5 – The Medication Of Choice

I’m a firm believer in the power of choice. Choice, that is, not only in everyday things such as the food we eat, the clothes we wear and the friends we keep, but also choice when it comes to our attitudes towards the circumstances life throws at us.

Deciding to start taking antidepressants was therefore not a choice I made lightly. For years, I had been trying alternative ways to perk myself up, such as running regularly even when it was the last thing I felt like doing, and becoming addicted to Blackadder and Billy Connolly. I also tried various natural remedies over the years such as St John’s Wort, Valerian, even pumpkin seeds. So why could I, such a firm believer in choice, not just choose to stop being anxious and depressed?

Well, I finally realised that all the time I had been facing my bigger black dogs and choosing not to take prescription medication, I did in fact have another choice. And that choice was to take.

Another way of looking at it is that I am not a miracle worker. If, for example, I were an experienced climber, and I wanted to climb Mount Everest and I had just become a radical nudist (admittedly one of my more far-fetched analogies, but bare with me, if you pardon the completely intentional typo) then I could choose to start climbing au naturel. But I would never get very far.

Much as I might want to, climbing all the way to the summit of Everest in my birthday suit would not be a choice available to me. I could, however, choose to stop being pig-headed, use the protective clothing available to me, just climb the mountain, and be happy. I’m sure you get my drift.

Anyway, as I alluded to at the end of my last post, after years of being chased around by increasingly bigger black dogs one at a time, I eventually found myself with a pack of them circling me all at the same time.

At work, I had just been promoted right in the middle of an unbelievably busy period, so I was having to learn a new job in testing circumstances. I felt like I was always working – 24×7 – because if I wasn’t actually working, I was thinking – and intensely worrying – about work. I would be stressing over deadlines, or any small, run-of-the-mill mistakes I had made, becoming fixated with them all and turning them into monsters.

As a single example, I clearly remember going to the movies one Saturday afternoon just before I made the decision to go on medication. Throughout the whole movie, all I could think about was work, obsessing over specific mistakes and impending deadlines. I was literally trembling with anxiety while my friends munched away on their popcorn.

Tess and I also had two very young children to support and love. We had also bought a business two years earlier, which Tess was running while at the same time doing her very best to be a great Mum (two tough challenges, yet she truly excelled at both!) I was acting as part-time unpaid Chief Bean Counter in my spare time, and we were trying to steer our business through what was the Global Financial Crisis. Our younger son Freddie was not sleeping well at all – so of course neither were we. Just to whack some icing on the cake, my red tape dispute with insurers, builders and lawyers over our investment property was still slowly dragging on, unresolved after over two years. And of course with all these pressures came the associated irrational worries and what-ifs.

I would more often than not find myself lying awake in the middle of the night, when the irrational mind is at its most active, fishing around in the dark for new things to worry about. Well, seek and ye shall find – especially in the middle of the night with nothing to distract you from your own dark thoughts.

I even got to a point where I felt it would be bad luck to stop worrying about something. I would try to reason with myself that that not a single one of my irrational worries – major or minor – had ever come to fruition over the years, so perhaps I should choose to just stop worrying, albeit easier said than done. But then I worried that if I let my guard down and stopped worrying, perhaps this would be the worry that would actually come true. Yes, I actually was worrying about not worrying!

I ended up spending months dragging myself through each day, with those pangs of anxiety constantly swirling around in my stomach. During more severe attacks, it would rise up as a gripping sensation to my chest and almost a physical feeling of doom in my head. I eventually got to the point where I had absolutely had enough. It was time to take drastic action. Time to choose my state of mind and conquer this proverbial mountain once and for all, regardless of my aversion towards the proverbial protective clothing.

I had in fact briefly taken Xanax on my doctor’s advice a couple of years earlier at the height of one of my larger individual black dogs. Xanax is a tranquiliser that chills you out more or less within the first two hours, but as my doctor said, “you can become dependent on it” ie “it can be addictive”. Even then, I was reluctant to take it for a brief period because it meant I could never again say that I had never taken medication for stress or anxiety – a specific question asked on many finance application forms, but as I also learned, not a show-stopper. It was around that time I also sat on the couch of an outstandingly great psychologist for the first time. This was another step I had been reluctant to take for all the taboo stigmatic reasons and a step worthy of its own dedicated blog post in the near future.

I therefore didn’t make the choice lightly to go back to my doctor and ask to be prescribed something more heavy-duty, something I could take for longer than just a few days at a time. But I knew it was now the right thing to do, the right choice to make.

The date in question was 13th July 2010. After I had made the decision to go and see my doctor, I spoke to a good friend the night before, who herself was on medication for anxiety. She reiterated that what I was going through, and the choice I had just made in admitting I needed help, were nothing to feel guilty about or be ashamed of. She explained her cancer analogy, that there is a widespread misplaced belief that anxiety is created solely by the individual. She also reassured me that nowadays it absolutely was possible to pop a pill that would take the edge off it all, yet I would still be able to think clearly and rationally. 13th July 2010, she exclaimed, was going to be the day I started to take back control; it was going to be Mark Pacitti Day. She deserved an Oscar for that inspiring conversation. Instead, she gets a mention on a blog. Thank you, Sandy. Sincerely.

