As of Friday, for the first time in three years, I am back on antidepressants. Given that World Mental Health Day was observed not too long ago, and that I’m quite heavily involved in Accenture’s mental health enablement initiatives in proactive “better” mental health as well as support systems for those currently going through issues in their life, I feel I need to talk about this publicly. I say this as someone who’s dealt with depression in the past and gotten out of it. It’s important to celebrate success stories of when people get through tough times and those issues are the rear-view mirror; it’s equally important though to talk about this and normalise the discussion while it’s happening.
My breaking point where I realised I needed help happened last weekend when I was the cinema, watching Bad Times At The El Royale. (It’s from the director behind The Cabin In The Woods; a great watch that is a slice of crazy Americana.) There was a point in the film where Jeff Bridges’ character breaks down sobbing and shaking because of he hits problems with memory recall (likely dementia) and the loss of self that it made him feel. This hit me super hard…because I realised how over the past few weeks, I’ve increasingly found it hard to recall information — and found myself similarly struggling internally with the rage of not being able to meet the bar I set for myself.
Now, to be fair, it doesn’t affect me at work as much, since I have a habit of copiously taking notes to remember things. (Oh hi folks! If you’ve ever been in a meeting with me and saw me on my laptop or my phone, it’s because I’m taking notes. I’m not ignoring you.) But in general I have a habit of ingesting an enormous amounts of random information and being able to flick it into existence in conversations, and not being able to do that felt like a loss on sense of control.
“The bar I set for myself” is a funny term, and a big reason why I’ve probably ignored the fact that I need to talk to someone for months now. So let’s talk about that, because I feel that’s something a lot of people going through mental health issues put themselves through.
For me, I’ve been on panels on mental health internally within the company / externally at industry events, or even socially in groups in my friend circle. I’d find myself talking as an “advocate” exhorting people to talk openly, seek help, and monitor proactively — all the while feeling like a hypocrite on the inside. Deep down, I realised I needed to follow my own advice. And I didn’t, because stupidly enough, I’d see it as “accepting defeat” and “hey, it’s not bad, I can deal with this”.
My way of dealing with the rising tide of symptoms of depression — as it always has been with me — was to throw myself headfirst into work. I’m sure that’s partly because I’m a workaholic anyway. Work gives me a sense of control over my life, and a sphere where I can achieve things to feel good about myself. But to an extent, it’s also like going to a buffet and piling on a plate with as much food as humanly possible so that you can stuff yourself until your body screams “no more”.
Honestly, I’ve had the emotional bandwidth of a soggy paper straw in being able to handle friendships and relationships, for months now. It’s not that I don’t want to hang out with my friends — I really do have a good time when I push myself to say “yes” — but the instinctive reaction, the tiny voice inside my head, has defaulted to saying “no” whenever a social gathering was involved. Even when I have said yes out loud, it has taken immense effort to shake off the crazy impulse to say no from the inside.
Quite often, I’ve used “work” or “oh sorry, I’m at a conference” as an excuse to portray that I’m too busy — but, really, that is a defense mechanism to stem the rising tide of panic I get every time I see the red notification dot of text / Facebook / WhatsApp messages. Dealing with those takes emotional effort, and I’ve massively struggled at finding the capacity to bring myself to engage.
It’s easier to lie to myself that the “real reason” is an external factor, like work. It’s less painful than the sinking feeling in my gut that I’m not being a good friend, who proactively engages. I stopped blogging, something that I love and have done for years. I haven’t read a book since 2015, because I’ve lacked the capacity to handle the attention one needs; instead, replacing it with a steady stream of articles Pocket and Twitter (so I’m not really out of touch with the world per se). I’ve steadily cut back on hobbies or things I do for fun. When my Apple Watch taps me to “breathe” through the day, my body reacts with a visceral shock of shock of “I can’t deal with this right now” and a dismiss notification.
The red notification dot of Outlook is less judgemental.
To be clear, my way of dealing with social situations is obviously unhealthy and unsustainable. And a terrifying time too, since in the past my combination of antidepressants and anti-anxiety medication has caused blackouts when out drinking. I’m also eternally grateful for friends and colleagues here who have pushed through that stubborn wall that I’ve built around myself — which I know I shouldn’t keep around — and dragged me out to just…engage.
