Saturday, 16 January 2010

... and Kansas went bye-bye

Ten years ago I was depressed. I was on student placement for a major pharma as part of my IT degree, my dog had just died, I had split up with a long term partner and felt that, as a mature student, I didn't quite fit in with the younger flat mates who shared my apartment block.

I went to the doctor. She prescribed anti-depressants. Finally, I thought, someone who has listened. I picked up a pack of 20mg Paroxetine tablets and took the first one that day, Friday lunchtime.

Night-time was a little bit strange. I felt strangely uncomfortably in my own skin, unable to lie still, kind of.. wriggly. I couldn't sleep. Saturday came. I took the second pill. And started to feel a little bit spaced out, but given that I didn't have anything particular to focus on, I relaxed for the day.

By the time I went to bed Saturday night, I suspected that something wasn't quite right, but couldn't work it out. I felt confused. My legs were in continual movement, as though trying to walk me out of the bed. My hands flexed and clenched constantly. My spine arched. My head buzzed. And every time I tried to close my eyelids, they snapped open again after a few seconds. I writhed and contorted, and eventually fell asleep.

On Sunday I was meant to drive to my Mum's, 35 minutes away. I felt a bit woozy, as though I couldn't focus, but matched it to the same kind of feeling that you get after a drunken night out and aren't sure whether you are fit to drive. Putting it down to tiredness, I took a third pill, left the house, started the car, and started driving. 30 seconds down the road and I realised that things were wrong - I couldn't read any of the road signs and didn't know where I was. My spatial awareness was gone. I couldn't remember what side of the road I was meant to be on, how to change gear, what way to go round the roundabout.

In short, I was completely off my face. I don't know how I got the car home in one piece, but somehow I did, and the nightmare began to unfold.

My pupils were blown so wide that it was barely possible to see that my irises were blue. On one occasion I looked in a mirror and thought I saw someone else looking back from behind my eyes, which led to the delusion that I must be possessed. I avoided the mirror from then on. My short term memory disappeared completely - so much so, that I couldn't read. By the end of each sentence, I had forgotten the beginning. I had a continual script running in my head, trying to calm myself down, trying to focus on something - anything - that kept the panic away.
"Neighbours is on in a minute. Neighbours is on in a minute. Neighbours is on in a minute. Oh... I'm watching Neighbours. This is Neighbours. Neighbours is on. I'm watching Neighbours. Neighbours is on in a minute. No, I'm watching it. This is Neighbours".

Making a cup of tea was virtually impossible - by the time I had remembered that I was making a cup of tea, the water was back off the boil, or the tea bag stewed. When I did succeed I forgot I had made it and the tea went cold.

I sat for hours, hands wringing, rocking back and forth on the couch like a mental patient, pupils blown, face drawn. My flat-mate was totally freaked and apart from checking that I was still alive, spent most of her time giving me a wide berth. And I can't blame her - I had completely lost it: I was a barn-pot, a fruit-loop, two sandwiches short of a picnic. Totally and utterly barmy.

The most frightening thing about this entire episode wasn't that I had lost my mind, but that I thought I would never get it back.

It was another 5 days before I was capable of crossing the road to reach the doctor's surgery, where I tried to explain the sheer horror of my experience. She laughed and said "Oh dear, I think you could say that these didn't agree with you then! Do you want me to try you on another brand? Or see how you go?" I opted for the latter, deciding that no matter how depressed I felt, it was nothing compared to the last eight days. Anything was better than that.

But this Friday I decided to give the pills another go. Just not the same pills. If I could find something that would keep me from hitting a low whilst I sorted myself out, all would be well. It was sensible, surely, to accept medical help to sort out a medical condition?

I talked to the doctor and explained my previous experience. She suggested I research my findings and come back in two weeks, but I didn't want to wait two weeks. She printed out some generic information on SSRI's and Tricyclic anti-depressants, written for total morons (and virtually identical) and then at the last minute prescribed Citalopram, 20mg.

When I got home, I started to search the Internet and was instantly alarmed - according to Wikipedia (and this document did look very scientific), both Paroxetine (Px) and Citalopram (Cp) are Pgp Substrates and if one does not work, the other is not an option. I expanded my research and found a White Paper on treatment of patients with Cp who had previously reacted to Px - and the results were positive. I looked at message boards to read other's experiences, and all looked well.

Feeling slightly more assured, I took half a tablet - 10mg - as prescribed, and carried on with my day. Everything was going to be fine. There will be no side effects.

