Category: psychiatrist

15 feb 2022: first day off meds

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Since last year I have been preparing for this day: getting off Fluoxetine. I spoke about it with my psychologist, and on 15 Feb with my psychiatrist, ’cause it’s her who needs to give the go ahead. And so she did. She asked me (to confirm) if I was feeling good, strong and self confident. I sort of am, I have had stronger times last year, when work was going well and I wasn’t doubting my skills. Today I feel good, not “happy” but good enough to give it a go. And I have a concrete reason to do this right now: I want to succeed at my flight school. They won’t let me fly if I am on antidepressants (makes sense). This means that I won’t be able to pass the medical test until months after I quit. The psy said that I will be able to pass the medical exam by July, by then there’s nothing more in my system and I will be stable in my moods. I will do that.

How does it work? I take one tablet every other day on week 1; then one every 3 days on week 2, and by week 3 I stop. Yesterday I didn’t take it. Today I did. Tomorrow I won’t. Spirits are quite high (despite the shitty weather). I am working it out: as soon as some negative thoughts come in (which they do constantly) I acknowledge them but let them go, just like meditation. However, I haven’t been able to sustain meditation sessions over the years, I just find it too numbing in a way, I prefer to have my eyes open and deal with my reality with all my senses. Kudos for those who can meditate, I envy them.

I am definitely scared about letting go of Fluoxetine, no doubt about that; however, I have never gained any benefit from being scared or worried, it just makes things more difficult. So, how about I put aside fear and worry, and let things evolve?

Stay the course, stay the course. Your objective is: by 2024 get Swiss nationality, live in a new home, be a pilot, stay off meds, and keep working at the same company. It’s a big objective for the next 24 months, but feasible, and it gives me reason to be here in Switzerland, and justify the hard times when I say “what the hell am I doing here”.

I am going to better weigh the significance of positive events in my life. Instead of undermining them and taking them for granted, I will pause, observe them and rejoice for every single positive drop in the ocean. It will counterbalance the negative drops that my brain so easily fuels into my body.

Also, 20mg of psychotropes a day, how much can it really be impacting on my whole body? Last night I had dinner with a friend who is taking much more than that. And after 3 years he is still stuck with them, his psychiatrist doesn’t want him to get off meds. Mine does. So that’s in itself a victory. I am ready to let go. My body is. 20mg: goodbye. I will replace it with another 20mg of self induced good mood. Like in the good old days.

Wish me luck!

Side Effects of Fluoxetine (Prozac)

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If I dig into my older diary pages, I will find my notes about side effects. I will check later. I thought this morning I would check again on the Internet, because I have two clear changes that I feel to attribute to taking Fluoxetine. I am sort of doing a self diagnosis, based on the fact that I have taken two long repetitions of Fluoxetin, and I notice the same pattern. Nothing major, but to be monitored.

The first time I took Fluoxetin was December 2019 until June 2020, the second time was December 2020 until now (April 2021). in 2019 I starting reducing from June to September, taking 10mg instead of 20mg, then I stopped in September and October, but by November I was feeling depressed again, and I started again December until now. I still take the same dosage, 20mg. In both cases I had no Fluoxetin in the gloomier months of the year for me: October-December, and I had to wait until end of Jan in order to start feeling better. I confirm that it takes 4 to 6 weeks for Fluoxetin (Prozac) to kick in. So, in both cases, I have the same pattern developing: 1. once my mood stabilises and I feel happier, I start dreaming very vividly; 2. I become more cocky, blunt, sometime verbally aggressive in my reactions. As if the social mask that inhibits our very being from expressing itself was taken off.

These are not amongst the common side effects of Fluoxetine. If I look at the NHS in the UK, the side effects that happen in more than 1 in 100 people are:

  • nausea, headaches, being unable to sleep, diarrhoea, feeling tired or weak.

    • I am far from that, I actually sleep like a baby. And I have these vivid dreams, they feel so real that I wake un in the morning remembering them as they really happened. Last night I dreamt something that has been recurring to me: I was missing the plane, and I felt this anxiety and breathlessness because I was stressed, I had to take that plane, and nobody around (my family) was helping me getting there in time. My father, who usually likes to get to airports 2 hours in advance, was telling me to not go until an hour from the flight time, but this was not going to help, as we were on the other side of London (why London I dont know…). I had this dreams in different sauces several times. It is not a happy dream, but it is not a depressive one either. It kind of gives me adrenaline.