But it also feels good to acknowledge, deal with it, and move onwards from here on.Being able to listen to my own advice, that I give to many others, without judging myself for it.
It gets easier.
There is, of course, a technology angle that I had to bring into this. When I finally had the “oh fuck, I do need help realisation”, thanks to the fact that I was registered with GP at Hand as my NHS GP, which offers 24/7 online video/audio consultations, I was able to get an appointment to talk to a GP within two hours.
People underestimate how much, when someone is going through depression, the prospect of having to set up an appointment over telephone (listening to Celine Dion hold music), and then getting a “convenient” appointment on a Thursday at 11.40am can be a turn-off to patients who need help now.
It’s been a while since I have spoken about my mental health issues publicly. And I think it’s time to talk because I’m trying to stop taking antidepressants…and I don’t know yet whether I’ll succeed.
***
My last blister of antidepressants
I stopped taking my antidepressants in the first week of December 2014. Not suddenly…I went on a proper action plan for slowly weaning myself off them.
My current bout of depression started in September 2012, which makes it just over two years now. For over a year, I had been on the highest dose of my antidepressant medication – citalapram, 40mg / day – as my course of treatment. Additionally, I am still currently on pregabalin – a drug more commonly used to treat nerve pain in chronic cases – to control my Generalised Anxiety Disorder (GAD).
Seven months ago, I started feeling better…and that depression was no longer my problem. I felt a modicum of control in my life, through the consistent treatment that I was getting from my psychiatrist and my therapist. Sure, I still had “issues”…but the world didn’t feel permanently dull and dim, like it did in my earlier phases of full-blown depression. So, I told them that I was feeling better and would like to begin proceeding with ceasing antidepressants. I began this process in June 2014.
I had good reason to be worried about “doing this the right way” because antidepressant discontinuation syndrome is a very real thing. In the alphabet soup of mental health disorders, this one’s bad because sudden or quick cessation of SSRI antidepressants (like citalopram) can cause electric shocks in your brain (“brain zaps”; which I’ve had to deal with earlier), sensory disturbances, insomnia and a whole lot more. The cause for this, like many other mental health problems, remains unknown.
It’s the possibility of insomnia that I was most worried about. I knew that worsening insomnia would flare up my anxiety disorder, because it usually does. I wanted this badly. There was a part of me which wanted to know that I had won. And I wanted this from a medical professional because I worship objective feedback.
I desperately wanted closure on this chapter of my life that had gone on for the past two years.
I needed this.
The road to the end of the tunnel wasn’t easy. Technically, it’s possible to taper off in a couple of months. It dragged out to six months for me because dose adjustments sometimes took longer to get used to. I also had to pause on cutting back dosage during weeks when I had to readjust the dosage of my anti-anxiety medication upwards to counteract issues are they cropped up. But, by mid-November 2014, I was on the lowest “starter” dose of citalopram and I got the go-ahead from my psychiatrist to stop once I finished with my last batch.
At first, everything seemed to be going okay. I stopped taking citalopram and felt fine. While it was too early to celebrate, I was secretly doing victory laps on the inside.
And then, a few days after I stopped taking it, everything went spectacularly shit.
The worst part was the first week or so. I found myself hitting random brick walls of grief which came out of nowhere. I found myself crying uncontrollably, something which always wrecks me because I hate crying. What shook me to my core was that all of this was happening without any reason: not a bad day at work, not fights with people, not a sad song or a book or a film or a TV show. I always look for rational explanations for life events, and especially when it comes to emotional matters I find that I can’t deal when emotions come out of nowhere due to the loss of a sense of control that evokes.
It scared me because after six months of slow progress, I was suddenly facing what happened at the height of my depression. A sudden and unexpected regression that seemed like an unravelling of everything that I worked towards to make go away.
The answer, of course, was that I needed to stick to the path of staying off my medication a tad longer to see if the situation improved.
I always talk about the importance of seeking professional medical help. When I detect things going wrong, when I notice the early-warning signs, I make an active effort to set up an appointment with a doctor as soon as possible. I exercise, practise meditation, eat right, ensure that I have an active social calendar so that I don’t stew in my own thoughts, stick to my medication religiously.
What bothered me is that I did everything right. What bothered me is that I have ended courses of antidepressant treatment in the past when my depression went away without any of these problems.
