F*cking Cipralex

I started taking Cipralex over three years ago. I had just started a new job that quickly became a big source of anxiety, depression and regret. In addition to this, my partner at the time and I were in a bad place surrounded by a lack of trust and a world of unspoken issues. I can pinpoint this as the time when if I had had the courage and the resources to change my circumstances, I may have been able to quell the anxiety enough to get by. Instead, it continued to mount and after a period of a few years where it had become quite manageable, I started to fear that it was returning at with the same strength it had 7 years earlier when it had more or less brought me to my knees.

I do not consider that beginning Cipralex was the easy way out; I do not consider that decision to be easy for anyone. There is so much uncertainty and fear that comes with that decision that anyone who says you took the easy way out and should have just “dealt” with it should be kicked in the balls, but hard. It can be a life altering decision and if you are really unlucky and find yourself experiencing the shopping list of insane side effects that can come with beginning one of these treatments, it can be more than just altering. I was prescribed 10mg to be taken daily but I only ever took 5mg, breaking each pill in half. Within a few weeks I was noticing that I was able to run more, go for walks on a busy street and make it through the work day without experience chest tightness, a rapid pulse or shaking hands. In other words, it really seemed to be working. I don’t know that I was less depressed, I just know that it allowed me to function without having the anxiety symptoms to contend with in addition to facing poor career decisions and a failing relationship. I felt a bit stronger. Sadly no pill in the world will change the people around you and jobs and relationships will fail no matter what safety net you have in place. So things went south and for the next three years there just never seemed to be a good time to come off of the meds. I still had some attacks while taking them, brought on largely by a lack of sleep, high stress and sometimes drinking (socially), but they were few and far between.

It was last fall (2013) that I decided to stop. I have been asked many times why I felt the need to come off of them and there is not one straight answer. I wanted to feel clean and clear, I wanted to see what life was like without the meds, I wanted to be able to take a cold & flu pill without worrying about possible drug interactions. I just got sick of being on them, logical or not. Very few people supported this decision and quite frankly they looked scared. Like me being off the pills was going to make life harder for them. I see their point, but Jesus.

I began by dropping the dose to 5mg every two days which I did for 5 months. In this period I did have some increased anxiety which actually leveled out after a few weeks. I was having a bit of head pressure, a bit of shakiness but nothing that I felt was more than I could handle and not what I would call severe. In late March of this year (2014), I decided to drop to 5mg every three days which I did for about three weeks and then, that was that. I was off of Cipralex, the one thing that I and I think anyone around me worried was the one thing holding me together. It was a terrifying realization that It was now just me and me alone. Freefalling

For the first couple of weeks things were mostly ok. I was moody, more depressed and definitely more anxious but anyone who experienced this past winter knows that many of us were in that state regardless of pre-existing conditions. That winter was relentless and I brushed off much of what was happening inside me as winter blues paired with a bit of withdrawal. Then around mid/late April, the bottom dropped out. There are many truths about these medications that a Doctor or online support group cannot tell you. You can prepare yourself for some discomfort (“you may experience a return of your anxiety”…), but you cannot prepare yourself for the world of shit that comes on when no one told you to expect it. So just when I thought the worst was over:

  • Immense pressure in my head that lasted for several weeks. It felt like there was internal bleeding.
  • Stiff neck that lasted for about two weeks and brought on significant pain and worsened the head pressure. No massage or warm bath alleviated this.
  • Numbness in my face, neck and arms as though that half of my body had fallen asleep but would not wake up for hours. *Intense twitching in my eye, lasting hours at a time.
  • Intense dizzy spells that would actually affect my balance when walking or standing still.
  • Night sweats, soaking night sweats.
  • Intermittent rage and uncontrollable crying. I mean sobbing.
  • Faster than usual resting heart rate (I work out and do cardio 6x/week so I noticed when my heart felt like it was on doing a 5K without me)
  • Anxiety attacks like I had never felt.

