enufodat Introduction, and a question

[enufodat]

Hello all. Note that there is a question at the end of this, for anyone who wants to jump ahead, about how to tell withdrawal from "regular" depression.

 

I started taking Zoloft in 1994 when, of course, these things were supposed to have few side-effects, and etc. I was not seriously depressed; down sometimes, had some things to work out and was told it would just make things easier. I remember reading Peter Kramer's book on prozac and his phrase, something like "better than well," or better than normal, whatever. Sounded great! And I was seeing a psychologist who was generally pretty good but in retrospect way too captivated by the new technology.

 

They did help, actually, and everything seemed good for a few years. By that time I was in graduate school and working on a dissertation and at times started to wonder if a lack of drive, a certain apathy at times, might be related to the drugs, but I have always had some underlying tendencies in this direction so wasn't sure. I think there was also some complacency about intimate relationships--I wanted one, but...not enough?...didn't happen. After about five years I first had some sexual dysfunction, anorgasmia. That was a shocker, though I wasn't really involved in a relationship so...distressing but tolerable. I had also gained a fair amount of weight, and first tried getting off the drugs around 2000. Fairly fast taper (a month maybe?), couldn't do it, went back on. Lexapro was supposed to have fewer side effects. Right. Back to Zoloft. With a few exceptions there generally wasn't "poop-out;" occasionally went to 100 mg, but mostly 50 was enough. I tried three more times to get off, not knowing about slow tapers, failed each time. A couple were truly excrutiating for a couple of months before I finally went back on. Well, each time I'd be fine for a month or two, then it would hit. Finally did a slow taper ending a little over a year ago, and even THAT didn't work. But it was a very stressful time, so after two months back on I did a faster taper--figued the intervening "on" period was short so this might work. And it did. Was fine for two or three months. But it started slowly, intermittently creeping back and has now gotten fairly bad, but tolerable, definitely not debilitating and have not consider resuming the drugs.

 

It's all complicated by 1) I've ended up in something of a professional and social hole after all this, am pretty isolated. The depression is generally situation, so I know this context is big, and of course getting out of the hole is tough with the depression. 2) I'm doing some intensive therapy which is bringing things up--big things, long burried, much in need of work--and there is some heavy family stuff going on--a dying parent (late stage dementia), most notably.

 

Okay, so my question is this. I never had any withdrawal symptoms other than depression. Some anxiety, but I tend to think of that as a return to normal, a move away from drug-induced complacency. No zaps, nothing physical..except the continued PSSD (not terrible, but not great, as these things go), which may also have to do with age--I'm fifty now. Oh: well, I do have, when the depression gets bad, a sort of diffuse physical pain that feels like it's inside my brain (not a headache) but is hard to describe. (I want to say my synapses hurt, but who knows?) That pain has not been too noticeable or frequent in recent months, though in times past it was sometimes more intense. I was fine for 2-3 months after last dose, then it gradually crept back over a few more months. How do I tell if this is withdrawal or just...depression? David Healey seems to think withdrawal-related depression comes on more quickly than this (days, weeks, a month maybe) but some on the paxill forum are convinced otherwise and seem fairly knowledgeable/credible. I'm pretty sure at least some of it is related to early pschological trauma that I am slowly getting at with therapy. But I just don't know if the withdrawal factor is still significant. No way to know for sure, but if any of you have wise thoughts I'd love to hear them.

 

The good news is that I've lost twenty pounds and, with not-the-best knees, can run a couple of miles for the first time in fifteen years. Well, also I have more access to emotions, have finally been able to greive the death of my father four years ago. I just started seeing a woman I dated for a short while several years ago; she says I'm different, more open. Still, it continues to be a rough time overall.

 

Okay, that's the story, thanks in advance for your thoughts!

[enufodat]

P.S. I suppose my other question, not unrelated, is regarding PSSD vs. aging. I'm quite sure the drugs had sexual effects while I was on them, since things had always worked just fine and then, despite no problems at first, after maybe four years on zoloft...very noticeable difference. The change was just too dramatic and at too young an age (late 30s) for it to be "natural." But at this point, at the age of fifty...things have improved a bit since my last dose seven months ago but not much really and I'm not sure if it's just plain old age. Thoughts?

