Tag Archives: Health

Adulting without medication

Since around the time I gave up alcohol back in 2009, I’ve been taking medication for anxiety and depression.

It’s the most recent part of a very long story; I spent years without a proper anxiety or depression diagnosis, self-medicating with alcohol, then to cut a long story short in 2009 I reached a point where I knew I needed to either drastically change my life or prepare for an early alcohol-induced death. Note that this was before I realised I had Asperger’s Syndrome.

I spilled it all out to my family doctor who was very sympathetic, helped me get off the alcohol with a short course of benzodiazepines, prescribed an antidepressant (Seroxat), and recommended a counsellor. I took advantage of all of these things, read the book “Rational Recovery” by Jack Trimpey (highly recommended) and haven’t touched a drop of alcohol since that day. (I ended up continuing the counselling sessions for about three years and they helped me through a break-up and a lot of personal growth.)

Things went well, other than a dramatic loss of libido as a side effect of the Seroxat. So a few months later I went back to my family doctor, explained this, and she switched me to a different antidepressant (Wellbutrin).

Wellbutrin was far kinder to my libido, but it didn’t do much for my anxiety (whereas Seroxat helped with both the anxiety and the depression).

So I returned to my doctor who referred me to a psychologist, and he prescribed Deanxit in addition to the Wellbutrin. This helped quite a bit, and that was my medication regime for several years.

Jump ahead to 2017. I hadn’t had a major depressive episode for over two years, and my general mood was fine too. I had given up smoking, replacing it with vaping, and I felt my anxiety was under control. I decided I wanted to try to reduce (and eventually eliminate, if I could) my dependence on these medications.

I spoke to my (new) family doctor and asked for advice about how to quit Wellbutrin (I decided that was the one I should try and quit first). He wasn’t overly helpful, just said I should take half my dose for a month then stop. I wasn’t convinced by this, so I did some reading, and in the end, because Wellbutrin tablets are very hard to cut into pieces, I came up with this plan:

  1. For 2 weeks, take my dose 2 days out of every 3
  2. For 2 weeks, take my dose 1 day out of every 2
  3. For 2 weeks, take my dose 1 day out of every 3
  4. For 2 weeks, take my dose 1 day out of every 4
  5. Stop

I did this, and it worked amazingly well – I had no depressive episodes, only some minor irritability and sleeplessness. I think the fact that I was still taking the Deanxit probably helped a lot.

So now here I was, free of one of my medications, but quite worried about quitting the other one. The way I saw it was that depressive episodes, while horrible to experience, didn’t actually happen that often, whereas anxiety was my daily companion, so taking the final step of quitting the Deanxit was likely to be much harder. Especially since Deanxit was chemically an antidepressant so likely to affect my mood as well as my anxiety levels.

And in fact for two years I did nothing about it, just kept taking the little pink Deanxit pill each morning.

Jump forward to this year.

In January 2019 my wife and I emigrated from Europe to the Philippines. That’s a big topic that I will touch on in other posts, but its relevance here is that I had no idea whether Deanxit would be available in the Philippines. In the end I decided to take a 9 month supply which would give me enough time to find a substitute if I needed to.

And indeed it turned out that Deanxit is not available in the Philippines. In fact according to its manufacturer’s website it’s only registered in 22 countries worldwide.

So that kind of forced my hand. There were clearly two options:

  1. See a doctor and get advice about switching to a different anti-anxiety medication
  2. Try to quit Deanxit and then see how things went before seeing a doctor if needed

I kept postponing this decision for the first few months in the Philippines, due to the stresses of settling in to our new life. My anxiety levels, even with the Deanxit, were higher than normal, which was perhaps to be expected, and I knew I couldn’t deal with the risk of switching or giving up for a while.

In the end, I waited until we had bought and furnished our house, and dealt with some other problematic family business, before deciding that my life was free enough from anxiety-inducing situations to go with option 2. I would taper down the Deanxit and see how I coped.

So this is what I did, and have just finished doing. Luckily Deanxit tablets are much easier to cut with a knife.