Faced with this supposed regression, I started questioning whether things really have gotten so bad that I need to stay on them longer. And how much longer I needed to stay on them. And whether there is any light at the end of the tunnel for me. Whether this will affect me for the rest of my life.
At this point, I found myself blaming one person: me. I was the one who thought that I was better. I was the one who asked to be taken off antidepressants. I have been the one pushing myself all these months saying “just a few more days / weeks / months until this is over”. I am the one who asked the training wheels to be taken off. Sure, my doctors agreed with me but they did so on my insistence. I did so because I genuinely thought that I was better off and by all indications things did seem to be going that way. Now, I was on the verge of being proven wrong.
I know better. I know that it’s not “my fault” that I have depression and the right way to go about it is to look at it like any other disease. But that’s not really true, is it?
It’s easy to find strength to fight depression when you know there’s an end. It might be a few months, a year, two years but if you believe this is something that you can get over then it makes it easier to handle the shit cards life has dealt you. That if you fall down, you just need to pick yourself up again and try again.
Maybe this was my depression-like symptoms talking, but through that week of hell I felt that if these symptoms weren’t a passing phenomenon, that if I needed to go back on antidepressants…I’d lost. I felt that I couldn’t pick myself up again – not even “just one more time”. I may have misjudged where the finish line was, but I felt that knowing that, I couldn’t find that last ounce of energy to push myself even a little longer. I felt like I’d reached my limit. As a friend said, I didn’t have the strength to let the loss gut me and carry on.
I had another scare during that period. I was still pushing myself to keep my social life active, and like anyone else, I enjoy drinks with company. Except…on one occasion I blacked out after four glasses of wine.
Now, the interaction between alcohol and antidepressants is a common one – albeit one I’ve never faced. It’s also an interaction with my anti-anxiety medication – pregabalin – but I’d never seriously considered this affected me until that point. I’ve had moments in the past six months when I’ve blacked out – which I discussed with my psychiatrist as well – but the consensus we both reached, and what I believed as well, was that was probably just due to the amount I’d drunk on those occasions (a lot) and the rate at which I had drunk (very quickly).
Blackout after four glasses of wine was new and worrying, because it’s well below my normal tolerance. So I looked into it, and discussed it, and what I found was worrying: it probably wasn’t just a “normal” drunken blackout, but central nervous system (CNS) depression (no relation to normal depression). CNS depression can result in decreased breathing, decreased heart rate, and loss of consciousness with very serious implications leading right up to coma or death. And I wouldn’t even know what was happening because I’d written it off as bog-standard drunkenness. Some people face this side-effect when taking my particular anti-anxiety pills and alcohol. Apparently I was one of those “some people”.
It also made me realise that through that period, I was drinking quite consistently. Never excessively, just a couple of bottles of beer every day and well within the recommended daily intake limit – but I was still doing it. Beer doesn’t affect me the same way wine does (I’ve entirely stayed away from spirits and liqueurs during the weaning-off period; and I don’t drink whiskey) and hasn’t caused CNS depression-like blackouts. I was swapping out juices, colas, milk for bottles of beer in my fridge. And while by no means what I was doing could be classified as alcoholism (I think; it’s not like I was polishing off bottles of wine daily), I still needed to – and did – put an end to it.
***
All of that was 3-4 weeks ago, which brings me to now, in 2015. During these weeks, I’ve continued to have major issues with insomnia. On most days, I find it unable to sleep until 4am, 5am, 6am, or 7am. My sleep cycle is completely disrupted, which obviously affects my general mood as well.
I’ve faced wildly oscillating moods: grief, euphoria, rage, calmness, happiness, anxiety – all which seem to come and go on their own without any external factors. I’m facing an increasing disconnect between my internal emotions and the brave face that I want to project outside. As I mentioned, what bothers me is the lack of control when I don’t know what’s causing these fluctuations.
Life goes on, work goes on. It’s helped that this happened over the holiday season, when I’ve had time off from work to deal with it. But during the weeks when I was at work, I found myself staving off panic attacks by rushing out of the building for fresh air or for a smoke or crying in toilets that I know are usually deserted. I’ve broken down many times – including during a hackathon event that I helped organise. And then back, as if nothing happened.
