Mental Health Post #21: Sleep

Few things screw me up more than not getting good sleep.  Ironically, not getting good sleep is part of the game with almost all mental health disorders.  Whether it's insomnia, or sleeping too much, or bedtime procrastination, there's always something in the grab bag for those who struggle with poor mental health.  I've struggled with all of these (and more!) in my fight to have good mental health.

One of the most severe times I experienced insomnia was when I was going through post-partum depression (PPD) after my first child was born.  I struggled to sleep every night.  It felt like I never slept at all, but after weeks of "not sleeping", I'm pretty sure I was experience micro-sleep or I would've been dead, literally.  Still, the feeling of laying there awake in bed, alone, for hours at a time haunted me.  I got up each day more tired than the previous one and I became fixated on my need for sleep.  I was just.so.tired.  Because I was bottle-feeding this baby, my husband and mother- and father-in-law stepped in to help withe night feedings so I could, ostensibly, "sleep."  We moved in temporarily for a few weeks with my MIL and she gave up her giant, super comfy bed for Derek and I.  It was exactly what I needed for healing and finding a new daily schedule as I was starting antidepressants and seeing a therapist.  But I still struggled to sleep.  Over a period of months, especially once I had started the antidepressant, I finally started getting a healthy amount of sleep and over the next few years, things eased.  I now know that what prevented me from sleeping was extreme anxiety (as well as the depression).  Not knowing when my baby would awaken and need me and all the fears of being a new mom, along with the lifestyle changes and the physiological changes of giving birth, realllllly made it hard for me to relax.  I still struggle with this because anxiety is omnipresent and never goes all the way away for me.  (It's just well managed.)  At night, I practice deep, even breathing (remember how I talked about breath-holding being a symptom of anxiety?), and I focus on relaxing the muscles of my jaw and neck.  I do this every single night.  The only times I don't have to do this are after extreme exertion (like hiking) or if I have to take something like a Benadryl that night.

I have to admit I have rarely had trouble with sleeping too much, though I know this is a common problem for those with depression.  But I have really struggled with having an uncooperative body clock.  I'm a night owl.  Like a SUPER night owl.  I find going to bed between 1-3am to be comfortable for me.  I've been able to sleep in late for the past few years because of arrangements Derek & I have made, but before that, I was a consummate napper.  Frustratingly, this body clock issue seems to have gotten worse as my hormones have been changing during perimenopause.  Just a few years ago, I found midnight a good time to go to bed.  I'm really hoping things will adjust better once I hit full-on menopause and the hormones get sorted.  In the mean time, I make due by napping when needed, and sleeping in when I can.  I often wonder how others are able to cope when they have wonky circadian rhythms like me, though I assume they are able to help control their sleep through the use of caffeine and alcohol.  (I tried caffeine and it's a good short-term solution for me when driving or vacationing, but I super-ultra-mega rapidly metabolize it so it just doesn't last for me.  Not to mention the fact that it messes with my mental health, and physical health, as well as my sleeeeeeep.)

But let's talk about bedtime procrastination.  I think this is something many, many of us struggle with, even those who may not have a mental health issue.  I think you can figure out what bedtime procrastination is from it's title, tho teasing out the why is a little harder.  It differs from day to day or situation to situation for me.  I know that when I had young infants, especially when I was breastfeeding and no one could take night feedings for me, I sometimes had to cut into my sleep time because I was dying from the lack of Me Time.  Derek would sometimes gently chastise me and ask me why I wasn't going instantly to bed, and I would explain to him that sometimes recharging the emotional reserves is more important than sleep.  This is still true sometimes today though I have a lot more time and flexibility in my schedule than I did with young children.  Today my biggest problem is the computer in my pocket.  Sometimes I find myself on social media or YouTube or reading the news and look up and it's been an hour.  This seems to me a common issue for all of us in the digital age, and especially bad for those who are working on better self-regulation.  I've used alarms, or screen time limits, or even going off of social media each time I feel like I am doing a poor job of moderating my usage.  Even then, I find that I sometimes struggle to go to bed, sort of like a toddler who needs a drink and a snack, and to pee again, etc, etc as soon as bedtime rolls around.  I attribute this to some residual sleep anxiety--after enough years of struggling to sleep, one can dread laying down and hoping that they will fall asleep without laying awake for too long listening to the clock tick.