[Altostrata]

Welcome, enufodat.

 

Is this your first question: Could this delayed-onset depression be withdrawal syndrome?

 

When you had the post-Zoloft anxiety, can you remember the pattern?

 

How would you describe your "depression"?

 

As for the PSSD, that it's improved a bit indicates it is PSSD, rather than aging, and most likely with time it will fade more.

[enufodat]

Welcome, enufodat.

 

Is this your first question: Could this delayed-onset depression be withdrawal syndrome?

 

When you had the post-Zoloft anxiety, can you remember the pattern?

 

How would you describe your "depression"?

 

 

Yes, that is precisely the first question; thanks for clarifying.

 

On anxiety, probably it's fairly low-level, perhaps even mild, as these things go--definitely no panic attacks or incessant anxiety, and I'd say fairly situational, though occasionally there's been a sense of a sort of "background" anxiety. But no question that there is more of it than when I was on the drugs and probably fairly similar to before I started taking them. I'd say it started at about the same time as the depression, 2-3 months after last dose, though it hasn't gotten worse since then as much as the depression--maybe somewhat, but not too much worse now than a few months ago. Overall I'm not too worried about the anxiety, take it more as a return to having a healthy indicator that helps steer one along in life. Honestly, sometimes I think I could use more of it; I'm fifty, single, and semi-employed despite having, at least objectively, all the advantages and talents that should have led to a completely different outcome.

 

 

The depression overall is marked by: decreased enjoyment of various things like music, food, etc.; decreased motivation to make the effort to do things that normally I enjoy; a certain feeling of reactivity and emotional vulnerability in social situation, around people who are unfamiliar or who I can't comfortably be myself with (this reactivity is tied to the anxiety, actually); trouble getting up in the morning; an accentuation of the general feeling of being stuck that seems to characterize this social and professional hole I've ended up in. One key thing is that what I've just described has been intermixed with (and sometimes overlaps with) a more general sadness, sometimes quite deep, that is more like the anxiety in the sense of recovering my emotional range, something that is hard--as I said, am working through some really tough long-burried things in therapy--but I believe also important and good. But I'd say more recently, past several weeks, it's been feeling more consistently like that first set of symptoms, a more sort of depressive pain and emptiness than active, alive sadness. There is at times a sense of desperation and hopelessness--not suicidal but not fun--although this is not too persistent. Overall there's a pretty strong situational component to it; whatever the cause, it is lessened and often goes away entirely when I have something fun with people I like to do or look forward to. Somewhat similarly, when I DO exercise, get it in gear, I feel better. When I DO get out of bed, I feel better. When I DO get focused on work (I'm working independently, trying to write...) I feel better. But it's hard as hell to get to those points, something holds me back, keeps me stuck, that I often have little control over. Perhaps I should add that my therapist tends to think a lot of that part is related to early trauma of which I still have minimal recollection. I generally agree but it's hard to know for sure.

 

Phew! Hope that's not too much information, but I figure better thorough than not.

 

MANY thanks!

 

E

[Altostrata]

"Depression" covers a lot of ground, too much in fact. It can mean a lot of things.

 

Rather, it sounds like you have the common withdrawal symptom we call emotional anesthesia.

 

This is distressing and can be "depressing" but it is not the same as endogenous depression.

 

Do the best you can, it will fade in time as your nervous system heals from the drugs.

[enufodat]

Thanks, Alto. Can you say a little more about what suggests this emotional anesthesia and not "depression." I agree the latter is both far to broad a term and, in my opinion, a lousy term in general. It sort of suggests something like low energy, not the intense pain that often comes with it.

 

You know, I should also say there's an increased rumination on the past, intensified anger, a general sourness.

 

I think the things that made me worry it was more endogenous were 1) lack of other symptoms unrelated to depression, which so many seem to have, 2) the delayed onset, hitting worst at almost six months out.

 

Your comments are reassuring, many thanks.

 

Would love to hear from others who may have had similar trajectories.

 

E

[enufodat]

I've been reading some posts on emotional anesthesia/anhedonia and finding them very helpful. This is a real eye opener, especially how it can make one indecisive, stuck, etc. You all are helping me look at symptoms in a more fine-grained way, seeing the variation and mixture and ebb and flow.