Once the real withdrawal started, it did not let up for about a month and a half before beginning to subside. Just thinking about these now is making me stop and rub my own shoulders. Like the memory could possible bring it all back. In that time I scoured the web for anyone who could list these similar symptoms and tell me that eventually it would subside, to just hang tight. Unfortunately that’s the real bitch of anxiety; it hits us all differently and takes different forms, much like the Cipralex withdrawal did. I found people who had somewhat similar symptoms and many who were going through something entirely different. I went to my Dr. (who frankly seemed angry that I had come off the meds and didn’t seem to want much to do with me after hearing this), got a series of tests and x-rays to rule out the possibility that it was something bigger (right back to 10 years ago) because telling yourself “this is normal” while the havoc is being wreaked on your body and mind is just not possible. I can’t remember a more frightening time since the onset of my first anxiety attack. I am not exaggerating when I tell you, it was hell. All I could do was keep showing up to work, to auditions, to social outings. I did my best to try and outlive it and it sucked. Every minute of every day of it sucked and I was scared as hell. The fact that my partner still looks at me as though there is anything desirable remaining after this ordeal is enough to make me consider marriage. He is a rock. I started a small regime after speaking to my Dr. and a pharmacist who suggested the following would help alleviate the withdrawal effects. I was already taking fish oil but splurged on a higher dosage. Each morning I took the following:

  • Fish oil (900mg EPA/DHA)
  • Vitamin B complex (50mg)
  • Magnesium (100mg)

I read many times that a common withdrawal effect was something that people online referred to as “brain zaps”. I also read that the fish oil could help with that. I don’t know what a “brain zap” is but it sounds truly monstrous and if the fish oil can be credited with sparing me that, then thank you to the people at Webber Naturals. I may owe them what small amount of my sanity was left in the embers after this experience because any more unexplainable bodily chaos would have been more than I could have handled. The magnesium was recommended to me by a pharmacist who told me that when we have anxiety attacks, our magnesium levels drop and that taking the supplement would help to build it back up and reduce some symptoms at least mildly.
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It is now August 18th and though I look back on the summer with some anger and resentment (and exhaustion) after having spent most of it continuing to battle the lingering twitches and the increased level of anxiety that has been left behind, I am feeling somewhat relieved. This worst really is over, it did get better. I can’t say that the supplements did or did not help, but they didn’t hurt. I noticed a slight calmness after taking the “calm” drink featured in the photo here. Also not a miracle worker, but a bit of the edge was taken off. I keep that on hand for days where I am unable to shake it off along with a pack of strong gum (my mother’s advice). The menthol helps keep my airways opened up and also helps me focus and think less about chest discomfort and dry mouth. Was coming off of Cipralex the right thing to do? I don’t know. My anxiety is worse again but I am having more good days as of late and it definitely is not life consuming. I am a bit more down sometimes as well, but I have always been somewhat of an Eeyore and I find I can live with that. I don’t spend too much time wondering if I should have stayed on the meds anymore, but I am angry. I have had to resist making an appointment with my Dr. just to take a few minutes to thank him for being so quick to prescribe something that he seemed to know nothing about. To thank him for not telling me about possible drug interactions (there were a couple of minor but scary incidents). Mostly to thank him for telling me that if I chose to come off the pills at any point, what to expect. Not his problem it seems, and that’s fucked up. Worse is that it seems to be the norm among practitioners (based on talking to people from the aforementioned online support groups as well as one or two friends who have opened up to me in the past couple of years) for a Dr. to prescribe these without a second thought and then say “the rest is up to you”. So I guess the bottom line is that a Dr. can prescribe, but he/she won’t be there to hold your hand when shit goes awry. I wished throughout this that people would talk more. These forums are great but why do we have to talk to strangers and then sit in front of a friend over coffee or a beer and pretend that none of this is happening?

