22 Days of Musing: 12

12. The candies of fun.

The treatment options available for mental illness are rich and varied, and include not only counselling – the first place I looked to for assistance, primarily because I was not in stable employment and the counselling service they offered through the university support services was free – but also psychological and psychiatric intervention that may or may not include medication. After some time spent working with the university counsellor, I experienced a general reduction in the severity of my symptoms, but not a complete dispersal by any means, and I had a relapse after a couple of months. But as I mentioned in yesterday’s reflection, in this little while I’d come to realise that there were additional options I could seek out through the public health system, and once I did my general practitioner was my next port of call; through him I was referred to a psychologist, and subsequently started on a combination of cognitive behavioural therapy and medication, with which we were able to get my depression more or less adequately managed.

When we anticipate, we’re the happiest. Unless you’re on antidepressants. The reason you take antidepressants is because you can’t anticipate. You think everything’s going to be horrible, so it usually is.
– Lewis Black

Previously I’d never thought about the idea that in my depression and anxiety a chronic illness might be affecting me, but after sitting down with the doctor and psychologist and developing a list of the episodes I’d experienced – not only since January, but since the first phase of depression I’d recognised in myself back in 2008 – it gradually dawned upon me that I was staring down the barrel of exactly that: chronic mixed depression and a social anxiety disorder (this is the precise nature of my illness as it was eventually diagnosed). Over the five years and a bit since my first diagnosis, I’ve been moved onto and off a range of medications: sertraline, desvenlafaxine, escitalopram, diazepam in a couple of instances where my anxiety has come to the fore unusually strongly, and most recently, paroxetine. Psychotropic medications of this sort can be of great assistance once the right one is found, but here also there are many challenges to confront. Starting on an antidepressant medication can disorient you, or even appear to worsen your symptoms for a short while. Missing a day of medication can unsettle you, either psychologically or physically (or both). Being on a medication too long can cause it to lose effectiveness – one of the reasons I’ve been on several different antidepressants; I was on sertraline for about three years before it lost its potency, desvenlafaxine for another year or so after that, escitalopram for just a few months (long enough to realise that it didn’t really work well for me), and paroxetine for the last few months. And changing from one medication to another, which necessitates spending a few days withdrawing slowly from the previous one to the upcoming one, can be even more disorienting than starting on antidepressants for the first time. That only happened to me once, fortunately, while coming down off desvenlafaxine; I’ve heard from other depression sufferers that this is one of the tougher therapeutic drugs to withdraw from, and the otherwise basically indescribable phenomenon some refer to as “brain zaps” were entirely alien to my experience. But they didn’t last long, thank goodness, and upon moving to the escitalopram they subsided within less than a day. I know people who are fundamentally opposed to much of psychiatric practice because of the use of psychoactive medications, but in my experience they’re a tool just like any other, to be respected but not feared; though times do occur when I feel as though the medications veil the positive and pleasant and desirable emotions nearly as much as it does the negative and painful and torturous ones, certainly I don’t think I would have made it through the last five years without their assistance.

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