Depression and Prozac

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28: Depression and Prozac

9 September 2000 – Diary

I almost don’t know where to start. It has been two months since I have sat in front of a computer and typed anything. My last truly conscious thought at the beginning of June. A friend of mine has written an e-mail to me, and I started a draft reply on Friday morning, That would have been Friday 20 July 2000. Then I went to work. That was the last thing that I truly remember doing.

This has been one of the worst depressions I have had since I was eighteen. I can only remember three that have been as bad or worse – the “black year” at age nineteen that I consider the start of the entire set of manic depression cycles, the one at age twenty one after I finished university and couldn’t get a job, and the one at age thirty which eventually led to my diagnosis.

It’s funny. Even knowing what is happening isn’t enough to prevent the depression. I have a great idea of what depression was about and how to fight against it. But it was still a losing battle. Somewhere around the early part of August I lost all of my holding strategies and fell to staying home or disappearing again.

It’s terrible, you know, knowing that you are becoming depressed and not being able to do anything about it. The consciousness of watching it happen is terrifying. I suppose that is the worst part. For the last two months I have been conscious of what has been happening but still being carried along by forces that override any effort I made.

In mid August I realised that I was fully depressed and made a panic call to my psychiatrist (in one of the lucid moments that allowed me to survey my situation and make informed decisions). I finally begged for an antidepressant and was reluctantly given a prescription for Prozac. Of course that doesn’t explain what happened in the three weeks since then.

It has taken me three weeks to get used to Prozac. For me it works and works very well. I have lost all of the anxiety and fear that goes with depression. However, I have also lost a lot of the motivation that goes with the old ways of doing things. It is only now that I am able to start settling back into functioning normally.

The problems that I have been having with the Prozac are certainly interesting. I had once told my mother that each time a take a medication and it starts to have a positive effect, my functionality temporarily gets worse. Basically, things apparently get worse before they get better. That doesn’t seem to make sense, but there is a logic. Because I have gotten so used to dealing with, well, being weird, I have to relearn how to deal with being normal. In the few days or weeks while I am changing over from being weird to being normal again, my ability to cope falters and my functionality drops.

I’ve estimated that each time I start a new medication I lose somewhere between two to three months of my life as I first wait for the medication to kick in, then decide if the medication has stabilised and then learn how to cope with the new way I am feeling. Psychoactive medicines are definitely not like aspirin – they don’t just make you feel better, they change your perception and your reactions to things that are happening around you. You have to learn to live with a medication just as much as you have to learn to live with depression or mania, and that takes time.

As an aside – none of the medications I have taken have ever changed the essential person that I am. I have been described as calmer, more relaxed, more together, less spastic by people around me. But no one has ever have said that I am a different person than before. And I have never gotten that feeling either. The person that I am remains the same regardless of what the medication does. It comforting to know that the fear these medicines will change me has not been borne out in practice.

But back to the Prozac. Prozac takes away my fear of interacting with other people. This sounds like a small thing but it isn’t. As I was explaining to C., people tend to do things because of a positive push or a negative push. Like taking care of plants. We water our plants every day because we like them. That’s a positive push. But there is a negative push as well. On the days when we are tired, we still water the plants because we know they will die otherwise. We don’t really feel like watering them but we do because of what will happen. This kind of motivation is like a negative push.

But many of the negative pushes are caused by what people will say. Think of how many of the things are done because someone will say “Why didn’t you do…”. The fear of interacting with people, which is a definite symptom of depression magnifies these negative “people” pushes way out of proportion and wreaks havoc on our ability cope with them gracefully or in any reasonable fashion. When the question such as “Why didn’t you pick up the laundry on the way home” carries with it the same level of pressure / morality / guilt as “Why didn’t you save the baby from the fire,” you begin to realise why people stay in bed and refuse to get out when they are depressed.

The Prozac relieves that fear and reduces the negative pushes to something that makes sense. I feel better because the anxiety and fear are gone. I don’t know if it reduces it to normal since I don’t know what normal is, but it the reduction of anxiety does make a pronounced difference to me.

