I once had a friend
who took Effexor for a while. It had
such horrible side effects for her that she now refuses to call it by name and
instead calls it "the devil drug."
She started calling it this after being picked up by the police
stumbling half-naked down the middle of a road slurring her words and yelling
nonsense to the sky.
I have my own now:
Prozac. I no longer will even say that I
have no drug allergies; I will list this medication as "DO NOT GIVE TO ME EVER" for the rest of my life
because of how crazy my reaction to it was.
Settle in, here
comes a LONG description of 2 weeks of hell:
It started with a
conversation about how maintaining my abstinence had revealed my anxieties and
obsessive thoughts and just how powerful and destructive they are. Like,
I-have-such-low-self-esteem-that-death-seems-a-sensible-and-logical-option
destructive. Like
I-am-so-anxious-around-people-and-sensitive-to-criticism-that-a-little-note-from-a-co-worker-makes-me-hide-in-the-bathroom-and-cry-for-twenty-minutes
anxiety.
I got the courage to
ask my doctor. I also 'fessed up to not
taking my first blood pressure medication (a diuretic that was making me rush
to the bathroom every ten freaking minutes)
because the side effects were bothering me even after months of taking it when
my body should have adjusted. Also, I
was sort of subtly not wanting to take those medications because I have a lot of resentment toward the doctor
who prescribed them to me. THIS is how screwed
up my head is, that I don't want to take medication I need (putting me
at risk for stroke and heart attack and vascular damage and who knows what
else) simply because someone hurt my feelings.
My doctor was
(miraculously, to my mind that was expecting revulsion or condemnation) very
understanding and said OF COURSE you shouldn't take medications whose side
effects are that disruptive. There are
PLENTY other options. And OF COURSE we
can get you on a medication to treat your totally clinical and
utterly-not-your-fault depressive/anxious/compulsive tendencies.
Can I just say how
awesome it is to have a doctor who is this AWESOME?
The first few days
were pretty ok. About day four I started
having these little flashes of feeling awake and energized, making my
ridiculously happy and carefree. I was
like, wow! I'm reacting quickly! They say it'll take weeks - this is great! I
had a really busy week, but that was ok. And oh yeah, I also had almost no
cravings or compulsive food thoughts haunting me. I know what you're thinking - PLACEBO EFFECT
- right?
Sure.
I had started the
medication on Tuesday morning, and the following Sunday I had a very nice
morning; after sleeping in, I went to church, and I actually paid attention to the message and enjoyed it! Yeah, I felt kind of weird, but
that's ok; l felt good too. I felt a
part of my own life, not an outsider. I was hopeful that this medication could help me get my head screwed on straight again.
But the weird
feeling didn't go away. I felt vague,
somewhat lightheaded, and almost like I was separated from my body. But my
blood pressure was slightly lower than my normal (high) reading [yay for new BP
meds!], and my heart rate was normal even after climbing stairs. I sat down to fold laundry, lounged in my
pajamas, and spent 15 minutes or so on facebook. I was having a gloriously lazy day.
Then it all went to
hell in about 15 seconds. I felt this
mad flush go through my body, starting in my chest, and started sweating like
mad. My heart rate, previously 60, was over
100 in about ten seconds and pounding painfully. I felt dizzy, heard a rushing in my ears, and
generally felt like I was going to puke in my mom's lap or else pass out at any
second. It felt physically effortful to
speak or move my limbs, almost like a drunk feeling. My right hand started tingling, and it was
shaking like mad. I said very calmly, "Mom, I think you should call
911. Take me to the ER now."
[a brief side note -
it is a mark of my always-think-of-the-worst-case-scenario mentality that I had
thought through previously what I would do if I ever had a medical emergency at
home and upstairs. My thoughts were
basically to get down the stairs and to the car if able, because waiting for an
ambulance to get to the middle of nowhere and then EMS people having to get a
gurney upstairs (or worse, lift and have to carry me down them, just for the
20+ minute drive to the hospital) is not a pretty situation and would make the
patient-to-hospital response time that much slower. Not to mention what the neighbors would say]
I stumbled to the
car, and mom proceeded to try to beak the sound barrier or else make my car
blow up. She told me later that she made
it over 100mph. Yikes. I talked to the
911 person on the phone, told him my symptoms, and told him no, we don't need
an ambulance because it'll be faster if my mom takes me, and yes, let them know
I'm coming. I was really out of it
(indeed, felt almost like this was happening to someone else) but doing my best
to describe my symptoms clinically to my mom in case I passed out. I even made sure she could give them a copy
of my new insurance card. I objectively listed my symptoms, my new medications,
and listed off the possible diagnoses that were in my head: heart attack,
stroke, or delayed allergic reaction to the new meds (oh, and what are the
symptoms of serotonin syndrome, by the way?).
I didn't pass out, and I listed the same symptoms and history to the
doctor in the ER. And to the nurse. And
to another nurse.
I remember
distinctly saying, "If this turns out to be, like, just a panic attack,
I'm going to be really pissed off."
They lay me on the
bed and took an EKG and my blood pressure.
