Tuesday, March 4, 2008

Itchy, bitchy, ditzy

so as i mentioned in my last post, i ran into a bit of a mental health crisis last year. my doctor and i decided effexor (generic name venlafaxine) was the way to go. one of my main symptoms was panic attacks, so an SSNRI (selective serotonin norepinephrine reuptake inhibitor) seemed preferable to an SSRI. i will admit this: at the time, i thought it was the right thing to do. actually, i thought it was absolutely necessary.

my weight had dropped during the crazy summer of '06, and effexor did address that. and then, during the next 11 months, i gained another 30 pounds. i can't imagine how much i'd weigh now if i hadn't been eating properly and working out regularly. effexor got me sleeping again, too: nine hours a night and napping at least once a day, always with lurid dreams. i started fainting. i suffered wicked night sweats -- the kind where i'd have to get up, change my sleeping clothes, and come back to bed with a towel to sleep on.

when i put together a list like this, it sounds coherent, and the solution seems obvious: get off the drug, 'cause it's totally messing you up! but the problem with diverse symptoms while you're experiencing them is that they don't organize themselves neatly into a coherent problem with an evident solution. particularly in the case of mental illness, symptom and disease, cause and effect, are hard to tell apart. am i drowsy from the meds or from the depression? is my fainting caused by panic or venlafaxine? and when it comes to bodies, especially women and their bodies, the tendency is always to blame ourselves: i knew i should have worked out harder, if only i hadn't eaten that cookie, this is what happens when you don't keep a food journal, etc. our poor bodies, right in kicking reach.

when i was down to two skirts i could wear, i was finally ready to consider that perhaps this weight gain wasn't all my fault. my doctor concurred, and suggested that perhaps the night sweats and lowered blood pressure could be traced to effexor too. (incidentally, the "literature" on effexor, aka The Book of Lies, says effexor usually causes weight loss not gain, increased not decreased blood pressure, and hyper-alertness rather than drowsiness. who are these lab rats?)

anyway, i've been coming off effexor for about six weeks now, and it has been frightful. at first it wasn't too bad. you go down in stages, and at every drop i would experience three bad days where my skin would crawl and i would feel more emotionally volatile than usual. then my body would adjust and, a week or ten days later, i'd adjust the dosage down again. once you're down at the lowest dose, 37.5 mg, you alternate taking the drug one day with not taking it the next. after a week or ten days of that, you're done.

going from the lowest dose to no dose was intense on an order i was not at all prepared for. first, the formication. that's the technical name for the feeling of ants crawling all over your skin. i could not for the life of me imagine why human beings were equipped with just ten fingers on two hands. how to scratch your right leg, your left ear, your back and your stomach at the same time? any change in body temp intensifies the itchiness, and sweating is the worst. picture me, if you will, at the gym, wondering how rude it is to scratch my ass in a crowded room. can i just turn to the folks on the elliptical trainers behind me and tell them i'm sorry, i have to scratch or i'll lose my mind? will they leave? would i care?

but that was over relatively quickly -- say, a week. the other symptoms: not so easy to shake.

like the irritability and the dizziness. especially on the days when i had to skip a dose, i found myself feeling like a two-year-old. everything irritated me. "why is the door locked?," i demanded, coming home to an almost deserted house. "why is everybody we work with so stupid?," i inquired of a colleague. "look, lady, if you think anybody in this house would EVER vote for the conversatives, you've got another think coming." (oh, wait, that was just yesterday. never mind.)

irritability's one thing; rage, quite another. rage! one day the heart rate monitor on the recumbent bicycle wasn't working. i kicked the bike. hard. twice. i snapped at my yoga teacher. i got so frustrated trying to print a pdf doc that i slammed my precious powerbook against the desk.

the alternative to rage? tears. now, for all of you who missed it, let me recap a recent episode of "Trading Spaces." the gag on this HGTV show is that two families swap houses for 48 hours and redecorate a room for each other. in this particular episode, the neighbours involved in the swap were sworn enemies: one, an uptight yuppie family with a precious two-year-old son; the other, a house full of teenagers whose rock bands practice day and night. the tenterhook: could an HGTV show succeed where police-ordered mediators had failed? i don't want to ruin this for anybody, but yes: yes, design saved the day. during the one-hour special, the yuppie family built an insulated studio for the boys, complete with a hand-lettered sign identifying the recording studio they hoped to set up. meanwhile, all those testosterone-crazed teenagers pitched in to paint Junior's bedroom with a panorama motif in chalkboard paint. they handmade a toy box that looked like a truck which in turn sat on the bookshelves resembling a garage.

i cried all the way through it.

and i cried when i was late for lunch with my friend olga.

and i cried when i couldn't do a downward-facing dog.

and i cried when i had to buy gas on my credit card, because it was the end of the month and i was out of cash, but i'd been trying so hard not to use my visa card, and i'd been, honestly, much much better with credit lately, but now clearly everything that i had fought so hard for had gone to hell in a handbasket and what was the use of trying to be responsible since i'm always going to fuck it up anyway?

the jonesing took me aback too. on the second dose-skipping day, i double- and then triple-checked whether i'd done the math wrong. maybe tomorrow is the day i won't have to take it? then i started bargaining. "maybe i've lost track, and i should take another one anyway." "better safe than sorry, since you never want to quit an SNRI cold turkey!" on-days, in between, i was appalled at my need. hankering for serotonin or, worse, norepinephrine -- compounds that, until just a few years ago, we didn't even know we humans produced, let alone needed -- felt ridiculous. when's the last time you found yourself craving progesterone, or heard someone say, "i could really use a shot of GHR about now."

but the dizziness and "brain zaps" might be the worst. some days i was so dizzy i had to hold onto a table while the room swirled around me. some days i couldn't look at my computer screen. some days i could only look at my computer screen. i cancelled meetings when i wasn't sure i could drive myself safely there; even walking felt treacherous.

brain zaps are peculiar to effexor withdrawal (and the main reason behind the many threats of class-action lawsuits flying around the internet). you know that feeling of being super-tired but having to stay awake? you feel like you're on the brink of a yawn: your eyes narrow, your jaw tightens and you can feel your ear canals getting ready for the release of a big yawn. that's part of it. now add the tzzt! tzzt! tzzt! tzzt! of an electrical circuit shorting out, and you've got it. brain zaps. they weren't so bad first thing in the morning, but once i stood up they started, and they lasted all day. sometimes my eyes would water with the desire for a tension-clearing yawn, but it never came.

that's what the last six weeks have been like. i've been off effexor for a week and a half now, and i've had two good days in a row: minor zaps, negligible dizziness, no tears. i'm hopeful that the worst is over.

my friend ted says that sicknesses are cleanses: "something unneeded or bilious wants to leave, but for some reason there is a struggle to let go." withdrawal is exactly like this. but i wonder, in my case, just what i'm finding it hard to let go of: the effexor itself? the history of my life on effexor -- the fact of having had to take it? or could it be that what's hard to let go of is a clear distinction between health and illness? anxiety and depression are like chicken pox: you get over the symptoms, but you remain vulnerable to the virus that lurks inside you. having to take effexor, having to take medical leave, having to take my mental health seriously really shook me up. to quit effexor is to let go of heather, damaged -- but i can no longer believe in heather, whole.

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