    The other thing is feeling cocky. The only common point I can interpret from the NHS list of serious side effects (happens less than 1 in 100 people) is this

    1. headaches, trouble focusing, memory problems, not thinking clearly, weakness, seizures, or losing your balance – these can be signs of low sodium levels

    2. thoughts about harming yourself or ending your life

    3. fits, feelings of euphoria, excessive enthusiasm or excitement, or a feeling of restlessness that means you can’t sit or stand still

    4. vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo – these can be signs of bleeding from the gut

    5. bleeding from the gums or bruises that appear without a reason or that get bigger

    NHS article on Fluoxetine

    I feel number 3 is close to what I feel. During the day, when working or doing my own personal projects, I feel I am regaining confidence, and strength, and I tend to cast away everything that threatens that confidence. I don’t feel inhibitors in telling people what I think, and I feel good in what I am doing. Work is going better, I started (yes, finally!) my podcast, it feels good.

    But I need to be careful not to exaggerate. I live in Switzerland, not in Italy, and the direct way of confronting people is not appreciated. I even thought of telling my CEO that he was wrong in doing what he did to one of my clients. But he is the boss, I have no right to tell him what I think, right? And he is not the kind of person who will easily accept a critic. So I need to be careful to not ruin my own happiness by saying too outloud, or being too enthusiastic (euphoric sometimes yes).

    All in all, I am doing well, I feel that the medicine is helping me. Unlike I read in another article, I don’t think it is like a placebo. But I need to prepare my own internal medicine, my own mental weapons to fight depression if it comes back after I am out of Fluoxetine. When will I stop Fluoxetine? I don’t know yet. I am scared of the gloomy depressive winter. I will check with my Congolese psychiatrist.

    10mg

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    I am back in Rome for a week. My mom had an urgent surgery due to a hernia that was pushing against the root of the nerve (L4 level), and caused her tremendous pain plus was preventing electric impulse from flowing in her left leg. Bref, as we say in French, I had to rush down to Italy from Lausanne, which was not easy, since COvid measures are still not totally relaxed between countries, and I had to start a sort of pilgrimage to the holy city, which entailed taking the train from Zurich to Chiasso, walk to the Italian border with a big luggage, the laptop bag and a plant for my mom, catch a bus to Como station, and jump on a train hoping it would lead me to Milano Centrale. Almost, it took me to Porta Garibaldi, a few metro stations from my destination. I slept in Milan at an Airbnb, and at 6am the next morning I took the Frecciarossa train to Rome. It took me almost 24h to get there.

    A few days earlier I had asked my psychiatrist to reduce Fluoxetin. As I said in another post, the self isolation time has helped me work on myself, and do mental exercises that have helped me get stronger, and feel that my core happiness that I am regaining is due more and more to me and not to the medicament. He agreed to reduce from 20mg to 10mg. Big step for me. I was worried about the consequences, and the effects or side effects it would have on me. I am still very careful, and am being vigilant to the mood shifts I may have. I started 10mg on 5 June, and today is 15 June. Already ten days.

    I can’t tell what exactly is the effect of the reduction, but I can certainly tell that my stomach is adjusting to the new intake. I was taking another brand of Fluoxetin, which was in gel capsules (with powder inside), and I had to change it to another brand (solid tablets) because I need to cut the tablet in two (there is no 10mg pill, at least in CH). I can tell that my stomach has been burning during the day, and I am sure it is because of this change. So, that is clear.

    What is less clear is whether the reduction is making me more angry, or whether it is my hormonal state. It so happens that I started the reduction just as I was about to have my period. I take Estrogens and Progesterone regularly because in the past years I had started having less and less menstruation (at about 42), as if I were in pre-menopause. I know now that this pre or peri-menopause is due to the stress my mind and soul found themselves in, a slow process towards depression that has blocked my body functions. Just like a high level sportswoman who has no more menstruation because of the strain the training has on her body.

