Adventures in Mental Health
So the main reason I’ve mostly fallen off the face of Tumblr in the last few months is that going off my meds did not go well. At. All. And I stopped caring about stuff and wanting to communicate.
Here’s the back-story (TW for depression and self-harm): Carl and I are considering parenthood, and before we could decide weather to act on that, two things needed to happen: I needed to get my IUD taken out, and I needed to go off of Cymbalta, which is an antidepressant that is harmful to pregnant women and their bebehs. When there’s the potential to get pregnant, it’s good not to be on any antidepressants at all, though a couple — Prozac and I think Zoloft — have been approved for use by pregnant people. But I wanted to aim for as a low-risk a situation as possible.
So back in February, I started to taper off the Cymbalta. Going from 40mg to 20mg, I became a bit more emotionally volatile than I had been, but was still pretty stable. The next step was to go down to 10mg, but it turned out the pharmacy couldn’t do that, so my therapist/APRN said to try taking 20mg every other day. But Cymbalta has a really short half-life (it enters and leaves the system rapidly), and that proved to be too much of a roller-coaster ride, physically and emotionally. So she said to just take the 20mg a while longer and eventually stop altogether. I ended up doing that for a couple of months, because there were certain things — a business trip, a visit from my mom — that were going to make it hard to suddenly be completely unmedicated. But, there’s never a good time for something like this, as I’ll illustrate below.
Meanwhile, the IUD: I had an appointment to get it taken out near the end of March, and was planning to stop the Cymbalta at the same time. But when I went to the appointment, the strings attached to the IUD were not visible and the doctor was unable to see where it was and was causing me considerable pain in the process of digging around trying to find it. So we set up another appointment a month from then, for which I would be all drugged up on Percocet and muscle relaxants, and I was sent to have an ultrasound in the meantime so they could give my doc a helpful intrauterine treasure map.
I decided to continue with the Cymbalta until shortly before that appointment. I stopped taking it a week before, and after about 36 hours, withdrawal started, and was weird, and seemed like it would never end. I was having constant bouts of intense dizziness (some people call these “brain zaps” because they almost feel like an surge of tingling in your head), my legs felt twitchy and shivery, I had no verbal recall, and I was just generally in a fog. And of course as the withdrawal progressed, my depression was coming back.
During that time I had my second IUD appointment. Taking a bunch of Percocet did not help with the foggy, disoriented feeling I was having. And it turned out not to even be worth it, because the doctor still could not get a grip on the IUD and had to stop after 20 minutes or so because I was crying from the pain. (Sharp, stabbing, intrauterine pain is, um, A SPECIAL KIND OF PAIN.) Anyway, the next step was to set up an appointment for outpatient surgery in order for the doctor to get the IUD out while I was under general anesthetic. And they couldn’t get me in for that for…another month.
So, this was a week into my Cymbalta withdrawal. At this point I was intensely preparing for a relatively high-profile premiere performance in NYC for a composer I very much wanted to please. The piece wasn’t particularly difficult, but had its unique challenges, and the stress of rehearsing it while going through all of this physical stuff and feeling my depression return in the form of increasingly frequent bouts of rage and despair, along with more anxiety than I ever remember feeling in the past, was real shitty. The day of the performance, I was just counting the hours until it would be over. I think it went really well, but I hardly enjoyed it at all.
I was also working on a piece of my own that had been commissioned, and was basically just plugging away at it through that fog of misery and brain-zaps. It premiered two weeks after I stopped the meds. It went well, and was well-received. And I didn’t enjoy any of it. When speaking to the audience about the piece before hand, it was all I could do not to just mumble, “Um, I’m not a composer and you’re probably going to hate this.” (A friend commented that that’s how most composers talk about their work anyway. LOL.) The next day, I had a performance with my trio. Again, a successful performance I did not have the capacity to enjoy.
