Fun and Games

I have had an odd couple of weeks. Because of various things going on at the moment I have for some time been feeling a bit stressed and increasingly lethargic. I have a history of depression but am generally able to recognise the symptoms early enough to take the necessary action to prevent slipping from detached and lethargic to actual depression. There have only been a few instances, usually for a period of a couple of months, where I’ve found it too much to cope with on my own and have had to get additional help. About a week and a half ago I started getting various symptoms of a bug or virus – headache, nausea, aches and pains – and initially thought it might be swine flu, as a few people at work have had it, or have relatives who have. The one thing that made me doubt it though was that I had no fever.

Having had a couple of days off at the beginning of the week because of having worked the weekend, I went back to work last Wednesday (12th) and felt completely wretched all day. That night I barely slept and woke up the next morning with a headache, and feeling dizzy and disorientated. I called in sick and got some bed rest. The next day I felt just as bad, so called in again. By the weekend I still had the same symptoms which showed no sign of abating, but still no fever, so I began to wonder if it was in fact a bug, or if it was something else. I follow NHS Direct on twitter and over the weekend they posted a link to a new part of the NHS Direct site which is a mental health symptom checker, so I figured as I had been getting on towards depression for a while I’d run through it and see if anything tied in. All the symptoms I was experiencing, it turns out, are symptoms of depression. Most of them I knew, but wasn’t aware that it can cause headache and nausea, so hadn’t initially made the connection. The advice at the end of the questionnaire was to go see my GP, which I figured was probably for the best.

The problem was that at that point I didn’t actually have a GP. I have a phobia of medical practitioners and establishments, partly due to a completely irrational fear, and partly due to bad experience with incompetent or indifferent practitioners. It is fair to point out that the vast majority of medical staff I have encountered have been superb and I have every faith in the health service and its staff, but the ones who were bad, were quite horrible. Anyway this phobia works in such a way that upon entering a medical establishment, I immediately get a sense of dread about all the things that can go wrong. My brain imagines horrific things no matter how hard I try to quash the images, and I start to feel faint, then invariably have a panic attack and pass out.

Part of the reason that the fear has become worse over the years, is that passing out is a truly horrific experience, and it is partly the apprehension about that which makes me feel worse, in essence making it a self-fulfilling prophecy. Lots of people talk about passing out after a heavy night out, which the majority of cases is just falling asleep, or losing consciousness. Actual passing out is very different. You start by losing coherence and focus, then start to get tunnel vision. When you are about to pass out, if you’ve done it before you know it’s happening, and that only makes it worse because you try to fight it and end up panicking. There comes a point where your brain is simply overloaded and you lose consciousness. Your entire body goes limp and you just fall where you are. If you are stood up, you just fall over and hit the ground hard.

Next comes the dream. This is usually, but not always, vaguely related to the situation which has made you pass out, and is generally like watching a short reel of film of about 3 or 4 seconds, over and over again. In one dream I was being hit by a bus, over and over for what I’m told was about 2 minutes – I think this stemmed from the fact that I had fallen heavily on one side, so had pain all the way down that side of my body, which my brain was trying to rationalise. While this is going on, it is not uncommon to seize, similar to an epileptic seizure, which although unpleasant is actually beneficial because it doesn’t have any detrimental effects (bar, occasionally, friction burn on one side for your face) but it does make people take notice. 

The next stage is regaining consciousness. This can be very unpleasant indeed as on awaking you initially have no idea where you are, how you got there or what has just happened. You invariably wake to find lots of people crouching down next to you looking concerned, but you have no idea why, or in most cases, who they are (this is also the case even if you know them). Sound and vision are both very hazy at this point and you have a ringing in your ears similar to tinnitus, usually accompanied by pins & needles and often sharp pain in whichever part of your body has taken the brunt of the fall. For this reason it is advisable to lie down when you realise you are going to pass out. Over a period of maybe 30 seconds, you gradually take stock of your surroundings, and on realising you have passed out, what usually follows is a brief period of calm, where you realise you are over the worst and that the feelings of nausea will pass. within about 5 to 10 minutes you are ready to sit up, and start talking coherently. Within about half an hour, the nausea usually passes, and you are left simply feeling drained and very fragile.

