Back on OCD/Anxiety Meds - 6 Lessons

Off-Brand Zoloft!

It has been awhile since I've written, but let's be honest - Life is a little crazy right now for literally everyone.  The pandemic crisis is hard on everyone.  With major changes to social, professional, and family life, even without anxiety, it would be hard to process everything.

With OCD and anxiety, and off of my medication, things became unbearable.  Even before the civil unrest, I was struggling to cope with all the changes and the disappointments.  I quit my tutoring job and took on more hours at the appraisal firm I assist at, my husband and I decided to postpone our plans to start a family, I couldn't see my parents or friends like before, we couldn't go to Disney as planned... I was crying. A lot.  My anxiety was skyrocketing, and I was feeling depression and hopelessness.

So, after discussing how I was feeling with my therapist, it was clear that it was time to call the psychiatrist and admit that I needed some more help.  Here are 5 lessons I've learned getting back on OCD/Anxiety Meds:

1) It doesn't mean you have failed if you need to get back on medicine.

I was off my medicine for almost a year, and up until the COVID-19 crisis, I was actually doing pretty well.  I delayed getting back on the medicine because I couldn't help feeling like I was failing.  I wanted to be able to just suck it up.  I would never judge anyone else for being on medication, but it was hard to practice what I preach.  However, I ultimately was able to rationalize that getting a little help from medicine during one of the most stressful periods my generation has ever faced was nothing to feel shame about.  Also, I'm able to be on a much lower dose than before.  Small victories! 

2) It is okay to take things a day at a time.

One of the reasons I got off of medication in the first place is that I want to be off meds for pregnancy if possible, or at least on something that is safer than the meds I was on before.  Another reason I delayed getting back on medicine was the feeling that I was making a long term decision and worrying about pregnancy.  

However, with COVID-19, our plans to start a family have been postponed at least a year.  Worrying about it now is really getting ahead of myself (which my anxiety makes me fantastic at!).  My therapist and psychiatrist both assured me that I could taper off again later if I was feeling better, and my psychiatrist started me on something that is better tested for pregnancy in case I still need to stay on it.  

3) Something that didn't work years ago may work better now.

When I was in high school, Zoloft worked great for me for years.  At one point, I switched from brand name to generic Zoloft and it was a hot mess: lots of sadness and crying.  I switched back to Zoloft, but then when I stopped taking it for a bit, it didn't really work the same when I tried to get back on.  

When my psychiatrist suggested trying Zoloft again (now approximately a decade later), I was skeptical and I was even more skeptical when I realized I got the generic.  However, I'm glad I didn't close myself off to it because its actually working really well now at a fraction of my former dosage.  Mental health meds are weird. 

4) Side effects are real, but some do taper off!

Even on a dose that is at least a quarter what I've taken in the past, I still experienced some side effects when I started.  The first couple of days, I can only describe feeling WEIRD.  It just felt like something was wrong.  Then, like I've experienced when messing with my OCD meds before, my period was thrown off a bit.  However, there was also something very new: I started to have insomnia (the opposite of my norm!).  The good news is that after a couple of months, the insomnia has really tapered off and things seem to be regulating back to normal. 

5) You can't medicate away a global crisis.

Maybe this is obvious, but it's also important:  everyone is feeling anxiety right now.  COVID-19 is scary because of the unknowns - and that is what anxiety feeds on. My therapist has reminded me that everyone is struggling right now. With other crises also dominating the news cycle, from racial injustice to unemployment, it would actually be a little concerning if you weren't feeling anxious.  Medicine can help you get by, but it won't make these stressors completely disappear.

5) Adjusting to medication can be like effective dieting - the gradual changes do add up.

When you get on an SSRI like Zoloft, it isn't like an immediate change after the first dose.  However, when you find the right pill, you do slowly improve.  It really is like losing weight... you won't notice a major change night to night, but one day your brain just fits better.  I wanted to quit at first because all I felt were the side effects without feeling a benefit.  Now, a couple months out, I'm  really glad I trusted the process.

Remember: I'm not a doctor, and I can only speak from my experience.  Since elementary school, I've tried a number of different OCD/Anxiety medications (from Zoloft to Luvox to Viibryd, just to name a few).  Some have worked better for me than others.  The best thing you can do is is to find a good psychiatrist, advocate for your needs and keep an open mind.  During these difficult times, don't forget to take care of yourself.

