Depression: Fighting a losing battle?

Today, I’m going to talk about depression. It’s pretty common, at around one in six becoming clinically depressed during the course of their lives, yet there seems to still be a lot of misconception and stigma surrounding the condition. This is a long post so make a cup of tea, get yourself a few Hobnobs and settle in for a bit of a read. I hope this is helpful. 

Personally, I have been through the vast majority of the spectrum when it comes to the scale of depression: a bit down and teary, right through to losing grip on reality and being a significant danger to myself. I have also swung the other way and become impulsive, restless to the point where I stop sleeping and spend money without thinking about the consequences… to name but a few. If someone described that to me, I’d wonder if they had a type of bipolar disorder. As far as I know, I’m only diagnosed with depression.

Over the years I’ve been unwell, I have tried to educate myself as much as I can about what’s going on in my warped little mind, so I can understand more of what the medical profession are saying and thinking, and also so I can be my own advocate and make sure I’m getting the right treatment. Suggesting medications or therapies to a psychiatrist can be similar to climbing Everest, but I’ve been fortunate to have found two GPs now that are willing to listen to me and actually consider what I’m suggesting because I do actually know what I’m talking about. 

I’ve also wondered why I became this way, when other people with a similar life experience have come out of it very differently. For the past year or so I’ve been intrigued by a new science: epigenetics. In a nutshell, it’s the heritable changes in gene expression or cellular phenotype. A phenotype is an individual’s visible traits. Here’s a link to a brilliant video that can explain it better than I can right now… Click

Family history can play a pretty big part in what their children turn out like. For example, if your parents have depression or anxiety issues, you may be born with the potential to develop significant disorders if the environment you grow up in, or a life event triggers those (epi)genes into action. 

Take my family tree: Grandparents; as far as I’m aware, there is only one case of mental illness and from what I’ve heard it’s a personality disorder. Parents; mother, depression and mild anxiety, father, probably bipolar disorder and personality disorder (from what I’ve read and discussed with doctors, it’s more than likely anti-social.) Paternal uncle is an alcoholic and maternal uncle probably has Aspergers. My younger twin brothers have Aspergers.

Fun, eh? From the age of around 10 years old I remember being emphatic that I wasn’t going to have children. At that point in time it was because I was terrified of having children like my brothers; but now I just don’t want to pass on the genetic curse. And I’m 99% sure I’d be a terrible mother and anyone that has any idea of what I’ve been like in the past would agree. It’s no secret I’m a disgusting excuse for a human being.

So, you could say I was born to become poorly. I’m of the opinion that couples with a history of significant mental illness should be sent for genetic counselling before deciding to produce another generation of pain and suffering. But that’s just me.

Now we come to the fun part. Medication. How to re-balance those pesky little neurotransmitters to turn you back into a functional human being? Oh, well that’s easy isn’t it; surely you just take some anti-depressants and let them work their magic. That’s what I thought at 18. God if I knew then what I knew now… Do you know how many different anti-depressants are on the market currently? How many different ‘classes’ there are? It’s a minefield and can become incredibly frustrating for patient and doctor alike.

Every GP will try an SSRI (selective serotonin reuptake inhibitor) first. They’re the newest drugs, and have the least sucky side-effects. These include drugs that everyone has heard of, like Prozac (fluoxetine) and Zoloft (sertraline). We tend not to use brand names in this country but the really popular ones can become known this way. Using their chemical names is termed ‘generic’ and is essentially cheaper.  

If you have the misfortune of having a complicated brain, like me, you will have to try 4 or 5 SSRIs before you get to try the next class, unless you’re seeing a psychiatrist or have an experienced GP; SNRI/NaSSAs, or serotonin noradrenalin reuptake inhibitor and noradrenergic specific serotonergic antidepressants respectively. These are the drugs patients love to hate, if they work. It’s a trade-off. You won’t be living in a black hole filled with elephant shit anymore but you will either gain a lot of weight or have horrible side effects like ‘brain-zaps’ to live with. Oh and then when the time comes that you don’t need to take them anymore; you will have the worst withdrawal of your life. Only alcohol and drug withdrawal would be worse but it’s quite unlikely you’d have to endure both and be able to draw the comparison to make the statement: I’d rather go through anti-depressant withdrawal a hundred times than endure drug withdrawal once. 

There’s a reason people are admitted to hospital to withdraw and detox from drugs and alcohol. It could kill you. As far as I know, trying to get an anti-depressant out of your system won’t need a hospital and/or a boat-load of sedatives to get you through it and still have a pulse.
Anyway. There aren’t as many of these medications as the SSRIs; you’ll only have come into contact with Zispin (mirtazapine - NaSSA) and Efexor (venlafaxine). I could write a whole other blog on the pros and cons of mirtazapine aka devil drug.