 

I think I sould add, looking over my description above, that there is at times more of an emotional turmoil--real emotional pain, not just deadness, anger I can't let go of, sadness, desperation. So I think it's a mixture, but the identification of EA/anesthesia is key.

 

Question: As Alto said, "depression" covers a lot of ground, and in the posts I read it was not as clearly described as EA/anesthesia. Is there a way to encapsulate what people here mean when they say, for instance, "I have depression and not anesthesia"? How are we defining "depression"?

[Altostrata]

Whether you have withdrawal "depression" or real "depression," the fix is exactly the same. See Non-drug techniques to cope with emotional symptoms

 

It makes sense you have some anger, disappointment, regret, etc. Many of us have to deal with regret over having depended on medication for so long, and what we lost doing that.

 

Normal living also incurs memories that may be associated with anger, etc. Each of us needs to come to terms with his or her own life.

[Barbarannamated]

Hi Enufodat. Alot of what you describe resonates with me. In case you haven't seen this thread, it also discusses similar patterns:

 

http://survivingantidepressants.org/index.php?/topic/1203-disconnect-between-interest-and-actionmotivation/

[Altostrata]

Hey, enufodat, how are you doing? Any changes?

[enufodat]

Hi, thanks for asking. I'd have to say the depression (or emotional anaesthesia...or both really) got worse since those earlier posts. Was really quite severe earlier this week, though it has eased since then and there have been a few pretty good interludes. Still rough, but better. The good news is that the PSSD seems to have lifted, suddenly things in that area are working again, I think because I've gotten pretty relaxed about it all and have been recently with someone who is also. Sometimes if you stop worrying about the end goal...you reach it. I was never terribly anxious about it, but still...

 

I've been playing close attention to the dynamics of it all. There's certainly a large situational component to it (oh, like my stepmother just died and my mother is losing her mind to dementia and not expected to make it past the fall), and a hypersensitivity to things that normally I could take at least a little more in stride. There's also a sense of vulnerability to stimuli that would normally be either routine/neutral or even a little pleasureable. I actually had a very faint but real momentary feeling of dread yesterday, a lovely sunny day, at the thought of...hanging clothes on the line. It's as if (and perhaps simply is that) the complex system of the brain that would normally be harmonically stimulated, or at worst resistant to perturbation, is in a baseline state of a certain vulnerability that makes for non-harmonic stimulation, even turmoil.

 

Positive, relaxed, supportive social context helps a lot. Exercise helps.

 

The question of whether it's "depression" or withdrawal is still out there. I suppose time will tell. What I try to keep in mind is that having these combined life and drug stresses do not just mean I've got a lot weighing me down (which is a drag) but that, to flip it around, knowing that both of those things are at play means...there's a lot that can improve.

 

Oh, and I'm starting a gluten-free diet. I don't think the odds are too high, but sounds like there's some potential that that could help.

 

That's it for now!

 

E

[Altostrata]

The waves sound like withdrawal to me. That you seen improvements in PSSD is a very good sign your nervous system is recovering.

[enufodat]

Well, it has lifted significantly in the past three days. Is it possible that the gluten elimination could have an effect that quickly? But it was starting to lift in the day prior to stopping gluten, so that makes it tricky.

 

Also notable is that the feeling of an almost physical (neurological?) hyper-reactivity is almost entirely gone, to the degree that it's still with me it's more of an emotional emptiness, I guess anhedonia, which also simply fits with situational factors. So all of that would seem to fit with the waves thing, and I suppose with withdrawal over endogenous.

 

Also, the positive emotional opening continues--or I suppose is back, since it tends to go away when the depression is bad. My step-mother died this week; we were not close, but there were some very sad things about it, and tied to my deceased father, and I have been able to feel this in a way I don't think I would have a year ago. So that is good.

[enufodat]

So much for lifing of depression and rapid miracles of gluten-free. Rough up and down stretch continues. I will stick with the gluten thing a little longer but I'm not too hopeful about that.

