My introduction to psychiatry was blessed by a doctor who spent half his working life doing neurology research. Why was this a blessing? Because people who do research in neurology know one thing very clearly: it’s damn near impossible to find out what’s happening inside the human brain. He knew better than anyone that his work in psychiatry was guess work–the best work the traditional Western medical community could do for patients in dire need of help, but far from the more precise science of other diagnostic procedures. When I asked him if I could be feeling something because of a medication I was taking, he once said “Well, it’s not on the list of common symptoms, but that doesn’t mean much.”
I’m not sure how my doctor for my first five medicated years would feel about my current work with a functional medicine/holistic medicine practitioner (Brie) and our effort to use amino acid supplements and nutritional changes to heal the damage done to my body and brain by years of trauma and medication. I do know that my heart draws me to this work, and the more I learn, the more my head says YES! THAT! that is what is for me!
Pause for clarification: when I say that damage has been done to my body and brain by my medication, I’m not referring to any weird theory about medication being toxic and “unnatural.” Meds saved my life. Meds keep me functional, today. I am pro-meds, when prescribed and taken by communicative, cooperative doctors and patients. Any doctor will admit that there are downsides to the kinds of medication I take, a benzodiazepine called clonazepam/Klonopin (generic/Brand) and a selective serotonin re-uptake inhibitor (SSRI) called venlafaxine HCL ER/Effexor XR–“benzos” and Effexor are both notorious for causing chemical dependency, which is NOT addiction, but which leads to withdrawal-like symptoms when we try to stop taking them. There are no clinical studies outlining the effects of SSRI use for long periods of time (10 years or more), but it does seem that SSRIs decrease serotonin made by our bodies and brains. Click that last link for more information about how SSRIs work–particularly if you think that they increase serotonin production, because they don’t cause our bodies and brains to make more “happy” chemicals. They just change the way those chemicals get used.
Now, what exactly is the work that I’m doing? First: a change in diet. This Monday, 13 days into my gluten-free, sugar/sweetener-free, soy-free, cow’s milk-free, low-glycemic diet, I began taking amino acid supplements in large doses. Why am I swallowing stuff you’ve probably only heard about in the context of food and nutrition to help with my brain? Because one way to get to the brain is through the fatty acids that cross the “blood-brain barrier.” This is exactly what amino acids do, among other things. Why such large doses? The Franklin Institute piece I just linked to explains that “The fact is, if amino acids reach your brain at all, it should be considered a success. Not only do brain cells compete with body cells for amino acids (body cells pull amino acids from the bloodstream more easily), amino acids must pass the protective blood-brain barrier.”
Another pause for another clarification: as the super helpful site I just quoted goes on to explain, “Food is your best source of amino acids. Be cautious about trying to manipulate your intake with individual amino acid supplements.” Please, do NOT read this blog post and go out and buy a lot of amino acid supplements from a drugstore and start popping them. I’m about to go into just how intense this gets, and trust me–you do not want to do this by yourself. If you’re curious about it, start by eating better. More protein, the right kind of protein, balanced with the right carbohydrates, etc. Again, all on this site, here, which my practitioner agrees is a great recourse: http://www.fi.edu/learn/brain/proteins.html. No, I will not post the details of the diet I’m following, because I really needed help feeling ok while making such big changes so quickly. High anxiety and increasingly bad migraine headaches warranted the kind of action I’m taking, in my opinion. But I’m paying an expert to help me, and she’s worth twice what she’s getting.
Now, 730 words in, the story that relates to my title! Sorry about burying the lead, as they said when people still read newspapers, but I’m not feeling so hot. I’m not in a super-high-energy place with anything, let alone editing.
I began taking the supplement course specifically designed for me on Monday. The plan is to send a urine sample for specific testing to see how it’s all going exactly 14 days after taking my first dose. It’s very specific. Two weeks. Not a lot of time. I was surprised, then, but not shocked, when I felt a sudden shift in my overall wellbeing. For the worse. The very much worse. I had been warned, though, that I might feel really badly as my body and brain adjusted, and that this could mean a bad reaction to the supplements, a need for more of the supplements, or that I needed less of my medication. It’s maddening, though, that all three of these things feel pretty much the same way, so trial and error is the only way to find out how to fix it. I did just what I was supposed to do: I left a message for my psychiatrist, who can take a long time to call back, then I called Brie, then my therapist, Linda. Brie was, as she has always been, incredibly smart, clear and helpful. I was going to try this, and if this didn’t work, then that. I called my therapist to keep her in the loop and for comfort (Downton Abbey fans–the woman has the voice, accent and demeanor of Mrs. Hughes). My usually rather warm and always helpful psychiatrist shocked me with her cold tone, short sentences, and distance.
