To be, or not to be... medicated.

I've had a tough year. It all started to go downhill this time last year and I have been in very dark places since the autumn of last year. I was on the highest dose of Venlafaxine and had previously had a good year on it but when things went downhill I was advised to wean myself off it in order to change over to Sertraline. The problem I encountered was that once I had achieved the long and slow process of weaning off the Venlafaxine, I found myself not wanting to start medication again.

My reluctance to be medicated is something I have always struggled with when not on it. I don't like the idea of being on meds. That's not new, so I suppose in a way it wasn't surprising that I didn't want to restart, even though stopping the old one was with a view to starting a new one. What made it harder is that in stopping the Venlafaxine, I lost weight (a positive for me), my bowels were a lot better (long story), I had improved libido (a little bit of interest compared to very little), not to mention the cessation of muscle spasms and the awful withdrawal symptoms if a tablet was missed (brain zaps).

So I stayed off medication for several months to see what would happen. In that time, I continued to struggle with depression and I found my emotions very up and down. For me, this was somewhat new as having a lot of dissociation, my tendency is not to really feel anything and when difficult emotions do arise, I tend to dissociate or self harm to manage them. During this time, I did do both of those things at times, but for the most part I found myself having to actually experience the painful emotions... which usually involved hours of bawling my eyes out in despair. I really struggled to know if this was a bad thing or a good thing. On the one hand, it is hard feeling like my emotions were up and down more than a rollercoaster and never knowing just when something little might set me off. On the other hand, I wondered if this was progress. I have never in my life been able to just experience the despair of sadness and stay with it and let it out in sobs and in a way, I need to begin to develop an ability to feel emotions and understand them. I talked about it with T, my clinical psychologist and I think the overall impression was that it was progress. But in between sessions, it was hard to always believe that and it didn't feel like it would ever end or improve.

Last month I made the decision to start medication. I didn't feel like things were progressing enough for the prospect of going back to work to be considered and I've been off now for a long time. Occupational health are monitoring me and although it wasn't plainly said, I felt that if I am refusing medication or not progressing enough without it, the chances of my job being held open for me to return to would be slimmer. And I really don't want to lose my job. I do acknowledge that there is no way I could manage full time work again but I want to be able to go back to what I was doing part time. I have worked so hard to get that job and I deserve to be able to keep it.

The other reason, which may seem silly but was probably a big factor, is that I am going away on holiday soon with a few people, one of whom is a member of my family and this for me will be a huge challenge. Katie and I get along together quite well these days but we have a lot of bad history and she can very easily trigger off a lot of really hard feelings in me. Usually if this happens I cope by just getting away from her, which is easy if you're not on holiday with the person. So in a way, I started the medication so that I could cope with the holiday, telling myself that I can review it afterwards.

I've been on the Sertraline now for coming up to a month, so I realise it hasn't had enough time to fully take effect. Since starting it, I have noticed my appetite has dramatically increased and this is not good. I felt so happy to have lost a bit of weight and now it's already fluctuating with me struggling to keep it at a level (and I had hoped for a lot more weight loss if I'm honest). I had a lot of headaches at the start although this has settled a bit and I wasn't sleeping well. This has improved too although still isn't good. My interest in sex has completely disappeared. I don't know if this is all due to the medication. Adam has been talking to me about how he wants more sex and how he feels I'm not attracted to him and at times how he thinks I'm not enjoying sex. There's nothing that puts me off sex so quickly as feeling pressure to have it, so that is probably a factor as well.

Another thing I have noticed since starting the Sertraline is that my emotions have completely flattened out. I was crying several times a week; I haven't cried once since I started it (good or bad?). I don't feel good. I just feel unreal. Really, really unreal. I feel like I'm dreaming all the time. I'm just drifting through my days. I'm more dissociated. This does happen when I'm tired so the lack of sleep might be worsening it but overall I am disappointed that my emotions have gone. Don't get me wrong, I don't enjoy bawling my eyes out every time someone says a cross word to me but I realise that in order to feel like I am alive and to make progress, it's crucial that I start being able to feel emotions and then learn to manage them myself, in a healthy way. I would like to understand my emotions: be able to identify what I am feeling and think about why and then be able to help myself not to be overwhelmed by them. I think if I could do that, I would be able to do better for myself in a lot of areas of life.

So what do I do? I am certainly going to stay on the medication until after the holiday, but then what? I saw a psychiatrist who said these side effects would settle as the medication takes effect, but I'm not sure I trust that. If I am feeling numbed by it already, how am I going to feel any less numb as it takes more effect? How am I going to be able to make progress in my therapy if this is the case? But if I come off the medication, I have no chance of being able to consider going back to work any time in the foreseeable future. I could lose my job and if that happens, then what? I don't intend on working in a job that pays less because I truly believe that pay level doesn't indicate the quantity of stress expected from a job. The most stressful jobs I had in my life were the least well paid. But I can't manage work as I am.

I have avoided work thoughts up until recently but I just can't see how things are going to go for me. If I don't work at all, I feel like I am a burden on my husband and the country as a whole and it puts financial strain on us. But I feel that if I do get well enough to work, I will be sacrificing making progress in my therapy because I wouldn't have the energy for both. I have come up with no answers to my predicament. Hopefully in a month it will be clearer what I should do.