The new antidepressant hypothesis

Being a science student and having studied antidepressants, I thought I knew how they worked or at least why people thought so but after a lecture on the history of their development, now I’m not so sure.

Originally, in the 1950s-60s the thesis was that too many Monoaxamine Oxidase neurotransmitters (MAOs) such as serotonin and norepinephrine, were being oxidised by the brain. This led to a deficiency of them and thus depression. Drugs were developed to maximise the amount of MAOs in the brain, by preventing them from being oxidised. The idea is that high levels= better communication= stronger mood regulating circuit. The results were good! They appeared to work, yet serious side effects were often seen.

In order to reduce side effects, a new hypothesis was developed. The serotonin hypothesis. The idea was too much serotonin was being taken up by presynaptic neurons in the brain leading to a deficiency and ultimately depression. People, therefore, speculated that altering the level of serotonin would alleviate the symptoms of depression. This is where SSRIs were developed. They act by stopping the reuptake of serotonin and increasing the levels of it in the brain. Again, they appear to work. SNRIs do the same thing but for serotonin and norepinephrine.

The basis of these theories was PURELY SPECULATIVE. No one has been able to prove them. Though it could be argued that new research does exactly that, but this would depend on who you talk to.

Irving Kirsch showed that for people who’ve been on SSRIs before and experienced the side effects, if they’re then given a placebo drug with the same side effects, it appears to work. In his study, there was no significant difference between an active placebo (with side effects) and SSRIs. Yet, many people have criticised his work.

Studies have suggested that; changing serotonin levels in a healthy individual doesn’t cause depression, attacking symptoms of depression with SSRIs is no better than with an active placebo, and the placebo effect is critical in treating depression. Furthermore, one popular antidepressant bupropion appears to reduce depression in some people but it has not impact on serotonin at all, but dopamine and norepinephrine.

Obviously, though, I couldn’t just accept all of this to be true because I have seen antidepressants work, hell I’ve even FELT them work at times. In my day to day life I have yet to come across a pill that makes me feel ‘not depressed’ but I know that when I’m at my worst, medication is the only thing that can pull me out of it. So I turned to doctor google.

Apparently, there is this other theory that antidepressants cause neurogenesis (birth of new brain cells). This could explain why ADs take a while to work in the brain (whereas if it were just the amount of neurotransmitters you would expect them to work right away) because they are altering the pathways in the brain. I was drawn to how lots of these studies list physiological and psychological stress as a causal factor because it reflects the idea of early mad doctors, that neuroses were caused by stress. However,  it’s not a foolproof theory because some AD studies show neurogenesis and some don’t + it could be unrelated to what ADs actually do. Yet, it’s still really interesting.

I refuse to believe that antidepressants don’t work, but maybe they don’t work the way we think they do. Or maybe they do and we just happened to stumble upon the MAO idea by accident without having a clear reason for why this is the case.

What is your personal opinion and/or experience on antidepressants?

 

 

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The day my cat saved my life

In more ways than one, she’s been my lifeline through the last few years. But there’s one day in particular that she saved me.

A little over a year ago, my mum came home from work late one night to find our cat meowing outside my door. It’s not normal for my mum to check on me when she gets home as it’s usually quite late but on this particular night, my cat’s behaviour concerned her. She opened my door and found me unconscious after a suicide attempt. If she hadn’t checked on me that night I may not have made it through. My cat saved me and allowed me to get treatment before my body starting failing.

A few nights ago, I had an incident with self-harm. I heard a noise at my door; my cat was outside meowing and wouldn’t stop until I let her in. She then proceeded to make herself comfortable on my bed and curled up against my chest all night long. The physical contact with an animal is often used as a therapeutic technique and remembering her beating chest and purs against my skin, I can imagine why. There’s something reassuring knowing that you are not alone in the world.

Now, this might seem normal to a lot of you but my cat knows that I am a restless sleeper and prefers to sit on the end of my bed. So the fact that she chose that night to curl up with me makes me think that she knew I was having a hard time and that I needed her. Her intuition was spot on.

I’m so grateful for her. She is my rock. My companion. My saviour.

No eating disorder movie is helpful

I got 20 minutes into watching Netflix’s new movie  ‘To the Bone’ and turned it off (and here’s why you shouldn’t watch it either*).