If those don’t work well enough at their maximum therapeutic dose, the side-effects suck ass or you just don’t get prescribed them for whatever reason then you’ll be introduced to TCAs, tricyclic antidepressants. These are old-school drugs, generally originating in the 60’s and 70’s! They get their name because their chemical structure resembles three pretty rings and they hit both serotonin and noradrenalin neurotransmitters. If you’re taking these, you’re coming at your depression with a sledge-hammer and the side-effects will feel the same in the beginning, but by this point, you’ll probably know the drill to some extent.

The only class left is the MAOIs, mono-amine oxidase inhibitors. I’ll admit; I don’t know much about these because I’ve had no reason to educate myself on them. All I know is they’re dangerous, old, and are only really used as a last resort, if ever. The side effects and interactions with both drugs and foods are frightening at best and incredibly restricting on day-to-day living.  There are way better options available now.

I have been tried on 4 SSRIs: escitalopram, citalopram, sertraline and paroxetine (seroxat!!), 1 NaSSA: mirtazapine, and 3 TCAs: lofepramine, imipramine and clomipramine. I’ve also taken trazodone, which looks like a tetra-cyclic to me from its chemical compound.

What worked for me was mirtazapine with lofepramine. I had to take the TCA ontop of the NaSSA because it wasn’t working anymore and needed to be ‘augmented’. I gained 3 stone – 7st to 10st in the space of 8 months - and sweated like an absolute pig, but I was genuinely free of depression. Looking at pictures, I can really see that it was gone. Oh, this sudden weight gain was also responsible for the worst phase of bulimia I have ever been through. I did say there was a trade-off. My delightful psychiatrist DID NOT TELL ME about the side effects and potential impact this would have on my appetite. He knew I was getting my backside kicked by my eating disorder and obviously the thought of eating and gaining weight back was terrifying. I refused to ever see him again after I pulled myself off the drug in October 2009. I couldn’t take it anymore. The cons outweighed the pros. I wasn’t happy or functioning. Again.

It was that disaster that made me decide I needed to learn about medications relating to depression and anxiety, as well as the conditions themselves. I also paid £250 to see a psychiatrist at The Priory when things got bad again because I couldn’t stand the idea of being fobbed off by the NHS psychiatrists again.

Of course, there is a lot more to managing depression than medication. I’ve not had any therapy. Well, I have had an extended amount of CAT with a psychologist when I was 18 but that’s it. Those sessions uncovered a history I had buried deep in the recesses of my brain, but my sessions were at an end and I was discharged from the CMHT (community mental health team) entirely, despite being promised continued support. They discharged me even though I was suffering with raging flashbacks and also trapped in an abusive relationship. It’s no wonder I started self-medicating with drugs and alcohol again!

During my brief interactions with Addaction, I was shown a couple of therapeutic approaches I’d not come across before which would have worked well if I had more time with my allocated keyworker, as was the case during my first contact with them, and if my second keyworker didn’t label my thought process and interpretation of the world/situations as ‘shit’.

It’s fair to say I have no trust in the CMHT but I think I have just been very unlucky. My now ex-GP, who I miss very much, became my therapist/confidant and I genuinely felt like he cared about what happened to me. He definitely kept me alive during late 2010 and early 2011 before he left the practice. My current GP has a very different approach, but we’ve found a working relationship and I trust him.

I’ve done my best to survive, but at 25 and depression once again coming back with a vengeance I do wonder what it’s going to take to make this go away. I wonder if I will be suffering with depression my whole life. This condition has robbed me of so much and is preventing me from making any further progress; this is where the line between M.E. and active depression becomes blurry. My social skills are awful. I have forgotten how to talk to people. I used to work in sales before this hit, and I was very good at my job. I cannot maintain eye contact. I stammer or get my words mixed up. I am living for my boyfriend – who can definitely do better and I will always think he has a ‘normal’ girlfriend on the side lines as respite from me. Every day I wake up and wonder if today will be the day he decides he can’t put up with me anymore, or I break it off to spare him watching another relapse – and my cat.

I’m scared at the prospect of mental illness always being a part of my life. It’s definitely hard wired into me. At this point, I do wonder why I bother keeping up the fight against my own biology, but I think that’s depression talking. I wish I could be hopeful, and say “It does get better.” I’ve not had that for an extended period of time, just those precious few months between when I was functioning and so happy with my new relationship and an actual social life and when eating disorder/addiction took over again. If I follow the epigenetic theory, it is possible to change this, but I am 100% certain I cannot do it on my own. Therapy is vital in treating depression. Even if you’re symptom free, the negative thought processes you developed while you were poorly can stick. 

All I can offer is this: find a GP that is adept at managing depression. Read as much as you can about the condition. If you don’t have a pet, get one. Lily has been my light in the darkest of hours, and having something to care for and repays you with unconditional love is priceless. It’s in our nature to care for children and animals and have a sense of purpose. Find a good support forum. Talking to people that understand what you’re going through is so important when you’re isolating or think you’re the only one feeling that way. If you can afford it, find a good therapist privately. You’ll be able to see them for as long as you need to, rather than what the NHS deems cost-effective. Don’t be afraid to admit you’re struggling and need some support. Do nice things for yourself; yes you do deserve it. You’re not alone and there are people that care. 

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