JOURNAL ENTRY: Saturday 20 July 2019

Today’s medication: 25mg Sertraline / 5mg Aripiprazole

I’m experimenting again with lowering my anti-depressant and anti-psychotic medication. I last tried to come off the Aripiprazole around February time. I did it cold turkey and it gave me insomnia, so after 3 weeks I started taking it again. I’ve been doing my regular dose of 5mg every other day for about 3 months now. There have been a couple of weeks where I’ve taken one every day, due to the high anxiety levels, but on the whole, the reduction plan has been working. I’m now aiming to take 1-2, 5mg tablets a week, which I’ve done this week, but to be honest, I don’t think I need to.

I felt OK when I woke up this morning, and who knows what my day would have turned out like without the medication, but I’ll felt a bit unsettled and impatient this afternoon. I know there is a better word(s) for my mood, but I’m drawing a mental blank at the moment… Ahh yes, restless and agitated, that’s it. I’ve not wanted to do anything, and I’ve had to force myself to watch some TV, just to pass the time. I’m not sure if this is related to the medication today or just my general mood, but it’s worth noting for future reference.

I’ve also been taking half my normal dose of Sertraline for the past 2-3 weeks too, although last week I took a higher than normal dose (75mg), as I wasn’t feeling very well at the beginning of the week. This all sounds a bit haphazard and hit and miss, but my goal is to get to 25mg of Sertraline everyday by September and have weaned off the Aripiprazole completely. I’m no longer convinced that the medication is helping and in fact, it may now be detrimental for me to stay on it for much longer.

I did a bit of research earlier in the week around the potential side effects of coming of Aripiprazole (Abilify) and Sertraline (Zoloft). On the one hand it was a bit disturbing to learn that many of the possible withdrawal side symptoms are the same as to why I take the medication in the first place. For example, coming off both drugs may increase my anxiety and cause depression. It does make me wonder what the very particular fuck these drugs are actually doing to me inside my head in the first place. I started taking them because I felt shit and couldn’t cope on my own, then I felt worse because of the side effects of taking the drugs, then I felt better as I acclimatised to them, then when I come off them I might feel shit again? If that isn’t a recipe for long term dependence then what is?

My theory on anti-depressants is this… I feel so shit I become willing to try anything, so I begin taking medication. (I never wanted to take medication in the first place.) The side effects of taking the medication make me feel even worse, but at this point there is a little hope that maybe, if I keep taking them, I might feel a little better. Eventually the side effects wear off and I do feel a little better, probably no better than I felt before I took them, but herein lies the placebo effect. I start to tell myself a little story every day, that if I keep taking the medication, I will start to feel better. This gives me a sense of hope and provides me with some faith that I’ll survive. As I continue to take the medication, which is now not really doing anything, my faith and hope grow slowly as I continue this positive narrative on a daily basis. It can’t passably get any worse, so it must get better at some point. Over time I embrace the hope and when things get bad, I tell myself that everything will be OK, as long as I just keep taking the meds. Did the meds cure my illness or was it the process of taking the meds that created a daily affirmation that things will get better? Hmm… don’t under estimate the power of positive intention.

Don’t get me wrong, sometimes my brain does go pop and I need some help to rebalance the equation, but as a long term solution??? I’m no longer convinced. I believe I’ve become mentally dependent on them. I now need to learn to self sooth, as I slowly stop taking them. The fact that they then cause some rather unpleasant and extreme side effects, as part of the withdrawal process, does just make me wonder if the only real difference I’ve ever experienced was going from feeling very shit, to really, really shit and then back to very shit again, so the meds never actually made me feel better. I did that with my daily self talk. But I digress…

On the other hand, knowing that reducing/stopping the medication is likely to make me feel shit is also a positive, as I’ll know not to panic this time round and to simply ride out the unpleasantness. I’m hopeful that I’ve been reducing for long enough that I won’t experience severe, long lasting side effects like the insomnia again. I also get on well with both the medications, as I experience little/no other adverse side effects, apart from the expected dulling down of my thoughts and feelings, so the outlook is a good one.

I think the 3 months I’ve been alternating days where I’ve taken the Aripiprazole is long enough. I think I’ll now take them only if I really need to, rather than on any particular schedule and try and limit myself to 2-3 tablets a week, if I do need to take them. I did check with the psychiatrist a while back, if it is OK to use the anti-psychotic on an ad-hoc basis and he said it was. The only reason I’ve gone back to taking a regular dose was because of anxiety induced panic attacks, but these may well be being caused by the withdrawal symptoms, so if this happens again now, I’m just going to ride it out and hope that it goes away over time.

I’ll continue to take half the prescribed dose of Sertraline everyday for the foreseeable and see how things change, or not, over the next 6-8 weeks. I’ve got a review with my doctor scheduled for September, which is why I’m aiming for that date. What’s important is that I continue to write down what I’m doing, because it’s very easy for me to get lost inside my own head and lose track. To that end, if nothing else, I will document here what medication I take each day. That way it’s an honest and transparent process for me.

I think the fact that I’m coming to the end of my story within my book is also a positive. I’m looking forward to moving onto the next chapter and starting the review process. I feel like I’ve got the bones of the narrative there, like most of the major points have been made. Now it’s a case of fleshing it out where it’s needed and amending sections that might not be reader orientated. I think what I’m going to do is get my story to the point where it has everything that I want to say, in it, and then save that as a separate copy for myself before I begin the editing process. That way I can keep a record of how I factually remember events, before I cut stuff out that might not be relevant for general consumption.

I’m not sure what my next move is after that, and to be fair, I don’t think I need to worry about that right now. I’m enjoying writing and I know I will enjoy the editing and review process. What I need to be mindful of, is that this doesn’t become a project in the pursuit of perfection. I have a real sense that I’ll know when it’s complete and that my expectation isn’t that it needs to be perfect, but that I get to a point where I’m happy to share it, in order to get constructive feedback. After all, I can’t do this on my own. I’m going to need other eyes and minds to help me get it to the point where I’m happy to hit the publish button, if indeed that’s where this is heading…

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