What do I look like when I am consistently not getting enough sleep?  I become super fragile, emotionally, and don't deal well with distress of any kind.  I become less able to function socially, and I have less control over how I speak and react to those around me.  Basically I turn into a big ole toddler who's naptime is overdue.  My family has learned that it's best for everyone if I make sure I get enough sleep.

I recognize that not every is like me and puts sleep down as one of their hobbies.  (I literally was flabbergasted when I realized that not everyone else put sleep down as a hobby when Derek and I moved into our first young married congregation and we were filling out get-to-know-you papers.  What is wrong with you monsters? ;))  Not everyone needs as much sleep as I do to be fully functional.  But it's also crystal clear that for those that struggle with emotional health, finding a way to tame  sleep by having a consistent schedule, and clean bedtime hygiene, is as important as any other tool used to improve mood and behavior.  It's also super tricky and can take a lot of time and effort to find solutions, and just when you find a good solution, bam, you are pregnant or you hit perimenopause and you find you need to reevaluate your approach and possibly your methods for getting enough sleep.  Being patient and flexible, as hard as it is, can again be one of the most important things to bring to the table when working to have better sleep.

Photo note: if only we could all sleep as easily as dogs do...

Mental Health Post #20: Addiction

I've been thinking a lot about addiction lately since the show Dopesick came out on Hulu (haven't had a chance to start it yet).  Like many other people, I've often used the phrase "addictive personality" in relation to myself mostly.  Recently, I've really come to hate that phrase because it is so pathological and makes me sound like this forever broken person.  It has a connotation that it's hopeless for a person to even try to overcome this "personality defect".  I do believe it is so helpful to know if you have a family medical history of addiction because there is a genetic link to addiction.  Often in looking back on one's family, one can see issues of mental health in their predecessors as well.  I generally believe that anyone who has struggled with addiction has generally struggled with some sort of mental health problem as well.  (Just a reminder that I'm not at all a health professional and you are always welcome to disagree.)  But to just say I have an addictive personality is one dimension of mental health in a world of complexity.  

We know that poor mental health is usually a combination of many, many factors: genetics, personality, past trauma (especially during developmental years), exposure to substances, parenting, cultural messages, etc etc.  Some of my ancestors struggled with substance abuse disorders, and because of that my parents were always very careful about how we approached using even over the counter medication.  I appreciate that perspective because it forced me to take note of my relationship to any kind of drug, but especially the pyschoactive ones.  I didn't always agree with my parents' opinions on how I was using those drugs, especially ones that were prescribed to me by legitimate physicians, but hey, we all have disagreements with our parents about various things as we grow and change.  

I think the point I want to make here is that instead of focusing on whether we have an addictive personality, it might be useful to look deeper and ask if maybe we are dealing with a mental health disorder?  This might seem tricky at first because there are a lot of different kinds of addictions.  I think many white people think of male people of color dealing in an alley, which is not only racist, but also deeply hurtful to both white people and people of color.  Instead, it might be helpful to look at all the different ways that addiction can be expressed.  For some people it can be gaming, for others it can be through substance abuse (with legal/illegal drugs and/or prescription medication from legitimate medical providers), and for still others it could be excessive exercise or masturbation or porn use or eating.  However you slice it, the issue is escapism pure and simple.  And when I say escapism, I am not talking about watching a little TV, hanging with friends, reading or scrolling through social media to relax after a hard day of work.  We all know that we require downtime almost every day to recharge emotionally.  

