Some words on – “Stability”

I haven’t looked it up, but there must be several posts on my blog where I mention the importance of waiting for periods of emotional and existential stability in order to make changes to your medication regime. I believe it is important to remember that such stability is oftentimes ephemeral and can vanish without notice. This is not to scare anyone or to make them renounce from weaning off their drugs, but I´m saying this to make sure no-one out there is waiting in vain for a complete standstill of affairs that may never occur.

Many changes in life are not initiated by us, but by external factors we cannot control. On such occasions, we may find ourselves sucked into a stream of events we never chose to be a part of. One day, we can be enjoying great peace and contentment, and the next day all hell can break loose, with us at the center of it. All we can do is try to limit the damage through appropriate reactions.

Some months ago I perceived myself to be walking a pleasant, smooth path. Everything seemed wonderful, including my new job. It took nothing more than a co-worker, whom I scarcely even knew, to walk through the door and furiously accuse me of a serious infraction I had – honestly – not committed. She herself had not been a witness of it, but was acting upon hearsay. She also reported me to the superiors. With me being the new one and her well established at the workplace, she had all the credibility. She also informed me very loudly that “everyone” was talking badly about me anyways. She refused to tell me who “everyone” was, but insisted it was literally the whole staff of the institution. My immediate impulse was to grab my bag, leave and never go back. It took quite a bit of willpower to continue my workday and remain halfway functional. The following weeks, I was internally boiling over with outrage and couldn’t help but look at other colleagues wondering “Is so-and-so among those who are talking badly about me?” As for the woman who attacked me, to this day she has been unable to look me in the eyes. I believe this speaks for itself. I also admit I now find slightly perverse amusement in facing her with a calm I-am-Buddha smile whenever our paths cross.

To make a long story a little bit shorter – lightning strikes wherever it wants, whenever it wants. Even out of the blue. So how can you make sure life doesn’t throw you a curve ball as you are in the middle of a dose reduction? You can’t. There is just no way of telling. Yet, you can do a lot about how you react, and about whether you look for support from people close to you.

Let’s talk about the support. If you are trying to recover from psychiatric crisis, undertaking a medication switch or readjusting your drug dose, you should have a personal support system mapped out. Let people you trust know what you are going through, and ask them to help you with careful observations, attention, honesty, good judgment, constructive input, friendship and love. An open conversation, a firm hug and an outside point of view can work miracles when you find yourself in distress. Plus, when you have a history of mental illness and psychiatric treatment, you are probably very vulnerable to self-doubt. Am I crazy? Am I sliding into a crisis? Is my reaction healthy? Commonsense could calm down such self-interrogation, but it is very reassuring and comforting to hear from someone else they understand you and think you are actually doing fine. And, in the opposite case, should you really be at risk of derailing psychologically, having this pointed out by someone is a vital contribution to preventing the situation from getting out of hand.

Now let’s move on to the reaction element. Depending on your personality, obeying to your momentary impulse may or may not be best. In my particular case, it is generally not. Impulses typically cater to an ancient fight-or-flight mechanism which is very useful when you are being chased by an enraged mammoth. In an office or other postmodern setting it is less practical. As you can tell from the incident at my workplace, my spontaneous, gut-driven response was to wrap it up, show off my middle finger, shout “Fuck y’all!” and leave with flying colors, in pursuit of unspoiled horizons. Similarly, upon receiving offensive or otherwise inappropriate e-mails, my impulse consists in proving to the unfortunate emissary of the message that my rhetoric is better than theirs, and that I can be an even bigger cunt than they are attempting to be. It can take a few re-edits before my response becomes suitable for sending at all. Experience has taught me that cooling heart and mind down improves the outcome of my actions. This also goes for emotions other than anger. Fear is another bad adviser. As simplistic as it sounds, succumbing to impulses fueled by negative emotions is never a good idea. As refreshing as spontaneous displays of affection, generosity and joy are, as devastating can the uncontrolled liberation of their opposites be – for others and for yourself.

This does in no way mean you should sugarcoat all your negative perceptions. They are there for something: they warn you of unfavorable situations, toxic relationships, bad intentions others hold, and so on. You need to recognize unhealthy circumstances for what they are in order to protect yourself from harm. The art lies in distinguishing impulse from intuition. Impulse is a reactionary force which can be laden with either positive or negative emotions, and serves to vent those. Intuition, on the other hand, is your inner voice expressing the observations and needs of your personal essence. Impulse is the lightning that strikes where and when it wants, blinding you as you act out. Intuition is subtle, constant and truthful, providing you with insight and strength. Impulse will say: “So-and-so is such an asshole, I totally hate him/her!” Intuition will simply advise you not to engage with that person because they might be harmful. The coworker who attacked me was being impulsive, and I almost would have been the same in response.