  1. For 2 weeks, take two thirds of a tablet
  2. For 2 weeks, take half a tablet
  3. For 2 weeks, take a third of a tablet
  4. Stop

I’ve now been without any Deanxit for about two weeks, and so far I’m coping. I’ve tried to examine my state of mind and have found that my mood has been, on average, a bit lower than before. I’ve felt, on and off, a bit ‘fed up’ without necessarily being able to pinpoint a cause – in other words, the dysthymia that I experienced for many years is creeping back. I’ve also experienced one stressful situation since stopping the Deanxit and I did experience something approaching a panic attack before forcing myself to calm down and examine the situation. My appetite is also a little reduced, and I’m not sleeping as well as normal. It seems that while the Wellbutrin helped protect me from major depressive episodes, it was the Deanxit that was a significant contributor to general mood elevation.

So, now I need to decide whether I should put up with these issues and see if they go away, or decide that I’m not willing to do that, and talk to a doctor about some replacement medication that is available here in the Philippines.

I think that to be fair I need to give it a few weeks and see how things develop. It’s possible that I will acclimatise given the fact that I’m so much more self-aware these days (thanks to the counselling) than I used to be when I was using alcohol, but it’s hard to be sure. In principle I would like a medication-free life but not at the expense of enjoyment and emotional stability.

UPDATE 6TH SEPTEMBER: I’m still battling some mild unsteadiness and slight feelings of nausea at times, and although it could just be the heat, I think it’s still Deanxit withdrawal. My sleep is gradually getting a little better, and my appetite comes and goes.

UPDATE 31ST OCTOBER I couldn’t do it. There are some things not worth going through hell for. I’ve seen a psychiatrist and after a long and cathartic discussion she’s selected some locally-available medication for me which will hopefully get my mental well-being to where it needs to be for me to function normally without distress. I’m currently battling some side effects but it’s only been a week, so I will persevere.

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The first ‘A’

Considering the name of this blog, it’s probably about time I posted something about my autism, otherwise I’ve wasted a damn good domain name.

I have Asperger Syndrome. Sometimes called “Asperger’s Syndrome”, “AS” or just “Asperger’s” (not Assburgers). To some that makes me an “Aspie”. I didn’t use to like that term, it felt like using it made light of my condition, but I’m more relaxed about it these days. So you can pretty much call me what you like. I’ll probably ignore you anyway.

I’ve known since I was in my early to mid teens that I was “different” from my peers in some fairly hard-to-define ways. I had obsessive interests and an amazing attention to detail, and although I was intelligent I had great difficulty understanding others, let alone relating to them in social situations, I couldn’t “read between the lines” or understand body language, I had problems understanding how to approach the opposite sex appropriately, I thought of myself as ugly and awkward, I didn’t really “do” empathy or grief (though I could imitate them), I had bouts of irrational and self-destructive anger usually followed by an anxiety attack, I was very serious (though I enjoyed certain kinds of humour) and I was hyper-sensitive to certain sounds and sensations. All these things are still with me of course. AS doesn’t go away, you just learn to cope and adapt.

Unknown Condition

During my teens, twenties and early thirties, I had never heard of Asperger Syndrome. Basically because it wasn’t recognised as a condition until 1994. In fact I barely understood what autism was, let alone that I might have some form of it.

Nope, I just thought I was weird. Sometimes I blamed my genetic heritage, sometimes I blamed my home environment, sometimes I blamed my schooling (inevitably, I was bullied), sometimes I didn’t blame anyone or anything. But the obsessions, emotional coldness and difficulties relating to people wouldn’t go away, and my gradually increasing alcohol intake didn’t help me to understand myself any better. I also suffered increasingly from bouts of depression, and when you couple all this with being in a long term difficult relationship, I was having a pretty miserable time of it.

In my mid thirties I started reading up on personality disorders, since by that time I was becoming more and more convinced that there must be something definable that was wrong with me, even though I had no idea what it might be. The internet had arrived by this point, and so I did some online tests and talked with some people on forums. I didn’t get anything conclusive from these tests, but then I followed a link or someone’s suggestion, I forget which, and did an autism test. I was almost off the scale. I found and did a couple of other autism & Asperger’s tests, and again the results were emphatic – it was extremely likely that I was autistic, specifically Asperger Syndrome.

