May Cause Side Effects

There is no doubt that medications for mental health related issues can be life-changing and even life-saving. It is important to say that not everyone will experience side effects, and if they do, they may range in severity, and longevity.

But what happens when the drug works but also changes your cognitive capacity? Or affects your behaviour, body or even challenges your very identity?

I’ve always thought it was unfair that an added and often overlooked part of mental illness and distress comes from the very treatment that we are given to help us cope.

Recently after a stressful period of completing training and a practical placement, I experienced an increase in my anxiety and OCD symptoms. After struggling for a month I realised that I needed more than talking therapy and EFT, so I decided to ask my doctor to up my dosage of Sertraline (Zoloft).

I desperately wanted to turn down the noise on the frequent thoughts about being trapped and reduce the intensity of my anxious arousal. Any perceived pressure to stay in a situation and behave ‘normally’ triggered a panic attack or the threat of one:

• I would get overwhelming intrusive and repeated urges to leave wherever I was – Cafés, bars, shops, work etc. Images of how far away from home I was filled my head, pouring fuel on the fire of my amygdala with increased fearful stimulus.

• Years of panic attacks and associating them with being away from home and unable to get to safety has well and truly carved a deep groove or pathway into my brain. The survival response dutifully kicks in and I am filled with adrenaline to make my escape which then makes me feel a whole other level of fear - confirming that I am in danger.

Back to the Medication

A couple of weeks after slowly upping my dosage to 150mg from 100mg , I began experiencing episodes of dissociation or ‘zoning out’. Although I was still having anxiety and panicky thoughts it was as if blank spaces had been created in my brain. Instead of my anxiety being trapped by a solid dome around my head, there were now sieve-like holes appearing. These gaps seemed to occur when I was distracted from thinking and my adrenaline had subsided. The only thing was that the effect was to feel as though I had lost myself momentarily, like I had disappeared, and then woken up a few seconds later wondering what the hell happened.

Dissociation is not new to me, I have experienced it previously, but the level of confusion and general brain thickness was really quite alarming. My cognitive function has definitely been impaired by the medication. Scarily, I forgot I had left a small pan of rice cooking on the stove (for my dog) and almost caused a fire, something I had never done before. If I wasn’t completely focused on a task in hand, I felt like I didn’t know what the hell I was doing.

While the side effects have been exacerbated by winter SAD, it is still an example of the double-edged sword that is medication and mental health.

You can’t reduce obsessive thoughts without also slowing down the brain’s ability to focus and stay on task. You want to stop remembering the places you panicked and the repeated images and thoughts of doom, it seems you might have to accept a certain amount of brain fog – much like the thick smoke that filled my kitchen during the rice disaster.

How I wish my brain could be both calm and sharp.

After the kitchen accident I seriously considered reducing my medication; I didn’t like feeling as though I was in a disconnected dream world, and I wasn’t sure if I was feeling enough reduction in anxiety for it to be worth sacrificing my mental faculties.

One of my friends who took medication for her bi-polar would regularly lower her dosage because she felt so tired, brain dead and lacking in motivation. She would feel wonderful briefly before she didn’t, and inevitably had to increase again.

While I know that people can and have achieved a balance with their meds, I hate that it often seems like there is a price to pay for getting some relief from mental distress.

Many people find the side effects from beginning their medications are too awful to continue and may never even feel the benefits from them in the first place. In fact, “You think your anxious now!” Should be the slogan for some drugs when beginning treatment.

The thing that makes it worse is the doctors who don’t advise patients to start on a very low dose and gradually increase. Doctors may think they are doing this when they follow the guidelines, but I can tell you now, the guidelines are not always correct or guided by patient experience. Message boards are full of people saying that they couldn’t manage the side effects when starting a drug because they started too high and increased too fast. They quickly stop taking it, believing that the medication was bad for them, when they could have gone up slower and had a better chance of reaching a level in which they felt positive effects.

I was told by my GP that it was standard practice and safe to increase Sertraline by 25mg for a week and then go up to 50mg. My reply was no that doesn’t work for me.

I cut the 25mg tablets into quarters and upped it week by week before finally getting to 50mg after around two months. Every time I went up, I had a manageable increase in anxiety and fatigue for a couple of days and then it settled again. I know my body is sensitive to changes and if I had gone straight onto 25mg the side effects would have been horrendous.

Some people would be fine, some, like me, just aren’t.

I do, however, suffer with anxiety and am therefore more sensitive to the common side effects of feelings of 'increased nervousness and agitation'. Titrating up on anti-depressants for someone with depression for example, may be very different and the speed of treatment may be considered very necessary in some cases.

• If anxiety while upping meds feels unbearable or pushes you towards crisis, don’t be afraid to ask for support or a beta blocker or a mild tranquilizer to get you through the side effects. It's hard but please don’t suffer or give up too quickly on medication that might help you in the long run.

Since I started to pay more attention to the dissociation, it has thankfully decreased. I have also noticed that the SAD light has made a positive difference to my foggy brain and feelings of, well let's call it - bleurgh.

If I consciously choose to focus on what I am doing, I do not seem to slip as easily into dissociation. I have to be aware of my surroundings and actively engage my brain with what is happening. My memory is still frustratingly bad, but I am coming to terms with it and have stopped my inner critic berating me for being 'thick'.

Switching off is easier with the medication, which I am grateful for in some ways. I am still in a pattern where I do sometimes give in to the urge to leave where I am when I have a panic attack. But I also have managed to stay in cafes and pubs and not let it beat me, and when I do it feels really, really good.