SSRI-ously: my first 100 days on fluoxetine

Extreme honesty alert! If you don’t like reading unfiltered accounts of mental health stuff, don’t read this blog post. It even contains the words “my sex drive”, in that order. Don’t say I didn’t warn you…

I know, I know. Mental Health Awareness Week was last week. I really meant to write this post then, but I was distracted by other things. Alternatively, by posting it today I’m making a statement on how we need to be aware of mental health all year round, not just for one week. Take your pick.

I mentioned in my last serious post that I’d just been prescribed fluoxetine. I’ve now been taking it for over 100 days. Fluoxetine is probably more widely known by the trade name Prozac, and it’s an SSRI (selective serotonin reuptake inhibitor), a kind of antidepressant which, in the lamest of layman’s terms, makes the happy chemicals in your brain stick around longer than they normally would. At least in the UK you can’t buy it over the counter; it has to be prescribed by a doctor. That’s the main reason I feel okay about writing what I’m about to write. Let’s be clear: I am about the furthest thing from a doctor that the human race has yet produced. Everything I say from here on is based purely on my own personal experience, and should be overridden by anything you hear in a consultation with an actual medical professional.

That said: based on the 100 or so days I’ve been taking it, fluoxetine is a goddamn miracle.

No, it hasn’t fixed all my problems. I never expected it to. To be honest, part of me never thought it would do anything at all. But it has. My life situation hasn’t changed much (yet; I’m working on it), but I feel much more stable and happy than I did at the beginning of the year. Back then, I was getting to a point where I would often avoid social gatherings even with my closest friends because I felt like I was being antisocial and because I couldn’t stop myself falling into a pit of hopelessness immediately afterwards. Today I still have plenty of insecurities, but they don’t overwhelm me; little things don’t snowball into massive avalanches in my head, petty jealousies are easier to let go of, and I think I’m a nicer person to be around.

To clear a few things up, I’m going to respond to some of my own doubts which I had before I started taking antidepressants.

Maybe I’m not actually depressed? Maybe this is how everyone feels, and they’re all just better at dealing with it than I am? I mean, how could anyone NOT feel this way when there are so many things in life to worry about?

There is no objective way to measure feelings, of course, but any doubts I may have had that I was actually depressed have been completely dispelled by the change in my moods since taking fluoxetine. I don’t exactly wake up singing every morning, but I also haven’t had any more of those why-should-I-keep-breathing days recently. I look back on those days now and I recognise them for what they were: signs that I was badly in need of help. I can’t say for certain that I’ll never have one of those days again, but I haven’t yet. Everything has been lifted up a bit. Bad days are now okay days, okay days are now good days.

I’m also finding it easier to relate to other people, in a way that suggests what I’m feeling now is closer to what they feel most of the time. Suddenly I can understand other people’s seemingly superhuman ability to brush off the sorts of little things that used to burrow into my brain and eat me from the inside out. I can understand why other people don’t feel the urge to message their friends after every single social gathering to apologise and ask if they’re still friends. It’s not that they secretly feel just as sad and insecure as I did and are better at keeping it bottled up. It’s that mentally healthy people just DON’T go spiralling into despair at the tiniest provocation, the way I used to. If they did, the world would not function even to the dubious extent that it’s functioning at the moment. So, if you feel crushingly sad on a regular basis and wonder how on earth other people can cope, I would posit that this is probably depression and that you should seek help.

Okay, if I take antidepressants I might not feel as downright miserable as I do now, but I’ll be forever wandering about in an artificial chemical haze, unable to feel much of anything at all. Isn’t being sad better than that?

This was my biggest concern before I actually tried taking fluoxetine. That the medication would make my brain fuzzy and slow. That all the vivid colours of emotion would blur together into a grey sludge. That the depression would still be there – covered up, perhaps, like furniture under a sheet – unseen but always THERE, an invisible, silent, unsettling presence.

That is not remotely how it feels to be on fluoxetine. It feels, to me, as though I finally have things in perspective – not that fluoxetine has tricked me into thinking the world is great when it isn’t, but that it has corrected an error in my brain that made me see everything as awful when it wasn’t. Things are actually clearer now; if anything made the world seem fuzzy and grey and unsettling, it was the depression that gripped me before.

