Depression Symptoms & Antidepressant Side-Effects Assessed

It’s becoming very clear that despite taking twice as high a dosage of venlafaxine / effexor now, the timed-release capsules work much better for me. The nausea and vertigo vanished completely, and in the mornings I don’t go through withdrawals anymore either. I do feel quite drained from the experiences of the last three weeks, though, very tired and listless. I lost 6 kg (13.2 lbs) – 4 kg over the first weekend and another 2 kg since – and even though I would welcome further weight loss very much, it goes without saying that vomiting, diarrhea and skipping meals due to nausea is not exactly a healthy way to drop the kilos and at least partially responsible for the feelings of weakness. On top of that, venlafaxine also suppresses my appetite for a good part of the day, until it returns in the evening and I suddenly start scouring the kitchen for all the stuff I did not buy when shopping…
There has been no improvements of the symptoms I primarily started taking venlafaxine for yet, the cognitive impairments and lack of energy, but I do feel more emotionally stable recently. Next Friday I have a follow-up with the psychiatrist, when I’ll find out whether I’ll increase the dosage further or stay on it for the time being.

As for the welfare process and related paperwork, the main appointment at the job centre had been cancelled on Tuesday already because the lady had become sick, and the one who works on our case at the employment agency was replaced with a colleague due to illness as well. While being very friendly as well, this colleague could do little more than collect the forms we had filled out at home and the documentation we had brought. Other than that, we will have to wait for them to get back to us. I handed in the questionnaire on my medical complaints today; the question was: “Do you have medical conditions which influence your current job or have done so in the past? Please give a short description of your illness respectively your symptoms and tell us which kinds of occupation would be influenced by these.” The space left blank was less than a quarter or a page, so I could not go into much detail:

“Diagnosis: chronic recurrent depression with comorbid panic disorder.
– permanent / daily symptoms: muscle pain in legs and arms; social anxiety; slowed-down thinking; word finding problems; problems falling asleep (at least 2 hours / night); severe lack of energy; hypersomnia; decreased libido
– frequent symptoms (at least 3 days per week): stomach pains; digestive problems (diarrhea); back pain; memory problems; concentration problems; depressive emotions (sadness, emotional emptiness, hopelessness); headaches
– periodically appearing symptoms: insomnia
– under stress also anxiety attacks
– currently (since mid-March 2013) additionally vertigo, nausea and vomiting due to starting an antidepressant regime (venlafaxine)

Because of the diverse symptoms, I am physically, intellectually and emotionally affected with any kind of occupation.”

That is as accurate an assessment as I could give of my daily problems in such a small space, and each of my healthcare providers should be able to confirm them. I learned today that the medical service will first contact my general physician for information, which is a bit of a problem since at least 80% of my depression treatment has been done by my therapist; the general physician does get reports from my psychiatrist, but except for the fact that I have participated in the medical study he does not know anything about the psychotherapeutic treatment. I do hope they’ll get in contact with him as well – if our regular case worker had been present today, I would have asked her, but her colleague was not familiar with the protocol in such cases.

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The End Of An Era

Yesterday, I exmatriculated from university. Thirteen and a half years of fighting, and then it took all of 58 seconds to leave – there is a form you print out, fill in your name, address and student-ID number, give the reason for exmatriculation (I checked “illness”), and hand it over to the student secretary. She double-checked with my student-ID, stamped the form, gave me a formal statement that I had left uni, said goodbye, and that was it. My niece, who had accompanied me, timed the procedure.

That was in the afternoon, however. The morning my husband and I spent at the job centre, where we had an official appointment to start the welfare process, and saw someone from the employment agency afterwards. She might help my husband find a job, and I had to see her to work out the procedure regarding the “impaired working-ability” label. We got a total of about 50 form sheets we have to fill out: the actual application, and different questionnaires on just about every aspect of our existence, from the flat we live in (size, number of bedrooms / bathrooms / kitchens, how much rent we pay, what kind of heating it has, how much we pay for water and electricity, etc.) over our respective job résumés and occupational histories to a questionnaire on my depression history. We have to bring bank account activity statements for the last three months, and attestations of my health insurance, my husband’s integration class, the exmatriculation from university, a copy of my rental contract, yadda yadda yadda. And all of that has to be ready by Friday next week, because then we have the next appointment.
The procedure regarding my medical status will be that I formally release my general physician, therapist and psychiatrist from their obligation to secrecy, so that the job centre’s medical experts can inquire about my depression history, the treatments and my current status. They will then write a formal assessment, based on these facts, and I will get an invitation for discussing the results. If the results are clear and nobody objects, I will not have to undergo any further examinations through a medical officer.
The lady from the employment agency was very nice and sympathetic; she even inferred that she had personal experience with it – I just could not tell whether she meant depression, panic attacks or both. Regardless of what was the case, I felt treated with respect and in a non-judgemental way, which certainly is a first in my dealings with bureaucracy outside of the mental health sector. She’ll also remain our contact person for the rest of the process, so I’m doubly glad about this.

