I’ve been changing up my meds again, under the supervision of my doctor. I was on 30mg of Cymbalta, which is an SNRI medication I have been taking to help with anxiety disorder and panic disorder. This is my second stint with Cymbalta, which I had previously taken after a back injury. I had sworn that I would never take this medication again after I had a really rough time coming off of it. But when I was way too anxious to try something new, I asked to go back on it. To be fair – it seems to do an amazing job of helping with anxiety and OCD symptoms for me. But there are also side effects that I was not happy about – and back then I was really feeling like it was a personal failure if I had to take medication. So I quit a much higher dose under no medical supervision, and it was fucking rough.
When I started Cymbalta in August of 2021, I was suffering with anxiety and panic attacks so hard core that I was very close to checking in to a hospital for help. In fact, the only thing that kept me from doing that was the fact that the Covid restrictions in place at the time would have meant that I would have been unable to see my husband and kids while I was in the hospital. And I could not see how I would be able to get better in a place where there would be no access to feeling loved.
When I finally started Cymbalta this time around, I don’t think that my dose ever went over 60mg. When I had quit in 2018, I believe I was on 80mg at the time, and I wasn’t seeing the doctor much and just quit without telling my doctor. This time around, I was very open with my doctor about my tendency to quit all my psychiatric medications cold turkey (yeah, that wasn’t the first time I had done that and I do not recommend it).
Throughout the duration of my Cymbalta treatment, I have seen my doctor at least twice a month, and mostly it’s been once a week. It’s good to have that kind of supervision, and since he’s a psychologist too, it means that medication has not been the only treatment I’ve relied on. This time I have actually learned a lot about how to cope with anxiety so I am not solely reliant on medication. I mean, having a steady stream of SNRI medication does a certain job – but it isn’t going to address all the shit that makes me anxious in the first place.
So why am I weaning off the medication? Two words. Side effects.
Okay, so I never just leave it at two words. So I’ll elaborate. Going on Cymbalta helped me a lot. But it also helped me gain a lot of weight. I mean, I won’t even get on the scale it’s that bad. But last time I looked I think it was somewhere around 20-25kg (or around 45-55 lbs). And the risks of carrying this much excess weight is starting to outweigh the benefits I am getting from the Cymbalta – especially since I have learned so much about how to cope when I am anxious, and because I have changed my lifestyle and expectations so much that I don’t get as overwhelmed as I used to.
And even if we talk about health at every size (HAES), I don’t like how out of control I tend to feel with my eating when I am on this medication. The sugar cravings are insane. And I am not alone in this; a bit of online sleuthing has shown me that there are lots of people who feel like the sugar cravings are hard to cope with. People who have never had a ‘sweet tooth’ have written that they have found themselves sugar fiends when on Cymbalta.
I also don’t like how my body feels when I am moving. It’s hard to get onto the ground, and hard to get up from the ground. My knees get sore. My back gets sore. And I am edging closer and closer to 50. I am sure that things are only going to get more difficult as I am ageing if I am dealing with this excess weight.
Another side effect I could do without is the sweating. Cymbalta seems to keep me really toasty warm. Which isn’t so bad in winter – but as soon as it starts to warm up, I am dripping in sweat from the slightest activity. Yuck. I hate the sticky feeling of being sweaty, and I have always been intolerant to temperature extremes.
And then there is the dryness. Can’t be too sure whether this is from the medication or from perimenopause hormonal changes – and maybe it’s the combination of the two that puts things over the edge. But my eyes are dry, and that’s been causing changes in my vision, and requiring me to use eye drops a few times a day.
And speaking of dryness – there’s the sexual side effects. More dry but also less impactful orgasms. It’s kind of like… they are there, but they are muted. The intensity is turned way down.
This makes sense to me when I consider what happens when I start to decrease my dose of Cymbalta; my senses all seem to heighten. But more on that later.