I was literally in tears as I made the ten minute walk to the doctor surgery the next morning. The blubbering continued as I sat in her chair. I explained my situation, and that I just wanted the feelings of anxiety and depression to go away. I had even been worried that she might send me packing – that there was nothing wrong with me, that I didn’t need medication, that I should man-up and get back to work.

But no, she was quite understanding, and happily gave me a prescription for an initial month’s supply of Paroxetine. She explained that Paroxetine was a Selective Serotonin Reuptake Inhibitor (SSRI) that acts in a different way to Xanax. Several people, she said, find that if it works well, they can stay on it for years and function normally – but without the anxiety and depression. She then said that she was obliged to point out it would take at least 4-5 weeks for it to get fully into my system and take effect. Just as I thought she had dealt me one huge enough blow in that I was not going to get instant Xanax-style relief, she also pointed out that one in five people get a lot worse before they get better. Oh, and if I should get any suicidal tendencies in the next few weeks, to go straight to a hospital. If not, I would see her again in a month’s time. And with that, I was off to the nearest pharmacist.

I was off work the following day, and actually felt a bit better. Wow, that was quite quick, I thought. Perhaps I am not going to be one of the one in five. But in hindsight, that was just relief that I had finally taken firm action. Within a few days, my state of mind nosedived.

One of the many listed potential temporary side effects was loss of appetite. Well, I knew something was happening when my own appetite completely evaporated into thin air. I’m the sort of person who was never much fun to be around if I got too hungry; I had always loved my food, priding myself on the fact that no matter how sick I ever was, I would still manage to stuff something edible down my gullet because I knew it would make me feel a little better. But this Paroxetine-induced loss of appetite was a whole new ballgame.

For the first time in my life, the mere sight of food made me nauseous. About a week later, there was one day when I hadn’t eaten a single thing by 3pm. Unbelievably, I had actually skipped breakfast AND lunch, yet I wasn’t growling at anyone or climbing the walls. I did finally manage to force myself to eat a slice of toast, though it took me about fifteen painful minutes to slowly nibble away on.

As the days passed, my appetite slowly but surely returned but I also started to sink deeper and deeper into my cave – deeper than I had ever gone before. It was like I had gone into my normal cave, and fallen down a deep, dark hole hidden behind a rock that I had never seen before. My irrational worries and my incessant what-ifs turned into inevitable and highly vivid whens – when I lose my job, when my house falls down, when our business goes to the wall.

With the benefit of hindsight, I don’t think I ever had any suicidal tendencies in those first few weeks, but I can’t recall for sure. I do however remember the vicious circle of worrying that I might become suicidal. I also clearly remember lying in bed wide awake in the middle of a Saturday night, feeling absolutely, completely and utterly, utterly useless – of no worth whatsoever as a husband, a father, an employee or a friend. I thought about the limited life insurance cover that I had, as well as my superannuation – and I literally felt that would at least be of more value to my family dead than alive.

The following morning, I lay in bed alone, with the door closed and the blinds down. To this day, I very clearly remember listening to our then four-year-old Jack chatting away with Tess in the living room. Young Freddie at just over one year old was innocently gurgling away in the background. I can’t remember exactly what Jack was saying, but his voice had never sounded so clear and so sweet. But it was actually a painful moment because at that very same time, I felt I was letting them all down. The reality of it all hit me like a sledgehammer in my already anxiety-ridden chest. Because of the state I was now in, after all, I would never be able to work again. We would lose our house for sure, all because of me. What sort of a future did my sons have now? What about their education, their shot at a decent life? Where were we going to live?

The whole enormity of it all came crashing down and if I were able to think rationally at the time, I would probably have said to myself “surely it can’t get any worse than this?” The problem was that what I did say to myself was “surely it won’t get any better than this”.

That weekend was probably the worst weekend in my entire life, about as low as I had ever felt.

I had gotten myself into such a state that I clearly needed some time out from work. I was incredibly nervous about telling my employers, but they were understanding, and I ended up taking two weeks off.

I had a lot of time during those two weeks to read newspapers and watch television, trying to keep my overactive mind occupied. One day I read in the newspaper about a local Federal MP, and Shadow Minister, Andrew Robb. Mr Robb had recently gone public about his own victorious battle over depression. His condition had also gone from bad to far, far worse as he had weaned himself onto his medication. In one radio interview, he was quoted as saying “You don’t turn around fifty years of body chemistry in three or four weeks. You need patience and there are lots of different pills and approaches.” This rang so true for me, and made me realise that perhaps what I was going through was indeed a normal part of the process. It was also the first time in a while that I allowed myself the luxury of hope.