I've often been asked how you know when you are doing too much.  I think there are a couple questions that you can ask yourself that will help you know if you are addicted to something.  First, can you live without the thing you believe you may be addicted to?   As in, can you go a few days without it or do you completely fall apart?  If you are not functional without 4 hours of gaming every day, you may have a problem.  Second, do you find yourself increasingly procrastinating deadlines to participate more in the issue you struggle with?  As a teacher, Derek often talks about how some of his students who do not know how to self-regulate come to college and get stuck in this rut of being stressed about classes and homework and self-medicate with some gaming.  Then they get even more stressed about how behind they are and retreat into more gaming because they are so anxious and eventually all they are doing is gaming and they end up failing a class or three.  For me personally, I feel like if I wondering if I am too addicted to something, then I probably am.  Hence my constant social media fasts.  ;)

I don't want to leave people on a downer note because I believe there is help for those struggling with addiction.  It almost never is overnight, and even when addressing the root problem of poor mental health, healing never happens immediately.  We have bumps in the road and we have to continually pick ourselves back up.  Many will struggle with addictions their whole lives.  Like many people, I have found hope in my relationship with God.  I have found strength in knowing that He cares about me and that I have worth in His sight.  I also couldn't do what I do without all of the mental health professionals that have been in my life for two decades now.  I'm especially fond of my therapist with benefits, Derek.  Truly this road is best traveled in groups.

Mental Health Post #19: Intrusive Thoughts

When my kids were much younger, we used to have a conversation every Sunday as we drove to church.  It was not about anything religious, nor was it about anything prosaic like dinner plans.  It was, in fact, about Frozen Girl.  You don't know this title, so let me explain to you exactly who Frozen Girl is.  Frozen Girl is an Incan mummy found in the Andes mountains in the late 1990s, and featured in a children's non-fiction book that my kids had checked out from the library months before.  Frozen Girl both repulsed and deeply fascinated my kids, to the point that she featured in daily conversations.  Now, months later, one of my daughters began bringing her up habitually, like clockwork, when we passed a certain road driving to church.  I would hear this little voice in the back say, "I wanna talk about Frozen Girl."  Said daughter was only 5'ish years old and at first it was kind of funny.  We would talk about Frozen Girl for a few minutes and then we would move on.  Every time, I wrestled with how much I should say in describing how she had died, especially when I was asked if it had hurt and if she had been scared.  After thinking about it long enough, I realized that it was her (and her sisters') way of contemplating death and the fear of going away.  After enough time, we stopped talking about it, and now that my kids are old, we sometimes bring up Frozen Girl again in reminiscence of how cute and silly they used to be as littles.

This story illustrates to me the repetitive nature of our thoughts when we are worried about something.  When you have chronic anxiety, you can find yourself ruminating about things all the day long as you replay what you should've done and what you should do in the future.  You can have compulsions like needing to go over and over procedural lists in your heads of how to behave or what you need to do.  It takes up a gross amount of bandwidth and drains energy away from other important aspects of living.  Many people with mental health diseases complain of brain fog, and the inability to think clearly and consistently.  I personally find it almost impossible to hold thoughts in my head and my memory goes to the dogs.  

Besides having repetitive thoughts, someone with anxiety/depression may have strange intrusive thoughts that are deeply unsettling.  I'm not talking about the normal weirdness that is inherent in the human condition.  Everyone wonders what it would be like to kiss some random person, or curiously thinks what it would feel like to jump off a cliff.  We have the weird thought and we throw it away because it's such nonsense.  When you have intrusive thoughts, the same distressing thoughts can keep coming back, sometimes worse each time.  I remember after I had one of my babies when we lived in family housing, I became almost obsessed with worry that my kids would get a hold of the kitchen knives and somehow fall on one.  It was just specific enough and often enough that it started to cause me real anxiety.  Thankfully it started getting bad around the same time I was finessing my antidepressant dosage, as well as seeing a truly wonderful therapist.  She talked to me about not letting my mind focus on those weird thoughts and how to recenter myself so that I didn't get so hung up on unlikely scenarios.  I like knowing that when we think about things over and over again, we are creating roads in our minds.  The more often we walk those roads, the more formed they get.  They may start out as just a deer trail, and with enough time and rumination, they can become 8 lane highways.  The goal is to not allow that kind of development to happen with the toxic thoughts.  We all have Frozen Girls in our lives and while we don't want to repress them in an unhealthy way, we also don't want to be thinking about them all the time and ruin all the good living to be had.

Photo note: we planted a tulip poplar last fall and it has the BIGGEST leaves.  They are so glorious and I hope that tree gives some family so much joy in 40 years when I no longer live here...

