Mental Health: Switching Meds – My Experience

My blog has always been an open and honest safe space, where mental illness can be discussed without judgment. Something I haven’t discussed on here before is my medication. I have been taking medication for generalised anxiety disorder with depressive and obsessive episodes for around 5 years. In that time I have switched medication a total of three times, each time very different. When I was switching I looked for other bloggers that had written about their experiences switching meds – I couldn’t find any, so I thought I would write one.

A Little disclaimer – I am just a patient sharing my experience of various medicines and I am definitely not a medical professional. Everyone reacts to different medications differently.

Medication 1: Citalopram (Celexa, Cipramil)

Citalopram is a selective serotonin reuptake inhibitor (SSRI) – meaning it should increase the amount of serotonin in the brain as well as regulate serotonin levels.

In short, Citalopram didn’t agree with me at all. As with all medications, Citalopram takes 4 -6 weeks to reach a maintenance dose as well as for any initial adverse effects to dissipate. So I stuck with it to give it the best possible shot at working. The plan was 10mg increases every 3 weeks until I reached 40mg – a total of 12 weeks. During that time I felt as if I had the flu constantly – muscle aches, woozy, nauseous and very weak. Mentally my emotions were completely absent. I knew something was definitely amiss when my aunt’s lovely dog Lucy passed away suddenly. Usually, death in the family – pet or human – hits me deeply. I don’t tend to have an extreme outward emotional reaction but inside I feel deeply. I loved Lucy – she was a lovely dog and I stayed with her every year when her family went abroad – but I couldn’t feel anything. I felt like an emotionless zombie. That’s when I went back to my GP to say Citalopram wasn’t for me.

Coming off Citalopram wasn’t as difficult as I expected it to be. However, I was only taking it for a short period of time. As I tapered down the dosage over 4 weeks, 10 mg lower per week, the side effects subsided alongside. When I had been without Citalopram in my system for 7 days I started my next medication – Venlafaxine.

Medication 2: Venlafaxine (Effexor XR)

Venlafaxine is slightly different to Citalopram in that it belongs to a group called Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI). The mechanism in the brain is the same except it also regulates norepinephrine.

Starting at the end of the story, I took Venlafaxine for just over 2 years. My dose was reviewed and adjusted. Eventually, I hit the maximum dose of 375mg per day. In terms of physical side effects – there were none of note. Mentally it allowed my brain space to process information without anxiety interfering too much. My mood was stable and I could feel.

After 2 years of taking Venlafaxine, I had built up a tolerance to its effects. My mood was steadily declining and my anxiety was slowly creeping up and up.

I was sent to a psychiatrist for a medication review, she said it was common for some people to build up a tolerance to medications when taking them long term but was reluctant to have me taper off medication completely. Instead, we decided on what is known as a cross-taper. I would reduce my Venlafaxine each week but also add in increasing amounts of Sertraline, eventually leading to a complete switch to Sertraline. Sounds straightforward enough.

Withdrawal. One word – such a simple word. Oh my – it was hell. For the time I was cross tapering I felt like I had been run over by a steamroller. On top of this, my brain felt a bit like a wheel of fortune and it could land literally anywhere and spin again at any time. One of the symptoms of withdrawal that I found particularly painful and disorientating are colloquially called “brain zaps.” I still get them even now occasionally and I had never had them before coming off Venlafaxine. Brain zaps feel like someone has put a taser to the base of your skull or the feeling aside from pain that happens when you whack your head on something. It isn’t pleasant.

Medication 3: Sertraline (Zoloft)

Back to the SSRI’s. Given the hell that I went through coming off Venlafaxine, I gave Sertraline a good chance. I remained on Sertraline until October 2017 – a total of 18 months. In retrospect, I should have at least considered changing medication sooner but I didn’t want to go through withdrawal again. So, I stayed on Sertraline for quite a long time. Granted in this time there was a lot of upheaval in my life: buying our first house, moving, jaw locking, jaw surgery, 2 degu deaths, a cat with a gloopy eye, starting Open University… the list goes on for quite a while. Plus a good old dollop of chronic illness on top of it all. Needless to say, I didn’t have the time, motivation or spoons to go through anything like I did when I came off Venlafaxine.

In September I had a rather bleak conversation with my gastroenterologist, the conversation no one wants to have. “There is nothing more we can do for you, none of the treatments has worked.” It’s a hard conversation to have. One thing he did mention was that off-label the medication Fluoxetine has been shown to improve symptoms in those that other treatments have failed. “A shot in the dark” is how he described the chance of improvement, but I would try any treatment once.

So, I switched meds. In reality, I should have changed much, much sooner. I’ll be honest though, I was scared. A switch from Sertraline to Fluoxetine wouldn’t be cross tapered, it would be completely getting Sertraline out my system and then starting out on low dose Fluoxetine. But it was worth the chance.

Surprisingly, there was very little withdrawal. The last week of tapering off I felt run down and my mood was flatter than usual, but it was nowhere near the withdrawal from Venlafaxine.

Medication 4 (and 5) Fluoxetine (Prozac) and Pregabalin (Lyrica)

Fluoxetine is another SSRI and Pregabalin is an anticonvulsant used to treat seizures and off-label for pain and anxiety.

One of the most frightening symptoms of my anxiety is non-epileptic seizures. I have been having them for about 2 years. My GP suggested adding in Pregabalin as an extra defence against my anxiety. Currently, my dose is 40mg of Fluoxetine – with scope to increase to 60mg if needed and 150mg of Pregabalin – with the ability to increase if necessary as well. The only side effect I have noticed is that I am tired but unable to sleep continuously through the night. On the positive side, I feel more motivated and generally positive with this combination.

As a last note, I would like to reinforce that this is my experience and yours may differ vastly. However, I feel that an honest account of the varied effects of medication illustrates just how widely the effects are spread among seemingly similar medications.

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