I can certainly still SEE the bad stuff, and even feel bad about it. But I can see the good stuff now too. The distinction between bad and good is sharper, and I seem to have lost my joy-stifling tendency to think of good stuff as bad stuff in disguise because it will some day betray me by coming to an end. I’m still capable of feeling happy and sad and angry and shocked. But my default mood has shifted. Whereas before, left to its own devices, it tended to drift back towards lonely, angry, hopeless self-hatred, it is now anchored in a much calmer, more rational place. Sometimes this takes me by surprise; I’ll catch myself feeling happy, or at least contented, and I’ll think “wait, what are you feeling like that for?”. And then I think “oh yeah, I do have quite a few reasons to be happy, don’t I?” Which is pretty much the opposite of the spiral I’ve been getting trapped in for the last few years.

But if you get rid of depression, aren’t you getting rid of a useful motivator to make your life better?

ABSOLUTELY NOT. This is a question that fundamentally misunderstands the nature of depression. Depression is the opposite of a motivator. It’s the sense that there isn’t any hope of making things better, and that you wouldn’t deserve it even if there was.

As proof that fluoxetine isn’t just a pill to make you accept whatever crappy situation you find yourself living in, I will say this: there are many aspects of my life that I’m not happy with. The main difference now is that they don’t prevent me from enjoying the aspects I am happy with. I can be upset that I don’t have a job, and still love hanging out with my friends. I can wish I had a cute human or pangolin to cuddle up to at night, and still enjoy curling up with a good book. I am able to feel good about the ways in which I am lucky, and still aspire to do more with my life. You know, like people are supposed to.

Surely there must be better ways of achieving the same thing, without using medication?

For some people I’m sure there are, and they’re certainly worth trying too. But the hardline anti-antidepressant stance that some people take strikes me as sort of a weird holdover from a (mostly) bygone era when mental illnesses weren’t considered as “real” as physical illnesses. If I had an infection I wouldn’t try to “think” myself better – that idea would have more than a whiff of new age absurdity about it. No, I’d go to the doctor for some antibiotics. Obviously this is an oversimplification, as many mental illnesses can and have been successfully treated using non-pharmaceutical techniques like cognitive behavioural therapy. But to outright reject the use of a drug that has been clinically proven to work, at least for some people, seems misguided.

Does fluoxetine have any side effects?

For me: nothing that is anywhere near as bad as the depression was. I am sleeping quite a lot. Often I’ll get tired in the middle of the day and have to take a nap, which I didn’t used to like doing. But this may just be my body catching up on all the sleep I’ve lost to depression, anxiety and panic attacks over the last few years. I’ve also had some strange and elaborate dreams, but nothing too nightmarish.

Aside from that, my stomach felt a bit odd for my first few days on fluoxetine, but after a week it was fine. Also, this may be a little TMI, but my sex drive has been reduced quite a bit. Not the sort of thing I’d normally bring up, but as I actually want this post to be informative I thought I’d better mention all the side effects rather than getting squeamish about them.

Also, I know I said I’m not a doctor, but I have been told BY a doctor that for most people there are no serious long-term risks to taking fluoxetine, so, prescriptions permitting, you can pretty much keep taking it for as long as you need to.

Hey, um, I know I’m supposed to be your pre-fluoxetine past self, but you’re being so effusive that I just have to break character and ask: are you being paid by Big Pharma to write this?

No. And I have no idea who produces fluoxetine or how ethical they are. All I’m saying is that for me, it works. (And I’m not trying to convince you to spend money on anything, because where I live this kind of healthcare is free, as it should be everywhere.)

For you, it works. Okay. But what if this is just some weird you thing?

It could well be. But the reason I wanted to write this is because I haven’t read much stuff about antidepressants that’s as unambiguously positive as my experience so far has been. Understandably, self-help books, NHS websites etc. tend to be quite cautious when talking about them, emphasising that they’re not for everyone, and stopping short of fully endorsing them. And yeah, I’m sure they’re not appropriate to every situation, they won’t work for everyone, and some people will suffer side effects. But, purely based on my own experience, and to avoid adding to the pile of frustratingly tentative prose about antidepressants, I will say this: if you think you are depressed and you just don’t know how to go about feeling better, you SHOULD at least ask your doctor about fluoxetine. It might not work for you, or it might give you bad side effects, in which case you should of course stop taking it. Even if it works, it won’t solve all your problems in one fell swoop.

But in my case it’s made a world of difference. I can’t promise it will for you too, but I promise it’s worth trying.

Footnote: just in case anyone reading this has social anxiety issues similar to mine, I feel I should also mention that it is perfectly fine to take a friend or family member to the doctor with you. Lots of people do it, and it can be very reassuring to have someone else there to back you up.