I didn’t actually feel 100% ready to go back to work when I did, but I felt I could at least do so after just two weeks off without raising suspicion amongst those not in the know. My doctor formally signed me back on anyway – again, in hindsight, I was only ever going to feel 100% ready for work again after a few weeks back at work, and I guess from experience of dealing with people like me, she knew this. I was still feeling like hell, but I was on a sunny Sunday afternoon picnic in the countryside compared to where I had been that woeful weekend just two weeks earlier. And somehow, while my anxiety and depression were still there, I could sense that I was slowly starting to mend.

My next post will be focusing on the weeks and months that followed as my recovery continued. But before I finish on the topic of medication,I also need to make a very important point. In telling my story, I do not mean to portray myself as an advocate for medication as the only way to tackle anxiety and depression. As I’ve said before, I am not a qualified medical professional, but I do know that medication can be surprisingly effective, yet not all medications work for everyone.

What I do want to be an advocate for, however, is that taking any form of action against a mental condition is a bit like the lottery – you’ve got to be in it to win it. And the odds associated with taking this action and subsequently hitting the jackpot are stacked far more in your favour than the weekly numbers game variety. Furthermore, the jackpot may not be measurable in dollars. It is, however, truly priceless.

At the height of my own anxiety I used to play the lottery a fair bit. I held the faint hope – despite the odds – that winning millions of dollars would fix my life once and for all. I would be able to stop worrying about work and money all the time. But if I had won, I would simply have conjured up reasons to worry more about things that money cannot fix. I may have become more of a hypochondriac, for example, overanalysing those moles on my skin, that tightness in my chest, those occasional headaches. What an utter pain in the arse that would have been.

I can now hand-on-healthy-heart say that I absolutely and without question would not change the life I have today for one of an irrationally worrying hypochondriac millionaire. And yet the only thing that has fundamentally changed between the life I have today and the one I had a few years ago is how I think. All because I chose to take what at the time seemed like drastic action.

If, on the other hand, you choose to take no action against anxiety, and bravely battle on, then the outcome will likely always look bleak. After years of facing my own bleak outcomes, I did occasionally trick myself into believing I had finally beaten my own black dogs when my levels of anxiety might drop significantly for a brief period. But in hindsight, I now realise that it was all relative. To say that I was feeling better would not be as accurate as to say I was just feeling less crap. I hadn’t beaten my black dogs; they just weren’t growling as hard for a while. Or, the cunning little bitches were just taking a sneaky snooze. It may have felt like relief, but they were always there – lurking, resting, recharging their batteries, preparing for the next big attack.

Well, I have now found that medication has absolutely worked for me for over a year now, kicking my black dogs into touch, and it continues to do so. Medication, that is, in conjunction with several hours at the start of the journey on the psychologist’s couch.

I do however want to be an advocate for something when it comes to medication, and it is this: if you too have found that it works well for you, and if you do end up staying on it long-term, even for life, then there is nothing whatsoever to be embarrassed about or ashamed of.

Unfortunately, despite the growing number of people taking medication, there is still a huge and needless stigma associated with it. But some of the statistics I’ve stumbled across are quite staggering – statistics such as “antidepressant use up 400% in 20 years”, “40% of Americans affected by depression”, “around one in six Australian men suffer from depression at any given time” And these statistics only relate to people who have and taken action and are therefore part of the prescription statistics. What of those who are still cowering away in their caves? Isn’t it therefore likely that someone you know may secretly be struggling, and resisting the option of taking medication? Unfortunately, many feel that taking them is a sign of weakness or failure.

It is not a weakness. It is not a sign of failure.

I also believe that part of that stigma may be associated with an unspoken and wholly incorrect general consensus, that once you succumb to any mental condition, you are a write-off. I remember several years ago – and I have no idea why this particular story sticks in my mind – reading about how Princess Diana had beaten depression after nearly a decade of suffering. How can she have possibly recovered, I thought? Maybe, I thought, if she is taking medication, it helps her get by, to barely function and no more. But surely she would never be the same again, a numbed-down version of her former self, scarred for life, broken goods.

Nothing could be further from the truth.

I often hear the analogy that it’s easy to get sympathy if you break a bone because people can see your plaster cast, but not so if you have a broken mind. I can now speak from my own experience of having had a mental condition, as well as once fracturing my collarbone in a car accident, that broken bones never quite heal 100%, the cold weather can bring on the occasional twinge.

With my anxiety and depression, on the other hand, as you will discover in my next post, for me it was more like tearing a sheet of paper and then repairing the tear with superglue. It really is possible to come back brighter, stronger and better than ever before, and to take on challenges you previously only ever dreamed of. Funnily enough, I did have a dream recently about standing on the summit of Everest. But I think it’s best for everyone’s sake if I choose to spare you the detail.


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