Farewell Phenelzine 2.0 (The 2021 Edition)

The decision to change my medication has been a long time coming. I was diagnosed with ADHD back in January but, for various reasons, I haven’t been able to take any medication for it up to this point. As I said in this post, my specialist wouldn’t allow me to take any of the classic, stimulant medications for ADHD while I was still taking my current antidepressant, Phenelzine. So, in order to take anything for my ADHD (other than the less common medications that would only make me even drowsier than I am currently), I would have to come off the Phenelzine and either try a different antidepressant or try going without one. That all felt too much to manage while I was doing my Masters – it feels like a lot to manage now – but now that the Masters as is over and I’m already in a period of transition, it felt like it was time to come off the Phenelzine. The side effects were going to throw a wrench in several plans but that was going to be the case regardless of when I decided to do it and I hated the feeling of having it hanging over me. I know I need to do it but a big part of me really didn’t want to (and is still sceptical to a certain degree): over the last ten years, I’ve found it all but impossible to write songs during the periods when I wasn’t taking Phenelzine so it’s not surprising that it’s not exactly an easy decision. But if I want to get out of this limbo state, then I need to try.

So, beginning the 18th November, I started to reduce the dosage of the Phenelzine. For two weeks, I took half my normal dose and then I went another two weeks without anything in my system, giving my body the time to filter out any traces of the Phenelzine (known as the wash out period) and ensuring that way any new drug I take won’t result in a negative interaction. As always, it’s important to point out that this is a plan I’ve worked out with my psychiatrist and my ADHD specialist and is specifically tailored to me. If you’re making any changes around any medication you’re taking, please consult your doctor first.


REDUCTION PERIOD

WEEK 1 (Monday 18th October – Sunday 24th October)

For most of the week, I felt fine, which surprised me: usually, if I miss a dose of Phenelzine, I get hit with a headache pretty quickly but for some reason, that didn’t happen this time. I was tired and a bit more emotional than usual but nothing that out of the ordinary, nothing that couldn’t just happen anyway. I think those first four days lulled me into a false sense of security.

It hit me on the Friday. I felt weak and shaky and had a really unpleasant headache. And that turned into feeling absolutely awful over the weekend: I had debilitating migraines; I felt nauseous, shaky, and lightheaded; I thought I might faint every time I stood up. I also developed an annoying cough and, after multiple COVID tests, I had to assume it was part of the withdrawal and not COVID related (thank goodness – I don’t think I could’ve coped with that as well and I’m glad my family didn’t either).

WEEK 2 (Monday 25th October – Sunday 31st October)

The cough and the migraines continued into the middle of the week and then, fortunately, they started to let up. My sleep schedule was utterly screwed up: I was struggling to get to sleep and not drifting off until between two and five am and then, because I was so exhausted, I was sleeping in to the middle of the afternoon. And as hard as I tried, I couldn’t correct the schedule. I also had really weird, really vivid dreams that took me a while to drag myself out of and separate dream from reality. I did have a sudden, deep dip in mood where I felt really awful and discouraged about the various things I’m currently working on, which was scary: my big fear about coming off the Phenelzine has been returning to that really depressed place I was in before so to feel it happening was horrible. But fortunately it didn’t last and I’ve tried to just stay away from things that trigger those kind of feelings, for the duration of this changeover at least.

By Sunday, things had started to improve and I was feeling a bit more human. Having said that, I was not looking forward to the rollercoaster that the next two weeks were likely to be.

WASH OUT PERIOD

WEEK 1 (Monday 1st November – Sunday 7th November)

The beginning of the week was okay with just minor headaches and some nausea, both of which were pretty ignorable. And apart from sleeping really deeply and the continuation of the weird, vivid dreams, I felt okay. But by the end of the week, I was feeling very tired and just generally unwell again. The cough had faded but it picked up again and then, on Sunday, the nausea was back in full force.

