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Medication change: Reflections from Week 1

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On Monday, I talked to my doctor about reducing my dosage of my SNRI medication. As noted in my post here, my usual behaviour when I was questioning my medication was to just quit cold turkey (which I am definitely NOT recommending – see disclaimer info above).

Well, that’s not completely true. For years, my usual behaviour was to talk to my doctor or psychiatrist about medication. But the solution was always that I needed to take more medication. Maybe the plan was to increase the dose. Maybe the plan was to add on another medication. Maybe it was both. So the first time I quit taking medications cold turkey it was after about a decade of taking some cocktail of psychiatric medications. And I had been taking something my whole adult life at that point. Part of my motivation to quit cold turkey was to find out who I was underneath all those medications; and I didn’t want to tell anyone in my life because I didn’t want to be talked out of it.

Making a sound plan

But this time around, I did talk to my doctor. And even though he had brought up the idea of decreasing my dose a little while ago, I was still prepared to ‘make my case’ for why I was thinking about quitting my meds. The truth is that I didn’t want to quit cold turkey again. I had done it twice, and it was a very hellish experience, with ‘brain zaps’, nausea, insomnia, and wild mood swings. So when I mentioned that I had been thinking about quitting, and had blogged about it, and that there were side effects that were bothering me… I was met with support for the idea of reducing the dose. I was given the opportunity to ask about what I might experience (my biggest concern was those awful, jarring ‘brain zaps’ and the medical anxiety getting out of hand) and after a short discussion, I was reassured that the brain zaps were unlikely and that I did have a lot of resourcefulness to cope if I did get ‘too anxious’ and we decided that it was worth reducing my dose by about a third. My doctor also told me that if I was struggling then I could alternate my dose – on one day I could take the reduced dose, and the next day I could take the regular dose. That was reassuring enough for me to drop the dose that day.

What a wild week it’s been

I’ve tried to gauge the impact of the dose change, and with the week I’ve had it may seem hard to know how I’ve been impacted – but overall I would say that the decision to reduce the dose has been well tolerated, and I will talk to the doctor again on Tuesday but I would anticipate staying on this reduced dose for the time being.

So what has happened this week? It’s been so full on. So, Monday, the day I dropped my dose was the first day of school holidays. Kids are home now all day. So that adds to my sensory load, responsibility load, and also means that I am getting less time to myself, and my own routine is really disrupted.

I also decided to change my diet that day. Even my ‘fat clothes’ were no longer fitting and I felt like I really had to make a big effort to at least fit into something instead of going out to buy new clothes. So, Monday was a fasting day on the New 5:2 diet that I started. And even on the non-fasting days, I have found myself really hungry!

As if that wasn’t enough, I had to stop taking my calming progesterone pills, as I started a period quite unexpectedly on Tuesday. This also seems to impact my sleep. And speaking of sleep, my 9 year old has been having horrible insomnia, and she has been waking me up and keeping me up more nights than not.

We also had planned to go to a sporting event this week, so I had to also go to a stadium with around 11,000 people one night this week. And today is Easter, which meant planning when to shop for the fruit I needed to bring to the family gathering so that I wouldn’t be dealing with the worst of the holiday shopping crowds – and attending a loud family gathering. And all the chocolate everywhere!

It hasn’t been easy

So here it is, another case of me feeling like everything is happening at once. And asking myself why do I constantly put myself through the wringer? Yes, I made some conscious decisions about what I was going to do this week; reduce the dose of the SNRI and change my diet while the kids were off school. But I didn’t expect the diet change to be as hard as it was, and I didn’t expect the insomnia to flare up. And I didn’t expect to have a period and to have to pause the progesterone.

Is this another case of me not being able to cope with feeling good? Is it my constant desire to ‘improve’? Is it just bad timing?

I had talked to my doctor about the diet change too. And he knew it was school holidays. And I talked to my husband about it all. And I came to the conclusion that if they both thought the time was right, then I should probably give it a go. And I knew that I had the ‘backup’ of being able to alternate the dose, or really, there was nothing stopping me from going back to the regular dose.

What I noticed this week

So how did I feel this week? One of the things that went through my mind was that maybe I actually was making this week as full on as possible in order to avoid the holiday blues. It’s always hard to go through holidays while living overseas. Maybe this busyness was a way to avoid feeling sad. That was something I did reflect on, and was able to recognise and admit my sadness and allow it. Which helped.

Beyond that I noticed a lot of changes in how I cope; in how flexible I am; and in how I process my experiences.