Unfortunately, although I feel better, my functionality has taken a massive nosedive. I have been so used to being calibrated to dealing with high anxiety situations that when the the anxiety drops, the urge to do something falls off. It is a bit like having learnt to take action only on things which rank at 9 or 10 on an anxiety scale. When I am anxious most things are in the 9-10 scale so they get done. With depression everything is off the scale and I can’t cope. With Prozac, the anxiety level for most things fall back into the normal 3-7 range. Unfortunately I am still calibrated for doing things that happen in 9-10 range, so nothing gets done and functionality suffers. The negative push isn’t strong enough to get me to do anything.

As a result of being miscalibrated, I have had a peculiar sensation since I took the Prozac. I started taking it on 23 August. In my usual non-standard way, it worked almost instantly and I started feeling its effects within two hours. Many of the physical effects that I associate with being depressed disappeared. However, because I had been depressed for the two months previous to that, I was still in an extremely high stress situation.

The fact that my physical symptoms disappeared didn’t automatically mean I was better. I still had to cope with the fact that I wasn’t yet ready to go back to work and still didn’t want to meet people quite yet. I might not have been incurring any more psychic injuries any more but I was still wounded and I needed time to heal.

I stayed home from work on the 24 and 25 August and I had the weekend to recuperate. I think it was over the weekend that I started realising the disparity between what I was feeling and what I was doing.

I felt better, much better than I had for the last two months. I felt as if I had come out of the gloomy scary forest with looming tall trees into the meadow filled with flowers and sunlight and butterflies. A peaceful place, warm and filled with light.

At the same time, my urge to do anything remained stuck in exactly the same place as it had been for the last two months. I still wasn’t doing much, I wasn’t organising my life to get things back in order and quite frankly I didn’t much mind that I was being lazy. There was no urge to get things done.

I knew I was feeling better, but anyone outside looking in would have assumed that nothing had changed. To this point I had only been taking Prozac for about 5 days and I wasn’t sure if the medication has stabilised.

On Monday the 28 August, the problems really started. I had told my parents that I was feeling better and they assumed that meant that I would be going back to work. But I wasn’t ready to go back to work yet. The stress involved in that situation was very high and I reverted to my old patterns of behaviour – I disappeared for the day.

The next few days were pretty much the same – I felt better but my functionality was low and the stress caused by all the things that I wasn’t doing kept me acting exactly the same as if I was in major depression. To be honest I was confused as to what was happening. My indicators were saying that I should be acting in a much better fashion than I was, and I couldn’t figure out what was wrong.

On Friday 1 September I made it back out to work. I didn’t have any problems dealing with people, which was a new experience for me because I expected that it would have been difficult to deal with the persons at work. But in keeping with my lowered anxiety from depression, I found it easy to go to work. However once at work, I felt useless. There was no motivation to do anything.

Eventually my parents called in a new psychiatrist to talk with me on Monday 4 September because from their point of view I was depressed and steadily getting worse. It’s really difficult to explain that things are getting better when all your actions point otherwise. The psychiatrist chatted with me and I explained what was happening. And perhaps most importantly, I asked her to explain to my parents what I was going through. That was a major step. Although the psychiatrist didn’t say anything that I hadn’t already told my parents, they did of course accept her conclusions better than my comments. You know, getting the professional response and all that.

Basically the psychiatrist told my parents to lay off trying to “help” me. She said that I was doing a pretty good job of taking care of myself and that I was pretty responsible and that I would settle down in a few weeks. In a sense it was the reassurance that my parents wanted to hear and it served two purposes. It made them feel better and it got them off my back. And my stress level dropped since I didn’t have to deal with their concerns anymore.

With my parents out of the way, the rest of the week to Friday 8 September was an extremely low stress period. So I could concentrate on trying to get back to normal functionality. But it kept on eluding me. At some level I knew what was wrong. I kept waiting for my hypomanic urges to push me onto doing my work. But this was a no go. I had stabilised and there was no hypomania.

The fours days were peculiar. I was still feeling good, but not getting things done. I intellectually knew that the hypomania wasn’t going to kick in and I kept trying to organise myself. I got my schedule done, I started organising my house, I tried writing for the website again. But all of it was half hearted and not very effective.

It wasn’t until 9 Sep when I spoke with C. about the problems I was having that the matter sorted itself out. By explaining to C. what was happening, I realised that I needed to recalibrate how I do things.