WEEK 2 (Monday 8th November – Sunday 14th November)

This was a very big week. Unfortunately. It was a really bad time to be coming off a medication but, as I said, it’s almost always a bad time. There’s always something happening so I just had to get it over with. But this week held both my graduation from university (I had a great time but physically, I did spend the day counting down to the next dose of painkillers and – on several occasions – actively focussed on not throwing up) and my Granny’s Celebration of Life service (thankfully, by that point, I was feeling a bit better and was able to just focus on the day without too much distraction). Given those two huge things, I spent a lot of the week dealing with a lot of physical exhaustion and pain.

The cough was ongoing and I had migraines for most of the week, although they did lessen in intensity by the end of the week. I was nauseous, shaky, and overly emotional but, again, that had mostly passed by the weekend. On the Sunday, I was a bit weak and nauseous but I felt a lot more human than earlier in the week.


So, four weeks later, I’m finally starting medication for my ADHD. I’m excited but I’m also nervous; I haven’t had many good experiences with medications and it’s taken a lot of trial and error to find the only one that’s helped so far. So it’s a bit scary to be starting over with a whole new category of medications but I’m trying to stay… cautiously optimistic. I’ve started Xaggitin XL and now, I guess, I just have to wait and see.

Reducing and Coming Off Pregabalin

Months and months ago, I had an appointment with my psychiatrist and we reviewed the medications I was taking and how I was faring mentally. There was a lot to discuss but we spent a significant amount of time talking about how affected my life is by the sleepiness I experience, as well as the high levels of anxiety I’d been experiencing despite taking the Pregabalin. The result of this conversation was the decision to reduce and eventually stop taking the Pregabalin as it didn’t seem to be helping.

The reduction ended up being pretty uneven, without any particular structure. That was mainly due to the decision to take my time and take less as I felt able to; I didn’t make any alterations during my assessment period at university, for example, as I figured I had enough to cope with. But there were also periods when I was so preoccupied that I simply forgot that I was in the process of reducing it and only lowered the dose when I remembered. Fortunately it wasn’t as traumatic a transition as some of them have been.


150mg —> 100mg

Dropping from 150mg to 100mg, I noticed fairly quickly that my levels of anxiety were going down. At the very least, I had fewer periods of the paralysing, suffocating anxiety that short-circuit my brain, killing my ability to do anything at all. I also started to have more periods of general okay-ness. I wouldn’t quite describe my mood as good, but it definitely moving in a more positive direction than it had for a long time.

I was experiencing specific anxiety around the spread of Covid-19 but I figured that was normal for most people, especially those who already suffer from higher levels of anxiety or anxiety disorders. My as-needed prescription for Diazepam was helpful when it came to managing that, as well as taking precautionary measures.


100mg —> 50mg

I immediately suffered from side effects after this change. I had almost migraine level headaches that I could only manage by lying in bed in my darkened room. They remained at that intensity for several days before fading to a dull throbbing that painkillers took care of for the most part. I also had trouble keeping food in my system; I don’t think I need to go into any further detail on that.

I didn’t feel any different once the side effects passed but after a while, my Mum commented that I seemed less sleepy. I wasn’t convinced but kept an open mind and eventually I did think that I wasn’t feeling quite as drowsy. Part of that was down to the fact that I was drinking less Red Bull than I had been. That seemed to prove that I was needing less caffeine to function and was therefore feeling less sleepy.


50mg —> 0g

Again, I felt the side effects straight away. I had the same headaches although fewer of them and my digestive system also struggled. But with this reduction, I was also nauseous on and off for days and constantly shaky. It was very unpleasant and still hasn’t faded completely, even though I’ve been Pregabalin free for a couple of weeks. But maybe that’s been underneath the Pregabalin all along. I don’t know.

Aside from the side effects, my ability to sleep well disappeared overnight. I can’t be sure that it’s connected but it did start happening around the same time so I think it’s important to include here. I either wasn’t sleeping or having vivid nightmares that left me feeling disturbed and unsettled throughout the next day. I’ve read that this has been a common complaint during the pandemic so I’m thinking that it’s more to do with that than the Pregabalin however, it did start just as I finally stopped taking said medication. It seems unlikely that there’s no link at all.