We were at the job centre for over two and a half hours, with over an hour of waiting in chairs in between. I had not taken the venlafaxine that morning, because I didn’t want to go into a side-effects frenzy during the appointment, but halfway through the withdrawal set in and my brain started buzzing like a mobile phone. I hope that for our appointment next week the timed-release capsules will prevent that scenario.

Venlafaxine: Doubling The Dosage

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.

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 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).

Physical Side-Effects of Depression

In the therapy sessions, we usually concentrate on the emotional and behavioural aspects of depression, since this is the area where we can work on change. The physical side-effects of depression, which used to even eclipse the emotional pain quite often, will go away too when the depression vanishes.
For a long time, however, I wasn’t aware that these two aspects – mental/emotional well-being and physical pain – were so closely related. I blamed my thyroid and the Hashimoto’s disease for feeling fatigued and for the memory problems I was experiencing, even if the lab results showed that my medication was perfectly adjusted. For all the other complaints, I saw three doctors in total who all diagnosed me with a variety of conditions which usually matched the most recent physical manifestations, but always ignored the full picture. Nobody suspected depression before I started having panic attacks, and even though I personally suspected a mental health problem earlier, all the symptom lists for depression I checked mentioned weight loss and sleeplessness, while I was (am) clearly overweight and slept much more than the average person: I always dismissed the self-diagnosis again on these grounds. Only at the hospital I learned that in chronic depression, weight gain and hypersomnia can occur too, as well as many other symptoms.

Today, I wanted to take inventory of the physical side-effects which one would not necessarily relate to depression and which I experienced over the course of the years.

Permanent or frequent complaints:

• Muscle pain in the limbs: I’m not entirely sure when this started, but by spring 2009, I very often had severe pains in the muscles and nerves of my arms and legs. Sometimes it would feel like a “tennis arm”, sometimes like the kind of muscle cramps you get when over-exercising. I combatted the pain with ibuprofen, paracetamol or aspirin, which brought relief for a few hours.
  My second general physician diagnosed me with multiple sclerosis because of it.
  When I was put on an antidepressant in summer 2011, the pain went away after only four days. It returned after I discontinued citalopram; my therapist was the first person who told me that it was stress-related and caused by an inability to relax. Ever since, I lie down and try to consciously relax all of my body whenever I feel the pain. With the progress in therapy, the days when my limbs hurt become fewer and fewer.

• Inflammation of the eyeballs: This symptom first occurred in spring 2009 too, when my eyes became red, dry and sensitive to light. In the beginning, the intensity would be sometimes less, sometimes worse, but last year, it was permanent.
  My first general practitioner diagnosed it as hay fever – never mind that weather or seasonal changes had no influence on it at all. My sister and niece both have hay fever, so I am rather familiar with its symptoms, and I was very certain that the inflammation of my eyes was not allergy-related. The next doctor saw it as a symptom of MS, together with the muscle pain.
  As with the muscle pain, the inflammation vanished when I started to take citalopram and returned afterwards. Recently, the inflammation had come back, but as I try to counteract the stress, it gets a little better every day.

• Headaches: I used to have headaches very frequently; up to four or five times a week during the most intense periods. The most common form was a consistent, one-sided pain directly behind the eye, as if someone was relentlessly poking me into the eyeball from behind. In 70% of all cases, the left side was concerned. Rarely (once every couple of years), I will also have a case of migraines, when I can’t tolerate light and sound and have to lie down in a dark, quiet room with a wet cloth on my face.
  The headaches started very early, during my teenage years already, and currently occur on about two or three days per month.

• Digestive problems: Another group of symptoms that I had since adolescence – stomach aches / cramps, diarrhoea, a couple of episodes when I couldn’t eat anything but apples and plain rice, one episode of histamine intolerance that vanished after two weeks. Now I experience those problems about 2 – 3 times per month, but during the worst of it, that would be 4 – 5 times per week, for months on end.

• Backaches: For about twenty years, I used to have “typical” complaints like tense muscles around the shoulder and back of my neck, but in recent years, there have also been intense phases of lower back pain. The latter first occured early in 2008, about two weeks after I had started a new job that pushed me to the limit in regards to social anxiety. I didn’t make the connection back then, but in retrospect, it seems very clear that the job and the new type of backaches were related.

Infrequent or singular complaints:

• Vertigo: One morning in 2007, I woke up with such a heavy case of vertigo that I literally couldn’t get out of bed. Lifting my head alone brought such waves of nausea that I had to vomit. It took three days until I could leave the house and see a doctor for it, who was clueless and referred me to a specialist. I had my ears and head checked, especially the sense of equilibrium, but everything was fine. They sent me home, “If it happens again, come back.” So far, there has been no second episode of unexplainable vertigo.