    In the past 4-5 days I have found myself angrier, and more “delicate”. I love this word, delicate, Roy from “The IT Crowd” very cutely says it at the episode called “Aunt Irma”. You have to watch this : Series 1 Episode 6 . Hilarious. So, yes, I think I am sensitive because of my period, but my period started and didn’t continue at this round, so that’s another story. I am guessing that I have been hormonally challenged, and on top of that work has been exciting yet stressful, a lot to think about and to follow up on; couple that with the long journey to Rome and the worry that the surgeon might injure my mom even more, I was ready to kill somebody 3 days ago! I didn’t literally kill, but I was very vocal with my words, and found myself being angry at every little thing that was happening to me, all the more when the little thing was against my self. Example: a colleague who didn’t want to help me at work, or the train manager who didn’t want me to get on the train; the lady at the Airbnb who was not talkative and was rather dry (she did her job though, handed me the keys to the room and showed me the kitchen), but I wanted her to be more lovely, just like I am with my guests at home.

    Bref…. (long story short), here I am in Rome, I finally made it. My mom had her surgery, she is fine and now I will work from Rome remotely, nursing my mother and giving my father a break. They are getting old. I still don’t know whether my mood swing towards anger had to do with the 10mg, or with my period. Maybe a bit of both? I will monitor the situation and will revert asap.

    More soon.

    Recipe for Happiness

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    Happiness to me is the conditio sine qua non in life. It’s not very clear what happiness is, and how we measure it. I have been trying during my life to understand what makes me happy and what makes me sad, and I have associated often a place to a happy moment, or maybe a happy moment to a place.

    I often wondered if my gauge for happiness was the same as in other people, or to all people. The same goes for pain. Let me explain. When I have had moments of full bliss, happiness, plenitude, abundance, or whatever we want to label it, it felt amazing, and nothing more could make me feel better – I wouldn’t want to be anywhere else. If I think of such moment in the past, my memory brings me back to when I was in New Zealand with W. (the love of my life, haven’t talked much about him yet); it was July 1 2005, and I labeled that day as the best day of my life. I have had other best days before and after, but this one in particular stands out. We had ventured into a farmland the day before, we had parked our rental Britz van near a sheep farm, had made a lovely breakfast in the morning, with lots of things from a local store called …. Mmm can’t remember (Hackleberry’s maybe?); we did our first sheep shearing of our lives, took some lanolin straight from the sheep’s cut wool, and ventured off into this wild NZ land full of magnificent colours, rivers, etc. When I told W. that it was my best day, we were staring together at the vast spaces of New Zealand and we were closely wrapping in each other’s arms amazed with the beauty of that land. That was a happy moment that I will always remember. A moment that lasted many days actually, and months, and years, as W. and I were traveling around the world.

    Now, when I think of the happiness of another person, I wonder if he or she would feel the same level of happiness, and if so, in which conditions. I mean, was my feeling of happiness on July 1st the highest a person can feel? Does a woman somewhere else in this planet, at this moment, feel the same level of happiness doing what she does love most? Could I be more “happy”? If so, how? The point is actually not whether I can be happier, but how I measure my happiness compared to others, and if my state of bliss staring at the sheep farm is the same bliss another person, with another character and history, feels when driving his/her favourite car. Is it the same happiness a grandmother feels when she spends one day with her nephew? Is it the same bliss Elon Musk feels when he sees his first shuttle take off? Or Armstrong and Aldrin when their foot first touched the moon? So, is happiness relative or absolute? Do I need my neighbor’s Ferrari to feel the same amount of happiness he feels when riding it? And is my joy higher than his, when I am hiking a mountain, or I am kitesurfing in a turquoise waters? Do I need to envy other people’s happiness? Cause that’s the feeling I get when I watch TV.

    Same for pain : was my surgical pain last year the highest a man or woman can endure ?

    I am still looking for a way to gauge happiness levels. Because if it were measurable, we could possibly help each other being happier. No? It’s a difficult task. I am open to suggestions.

    Back to happiness, why am I saying this today? Because I am preparing for the month of June, when I am going to reduce the intake of Fluoxetin (Prozac). I have a meeting with my psychiatrist (the jolly Congolese guy) on 4 June and I will ask him if he is ok with me reducing the antidepressant. I want to do it during summertime, when it’s nice out, the days are long and sunny, the air is warm and everything is alive. I don’t want to do it in autumn, which per se is depressant to me. I know, many people love autumn, I don’t like it, despite the beautiful colours (Quebec has some of the best landscapes in the fall, check it out, I have been there, wow). It’s been 6 months since I started taking antidepressants, and I feel good, very good. I think I can start move away from them. I am scared, I admit, because I can’t tell how much my good state of mind is due to medicine at this very moment, and how much is due to my self-training (meditation, routine, enjoying work, doing sport, yoga, buying new plants…).