Within ten minutes, I had a strong metallic taste in my mouth. No problem. My heart was pounding a little, but not enough to cause concern. I made myself something to eat, and couldn't finish it. I started to get icy cold shivers down my spine and the back of my arms, despite just having had a hot meal, having the heating on and wearing several layers. The shivers turned in to sharp goosebumps. Even so, it wasn't getting in the way of my day. Then I started to feel a little bit drowsy - a little bit spaced - again, nothing to panic about. But I decided to contact NHS Direct and ask them a few questions.

They were very good. The initial health adviser had no training whatsoever and could only tell me that Px and Cp were SSRI's, but she referred me to the (mental health) website and ask if I wanted a pharmacist to contact me. I said yes.

I visited the Mind website and downloaded the Patient Information Leaflets for both Px and Cp, and it was here that I made an alarming discovery with reference to side effects:
Likely to affect up to 1 in every 10,000 people:
If you have some or all of the following symptoms you may have something called serotonin syndrome. The symptoms include: feeling confused, feeling restless, sweating, shaking, shivering, hallucinations (strange visions or sounds), sudden jerks of the muscles or a fast heartbeat. If you feel like this contact your doctor.

I started to research Serotonin Syndrome and for the first time realised that this is what I'd had ten years ago. Thank goodness that I'd stopped at 3 pills - I'd had every symptom except the high fever, coma and death. What angers me is that the first doctor took this so lightly and made no note on my medical records - or reported this back to the clinical teams.

When the pharmacist rang, I gave her this information, and she informed me that Cp and Px were very different drugs and that there was no reason why I should react in the same way. But given that I had some odd symptoms, perhaps I should call my doctor. It was already too late as the surgery was closed, so I decided to call on Monday. And anyway, I felt a little spaced, but conversant. Although it did feel as though somebody else was actually having the conversation while I sat by and listened in.

Ten minutes later I started to get ready for my evening out - it was the New Moon of Aquarius and Friday Night Shabbat all rolled in to one. I was really looking forward to it. But when I tried to decide what to wear, I couldn't make a decision for toffee. I couldn't even remember what I had chosen, kept forgetting what I had and several times forgot what I was doing altogether. I would pick up a pair of trousers and then think "what am I mean to be doing with these?"

With time running short, I threw an outfit together, then impatiently tried to apply some make up. I'm going to miss this train. What is wrong with me? I applied foundation, powder and mascara and stood back to review my progress. It looked as though it had been applied by a chimp. An untrained chimp. I felt as though I had just downed ten glasses of wine - and if you knew my tolerance for wine, you would realise that this was ten too many.

Once again I was completely gone. I had a high pitched tone ringing round my ears and felt dizzy and disassociated from everything around me. I stumbled downstairs and rang my friend and explained that I wouldn't be able to make it. I laughed about it, said that I couldn't believe how I was feeling - that this had happened again. There was a voice inside saying "Why are you laughing? This isn't funny - you're going to miss a fabulous night out" but I couldn't help it. I felt as though I was halfway through a really good night out already, and it was even funnier because someone kept moving the floor.

Somehow I managed to make some pasta, checking, double-checking and triple-checking that I switched the hobs off afterwards.

And today... well, today I just let go of any attempt to gain control, because it wasn't in my hands. Dorothy was caught in the hurricane. Kansas went bye-bye. So I lay in bed, sometimes catching a song from the radio, most of the time floating around another dimension altogether. A few times I shuffled down to the kitchen and made a cup of tea. I even read a few pages of a book, although along with all of the conversations I have had over the past day, I can't remember anything - what I read, who I've spoken to, what I said to whom.

Slowly as the evening has worn on, the tablet has started to wear off.

At least this time I knew that at some point, I would be able to click my red heels together, and come back to Kansas. Although to be honest, given that I have run out of both milk AND chocolate, I wonder why I bothered....


  1. i'm really sorry for you
    and that totally sucks
    i do hope you find somethng soon

    and the untrained chimp made me laugh

  2. Terrifying! I hope you are feeling more like yourself today. Take care.


  3. If your doc doesn't listen, is it easy to switch and get another? You should never have gone through this once, let alone twice...

    I hope you find something that works.

  4. JST: Every experience is valuable - yesterday I learned to let go. Not what I would have chosen, perhaps, but not something that I can change either. Today I applied my make-up and it looked like a trained chimp had applied it. So back to normal again :o)

    IB: Terrifying the first time round, a waiting game the second. I'm feeling good, thanks!

    e: I have a few things in place which may avoid the pills altogether and be the right 'something that works' And yes, the surgery are going to hear all about my experiences, they are going to listen this time, and they are going to update my notes!! xx