Four Surprises in Transitioning off My OCD Medication

Bii for now Viibryd!

With Luke and Lily as our puppies, we already have a family.  My heart is full, but my husband and I would still like to have human children someday.  The medication that I was on for OCD is not generally considered safe for pregnancy, so something had to change before we could move forward.

I found a psychiatrist with fertility experience, and through discussions with her and weighing pros and cons, we agreed I would try going off of my medication.  

This has been a big step for me.  I started on Zoloft when I was in grade school.  I've switched medications around a number of times since then, but I've almost always been on something.  The few times I have been off meds, it hasn't gone well - everything inevitably crashes, and I end up going back on pills.

I've had psychiatrists and therapists tell me that I might never be able to go without medication.  I've also been warned that sometimes when you have an anxiety disorder, your natural anxiety levels can get so high that they can prevent you from getting pregnant or cause issues for the baby.  In some cases, it is actually safer for mom and baby if the pregnant woman is on something, provided the medication is approved for pregnancy and everything is overseen by a doctor throughout.  

The pill I had been on the past few years was a relatively newer brand without much research in terms of pregnancy. Since I would have to transition to something else anyway, and since I had been pretty stable for awhile, my doctor and therapist agreed that I would try going "clean."  This way, I have some time to feel it out before we start family planning.  Ultimately, if it doesn't work, I'll get back on something that the doctor approves for pregnancy.

I have been off of the pills for a few months now.  It has not been easy, but it also has gone much smoother than previous attempts.  That said, here are the four biggest surprises so far:


1.  Life has become an emotional roller coaster.

The highs are higher and the lows are lower.  Small setbacks can send me crashing down and feeling hopeless, but one good day can offset a week of the blues.  For better and for worse, every emotion just seems to be hitting at a higher level.

2.  Sometimes declines are unconscious.

Have you ever put on 10 pounds?  You don't notice it as it comes on a half pound at a time, and then one day you realize your pants don't fit.  My OCD symptoms have similarly snuck up on me.  For example, I didn't really feel my reassurance seeking behaviors and intrusive thoughts increasing day by day.  However, I realize now that they are considerably worse than before and it is something I will need to keep an eye on personally and in therapy.

3.  The anxiety and depression increased more than the OCD symptoms.

I was worried about my OCD getting out of line, but it is actually the anxiety and depression that have been the bigger bullies now that the medicine is gone.  Something as simple as balancing my schedule can seem overwhelmingly daunting, and I am constantly jumping to worst case scenarios in my head.  I wake up many mornings with a sense of dread completely unrelated to any intrusive thought.  So far, this generalized anxiety has been one of the toughest things to battle.

4.  It threw off my cycle.

I had no idea that getting off my medication would have an effect on the timing of my periods.  For a few months, I felt like I was getting my period every couple of weeks.  It wasn't until I went to the gynecologist that he explained that psychotropic medication changes can throw off your cycle because it is your brain that tells your body when to have a period (makes sense!).  To be safe, he did some tests, but everything else looks fine.  Luckily, he told me it should balance out, and this last month my timing seems to be returning to normal.


I'm about four months out now, and I just have to continue to take it a day at a time.  Maybe I will find a way to successfully use the tools from therapy to manage my symptoms on my own.  Maybe I will have to go back on some sort of medication.  For anyone out there on meds right now, there is no shame in needing medication.  Just like any other illness, you prefer not to have to remember a pill every day or worry about side effects, but if you need the pills you take them.  If going back on is what is best for me and my potential offspring, so be it.  But for now, Laura's Adventures in Brain Chemistry will continue.  Onward and (hopefully) upward!

Another Psychiatrist, Another Let Down

Blooms that meet my expectations.

*Sigh*

I've definitely had my fair share of bad experiences with psychiatrists.  I have even discussed it before on this blog.  So, it is very frustrating to me that a new psychiatrist has just let me down.

It's important to realize that at this point, I am like the dream patient for a psychiatrist.  I know that I have an OCD and anxiety diagnosis, I know what pills work, I am stable, and I just show up twice a year and basically confirm that everything is still going relatively smoothly.

Well, I started with a new woman last summer and maybe I should have known from the beginning it was going to be trouble.  She didn't accept like any insurance plans.  But fine, whatever, I'm on autopilot... how hard could this be?