More worryingly, I’ve had recurring thoughts of self-harm. Like I’ve written about earlier, I’ve never been suicidal; pain, for me, has always been a way of dealing with distress, a sense of release. Not being able to sleep drives me up the wall. Even though I haven’t had thoughts of self-harm in the past months, I’ve worked with my therapist on coping strategies, just in case. For instance, I’ve thrown away bandages and antiseptic wash because knowing they would be there was an enabler for me in “safely” cutting myself. But I’ve found myself berating for being stupid when I’ve had thoughts of self-harm, because I would do it “just this once” and I shouldn’t have thrown those items away.
I’ve had the urge to binge eat then force vomit. Not that it matters, because I often feel nauseous anyway.
I’ve had the urge to burn myself with cigarette stubs; as I get more desperate, I’ve imagined doing in increasingly painful ways: moving on from my limbs to my face to inside my mouth. Or my eyes. Whatever makes this go away, even temporarily.
I’ve had hallucinations – or perhaps that’s the wrong word. Half-awake dreams? Visions? While I’ve still been able to distinguish between reality and imagination, I’ve felt strongly that as if my coffee machine or my phone or my desk are part of my body and oh god it’s itching so bad and that I need to scratch it until it bleeds. I’ve felt that my bedroom walls are actually just dirt that I can dig out through. I’ve found myself obsessively and laboriously cleaning every surface in my home with cleaning spray and single portions of toilet paper, just to keep myself occupied. Or watching myself into a Netflix coma of endlessly-loading TV shows. Or obsessively gnawing on headphone wires. Anything and everything to regain control.
My employer offers a 24-hour employee assistance hotline that’s operated by a third-party provider. Even though I’ve wanted to, and even though I’ve used it in the past when things were way better, I haven’t been able to bring myself to lean on this avenue for support. People on the outside, with no knowledge of who you are as a person necessarily err towards the side of caution – and they should – but rationally or irrationally I’ve stayed away from it, in case they call in the emergency services or tell my workplace. I don’t want that escalation, just someone to talk to in that mental state, and personally I’m not comfortable with telling them these thoughts when there’s even the slightest possibility of getting formally escalated. Because that would only worsen my sense of control over the situation.
“No matter how bad things are, you can always make things worse.”
All of this sounds scary and bad and alarming, I know. I haven’t done any of things – no matter how strong the urge has been – because even in my worst moments I know that actually doing it would be a slippery slope that leads to much, much worse.
But I’m also trying to finally be honest, brutally so, because facing what I was going through publicly helped me the last time I was in such a bad place. I haven’t spoken this openly – not in its entirety – even to my friends, because in a way I must have realised that admitting to them would first involve admitting to myself that things were bad. Invoking one of my personal idols, Paul Carr, (once again) who decided to quit drinking publicly…
When I decided to stop, I wrote an open letter on my blog, explaining that I had a serious problem with alcohol and asking for the support of those around me. Posting on Facebook or Twitter for just your friends would work just as well. If you’re worried about your professional reputation if you “come out” as an addict, you might want to consider sending a group email to a dozen or so people you trust. Believe me, word will get around. The key is for people you encounter on a day-to-day basis to be aware that you have a problem and are trying to fix it. Those people are the ones who will be your greatest allies in quitting.
I’m scared shitless and I have been for the past month. I want to put an end to that by taking the step of writing about this because, once again, I’m tired of hiding. I feel the element of having to tell my friends that I lost was playing on my head. So I’m throwing that out of the window by telling everyone. I’ve come to terms with the fact that if do have to get back on antidepressants, I will be able to do it. That I’ll not see it as “losing”. That it will be the right thing to do. Or at least, that’s what I believe I can bring myself to do.
While it’s certainly unusual to get antidepressant discontinuation syndrome with a slow taper off (like the one I’ve gone through) and specifically with the medication I was on (citalopram), there is still a chance that it explains everything that I have been going over the past month. I’m hoping that is the answer.
Maybe it’s too early to declare victory…on my plan to ultimately get better. But I’ll take that. I’m resuming appointments with my psychiatrist and therapist, now that the holiday season is over and they’re back. I can’t call this a New Years’ “resolution” but I hope and wish that going off antidepressants this year will be first step towards a final resolution of my mental health issues. At least for this time.