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Me & Clonazepam

I don’t remember the first one I took or the sense of relief it brought.  This does not surprise me as there was a period of several months where I was taking two before lunch and another at some point in the afternoon.  I have never been a napper and during this time I would find myself extremely fatigued (and I actually believed inexplicably) and would lay down to rest and wake up 4 hours later.  I would pop a Clonazepam at the first hint of anxiety because the whole mess was still new and terrifying to me and it was the only thing ( I stress that, the ONLY thing) that offered me any reprieve.  I was about 25 at the time and had just started experiencing severe anxiety attacks and there was not a person alive that could convince me I was not going to die at any minute.  I visited my Dr. at least weekly, begging for him to just consider the fact that there may be something bigger wrong (my heart, an illness) but leaving each visit no further ahead.  I look back on that man with great fondness and appreciation.  He put up with a lot, and he never snapped, not once.  He had tired eyes and a kind heart and I think I was exhausting him.  It wasn’t just anxiety symptoms, I became increasingly paranoid that I had contracted an illness.  I had HIV tests done almost monthly, insisting that I had at least 3/4 of the symptoms listed on various websites.  I would get myself into a state where I was physically shaking, crying, laying awake, knowing that a positive test result was coming.  Each test came back negative but rather than feeling relief, I would cry.  Uncontrollably.  If it isn’t that, then what is it?  Take a Clonazepam and wait it out.

When my anxiety first began I was smoking marijuana daily and drinking heavily on weekends.  I wasn’t so stupid that I didn’t notice that both were inducing attacks, but I was certainly stupid enough to keep doing both and to use the Clonazepam as a means of enabling me to do this.  Smoke a joint, have anxiety, take the pill.  Worst part being once the pill kicked in it enabled me to smoke more and drink more without the onset of anxiety at all.  Until the next day when of course, all hell would break loose.  Take another pill, wait it out.  I woke up every day with a pill hangover and by 11am I was treating it with a fresh dose.  It felt better than the anxiety and fear of death did.  I was spiraling a tad.

My Dr. had tried me on a daily anti-depressant/anti-anxiety medication, Celexa.  I took it for about a week and became so disoriented that I left the house one day and quite literally forgot where I was going, only realizing it after I had walked several blocks in the wrong direction.  This did not help things.  After that I insisted that the dailies weren’t for me and I refused to try another brand.  This cycle of attacks, major depression, self-diagnosis of major illnesses (based on web diagnosis) and self-medication on Clonazepam in total lasted close to a year.  A year of falling apart and being a complete mess in the eyes of those around me.  Should someone have stepped in at that time?  Probably.  Was someone obligated to?  No.  At 25 I think a common approach to such things is to believe that “he is still young” and “he will outgrow it”.  I believed I was dying and no one had an answer that my head would allow me to accept.  And those who did not understand that anxiety is a physical disorder and not just a mental one, could not sympathize or offer much support when I was screaming into a phone “help me”!

It wasn’t until I went to the third of several therapists in that time that I got what I needed.  A kick in the ass.  She was tough, she didn’t want to hear much after learning of the substance abuse and basically told me that until I stopped smoking pot and drinking as much as I had that there would be no end to the attacks that had been crippling me.  She had no other advice to give.  I had heard it before when friends would comment on the amount I was ingesting, though in a sort of “geez, look at you go” kind of way.  It was the first time it hit me that I may not be to blame for anxiety having found its way out of wherever it had laid dormant for 25 years, but I was absolutely 100% to blame for allowing it to become as life altering as it had.  I quit smoking pot immediately, I cut way back on my alcohol intake and I even quit smoking cigarettes (forgot to mention that I was a pretty heavy smoker too, the effects of which were an accelerated heart rate, then more attacks, then more pills).  I tapered off the sedatives which, I won’t lie, was not something I handled well, until I was off them entirely.  I didn’t do it with grace, but I did it.