I don’t need a movie to tell me what it’s like having an eating disorder, because I’ve been there done that. To anyone out there who has suffered or is suffering, potentially triggering yourself isn’t worth it. You don’t need to have every symptom portrayed in a movie in order to be a ‘good anorexic’, because the only way to be a good anorexic is to be dead.

Maybe the movie is in fact a good portrayal, unlike many already out there that can act us ‘how to’ guides to young people, or not (I wouldn’t know. I haven’t watched it). But that’s not really the point.

The point is, I don’t think I will get any benefit out of this movie and I don’t think that anyone else who has experienced an ed will either. And more than that, I’m sick of eating disorders. They are BORING. You hear the same thing over and over. One day someone is fine or maybe it’s gradual but then suddenly ‘boom’ and there’s the ed. The lucky people recover the first time. Some never do and most of us spend years in bouts of recovery and relapse. There’s nothing interesting about starving yourself or ending up in hospital.

I’ve had my share of supervised toilet and shower use and I’m not a fan. I didn’t enjoy being forced to eat and swallow when I didn’t want to, and sometimes wasn’t allowed the luxury of tasting my food. Where’s the joy in that? I’m sick of being weighed and pricked by needles. Of never feeling beautiful no matter what any number says. I’m sick of never feeling ‘enough’.

It’s true that the worst day in recovery is better than the best day in a relapse. I’ don’t know about you, but I’d much rather be choosing what I eat because I enjoy it and not because I have to have it. I like that I can spend my days doing things; waking up when I want, going on adventures and spending time socialising and having a life. I like that my cat sleeps on my bed and I look forward to preparing breakfast each morning.

I hope that soon I won’t have to associate with the word recovery because the eating disorder just won’t be in my life.

Don’t watch the movie. You don’t need it to tell you how difficult things have been or how strong and brave you are being for fighting. You don’t need to hear that because you’ve lived it.

A movie won’t tell you that you are beautiful and amazing and so worthy of life and love, but I am. You are wonderful because you are alive, with a beating heart inside your warm chest and not a character in a movie that only exists inside a screen.

You are you and that’s more than enough.

For more information about eating disorder please refer to the National Eating Disorders Website or visit the Butterfly Foundation.  You can also check out Headspace or contact the national eating disorders hotline on 1800 33 4673.


* this is especially important if you are or have suffered from an eating disorder in the past, or if you happen to be a teenage girl between the ages of 11 and 18 (adolescent girls are most at risk of developing an ed).

The inner battle of taking my medication

These pills, these tiny little pills. Especially this one. this single white pill.

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It seems so simple, so easy. Follow the instructions on the packet. Yet, my experience with it is so far from easy. Me and this pill, we have a complicated relationship.
This white tablet in my hand, you see, is an antidepressant. And it’s not just any antidepressant, it’s my antidepressant. Prescribed by my doctor because she believes it helps me, but I have so much trouble taking it.

I can’t tell if it helps me or not and taking it is difficult because it means I’m actively doing something to help myself. A lot of the time I don’t feel like I deserve help and I don’t know if I want to get better. Why? Because this is safe and familiar and anything different is scary. I don’t know how to live without mental illness. Feeling better terrifies me because who will I be if I am not who I am now?

For some reason, I can take sleeping pills and vitamins but antidepressants scare me. It’s because they affect your brain chemistry and your brain chemistry is makes you who you are. I am still the same person if I take this or not though and I need to keep reminding myself that. Taking this does not mean I am weak or will magically be cured. All it means is that I am taking it. Maybe it will help or maybe it won’t but regardless, I am still me.

I wish it was easier to do this. I wish my brain could see it as a solution or medicine but it’s hard to see it that way when results aren’t immediate and when it’s your brain that’s sick.I’m scared of feeling better but I’m also scared I’m going to feel like this forever.

I am starting these again because I have to, deep down I know I have to. I need medication and that’s okay. I wish there was a sign pointing to the one that is the right one; the solution of all solutions. But I’m learning that it’s not that simple.

Please work little pill, I need you to work, even if sometimes I don’t want you to.

You’re not beyond help

I know what it’s like to feel like the world would be better off without you. To have gone through medication after medication, sit through unproductive therapy sessions and to experience life through hospital walls. To feel like nobody can help you. I know how much it hurts to see how your suffering is affecting other people. I get it. I do I’ve sat and cried and begged for everything to stop because the pain was so unbearable that death felt like the only way out. But I’m here to tell you that there is no such thing as being beyond help.

