It was time to go from 37.5 mg to 70 mg of venlafaxine per day, and also to switch from the regular tablets to timed-release capsules. Today is a public holiday in Germany, and with the long Easter weekend ahead, I would have a few days in a row for adjusting to the new dosage. I was prepared for the worst – more nausea, maybe even vomiting, but in the end it turned out relatively harmless. There was a bit of vertigo and some tingling in my limbs, but generally the transition was rather smooth. I can definitely tell a difference between timed and regular release, because as a capsule, the side-effects do not (sometimes violently) spike within the first 120 minutes after consumption, but create a gentler wave rather that carries you into the afternoon.
Tag: chronic major depression
I’m Going To Quit University
Instead, I will enroll at the only state-maintained German distance teaching extramural university, starting next autumn. The idea was actually proposed to me by my mother and sister, because my sister is considering doing the same, and they thought it might make studying easier for me. I also discussed this with my husband, and slept over it, so while this was a relatively sudden decision, it’s not a rash one.
Arguments in favour of the change:
- You study online and out of books. Apart from the written tests, there are only two weekends during the entire Bachelor’s programme where you have to attend a seminar in person – and one of the study centres where you can do so is easily accessible to me, even without a car. Since I waste about 75 % of my energy in class on fighting off depression and only the remaining 25 % on taking notes or studying, I believe I will actually be able to study more effectively that way. You receive the materials and literature lists via mail, and you send in your homework and term papers online. There also are video streams of lectures and special software programmes for learning. At any time, you can contact qualified docents if you need additional help, and should you need to see someone face to face, you can also visit the study centres.
- It’s cheaper than a regular uni. Money is always a factor for me. And you pay for the classes you take only, not a fixed sum regardless of whether you actually take any classes at all. So, if shit hits the fan and I have to take a sabbatical (which I hope never happens, but we are talking eventualities here) again, I don’t have to pay just for staying enrolled in the programme.
- It’s more time flexible. I can adjust the learning to my personal schedule, because nobody cares whether I study something on Tuesday morning or Thursday afternoon or Sunday night, as long as I send in my homework punctually.
- Academically, it’s worth just as much as a degree from a regular uni.
Arguments against the change:
- I’ll not have a semester ticket for public transportation anymore. But: With the money I’m saving every semester on fees, I can buy a good number of tram tickets if needed…
- It sets me back to square one. But: I only took 6 hours per week last semester, and the next one would have been the same – I might actually be able to take more classes than that and thus eventually make up for “lost” time.
- They have a limited offer of subjects you can study only. And geosciences is not one of them. That is, in the end, the only heavy argument against it, in my opinion – and the reason why I never thought about making this step before. It would mean changing my major again. But: You can study psychology with them, and that is something I would be really interested in.
In the end, I believe the scale tips in favour of going ahead and doing this, because there are also arguments which fall outside of the pro-and-con-scheme listed above. The days of fantasizing about becoming a world-famous archaeologist are long over, and I don’t see myself crawling through the Andes or Alps, looking for rare minerals, either. What I want above everything else is to finally have some kind of degree and become employable; I’ll happily work as a secretary or a boring office job afterwards. The pipe dreams of glory are firmly buried.
And there are some obstacles in my current university course which did not occur to me when I had to make a quick decision in August 2011, and which I pushed into a remote corner of my mind afterwards: field trips abroad. I can’t do them – it would be ok if I got my own private hotel room at the end of the day, but going abroad and sharing a cabin with people who are essentially strangers for two weeks horrifies me to no end. I have worked really hard on my social phobia, but that is a problem I don’t think can be “treated out of my system”. On top of that, you also have to pay for those trips and all the equipment needed for it in addition to the semester fee, which runs up sums of several hundreds of euros every time, and I just cannot afford that.
Finally, seeing how the current semester ends on Sunday, I could actually apply for welfare myself instead of hoping some cryptic system where I take over from my husband works out – I haven’t been able to pay for the next semester yet, so all it needs is a phone call that I won’t be returning and I’m out.
Maybe it makes me look fickle in the eyes of some, but over the course of the last three semesters I realized that most of my problems with uni stem from the system itself, and I genuinely believe that my mental health would profit both from taking a break until October and even more so from getting out of that system. I love learning and writing papers and all of that, and I want to focus on this instead of how to effectively hold back tears in a classroom.
Arranging Appointments Around An Antidepressant
The good news of the day: after my therapist’s statement arrived in the mail, I was able to start the application process for welfare today and it got dated back to March 1st, meaning that once the application gets approved, I’ll get the full sum for this month already.
The bad news of the day: it’s a damn complicated process. As a university student, I am not covered by welfare – except when the student is not able to work at least 18 hours per week, which I’m currently not. But to earn the “impaired ability to work” label, I first have to meet the job agency’s doctor; until then, I count as a non-impaired person seeking state support – and as such, I cannot apply for the kind of welfare I would qualify for, because I am a student. Are you still following me? So the idea the people at the job centre came up with was that my husband needs to start the process, and put my name on the list of other people in the household who’d belong to the “community in need” (a rough approximation of the German construct “Bedarfsgemeinschaft”) instead of the other way around, and once I saw their doctor, we would switch the application over to me as the main applicant… We have another appointment on Thursday morning, which will hopefully bring more clarity about the proceedings.
