Meta symptoms of SSRI withdrawal

Derail

SSRI withdrawal causes many symptoms, both physical and emotional.  In some cases, the emotional symptoms can combine to create larger symptoms, meta symptoms.   Renewed or new depression is one of the most common symptoms of withdrawal.  Depression is an inward emotion.  It forces the patient to examine themselves in an overly critical manner.  In that compulsive self examination, other symptoms can emerge.  It’s not the healthy self examination of mindfulness or self awareness, it is an uncontrollable focus on the negative.  The patient doesn’t see themselves in a mindful light, but through the dark lens imposed by the depression.  Even joyful memories are seen in that distorted way.

Regret and Guilt

The depression of withdrawal forces the mind to pick negative aspects out of any event and focus itself on that exclusively.  That single minded focus creates regret in the patient.  Many times, it is out of proportion to the event itself.  Regret and guilt are very similar to each other.  They feed on each other.  Withdrawal pushes the mind to see guilt in places that the patient normally wouldn’t.  Withdrawal depression narrows the focus of the mind to see only the negative in an event.

I only remember a few things from my 10th birthday.  My parents had organized a party for me and invited several friends to come over.  I had wanted toe clips for my bicycle for a long time, and was very happy that I got them for my birthday.  Being 10, I wanted to install them on my bike right away.  During withdrawal, the nature of that memory changed.  Instead of remembering the happiness of the event, I focused on the fact that my parents scolded me for installing toe clips instead of playing with my friends.

Compulsive memories

One of the symptoms of SSRI withdrawal is renewed memories.  While taking the drug, memories are largely suppressed.  Many patients report that they do not have a good sense of what happened to them while they were on the drug.  They know the larger arc of events, but many of the details are missing.  The emotional nature of memories is likewise suppressed.  During withdrawal, the emotional tie to memories is reawakened.  It doesn’t happen in a linear way, though.  Instead of recalling memories in an associative way, where one memory reminds you of another, memories flood into the conscious mind without context.  It can be profound or trivial, the only commonality is that the memory is not recalled, it is imposed on the mind.  It is a sign that the mind is reordering itself, cataloging memories and emotions into a new order.

For more than a month I couldn’t get the image of a fast food restaurant out of my mind.  I ate lunch there 2-3 times a week for a year, 4 years ago.  The restaurant didn’t have any particularly strong memories associated with it for me.  Every time I tried to go to sleep, though, the image of that Wendy’s just wouldn’t leave my mind.  There was no guilt or other emotion associated with the image, I just couldn’t see anything else when I closed my eyes.

Fear of relapse

At first, withdrawal is unrelenting and overwhelming.  The symptoms occur continuously.  As time goes by, symptoms begin to break up.  Withdrawal becomes a cyclical thing.  There are times when symptoms are severe, and times when they are light.  People call them Windows and Waves.  A window is a period where symptoms are lighter, waves are times when symptoms are more pronounced.  There is an inevitable fear that arises from feeling better.  It’s not intuitive to an outside observer, but it is a real phenomenon for the person going through it.  Withdrawal creates a mental relativism where the way you feel at the moment feels like a permanent state.  Combined with uncontrollable negative self examination, waves begin to feel “realer” than windows.  That breeds a distrust of windows.  There is always the fear that a window is just a prelude to another wave.  Windows and Waves are closely connected, they are part of the cycle of recovery in SSRI withdrawal.  There is some validity to that fear of relapse in the beginning.  Windows will revert to waves, just as waves will break up into new windows.  As time goes by, the windows become longer and the waves become shorter.  There is no point in time that the patient can point to when the severity of waves falls below the level of awareness.  It’s one of the subtleties of withdrawal that progress can only be measured once it has occurred.  You just realize one day that you haven’t experienced a wave in a long time.  The last window has just extended longer than the others, with no wave afterwards.  The fear of relapsing into a wave lingers, though.  It becomes one of the central thoughts during recovery.  Slipping into a wave feels like getting sick, just mental instead of physical.  It begins with a subtle feeling of instability.  It then progresses into more profound feelings of despair.  Waves are very difficult to deal with.  The entire context of the mind has been altered.  There is little memory of feeling better, just the emotions associated with the wave.  So, when the wave breaks up into a window, there is a legitimate fear of the next, seemingly inevitable, wave.  The inevitable thing about withdrawal is that recovery will happen, though.  Many people have experienced prolonged feelings of despair, even suicidal ideation, and recovered themselves in the end.

The best way to deal with the window/wave cycle is to recognize that it is occurring.  It’s difficult to think of waves as temporary phases in recovery.  Somehow, it’s easier to believe that the windows are the temporary phases.  Being mindful of the cycle between windows and waves helps.  Just as windows are temporary in the beginning of withdrawal, waves likewise become temporary as recovery progresses.  Think of the last time you started a new job.  At first, all the new information felt overwhelming.  It’s easy to think that you will never absorb it all.  You quickly become accustomed to the new routine, though.  Eventually, the daily tasks lose their overwhelming quality and become easier to accomplish.  Withdrawal is similar in some ways.  At first, it’s very hard to believe that it will ever end.  Eventually, you begin to reclaim yourself, and it gets easier the longer you do it.