Finding the optimal dose is not easy
I think that it was my doctor who brought up the dose reduction (this has never happened before in the long history of Jamie taking psych meds – it’s always been adding on more meds instead). I had been on this dose since April of 2022. I was supposed to reduce my dose in July, but just before that happened I got Covid, and the kids were home for school holidays, also with Covid, and then I was just under too much ongoing stress to change things up.
But in November we talked again about reducing my dose from 30mg to 25mg to start. Not necessarily expecting that I would completely come off of the medication, but truthfully that had snuck back into my brain as a goal once again. Most of which had to do with the weight gain and out of control eating. But in looking back, I can see that I have been seeing it as some sort of marker of success. Which I do need to explore a bit more. But that’s for another time.
In early November, making that cut from 30 to 25 was a bit rough. This is where I noticed that there was a lot of sensory overwhelm. I was noticing everything again. Sounds were really intense. I couldn’t cope with conversation, the buzz of the fridge… everything was agitating me. I suspected that this was a part of the dose reduction, and went back and read my older blogs about reducing the dose, and yes – it was all there. The reduction in dose led to a temporary increase in sensory awareness and overwhelm. But it would go away. I felt better, knowing that what I was experiencing was going to go away once my brain acclimated to the new, lower dose.
Going from 25 to 20, I felt a bit more mental overwhelm. It’s a bit hard to describe and since I wasn’t writing I don’t really know what I was thinking. I just felt a bit ‘off’. But I was still coping okay. In fact, in my therapy session, we talked about how I had gained some emotional maturity. It felt as though I was on the right track. Yeah, sometimes things would be challenging, but I really felt like “I got this!”
And then after adjusting to the new dose for a couple of weeks, I had a car accident. It was pretty intense, with air bags going off, ambulance, police, hospital. There were no serious injuries but it was still massively overwhelming to my nervous system. But I knew what to do to help myself in that situation. And I remember crying a lot for the first couple of days, and having flashbacks, but I felt as though the things I did for my nervous system in the hours after the accident had made a big impact, and I felt eerily calm about things. Still feeling like I was doing much better overall, we decided on lowering my medication dose again.
I hit my threshold
Going down from 20 to 15 has been really difficult. And I don’t think I can do it. Not now.
I suppose in part, it’s a higher percentage drop. 5mg becomes a lot as the dose decreases. I knew I was struggling pretty quickly, and checked in with the doctor who recommended that I alternate between 20mg one day and 15 the next. But I didn’t do that. It was close to Christmas when we had that conversation, and I decided that I would just wait and see how I felt after the holidays. The holidays are always challenging, and I wanted to know what was ‘me’ and what was ‘my circumstances’.
But it’s now January 8th and I have been struggling more and more with each passing day. I noticed that the sensory awareness had turned way up again. I am noticing too many things. Sounds. Inner sensations. Agitated by clothing, sweat and other tactile sensations. One part of one song playing on incessant loop over and over in my mind.
I have been really emotional. Teary. Teary over silly things, or just a ‘depth of emotion’ kind of teary. Like it’s all too much to endure. Like those tears are just waiting for something to bring them out, so there’s some kind of release.
Teary I can live with. I don’t even really mind it. I used to cry nearly every day.
But as the days wear on, it seems like I am slipping further and further away from my version of okay. I have felt depressive feelings; I’ve been lacking motivation, thinking things like ‘what the fuck is the point of life?’ and ‘why bother with trying to get better?’ And thinking that any improvements in my life have been a result of medication only.
I’ve been (unreasonably) angry with my doctor for believing that I was okay to do this, and especially over the holidays, and while he’s gone on leave.
I am struggling
I find it harder and harder to get going in the morning. Harder to get anything done without some significant outside pressure (such as a work deadline). I have hardly written anything; felt like what’s the point of doing this blog for an audience of nobody (even though I know I haven’t made any effort to build an audience). Wondering if I could be bothered doing anything besides the bare minimum of what’s required.