• Chest cramps: This is a strange one. The first experience was the night after I celebrated my 18^th birthday with a party; I woke up in the wee hours of the morning with a feeling as if my stomach was starting to petrify. Since then, I have spells when it happens a couple of days in a row, just to stop again just as suddenly for about half a year.
  Very often, the cramps come at night and I wake up from the pain, but sometimes they can also occur during the day: the muscles around my stomach become hard and cramp; a very intense ache that I feel under the sternum and in the middle of my back. Sometimes, I can sense the muscles there going tense a few hours before the actual cramping, but usually it happens within minutes only.
  Heat helps as it relaxes the muscles. At my most desperate, I had hot water bottles on both chest and back and was drinking hot water to relax the muscles from inside as well, because the pain can get so intense that I can hardly stand upright anymore and feel like opening my chest with a knife just so I can reach under the sternum and massage the muscle.
  Some people have suggested that it might be heartburn, but it feels completely different and is not inside the oesophagus or stomach, but very clearly outside of it.
  It appears that the chest cramps have become less intense and more infrequent, but is too early for making a definite call still: I had episodes of up to nine months without them and experienced some chest cramps this spring, so it will need at the very least a year without them before I consider them gone.

Painful Reminders

For the past two days, my eyes and legs hurt. There could be many reasons for it: the long stressful drive home on Thursday – I’m the only driver in my family and nobody can take over. The change of climate. Having my period. Or a symptom of my depression that comes and goes since I started therapy.

Beginning in spring 2008, I suffered from inflamed eyeballs and increasing muscle pain in the limbs. At first, it was moderate only, but grew more intense as the months went by, causing a doctor to (wrongly) diagnose me with multiple sclerosis.
Only after I had a few panic attacks in June 2010 and was put on citalopram by a different doctor, the ache and inflammation vanished when previously I had taken painkillers on five days out of a week to find relief for a couple of hours.

That is the main credit I will give to being on an antidepressant: that it took the pain away relatively quickly and (for the duration of being medicated) permanently. Mood-wise, it did not change a lot, and so I was not sad when I had to wean myself off before starting therapy in December.

I know that medication is very beneficial for a lot of people and am far from condemning it, but the popular stance of “it is only a chemical imbalance of the brain and a few pills will fix you” certainly does not hit the nail for me. Even if I get occasionally re-visited by the physical pain, the citalopram came with its own set of side-effects: nausea, vertigo, sleepiness, nightmares and something called “brain zaps”. If you’ve never experienced them, they probably are hard to imagine – basically, the sensation is like electrical impulses travelling over your brain, which for me felt like bubbles rising in carbonated water, trying to escape a bottle you just opened. They started at the bottom of my brain just behind the eyes and would crawl all the way up to the top of it, rising just under the highest point of my skull.
Brain zaps don’t hurt (well, at least to me they did not), but they do not feel like anything else I ever experienced and in the beginning they were really scary because I did not know what was happening. Each zap lasted about two to three seconds and during that time, I had to stop whatever I was doing, even if only walking, and wait until the sensation faded. Only when I started to look for online information on why my brain started shivering, I came across this term and understood that I was not alone with it.
If I recall correctly, I had the first brain zap on the third day after getting on medication and they lasted for a couple of weeks until I had reached the therapeutic dosage and gotten used to it. Rapid eye movement could trigger them, but they also came spontaneously. When I discontinued citalopram, the same happened again, but since late December I haven’t had any brain zap at all.

The brain zaps were curious rather than inconveniencing for me, though, but there were other side-effects that lasted far longer which I could not tolerate. The depression led to hypersomnia in me, excessive sleeping, but instead of giving me more energy, citalopram made me so tired that I needed several (sic) naps each day and still slept twelve hours at night. I would get so tired that I almost collapsed on my bed, and the extremely vivid dreams I experienced from the drug often turned into tormenting nightmares.

Another lasting side-effect that never went away during the half-year was that citalopram completely neutered me. It erased any physical, mental or emotional sexual response – in other words, it turned me completely asexual. The mental and emotional parts started to recover after about three months, but physically I remained completely unexcitable. It would have put a huge strain on a partnership had I not been single then, but even so it was hard to bear because I constantly wondered if I’d ever go back to “fully functional” afterwards. I did, but it reduced my willingness to take antidepressants a lot.

Of course, others might not experience the same. Chances are they wouldn’t. No two people are the same. A different drug might have worked better for me. But given the choice between drugs and therapy, I’d always go for therapy first after the good experiences I made with it: it takes a little longer to get started and in the beginning it might make you feel worse instead of better because you start “poking” a lot of sore spots, but even if I got out of a session without having experienced an epiphany, at some point during the following days there would come up a situation where the previous sessions suddenly allowed me to understand better and take a different approach.

So therapy has made me feel emotionally better and it even gave me a little more energy, though I’m still not on “normal” levels. Most of the time, I’m pain-free, but once in a while it comes back when I am going through a more difficult phase than usual. For example, if I argue with my mother, I will feel the stings radiating from my fingers into the arms as we are still speaking. Given that I still have a couple of problems without solutions in my life, the duller aches in my thighs and the dry, itching eyes are like a silent reminder that even though I’ve already come so far, I cannot lean back yet.