Which brings me to the next problem: the new appointment is at 9 AM. Right now, I’m toying with the idea of taking the venlafaxine afterwards, because the withdrawals in the morning are generally less severe than the side-effects after taking the pill. That also means that I am going to stay on the current dose until then, because I am sure increasing it will also increase the side-effects again for a while.
Generally I am doing better; the nausea / sickness is finally gone and my appetite usually returns around 4 PM, which allows me to have a normal dinner. The only persistent symptom I currently have is vertigo or dizziness, so that I still have to lie down again after breakfast, but it feels very normal, no paraesthesias or “funny feelings”.
I am not sure if I have any positive effects from the venlafaxine yet. My husband claims I handled our financial crisis last week much better than he expected and credits the antidepressant for it. It might very well be the case; I have not had any severe anxiety recently, but on the other hand I have been so consumed with just managing every single day that there was literally no time for me to worry about anything else.
More Financial Woes
The last two days, we had a financial crisis to weather: I had exceeded the credit limit of my bank account and was two months behind with the payments of the electricity & gas bill, and had two letters in the mail which threatened me with termination of the bank account and gas supply respectively if I didn’t pay off the debts immediately. The bank account wasn’t a major obstacle since a smaller sum only was required to bump it back into the credit range, but the electricity & gas bill posed a huge problem – no matter how we juggled the figures, we did not have enough money to pay it off. I tried to arrange a payment in rates, but while the idea got green-lighted by the company representative I spoke to on the phone, the finances department never called me back to discuss the details. So in the end I had to ask a friend to help us out – which she graciously did, and actually had offered to do first.
I don’t like mixing friendships and finances, but when forced to choose between having the heating turned off and asking for help, I will swallow my scruples and pride. As bad as it is that I have to ask for help and as much as I have cursed my situation and the depression which led me into it, one positive aspect of it is that I can be certain that my friends are not fair-weather-friends only, but genuinely care.
It also reminded me of something my therapist once told me – that one cannot be successful in this world without a support net of other people, and that you cannot recover without asking others for help.
The good news are that my therapist’s statement is in the mail and should arrive within the next two days, which means that on Monday I can officially start the application process for welfare. So hopefully the financial problems will be alleviated a little soon.
One huge problem on top of the monetary hassle was that I had to manage the organisation of all the “negotiations” while suffering through the venlafaxine side-effects: yesterday I made my phone calls in the morning, before taking the antidepressant, with the result that I was well past my usual breakfast time when finally being done with them, and already had withdrawal symptoms. Today I had to wait for a company representative to come over, which was scheduled for 11 AM. So I was up and dressed the entire time when during the past week I would tide over the most intense side-effects in bed, meaning that I completely spaced out on the sofa because of the brain zaps. I was so dizzy that I could hardly see straight. Eventually my husband persuaded me to take a nap, which was just as well, because the guy showed up at 2.30 PM only.
Generally I am doing better, though: my appetite is getting up and while meat still is a no-go, I actually had a proper dinner tonight (spaghetti with tomato sauce), the first in a week!
Day 4: Trippin’ On Venlafaxine
That’s the only way I can describe it. The nausea has shrunk to a 15-minute-period which sets in about an hour after taking the venlafaxine, but in the afternoon I experienced paraesthesias wandering from my brain over the back into arms and legs – a tingling sensation, not unlike the feeling when the hair stands up on your arms. It was, and here I start sounding as if being high, as if I was floating in water, or as if my body was filled with water and jellyfish were drifting through it, pulsating. My brain was the biggest jellyfish of them all, from where all activity radiated over my body.
I did not hallucinate – at all times I knew who I am, where I was and why I felt that strange. But when you go see a 3D-movie, you know that what you see is not real, yet the illusion still works, and that was how it felt for me.
The Third Day On Venlafaxine
I lost 4 kg (8.8 pounds) since Friday. Even though it is getting easier on my digestive system and the nausea usually starts dissolving 90 minutes after taking the venlafaxine, I still can eat only selective groups of food, and only in small portions – apples, bananas, pineapples, potatoes, rice, bread. Oh, and my soy drink works too. But meat, fish, eggs or vegetables make me instantly sick. While I actually welcome the weight loss, I hope that does not lead to a rebound further down the road…
The brain zaps are increasing, and sometimes it feels like thousands of ants are crawling over the surface of my brain.
The Second Day On Venlafaxine
… was better. I took the tablet directly after breakfast instead of during it, and that helped: the nausea was tolerable and I did not have to puke. Still cannot eat much, though. More vertigo than yesterday and a slight headache. When moving my eyes quickly, my brain starts “shivering” – those are not full-blown brain zaps, but it rather feels like my brain turned into jello and quivers with every eye movement.
Even though I didn’t do much today, I feel exhausted.
The First Day On Venlafaxine
Googling venlafaxine yesterday did not do me a whole lot of good. For a while, I was pretty scared, but then decided to judge it according to my own experiences with it. After all, the effect citalopram had on me was different from what the majority goes through as well.
