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.

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.

Suicide warning signs from a survivor

Disclaimer

Before I get into this I want to put a disclaimer here; this post is solely based on my own experience and may or may not relate to others. It is far from a complete list and it’s important to acknowledge that many people who attempt or commit suicide do not show any signs and also that displaying any of these does not mean someone is thinking of hurting themselves or suffering from any sort of mental illness. But I’m writing this anyway because I think it can be helpful to be aware of what to look for as an outsider and also within yourself.

Regardless of everything else, any talk or behaviour of suicide or self harm should be taken seriously.

The background behind this post

Once during a really bad spell I decided to record what was going on for me using the beyondnow app (available here). At the time it felt pointless because surely I’d be able to remember and notice when things were going downhill? Well it turns out sometimes it’s hard to have emotional permanence and your cognition when you are suicidal is often significantly impaired which means you aren’t thinking straight. This list is helpful because I’ve been able to look back at it when I think I’m doing okay and realise that maybe things aren’t great. Maybe they are slipping. Maybe it’s time for me to reach out.

The list

Disturbed sleep. One of the first things that I notice is that I can’t seem to sleep during the night. I toss and I turn but I can’t get my mind to switch off and this can easily escalate to the point where I can’t cope anymore. Dispersed amongst these periods are for me days at a time where I do nothing but sleep. Insomnia or hypersomnia are common symptoms for many people.

Decline in self care. I’ll go from showering every day to a week passing before I’ve even touched my hair. Leaving me feeling disgusting and horrible but without the energy to do anything about it. Which is hard when I know showering is exactly what I need to feel slightly better. It’s disgusting but sometimes I can go days without remembering to change clothes or brush my teeth.

Increase in negative coping skills. I find myself engaging in behaviours such as self harm or binging and purging in search of any sort of relief. Some people turn to alcohol, drugs or just general reckless behaviour.

Agitation. This doesn’t always happen and sometimes I experience the complete opposite but it is common for me. I get this restless anxiety within me both physically and mentally. I feel the need to be constantly moving or playing with my hands. My thoughts become loud and racing. This is usually the point where I need help from someone whether it be medication or increased support.

Feelings of guilt and worthlessness. I mean nothing and my presence is merely hurting people. My head tells me that everyone would be better off without me.

I feel like I’m being weighed down. Like there is something pressing on my shoulder and stopping me from achieving anything.

Cleaning. I have at times been known to go through all of my possessions throwing things away so that I don’t leave too much mess behind for other’s to sort through. My thought process is that I want to make things as easy as possible for them. This has also sometimes meant printing out photos into albums so that my family will only have good memories of me.

….and yet

Despite all of the above, sometimes there are no signs. Sometimes I have a clear plan in my head with a date and method, sometimes just a method and at other times everything is impulsive and decided in the moment. There is no certainty when predicting suicide, it is not an exact science. But that doesn’t mean it’s not worth trying.

For those of you that have been suicidal or depressed or had thoughts of hurting yourself it’s worth working out what some of your signs are. If you can work them out then consider letting someone know and asking what they notice as well because sometimes other people are better at noticing these things.

And for those that know someone who may be struggling or who are worried about someone, look for if they are doing or saying anything out of the ordinary. And most importantly; ask. Ask if they’re okay. Ask if they want to talk. Ask how you can help. And if they don’t want to talk just remind them that you’re there and then keep reminding them because sometimes if there’s a small chance that it can help then it’s worth it.

Small steps are sometimes the biggest

Tomorrow I start back at university. It will be the first time in over 7 months that I’ve sat in a classroom and I’d be lying if I said I wasn’t terrified. I’ve been hyperventilating and breaking out into tears all week because it just feels like to much and I’m worried I won’t be able to cope. I even considered deferring again or dropping out completely but studying is what makes me happy and hopefully this year is going to be different.

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first time back on campus during o-week wishing this was butterbeer

I’m in the (lengthy) process of registering with the disability department and developing an adjustment plan that will be sent out to all my lecturers. This means that if I need extra time or support the way to get it will be much simpler. Despite uni being the place that first referred me to mental health services, I still have not disclosed to them that I suffer from mental illness. In part this was because I don’t feel like I deserve any extra help and also, because I feared that having my diagnoses listed on my record would have negative consequences for my future. But I’ve realised that this doesn’t mean I have to use the support just that it is there and to my relief I haven’t been asked any specifics about what I’m diagnosed with, just what will help me in my studies.