You may feel like you are not worthy or that you’re too much trouble, but none of that is true. You’re not too much trouble and there are people out there who care and want to help. It’s okay if you haven’t achieved everything you want to. There’s still time. There’s still time.

The worst day with you here is better than the best day without you. I get that this may not feel true. I understand it might be hard to believe, but you make the world a better place just by existing. You are worthy of life and worthy of help. No matter how hopeless the future seems, you are worth the fight. Please don’t give up because you are worth it.

You are not beyond help. I haven’t given up on you and you shouldn’t either. Hold on. Please, please, please keep holding on. One day this pain will all be worth it. You are not alone in your suffering.

You are not alone.

Choosing Real Recovery

I’m sick of being sick. I’m sick of admissions and appointments and not being able to do what I love. I’m sick of putting hunger and a half-assed life over my own happiness. Of having to enrol and unenroll from university each semester because I’m too ill. I’m sick of denying myself foods that I love so that I can keep my weight at the bare minimum of healthy. None of this is healthy. I didn’t choose anorexia, but now I’m choosing to get rid of it.

It’s not that easy, I know, but I’m determined to beat this. I know it’s not going to be an easy journey and I don’t expect it to go smoothly, but I do believe in recovery. I know it’s possible because I’ve seen it happen for other people.

I’m finally accepting what it means to recover. For me, that’s eating enough food to satisfy myself and my dietician and increasing the variety of my diet. It’s choosing things for taste and not because the bitch in my head says so. It’s facing the thoughts again and again and not giving in. Recovery is going out and eating meals with my friends. It’s going to bed thinking about relapsing but waking up and sticking to my meal plan anyway. It’s gaining weight even though I’m scared of what that will mean, engaging in therapy and taking my medication.

The reality is, I cannot be healthy whilst I am undernourished. And I cannot be happy unless I am healthy.

I want to work and study and be independent. I want to have friends and joy in my life again. And to do that I need to recover.

You don’t have to feel ready to recover because chances are if you wait for the perfect time it will never come. You don’t have to feel ready, you just have to be brave.

Today I am choosing recovery, and not that fake eating disorder turned vegan or clean eating recovery you see on Instagram. I’m choosing chocolate and ice cream and happiness. Today I’m choosing myself.

I was hospitalised for Anorexia Nervosa Part 2; Inpatient life

(This is a 2 part series and if you haven’t read part 1, you can click here to read it first – Part 1; The lead up)

7 weeks. That’s how long the eating disorder ward was my home, by far the longest admission I’ve ever had. I ate, slept and lived within those walls with no more than 7 other patients at any time. Those girls (and guys) became my friends and my family, along with the lovely nursing staff.

The day I was admitted, I thought they had made a mistake. I wasn’t sick enough and I didn’t need to be there. I didn’t ‘deserve’ the label of anorexic or the privilege of a hospital bed because there were so many people out there who needed it more. But the thing is, that’s how eating disorders work; they convince you that you don’t deserve help when in actual fact everyone does regardless of the severity of their illness.

 

I sat on my bed and cried. And cried. And cried. I was escorted to the dining room to sit with the other patients. Then began the routine of eating, resting, more eating and still more resting. I began on level 1 of a refeeding meal plan and eventually worked my way up to a meal plan of three meals and three snacks a day. A meal plan that meets my bodies nutritional needs. In the beginning, it was extremely difficult. I spent many a mealtime battling my thoughts and wanting to refuse the meal or supplement. And sometimes I did. But the nurses were determined and week after week it got easier.

My day began at 6.30am each morning when I’d take my first lot of medication, and on Mondays and Thursdays I’d change into a gown and be blind weighed. Breakfast was at 8 am, morning tea at 10, lunch at 12 pm, afternoon tea at 3 pm, dinner at 6 pm and supper was 8.30 pm. For 15 minutes after snacks and 30mins after main meals (also the length of time we had to eat) we weren’t able to move around and had to sit in a living area. Afterwards, we had a little more freedom and could use the toilet (next to the nurses station) or go into one a small ‘quiet’ room, but really we were fairly sedentary. Throughout the day we had regular blood tests and our physical obs taken (anywhere from once a day to hourly depending on our health).

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Between 9.30 am and 9 pm at night, our rooms were locked. This was so that it was possible for us to be supervised with fewer staff, to help keep a regular sleeping schedule and to prevent overexercising. It was really hard not being allowed to sleep during the day or to spend time by myself and that’s one of the things I found the most difficult. I’m not a very social person so having to spend all day every day with other patients was a nightmare for me. Or at least it was in the beginning.