Why? Well, despite the fact that during our last session together, she smiled, nodded and expressed a lot of curiosity about amino acid therapy to help with chemical dependency on medication, my doctor had not done any of the things she had told me she would do. She had not returned Brie’s phone call. She had not done any research into this holistic therapy. Most importantly, she was not supportive of trying a decrease in my medication dosage to see how that reacted. In short, she didn’t believe in any of this. The contempt in her voice shocked me.
This doctor is good at her job. When I was pregnant, she was calm, steady, communicative with my midwives, and always ready to schedule and extra session if I felt nervous. I wish that kind of vigilance were the standard of care for pregnant women with a history of mental health issues. What I’m doing now, however, is far outside her purview. She’s not comfortable, and that’s fine. But she didn’t tell me that when I first explained what I would be doing, when I directly asked her if I could call her, list symptoms and get her opinion as to whether I was feeling too much Effexor or too much Klonopin. Perhaps she didn’t believe that it would do anything, this “kind of thing.” Perhaps she has such strong convictions about the medications she prescribes, that she believe they should be the last change I make. Whatever is going on with her, she handled this badly. I cried a lot. I talked to my therapist for the third time in one day. I ranted and raged about communication and meeting me halfway.
This morning, I woke up newly determined to stay the course with this holistic treatment and very carefully try a lower Effexor dose, before changing my supplement course. This dose of supplements is only supposed to last two weeks, so I wanted to try a tiny step down in the meds before messing with such a short-term program. I felt confident about this because I am very good at communicating with my doctors (yes, even when they suck at communicating with me). I am always honest with myself about my mental health. I feel no hesitation about the idea of going right back up to my previous dose at the first sign of trouble. While my psychiatrist remains uncooperative, she did finally speak to Brie and she is willing (if not happy) to write me prescriptions for lower doses, provided they are within a reasonable range. I’m not interested in huge changes. This afternoon, after a lot of communication with I dropped from 200mg to 175mg. I’ve been paying very close attention to the nutritional aspect of all this, too, so I’m being extra careful to eat more often (an empty stomach exacerbates everything, I find, and makes it really hard to figure out what to do next). I’m sleeping more.
The larger issue here is that I have very few options, when it comes to working to decrease my dosage of psychiatric medications; when I was so ill that the only way out of that darkest of all places was via medication, psychiatry worked exactly the way that it should. I worked with my doctors. I made informed choices. I was never handed a sample or a prescription without a proper explanation of the short- and long-term side effects and consequences. I was never shamed by a doctor and always felt like an active participant in my own care. In the last 24 hours, I felt as though that had disappeared.
It’s important that doctors are cautious about patients who suddenly want to decrease or drop a medication, especially with histories like mine, that include such extreme symptoms and a hospitalization.
It’s also important that patients like me have a chance to try to find a way out of the prescription cycle, if we want to do that. I’ve been taking meds for seven years. At one time, the idea of taking them forever didn’t bother me. But I have this chance, right in front of me, to try something that could help make meds a less significant part of my mental health treatment, and I want to take that chance. No one who knows me well is worried that I will do anything drastic, like flush my meds. No one is even worried that I will fail to report every single feeling and sensation that I have! And yet, I am stuck working with someone who thinks I have been taken in by “so-called ‘science'” because there is almost no one who can write me the new prescriptions I’ll need who believes that anything else works! It’s a cycle that takes enormous strength and delicate self-care to break. I am so angry that my doctor is withholding her expertise while I Google “symptoms of Effexor overdose” and choose all by myself which drug I want her to decrease, all so that she doesn’t have to be afraid that she has made the wrong choice. I get it. Doctors don’t want to experiment. I don’t want doctors to do much experimenting, either.
But there are many people who point to psychiatry and call my doctor’s theories “so-called ‘science'” – we have no way of actually seeing how these medications work. No one has ever SEEN a neurotransmitter in action, in the brain! No one has watched an SSRI travel through a patient’s blood stream, past the blood-brain barrier, and watched it stop the re-uptake of serotonin from happening. It’s good guess work. There is solid evidence. But there is also a lot of money from many drug companies funding the research that provides that evidence. Holistic treatments, for many reasons, don’t get that kind of research. Before now, I didn’t know how to go about caring for my body in a way that would help my brain, even theoretically. I just want to try this very clear, very specific path, to see where it leads.
The truth is that I’m lucky my doctor is willing to even see me, let alone write prescriptions she doesn’t like writing. She is very interested in keeping me safe, even if she would rather I didn’t do this. I have heard so many stories, mostly from readers I’ve never met, about doctors who simply ask a patient to leave and never come back, because she does not agree with the doctor’s assessment. That would be frustrating no matter what, but it’s downright irresponsible when that patient is chemically dependent on a medication and suddenly left with no refills. It’s not safe to simply stop taking this stuff.
I am safe. I am feeling better. I am moving forward in a way that feels true to my heart and mind. I am scared, of course, because this is brand new territory for me. I am hopeful.