 

Mental Health Post #18: Some Random Causes of Poor Mental Health

I'm sure many of you have heard a few things by now about serotonin and other neurotransmitters and their probable involvement in mental health.  But mental health is so much more complex than changing how much neurotransmitter is hanging out in the brain.  We have these awesome antidepressants that help us to help ourselves, but we still don't know fully why or how different physiological changes can affect our psychology.  Plus, there are many other factors, both internal and external, that can affect how a person is feeling from day to day or year to year.  Here are a few that I've experienced or witnessed throughout my life:

1. Infectious/chronic disease: This is not black and white but also can have an intricacy of effects.  On the one hand, just feeling crummy from chronic pain or fever literally makes you not feel good.  I had the misfortune to suffer from mastitis (breast infections) after most of my pregnancies which would cause me to run very high fevers for days at a time.  Twice I was hospitalized and given IV antibiotics to get it under control.  Those fevers sapped me of my ability to think clearly, to make decisions and to feel whole.  Anyone who has been really sick can understand how something as innocuous as a fever can cause your mental health to diminish.  There is another aspect to this too, especially for those who have chronic or long-last conditions: being sick and unable to do the things you love is draining and often causes feelings of loss.  Even the most emotionally robust person is going to have times where it can be hard to have a good mood because they need so much more care from others, and spend so much more money on their medical interventions, and can have restricted activities.  These things can lead to poor mental health in the short- and the long-term.

2. Prescription drugs/OTC/supplements: I've had more lightbulb moments than I would've liked over the past few years regarding the medications and supplements I've taken for various things and their affect on my mental health.  For instance, I learned long ago that antihistamines affect my mood in a negative way.  The higher the dose or the stronger the medication, the bigger the effect.  Not too long ago I was prescribed a cheap, common prescription antihistamine called hydroxizine to help with the eczema in my basement (sorry, I just learned this euphemism so you're going to hear it non-stop because it's hilarious!).  It's also supposed to help with anxiety and has the added benefit of causing sleepiness which can be a godsend for someone who is unwittingly digging furrows in their own skin at night from the itchiness.  What my dermatologist didn't know is that hydroxizine may be great for anxiety, but it's a real bummer if you have major depression.  Two days after I started taking a baby dose, I was a complete wreck and I could not figure out why.  I had been sleeping tons, eating enough, and it wasn't almost my period.  But I was crying non-stop (okay, that's not abnormal since I'm a crier, but this was over the top) over my own parking job or ridiculous things like that.  Thankfully Google helped me find some good academic information that said hydroxizine can be contraindicated in persons with major depressive disorders.  To a lesser effect, I've noticed that even OTC allergy meds like Claritin and Allegra do this too, as well as Benadryl.  Because I have to take these drugs daily/weekly, I've learned to be ready if I am going to have to increase a dose and know to give myself extra time and self-care.  Benadryl, a cheap, super helpful rescue allergy medicine, will leave me a little moody the next day, and knowing that helps me to be able to be kinder to myself and lessen expectations for a couple days, as well as let the people around me know so they don't take my moodiness personally.  Other drugs that I'm aware of that can affect mood include all steroids (especially when coming off of a steroid), many herbal supplements for mood, and some cancer medicines.  Here's the take-away: if you just started a new medication and your mood has precipitously dropped, look it up and consider if maybe it is either that medicine you are taking, or maybe an interaction between two or more medications.  Or you are eating grapefruit.  (Am I the only one that thinks it's super weird how you cannot have grapefruit with like every single medication ever?!?)

3. Temporary medical conditions: I want to specifically zero on vitamin and mineral deficiencies here.  I've had a long-standing war with my body and it's ability to hang on to ferritin (iron) in my red blood cells.  Thus, I've had chronic iron-deficiency anemia for literally decades now.  About every year, I go in for iron infusions which tops me off for a few months before I need more gas in the tank.  Anemia makes me not only fatigued and craving corn (I have no idea why, but I'm just grateful I'm not eating detergent or dirt like other people with pica), but also incredibly fragile mentally.  I know many different deficiencies in essential nutrients can cause this symptom in people.  One of the first things my new psychiatrists from every move have ever done was order a full CBC (complete blood count) and a workup on my nutrient levels.  For some people, getting more folate or vitamin B in their diet can be enough to help them sustain a positive mood.  For others it can be a big piece of the puzzle with other interventions to figuring out better mental health.