Now, a few weeks later, I think it’s safe to assume that I’m no longer being affected by the Pregabalin or any withdrawal symptoms. Having said that I am still pretty sleepy and drinking at least one can of Red Bull a day, usually two. I still feel pretty weak and shaky, especially if I have to stand up or exert myself for more than about fifteen minutes. I’m also still sleeping badly with nightmares almost every night. It’s pretty gruelling.

I’m continuing to review the medication situation with my psychiatrist – although it is more difficult while we can’t have face to face appointments – and there are multiple options to think about. I haven’t decided what to do yet. We’re also continuing to investigate physical causes for my fatigue, although that has been put on hold by the lockdown. The restrictions are loosening but I’m not sure what that means for this situation. So, for now, all I can do is research and hope to make the right decisions when the time comes.

Don’t You Lose Your Halo

The last few months have been particularly difficult, anxiety and depression wise. I came of my anti depressants and one of my anti anxiety medications with the intention of starting a new medication but starting that new medication has been a real struggle. This new low brought on by the withdrawal and the lack of meds has been possibly the worst I’ve ever felt. I’m aware that it’s affecting my thinking and my decision making but right now, the starting of a new medication just feels impossible. Just the thought of it triggers an autistic meltdown. So it’s safe to say I’m struggling.

BUT the last week has been better for exactly one reason: I got to see Maren Morris in concert! In fact, I got to see her twice! So that’s what I want to write about: seeing her and how concerts are something that can really help me when I’m feeling very low. There’s something about the energy that just lifts me, makes my body feel lighter and that’s so very valuable when I’m in this place.

My first show of the tour was Bristol. As I’ve mentioned in previous posts, if possible, I like to go to multiple shows of a tour because I get overwhelmed so easily. Seeing the show more than once allows me to really experience and enjoy all of it. Concerts are pretty much the only thing I spend money on so I’ve been very fortunate in this endeavour.

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The show was incredible. I’d been feeling very, very depressed in the days leading up to the show and didn’t even want to go – it felt like it was wrong to want such a simple ‘fix’ to my low mood and like seeing such an amazing songwriter would hurt too much given that I haven’t been able to write a song in months (if not longer) – but as soon as Maren Morris took the stage, I started to feel lighter. It felt easier to breathe. She’s an incredible songwriter and performer and her voice is out of this world: I remember once describing it as sounding like a gorgeous sunset. Hearing the new songs was like hearing them for the first time and hearing the old ones was like a wave of nostalgia: they remind me of my degree, of my first trip to Nashville, of writing songs in my best friend’s living room, of a younger, less troubled version of myself.

The song that really got me was ‘A Song For Everything.’ This is what I wrote in my diary after the show:

“Given how emotional and tearful I was, I was crying by the first chorus. It just lifts my soul and makes me feel lighter, like I’m going to be okay, like I need to dedicate my life to writing a song like that and so I have to be alive to do it. I was breathless by the time the song finished.”

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“I don’t often cry at concerts (it usually happens when I hear the songs again for the first time after the show) but this one just got me. My depression is the worst it’s ever been but tonight… helped. I could write a book about the emotions of the last few days but I’m so tired that even this is a struggle. @marenmorris, thank you for being there exactly when I needed you to be. Thank you for reminding me that there’s a song for everything and that maybe one of them could be written by me, but that I need to be here to write it. #girltheworldtour

I had a day to recover before my next show, in London. At the freaking Royal Albert Hall. This is probably my favourite venue I’ve ever been to and it’s my ultimate dream to sing there one day. One can hope. And work hard. Anyway.

The day of the show, I cried all day. I was miserable, deeply, deeply miserable. I was on the edge of a meltdown all day but somehow I was holding it back because I knew if I had a meltdown, I wouldn’t be able to go to the show. Me and Richard (my best friend and writing partner) had bought the VIP packages, which meant we would get to meet Maren before the show and I couldn’t miss that. But even though I was looking forward to it, I was paralysed with anxiety. I didn’t know what to say or do and the fear of wasting the opportunity was so great that I couldn’t think. I couldn’t think my way through the problem and that was almost the worst part.