The million dollar – or yen, or euro, or pound – question is: how to make out your intuition among all the thoughts, feelings, images and ideas scrambling about inside you? There is no standard recipe, and finding out how to do it is one of the great tasks in life. It seems nobody ever masters this skill completely, otherwise disgrace would not continue happening all the time and everywhere on our planet. However, everyone is able to improve.

Finally, I shall tie the know with the subject of psychiatric treatment and life skills. Even if you have been in crisis and are taking one or more drugs, you can and should exercise your intuition, as well as other life skills. Never assume that, because you have been labelled mentally ill and prescribed neurochemical crutches, you are doomed to be handicapped forever. Consider yourself in the process of rehabilitation and keep in mind that most people are in need of healing, too. Just because they have not been diagnosed does not mean they are healthy. Society is sick in many ways, and will imprint some of its illness upon its members. Within countless families, toxic emotions and destructive behavioral patterns are handed down through generations like old, creaky furniture. And one traumatic experience with an abusive individual can throw formerly strong people off kilter for years to come. It so happens we call such wounds “psychiatric illness” when they are particularly evident or render someone dysfunctional in regard to the current social norms. However, it is a type of injury everyone suffers from in varying degrees. There would be nothing for us to learn and grow by if this were not so. Walk ahead. Always walk ahead.

Advertisements

How it´s going – Completion of phase three

Hello Everyone!

I am now taking half of my original dose on both medications. So now I am on 75mg of Sertraline and 150mg of Quetiapine. There have been no unfavorable reactions to the dose reduction whatsoever. Again, I have to stress that I do not simply switch to a smaller amount of any of my medications from one day to the next. Every decrease in dose takes me about three weeks to complete. Also, I never modify the dose of both medications simultaneously, but do it one after another. This adds up to a total of six weeks for the change to be complete. I always start with the antidepressant, and finish with the anti-psychotic.

Given that I am feeling so well, I have decided to continue dose reduction throughout the month of December. I will take the Sertraline down to 50mg. In January, I will be travelling abroad, which is why I intend to wait with the further reduction of the Quetiapine dose until after the trip. I should point out that we will be visiting my partner´s family, and that I have made this same trip twice before. In other words: we will not be exposed to exotic stimuli and strange locations, but rather be welcomed into some sort of home from home. I find this important to mention because dose reductions are safest when there is no stressful situations or emotional turmoil ahead. Of course, these can come up unexpectedly at any moment and even in the middle of a dose reduction, but why deliberately risk any instability in the face of anticipated psychological pressure?

Once I am down to 50mg of Sertraline and 100mg of Quetiapine, which corresponds to one third of the original dose, I will not make any further changes for at least half a year. Frankly, I have not even clarified for myself if I should ever be completely medication free. The habit of popping those pills every morning and evening has become so strong and reassuring that the idea of not having them as a safety-net gives me vertigo. Knowing myself, I might be able to overcome that fear once I am getting closer to the right moment, but I am more of the one-step-at-the-time type, so for now I will be dealing with the next dose reduction and nothing beyond that. This tactic has worked fine for me until now, and not just regarding my medications but also other matters in life, so I shall stick to it.

I will keep you updated.

Felicia.

How It’s Going – Completion of Phase Two

I am now permanently on 200 mg of Quetiapine (Seroquel) and 100 mg of Sertraline (Zoloft), which means I am concluding phase two of my withdrawal plan. According to this schedule, as I had originally laid it out, I am supposed to stabilize these doses over the course of two to three months. However, given that I am experiencing no withdrawal symptoms or other anomalies at all, I might reconsider the duration of the stabilization period and possibly reduce it to somewhere between one and two months.

My current doses correspond to a 30% reduction of the amount I was prescribed when I first started taking my medications. I believe my organism is already perceiving some degree of relief. My overall well-being has been improving, certainly also thanks to a healthy diet and regular exercise. Mentally and emotionally, I feel perfectly functional and healthy. My partner is a great source of support, and I know I can trust him to report any unusual observations to me.

I am also pleased to see how each prescription of a hundred coated tablets now lasts one month longer than it used to. The medication supply that was meant to be good for three months is now sufficient for four. One could say I am 30% less stressed about getting my new prescription.