I remember that year, mostly the winter, only enough to remember the worst.  I remember treating my family, my close friends, my best friend in the world as a punching bag and saying unforgivable things  in fits of anger and hopelessness and fear.  My best friend is a strong personality and babying was not and is not his thing.  He could set me off as easily as he could comfort me.  But he never left my side when the shit hit the fan.  No matter how ugly I got, how much I used him to keep me afloat, how many medical appointments he drove me to just to hear “you’re fine”, he never faltered.  Save for a few times when he snapped and frankly, he should have put me out with the trash.  He is still my best friend today.  I am lucky, I do not deserve that.  His lack of sensitivity still makes me want to throw him out a window at times but he’d be the first the pull me back in if I tried to make the jump myself.

Nature's Way ChamomileCut to today.  I keep a bottle of Clonazepam pretty close by at all times.  Knowing it is there helps.  It is taken only when necessary (a couple of times a month on average I would say) and thankfully I do not have major attacks daily and have learned to pull myself through the minor ones without medicating.  I often wish that my Dr. had never prescribed it all those years ago, it is a very dangerous drug.  I stress this also:  Before you take a sedative, promise yourself that you will remember the times you felt good without it.  Before you even take the first one, remember living a life without them.  Life is hard, who doesn’t want to take a pill and tune out every now and again?  But then life stays hard and you end up tuning out more than you are tuning in.  Going on the Cipralex three years ago was the result of the threat that the anxiety was returning with the force that it had first appeared 10 years ago.  Now that I am off of it and not dependant on sedatives, I have spent a lot of time (and money, my god the money) on finding alternatives.  Recently I purchased  bottle of chamomile supplements.  It ran me about $16.99 at a local supplement joint and that gets you 100 capsules.  The instructions say to take two capsules, three times daily.  Don’t do that.  This is not a tea.  The first day I took two and an hour later found myself shaky, nauseous and very uneasy.  I will say I felt a bit more calm and less anxious, but the other effects sort of outweighed it.  I tried on two other days taking one capsule and had a period of uneasiness again, followed by a slight numbing feeling which was pleasant and seemd to take the edge off, but then I got damn tired.  Again though,  I was in fact a bit less anxious (a bit).  I am not sure what the trick is with these.  Would I rely on one if a severe attack came on?  Absolutely not.  However, I think that maybe it is a tolerance/adjustment issue and that if taken in moderation

In a Nutshell

Once in high school I had finished smoking a joint and got this breathless, tight but not unpleasant, feeling in my chest.  I let it ride and just figured I was hitting a new high.  I stood up, unphased by my quickened pulse or slight dizziness. I was so bored with pot at this point that it was a welcome change. I walked through the summer sun, away from the high school parking lot, leaving behind the ghosts that I hate to admit still haunt me and still dwell there.  I felt sexy, untouchable and ready for whatever the evening may bring.  It was likely my second or third joint of the day, worry didn’t exist at that point.  Just heat, breeze, The Cranberries on a walkman and my imagination.

20 years later that sensation causes me to drop to my knees with my hand on my pulse, waiting for the “big one” to finally hit.  The heart attack that lays dormant.  A sensation that arises only to threaten and remind me that my time will come.  It hits me like a disease that spreads in a matter of seconds throughout your entire body, a poison.  One minute I am ok and the next an invisible demon bitch shoots a needle full of adrenaline into my chest and then:

My chest tightens
My heart rate increases, rapidly
My eyes begin to lose focus
My hands and arms begin to shake
An ache spreads across my upper chest and my airways feel as though they are closing up
I am unable to inhale without feeling like there is a rock in my chest, blocking the air from entering my lungs
My heart speeds up more
A pressure begins to mount starting in my shoulders and moving up into my head.  So intense that I am sure I will black out
I lose balance and need to get into a crouching position in order to stay grounded

People stare.  I am sure they are staring.  I believe, each and every time, that I am going to die.