 

4. Trauma: I've mentioned this before because I have experienced trauma in my life.  Examples can include physical, sexual and emotional abuse, living through war, moving frequently, medical trauma, experiencing the death of a loved one, and many, many other things, particularly as they happen to a young child.  Childhood trauma literally changes the way the brain develops and grows.  It can cause certain parts of the brain to shrink, or neurotransmitters to release too much or too often, or not enough or not often enough.  It literally changes the scaffolding of the nervous system and can have long-term impacts on a person's mood as well as their approach to life.  How to address this?  Through boat-loads of trauma counseling and usually medications.  And then of course patience and time.

I think the hardest thing about mental illness for me has been the amount of patience I've had to learn to deal with the time it takes to address any of these things.  Even when you have something as small as a fever that is making your feel rotten, time seems to slow down and it can be hard to get to the next day.  Dealing with poor mental health in a loved one is also just so difficult.  You want them (and yourself) to stop suffering immediately and for everyone to be happy and contented.  Please don't give up, on yourself or your loved one.  Hard times usually do end and joy and happiness come back.  Sometimes the hard things don't go away, but your capacity to live with them and still be joyful is increased.  I know truth this and depend on it myself.

 

Photo note: am the only one that thinks the little antennas of slugs and snails are SOOOOO cute??  Ya they are covered in a mucusy slime, and they eat holes in my tomatoes, but those antennas!!

Mental Health Post #17: Medications

Ah, medications for mental illness.  I thought there was nothing more controversial to talk about in health care until Covid came to town.  ;) Now we get to fight about masks, vaxxing and people spit-talking at us.  But this post isn't about Covid.  Today I want to talk about my (limited) experience with antidepressants and what kinds I've taken and what I know about them.  Which isn't a lot, but that's okay--we have Google and all sorts of reputable websites (see my previous posts about good medical websites) for the in-depth stuff.

The first time I wandered in to the arena of antidepressants was after I bore my first child and had severe PPD (post-partum depression).  I was prescribed the generic of Prozac (fluoxetine) which I took for about 8-10 months if memory serves me correctly.  I took a medium dose during that time and then eventually weaned off of it.  I don't actually remember how that wean went, but that tells me it probably wasn't a huge deal and I didn't have severe side effects from going off of it.

The second time I started antidepressants was when I had PPD after the birth of my second child, AND realized that I had never felt truly good since I had weaned off the Prozac a couple years before.  This time, I was committed to stay on the anti-depressant until I was sure that I could function well without it.  (Joke's on me since that will be my death probably!  ;)  I tested out the generic for Zoloft (sertraline), which was newish at the time.  I started on a medium dose, but after months of consultation with my amazing psychiatrist (Sheila Marcus at UofMich, she's famous!), I moved to the highest dosage.  At this dosage, I found my anxiety was better managed than at the lower doses.  The depression was kept at bay by all but the very lowest starting doses, but anxiety is a little trickier beast.  

I took the Zoloft for about 2 years before I "pooped out" of it (this, I kid you not, is a technical term!).  See I kept getting pregnant and when you are pregnant, your blood volume increases drastically, and you need higher and higher doses to maintain healthy mood.  During this time I found that some drugs did absolutely nothing for me (looking at you Celexa (citalopram) & Nexapro (escitalopram)), and I ended up back on Prozac when all was said and done.  Unfortunately, I pooped out out of Prozac (as well just pooped a lot in general) during my last pregnancy.  I went back to Zoloft which was fine for a few years before it began to lose it's efficacy.  Not because I was pregnant anymore but because after a period of time, the body seems to habituate to the drug and they no longer do as good of a job at keeping those neurotransmitters hanging out.  This is absolutely not the same thing as becoming dependent on a drug (like an addiction)--the mechanics are totally different.  You can Google it if you want the complete run down since I don't want to go too in-depth here.