    So I want to pack in as much as info as possible on myself, and in what conditions, when and how much I am happy. During my preparation to less Fluoxetin, I am appreciating some down moments, like the little “fight” I had with my friend M., which brought me back to negative moments. It was good to be reminded what bad moments feel like. I managed to revert those bad feelings into positive, by thinking of something I like, by not letting her bad mood affect me, and by being more “egoistic” towards my own feelings (translation: I value my own state of being more that hers, what’s important right now is that I feel good). I stay away from negativity. It helps.

    Take action before it’s late

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    Dr. G., my psychologist, said one thing that struck me, and that I will forever remember. He said it in such a natural and unassuming way that it resonated clearly in me. He said “you have a certain fascination for dissatisfaction”. And I realised, it’s true. Why? Because when I was at the beginning of the practice, I used to tell him my story, stories, thoughts, fears, anxieties, long story short, I was a mess and he was my punching ball. The thoughts I was sharing with him were initially, say, 99% negative, sad, hopeless; as the medicine was starting to have effect, I started to relax more, the problems in my mind were taking more distance from me, and I tried to see more positive; he was telling me that I had to shift the way I see my reality, and make it work for me. Not easy, as I initially interpreted this recommendation as a way to say “be contented with what you got, that’s all there is, resign yourself to the reality”. Which, in other terms, meant for me “you are a failure, pal, you have messed up, lost the love of your life, never got to finish one thing, are back in a country where you feel trapped, just accept it and find happiness in what you can get”. That’s what I was thinking, and that feeling of dissatisfaction and forced resignation fueled my depressive state. I had such a clog in my stomach every time I was thinking what I was missing in the world, while others were living the life of their dreams, why not me, and yet I am a smart person. Etcetera, etcetera.

    Oh, if I recall these thoughts my mood becomes more grey. So I won’t linger too much today, and I will say why I am mentioning this now, months after it happened. First because I want to remember how bad depression felt, and remember to always compare those moments with my moments today; that sadness with today’s serenity, and I’d dare to say, even happiness. I am happy with myself right now. It has only taken me a few months to feel this way. And that’s the other reason why I am mentioning my sad memories. It took me 4 months more or less to feel good again, like I have not felt in years. This is, and I am sure of it, thanks to the medical help I received. I was too low to get back up on my own. BUT! It doesn’t have to be this way. and I am here to warn whoever is reading these notes, whether it is today, 9 May 2020, or in 5 years, or in 20 years. If I had listened to the signs sooner, I would have been able to heal on my own. There is no need for medical chemicals, and I am pretty sure of it. My mother had warned me several times prior to my deepest depression in November. She told me years before, that I should go see someone. Initially she meant a psychologist, and when things got really bad, she advised I go to a psychiatrist. She meant good for me, but I always thought that the mind is something we can control, unlike a broken arm, a heart attack or a kidney infection. We go to the doctor whenever one of our organs hurts; we visit clinics and hospitals way too much even, but whenever the head is concerned, it becomes a taboo, at least in my culture and family environment. So I always felt that going to see a “shrink” meant a defeat, cause I wasn’t able to take care of my own thoughts. Today, 5 months after my biggest (and last!) depression phase, I am glad I listened to my mother – and I know she is glad too.

    Each of us goes through his or her own life the way we deem right. We all want to be happy, right? We all want to feel those great sensations that we associate to words such as satisfaction, victory, love, happiness, serenity; I don’t feel good when I hurt somebody, or am hurt, or when I see people murdered on TV, or when a client doesn’t close my deal. There’s some strong feelings in our stomach, in our guts (and I know that Agata has a brain – who the heck is Agata ?). Well, I haven’t listened enough, and am only starting now, because I am in survival mode and will do anything to beat the beast, which is my depression. But it doesn’t have to wait until this late, so if you are reading this and feel depressed, but think you can make it on your own, start taking measures. I took up meditation . It’s soooo good. Can’t believe I didn’t do it until my forties. For you it might be something else. Take action before it’s late. Trust yourself.

    Speak soon.