No sooner had I started to absorb this enlightening information than I had a reason to use it as a way of getting out of trouble. I had a meltdown at work due to the inflexibility, jobsworth-ness and general asshattery of a colleague, and I was in big trouble. Sent to the director, I decided to use the only piece of ammunition I had, and I said that I had Asperger’s and that it caused me to have trouble containing my reactions appropriately at times. This got me off the hook, life got back to normal and in time all my research and enlightenment kind of faded into the background. It’s like I knew that I probably had AS, but I was scared to consciously embrace it, because I didn’t want to be different. Looking back it seems like it was too much to handle, with all the other pain in my life. Dumb, really. I should have stuck with it and tried to work out a better understanding of myself. I blame the booze.

Fast Forward

So after several years of not really thinking about AS, and all kinds of other life events (emigration, giving up alcohol, counselling, relationship breakup, a subarachnoid haemorrhage that nearly killed me, new relationship, etc etc), I was triggered into thinking about Asperger Syndrome again more recently by a friend – or rather the difficulty I was having interacting sympathetically with this friend.

Something went ‘click’ in my head and I thought “so this must be what AS is all about”. I decided it was time to be honest with myself, learn what I could about whatever it was I had, and respect myself by embracing it.

Now it was 2015 and there were more online tests available. I did them all. Every single time, the result was “Asperger Syndrome” or “High Functioning Autism”. And every time I was well into the autistic range of results, never borderline.

Lots more clicks in my head. So this was why I couldn’t tolerate being in the same job for more than two or three years without losing patience with the people I worked with. This was why I literally couldn’t see things from other people’s point of view – I had a severely stunted “theory of mind“. This was why I was so hyper-sensitive to light touch and could hear a mosquito at 10 metres. This was why I “stimmed“, in my case picking at skin and pulling eyelashes, and moving my fingers in patterns. This was why I was so clueless when it came to the opposite sex. This was why I always hated eye contact (I can do it when I have to but it leaves me feeling violated). This was why, when I had a meltdown due to an inability to cope with someone’s behaviour or attitude, I could never face them again and so I simply cut them out of my life. This was why, in social situations, I always felt like I was watching a foreign language film without subtitles. This was why I got obsessed with certain things to the exclusion of everything else. This was why I only felt truly myself when alone. Let’s face it, not understanding all “this” was probably also why I got depressed and why I had spent most of my twenties and thirties getting drunk most evenings.

Right Now

So now we come to the present day. My autism is still officially self-diagnosed – though I’ve talked to some knowledgable people about it, including my counsellor, I haven’t been to a specialist and undergone tests to get an official diagnosis. Sometimes I think I’d like to do that, to get a final confirmation of what I already know. Othertimes I can’t be bothered – why bother when I do already know? What would I gain from it? Nothing that I can think of. I’m certainly not looking for special treatment.

This recent understanding and recognition has already changed my life in a very significant way – I finally realised that I would never, ever find a job that I would stick to without getting terminally pissed off with colleagues after a year or two, so why put myself through that any more? So last year I went self-employed and am now a busy independent IT consultant. Who says autistic people can’t succeed in life?

I’ve also found more, what can I call it, inner peace. That’s probably the best way to describe it. Now that I know why I am like I am, and I know there is no cure, I have no choice but to accept it, and accept everything that goes with it. So I do, and I live my life accordingly.

For example, I know that I will always hate and regret going to parties, so I don’t go to them any more. I know that truly understanding (not just intellectualising) someone else’s point of view will always be severely challenging, and so when it comes to my girlfriend, I make an extra effort to imagine I was in her shoes when I’m trying to understand her reasoning and emotions. It’s not easy but I’ve made some progress, which I don’t think I would have been able to make if I didn’t fully understand what was going on in my head.

I also know that I tend to neglect friendships to the point of losing them, so I simply don’t prioritise making friends any more. To be honest my relationship with my girlfriend gives me pretty much all the personal interaction I need, and I don’t miss having more friends. I have one or two people I feel quite close to, some acquaintances who I get on fine with, and people who have been friends at various points in my life and remain as social media friends, and I find that’s enough. I don’t feel lonely.

There have been two further side-benefits of this new-found self-awareness, and I can connect both of them with the easing of stress and angst that my self-diagnosis has given me – a few months ago I gave up the antidepressants I had been taking for several years, and then a little more recently I gave up smoking, replacing it with vaping.

