An Introduction to Amitriptyline

I have now been taking Amitriptyline for about six weeks so it’s probably time to take a step back and get some perspective. I usually look at it week by week but this time, that doesn’t really make sense. The effects (and side effects) have been fairly consistent…

I’ve been feeling overly emotional ever since I stopped taking the Venlafaxine and that hasn’t changed with the addition of Amitriptyline. Everything makes me cry, from difficult decisions to TV storylines. And sometimes I cry for no reason at all. After twelve months of feeling incredibly disconnected from my emotions, it’s pretty overwhelming. I’ve described it as similar to turning an old tap: it’s nothing, nothing, nothing and then suddenly, it’s spilling everywhere and I’m emoting all over the place. It feels very extreme and I don’t seem to be able to control it.

But having said that, I am thinking more clearly. Up until very recently, I’ve been struggling to think, to write, to engage at all. I’m not sure I can really explain it: it’s so deeply rooted in feelings rather than words. It’s not really measurable. It’s kind of like trying to run through water: it takes so much energy to achieve so little. And once you get out of the water, moving is so easy and it’s such a relief. I’m so relieved to be able to think again. I don’t feel like I’m back to normal (and I’m still struggling in the songwriting department) but the fact that I can even write this out is a big deal.

One weird consequence of changing medications is that I want to eat all the time. I really hadn’t expected that. When I stopped taking the Venlafaxine, I was eating about one meal a day: I didn’t have much will to eat and the medication made me incredibly nauseous. And now, the urge to eat is there at all times. There have been days where I haven’t been able to concentrate because all I can think about is food. It’s causing me a lot of anxiety: firstly, because it’s a pretty extreme change (and I am NOT good with change) and secondly, because eating doesn’t satisfy the urge. I eat and it’s still there. It’s so frustrating. I’m not quite sure what to do about it.

My depression hasn’t lifted (yet?) but it has definitely shifted and in the reshuffle, my anxiety has come back in full force. I’m anxious all the time. Before, it felt like I was too disconnected from everything to really feel any anxiety but now, it’s almost overwhelming. I feel like I’m constantly running from it, filling my day with distractions to keep it at bay. But then, at night, it takes over. It’s made me anxious about going to bed and there have been more than a few occasions where I’ve accidentally stayed up all night in my attempts to distract myself. The anxieties themselves aren’t new but usually I’d only have to deal with them one at a time whereas now it’s like they’re all present all the time. It’s exhausting and scary and draining.

So it’s neither a miracle nor a disaster. And it’s better than the Venlafaxine. Other than that, I don’t know. I’m feeling very overwhelmed at the moment.

I’m Running Out of Clever Titles for Medication Reviews

A couple of months ago, I (with the help of my psychiatrist) decided that it was time to stop taking the Venlafaxine. I don’t feel like it’s helping; it just makes me numb to everything and, as overwhelming as my emotions tend to be, feeling is better than not feeling. It might not always feel like it but that’s the truth. Plus, the side effects are not worth it, even if it was helping: my concentration and motivation were pretty bad before I started taking it but I’m pretty sure it’s gotten worse, especially recently. Writing has been such a struggle, even the practice of it. My depression has always had a negative impact on my creativity but this is the first time I’ve found it so incredibly difficult to simply write at all: getting words out has been like pulling teeth.

So I had some good reasons for wanting to stop and I’d put in the time to make sure I had an informed perspective. So I discussed it with my psychiatrist and we decided that the right move was to wean myself off the Venlafaxine and try something new.

When I first reduced the dosage, I didn’t really feel the difference. I still felt both depressed and numb, which is a really weird combination. But over time that’s changed. Obviously I can’t know how much of that to attribute to the medication change or to life in general but I still think it’s worth keeping track and I recommend this practice to everyone: it allows you to see the trends in your life and analyse what does or doesn’t work for you.

Not long after lowering the dose, I started getting headaches. The pain was very similar to the pain of a migraine but I didn’t have any of the other symptoms that come with it. Normal painkillers didn’t seem to help much and there were several occasions where I just retreated to my bed and tried to sleep through it. I had one of those headaches almost everyday for about two weeks, which was horrible but they have now passed at least. So that’s progress.