As for this blog, it has been slowly, but steadily, attracting more readers. My hope is for them to find useful or at least interesting information on its pages, be it for themselves or in order to help loved ones. I want to stress once more that your comments, questions and suggestions are more than welcome. Reader’s contributions make this kind of blog so much richer and so much more helpful. Feel encouraged to send me your thoughts and experiences – they will all be considered and responded to.

How It’s Going – Completion of Phase One

Yesterday night was, hopefully, the last time I ever took the old dose of Quetiapine, 300 mg. So from today onward I will be taking 250 mg of Quetiapine at night and 125 mg of Sertraline in the morning. If you have a look at my dose reduction plan, you will see that I originally planned to stay in this place for a while. However, as I have had no withdrawal symptoms or other adverse reactions to the dose reduction so far, I feel I should move on to the next dose reduction sooner. Thus, I shall begin lowering the Sertraline dose further next week, in the same way I have already done it once. This modification is to be followed by another dose reduction of the Quetiapine. My next aim is to reach a plateau phase with 200 mg of Quetiapine and 100 mg of Sertraline. This corresponds to a 30% reduction of the original dosages, which I find to be quite a significant change. Once I get there, I still plan to remain there for at least a few months.

The question now is whether I have noticed any changes so far. As for negative ones, luckily not! On the positive side, I do feel slightly more alert in the sense that I make faster decisions, seem to have an improved concentration and feel more open towards learning new things. A lot of this, admittedly, has to do with my recent changes in lifestyle and the accompanying shifts in priorities. Logically, I have some restructuring and decluttering to do. Nonetheless, I feel that I am mentally and emotionally better disposed to pull through with these reconfigurations. Lowering the dose of my medications may be contributing to that.

Physically, there have been slight improvements as well, although these most likely have to be attributed to factors other than medication withdrawal. My weight has been going down very gradually, which is probably mostly a consequence of my doing daily yoga routines and eating a low-carb diet complemented with veggie shakes. I have a very sweet tooth, but lately I have managed to steer clear of too much self-indulgence in this area. My partner and I have agreed we can be naughty – in culinary terms – every once in a while on special occasions, but certainly not on a daily or even weekly basis. Our naughtiness in other areas seems to be improving. Our relationship is thriving, yet it is impossible for me to say whether lower medication doses have anything to do with that. I suppose, and hope, that we are simply doing things right.

Lately, my sleep is less plagued by nightmares. I used to have them every night, and they were intense enough to have me wake up screaming every so often. Since I have moved in with my man, this has not happened again, although most of my dreams are still weird and unsettling. They very evidently deal with traumatic experiences as well as the fears and conflicts derived from those. As a result, my dreams are quite repetitive in topic, which makes me assume I have a considerable quantity of psychological knots to untie if I want to get rid of them. Several sources on psychiatric drug withdrawal explain that as you lower doses, emotions and thoughts may resurface that had been lingering under the surface of your drug induced stability. To me, that makes perfect sense, as the drugs do seem to suspend you from hammering away desperately at your worst conflicts. So, as a consequence of medication withdrawal, I expect some serious processing and coping challenges to lie before me. At this point in time, such challenges have not occurred to an extent that would make me consider seeing a psychotherapist. My partner is a great source of support, encouragement, comprehension and love. The list of his wonderful characteristics could go on and on. My close friends are caring and sincere. In other words, I have a support network that wants for nothing. Thanks so much for that!

All in all, I am happy about how everything is going. My initial fear of lowering medication doses has receded. I am still very careful and slightly apprehensive about the process, but so far I have felt motivated to think that as long as I proceed in a sensible way, I should be able to minimize risks. I am glad I have started this process.

My Personal Withdrawal Plan – Sources and Outline

Although I seem to tolerate my current medication plan quite well, I have been striving to wean off my pills, or at least decrease the dose I am taking. But before I altered anything, I needed information. Despite my recovery from psychosis I have developed a profound mistrust towards psychiatrists and psychotherapists. Out of all the professionals who saw and treated me, maybe 20% actually knew what they were doing. The other 80% either didn’t care to help me, or they wanted to be helpful but didn’t have any idea how, or they were abusive of their authority, or they needed therapy themselves. No joke.