So, as Freddie Mercury would say, there you have it. I’m not slightly mad (sorry again Freddie), I’m just autistic. And I don’t think I mind, either, most of the time. It is what it is, and I can’t change it, so I may as well get comfortable with it. It feels settling to be able to give my weirdness a name. I’m not one of these “autistic people are better” would-be activists, and I don’t really care either way about the controversial organisation Autism Speaks, which seems to generate so much heated discussion in the autistic community. In fact I don’t really think of myself as part of a ‘community’. I just am who I am. And that’s kind of OK.

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Did Lariam cause or worsen my depression?

Today I came across an article on the BBC News website, discussing the vivid hallucinatory dreams that one person experienced while taking Lariam tablets as a prevention against Malaria during a trip in Africa.

This got me thinking back to an African road trip I had done through Botswana and Zimbabwe way back in 1994. Like the article’s author, I took Lariam (the brand name for the drug Mefloquine) for a few weeks before, during and after my trip.

I didn’t (to the best of my memory) experience any vivid dreams, but I do remember a 2 day period during the trip when I felt extremely depressed and nervous. At the time I put it down to a bit of homesickness and after it had passed I forgot about it.

But the BBC article author’s experience with depression, paranoia and anxiety after his trip piqued my interest, and so I did a little googling. Guess what I found:

All these sources are agreed on two things:

  1. Lariam is proven to be a cause of depression and anxiety (among other equally serious issues such as psychosis and suicide ideation)
  2. The effects of Lariam can persist for months and even years after the patient stops taking it and may in some cases be permanent.

My own experiences of depression (apart from the brief episode while on my trip) started a year or two later, as far as I can recall. It wasn’t as if I woke up one day and suddenly found I was depressed – it crept up on me slowly and insidiously until there came a point where I realized that something was wrong.

My family doctor was not particularly helpful and simply prescribed a few weeks worth of tricyclic antidepressants, which had the effect of numbing my feelings, both positive and negative, and in the end I discontinued them, figuring that I would get over it in my own good time.

During the next few years I didn’t connect my state of mind with depression, though my drinking steadily increased and if I look back there’s absolutely no doubt that I was depressed. In 2005 I sought help from a counsellor at my family doctor’s clinic, and they suggested I attend some cognitive behavioural therapy sessions. I attended a few but wasn’t convinced by their conclusion – that I was suffering from low self-esteem.

In the end I had to stop the sessions due to my plans to emigrate to Malta finally bearing fruit.

And to cut a long story short, it wasn’t until 2009, in Malta, that I discussed my depression and alcohol abuse with an understanding doctor, got medication that actually helped, gave up drinking, and started 3 years of weekly counselling sessions that were ultimately my salvation.

Now, looking back on the various stages of my life, the places I was educated, the places I’ve worked, the towns I’ve lived in, and the state of mind that prevailed during each of those stages, I can see that before using Lariam I had some minor anxiety issues and the occasional brief bout of depression, whereas after that period my depression gradually grew until it effectively controlled my life for many years before I finally got the right kind of assistance and support.

Now, I will never be able to prove that taking that course of Lariam was directly responsible for my depression and anxiety over the last 20 years, but it certainly seems possible that taking Lariam could have been a factor in worsening my symptoms, even if it wasn’t the sole cause.

Now, thankfully, Lariam is hardly ever prescribed for malaria prevention – there are far better drugs available. But as far as I know it still isn’t actually banned worldwide. And if you’re ever advised to take it, I would seriously recommend that you refuse. It could change your life, permanently, in ways that you really, really don’t want.

And where does this leave me? Well, where I was before, I guess. I suffer from depression and anxiety, that’s a fact of my life that I can’t change. I keep both controlled reasonably well, most of the time, using medication and ways of coping learned during my counselling sessions.

Does the thought that my depression may have been prevented or lessened if I hadn’t taken Lariam make me angry? Well, yes, up to a point, but what’s the point in being angry at something in the past that you can’t go back and change? Being angry at things has always been one of my depressive symptoms and I can do without even more of it.

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An improved prognosis

This is a follow-up to my post from two years ago, “Dealt a Blow“.

So, having had the subarachnoid haemorrhage in 2011 and a number of follow-up interventions in 2012 and 2013, it’s time for me to bring you up to date with what the hell is going on inside my skull.