Coming out of that, I felt really raw and emotional, which was very weird, having felt so blank for months. I felt like I had no control over my emotions, which was more than a little bit scary, and kept bursting into tears over the smallest things. It’s felt a bit like I’ve had all of my emotions bottled up since I started taking Venlafaxine and suddenly they were overflowing everywhere: if something upset me, I became inconsolable and if someone irritated me, I had the urge to scream at them. I feel very lucky and grateful that I’ve managed not to scream at anyone because that isn’t how I actually feel. Once that emotion has died down a bit and I’ve been able to process the whole experience, that’s how I really feel. I live in fear of saying something I don’t mean and it ruining everything. So far, I’ve managed to manage these emotional tidal waves. They’re still happening though, even now that I’ve stopped taking the Venlafaxine completely.

And more recently I’ve started to have moments where I can think more clearly. They don’t last very long and to begin with, they were so sporadic that I didn’t even connect them to coming off the medication. But now that there have been a handful of them, it seems pretty likely that the two are linked. These moments are amazing. The feeling reminds me a bit of coming up for air after being underwater for a long time. You breathe in and you can almost feel the freshly oxygenated blood rushing around your body; everything suddenly feels so easy and you’re shocked by how hard it was up until that moment. These moments aren’t lasting very long and I wish there were more of them but it’s something.

I realise that I’m not giving this progress the recognition it probably deserves but I’m really not in a place where I can be enthusiastic and optimistic; the most I can manage right now is one foot in front of the other. My depression is worse than ever but at least it’s real. And I’m doing the best I can. That has to be enough.

So I Accidentally Went Into Withdrawal…

Most of the time, I’m very good at taking my pills. I’ve had a few moments where a change in routine or a dramatic event has thrown off my rhythm but usually, I’m very diligent about taking my medication. We have a good relationship, even when I’m struggling with side effects: I know that I’m taking them to improve my quality of life and that knowledge helps me to push through whatever worries or difficulties that I have.

Having said all of that, I accidentally went into withdrawal a few weeks ago. A series of exceptionally busy days left me so tired that I just kept forgetting to take my meds before going to bed. As a one off, it’s not great but it’s not a huge deal. It happens and you resolve to be more careful. But with everything going on, suddenly four days had passed and I was in withdrawal.

I’d had a headache the day before, one that felt like my brain was too big for my skull and made me feel nauseous if I moved my eyes too fast. It was very unpleasant but I hadn’t thought much of it since it followed a very long, very busy day; a terrible headache after something like that isn’t uncommon for me. It’s like a hangover, but from socialising rather than alcohol. So I hadn’t been too worried but when I woke up the next morning (the fourth day without my medication), I couldn’t think properly. It’s hard to explain but it was like I couldn’t hold on to a single thought: one would appear and before I could follow it through, another ten would’ve flashed passed, leaving me confused and nauseous. I’ve never felt like we have full control over our thoughts – sometimes ideas appear out of nowhere and sometimes you can’t stop thinking about something regardless of how hard you try – but I do believe we have some control; you can choose which pathways to follow and which to leave unexplored, even if you can’t forget about it, for example. So to have absolutely no control over my mind was terrifying. I tried to keep calm and slowly collect my thoughts but I just couldn’t do it and ended up sobbing in my bed, curled up in the foetal position. It was really, really unpleasant.

My Mum called my psychiatrist and his advice was to take a normal dose straight away and then restart my normal routine that night so that’s what I did and within a couple of hours, I felt more normal. I could think again; the thought progressions had returned to their normal speed and made more sense, rather than being so chaotic and out of my control. So that was a huge improvement but I was completely exhausted by the experience. I spent the rest of the day on the sofa.

It was almost a week before I felt like myself again. I had trouble concentrating and had a tendency to zone out mid conversation; it kind of felt like I didn’t have enough brainpower to sustain one. Everything felt much more tiring.

So that’s my little cautionary tale. It’s so important to take your meds responsibly because not doing so can have pretty serious consequences. I was lucky: it was miserable but easily and quickly rectified. It could’ve been much worse. So, if you’re reading this and need to take your medication, please drop everything and take it now! This isn’t supposed to be advice for how to handle withdrawal (if you need that advice, please ask your medical professional!), more a description of the experience in the hope that it might be helpful to someone. Taking medication can be such a complicated, confusing ordeal and not talking about it only makes the process harder.

Hello and Goodbye to Lithium

About a month ago, I went back to my psychiatrist. We discussed the Venlafaxine and since it hasn’t had the effect we’d hoped for, it was time to think about what to do next. The most obvious option, the one most likely to work in the shortest amount of time, was to add an ‘augmenting agent’ and so I started taking Lithium. I’m aware of the perception of Lithium but it didn’t worry me, not any more than any other medication anyway. I’m always hopeful that a new medication will work, and if that comes with the opportunity to defy expectations then it’s even better. So I was feeling optimistic and, as I did with the Venlafaxine, I took notes so that I could track any progress and/or side effects.