We met and she seemed nice.  I met her again in January, confirmed things were good, and asked if I could just have some Xanax for emergencies.  I had them in the past, but didn't have them anymore.  She looked at me like I might be a drug addict.  She looked me up in her computer system, saw that I wasn't a pill shopper, and agreed to give me a prescription for 10 pills, but lectured that this wasn't the standard of care anymore and told me she would never give me a refill.  (Please note that since she prescribed them in January, I have taken a total of one.  I seriously only use them for extreme panic attacks.)

So I was kind of off put by that situation, but okay.  I see this woman twice a year.  She doesn't need to trust me.  Whatever.  

That brings us to last week. I get a bill in the mail for $125.  Underneath the date and total info was handwritten only, "missed appointment."  I didn't even recognize the name at the top of the invoice at first.  What even was this?

I was angry, but remembered that I had made an appointment with my psychiatrist back in January for July. It was 6 months ago that I made that appointment, so I had just forgotten the day. I've never had a doctor before who didn't do some kind of confirmation.  Email, text, call... even my manicurist confirms her appointments!  

I called in to figure out what to do and her receptionist basically said all she could do was take the money I owed, but if I wanted to make another appointment I'd have to leave the doctor a voicemail.  I paid and let the receptionist know I wouldn't be returning.

This whole situation had me fuming.  Regardless of the fact that this woman has no confirmation system, what I think the real tragedy is here is that this woman is a psychiatrist who had a patient not show up, who she has had no contact with for six months, and her only response was a bill with the handwritten note "missed appointment."

Luckily, I am stable.  But what if I wasn't?  Apparently she sees no need to confirm and remind patients of their appointments and believes they can remember them on their own.  Well, in that case, the fact that I missed the appointment should be even more disturbing.  What if I hadn't shown up to my appointment because I was in crisis?  A lot of these pills that are supposed to help mental health can sometimes lead to negative effects.  She's supposed to be a mental health professional... shouldn't she at least check in?

I talked to my friend about it who agreed it was ridiculous.  She said her therapist calls her if she's even 15 minutes late for an appointment just to make sure she isn't dead.  

I know most doctors don't check-in when you miss an appointment.  But, as a mental health professional I would hope psychiatrists would understand the importance of showing care and empathy to their patients.  Even if you tell me this woman has no time to send emails or make phone calls, if she had expanded her handwritten note to read, "Missed appointment.  Hope all is well, please check in,"  that would have been enough.

Maybe that's a good lesson for all of us:  Take the little extra step to show people you care.  It can mean a lot.

Don't Try This at Home

As I mentioned previously, I've been in kind of a funk lately. 

Take as instructed!!

As I also mentioned, I was exasperated by my psychiatrist's decision to do nothing to change my medication.

So, a few weeks ago I did something dumb:  I took matters into my own hands.

I was on two different kinds of medication for OCD, and I decided that I didn't want to take one of them anymore.  (I'm leaving out their names because I don't want anyone copying my stupidity and thinking they will get the same result.)  

I had started this second one and loved it.  It gave me amazing amounts of energy.  I felt so much BETTER.  Not just with OCD, but in general.  I was ready to tackle the world! 

Unfortunately, this was just a side effect that wore off after a few weeks.  Then, even though I stayed on the lowest dose possible, I think another common side effect took over... and this one was much less pleasant: weight gain.

See, when I was on this pill I rarely ever felt full.  This isn't a huge deal until you put me in front of a bowl of mindless snack food, like chips and guac. Imagine being able to eat chip after chip without any signal from your body to stop?  It's almost like a super power, but with unfortunate consequences.

Now being a girl is hard enough.  Being a girl with OCD?  Very hard.  But getting chubby on top of it?  No.

So my funk had hit and I decided since I was on the lowest dose just to stop taking it.  It didn't seem to do much for me besides potentially prep me for a food eating competition.  

I didn't tell my psychiatrist.  I didn't tell my mom or my boyfriend.  I didn't want any naysayers.  I figured I'd tell them when it was already done and my transition off was complete.  I ignored the fact that I had stopped taking other OCD meds before and had total freak outs weeks later.  I didn't even Google what might happen.  Just did it.

And in the following weeks I saw no change to my mental health.  With a strict diet, I very quickly lost 8 pounds, but who is to say if the pills had anything to do with it.

I finally told my mom, who went straight to the internet to find out what horrors I may have risked.  Turns out, they were pretty big.  People experience drastic side effects coming off this medication, including seizures.