My previous post got as far as me not looking forward to a further angiogram after the one in March 2013 showed that there was still some blood flowing inside my coiled aneurysm after having two coilings in 2011 and 2012.

Well, I flew back to London to get a further MRA in September 2013, and towards the end of the year got the results which said that I would have to have ANOTHER coiling via angiogram (my third), since the aneurysm wasn’t sufficiently blocked off. So I jetted off to London again in January 2014 (this time with girlfriend in tow) and underwent the coiling process via angiogram (under general anaesthetic) at what was becoming my regular haunt, the National Hospital for Neurology and Neurosurgery in Bloomsbury.

Before, during and after a coiling of an aneurysm

It was around this time that I looked back to all the medical interventions I had since my original haemorrhage, wondering why it was proving so difficult to block the aneurysm completely. I reluctantly decided that I simply couldn’t risk training in the gym any more, no matter how light the regime. It seemed entirely possible that too much training was raising my blood pressure and preventing the total blocking-off of the aneurysm.

After I got home I learned that I would no longer be able to have follow-up MRA scans in the UK, I would have to have them in Malta. No problem, I thought, and called Malta’s national hospital to arrange one. Three weeks of complex negotiations, phone-call hopscotch and red tape cutting later, I finally got myself onto the patient list of a Maltese neurological consultant and had my first consultation in February 2014. They scheduled an MRA for July to review the most recent coiling.

This MRA in July 2014 was, believe it or not, the first time I had treatment in Malta since the original haemorrhage back in 2011. The results came through quite quickly (quicker than in the UK), and this time, FINALLY, it was good news. When I met my consultant in August 2014 she said that the aneurysm appeared to be totally blocked off, though they would need to send the images to the NHNN in London to get a second opinion.

This was done and in March 2015 I received my first ever official ‘All Clear’. The NHNN agreed that the MRA showed there was no blood flow in the aneurysm – the blood flow in the vessels of my brain were bypassing it completely. I would need annual MRAs to check all was still good, but no more angiograms would be on the immediate horizon.

You can imagine the level of relief I felt. Since 2011 during my initial recovery, the aneurysm had felt like a huge shadow stalking my every step through life, and now that has been lifted.

I still bear the invisible scars of the subarachnoid haemorrhage, like a lot of SAH survivors. My eyes get tired and vision gets blurry much more frequently, and I have a much harder time with bright lights and glare. My medium and long term memory is nowhere near as good as it used to be. I get dizzy spells. Once in a while I suffer a day or two of extreme physical fatigue when I can hardly support my own head. And of course I have to avoid heavy lifting and anything which is likely to increase my blood pressure. But I’m still here, and with this prognosis I’m likely to be still here for some time to come. That’s what’s important.

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Dealt a blow

Sometimes a piece of news, while seemingly small, can rock your world – and not in a good way.

I’d better backtrack a bit, since there’s one big life event that I haven’t posted about here yet. This could get quite long…

In the summer of 2011, I had just returned home from an excellent holiday in central Italy, and was settling back into my normal routine of working at the office, training at the gym, relaxing with TV, etc. At one of my gym sessions I was using a multigym-style machine to do chest presses, and, smart cookie that I am, I decided to up the weight a little (from 35kg to 40kg) to see how I coped. Well, I didn’t. About 3 presses in, I suddenly felt what I can only describe as a silent “snap” somewhere inside my head; immediately I felt faint, dizzy and nauseous, and swirling colours were dancing in front of my eyes. And the pain…

I stumbled outside to the parking area, with my personal trainer anxiously following me, and collapsed in a heap on the ground, vomiting and clutching my head, trying to stop what felt like an army of elephants quick-stepping through my brain. Eventually I felt stable enough to be driven home, and home is where I stayed for 4 days, figuring it was simply the worst migraine I had ever experienced. A friend bought me painkillers and tried to get me to eat though I had no appetite.

In the end I realised that something major was wrong, and got myself driven to the local hospital, where, after eliminating meningitis via a spinal tap and other tests, an MRI finally confirmed that I had a subarachnoid haemorrhage (SAH) – a bleed in my brain, where an aneurysm (a long-standing weak-walled bulging blood vessel) had burst when I tried those ill-advised chest presses.

