Archive for Paroxetine

Life and Chemical Imbalances

Posted in Biographical, Cardiff, Maynooth, Mental Health with tags , , , , , on July 21, 2022 by telescoper

Although it has weighed on my mind in recent weeks, and I have mentioned it on this blog a couple of times, I’ve managed to avoid writing too much about the fact that exactly ten years ago I was languishing in the high-dependency unit of a psychiatric hospital. Today I saw that there’s an article doing the rounds about mental health issues so I thought I’d use it as a pretext for getting some of the memories of that time off my chest.

The article I mentioned above has the rather misleading title Depression is probably not caused by a chemical imbalance in the brain – new study. What the article argues is that there isn’t a simple cause-and-effect relationship between depression and the chemical serotonin. There may well be a biochemical explanation of depressive illness that involves serotonin, but it’s obviously very complicated. That shouldn’t surprise anyone. Very few things in neuroscience are simple.

Unfortunately some people are misrepresenting the piece by claiming that it proves that a widely-used class of anti-depressant drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs; the best-known of which, Fluoxetine, is known by the trade name Prozac). This class also includes Citalopram and Paroxetine (trade name: Seroxat), both of which I have been on. The latter is not available on the National Health Service through a General Practitioner, but must instead be prescribed by a consultant psychiatrist because of rather serious side-effects.

I refer you to an explanatory article Dean Burnett who explains that nobody really knows how these SSRI 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.

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. It is for these things rather than depression per se that I have taken SSRIs. 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.

Ten years ago, in the summer of 2012, I experienced awful problems 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. My mental and physical health deteriorated steadily until my GP referred me to a psychiatric hospital just outside Cardiff. When I arrived there they took one look at me and put me in a high-dependency unit, under close supervision.

I think they thought I was suicidal but I really wasn’t. I was just so exhausted that I didn’t really care what happened next. I was however put on a kind of `suicide watch’, the reason for this being that, apparently, even while sedated, I kept trying to pull the tube out of my arm. I was being fed via a drip because I was ‘Nil by Mouth’ by virtue of uncontrollable vomiting. I guess the doctors thought I was trying to sabotage myself, but I wasn’t. Not consciously anyway. I think it was probably just irritating me. In fact I don’t remember doing it at all, but that period is very much a blur altogether. Anyway, I then found myself in physical restraints, so I couldn’t move my arms, to stop me pulling the tube out.

Those days are painful to recall but I was eventually moved to a general ward and shortly after that I was deemed well enough to go home. Fortunately, I recovered well enough to return to work (after taking a short break in Copenhagen). I signed up for 6 weeks of talking therapy. I had to wait some time before a slot became available, but had appointments once a week after that.

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 realized 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, which I still experience (in a relatively mild form) from time to time.

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 at Sussex, 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 before.

In 2016 had no idea that I would move to Ireland in 2017. I’m glad to say, though, that despite the isolation and stress caused by the pandemic, and workload issues generally, I’ve managed without any form of anti-depressants since then, though it hasn’t always been easy. Let’s just say that I am greatly looking forward to reaching the end of my term as Head of Department of Theoretical Physics at the end of next month…

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’!