FIRST NIGHT AND NEXT DAY

As the first night and then day was pretty interesting, I thought I’d write this one up separately. I slept restlessly and woke up multiple times with night sweats. The first time I woke up was very surreal: I was overwhelmed by the physical sensations in my body. I remember thinking, “I can really feel my hands. I really have hands.” It was very strange. I struggled to get back to sleep and when I got up in the morning, I felt very nauseous. I had a headache all day and by the evening, I felt very spaced out and tired.

WEEK 1

The restless sleep and night sweats continued, joined by complicated and busy dreams. I found it very difficult to wake up and I was so sleepy that I was falling asleep multiple times during the day. When I was awake, I was tired and weak, like there was no strength stored in my body. It was frustrating and upsetting to struggle to do everything I would normally do. I was spaced out and nauseous and shaky; if I stood up for more than about thirty seconds, I got dizzy and nauseous and my vision went white. It was horrible.

WEEK 2

I was still having difficulty sleeping and was struggling with sleepiness during the day. I continued to struggle with nausea and feeling spaced out but I also felt low; I think I would’ve felt depressed if I was able to really feel anything. The shakiness and weakness also continued.

WEEK 3

And we STILL have difficulty sleeping. It was taking me hours to get to sleep and hours to wake up and in the few hours between, I slept very restlessly. Then when I was awake, I was very sleepy. The shakiness, weakness, and nausea combination was still around. I also started to struggle with almost constant anxiety; there were stressful things going on but I couldn’t seem to shake it off once I’d done those things so it was around all the time.

WEEK 4

Continued difficulty sleeping, especially staying asleep and then I was so tired that I fell asleep during the day. Those short sleeps were actually the best I’ve had in months, much better than the hours I got at night. I was also still struggling with the shakiness, dizziness, and nausea, as well as the anxiety.

WEEK 5

The restless sleep continued, as did the struggling to wake up. On several occasions, I fought to wake up only to fall asleep again; I also fell asleep during the day multiple times. I was constantly tired. The nausea and dizziness also continued, as did the anxiety.


I did not like taking Lithium. It didn’t actually help my depression – I’m still feeling very emotionally numb and the fatigue has only gotten worse – and the side effects were constant and actually got worse over time: the difficulty sleeping, the shakiness/dizziness/nausea combination as well as all of those as separate symptoms… I was struggling so much that I had multiple doctors’ appointments to make sure that nothing else was going on. I had blood tests and blood pressure tests and even an ECG. They didn’t show anything outside the normal ranges but the fact that it was bad enough to warrant those tests meant that I booked an appointment with my psychiatrist for as soon as possible to look at my medication.

I have now had that appointment and we’ve decided to stop the Lithium; he was surprised and impressed, I think, that I’d stuck with it so long considering how bad the side effects were. Since the Venlafaxine hasn’t done much for me, I’d like to try something else but given how much is happening in the next couple of months, I’m reluctant to put myself through the ordeal of getting off it, the period of no medication, and then getting onto something new. So for now, I’m trying a new augmenting agent and I guess we’ll see how that goes. I think the emotional numbness is preventing me from getting too low about anything but regardless of that, I’m still optimistic about medication, even with all the bad experiences I’ve had recently. I fully believe that it was Phenelzine that made going to university possible and even now, years later, I still remember so clearly how good I felt when I started taking it. It felt like I was flying. It was amazing. Searching for that will always be better than letting the depression take over, even if I have to let it take over to remember that.

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100 Days of Venlafaxine

I meant to post this yesterday, which actually was the 100th day, but then I managed to break my memory stick, where the file was saved. So that threw a spanner in the works. But here we are. The files were recovered. No harm done.

I’ve been taking Venlafaxine for 100 days now so I thought it was time I compiled my notes and summed up the whole thing. I know that when I started taking it, it would’ve been really helpful to know about someone’s experience. My psychiatrist gave me all the medical information but that didn’t really prepare me for what it felt like. So if you’re about to start taking Venlafaxine or are thinking about it, maybe this will help you. And if not, maybe this will give you a little insight into one experience of taking medication for a mental illness.


Week 1 (Dose: 37.5mg)

The nausea was so strong that all I could think about was not throwing up. I was very dizzy and tired all the time. But it was much easier to wake up in the mornings, quickly rather than having to drag myself into consciousness.

Week 2

The nausea faded a bit. I had headaches and was exhausted all the time. I continued to wake up early.