As this particular ward was underfunded, there weren’t many activities on. Twice a week, we hard art therapy run by a student and often only a couple of people would attend. I was usually one of them. I made a lot of collages in this time, as well as; watercolour paintings, paper mache type sculptures and journal pages.

Occasionally, though they were supposed to run weekly, we would have a group with the registrar that could involve anything from pros and con lists of our eating disorders to discussing identity or watching a video on the physical effects. We also had a pharmacy group with topics such as bone density, anxiety and sleep hygiene. Out of all of these, the best day of the week by far was pet therapy day. This was when we all got to sit around and cuddle a dog. Because what therapy is better than animals?

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art therapy helped me cope

Ward rounds happened twice a week and they were the bane of our existence. The night before we would fill out a form with questions relating to what we had achieved, what we were struggling with and what we wanted out of the program including any questions we had. The longer you were in hospital and the more you progressed in treatment, the more responsibility and privileges you would get. Common requests included; downstairs leave, leave from the ward, unsupervised bathroom visits, participation in ward activities such as cooking and take away challenges (a rotation of Thai, Indian and Italian) and the most requested of all; discharge.

During ward round we would go into a room with a whole range of professionals that usually consisted of about 10 people (psychologist, psychiatrist, registrar, doctor, dietician, pharmacist, social worker, nurse, medical students, unit manager and whoever else happened to be there that day) and it is one of the most daunting things I’ve ever had to do. Think of it as a job interview but with everyone prying into your personal life. Not ideal.

The nurses made my experience what it was and are the reason that I progressed as far as I did, farther than anyone had expected. They prepared our breakfasts (toast or cereal), snacks and lunch (sandwiches) every day, but not dinners which were provided by the hospital kitchen. They ate with us, provided meal supervision and encouragement, washed our dishes (low and behold there was no dishwasher on the ed ward) and became our supports. A lot of laughter was had over the dinner table, a lot of tears too but mainly laughter. I become close to a few of the nurses and will always be grateful for them and how they made me feel like a person again.

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One of the night nurses would leave messages for us to wake up to

I’m also grateful for the other patients and the special bonds we formed. Spending weeks and weeks with strangers, it was hard for us not to become close. Some of the girls I met were the kindest and most compassionate humans that I’ve ever come across and they are the reason I got through the admission in one piece. Having that support made mealtimes easier and gave me the motivation to eat so that I didn’t trigger anyone else or make eating more difficult for them. Though over time, it became less about that and more about getting better.

Though I went into this admission involuntarily, I am leaving with hope and desire for a better future. I take with me the knowledge that it is possible to beat this illness and that I possess the strength within me to do so. For the first time in a long time, I truly want to recover. I want my life back. I want to be free. It’s not going to be an easy road but I am finally ready to fight.


Part 1; The lead up

I was hospitalised for Anorexia Nervosa Part 1; The lead up

I never thought that it would happen, but here I am having just been released from an eating disorder ward. The last three months have been a blur that I would rather forget, but I am sharing my story in the hopes that it may help someone.

My eating disorder has been a part of my life for all my teenage years and now has made its way into my adult life. The two main risk factors for developing an eating disorder, though we know they definitely aren’t necessary, are being a girl and in the early teens. Combine this with being a perfectionist and having a chaotic home life, I never really stood a chance.

 

My weight fluctuated greatly throughout my teens and I crossed the line between OSFED, anorexia and bulimia nervosa many times. Most of the time I was still able to ‘manage’ it on my own, or at least I thought I could. It wasn’t until I finished high school and turned 18 that things got drastically worse.

I struggled through my first year of university and in the beginning of my second year my weight dropped drastically, to the point where I was physically and mentally at risk. Looking back, I should have been hospitalised at this point, but I stubbornly pushed myself through the semester with twice weekly physical checks and weekly bloods. I was falling down, unable to concentrate, my hair was falling out and I looked awful but I couldn’t acknowledge it. Eventually, as a result of my depression, my eating took on different extremes and I gained a lot of weight back as a result of a severe and lengthy binge and purge cycle.

A year later, in about March of this year things took a turn for the worse again and while in a psychiatric ward; I stopped eating and drinking altogether. Being in this particular ward was traumatic for me for many reasons and I believe was the reason for the severity of this relapse. I still have nightmares about it to this day. My weight once again reached the low it had been the year before and soon the dehydration lead to ECG and blood abnormalities. This is when I was made involuntary, had an NG tube inserted and was transferred to a medical ward.