Eventually, I started taking a new class of antidepressants, called SNRIs (serotonin and norephinephrine uptake inhibitor).  All of the previous anti-depressants I mentioned are in the SSRI drug class (selective serotonin reuptake inhibitors).  These newer type of antidepressants affect more than one neurotransmitter and seemed to be more effective in general.  I started with a drug called Cymbalta (duloxetine) which worked well for about a year before it seemed to abruptly stop working at all.  Though pharmacogenetic testing (tests that see what drugs you don't respond to because of your genetics), I found out that I was an ultra-rapid metabolizer of Cymbalta.  Bummer, that.  I moved to a newer drug called Pristiq (desvenlafaxine) and I loved it.  Unfortunately, I started getting baboon syndrome a couple years later (go look that one up, it's a real party) and as part of my efforts to see what was causing it over a period of a year, I moved off of Pristiq and back onto good old Prozac.  (It probably wasn't caused by the Pristiq, since it seems to be nickel and formaldehyde among other things that are my primary allergenic issues.  But some drugs can contain more of both of these trace allergens, so it's hard to know.)

Here's the thing about antidepressants.  Individuals have totally different responses to medications.  There may be observed averages in populations on many things like side-effects, half-life of drugs, etc, but people all have slightly different chemistries that means everyone can have slightly different affects to any medication.  You noticed that I said Celexa & Lexapro did absolutely nothing for me at all.  But I knew others who LOVED those drugs and found them super helpful.  A related note is that honestly we are still learning a lot about these medications.  When I first took Prozac, the pharmacists told me to take it at night because it would make me tired.  That was never the case for me.  It woke me up and I routinely took it in the morning.  (They also told me that I needed to talk to my doctor about taking it during pregnancy and that I was harming my baby when I was literally being prescribed to by one of the foremost depression-in-women experts in the world.  Note to everyone: gather lots of facts and remember that information that comes from someone in another industry may or may not be accurate.)  Now that I am taking it again, my current psychiatrist tells me all the time that Prozac is "activating".  I can back that up personally.  ;)  

Another medication that I have taken for probably over 20 years is called Buspar (busperone).  Buspar is an interesting drug, the only one in it's class.  It is specifically a serotonin agonist meaning it increases serotonin activity in the brain, but it also seems to have a mild impact on dopamine as well.  It's especially helpful for anxiety, and works well in conjunction with other antidepressants like the SSRIs and the SNRIs.  I also came off of this drug about a year ago in the search for what I was allergic to and found that while it REALLY SUCKED to wean off of it entirely, it also didn't improve my dermatitis.  So I'm happily back on it for life if I have any say about it.  

Here's a fun one I took: amitryptaline.  Before I knew I had POTS (a cardiac syndrome that can cause fainting, vertigo, etc), I was diagnosed with an inner ear disorder and was given amitryptaline to see if it helped.  It did nothing for the "inner ear disorder" but man did I sleep soooooo good every night.  Amitryptaline is part of a kind of older antidepressants called tricyclics.  They increase serotonin and seem to block some pain signals in nerves.  Some people take them for neuropathies and other nerve problems with varying degrees of success.  A big problem with the tricyclics is they are fatigue-inducing. So while I didn't keep taking amitryptaline, it did help me to find that moving to the SNRIs would be a good thing for me.  (I believe they have related affects on anxiety.)

Last, but certainly not least, I have taken a benzodiazepene for about 12 years, first only a couple times a year, and now still not daily, but more often than before.  I initially took Ativan or Xanax (depended on my prescribing doctor and since we moved a few times, they sometimes changed my medication).  They both worked fine, but later I discovered that Klonopin has a longer half-life and moved to it and found it to be highly effective for controlling the anxiety (which is much hard for me to control than the depression).  I've also had to use Valium for a couple of medical procedures, but baby, that stuff is strong and I hope I never have to take it again.  You feel "comfortably numb" to quote Pink Floyd, but not in a good way.  Here's the thing about benzos: they ARE addictive, deeply so.  I don't recommend them for just everyone because you need to know how addictive they are and use extreme caution so as not to fall into drug abuse.  I personally feel like I have the potential to have an addictive personality and exert extreme caution with how I use them.  But even more scary to me is the thought of not having that lifeline when things spiral out of control.  I don't know if anything is quite as motivating as the thought of losing a helpful tool in your mental health kit.  So I have certain nights of the week that I take it before bed to assure that I get a good night's sleep that night (yes I totally need to do a post just about sleep because people SLEEP IS EVERYTHING!!).  For all of these reasons, I think these are a drug class that are perhaps not always suitable for teens and young adults and anyone else that thinks they may struggle with abusing the prescription, much in the same way that opioids can be abused.