Week 3 (Dose: 75mg)

I was so tired that I fell asleep at random but I was still waking up early. I felt very faint and was too shaky to do anything but I had no concentration so I couldn’t do much anyway.

Week 4

The week was overshadowed by severe, unexplained leg pain. I had several doctors’ appointments to rule out the medication and DVT, the next most likely explanation, but eventually it faded by itself. Aside from that, I felt a bit lighter emotionally.

Week 5

I had some leg pain but it faded much more quickly. I was exhausted and very sleepy, regardless of how much sleep I got.

Week 6

I was so very, very tired, so tired that I could barely do anything. But I was still waking up very early.

Week 7

Again, still very, very tired but I was also feeling very anxious and depressed. I also noticed lots of bruising, especially on my legs that didn’t seem to have a cause. All I had to do was lean on something hard, like the edge of a table, and I’d have a bruise.

Week 8 (Dose: 150mg)

A bad week. I felt very disconnected and depressed. I was also exhausted so I didn’t have the energy to do any of the things that can help. I was also pretty unwell for a couple of days but I don’t know if that was related or just a coincidence.

Week 9

I started struggling desperately to wake up. It was like being trapped between being awake and asleep. It took all my concentration to wake up but all I had to do was blink and all that effort is wasted and I have to start all over again. I was exhausted and sleepy all the time.

Week 10

I was struggling desperately to wake up and still exhausted and sleepy all day.

Week 11

I reduced the Quetiapine from 125mg to 100mg (which I was prescribed while taking Phenelzine to help me sleep – I’d wanted to come off it straight away but was advised to wait so that I wasn’t dealing with reactions from both medications), which made waking up easier but I was still exhausted, depressed, and without any motivation.

Week 12

The sleepiness started to creep back in and I was still exhausted and without motivation.

Week 13

Again, I was really struggling to wake up; I couldn’t stay awake but I also couldn’t get back to sleep either. I managed to get the Quetiapine down to 50mg but I wasn’t sure if it was helping or not. I still had very little concentration and motivation which was really difficult and upsetting.

Week 14 (Dose: 225mg)

To combat the sleepiness, I reduced the Quetiapine to 25mg so my sleep was very all over the place. I was waking up really early and not getting more than about six hours. But I did feel more awake and alert which was a relief. I had several really productive days and wrote two songs after not being able to write for more than six months. That gave me an evening of complete joy, something I can’t remember feeling. Unfortunately that only lasted one night and my mood dipped afterwards because I missed it so much.

Week 15

My mood was fairly stable, no major ups or downs. I wasn’t depressed but I wasn’t feeling that positive either. I was tired and sleepy and feeling a bit lost.


I just wanted to draw particular attention to how long this process can take. When I started my last medication, I felt better very quickly but it’s been a very different story this time. It’s not as simple as taking the pills and feeling better. There’s the time it takes to decide or justify that you need a new medication (or a first medication), the time it takes to come off the old one, the time it takes to build up and adjust to the new one… I started this process in May and it’s now December. Seven months and I still don’t feel that much better. I’m hanging on to hope that things will start to get better – I’m holding on to that one really good day – but it’s hard.

I think there is a lack of understanding when it comes to this stuff. From the outside, it can seem like you’re not doing anything to get better and there’s a lot of guilt attached that, from other people and from yourself. But on top of whatever mental health problem you’re dealing with, there’s adjusting to the medication and whatever side effects come with it. That’s a lot. It’s exhausting physically, mentally, and emotionally and you shouldn’t feel pressured to do things you feel unable to or feel guilty about whatever you need to do to get through it. I’m still trying to learn this. I constantly feel like I’m not trying hard enough, even when I’m so exhausted that I don’t think I can get out of bed. But that’s a topic for another day.

I hope you all had a lovely Christmas and I’ll see you in the next post.

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Side Effect City

Just over a month ago, I started taking Venlafaxine for my depression. I’ve tried lots of different anti depressants in the past, many of which I had a bad reaction to, so I was nervous. Weaning myself off the Phenelzine was hard and I was very, very depressed but somehow, I reached a point where I felt ready to feel different. It was a bit like breaking the surface after being underwater. I was, and still am, desperate to feel better.

Week 1

I started on a very low dose, half the lowest therapeutic dose, so that my body could get used to it. But despite that, I felt the effects straight away and incredibly strongly. I was very nauseous. It was so bad that I couldn’t really concentrate on anything else; all my concentration was focussed on not throwing up. It made me dizzy and I was tired all the time. I did check with my psychiatrist to make sure it was okay to keep going with it and he said it would pass so I focussed on tolerating it.