Well, my first experience with it was rather horrible. The psychiatrist had told me to take the venlafaxine in the morning, with my breakfast, and so I had a banana, took the pill, and ate a sandwich afterwards. About 20 minutes later, I started feeling a little queasy and dizzy. I went to lie down on the bed, where I felt very ill very quickly. 45 minutes after taking the pill, I found myself in the bathroom, vomiting violently. I don’t want to gross anyone out by too graphic description, but it was so bad that while vomiting I thought: “This isn’t going fast enough! This stuff needs to get out NOW!!!”
Once my stomach was empty, I felt better instantly, but it was not over yet, because apparently my whole digestive tract was affected and I got diarrhea as well, while a couple more waves of nausea washed over me – those did not result in vomiting, though. In the early afternoon, the worst was over and I slept for two hours as I was completely exhausted.
After the nap, my stomach had calmed down and I only felt a bit of dizziness, but was left rather weak. I don’t dare eating anything but dry bread, plain rice and apples either, because I am afraid of getting sick again.
I just hope it will be easier tomorrow, because I don’t see myself lasting very long if I have to vomit that violently every morning. When starting citalopram, I got queasy too, but nowhere near as bad.
Originally, I’d wanted to cut the first pill (37.5 mg) in half and start with an even lower dose, but the pills are too small for that (I don’t have the extended-release capsules).
Back From The Psychiatrist
And thus begins the new treatment regimen with Venlafaxine (Effexor), starting tomorrow.
Everything went well; I was a little nervous first and not particularly in the mood for dealing with a stranger, but the psychiatrist turned out nice. He asked: “What leads you here?” I told him that I was in therapy for chronic depression for two years and generally was really satisfied with it, but couldn’t get a handle on some symptoms like concentration problems and energy, and wanted to see what medication could do for me in that regard. He knows my therapist and has a superficial idea of the CBASP programme I’m in, and I guess that was enough credit to not let me do all the lab tests and ECG again. I also gave him permission to send reports to my general physician.
I recounted a brief history of symptoms and the treatment I received so far: First depressive episode at 12, second at 16 (this time with suicidal ideation), since the age of 19 / 20 only oscillating between different stages of major depression; panic attacks at 30, treated with citalopram, then therapy; therapy major success, but then the start of a slow decline. The psychiatrist asked about living situation, family, family history of depression, school education, what I am studying. Whether I smoke, drink, ever did drugs, take any kinds of medications.
He performed some tests on my cognitive capacities, because I had complained about them:
– “Spell the word ‘radio’ backwards.”
– “What’s the difference between a river and a lake?”
– “What’s the difference between a ladder and stairs?”
He had me memorize the words “street, traffic lights, flower” and asked whether I remembered those in between other questions, and had me do a chain of mathematical exercises: 100 – 7, then subtracting 7 from the result again, and again, and again. I scored 100% and obviously am not demented.
Some questions on differential diagnoses: do I see or hear things nobody else sees or hears, do my thoughts race, do I think I am being watched or that people talk about me behind my back, etc.?
The most difficult question actually was, “How do you feel these days?” I honestly had to think about that, and answered, “On average days, I feel subdued. Pessimistic.” I told him about the insomnia, problems falling asleep and the stomach aches, that I like to withdraw from people, worry a lot and occasionally get anxiety attacks because of the worrying.
All of that took about half an hour, then he proposed that due to my previous experiences with SSRI in the form of citalopram, I should try out what an SNRI does for me. He explained that SNRI give most people more energy, explained possible side-effects and finally gave me a prescription for venlafaxine. Unless I experience really bad side-effects, I’ll see him again in four weeks.
Edited to add: Yikes, maybe I shouldn’t have googled venlafaxine / effexor, because the results sound pretty bad… “The antidepressant everyone loathes to have taken.” Sounds like I am in for a bumpy ride…
Getting Ready For The Psychiatrist
Tomorrow is my appointment with the psychiatrist. I have a vague idea of what to expect, based on the psychological examinations at the hospital and internet research, and I’m quite used to recounting my history with depression. Hopefully, he will accept that physical reasons behind the depression have been excluded two years ago; I have documentation on the lab tests of my blood, but not on the ECG, for example – that’s still in my file at the hospital. I just don’t want to go through all of this again only to come to the same conclusion… Other than that, I’m open for any kind of neurological or psychiatric test he might want to perform.
I’ve been thinking about what I’m going to tell him. My top priorities are the lack of energy and the cognitive deficits; if we manage to do something about those two “symptom clusters” with tolerable side effects, I’ll call it a success. It might sound odd to some readers, but medicating the sadness away is not very important to me, because I feel that there is a reason when I am sad – even if I am not immediately aware of it. I just want to reach a state where I am able to deal with those reasons sufficiently.
I also hope I can skip the citalopram this time around. Here in Germany, it’s the most widely prescribed antidepressant, and usually the first antidepressant you will get prescribed. While it helped me in some regards, I feel that in my current state the side effects would outweigh the use I got out of it. Not to mention that it made me extremely sleepy in the beginning, which is certainly not what I am looking for currently.
Well, tomorrow I will know more.