EKG was normal, but my blood pressure was ridiculously high. I lay there for what felt like a dizzy,
heart-pounding, out-of-body-what-is-my-body-doing-to-me eternity, mom trying to
distract me with funny stories, and gradually I started to feel better. The doctor asked me a lot of questions about
my history and when the new meds started, and said this could be "growing pains" from the Prozac. Sometimes
taking medication for anxiety can lead to increased anxiety. It should go away. Follow up in two weeks with your doctor.
F#$% &%*#%
^^&#$($ &$^#@* #@&# #*#$ @%%$
They gave me a
prescription for an anti-anxiety medication PRN, and a nifty little handout
about anxiety. Surreally, I checked off
every single of my stupid little symptoms, even down to the tingling fingers and "derealization" or "depersonalization."
"just" a
panic attack
"just" my
body betraying me
"just" my
body's fight-or-flight system going ape$%#!
"just" my
body trying to run a marathon without bothering to inform me of its plans
"just" a
hideous ER bill that will come in the mail.
For what?! For a little pamphlet and some benzodiazepines.
Let me stress this: I've had what my therapist called a panic attack before, but I knew what those were and where they came from. They came from my being in a situation that caused me anxiety, and I was so full of the emotions of fear and shame that my body over-reacted as well (cue the crying and hyperventilation). This was nothing like that. This was the physical CRAZY without any of the emotion or the fear. In those past situations, I ultimately had the power and the option to extricate myself from the situation or allow myself to work through the fear. This was the ultimate in feeling out of control - I had absolutely no say, no power, and no way to stop this from ever happening again. (cue pity party)
What followed was a
week of hell. I called my doctor three
times the next day, and she said - because surely it's too soon for the medication
to be taking effect - wait for the results, ride it out if you can, and call if
anything changes. I did my best.
That whole week I
was alternately fidget-can't-stop-talking-so-happy girl, or
get-me-the-hell-out-of-this-job-I-hate-life girl. I was mildly nauseated every single day, and
I started having mini panic attacks in the middle of the workday. You know, sitting with my co-workers in a
meeting and suddenly feeling like I'm having hot flashes and can't control my
racing heart while trying to discuss the finer points of dementia treatment
planning. I started feeling like
something was stuck in my throat; not blocking my breathing or interfering with
swallowing at all, but nevertheless feeling like it.
I was constantly tapping my feet, unable to sit still, and most of the
time had uncontrollable urges to rock back and forth or else jump up and down.
I was utterly unable to concentrate, my mind flitting like a bird from on thing
to another, and not letting me do my work.
I felt like work wasn't worth it, and I just wanted to stay home and
forget the world. I took to speeding
regularly (I'm talking 80 in a 45) just because 55 wasn't fast enough, and the speed limit didn't apply to me anyway.
On the bright side,
I never really felt like eating. Mild
nausea and a lump in your throat make that a little less desirable. On a few occasions I actually had to force
myself to eat. And the kick to it all?
Even with two days of help from my COTA, I worked nearly 50 hours; we had just that many patients.
I went in the
following Monday to ask my doctor what the hell was going on with this lump in
my throat. Am I getting sick and this is
just a swollen lymph node? Do I have
mono? Do I have cancer?! (yes, I do
frequently diagnose myself like this. Not an anxious personality at all).
As it turns out, it
wasn't.
Read about '
globus sensation.' And for the record, those
happy euphoric moments were clinical mania or hypomania, and the restlessness
was '
akathisia.' They (along with panic
attacks and personality changes) are listed in the little drug handout in bold
and all caps as "
SEVERE side effects - seek medical attention
IMMEDIATELY"
These were all
physical symptoms of my body basically being in a panic fight-or-flight state
at all times for the past week and a half.
The manic episodes are considered precursors
to reckless and suicidal behavior and in studies had led to death.
Awesome.
&**$^&@# #*^$*^ $^#& #*&@#*&\
As I stood [I
couldn't sit or even stop tapping my feet] there in the office, describing my
symptoms, my doctor's face became more and more flabbergasted that I could have
reacted SO quickly and SO strongly and SO BADLY to -get this - the exact same medication and dose I had taken and
responded well to in high school when I was depressed. She told me to
get the hell off that medication NOW and to tell her when the effects were
completely gone (it may take WEEKS).
We'll leave my serotonin levels alone, thank you very much. SSRIs are now a new addition to my Drug
Allergies list.
On the bright side, the not-eating and panic-fidgeting all the time had led to me losing
four pounds in two weeks.
Getting off the meds
was just as hard. The globus sensation
didn't go away for a week, and the mini panic and manic episodes got less
intense but lasted until the following Sunday.
What was worse was realizing how much of my personality had
changed. I had stopped caring even about
my patients or my family, and losing the ability to concentrate was near and dear to my proud-of-my-intellect heart.
(Another side note about how amazing my mom is for having stuck with me through this week of me treating her like crap and putting her through all this. Thanks mom.)
I called my doctor
yesterday to tell her the symptoms were gone, and I am ready to try bupropion,
an SNRI. Norepinephrine, you're
next. Please don't screw me up.
Oh, and here's the
kicker: how did I know I was back to
normal? A little voice inside my head
saying, "You know, even though last week was really bad, you still lost
weight. Maybe
it would be worth it."