Needless to say, knowing all this, and knowing that any trip to a doctor is liable to cause this to happen, I eventually tired of it and simply stopped going to the doctor. It can be quite restricting and leads to taking as few risks as possible with anything which may entail a trip to the doctor’s. Something which is a simple and mundane part of life for everyone else, becomes something which is virtually impossible, and it takes a hell of a lot to get me to go to see one. For this reason, after I stopped going to my old doctor, I simply never bothered registering with a new one when I moved house. By Monday of this week it became apparent that my options were either to try and get through this with no medication, and having to go back to work on Thursday, so I decided to bite the bullet and get registered.

So on Thursday morning, for the first time in about 8 years, I saw a doctor. I had been eating very little for the past few days and so was already quite weakened by the time I got there, and in the waiting room was on the verge of passing out. Fortunately I wasn’t waiting long, and the doctor immediately put me at ease. He was compassionate and helpful, and did not dismiss any of my worries or symptoms, simply took it all on board, asked for my opinion on things, and then discussed with me his prognosis and suggested course of action.

I have only once been on medication for depression, which was Seroxat. I did not have a particularly good time on it – it switched off all the negative emotions, which helped me get a hold on things and look at things objectively, but in so doing it also muted all the positive emotions so I really didn’t care enough to do anything. I essentially became an emotionless drone, incapable of much more than lying in bed waiting for each day to pass. This was obviously an experience I was keen not to repeat, but I knew that anti-depressant medication is quite varied, and was open to the possibility that the right medication may be what I needed. The doctor signed me off work for two weeks and prescribed Venlafaxine, with a view to reviewing both after the two weeks to see if the time off is sufficient, and if the medication is right for me.

He advised that there may be some nausea as a side effect and suggested taking the medication immediately before bedtime so that the majority of the nausea would be while I am asleep so I wouldn’t suffer too much from it. I have been taking the medication for two days now, tonight will be my third dose, and I had held off on reading about other side effects, in case reading about them made me project and psychologically cause effects which I would otherwise not have had. Since the first morning I woke up after starting on the medication I have felt groggy and nauseous more or less constantly, and have had a headache on and off. I have had a decreased appetite for days anyway, so this is likely a contributory factor, though it has definitely got worse over the last couple of days, and feeling constantly nauseated does not make you feel very enthusiastic about food, so I have now been living off one meal a day, with the odd cereal bar thrown in, for about 5 days. It is something of a vicious circle, but one which I hope to be able to beat by basically forcing myself to have food first thing for the next couple of days.

Tonight, having experienced a few things which I thought might be side effects, I decided to look up Venlafaxine to see if anything else could be attributed to the medication. This is what I found:

Common side effects

NOTE: The percentage of occurrences for each side effect listed comes from clinical trial data provided by Wyeth Pharmaceuticals Inc. The percentages indicate the percentage of people that experienced the side effect in clinical trials.^[4]

• Headache (34%)
• Nausea (21-35%)
• Insomnia (15-23%)
• Sexual dysfunction (14-34%)
• Dry mouth (12-16%)
• Dizziness (11-20%)
• Sweating (10-14%)
• Decreased Appetite (8-20%)
• Abnormal ejaculation (8-16%)
• Hypertension (4-5%)
• Vivid/Abnormal dreams (3-7%)
• Akathisia (Agitation) (3-4%)
• Decreased libido (3-9%)
• Increased yawning (3-5%)
• Apathy
• Constipation
• Ongoing Irritable Bowel Syndrome
• Fatigue
• Vertigo
• Orthostatic hypotension (postural drop in blood pressure)
• Impulsive Actions
• Electric shock-like sensations also called "Brain zaps"
• Increased anxiety at the start of treatment
• Memory Loss
• Restless Legs Syndrome

Less common to rare side-effects

Note 'Rare' adverse effects occur in fewer than 1 in 1000 patients.

