Withdrawal Speculation

My last post was about my decision to stop taking antidepressants, after over a decade of depending on them in order to function semi-normally, and it emphasised that there is a lot of uncertainty involved. When you come off medication, you have no idea whether you will face withdrawal or if the symptoms of your illness will intensify. All you can do is play the odds by reducing your dosage gradually and under the guidance of your doctor. It’s been just over a week since I took my last antidepressant, so I thought I would post an update.

Trouble is, it’s hard to observe your own thoughts, emotions and behaviour when you are going through change. It’s also difficult to distinguish between withdrawal symptoms and bad days: anxiety is a withdrawal symptom for the antidepressant I was taking (also a side effect, interestingly), but I have had anxiety for years and its ebbs and flows often seem to be without logical cause and effect. With this in mind, the fact that I felt quite vulnerable and shaky last week cannot be attributed without doubt to withdrawal, but I suspect it was a factor.

Yet while I felt more anxious and overwhelmed than I have been lately, these symptoms were mild compared to the anxiety I have struggled with over the past 14+ years. I didn’t even come close to having a panic attack, for example, and I still went out on my own. That was unthinkable 9 months ago.

I’m also wary about arbitrarily separating anxiety as a physical withdrawal symptom from anxiety as a natural response to making such a big change in my life. Being on edge is understandable during any period of uncertainty. I have googled my medication: I know that a lot of people have bad experiences in coming off antidepressants and that my particular drug is associated with some extreme withdrawal symptoms — and although these are very rare, they were a distinct possibility. I had no idea whether deciding to stop my medication was a huge mistake which could undo all the changes I have made recently and cause my wellbeing to plummet.

Thankfully, my anxiety seems to have been unfounded. I have noticed no other withdrawal symptoms and feel better than ever. I am even more confident that coming off antidepressants was the right decision for me.

Regardless of whether last week’s anxiety was down to withdrawal, I know there will always be fluctuations in my mental health. Everyone experiences these fluctuations and while mine might be more extreme, since I will always be prone to mental health problems, they are manageable. I can cope, with or without medication as needed. I can cope.

 

Flinging Away The Crutch

I recently made a big decision: to stop taking antidepressants. I have been on medication for most of the past 14 years — continuously for the past 11 — and they have helped me a lot. They have been a vital tool in helping me change from someone so controlled by her anxiety and depression that she rarely left the house to someone who actually has a life. I just don’t feel that I need to take them anymore.

Deciding to take or not to take antidepressants is a a personal choice.

I have read a lot of people’s opinions on antidepressants, ranging from those who think they are evil and that the side effects are worse than the illness they treat, to those who advocate taking as large a dose as possible for as long as possible. In my experience, neither of these extremes are true or helpful. Antidepressants don’t work for everyone and even when they do, it can take a lot of experimentation to find the correct type and dosage for you.

I decided to take antidepressants in the first place because my doctor thought they would help me and I was desperate to grasp at anything which might make my life more bearable. Too many people judge others’ decisions to start or continue taking antidepressants; whereas nobody judges people for relying on medication to treat physical illness, even when that illness could theoretically be controlled through other means, a lot of people feel the need to voice their (often misinformed) opinions on antidepressants. Perhaps it would have been “better” for me to have used other methods of managing my mental health, but these simply weren’t available to me when I was at my lowest points. Medication was available and I’m very grateful.

I should stress that I am in regular contact with my doctor and reduced my antidepressant dosage according to his advice before stopping completely. This was important to prevent withdrawal symptoms, but it also enabled me to gauge whether my symptoms worsened as the dose decreased. They did not, so I decided that coming off medication was the right choice for me.

One of the key reasons that I am able to cope nowadays is because antidepressants helped me access and implement other ways of managing my mental health. When my mental illness was at its worst, I simply couldn’t do things like taking regular exercise and using CBT techniques to challenge my negative beliefs. Antidepressants were the crutch which allowed me to take steps forward.