The withdrawal was just about gone after two weeks (except for some lingering twitchiness in my legs) but the despair, anger, and anxiety I was experiencing were getting worse and worse. It seemed like a good day if I just cried and didn’t hurt myself. The days when I didn’t hurt myself were hard to enjoy because my head ached from having slammed it against the wall or pummeled it with my fist the day before. You know how they say exercise helps with depression? Well, if I went swimming or running I would probably feel well enough not to hurt myself that day. But it was really just enough to keep me out of danger; I would still feel sad, angry, bitter, and hopeless. I woke up full of dread every morning.
When I was around friends or coworkers, I seem to have acted fairly normal. I could even appear to have fun. But when I laughed at a joke or smiled, it felt mechanical, and the corners of my mouth seemed to be stretching unnaturally, as if my mouth was actually part of a Joker mask. I wasn’t hungry, but I could always eat a normal amount if the food was there. I couldn’t cook though (usually my favorite way to relax in the evening) because any kind of complicated task would inevitably send me into a fit of tears or worse. Oh, and having a baby became a horrifying prospect.
I had one big Spring performance left, something that had come up last-minute and that I didn’t truly have adequate time to prepare for. But I liked the project and needed the money so I took it. The day of the performance in Brooklyn, there was a dress rehearsal in the afternoon, during which my car was towed. I was forced to retrieve it between the rehearsal and performance, a situation that entailed further mishaps resulting in my running in the front door of the venue right at the time the performance was supposed to start. It would have been a harrowing experience under normal circumstances, but in my fragile emotional state (which is possibly what caused me to be careless in the first place) I felt like I was going to explode. My performance was flustered and full of mistakes. I also had to pay the exact same amount in towing fees and parking tickets that I was getting paid for the gig.
This was three weeks after going of the meds. That weekend, rather than feeling relieved my performances were over and ready to focus on my health as I’d planned, my rages and misery continued. Even working in the garden, which is usually such a pick-me-up, felt grim and pointless. It wasn’t just hard for me; it was very difficult for Carl. I was really unpleasant to be around, and there seemed to be no room for his feelings at all. That Monday, I decided to call my therapist/APRN and discuss other options, i.e., going on another form of antidepressant.
A week later, I was on Prozac and my anger and despair were almost totally gone. I was genuinely enjoying things and laughing. I told Carl I felt like someone in the second half of an antidepressant commercial. The third try to remove the IUD was finally successful too.
The following weeks were still difficult, as the anxiety lingered while we adjusted the dosage and the drugs built up in my system. I had never really suffered from anxiety independently of depression before, and at first I didn’t even recognize it as such. During the week before going on tour with Carl and my trio, I finally had a day where I realized I hadn’t thought about how I felt for several hours, and by the time we left I was having almost whole days without anxiety attacks. I was able to enjoy the tour, though I still had some mild anxiety and felt uncharacteristically cautious and tentative in my music-making — particularly improvisation.
It was like I’d forgotten how to be myself, to do what I normally like to do. It’s been hard to remember how I felt about specific things (especially parenthood) before this period; it feels like there’s something blocking my access to who I was before these two bad months. It’s melodramatic to say it, especially since anybody besides Carl who was around me during this time probably saw little indication that anything was wrong, but I sort of feel like I lost two months of my life. Yes, I can remember the whole thing, and nothing terrible happened. In fact, I had several really good performances. I would have been excited at was I was able to accomplish, if excitement had been an emotion I was capable of during that time. The thing is I just did all of that stuff because it was on my calendar. I knew I’d feel miserable no matter what I was doing, so it was better to be productive and miserable and at least fulfill my obligations. I was also less of a danger to myself when other people were around.
Last week, I really started to feel like myself again. I’m so grateful. But I also feel guilty. Three weeks off the medication is really such a short time, and I feel weak and lazy for not sticking with it, for not trying harder to change my thought patterns and increasing my exercise. For not just trying to get pregnant while off the meds and seeing if I felt good during the second and third trimester, like many depressed woman do. Then again, I’m told that the stress that I was undergoing from the depression would not have been good for an unborn child, so I guess I’m probably doing the right thing. But the truth is I’m doing it for myself. So that every day will not be a struggle, and so that I can enjoy music, Carl, my family, my job, cooking, animals, the outdoors, glamour, and everything else that makes me feel like a human being.