Ripcords (and other flawed metaphors for understanding mental health)

Oh, January. Traditionally, my most garbagey month of the year. I’m not 100% sure why that is. Maybe it’s the fading afterglow of Christmas, with all its festive distractions and myriad excuses to mess about with friends. Maybe it’s seasonal affective disorder caused by the short days. In this case, I suppose it could be because one of the worst people in the world just became the president of America, or because my best friend just left to live in said dystopian nightmare land and I probably won’t see him again until next Christmas, assuming any human is left alive by then.

But largely, I think, I’m just freaked out by that new, unfamiliar digit in the year. It reminds me that time is still moving, and I’m … well, I’m not.

I’ve felt stuck for a long time now. Stuck in the same place I’ve been for much of my life, plagued by sometimes overwhelming anxiety and gradually growing depression, unable to do many of the things adults are supposed to be able to do, and worse than that, often unable to appreciate the ways in which I am actually very lucky.

One thing I’ve been struggling with a lot lately is how to deal with depressive episodes. Not the times when I feel a bit grumpy, but the times when I feel like I’m being buried alive (though the former can often turn into the latter if I can’t find a way to hold back the avalanches in my head). In my most recent books blog, I talked about buying Matt Haig’s book Reasons to Stay Alive as an emergency ripcord in case I ever needed one. This is something, I realise now, that I do a lot: I store up ideas for things I could do to try to feel better, or try to change my life, and only rarely do I act on them. I suppose it’s the same impulse that leads me to buy loads of cheap Kindle books when I already have hundreds I haven’t read. My fear of running out of options sometimes stops me from using the options I have.

In late 2015 I pulled one of these ripcords and went to see my GP for advice about my problems, which led on to a short course of cognitive behavioural therapy. This seemed to be helping a little bit for a while, but not as much as I wanted, and when it ended I felt lost again. And worse, I felt as though I’d used up a ripcord, shut off a potential escape route from future attacks of despair.

I suppose that’s the problem with using metaphors to try to understand life. If you choose one that doesn’t quite fit, you can end up playing by the rules of the metaphor rather than the reality.

Today, after a bit of nudging from family and friends, I was finally convinced to go back to the doctor. A different doctor this time, who referred me for a different kind of therapy, and prescribed me an antidepressant in the meantime. I have no idea yet if either of these things will work, but I’m glad I went. It reminded me that, when it comes to mental health, there are many many different options, and I’m sure every one of them has worked for somebody. If I’m serious about wanting myself to be better – for the sake of the people around me, if not for myself – then shouldn’t I keep trying until I find one that works for me?

It’s a classic one of those things I know perfectly well intellectually but cannot seem to accept emotionally: getting help isn’t a sign of weakness, and it doesn’t have to be a last resort. In a lot of cases, you’re not pulling ripcords; you’re opening doors. If you feel sad and want to talk to a friend – rather than worrying that you’ll use up some imaginary allowance of goodwill, maybe you should just do it. If you feel like you might need professional help – rather than waiting until things get worse, maybe you should go to the doctor. If you think of anything you could try that might help you – rather than squirreling it away for some hypothetical winter of the soul when you’ll have no other hope left, maybe you should just try it. It’s not worth waiting to see how bad things get. To return to the ripcord metaphor: when you’re plummeting downwards, it’s not always obvious how long it’ll be before you hit the ground.

Maybe, instead of putting all your faith in a ripcord you’ve never tested, you should go ahead and pull a whole bunch of them so you know which ones – oh, forget this metaphor, I told you it doesn’t really fit! Maybe, instead of putting all your faith in a single solution at a time, or hoping things never get bad enough that you need a solution, you should branch out, try different approaches, and experiment until you find something, or a combination of things, that make you feel better, even a little bit better – and from that slightly better place, you can continue your search.

And this doesn’t mean “growing a pair” or “pulling yourself up by your bootstraps” (that sort of tough love might appeal to some people but I’ll always see it as corrosive, macho posturing garbage) but it means being willing to try a wide range of options, accept help when it is offered, and go looking for help when it’s not immediately visible. Hopefully you won’t have to look too far. Despite recent events, I truly believe there are a lot of wonderful human beings out there in the wild. And, as much as our increasingly hateful political culture might try, historically, wonderful human beings have proven themselves rather difficult to weed out.

P.S. Don’t mistake this for advice from someone who actually knows what he’s talking about. I have a long way to go before I can claim that title. I’m just stating things as I see them right now, because this is the first time in a while that I’ve felt even a little bit optimistic. Got to capture that lightning in a bottle.