It’s scary, but I have contingency plans — including going back on antidepressants if needed.

I will never be anti-medication, as much as I advocate using other therapies and activities to manage mental health, and I will take antidepressants again if required. I know that I have to monitor my mental health so that I can observe and address any changes — I still have mental health problems and they will never magically disappear. I hope to manage my mental health well enough that I can be considered “recovered” in the future, but I’m taking things one step at a time.

I know that my progress won’t be linear. Everyone has good days and bad days in terms of mood and mental health, regardless of whether they have ever been mentally ill, and recovery from physical illnesses and injuries os rarely straightforward. I think it’s important for me to keep this in mind. While I’m confident in my decision, the uncertainty still terrifies me. I don’t know what will happen — whether there will be a dramatic deterioration or improvement in my mental health or, as I suspect is more likely, whether things will change gradually.

So being congratulated for coming off medication is tricky.

For one thing, I don’t know whether I will have to take antidepressants again in the future. I feel unable to claim this as an unmitigated success because I have no idea if the change is permanent. I’m happy to be able to try life without medication, but it feels like being congratulated for starting to learn to drive — it’s a step in the right direction, but I don’t know whether it will turn out well.

The thornier issue is that congratulations imply that you have achieved something through hard work and while I have worked hard to control my mental illness, I was struggling a lot more when I was on antidepressants. I worked hard even when there were no positive results. It comes back to the idea of being judged for taking medication: congratulating me now implies that I was doing something wrong because I needed to take antidepressants. That makes me uncomfortable because it’s not true — needing medication doesn’t mean you are weak or a failure. Regardless of how you choose to treat mental illness, battling it takes courage and strength every day.

More than anything, I’m curious about the future — and a bit excited!

I have no idea whether I have suffered side effects from my medication for a start, though I have my suspicions. I don’t know precisely how much my antidepressants helped me, or in which situations, so I don’t know how (or if) anything will change. I never felt that the medication blotted out my personality — though my mental illness did — but I have no idea whether it affected certain behaviours or personality traits. I can’t wait to find out what life without antidepressants is like.

Having said that, coming off medication is just one of the changes I have made this year and my curiosity and excitement about the future owe more to these other changes. I may be taking tentative steps now I have flung my crutch away, but hopefully I will be skipping ahead someday soon.

 

 

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7 Ways to Deal with Anxiety When You Are Getting Out More

Recovering from anxiety enough to get out more and do more activities presents a paradox: you feel more anxious when you are pushing yourself to do something different. It is tempting to give up and go home. However, the only way to move past anxiety is to face it head on. These tips and techniques are for anyone who is trying to push his/her boundaries, but finds anxiety gets in the way.

1. Control your breathing — before you get too anxious

There are lots of breathing exercises which are said to help anxiety, so it’s worth experimenting to find out which work best for you. In my experience, the main criterion for choosing a particular technique is convenience. Most of the breathing exercises I have come across are effective, but what makes a difference for me is finding one I can do easily. I like counting breaths because it’s easy to remember what to do and I can do it without anyone else being able to tell what I’m doing. My favourite is 7-7-11 breathing: in for 7 counts, hold for 7 and exhale for 11.

The key to using breathing exercises effectively is to practice them when you are not feeling anxious. Start doing them when you are at home and feeling comfortable. Practice until it feels natural. Don’t wait to try a breathing exercise until you are freaking out — it’s bound to feel weird when you have never done it before.

When you are accustomed to using a particular technique, you can use it when you feel anxious. The trick is to start controlling your breathing as soon as you begin to feel anxious. Don’t wait until you are heading for a full-on panic attack: do your preferred breathing exercise  when you are a bit jittery and it can prevent your anxiety from escalating.

2. Leave the room

If your anxiety is getting worse despite your best efforts, exit the situation. Go to the toilet or out for some fresh air. Give yourself time and space to calm down.

Most of the time, nobody will notice your absences. If they do and you are uncomfortable with explaining that you feel anxious, just say you needed to cool off or have a bit of a headache. Don’t make a big deal out of it and no one else will.