I used to think that I was a really flexible person. But now that I am digging a little deeper into what that means, I realise that my ‘flexibility’ was in areas of people-pleasing. I was very flexible for other people; but very rigid toward myself. One example of my all-or-nothing thinking and behaviour was my tendency to quit medications cold turkey. This time around I have been more flexible; I no longer believe ‘quitting meds’ should be a goal for myself. I am not either a fuck up because I am on meds, or a success because I’ve been coping without them. And as such, when I noticed my desire to quit flaring up, I didn’t make an impulsive decision. I talked it over, and made what I believe is a good choice – to reduce the dose.

I also didn’t need a definite answer of what getting off of meds would look like. I just made plans for the step that I was currently at without needing to know what comes next. What’s important is to experience what I am experiencing now, and to trust that when it’s time to make another change I will have that discussion.

Another area where I have been able to really notice that I have become more flexible is with my diet. I went back and forth about whether to ‘do a diet’ because I have done so many diets in the past. My weight has fluctuated since I was a teenager, and I have been very successful when I am ‘on a diet’ because I can be really good at following the rules. Sometimes it’s been to extremes. For instance, my last ‘diet’ was a highly restrictive diet that should only be done for six weeks at most. I followed the diet for about a year. And then I got really anxious about adding foods back in, and ended up with significant anxiety. It wasn’t until I started the SNRI that I was able to eat without anxiety. But, like with every other diet, once I stopped the diet and there were no longer external rules about what I could eat, I gained a lot of weight back.

So I was hesitant to start a new diet. But I also know that without rules, I will just keep gaining weight. So I took the advice of my doctors and signed up for the Fast 800 program. The quiz I took on the website recommended that I do the Very Fast version of the diet, which is eating only 800 or so calories for up to 12 weeks. I recognised that this would be way too hard for me, so I started more conservatively with the New 5:2 plan.

And guess what – I didn’t do it perfectly. I was supposed to have two days where I only eat around 800 calories, and the other days, I am supposed to stick to a Mediterranean style diet with their suggestion of 1500 calories a day split between 2 or 3 meals. In reality, I only did the 800 calorie plan for one of the 7 days. And sometimes, I had more than three meals. Sometimes I added in extra calories to some of the meals. I had honey in my tea a couple of times.

This is actually a really big sign of progress for me. I was able to be flexible. To prioritise meeting my needs when hunger became too much for me, instead of placing more importance on following the rules. I made sensible decisions. My extra calories didn’t come from chocolate bars. They came from healthy, whole foods. And I was okay with that, and didn’t decide to just give up on the plan because I ‘failed’ by eating something off plan, which is what I have done in the past. And today was Easter, so yeah, I had some chocolate. I am not going to constantly miss out on celebrations just to follow the rules. I didn’t wolf down a whole milk chocolate bunny in one sitting like I would like to – but I savoured my dark chocolate lindt bunny little by little.

I feel like a broken record… but I have to talk about self care yet again

I feel like I keep harping on this idea of self-care, but increasing my self care in areas where I could definitely helped me with my ability to cope.

There are a couple of approaches I had to keep in mind. First, I am much more aware of what sorts of situations are likely to stress me out or overwhelm me. I can’t avoid all of them, so I have to plan accordingly so that I can give myself what I need to get through the situations, and do what I can to replenish my energy afterwards. And secondly, if I find myself in a situation where I am surprised by how stressed or overwhelmed it made me, I need to use what I can to get through it in the moment, as well as give myself what I need to process what happened, and get regulated.

Some of the things I really try to do is plan any outings to malls or shops when it’s likely to be less busy. When I knew that we were going to a sporting event in the evening, I was sure to make my errands in the morning so that I would have a lot of time to recover in between, and I also had no obligations the next day so I could sleep in and stay home all day. When I had to go to the shops on Saturday before Easter, I got up early and went before the shops got very busy. On Easter Sunday, I made sure to have a very chill afternoon so that after the family gathering I could relax.

I am also using things like headphones or these ear plugs when I go out now. The ear plugs I use dull the background noises but still allow me to have conversations. I don’t know how I made it without them. I am also going to pick up some active noise cancelling headphones soon.

And overall, I have reduced the demands I put on myself over this week. I accepted help where it was offered. I asked for help in some areas where I normally wouldn’t have asked for help. Instead of getting overly upset about the changes in my routine due to school holidays, I was able to just accept that while I couldn’t do everything I wanted to, the things that I want to do will still be there when the kids go back to school.

Breaking cycles

There are cycles that I had felt really stuck in for years and years, but it seems to me that I am starting to break a lot of those cycles. I used to be really afraid if life was going well. I was always on guard for something to blindside me. But now I have more of a sense of safety and confidence in things going well. And I also have changed my ideas on life being some kind of linear experience. Even when I knew ‘rationally’ that life was not lived on some kind of linear path, I was still behaving as though I needed to live my life in a way where things would only get better and better over time. And if it didn’t, then it must be my failings that were ‘setting me back’. But now I am more accepting that there is an ebb and flow to life.

And I can be flexible enough to ride that out.