As a result, my first thought was that I needed information to be able to distinguish a competent psychiatrist from a quack, so I could pick the right support for my undertaking. Yet, by continuing to read about mental illness, treatment options and psychoactive drugs, I became more knowledgeable and eventually felt I was able to make informed and more autonomous choices regarding my recovery and withdrawal process. One book in particular stood out as being clearly understandable for any reader and for promoting a holistic approach to the treatment of mental illness and to medication withdrawal: Psychiatric Drug Withdrawal – A Guide for Prescribers, Therapists, Patients, and Their Families. It is one of the more recent publications of Dr. Peter Breggin, who draws on over half a century of medical experience in psychiatry. As a defender of the patient’s freedom of choice, Dr. Breggin promotes what he calls a “person-centered, collaborative approach”. Instead of turning the patient into a depersonalized and passive onlooker of their own treatment, Breggin places the patient at the very center of his therapeutic model. Around the patient, he constructs a support network consisting of a prescriber of psychiatric drugs, a psychotherapist, and significant others (family members, spouses and friends). The prescriber and the therapist can be one and the same person, but do not have to be. What is indispensable, though, is that the patient’s wishes and decisions are taken into account at all times, and that all participants in the collaborative, person-centered approach are communicating efficiently and monitoring the patient’s health development. As the title of the book reveals, Dr. Breggin writes for health care professionals, patients and their significant others alike. None of the information he gives is classified exclusively for one or the other. All people involved have the same right and access to knowledge. The patient and his or her loved ones are empowered rather than patronized. You might be able to guess by now that I highly recommend this book. Further on, I will be reviewing more literature, but for now this is my starting point.

First of all, it is important to understand that there is no standard recipe for withdrawing from psychotropic drugs. Every organism reacts differently to changes. Also, it is impossible to foresee how long it will take to wean off medication or to securely establish a new dose. As a general rule, however, slower is better, and small changes in dose are safer than big ones. This is especially true for those who have been on psychiatric medication for a long period of time. Certainly, you often hear stories about individuals who have successfully gone “cold turkey” or got rid of their pills in the course of a few weeks or months, but they were taking a high risk and were extremely lucky. They were literally playing Russian roulette with their lives. Reducing medication doses is not a sport, and there is no competition going on in who gets there first. The only reasons for withdrawing on the fast lane are life-threatening or disabling side-effects, dangerous drug interactions, pregnancy and medical conditions that turn the use of psychoactive drugs into an additional health risk. Personally, I am not in a hurry. Luckily, nothing in my life forces me to withdraw, and I can take it as slowly and safely as I like. And I like it very safe.

Evidently, withdrawal is easiest to plan being on only one drug. Now, I am on two different medications which counteract one another and are thereby meant to keep me in balance. In the morning, I take 150mg of Sertraline (SSRI antidepressant), which should have a stimulating effect. At night, right before going to sleep, I take 300mg of Quetiapine (atypical antipsychotic), to sedate me. My aim is to reduce doses alternately, maintaining the proportion between both drugs. I will start with the antidepressant. If everything goes well, the antipsychotic is to follow. Again, if the new dose works fine for me, I will keep it up for a period of time and eventually attempt another reduction.

As for the monitoring of my progress, my partner is around me every day and is in the know about my withdrawal plan. He will communicate any observations and concerns to me, is reading the same literature as I and is following my blog. Other friends will also be part of my private watch team. I do have a prescriber, yet I admit I haven’t decided on the involvement of a psychotherapist. Frankly, I feel reluctant to do so. Right up to my psychotic break, I had been seeing a shrink for several years, and she was unable to identify any warning signs or put her finger on the deeper causes of my troubles. I believe I’ve had it for now, as far as psychotherapists go. Also, after the ride I’ve sat through, I am quite confident I know myself better than a therapist who sees me once weekly could. In order to boost my general health and well-being, I will work out regularly, stick to a healthy diet, sleep enough and enjoy relaxation therapies – occasional foot reflexology and back massages.

The following is an illustration of how I ideally wish to proceed. This plan, as for now, has five phases that may be subject to changes, depending on whether I tolerate the dose reductions. If I don’t, I may need to return to the previous dose and postpone further changes for a long enough while to become stable again. You will notice I haven’t planned a complete withdrawal. While I was figuring out the graphics, the thought of actually putting this plan into practice made me feel all wobbly. In the attempt of outlining a sixth and seventh phase I might have fainted and slipped underneath my desk. So, let this be good for now.

I apologize for the miniature format of the graphics. The originals are a good size, but for some reason, they won’t come out bigger once inserted into this post. You can upscale your view of this page on the bottom right of your screen.

withdrawal plan phase 1

withdrawal plan phase 2

withdrawal plan phase 3

withdrawal plan phase 4

withdrawal plan phase 5