Actually, a lot of people regularly leave social situations for a break — and for a variety of reasons. Some just need to be alone for a while and away from the noise. It’s fine; it’s normal.

3. Tell people you feel anxious

I have had a lot of success with this trick, partly because it means I no longer worry about whether everyone can tell I’m anxious. How much you say is up to you — I have previously explained that I have bad anxiety, but nowadays I’m more likely to say I feel a bit nervous. It’s up to you. Most people will be understanding (and even those who can’t empathise won’t berate you) and help to put you at ease.

If you are in a situation where elaborating on your anxiety can help, do so. It’s okay to say ‘when I get anxious I hate being fussed over, so don’t be offended if I need to be alone.’ In fact, it pre-empts issues which may arise. I recently had to explain to my gym instructor that when I get out of breath my anxiety can kick in, so when I stop exercising to control my breath I’m not having an asthma attack or anything. The result: I feel less self-conscious when I need to take a break and my gym instructor knows I don’t require medical attention.

4. Take a friend along with you

There is no shame with having someone there for moral support. I do modern jive classes with a friend — something I would probably have never gotten around to by myself. Friends like to help and will be flattered to be asked. Taking  a friend for the first couple of times you go somewhere new can help you to feel confident enough to go alone in future, so it doesn’t need to be a big commitment for them — you can use them as a stepping stone.

Give your friend guidelines before they accompany you — do you expect them to sit beside you all night or would you prefer to spend a proportion of the time building your solo social skills? Would you be pleased or terrified if they introduced you to people? Do you prefer your friend to order from the bar rather than get tongue tied yourself? Often, a close friend will naturally know how you wish to proceed, but discussing guidelines can help you to feel more at ease and lets your friend know if you plan to experiment with pushing your boundaries.

5. Try essential oils — or perfume

Having some lavender oil on a tissue available takes the edge off my anxiety. Apart from its relaxing properties, focusing on a sense which often gets overlooked (unlike sight and hearing) helps me to be more mindful. It forces me to get out of my head, however briefly.

Wearing perfume I love helps me feel more confident and less anxious. I have no idea whether my favourite scents have any relaxation properties and it doesn’t matter: it helps me stay grounded and reminds me of all the great times I have had when wearing that particular perfume. It’s a subtle trick, too — it took me years to realise that my perfume helps me feel less anxious!

6. Focus on other people, not your anxious thoughts

Watch other peoole, listen to them, pay attention. As long as you are doing this, you aren’t worrying about yourself. As soon as you are in a new situation, look for people you can focus on without drawing attention or seeming odd. In classes, this is obviously the teacher/instructor. People dancing, singing karaoke or otherwise performing are great to watch, too. If there are several people between whom you can divide your attention, that’s even better.

Truth is, unless you are extremely creepy and obvious, people tend not to notice being watched. Most of them are too busy chatting, having fun or worrying about themselves. The advanced version of this (which I’m trying to work towards) is to engage in conversation and really listen to other people. Find out three interesting things about each person you meet. Keep a list (mental or literal) of fun questions and conversation starters. Just keep your attention on others, not your mental chatter.

7. Have an escape plan

If all else fails, what will you do? Knowing how you would leave a situation helps you to feel more confident and secure — regardless of whether you put the plan into action. Who could you call to pick you up? Where could you walk to? Have you got money available in case you need to take a taxi?

Even noting the exits can help — when I know the location of the nearest door, I can visualise walking out of the room and it emphasises the fact that I have options. I don’t have to succumb to anxiety, because I know I can walk away if it all gets too much.

Leaving earlier than planned isn’t ideal, but don’t berate yourself if it’s necessary. Tackling anxiety isn’t easy and you deserve credit for getting outside your comfort zone. Leaving an unfamiliar situation isn’t failure — it’s a successful attempt to expand your boundaries and when you keep expanding your boundaries, your anxiety gets easier to control.