 

The interesting thing I've noticed recently is that the sense of physical pain in my head--a subtle but very definite feeling, hard to describe but maybe a little vibrational?--is at times somewhat independent of mood. It is related in a broad way--it's there on days when I feel significantly down--but moment to moment sometimes, I'm finding, I feel that sensation at a moment when my mood is actually okay. Other times they're closely related. I find myself wondering if this may have some relation to the "brain zaps" people speak of but which I have never experienced. Still, I could also imagine something like this accompanying garden-variety depression. Who knows?

 

On the promising front, I find the PSSD much improved. I am finding a sensitivity in, well, that area that I have not had in a very long while. So that, at least, does seem to suggest some definite healing.

[Skyler]

Rough up and down stretch continues. I will stick with the gluten thing a little longer but I'm not too hopeful about that.

 

The interesting thing I've noticed recently is that the sense of physical pain in my head--a subtle but very definite feeling, hard to describe but maybe a little vibrational?--is at times somewhat independent of mood. It is related in a broad way--it's there on days when I feel significantly down--but moment to moment sometimes, I'm finding, I feel that sensation at a moment when my mood is actually okay. Other times they're closely related. I find myself wondering if this may have some relation to the "brain zaps" people speak of but which I have never experienced. Still, I could also imagine something like this accompanying garden-variety depression. Who knows?

 

On the promising front, I find the PSSD much improved. I am finding a sensitivity in, well, that area that I have not had in a very long while. So that, at least, does seem to suggest some definite healing.

 

Hi enuf.. I'm a fan of a good solid diet, keeping away from food additives and think some folks find gluten free diets helpful, not because there is gluten intolerance, but because it's based on sound dietary principles. All withdrawal symptoms are painful, leastwise this is the way I look at it.

 

Glad to hear the PSSD is improved, sounds like you are making progress. Can you find something to take your focus off withdrawal symptoms? I can't help but wonder if they seem worse (admittedly they are the pits!) because you are taking their 'pulse' so often.

[Rhiannon]

What you're describing sounds like withdrawal to me. It's a fairly common pattern to get hit with a "relapse" of "depression" around six months out. Used to happen to me too. (Interestingly, it appears that it takes around six months for new neuronal networks to grow, too.)

 

The thing is, like Alto says, it doesn't really matter anyway. The whole "depression as a chemical imbalance/disease" thing turns out to be largely invented by pharmaceutical companies; there's no actual scientific evidence that there's any truth to it. But once the brain's chemistry has been disrupted by chemistry-disrupting drugs, NOW there's a chemical imbalance. Which the brain itself can heal and restabilize, given enough time and support.

 

And meanwhile, simple lifestyle changes and emotional support and therapy are still, as always, consistently found to be more effective than drugs in treating depression, and safer as well and without side effects. And it sounds like you're doing all those things now.

 

Really, the up and down nature of the symptoms you describe, plus the ruminations about the past, and the emotional fluctuations, and the PSSD--all of that sounds a lot more like withdrawal to me than any kind of natural process.

 

Or, rather, a CNS that's working to re-establish homeostasis and get back to normal after being chemically mangled. Not just withdrawal, really, but the actual recovery from having been on the drugs in the first place. The brain can fix the damage caused by the drugs--rebuild receptors, regrow new neuronal networks, et cetera--but these are not fast processes and it takes time. Hang in there and keep doing things that you know are good for you.

[Altostrata]

The interesting thing I've noticed recently is that the sense of physical pain in my head--a subtle but very definite feeling, hard to describe but maybe a little vibrational?--is at times somewhat independent of mood.

This is not mentioned anywhere in the entire history of literature on garden-variety depression, why would you think it's associated?

 

It sounds like another neurological destabilization symptom to me. Maybe related to "brain zaps," it's all electrical.

[enufodat]

The interesting thing I've noticed recently is that the sense of physical pain in my head--a subtle but very definite feeling, hard to describe but maybe a little vibrational?--is at times somewhat independent of mood.

This is not mentioned anywhere in the entire history of literature on garden-variety depression, why would you think it's associated?

 

Hmm. I did not realize it was that far outside the norm for non-withdrawal depression. And I suppose because it's far more subtle than what people describe as brain zaps, and also because I didn't have it for six months...it just didn't seem clear.

 

In any case, yes, I suppose that's probably what it is, which makes the idea of giving it time, patience, easier. Clearly the PSSD change suggests healing is taking place.

 

Many thanks to all for the comments and reassurances.