• Cardiac arrhythmia
• Increased serum cholesterol
• Gas or stomach pain
• Abnormal vision
• Nervousness, agitation or increased anxiety
• Panic Attacks
• Depressed feelings
• Suicidal thoughts
• Confusion
• Neuroleptic malignant syndrome
• Loss of appetite
• Tremor
• Drowsiness
• Allergic skin reactions
• External bleeding
• Serious bone marrow damage (thrombocytopenia, agranulocytosis)
• Hepatitis
• Pancreatitis
• Seizure
• Tardive dyskinesia
• Difficulty swallowing
• Psychosis
• Hair Loss
• Hostility
• Activation of mania/hypomania.
• Weight Loss (of concern when treating patients suffering from anorexia nervosa)
• Weight gain (effect not clear, but of concern when treating people who may have Body Dysmorphic Disorder).
• Homicidal Thoughts
• Aggression
• Depersonalization
• Visual Hallucinations
• Swollen and/or bleeding gums
• Frequent urination

Quite a list isn’t it? I’m happy to say that I have never in my life been suicidal, and have never really had suicidal thoughts, so am not too worried about that, however an awful lot of the side effects seem to match up exactly to symptoms of depression, and I have already had an alarming number of the side effects. Most I had put down to ongoing increasing symptoms of depression, but as the majority have only started in the last two days, I am now not so convinced. My hope is that most or all will be temporary and that as the drugs start to take effect it will all be worthwhile. I remain open-minded and positive am not going to draw conclusions until my body has had time to adjust, but all the same, it is an alarmingly large list. I just hope the positive effects make up for the negative ones.

One of the biggest problems I face as a sufferer of depression, is that it is so widely misunderstood and dismissed as a cop out. Depression is an actual chemical imbalance in the brain, it is not just feeling down or sad. On the contrary, I don’t feel particularly down or sad at all, it is more a lack of emotions, than it is an onslaught of negative ones. It affects different people in different ways and I know some people do feel absolutely miserable as a result, but from speaking to other sufferers, it seems that the one unifying symptom seems to be lethargy. It is like actually physically being depressed, in the way that you depress a button on a keyboard – being pushed down, like your whole body feels to weigh far more than it should, and *everything* takes far more effort than normal, while bringing far fewer returns in terms of feeling satisfaction and accomplishment. One of the most important things to do to remedy depression is to keep busy, doing things you enjoy, and getting exercise, but getting exercise is a hundred times harder than normal – you have absolutely no motivation whatsoever, and are physically drained, making it that much more effort, both psychologically and physically. Doing things you enjoy is also relatively moot, as it is very hard to get joy out of anything – even things which would normally make you laugh or smile, or which would satisfy you now seem mundane and futile.

A lot of people, who have been lucky enough to never have suffered from depression, have the idea that it is simply that the person feels a bit down, and often dismiss it simply as laziness. Until you have been through the sheer mind-numbing futility of it all, it is impossible to fully grasp just how all-encompassing it is, and how hard it makes even the simplest of tasks. Trying to explain it someone who has never been depressed is like describing purple to someone who has only ever seen red and blue. It’s a mixture of both, but is also it’s own distinct colour, and without being familiar with the concept of purple, it is virtually impossible to envisage it.

Whether you are aware of it or not, several people you know have, or have had depression, and have been through exactly what I’ve described here, and it’s likely that among the primary feelings they have had have been guilt, brought about by the general opinion of society that they are just wasting everyone’s time and being lazy, and frustration at feeling so unbearably disconnected from everything and yet still expected to function as normal.

If you have, or have had depression, I’d love to hear from you, either in the comments, or by email, to discuss your experiences, and how you have coped with it.