The other immediate change was my sleep. I went from struggling to wake up before eleven (and I mean really struggling: it felt like I was drowning) to being wide awake at eight o’clock in the morning. It was bizarre.

Week 2

The nausea faded around the beginning of the second week, which I was very grateful for. My mood, while still pretty low, was stable, and I was still waking up much earlier than I had been able to previously. However I started having headaches and I was exhausted all the time, which made it very hard to do anything.

Week 3

In the third week, I went up to the lowest therapeutic dose. This caused a pretty dramatic reaction. For the first few days I was so tired that I fell asleep in the middle of the day, something I haven’t done in years. But despite that, I was waking up even earlier, between six and six thirty am.

By the middle of the week, I couldn’t concentrate at all. I couldn’t hold a conversation, I couldn’t follow the storyline of a forty-minute TV episode, I couldn’t even play a game on my phone… That was scary, but I couldn’t even really feel that because I couldn’t seem to process the emotion. I started to feel faint and very shaky and that went on for several days. If I stood up for longer than a couple of minutes, my legs started to shake and my hands shook so badly that I couldn’t hold a pen. That was very unpleasant.

Week 4

Most of the fourth week was lost because of severe, unexplained leg pain that had me in tears. My psychiatrist didn’t think it had anything to do with the medication and DVT was ruled out but other than that, we don’t know what caused it. I’ve been taking painkillers since and it’s been better. So that tired me out and overwhelmed everything else. But since then, the shaking has mostly stopped and I’m back to waking up between eight and nine in the morning.

This week is the first where I’ve felt different mentally and emotionally while taking Venlafaxine. I wouldn’t say I feel better but I’ve been feeling a bit lighter. That feels very strange and a bit scary. With this new lightness, I’ve been feeling a bit lost which I’ve written about here. I’ve been so depressed for so long that I can’t remember what it’s like to not be depressed. But despite all of those confusing emotions, I am pleased that this medication is starting to work. It will probably take another month or so to really know how it’s affecting me but it’s looking positive and I’m really grateful for that.

The Big White Room

Since taking the Venlafaxine, I’ve felt different. I’ve felt a little bit lighter, mentally and emotionally. In some ways this is better but in some ways it’s not. Depression is such a heavy feeling but now I feel a bit like I’m floating away. I feel kind of lost, or like I’ve lost something really important. In a weird way, I miss feeling depressed. No, that’s not right. I don’t miss it, but I feel kind of lost without it. And feeling like that makes me very anxious.

Objectively I understand why I feel this way: I’ve spent a lot of time feeling depressed. It’s familiar. It’s certain. It’s a world where everything is in focus with clear and sharp edges. Now the edges are fuzzy. I feel like I don’t know who I am or what I’m doing. And emotionally, I’m finding that really hard to get my head around.

I know who I am when I’m depressed. Those emotions overwhelm me, they define me. Depression takes over my personality, or becomes the biggest part of it. It affects everything. It’s like depression takes up all that space. But now, there’s suddenly all this space that wasn’t there before. It feels a bit like when you stand in the middle of a really massive empty room. It’s quiet. It’s cold. It makes you feel so small and lonely. And if I look at myself in that big white room, I don’t know who I am. I don’t know if I’m optimistic or pessimistic. I don’t know if I’m a good person or a bad person. I don’t know if I’m loud or quiet. I know some little things but not the big things.

I do recognise the opportunity here, the opportunity for things to be different: to fill the room with new things. That thought is both thrilling and terrifying. But I’m not sure I’m there yet: I’m still pretty overwhelmed by how big this room is, how empty it is. I don’t know where to start.

I’ve thought a lot about identity, both mine and in general. It’s something I’ve struggled with for a long time and something I want to write more about. But I think your identity is made up of the things about you that don’t change, the fundamental aspects of your personality. I don’t know much about myself but I do know that I’m very sensitive. I’ve always been sensitive and I can’t see it ever changing. So I guess that’s a part of my identity.

I’m not sure my depression is gone but I’m not drowning in it anymore. And that’s scary. I’m so used to it that I’m not sure who I am without it. When I’m depressed, that big white room is so dark that I don’t know that all that space is there, so I don’t even know the room is that big. But now I know it’s there and it’s very compelling. I keep turning it over in my mind. As I said, I know who I am when I’m depressed. I want to know who I am when I’m not. So I guess that starts now. It’s a brave new world.

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