A note about the half-life of a drug: you know how you learned about Carbon-14 dating in school?  How the radioactive isotopes decay and when they are halfway decayed, that is their half-life?  The concept is similar with the drug's half-life.  The half-life of fluoxetine (Prozac) is 4-6 days.  That means around day 4-6, you have half the amount of the drug circulating in your body.  (BTW 4-6 days in a very long time for an antidepressants.  Part of the reason I do love Prozac.)  However, if you are an ultra-rapid metabolizer, as I am with Cymbalta, which already has a very short half-life, you may literally be experiencing withdrawal every day because your body is breaking the drug down and excreting it the way the Kardashians spend money.  I am also an ultra-rapid metabolizer of ibuprofen which means it basically doesn't work for me.  Knowing this stuff can be so helpful, and if you have the funds and the opportunity, I highly recommend getting the pharmacogenetic testing done for yourself and loved ones.

I would be remiss if I didn't also briefly talk about withdrawal feels like.  A couple of Christmas's ago, I ran out of my antidepressant and forgot to order more.  So when I took my pills out of my pill packs, I wasn't taking the Pristiq.  I got super sick, like I had the flu.  I literally thought I was going to die by day 5.  Thankfully, I realized what was going on by day 6, but it really showed me the value of putting reminders in my calendar so that hopefully NEVER happens again.  When I had to go cold-turkey off of Buspar, I had similar symptoms of nausea, dizziness, extreme fatigue and moodiness, but not at quite the same severity.  Going cold turkey off of Cymbalta was actually not super difficult since, as I mentioned, since I was basically withdrawing every single day as my body speed-walked the Cymbalta to the exit.  <<insert eyeroll at my body having to be a special snowflake in this way>>

A couple important things I've learned over the past two decades: one I already mentioned, that everyone can have small or big differences in effect of the same drug because everyone has different chemistries in their bodies.  Two, that sometimes a medication may not work, and that it takes time to move from one drug to another (when you taper off of one antidepressant and taper on to another one at the same time, it is called cross-tapering).  It can be a difficult time for anyone experiencing it, but I know it helped me so much to know that the next few weeks or months would be difficult and adjust my expectations.  A couple of times I have been asked by my doctor or have had to go cold turkey off of an antidepressant and I highly do not recommend it.  One of those was Buspar, and at the time, I was desperate to figure out why I was having extreme eczema in my basement.  If I have to change drugs, I try to do it when the day is lengthening (late winter, spring/summer) and never in the autumn.  But I had no choice with the Buspar and that fall was a difficult one for months even once I had completed my taper off.  

One final observation: the medications I have mentioned are the tip of the iceberg.  There are other classes of medications and even therapies that do not involve a pill, like ECT (electroconvulsive therapy), or TMS (transmagnetic stimulation) or VNS (vagus nerve stimulation).  I feel like the world is truly starting to blossom with better knowledge about the multitude of causes of poor mental health, and treatments are slowly catching up with that knowledge.  I truly pray that my children and grandchildren will find it so much easier and cheaper to get the relief they may need, especially as we see the world erupting into vast numbers of mental health crises over the past few years (particularly since the pandemic began).

Photo note: I found my first silver leg hair.  I had no idea that all of your body hair eventually turns silver until a few years ago.  And when I say all, I mean everything, including the stuff in the basement.  You can thank me later for this educational moment...  (And just in case someone is really freaking out about why I don't shave, there is nickel and/or lubricating strips on all the razers in the whole world.  I'm very happy to have hairy legs year round, honestly.  Have you ever felt your leg hair flutter in a breeze?  Or sway around in the water?  I'm telling you, ladies, you are missing out on some cool sensory experiences.)