And the worst thing is that the obsessive thoughts about my body are back in full force. Like the volume on everything else is turned way down, and these thoughts are turned way up. Like I don’t want anyone to talk to me, so I can focus on ‘checking’ on my body. That sensation in my side; there’s no ‘pain’ – just ‘noticing’. And while I am not stressed about whether I am actually dying like I used to be – I have gotten caught up in the loop of thinking, and checking. I am pretty sure this is OCD. And the volume is just up way too high right now for me to access the things that could help. I am way too distracted. Obsessed.
And sometimes I do get caught up in tasks and focused in, and I have a brief reprieve from this kind of thinking but as soon as there’s some transition away from the task, I go right into the obsessive checking of my body. For instance, I had to get the groceries yesterday. I was obsessing before I went, but while I was shopping I was so focused on the task of dealing with all that it takes to shop that I didn’t think about my body. But as soon as I was on my way back home, it started up again.
I hate this, and I know that my hatred of it only makes it worse. But I haven’t been able to stop myself.
And I cry because I feel like a failure because I haven’t been able to cope with the reduced dose. I don’t care if it’s because of the accident; or because of the holidays; or because I have the kids home for 6 weeks and have to deal with more demands and less solitude. I am judging myself for my inability to cope. I am coming to terms with the fact that I do still see being on this medication as a failing. But I also think that I want to be ‘the good patient’ and prove myself to my doctor that I can be a success without the medication. Even though I am quite sure he explicitly told me that it’s not the goal. I guess I feel like if he believes in me being able to do this, I should be able to live up to it. To gain approval. To feel a sense of accomplishment.
But that’s just the tip of this iceberg. The more ‘obvious’ underlying motivation.
Peeking underneath the iceberg
As I write this I am discovering something even deeper. Another trauma response perhaps. This seems to be an inner child kind of thing. I think it is to do with wanting to reflect back that he’s a good doctor because he could help me. What the actual fuck. It’s not like he needs my validation. I am sure that has more to do with my past, and my father & former stepfather, than with my present and my doctor.
Why am I acting out this shit, in this way? Like if I could make my parent feel good about themselves then that was the fastest, most reliable path to being safe, loved, accepted – or even to get the bare minimum of the attention I was seeking. I’ve had to pause here as this is a lot to get my head around. I think I will be bringing this up to my counsellor who I will see later this week.
But for now, I want to delve into what came up for me around attention seeking. Anxiety and depression have, in the past, been the only acceptable reasons for me to stop pushing so hard and to take care of myself. In the past this has meant taking very long stretches of being in shut down. It’s all too much; I spend as much time as possible in bed, doing as little as possible.
Over the last few years I have learned to add in some self care on most days. Usually this means taking about 45 minutes in my room by myself. I usually get under my weighted blanket, put an eye mask on, and listen to a guided relaxation. Usually a body scan. I often drift off, either just becoming unaware of my ‘self’ or falling asleep.
I have continued to do this throughout the medication changes, but I don’t think it’s enough. I have had less of my outside supports lately too. Less massage. Less therapy. Less structure. Less routine. And more stressors. More noise. More time with people. More interruptions. More work. More stuff to deal with overall. But I haven’t changed what I am giving myself. And ironically, I end up feeling more and more alone, although I am never alone. I just cannot connect with people because I am too overdone.
My husband has been dealing with ‘his own shit’ and I haven’t wanted to ask for extras from him. But maybe that is also a part of the anxiety loop. Maybe I feel like it’s acceptable to ask for his time and attention, and to meet my needs if there is a ‘legitimate need’ – that need being that my mental health is suffering and I need his help. I want to be taken care of, but I want to be taken care of by someone other than me. But why not both? I am going to have to do better at taking care of myself.
The plan – for now
I need to write. I haven’t been doing it and I feel so much better having sat here and written this. Regardless of whether anyone ever reads it.
I have decided to increase my medication back to 20mg tonight; may do the alternating thing for a few days to see if that helps, or might just bump to 20 until my next appointment.
I have also decided to take more ‘breaks’. If I need two of those 45 minute sessions, then I will take them.
And I will try to figure out what it is that I want and need from my relationship with my husband. And communicate that.
But now I am really exhausted. So I am going to listen to what my body is telling me, and I am going to have a rest before I do anything more.