I fumble for my phone with my free hand and desperately dial my boyfriend or best friend, who ever I think will be available.  I know they can’t help me now, nothing can stop this, but just the sound of a voice that loves me.  At least I won’t die entirely alone, someone will be here with me.  Sometimes they answer my call, a sixth sense they have developed that tells them I am not calling to check in.  We immediately begin the ritual, the dance.

“You are fine, Scott.  Just breathe”
“This happens all the time.  You are not dying”
” You are NOT having a heart attack”
” You are a healthy person, you are NOT dying”

In the right context it could all read as a comedy.  It is not.  It is not funny.  If I manage to escape this attack without taking a sedative the best case scenario is that my heart will slow enough to alow me to stand up.  After a short while of standing, hand still on pulse, getting a handle on the dizziness, the disorientation, I begin to move at a snail’s pace toward home.  Home if I am lucky and not work, an audition, an appointment where I will bring this with me like a suitcase that has been torn and kicked and is tied to me.  The invisible weight that really is not so invisible.  It will hover around me like a shadow waiting to engulf me again if I look it in the eye.

“Just give me one fucking reason and you are done”

I keep my head down, I move slowly, I exhale forcefully over and over, trying to slow my heart.  I force the unlucky soul who answered the phone to stay with me.  I hear him typing away, rustling papers.  Working.  Living.  Having a normal life filled with normal things.  They are adults, going about their adult business, cradling the phone between their neck and shoulder, cradling me the invalid between their neck and shoulder, saying “all the right things” but mostly quiet and waiting to be relieved of their duty.

If you know, you know.  You know that as this condition ages with you, it takes different forms.  Sometimes I bargain with the sensation in my chest, as it intensifies.  Telling it that it doesn’t need to do this, that we are ok today.  It can subside and I promise I will be good.  I promise I will not do the things I want to do.  I will not run or have fun or raise my voice too much.  I won’t drink a coffee, I won’t exercise, I won’t laugh too hard, I won’t make plans to be anywhere but somewhere safe.  I will play dead.  Other days I am stumbling off of a subway three stops early for fear of emergency personnel having a harder time getting to me with a defibrillator if I am in the tunnel between stations.

Not every day.  Some days are ok.  Just ok, but really ok is…ok.

I medicated this asshole referred to as anxiety & depression for three years.  I stopped this past April when I was afraid of what it may do to me in the long-term.  Not based on medical evidence.  Who the hell is going to remind me to take my daily pill when I am 90 and can’t remember the names of the kids I never had?  What if I miss a few days and completely lose my mind?  How much concern do you figure they give a 90-year-old man who forgot to take his Cipralex?  I figure they’d slap a “dementia” sticker on it and just wait for me to finally free up a bed.

4.5 months off of the medication and things are not great.  FAR better in month 4 than they were in month 1 or 2, but the me that I am sure once existed is still very much buried beneath a thing that seems unable to kill me but still able to keep me pinned under its foot.  The me that wakes and walks and speaks every day is not me.  At the moment it is the next best thing.  So now I have come to a point where crying and wishing and despair have not helped.  Well fuck.  So now what?  The things I feel I need to tackle in order to co-exist with this beast, while trying to live the life of a functioning, healthy, 35-year-old man…

When did this start?
Why did this start?
Why does it seem to come and go?
Is this all my fault?
Is this circumstantial?
Is this a medical issue?
Should certain people be held somewhat responsible?  Are certain people helping or are they making this harder?
Can I live without a daily medication?
Can I ever go for a run again without suddenly gasping, checking my pulse and hitting the emergency stop button on a treadmill?
Should I stop spending $40 a week on supplements that the kind eyed ladies at the health food store insist will help but don’t?  Bitches.

People do live with this.  They make life happen.  They have children and homes and awful marriages and take this as it comes.  So in an attempt to do the same, I will try just about anything shy of going back on a daily medication.  I will research, ask questions, share, learn and with any luck find myself remembering this period as exactly that.  Just a bad time in my past when sometimes just leaving the house was more than my body and mind would allow.