P.P.S. Damn. Ripcords… bootstraps… lightning… I can’t seem to stop using metaphors today! Excuse me while I double-check the side effects of fluoxetine…

Things I learned in Atlanta

A couple of weeks ago I travelled to America in the company of some friends of mine to attend Filmapalooza, the annual gathering of the winners of the 48 Hour Film Project (which we won last year in Edinburgh and Glasgow). It was held in Atlanta, Georgia, not a place I knew much about, but I was excited, particularly as I’d never been to America before.

The experience was a bit overwhelming and hard to summarise, so I’ve written a bunch of fairly unconnected paragraphs in the hope that together they’ll convey the whole chaotic experience better than a linear blog post could. Here goes!

airport3

I kinda hate airports. For a person with social anxiety, an airport is an obstacle course of awkwardness. There are even forfeits: if you fail to understand the instructions being barked at you at the security checkpoint, your punishment is to be felt up by some guy you don’t know. And if I didn’t have two well-travelled friends with me, the whole thing would have been much worse, as nothing about the process of checking in / checking bags / passport control / boarding is at all self-explanatory, and there is the constant sense that if you do something wrong you’ll find yourself in a lot more trouble than if you, say, knock a Fruit Corner off a shelf at Sainsbury’s.

The actual flying part is okay, except when it’s not, but most of the time it is. I don’t understand how anyone ever has the nerve to put their seat back though. I think there should be some sort of prize — maybe a cash reimbursement — for getting through the whole flight without putting your seat back, especially if the person in front of you has. Also, sometimes the plane is way too hot and they only bring round tiny cups of water every hour or so, probably to stop everyone needing to use the toilet. And whenever there’s any turbulence I quickly think back over the last day or so of my life and convince myself that this would be a dramatically appropriate point for the plane to crash and kill me. And one time I noticed this bit of the wing that was flapping up and down as if it was about to come loose. Actually, maybe flying isn’t okay.

Atlanta is pretty. Just the right amount of sleek modern city centre surrounded by picturesque suburbs sprawling off into the forest. It feels nice and, considering the high crime rate, unexpectedly not scary. I didn’t think much about the fact that anyone passing me on the street could be carrying a gun, or that there’s no universal healthcare, or that they still execute people, or that they’re considering electing a billionaire cartoon villain who frequently makes misogynistic comments and has suggested banning an entire religion from entering the country on the basis that he thinks they’re up to something. I suppose the niceness is what allows the people living there to forget these things most of the time too.

atlanta1

American people are also nice. Nice enough that I am now baffled as to where the stereotype of British politeness came from. The people I encountered in America were infinitely more polite than the grumps you meet in Britain – with the notable exception of the border control guy to whom I had to justify my existence at Atlanta airport, and who managed to make me feel like I shouldn’t be there as soon as I arrived. But border control guys aren’t technically people, so I won’t count him.

America may be nice, but here’s one thing it is not: it is NOT an enchanted land that causes me to shed all my social inhibitions the minute I set foot on its soil. As is my habit, I’d sort of fooled myself into thinking it might be, but the disappointing truth is that I am the same person even when I’m on a different continent. This meant a certain amount of standing around awkwardly at the social events I attended, particularly during the ice-breaker. And after that, a certain amount of staring out the window of a revolving restaurant rather than talking to the people I was with, and then a certain amount of staying in my room while my friends were off partying, talking to myself and trying to come to terms with the fact that this trip might not be quite the personality transplant I’d been hoping for. (That all sounds bad, but if you know me it’s actually pretty normal.)

Staying in a reasonably fancy hotel is a cool experience. If you ever get the chance to stand in front of a floor-to-ceiling window high above a nocturnal cityscape of twinkling lights, holding a drink and wearing an actual shirt with buttons and everything, you may experience the strong sense that you have finally “made it”. However, this sensation is fleeting and untrustworthy, and when you retire to the nice room you are only staying in thanks to a hefty discount, you may find yourself terrified to touch anything in case it costs you hundreds of dollars you don’t have. Seriously, they had a bottle of water with a cardboard thing around it saying “enjoy”, and it was only if you looked closely you could see it also said “$5”. After that I started looking for prices on everything. It took us several days of tentative experimentation before we discovered the Wi-Fi was actually free after all. Awkward unemployed Scots are not made for such surroundings.