One thing I am struggling with, is that I’m going back to uni on Monday x kg heavier than I was a year ago. I am embarrassed and uncomfortable in this body but I know deep down that the increase is a good thing. With this weight comes better concentration and mental capacity and hopefully the strength to cope with studying again. Last year I though I was fine and while my bloods reflected that, I was exhausted and looked like death. Every day I had to get out of bed was hell because physically my body was weak and compromised. And while I hate admitting it, so was my cognition. No one really knows how I lasted that semester because I was running on empty and despite what I thought at the time, it did catch up to me just not in the way I would have expected (insert many hospital and crisis admissions).

Now I know I still have weight to gain. I know that things could easily go downhill and I know I still have far to go. But I’m willing to fight this time. I’m willing to look after my health so that I have a chance at making this work. I’m not ashamed of my body or my history. With health comes strength and nothing is taking my studies away from me again. I’m going to make uni work this time.

Aside from the above, some other changes in my life have occurred. My old case manager left which (excuse me being dramatic here) pretty much broke my heart and I don’t think I’ve come to terms with the fact that I will never be able to talk to her again.  I was assigned to a new one and we seem to be getting along. I have also begun seeing my gp regularly again and am on the waiting list for an eating disorder program. Small things but with a big impact all the same.

 

I’m falling backwards

If I’m honest, 2017 isn’t shaping up to the year I had hoped it would be. The last few weeks have been rough and unfortunately I’ve found myself deep in depressions grasp again. I’m not really sure what happened or how things got this bad this quickly but I haven’t been very well and I feel like I’ve lost any sense of direction.

In late January I was hospitalised  in a medical ward for a few days following an overdose and was then transferred to a youth psychiatric hospital where I stayed for about 4-5 days. I’m currently home and have been for a few days but am still finding things extremely difficult. I’m not sure if I want to accept the help being offered to me or where I want to go from here. Putting it bluntly, I’m not sure if I want to be alive.

So much has happened in the last year but I feel just as stuck as ever and I don’t know if I can see things ever getting any better.

This is a short post because I’m obviously still struggling and I don’t think negativity is a helpful thing to put out there but I don’t want to pretend things are all sunshine and rainbows when they’re not. Things are bad but I’m trying and taking things day by day.

I have just had my birthday and turned twenty which is a pretty big achievement. I didn’t expect to still be here and I think that’s part of why things aren’t great right now. Getting older is hard because it means I’m still alive and still breathing but I am proud of myself for making it this far and it needn’t be scary.

I was meant to go back to university early but being in hospital has meant that I’ve had to postpone that and will now go back at the end of February for the start of semester 1 with everyone else. I’m hoping that returning will help motivate me and give me something to work towards, I just hope that by then I am well enough to study.

I hope you’re all doing well and I will post more when things improve but right now I need space and I hope you can understand.

Keep hanging in there everyone, better days are coming.

-S

BPD doesn’t make me attention seeking

‘Attention seeking’, ‘dramatic’ and ‘manipulative’ are just some of the terms that come appear in google searches of Borderline Personality Disorder (BPD). Within the mental health community there is still so much stigma associated with this diagnosis and you do not have to look far to find people who have been treated with prejudice because of this diagnosis. There are even professionals out there who refuse to treat borderlines because they believe we are too high risk or manipulative. And they call us the crazy ones.

Borderline Personality Disorder is classified in the DSM-5 as an axis 2 personality disorder.It is an ingrained pattern of behaviour that causes significant difficulty in a person’s life. The core features are difficulty regulating emotions, impulsive behaviour and unstable relationships and self image. That’s the clinical description. Diagnosis requires 5 of a possible 9 criteria to be met, and thus there are 126 possible ways that the disorder can present meaning that two people with bpd may only have one symptom in common and it has a highly variable presentation.

On a more personal level, it causes me to feel things deeply and often and on a level that most people don’t experience. I am wounded easily and dealing with these intense emotions causes problems in my day to day life.

