego-trip blog. The advantage of that being that they pay, whereas this blog doesn’t make me any dosh at all, and also presumably generates significantly wider exposure. As well as making a pitch for the content of the proposed blog, I had to think of a new title if In the Dark was to carry on, so I came up with Across the Universe, which seemed to me to emphasize nicely the cosmological slant of the pieces I would be likely to write. It’s not a new coinage, of course. It’s based on a Beatles song I have posted about previously.

So I filed the application and waited. Then I was contacted by Alok Jha, who looks after the Science blog network at the Grauniad, who initially made encouraging noises, explained that there would be minimal editorial control and  I would keep copyright of anything I wrote for them, etc. Most of my questions having been answered I awaited further developments. Then Alok Jha contacted me again and explained that the editorial team wanted me to jump through several extra hoops if I wanted to take the idea forward. I sensed cold feet. For a number of reasons, the timing of these new phases of the process were also very inconvenient, so, after mulling it over, I contacted Alok Jha and politely withdrew my application.

I’ve no regrets about that decision, and thought no more about it, until last week when the Guardian started to roll out its new blogging team. I was delighted to see neuroscientist, comedian, and fellow Cardiff University chappie Dean Burnett among the bloggers. Their new blogger for matters astronomical is Stuart Clark, a well-known and respected science writer who I’m sure will cover a wide range of interesting topics (as he has already started to do).

What I’m peeved about, however, is that Stuart’s blog title is Across the Universe, exactly what I had suggested in my proposal! Coincidence? I asked Stuart via Twitter and he told me that the name was suggested to him by none other than Alok Jha.

Of course the title isn’t copyrighted by me, and wasn’t even original, but it was my suggestion and I do think it’s very poor form to have appropriated what was on my proposal without asking or giving acknowledgement. I’ve no complaints about Stuart Clark, of course. He didn’t know what had happened, and I wish him well with his new blog – which I shall certainly be reading. But I’m not at all chuffed about the way this was handled by the Guardian.

In the interests of full disclosure, I should point out Alok Jha recently contacted me to apologize and say that he had “forgotten” that Across the Universe was the title I gave on my proposal.

\end{gripe}

Anyway, the upshot of all this is that I’ll be keeping In the Dark going pretty much as it is for the foreseeable future.

Health willing.