On Meds, or Off?

I had started another entry for this week, which will probably be published next week, because something else came up that I really wanted to share, and sooner rather than later.

On Tuesday afternoon, I had a fairly routine appointment with my doctor. As I’m sure has been fairly obvious to my readers, I’ve been struggling to get back to a more stable place with my depression, and it’s a struggle that has lasted for more than a month. So, I decided, in the exam room, that it was a good time to bring it up with him. I’ve been on bupropion (Wellbutrin) since late January of this year, and it had been working pretty well until recently. I know that a lot of what has triggered a slight backslide has been due to environmental stressors and external conditions, but, at the same time, I’m not too proud to admit that I haven’t been able to willpower my way back to some semblance of balance and stability.

As we were getting close to the end of the appointment, I brought up that I’ve been struggling a bit more with both the physical and emotional symptoms of my depression, and I wasn’t wanting it to get too bad before asking for help. We discussed the options, including increasing my existing prescription, and I mentioned that, at one time, a combination of fluoxetine (Prozac) with the bupropion had worked well to get me to a point where I could work my way down on my dosage. He mentioned that he usually prefers to prescribe sertraline, in the same family of drugs as Prozac, because it has fewer side effects. I agreed, and went on my way.

That evening, Hubby was kind enough to pick up my new prescription for me. The next morning, as I was looking at the new prescription right before taking my pills, I noticed that sertraline is the generic name for Zoloft. I’m familiar with Zoloft. It was the first antidepressant I was ever on, and I was on it for a few months. That entire time, I struggled, but didn’t realize there was a problem. I’d never been on antidepressants, I didn’t have a regular doctor, and the public mental health resources in the area (eastern Kansas) were less than supportive. This was also during some of my darkest days of depression, and, since my mood was feeling slightly more stable, and slightly less dark, I figured it was working, and as expected, because no one told me otherwise. The whole time, if I took my meds in the morning, I would be queasy, shaky, and lightheaded all day. If I took it at night, well, my sleep was already messed up, so I didn’t really notice if it worsened my insomnia or not, but, either way, my GI tract was none to happy with the meds.

My journey towards regulation continued with the County Mental Health department when I moved back to San Diego. I let them know about the gassiness, as well as what would happen if I took the Zoloft in the morning, and they decided to try me on Lexapro. After the first month, I noticed that I had 0 libido, and emotionally, I was numb or angry, nothing in between. I let them know (I can’t remember if she was a psychiatrist or what, specifically), but, since she saw I was still picking, she wanted to increase my dosage. Since anger was the only emotion I could feel, it drove my reaction. I had tried to speak up about something that felt wrong, and was ignored, so, driven by frustration, I stopped going to County Mental Health, took myself off my meds, and started a several year journey of white-knuckled survival in the battle with depression.

A couple years later, for a short time, I was insured through my job (the same place I was at during the reflux problems), and was able to get on Prozac, which worked OK. Then, I was laid off, and ended up back off my meds, back to the white-knuckled survival route. About 9 years ago, I went back on meds again, and that’s when, through working with my care team at that time, we found that the combo of Wellbutrin and Prozac worked incredibly well for me. So well, in fact, that we were able to eventually wean me completely off meds, because I was so physically active that the meds were waking me up in the middle of the night, no matter how early I took them in the morning.

I maintained pretty well, until I wasn’t. Until my physical activity was decreased due to needing to be at low impact, low intensity activity during my pregnancy. Until the postpartum months, which included spending most of the first 3 months after my son was born waking him every 3-4 hours to make him eat, because he was struggling to gain weight. Until my Grandma’s Alzheimers was no longer deniable, and I watched her turn into a shell of herself.

So, once I realized how far I had slid into the depths of depression, and could admit it to myself, I asked for help, and started on the journey that led me to creating this blog. All of this leads to this week, this conversation with my doctor. This moment, Wednesday morning, seeing that my new med is Zoloft. It’s been 14 years since I had the problems that I’d had, and my health and everything else was in a very different place. I’ve walked a very long road, fighting the whole way for survival, learning about myself and my depression along the way. I know, too, that body chemistry can change over time, so I decided to give it a try.

It did not go well. By noon, I was having problems getting food down, because I was so queasy. Then my hands started to feel trembly. Then, each time I stood up and started walking, for the first minute or so, my equilibrium would feel a little off. By 2, I was on the phone with my doctor’s office, letting his receptionist know I was having some side effects. She sent him a high urgency note advising of my call and symptoms. I then found my boss, explained the situation, and went home, then, once there, I texted my therapist. I’d been scheduled to see her that evening, but I didn’t know if my symptoms would get any worse before they got better, so I explained the situation, and we cancelled the appointment.

Around 4 on Wednesday afternoon, my phone rang. I answered, hoping it was my doctor, and it was. He asked again about my symptoms, and I talked him through them again. He suggested trying to slowly build up to a full dose, in the hopes to minimize the symptoms. At one point, not even that long ago, I would have deferred to him, since he’s the doctor, but that isn’t what happened. I spoke up. I let him know that, once I saw that the sertraline was the generic name for Zoloft, I remembered that I’d taken it before, and had the same symptoms, and that they persisted for the 2-4 months I’d been on it last time. We then had a discussion of our other options, and I mentioned again that Prozac and Wellbutrin was a combination that I’d taken before, with no ill effects, and with notable success. Thankfully, my doctor was willing to listen, and willing to work with me on what’s best for me, my mind, and my body. He sent a prescription for Prozac over to the pharmacy, and, by the time you’re reading this, I will have started the new, yet familiar, combined meds.

At two moments, in two days, I made a decision that was nerve-wracking in the moment, a decision that, just a few days ago, I might not have made. I made the decision to speak up for myself and ask for what I needed. I asked to increase meds, at least temporarily. And, I asked for help when I had a reaction, and spoke up for what I know has worked well for me in the past. And that, in the end, is the biggest win I’ve had in a very long time.

Are you comfortable with speaking up for your needs? When did you last ask for help, or speak up for yourself?