Every emotion that we express is 100% real and we lack emotional permanency. If we push people away or cling to them, it’s because we fear that they are going to leave us to deal with this pain on our own.When we cry it’s because the sadness is so overwhelming that it feels like our insides are burning up and nothing is ever going to be okay again. If we yell, it’s not to hurt anyone but because we have to let the anger out somehow. We don’t want to feel everything this deeply but we don’t have a choice. Living this way is exhausting.

Often the emotional pain is so intense that we’d do anything for some brief moment of relief. This is why people with bpd engage in impulsive behaviours such as self harm or drug and alcohol abuse. Unfortunately, these actions are often viewed as manipulation or attention seeking when really we’re just trying to make it through another day alive. There are times when we’d wish someone would notice our pain and that we possessed the right words to describe our suffering. Sometimes this might lead sufferers to try and show others through our actions but this isn’t true for everyone and it usually  isn’t an isolated reason. But please don’t let that turn you away  because when someone collapses onto the ground you do not leave them there. Our pain may be emotional but it is just as real as anything physical.

Living with bpd is a full time job, and when our behaviour annoys you just remember that this is an illness and it doesn’t just disappear when we need it to. We our trying our best and what you see is only the tip of the turmoil going on inside.

Phrases that trivialise teen mental illness

1. Adolescent angst is a normal part of growing up.

There is no denying that adolescence is a complex and confusing time. It involves changing relationships with peers and family, identity confusion and juggling pressures from school and home. Yet what appears to be normal teen behaviour can often mask deeper problems.

Research indicates that half of all mental health conditions emerge by the age of 14, and 3 in 4 by age 24 (i). Despite the high prevalence, studies have shown that less than a quarter of young people (16-24) suffering from a diagnosable mental illness have had contact with professional services in the last 12 months (ii). Suggesting that despite suffering, most young people are reluctant to seek out help for themselves and therefore dismissing their issues as ‘normal’ teen behaviour could be preventing them from getting the support they need.

2. It’s just a phase

In fact depression is a progressive disorder and instead of getting better without treatment, it’s probably going to get worse. There’s also the risk of suicide and you can’t outgrow something that kills you.

Instead of doing nothing we should take steps to prevent things from becoming a bigger issue.

3. Your mood swings are hormonal

Puberty in teens and menstruation in females may very well cause mood swings but they’re still real and valid. It’s also possible for puberty to mask an underlying problem and  dismissing problems as ‘hormonal’ can invalidate the experience of teens and prevent teens from receiving help.

Some girls do become depressed or suicidal when on their periods. This could be because of hormones exacerbating an existant condition or it could be something could pre-menstrual dysmorphic disorder (PMDD) which is a serious and legitimate medical condition that can be treated and managed.

4. You have nothing to be depressed about

That’s why depression is classified as an ILLNESS. It doesn’t need to have an obvious cause, it just is. Some people are more vulnerable to becoming ill because of their genetics or upbringing and whilst this doesn’t mean they will become unwell it definitely increases the likelihood.

When you’re 15 the ‘worst day of your life’ will differ greatly to when you’re in your 40s but that doesn’t mean it isn’t still ‘the worst day of your life’. Being a teenager isn’t easy. You’re coming to terms with who you are, juggling stressors from school and home and are usually dependent on your parents. Teens can and do experience abuse, poverty and violence. And they do experience mental illness.

One thing that can separate normal teen behaviour  and emotion from an illness  is the duration and degree of difficulty it causes. A good guideline for depression, for example, is that a negative mood which persists for longer than 2 weeks could be a sign that something is off and needs to be checked out by a professional. This method isn’t foolproof though and if you think something is off, and even if you don’t, just ask.

For many young people who are suffering, the stigma and discrimination surrounding mental illness can be as difficult to deal with as the disease itself.

Sources

i Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR & Walters EE (2005).  Lifetime prevalence and age of onset distributions of DSM-IV Disorders in the National Comorbidity Survey replication.  Archives of General Psychiatry, 62, p 593

ii Slade, T, Johnston, A, Teesson, M, Whiteford, H, Burgess, P, Pirkis, J, Saw, S. (2009) The mental health of Australians 2. Report on the 2007 National Survey of Mental Health and Wellbeing. Department of Health and Ageing, Canberra.