Unfortunately Malta’s hospitals lack staff with the right skills and specialisms to fix subarachnoid heamorrhages, and so I was booked on a flight to London, where I would be taken to the National Hospital for Neurology & Neurosurgery (NHNN) to be treated. However I had to wait 3 days for the flight, and those three days were the most agonising and depressing of my life. Each dose of morphine or codeine eased the pain in my head for about 20 minutes, before it returned as strong as ever. I couldn’t eat without throwing up – in fact I couldn’t even sit up straight. I lost about 8 kilos. Friends and colleagues came to visit but to be honest I can’t even remember everyone who stopped by. I think my brain has blurred those memories so that the memory of the pain is also softened. But I remember being aware that I wasn’t expected to survive and that efforts were being made to contact my family.

The flight was interesting – I was lying on a stretcher bolted above 3 rows of seats, with a doctor and a nurse sitting next to me with bags of gear to try and keep me alive if I needed it. I also have one distinctive memory of my doctor escort telling me how lucky I was, as I was being transferred to an ambulance at Heathrow airport. I remember not feeling very lucky at that point.

At the NHNN in central London, I underwent a procedure called “coiling”, which involved the surgical team sending a catheter into my brain via my femoral artery and aorta (this process is called an angiogram), and then pushing tiny coils of platinum or tungsten wire (I’m still not sure which) into the aneurysm, to force the blood to clot and block off the bleed. It was successful, and I then spent two weeks on a ward, gradually regaining some strength. After that, I had another two weeks convalescence at my sister’s home, before I was strong enough to fly back home to Malta.

The months following the operation were frustrating – I had memory recall problems, trouble with puzzles of any kind, frequent blurred vision, periods of severe depression – all of which, apparently, are standard fare for someone recovering from a SAH. And to this day I have intermittent loss of sensation in my legs and feet – also something to be expected apparently. But eventually I gained enough strength to go back to work, part time at first, then eventually full time about 6 months after the op. During this period I relied heavily on sessions with a counsellor to keep my fears and depressive episodes under control and to simply adapt to a post-SAH life.

Round Two

Nine months after my injury, an angiogram at the NHNN to check me out revealed that there was still a small part of the aneurysm which had blood flowing in it, and I was therefore still at risk of having a second SAH. So I was booked in for a third procedure in the summer of 2012, during which the angio team placed a small metal mesh stent (tube) across where the aneurysm met the blood vessel, which would seal it off totally once blood clotted in the mesh. They did this again via angiogram, thus again avoiding the need to make a hole in my skull.

When I woke up I was told it had gone perfectly, and I should have a final check in six months. In the end, six became nine and I was checked out again, with an MRA this time, in March 2013.

Round Three?

Which brings us pretty much to the present day. A few days ago I was finally emailed the results of the MRA I had in London in March. The letter was terse and to the point – they could see a small recurrence of the aneurysm, and wanted to check me again in a further six months. In the meantime I should try to stay fit and healthy but avoid lifting heavy weights.

You can imagine that this is bitterly disappointing news, however, for some reason it has hit me even harder than I expected. I had really thought that I was risk-free, and that my days of repeated shuttling to London and back were over. I have reached a point in my life where I am actually very happy with almost every aspect of it – I live (by choice) on a sunny island in the Mediterranean, I have a great job, a loving girlfriend, a lifestyle that I love, a nice place to live, enough money to be comfortable, the list goes on. And now the threat of mortality is back, complete with scythe and hood in my mind’s eye.

Frankly, I’m scared. I know that I have to keep my blood pressure down to reduce the risk of a further SAH. Luckily my blood pressure tends to be below average. However, I love coffee (but hate decaff), and I still haven’t managed to entirely kick a 25 year smoking habit, though I have cut down somewhat and only smoke tiny roll-ups. Still, both caffeine and nicotine tend to increase blood pressure, as does stress, which creates a vicious circle. The more I’m scared, the more stressed I feel, the more I want to smoke, the more my blood pressure will rise. At least I no longer use alcohol, I guess.

I need to find a way to cultivate a more “zen” attitude to the whole thing, but that’s not easy. Roll on October, when they’ll MRA me again and we’ll see if the aneurysm has grown at all in the meantime.

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