Sunday 19 November 2017

'Fog that blighted my mornings and drained me is lifting as I come off medication' - Are antidepressants always the answer?

Fiona Kennedy from Oughterard, Co Galway. Photo: Andrew Downes
Fiona Kennedy from Oughterard, Co Galway. Photo: Andrew Downes

Fiona Kennedy

'For 10 years, I believed that the best chance I had of getting to grips with recurrent depression, and later borderline personality disorder, was medication. As I understood it, I had a mental illness - two in fact - caused by a chemical imbalance in my brain. That chemical imbalance could, for the most part, be rectified by finding and maintaining the right combination of drugs.

Granted, I knew there were other things I could do as well. Therapy. Exercise. Eating a good diet. Getting enough sleep - the things we all know, but if my behaviour is anything to go by, things we frequently choose to ignore. A crucial part of my choice to ignore this advice was the belief that it didn't really matter what I did, or how hard I tried, because none of it was going to fix the imbalance in my brain. I would experience periods of reprieve after trying a new combination of medication, but depression would always come back. And if it was always going to come back, what was the point in fighting it? Why not just give in to the inevitable, accept my lot in life?

For a while, I did just that. I accepted my labels, took my medication and kept going. However, almost two years ago my mood and ability to function started declining rapidly, and the medication increased in equal measure. I made occasional progress towards feeling better, but it never lasted. By November 2015, I was unable to work, and have yet to go back.

In April last year, I started working with a clinical psychologist. At our first meeting, she told me she didn't believe in labels, that any one of us at any given time could tick many of the boxes leading to a psychiatric diagnosis, depending on circumstances. Over the weeks that followed, we established reducing, if not eliminating, medication entirely as one of the goals of therapy. At that time, I was taking an antidepressant by day and an antipsychotic by night, and was resigned to having to take them for the rest of my life. In fact, I almost wanted to, because if nothing else, the antipsychotic guaranteed me a decent night's sleep.

What I didn't realise until several months later when I started reducing it, was the phenomenal impact it was having on my ability to function, particularly in the mornings. I would struggle to wake and get through the morning routine of getting the kids up and out to school, and as often as not I would go back to bed when I got home. I had little or no motivation for doing all the extras that could help, and with hindsight, considering the level of sedation carrying over each morning from the night before, it's not remotely surprising. What is surprising in fact, is that I managed to get anything done at all. It never occurred to me that it could have been the medication. I assumed it was symptomatic of depression.

The most important outcome of the work I've done with my psychologist has been freedom from a belief that was stopping me dead in my tracks - the belief that I was sick, that I was ultimately powerless to do anything to help myself, that I was at the mercy of rogue chemicals. She taught me about how our brain works, how it's evolved, how it tries to make sense of the ridiculously fast-paced and complex world we live in. She taught me that emotional responses to situations work in the same way as physical responses, insofar as they're trying to tell us something. We touch something hot, pain tells us to pull our hands away. It's a survival strategy. So, we feel anxiety, anger, depression - they're emotional responses to stimuli, we're just not used to understanding them. What I've learned over the last 10 months has been incredibly empowering. I wasn't depressed, or borderline, or anxious because there was something intrinsically wrong with me, but rather because there were issues in my daily life, and in my past, that I had to address. Short term, there are so many readily available ways to stop ourselves from feeling difficult emotions - distraction, food, alcohol, medication - but there's a problem with all of those strategies. They block the pain temporarily, but it will always come back, and as I learned in the hardest way possible, it comes back stronger every time.

As things stand, I have eliminated the antipsychotic (under medical guidance) entirely and have started reducing the antidepressant. This will happen very gradually, as tapering too quickly can have horrible side effects. While tapering, I am continuing to work with my psychologist, and am putting in place as many self-supporting strategies as I can.

I'm not suggesting medication doesn't have its place. In the absence of adequate therapeutic support, there is no viable alternative for someone in a crisis. But imagine those alternatives were readily available, and affordable. Imagine the freedom that would give us.

Despite 10 years vehemently believing otherwise, I no longer regard depression and borderline personality disorder as illnesses in their own right. They're symptoms, for sure, but not of a chemical imbalance. They're our beautiful brains trying to tell us something isn't right, we just need to be taught how to listen, and how to help ourselves."

Fiona Kennedy (37) is from Galway. She writes about her experiences on sunnyspellsandscatteredshowers.org

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