My recent antidepressant adventures
Before I go any further, let me be really clear about one thing. This is my personal experience with anti-depressants. It is not a typical experience at all. Antidepressants can be life-changing (in a positive way) and even life-saving for some people. I'm going to express a lot of frustration with what these drugs did to me, how they were studied, and how I was informed about their possible risks. This is not intended to deter anyone else from taking these medications if it makes sense after a conversation with your doctor about the risks and benefits for you.
Some history. I actually started taking my first antidepressant before my pain disorder was even diagnosed. My GP hadn't been able to give me a proper diagnosis for my pain but suggested that Cymbalta might still help. It did help somewhat, and I stayed on it for several years. A couple years later, after I've gotten a proper diagnosis, the rheumatologist who diagnosed me suggested trying Savella instead of Cymbalta for my pain. I had significant headaches and dizziness while trying to transition from one drug to another, and my doctor and I made the decision to discontinue that transition and return to Cymbalta.
Fast forward about four years and I'm a graduate student. My anxiety has gotten really bad and started to seriously interfere with my studies, which is finally enough to motivate me to see a psychiatrist. After trying a few other things, this doctor concluded that I was having an unusual side effect of SNRI's where they can actually make anxiety worse. So he had me taper to zoloft, an SSRI. The side effects were again terrible. For about two weeks I laid on the floor of my apartment and tried not to move because any movement made me extremely dizzy. I picked the floor rather than my bed because the stability of the floor minimized my dizziness. Even shifting position in bed made me feel like I was spinning around or swinging in a hammock. Within a couple days of reducing my Zoloft, though, my anxiety improved considerably. That improvement and anxiety gave me the motivation to wait it out. It was a couple months before I was fully back to normal, but the worst of the dizziness and other symptoms improved within three weeks.
And now we are reaching close to the present. I've been struggling with anxiety quite a bit for the past several years, though I have been quite successful at blaming it on external (and hopefully temporary) factors: COVID-19, moving to a new city, starting a new job, having difficulty obtaining disability accommodations at that job. Well, this past January, I made the decision, together with my therapist, that I should see a specialist about medication management and hopefully see if a change in medication could help me. To say that that has backfired would be a massive understatement.
I found a physicians assistant in psychiatry who I genuinely do like. I had my first appointment with her in late January. I shared with her my prior experiences changing antidepressant medication and how many side effects I've had and how severe those side effects have been. She promised me that we would use a very slow taper, and also assured me that she would support me with FMLA paperwork if I needed to take time off of work due to side effects. She recommended that I try lexapro, wrote me a prescription and a tapering schedule, and sent me on my way.
Somehow, this time was worse. Within two days of starting the taper, I was dizzy, had frequent headaches, couldn't sleep through the night, had frequent mood swings, and was having alternating diarrhea and constipation. Based on my experience switching from Cymbalta to Zoloft, I assumed these symptoms should resolve within three or four weeks. They did not.
I spoke with my provider at the three week mark. She told me that she was surprised I was having such severe side effects but that she thought they would go away once I was stable on a constant dose of Lexapro.
So I stuck it out. I had to work from home because I couldn't safely drive. I couldn't take my dog on walks because I was scared he might pull me off balance leading to me falling. Instead of taking my dog on walks, I took my hiking sticks for extra balance. My exercise was limited to just walking because, again, I couldn't drive. I struggled with social isolation.
After a five week taper, I was on a constant dose of Lexapro. I was still having the same set of side effects. There were day to day variations in severity but no trend towards improvement. I spoke with my doctor again and she encouraged me to give Lexapro a full four weeks for everything to stabilize. I did. It didn't get better.
At this point, I've been dealing with substantial additional impairment for a full two months. I haven't driven in two months. My ability to exercise and manage my pain disorder has been significantly limited. I have been socially isolated, making my anxiety worse. I want to be done and this is what I tell my provider. She agrees to a rapid two week taper off of Lexapro. Unfortunately, eliminating the symptoms would not be so easy.
During the two week taper, my symptoms are very similar to what they have been. I'm still dizzy. I'm still having G.I. symptoms. I'm still having mood swings.
I took my last dose of Lexapro on April 8. A couple days later, the symptoms got much worse. My dizziness got substantially more severe. I no longer felt safe taking a walk, even with my walking sticks. I felt like I had a fever, complete with the chills and the alternating sensations of feeling hot and cold. My sleep is a total mess, and I'm waking up more than a dozen times each night, eventually lying in bed tossing and turning for hours. I'm crying uncontrollably about everything and nothing. I started experiencing a lot of muscle tightness especially in my shoulders and upper back, and this leads to severe pain.
Up to this point, I had been continuing to work full-time from home. After this new wave of even more intense withdrawal symptoms, even I had to admit that I couldn't do it anymore. I've reached out to HR and medical provider and coordinated medical leave. I ended up being fully off work for three weeks, and then I worked part time for another month after that.
Through the months of April and May, most of my symptoms did resolve. By the time I reached June, I was only left with the muscle tightness (And accompanying pain) and the dizziness. And it's honestly hard to tell where the line is between medication withdrawal causing tight muscles and fibromyalgia simply perpetuating tight muscles. But the dizziness has been extremely stubborn. It has slowly improved since mid April, but I am still dizzy as I sit here today writing this post in late July.
As I sit here today, it has been 3 1/2 months since my last dose of an antidepressant. And yet I am still dizzy. As I sit here today, I don't feel it is safe for me to drive after about 2 PM (the severity of my dizziness is related to time of day). As I sit here today, I am still socially isolated by my inability to drive in the evenings. As I sit here today, my pain management options are limited, again by my inability to drive. As I sit here today, I don't have a good explanation for why I am still dizzy 3 1/2 months after discontinuing my antidepressant.
At risk of stating the obvious, this is not what I signed up for. I knew I had had bad reactions to changing antidepressant medications in the past. I knew that I might have severe symptoms for several weeks. But I never dreamed that it would be several months. And I never guessed that those several months were turning into half a year.
I am angry, pissed off, livid. I'm also scared. While my dizziness does seem to still be very slowly improving, I'm scared that it won't resolve. I'm scared that it will become one more chronic issue that I have to manage. I'm scared this is another manifestation of central sensitization and that, now that I've had the sensitizing experience, I won't ever be able to fully recover due to my broken nervous system. A lot of that is probably my anxiety disorder talking. But my brain isn't pulling these things from thin air. The last time I had a medical issue which lasted multiple months and for which I could not get a clear explanation doing those many months, well, I ended up with my chronic pain disorder.