I somehow was lucky, and consider this a triumph over my own stupid choices.  I made it out unscathed, but I beg you, do not try this at home.  Don't let some weight gain make you go rogue.  Consult your doctor first to come up with a plan if you want to get off a certain medication regimen.  That way, you will make sure you do it safely.

You will also make sure your mom doesn't waste hundreds of dollars on refills that you don't plan on taking.  Yikes.  Sorry mom!

Normal

A comfort after a cry.

I've been in a major funk lately, and not the cool Uptown kind that Bruno Mars sings about.

To top it off, I just discovered that my feelings of awful might not be OCD or anxiety disorder related.  They may just be normal.

What?

I go to my psychiatrist and I tell her about my current life situation... how my business has not been picking up and I may have to find a new job and how my boyfriend has moved to Dayton. (Her response to my boyfriend moving away was just one word: "Yikes."  I hadn't heard that word since like '96.) 

I also tell her how I've been feeling.  I explain how my energy is so low it's hard to get out of bed in the morning, how I have a lack of motivation to do basically anything, and how I've put on weight.  I just generally feel anxiety and eugh all the time. 

I expected her to recommend something different for my medication.  Instead, she reflected that there was a lot of "uncertainty" in my life right now, and then made no change to my drug regimen.

What?

So, I go to see my therapist yesterday and tell her all of this.  I explain how I thought it was weird that we weren't making any changes to the meds when I feel this bad.  Surely something should be done. 

That's when my therapist put things in perspective.

She told me she wanted to "normalize" what I was feeling.  This anxiety wasn't because of the OCD or other anxiety issues: This was anxiety that made sense in my situation.

I've read before and recently talked to my mom about how with OCD, or any other mental health issue, you tend to pathologize everything.  It's easy to blame the OCD for any anxious or bad feelings.  But the fact of the matter is that yucky feelings happen to everyone.  

Now, I don't often like the theory of "normal."  It can serve to make us feel like we don't belong, or we're crazy, or we somehow don't fit a made-up standard. But sometimes we need the concept of normality.  It keeps us in check.  Plus, we all have times where we need to just feel "normal."

So now that my problems have been qualified as not just in my head, I'm left to fight on and figure this out. Triumph or Tragedy? Still unclear.

Psycho Psychiatrists

Chilling in the pool during my trauma-free childhood.

Tragedy: All men may have been created equal, but all mental health professionals definitely were not.

Yesterday, I saw a new psychiatrist.  I thought this would be an easy transition... give her my OCD backstory, explain the medications I'm on, let her know I'm doing pretty well working with my therapist about once a month.  Easy peasy.

Wrong.

Instead, the woman I saw described my medication as "toxic."  She suggested that I do intensive psychotherapy instead, twice a week.  TWICE A WEEK! As my dad asked, "What is this? Hollywood?"  This remark made me feel a little better, like Marilyn Monroe.

This woman was also obsessed with my past.  It was like a run in with Freud.   She wanted to know details and memories from when I was very little, even asking me to do research to see how my mom's pregnancy was and how I acted as a baby.  It was clear she thought there must be some trigger for the anxiety from my childhood. 

This is far from the case.  My childhood was awesome: Nothing bad happened.  I am not repressing something.  I am not hiding something.  I'm seriously just lucky.

That's the thing about OCD that many people don't seem to grasp: It's genetic and chemical.  Situations may trigger it in some people, but nobody had to do anything wrong; there didn't have to be a trigger.  It's not like PTSD... some people even call OCD a brain disorder instead of a mental disorder.

The psychiatrist also just didn't seem to understand some of my OCD symptoms when I described them to her.  Now, I get that this was our first meeting... but I'm pretty textbook.  I felt like I was dealing with someone who didn't have a good grasp of the problem.

This is the big issue with finding a psychiatrist.  To rephrase Forrest Gump: "Psychiatrists are like a box of chocolates: you never know what you're going to get."  They all have different views and different training.  Some of them hate medication, some are pill pushers... some are more Freudian, others lean toward more modern theories. Some you would trust with your life, others you wouldn't want to trust with your lunch.

My advice to OCD friends out there looking for a psychiatrist is to find a specialist if you can.  Also, follow your heart.  Find treatment that you can feel good about.  Just because someone has an M.D. doesn't mean that they know everything.  You are the best expert on you, so find somebody compatible who can support your recovery.