2016; The year that was

,The year. The worst year. The year that was the worst year so far.

January-

My weight has declined rapidly. I am in the depths of my ed but I cannot see it. I feel amazing. Depression is nowhere to be found.

February-

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I started falling all the time

I am forced to have twice weekly physical check ups, weekly therapy and blood tests in order to stay out of hospital. I see a dietician for the first time but don’t stick to the meal plan because ‘I’m not sick’. I struggle with turning 19. I am miserable.

March-

I return to uni against everyone’s advice and do well for a while but it’s difficult and I can’t concentrate. I am isolated from my peers by my illness. Inevitably I  gain most of the weight back, leaving me full of self hatred. I stop my meds. Stop talking to people. Stop going to appointments. Start skipping classes.

April-

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Depression roars it’s ugly head. I throw everything into study.

May-

I start on medication #2 (escitalopram) and sleeping pills again because my head is too loud. I recommit to therapy. Almost exam time and I become incredibly suicidal. I don’t study because I don’t plan on sitting them. I’m failing my classes. My exams are deferred.

June-

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Admitted to an adult psych ward. First time in hospital and I’m terrified. Everyone is so much older and I feel like I’m making everything up. I am kept physically safe but there is no treatment. Out after a week but nothing feels better.
July-

 

I get to vote in an election for the first time. Struggle through exam time. I’m not getting better. A culmination of things lead me to taking a large OD and ending up in hospital. I have a bad reaction to a medication they give me, and hallucinate but then I wake up the next day and I’m fine. Covered in bruises from being restrained, but fine. I’m glad I don’t remember this. Have to have my heart monitored in hospital for a few days. I am angry at being alive. Have to defer uni. The pressure eases.

August-September

I spend these months holed up in my room miserable and wishing I was dead.

October-
I am stopped from making another attempt and am transported to a youth ward. The nurses are lovely and the patients are kind but being locked up without my normal coping mechanisms causes me to stop eating.  I trick everyone into thinking I am fine. But when I’m allowed out after a week I really do feel good. Strong. Maybe I can do this.

November-
I’m starting to feel better and positive about the future. My meds are working and I’m seeing my friends again. Things are great.

December-

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Coasting along. Starting to make plans for next year. Didn’t think I’d still be here. I’ve stopped taking my meds again but I feel happy and stable. For the first time in a long time, I am hopeful that things might get better.

Please wait for me

What I’ve always wanted out of life is to help people whether it be as a health professional a stranger or a friend. It’s been the thing holding me to this world, getting me through the dark nights. My dream is to one day become a clinical psychologist and I really hope I get there. If I could make any small difference in one person’s life then I have to fight this. The suffering would be worth something.

I love when people that have been through hell walk out of the flames carrying buckets of water for those still consumed by the fire. -Stephanie Sparkles.

Except that right now…. I don’t know how to help people. I can’t be that person because I’m still burning. I can’t even help myself.

Sure, I can spread positivity and tell people to not give up because one day things will get better and they deserve to see that day. But I’m not sure if I believe that. For other people certainly, I do but I’m not sure things will ever improve for me. In fact, I’m certain they won’t. I feel like a hypocrite for telling someone something that I can’t apply to myself but I don’t know what else to do. I don’t know how they can recover or what will hep because I’m still struggling and I’m going through this all myself.

To everyone out there who is struggling, I want you to know that you are not alone. It may be impossible for another person to know exactly what you are going through but the things you feel, the thoughts you have- other people have them too. You are not alone. You are not alone. Repeat that over and over if you have to until it sinks in. There is help available and there are always other options. The times you feel like giving up, are the times that another person wants to give up too.

We need to fight. for each other. We need to fight so that one day adequate treatment is available and all mental health workers show the kindness and respect that is so desperately needed. We need to fight so that one day the stigma associated with the word ‘mental’ will be no greater than that of ‘illness’.We need to fight so that the world will become more understanding. You can make a difference so please don’t give up.

To those struggling, I want you to hear that I am coming. I am coming with buckets of water and firetrucks and bandages but I need to heal myself first. Please wait. I am coming.