I cried all the way to London (listening to ‘A Song For Everything’ on repeat) and I only really managed to get myself together when I arrived at Victoria station. Holding onto that song helped somehow. I got to the Royal Albert Hall, met Richard, and we (all the VIP package holders) were all taken in for the pre-show Q&A and meet and greet. It went okay. I’m not gonna lie, I was actually shaking. It wasn’t specifically because I was anxious about meeting her – I’d met her on the previous tour and she’s absolutely lovely – it was more that I was worried about it going wrong, that I’d waste the experience by saying something embarrassing or meaningless. Looking back at it now, it went okay. It could’ve been worse, it could’ve been better. Maren was very sweet but I didn’t feel able to be as honest as I would’ve liked to be, for multiple reasons.

When the doors opened, we went to find our seats and discovered that we were FRONT AND CENTRE. At the Royal Albert Hall. For Maren Morris. I think that was when I first started to feel more excited than anything else – anxious, depressed, lost (“The depression was receding – just out of reach – and it felt easier to smile, even if it was a little slow and stiff.”). And all of that completely fell away when the show started.

It was one of the best shows I’ve ever been to. Maren is one of the best performers I’ve ever seen, her vocals are unmatched, and I love her songwriting more than I can properly express. The upbeat songs were so much fun and the slower songs were quiet moments filled with emotion. It might sound like any other concert (any good concert) but the energy was bigger and bolder and brighter than any other concert I’ve been to. I lost my voice long before the show was over but that didn’t stop me from singing along. And as I said in my diary, “I’m always self conscious dancing but sometimes, if all the stars align, the constant tension in my body releases and I can just move as my mood dictates. It’s not very elegant but it is fun.” She even had special surprises planned: performing ‘Seeing Blind’ with Niall Horan and bringing a string quartet (an all female string quartet!) on stage for several songs. The whole thing was magical. I never wanted it to end. But unfortunately it had to, although she closed the show with style: an amazing performance of ‘The Middle.’ Me and Richard have spent so many car journeys and writing sessions and just hours of our lives singing that song; singing it with Maren Morris from the front row of the Royal Albert Hall may be one of my favourite memories of all time.

Another snippet from my diary: “The performance was incredible and hearing everyone sing along just made my heart soar. It was all gone and I felt alive and light and happy. I was tired and achy but it was amazing.”

Getting home was hard. I had a huge adrenaline crash and all the negative emotions returned and that, combined with several unpleasant incidents on the train, had me in tears before I was even halfway home. I also struggle physically after concerts: my whole body hurts and that was starting to set in so yeah, getting home was a struggle. But I made it and my Mum was kind enough to prepare macaroni and cheese and ice cream (not together), which did help a bit. My brain wasn’t really ready to go to bed but a migraine was setting in (another side effect of concerts) so I didn’t have a choice.

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“Yesterday was a very difficult day. The depression was bad; I shook, I screamed, I cried (probably seven or eight times). It was miserable. But in the evening, I got to see @marenmorris at the @royalalberthall and my god, it was like it was built for her voice. What a special artist in such a special venue. Somehow, me and @richardmarcmusic ended up with front and centre seats and the whole show was just incredible. Every second was fun, every second was amazing. I wish it could’ve gone on forever. The tears returned on the train and I cried most of the way home but I am so, so grateful to have been there, so, so grateful to have had that escape for a few hours. I will treasure those memories.”

Recovering from these concerts has been an experience. Over a week later and my back is still bothering me. But it’s an improvement: the day after the London show, I could barely walk and it took days for the limping to fade. But I’m doing better. Surprisingly, the post concert low hasn’t been too bad. Mainly, I just miss being at the show, in the show. I physically miss it. My body misses it. But I’m doing okay. These concerts have given me a lift I desperately needed and will keep me going while I take my next steps, whatever they end up being. For that, I’m incredibly grateful.