Despite all that, the film festival was fun. The screenings — of ours and other people’s films — were very enjoyable, and the people I did talk to were nice and often quite complimentary about our films, which was double nice. If you’re lucky, I might do another blog post soon about my favourites of the other teams’ films, because there were too many good ones to cram in here.

cocacola1Coca-Cola World is a little pocket of brightly-coloured dystopia where any staff member who doesn’t show appropriate enthusiasm for the ubiquitous fizzy concoction is presumably taken to a back room and dissolved in a vat of it like an unfortunate tooth in a school science project. But it’s quite fun, and all the propaganda did help me remember how much I love Coke.

Zaxby’s is not a great restaurant for vegetarians. And by not great, I mean not only does it offer no substantial vegetarian options, but it also has slogans on the walls making fun of us for being sissies. The rebellious side of me felt that they’d initiated hostilities towards us, and that it would be quite within the rules for me to perform some minor act of vandalism in their restaurant that they wouldn’t discover until after I’d left. But then I found their drinks machine had raspberry Coke, so I decided they were okay. Coke is great.

Zaxby’s aside, finding vegetarian food in America wasn’t as hard as I expected – most burger places have a veggie option, and even the fried chicken place we ended up at on the last day offered the welcome option of ordering four sides in place of a main course. I won’t claim to have gained any real insight into American cuisine, since my diet both there and here consists almost entirely of bread, cheese, meat substitutes and sugar in various configurations, but I did discover that working out how much to tip is not quite the ordeal I’d been dreading. Oh, and non-alcoholic drinks aren’t an issue either, because literally everywhere has Coke. And why not? Everyone loves Coke.

muppets1

The museum at the Center for Puppetry Arts will make you happy if you like the Muppets. If you don’t like the Muppets you don’t deserve to be happy, so you should go there either way.

Six Flags Over Georgia, which we had planned as a treat for our last full day in America, turned out to still be closed for the winter. This was a bit of a downer, but on the plus side, we went to the Amazing Escape Room instead! I knew I’d like escape rooms, as they appeal to my unfulfilled childhood ambition to be a contestant on The Crystal Maze or Knightmare. And now I’ve done one (and we did escape, with over ten minutes to go, which is basically like getting over 100 gold credits after deductions in the Crystal Dome – shut up, it is!) I kinda want to do all of them. In the world. While swigging from a hip flask of Coke. I heard somewhere that Coke increases your brain power. Now where did I hear that?

Regarding not setting my brain on fire

Several months ago I sent off the opening of my novel (codenamed Project Snails) to three different literary agencies, and promptly tried to forget I had done so. Primarily I did this by pouring myself into a brand new project, an inconveniently hard-to-describe podcast called Rainy Day Adventure Club. I might write some behind-the-scenes stuff about it later, but for now you can go and listen to the first six episodes if you find yourself similarly in need of distraction.

Now I’m trying to work out why exactly I’m finding it so hard to actually read the two rejection emails that are currently sitting in my inbox. I know they are rejections because, in order to extract the vital information from them without having to read the words myself, I have cleverly used the Yahoo! mail search function to confirm that certain strings of words are in them, and that certain others are not. Short of the emails being written in some sort of topsy-turvy Doctor Seuss style, I am extremely confident in saying they are rejections.

But why don’t I just read them to make absolutely sure? I mean, isn’t the fact that they’re rejections the worst part? The actual words used to convey this information can’t hurt any more, can they?

The trouble is, I know myself, and I know the words will hurt me. Even glancing at them will set my brain on fire. I’ll glom onto some phrase or other and pick it apart endlessly, letting myself believe all the worst possible interpretations of it. However kindly the agents’ words have been chosen, they will come to me when I wake up in the night, or when I’m with friends on a sunny day, and they’ll make me pause and cringe and hate myself a bit. I’m not saying it’s rational – I know perfectly well it’s the very opposite of that. But as I said, I also know myself, and my impish brain will use any implement it’s given to torment me. So, back to distracting myself until I feel strong enough to cope with that.

Hopefully that time will come. If I want to keep going with this writing thing, which I think I still do, I’ll have to learn to be less sensitive – or at least not let my sensitivity get in the way of what I continue to think of as my (as yet unpaid) job. Ideally the intellectual side of me should be able to tell the emotional side that rejection is very much the norm for new writers. But it does sometimes seem that my emotional and intellectual sides aren’t talking to each other much these days.

That if nothing else is a reason I should post here more. 2014 has been a weird year, and my brain has a lot to talk to itself about…