The Pain of Paxil

Sugar Maple

I began weaning myself off of Paxil in June, 2011. I had this sense that my life had been put on hold for more than 10 years, and I wanted to start feeling again. It seemed like I hadn’t been myself for a long time. It was very hard to define exactly what the differences were, but I knew that I was not as connected to the things that I enjoy in life anymore. I began by consulting my doctor about a reduction schedule. He advised me to reduce my Paxil dosage at a steady rate over the next two months until I was not taking the drug anymore. I decided to double his schedule and aimed to be Paxil free by November, 2011. I cut my 40mg pills into smaller and smaller doses, starting with 30mg, then 25, then 20, then 15, then 10. Finally, I was taking 2.5 mg/day until I took my last dose on November 14, 2011. September and October were very challenging months for me. I lost a lot of weight, I experienced severe anxiety and anger. My emotions were a bit beyond my control at times. My doctor thought that it was the re emergence of a pre existing problem. I was originally diagnosed with situational and social anxiety. Both of those conditions were very mild compared to the problems that I was having while stopping my Paxil usage, though.

I eventually made it through the bad times and was able to see what I was like without Paxil. November and December were much better months for me. I still had withdrawal symptoms, but my mind and my mood were much clearer. I started to write short stories and blog posts more often, I read a great deal more than I had in years. I went back to my old office and the people there were amazed at the difference that they saw in me, the way I talked, the way I carried myself. I had completely transformed in their eyes back to the way they remembered me from 12 years ago. It was a profound experience for me, seeing myself through their eyes. I began to see what effect Paxil had on my mind, and how it had changed my personality. I had been taking my life and career for granted far too much in the past decade. I thought that my apathy was a result of an internal failing. I never realized that Paxil was suppressing so much of my mental strength that things like work or relationships didn’t matter to me, anymore.

About two months after my last pill, I entered a severe withdrawal period. In the middle of January, I found myself lying on the living room floor, curled in a ball, racked with anguish. I envied those that had the strength to kill themselves. Suicide had never been an issue for me, I had never thought about it until I tried to stop taking Paxil. As I said, I have social anxiety. I am a very shy person who feels uncomfortable in crowds or when dealing with interpersonal situations. I started taking 10mg/day of Paxil again January 18, 2012, and those symptoms largely disappeared. I’ve found that I have a very foggy head, though. It’s very difficult for me to concentrate on anything for extended periods, and I have again been cut off from my emotions. My cat died a few days after I reinstated my Paxil usage, and I still have not grieved for her. I now know that Paxil is suppressing those emotions. They are still there, but I am not dealing with them in a healthy way. Instead of experiencing grief and loss, the drug is pushing all that away from my conscious mind. The feelings are still there, but hidden from me. I’ve found that I can’t write creatively, either. I’ve tried to sustain a story idea, but the continuity is missing. The creative force is gone. I’ve always been a slow, deliberate writer, but now the ideas just refuse to form in my mind. I can almost feel a physical barrier between myself and my creativity.

I took this drug not knowing the nature or strength of the effects. I went to my doctor, told him that I feel anxious in social situations, he prescribed Paxil, and I started taking it. I had great trust in the medical profession and the solutions that modern chemistry could provide. Now that I’m looking back on my Paxil experience, especially after the short period that I was Paxil free, I want nothing more than to stop taking this drug. I know that the underlying issues will still be there, but they are mild compared to the profound effects that Paxil has on my mental processes. I need to be patient with the process, though. I know that my crash and relapse into Paxil use was caused by weaning myself off of it too quickly. My current schedule extends into the first part of 2013, which seems like a long time, too long. It must be that way, though, or I will find myself relapsing again. I say relapse because I’ve come to think of this drug as equivalent to any other narcotic that causes dependence. The only difference between Paxil and a street drug is that it has been approved by the FDA for prescription use. It’s just as powerful and addictive as any street drug, and has an equal capacity to ruin the user’s life. It should be used as a last resort to treat severe mental issues. Instead, the Pharmaceutical companies market these drugs in a reckless, casual way. Television is filled with advertisements for drugs to treat an ever widening range of symptoms. Instead of developing more refined treatments for problems, the emphasis has been on wider applications and acceptance of these powerful psychotropic drugs. Most likely, there will come a time when there is a national crisis fueled by a celebrity death that will focus our attention on the harm that these drugs are doing to our society. Suppressing a population’s mental strength through the use of drugs is a dystopian idea that I thought could only exist in fiction. Instead, we live with it every day, and don’t seem to care. It’s just another effect that the drug has on us.