I did, ultimately, get a degree in September 2013 (without having an official graduation ceremony). Having a degree at hand and all my work experience would have been of little consolation if my terrible university results (a final degree classification of 2:2) precluded me from finding a permanent job. I’d been progressing with multiple conditional job offers at that point – conditional on my degree results, for which every employer needed a minimum of 2:1 – without a final contract in place.
My student visa in the UK expired last year October 14, the day I left the country. On October 16th the same week, I had a confirmed contract from Accenture on the table.
A lot happened between then and this year in February 2014, when I finally accepted that offer and joined Accenture – my current job. I had another job, took time off, got to meet friends I hadn’t seen for years…but coming back to the narrative I started with, I was still on the highest dose of antidepressants possible. By this point I was also battling with major anxiety disorder issues and insomnia.
Depression is a bastard that doesn’t particularly care about how well your life is going on paper, as it was for me. A consistent lack of sleep was affecting my anxiety issues was affecting my sleep was affecting my depression was affecting my depression. My biggest worry was that all jobs that I’d had so far were either at startups, universities, or small businesses. I didn’t know how or whether I’d be able to work in a large consulting company (Accenture is as close as it gets to how large a corporation can be) while still being able to deal with my personal issues effectively.
I’d never disclosed my mental health issues in a workplace context, ever. By nature all the teams that I had worked until that point were small and tightly-knit – 3-10 people – and even though I’d never told them my issues, the sense of bonding was enough to tide any issues over. How would it turn out when I was part of The Machine? (I say that in the nicest terms, because I was apprehensive about the workplace culture change.)
As hard as it was for me to do, I knew that I needed support…so I decided to “come out” to my company. Not to everyone, but at least to HR and my line managers so that I got the support that I needed with flexible working times and time-off while getting treatment. I got a little courage from the fact that Accenture seemed to have well-defined processes in place to handle these situations – and that there were protections that I had under UK’s Equality Act.
And I have to say, I’ve been completely blown away by the level of understanding and empathy that I’ve received. I’ve had occupational health counselling to determine what adjustments could be made, monthly catchups with my HR advisor on how I was doing, the ability to be a part of the company’s flexible working programme.
I attended a workshop for the launch of an initiative within the company called “Mental Health Allies” a couple of months ago, which is a step Accenture is taking for helping employees with mental health problems. There’s one comment that stood out to me, from someone within the leadership team: that 8-10 years ago, when companies talked about such issues, the question they were asking themselves is “Are we liable for this?”; now, the conversation has moved to “How can we help our people?”
I’m genuinely thankful that I’m part of the generation where social norms around depression and other disorders may finally be moving on from outright stigma. (Who know, even this might be too early to celebrate.) I also feel glad and comforted by the fact that at least at Accenture, I’m part of company that takes the wellbeing of its employees very seriously.
This support that I got at work was instrumental in helping me feel better. That I had support structures that I can count on, including taking time-off should I feel the need to.
Work…gives me a sense of purpose. It helped me battle my depression because it gives me a reason to get out of bed. It motivates me to get better by doing the best job I can.
***
Selfie time! It was this professor’s first selfie ever – he said he’d heard of this new thing, but never participated. Glad I helped him tick that one off his presumed bucket list, because I’m a millenial like that.
I wanted to end this blog post on a happy note. I did, finally, get to attend a graduation ceremony this year. Without my invites being pulled at the last-minute, or not getting the awards for exceptional performance that I got at university that I was supposed to get.
Graduation is obviously an emotional moment in every university student’s life. But the vindication that I felt from proving to myself, and proving to all those who said I was in too bad shape to graduate and maybe actually I should try again later, wrong.
Looking back, I now know that my university lecturers did try to do the right thing and weren’t just out to get me. And I can also finally acknowledge that I did find a lot of support through the exceptional people at Surrey University’s Centre for Wellbeing, all of which was critical in helping me get better. And of course, my friends, who in their own ways – even without directly talking about my problems – helped me get over my problems.
That was the moment that I finally felt that I’d gotten over my depression, because I could close the university chapter of my life, the time during which I was at the height of my depression. I’m not going to be in denial if I need to get help again, on this occasion. But it was also a reminder to myself that I want to get better…and I can.