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The week I spent in a medical ward was awful. I was bedridden, had a special nurse watching me at all times, 24/7 nasogastric feeds, daily ECGs, constant bags of fluids and electrolytes and supervision that included toilet visits and showers. The ward was a locked medical ward that meant I could not leave and I was kept awake by the machines beeping and the 5 other patients (many who had dementia) in the same room as me.

During this time I gained a fair bit of weight back and at a rate that was traumatic. My body was changing too quickly and yet I still wasn’t eating. At the same time, my outpatient team were hurriedly trying to get me a public eating disorder bed, a hard feat in Australia as there are scarce few available.

In the meantime, I spent two weeks in a youth psychiatric unit where the non-eating-disorder trained nurses tried to manage my declining mental health and eating. I was given meal support, but usually for only one meal a day (lunch) and by the occupational therapist who had experience in eating disorders. She was my saviour during this time. After two weeks I was discharged and put on a community treatment order so that when an ed bed came up I would have to take it. This was necessary at the time because I was still refusing help.

Barely a week later, and a month after I had the tube in, I gained access to an eating disorder bed in a public hospital which is where I’ve spent the last 7 weeks of my life.


Part 2: Inpatient life

Things I am grateful for

Sitting on the dining table in the ward is an empty glass coffee jar that has been repurposed as  a gratitude jar. Essentially, patients write down things or people that they are grateful for and then every few days we go through and read some out. It’s a great way to brighten someone’s day by paying them a compliment as it’s completely anonymous, and it also helps to practice mindfulness.

I love this concept because it is such a simple action to take and after a while it becomes less of a  ‘why am I doing this’ activity to something that can be quite enjoyable. Below are 7 of my own;

I am grateful for…

  1. Being able bodied and physically healthy.
  2. Authors who write books about feelings and experiences that I can relate to, and just seem to ‘get it’.
  3. The existence of therapy dogs and their owners. There’s been many a day that I’ve been calmed mid meltdown by a four legged friend. Animal therapy is the best therapy.
  4. Hot cups of tea and cosy blankets
  5. Chocolate fortisips (hospital desserts) that taste amazing. (probably the only thing I’ll miss from hospital)
  6. Lovely, compassionate and understanding patients who are always there for a chat or a hug or even just to pass the tissues. Knowing that I’m not going through this alone is a huge source of my strength right now.
  7. My gorgeous and strong mother who despite everything, has never given up on me. She’s put up with a lot and has learnt and sacrificed more than I could have ever asked for. She’s my lifeline.

What are you grateful for?

Involuntary ed treatment feels like

It feels like my life has been put on hold, intercepted by a greater power. As if I am frozen in time and space, existing within this small bubble that I cannot escape. The only way out is via a door that I do not have keys to. I catch glimpses of the world outside; newspaper headlines, family gossip, the sound of rain against the hospital roof, but it’s like trying to put together a puzzle despite missing the pieces that fit in the corners. Everything just feels so far away.

My attention is focused directly on my current situation; what I’m going to have for breakfast tomorrow, what time to ask for medication. Whether I can manage to sneak out and go to the toilet in the middle of the night without supervision, or if the relief isn’t worth the embarrassment. I spend my days crying over plates of food and attempting to comfort other patients but mostly being comforted. I’m trying to work out what the right moves are. What actions I need to take to be deemed well enough to make my own decisions. Well enough to choose to go home.

It feels like all of my decisions have been taken away and I am just a machine going through the motions. My interests, dreams, ambitions- all the things I should be holding onto tightly, I can sense slipping out of reach. None of these things matter here. Not now. Not really.

What matters is the contents of the silver spoon being brought up to my mouth, the empty supplement boxes and white chipped plates being put in front of me. I’ve had so much practice now that you’d think it would be easy but every swallow is a challenge. Sometimes I can do it without thinking, but other times I can spend what feels like hours staring anywhere but at the food until it is taken away. And then it all happens again.  Some people go to work, I eat.

It feels like everyone is telling me that my thoughts are all made on false pretence. That the monsters I face daily, are not real. It’s as if my world is being taken apart bit by bit and I am challenged to start again from the ruins.

I am constantly terrified. It’s difficult not having any say over my treatment and to be questioning everything. It’s exhausting. Painful. Endless. But it’s worth it, I know it is.

Or it will be.