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World Mental Health Day 2020

I wasn't going to write anything for World Mental Health Day, then when I sat down at my computer I accidentally did! Here's a little piece I've written on the process of finding the right medication.

It's #WorldMentalHealthDay, and I'm relieved and grateful to still be here. In large part, that's because I found the right medication. But it wasn't a straightforward route to finding the right one. Finding not only the right type, but also the right dosage, is important.

When I was first diagnosed with depression (after a *LONG* time of being unwell pre-diagnosis), my doctor suggested I try sertraline. I got a low dose initially, and gave it a go. I don't know what I was expecting, but it didn't feel like it was helping. I asked the doctor for a higher dosage, which I got, but I still wasn't feeling the benefits. I was a bit unsure about this, because I knew nothing about anti-depressants. Some very well-meaning people in my life were discouraging me from taking meds, which added to my confusion.

I got the higher dosage, but still I wasn't feeling the benefits. I felt that I was irreparably broken - prescription anti-depressants weren't even able to fix me! I explained this to the doctor, and was surprised to hear them say, "Maybe that's not the right one."


I thought anti-depressants were a one-size-fits-all thing - I had no idea different types would yield different results. Genuinely no clue. (Side note: why the hell aren't we taught more about anti-depressants at school?)

Anyway, the doctor then prescribed me with venlafaxine. I went through about a year with it before I had to admit to myself that I wasn't feeling any better. But this felt absolutely mad - after TWO different anti-depressants (and by this stage I was on the maximum dosage of venlafaxine), I still wasn't any better. I explained it to the doctor, who was honestly so great. They explained that they thought another medication might be the ticket, but that we'd have to gradually lower my dosage of venlafaxine, then give my body a brief pause, before starting on the new course of meds.

So we did that, and in July 2016, after I'd experienced about a year of altered chemical balance from anti-depressants, suddenly I was off meds for the first time. And I was ropey as all fuck. I won't go into details, but it was during this spell that I decided to kill myself. I've spoken about it before, but this was the one time my suicidal thoughts have properly gone from passive to active. And it coincided with this spell where I was btw meds. My chemical balance was totally off, and it affected my ability to function/exist in a very real way. It was the scariest thing that's ever happened to me. I was trying to write a joke here ('It was the scariest thing that ever happened to me, and I once <insert joke here>'), but actually, I'm not sure I am as ready as I really want to be to laugh about some of this stuff.

Obviously I didn't do it. My amazing partner and our ridiculous cats (pictured) saved me. Doesn't matter how, but I assure you they did.

But I had to get help urgently. I spoke to the doc the next morning, still feeling petrified, and they immediately started me on new meds. They gave me the maximum allowable dosage (I need ALL the help I can get!) of mirtazapine - 45mg, which I've been taking every night before I go to sleep for the last four years and three months exactly. And it's keeping me alive. But it's not without it's problems...

Mirtazapine is an appetite stimulant. It is often prescribed to people with eating disorders. It also happens to be the medication that has finally started to help me. Did this already chubby guy need an appetite stimulant?! No, certainly not. But has it helped me? Hell yes. I was already overweight, but since I started taking my medication, my weight has really ballooned. And that, ironically, makes me really embarrassed and upset, and fuels my depression. BUT, I'm here! I'm able to balance that with the relief and gratitude that I'm alive.

There's also a weird thing. Every single night without fail, when I look at the tiny white pill that I have to take to stay alive, I do feel a bit sad. It makes me feel like I'm a bit broken, that I need a supplement just to exist in the world like everyone else is able to. It does make me sad, but on balance that slight sadness is absolutely nothing. Well, not nothing, but it's tolerable by the fact that taking that pill allows me to feel and experience and live. It took a lot of effort and trial and error to get to this point, but it happened.

I'm lucky in that I haven't experienced much of the stigma that I know others have experienced with mental health. I'm so supported and loved by the most wonderful wife, dopey cats, fantastic family and brilliant friends. I got therapy when I needed it. My doctor was great. But a big part of it all was that process of getting the right meds. That stigma is borne out of often very well intentioned, but ultimately 100% misplaced ignorance. Not every pill is for every person. Sertraline and venlafaxine didn't help me, but they help SO many others.

Mirtazapine has helped me so much. Is it perfect? No. But I need it, and I'm grateful I had a doctor who worked with me to find a course of medication that made me feel better than I'd felt in a long time. If I'm being honest, I don't think I'll ever be off anti-depressants. That night in July 2016 scared me more than I can express. That feeling was something I never want to experience again, so if meds help me avoid that, then it's worth the slight heart-sinking moment when I pop it every night. I think I'll live with depression forever.

Obviously I wish there was some cure, but that's not what anti-depressants are, at least not for me. In my experience they shouldn't even really be called 'anti-depressants', because I still feel depressed. My pills haven't *cured* me, but they've made my depression bearable. I can live with it. They've helped to facilitate my continued existence. But 'existence-facilitators' is perhaps a bit of an intense name for pills, so I vote that we just stick with the current name...

I still feel sad. For example, today I feel like shit! Really bad. Woke up, had a cry. Yesterday I felt off-the-scale anxious, despite the fact my to-do list was full of things that I LOVE doing, like making & editing podcasts. But I felt terrible, and today's not much better. I have bad days, bad weeks, bad months. This has been a bad year. It happens. I still feel low, struggle, I still sometimes act out and find it difficult to differentiate between what is proportionate, normal, everyday, healthy stress and anxiety, and what is mental illness.

But that's part and parcel of it all. All of us have to balance our mental health, because despite some general ignorance out there...we *all* have mental health. We're feeling, thinking, emotional animals that go through good times and bad times. Nobody is beyond depression or any other difficulties with mental health.

If you're feeling low, there's help available. Yes, GPs are slammed even at the best of times, and especially now, but if you need help, reach out. People might tell you not to take medication, that it's not 'real' happiness or that it's only papering over cracks. Fuck that.

It makes my blood boil that therapy isn't more readily available to people - the current system benefits people w/ financial means, and that's so bitterly wrong. Meds alone can't and won't fix everything, but they might serve to solidify your foundations. Don't dismiss that.

It takes time to find the right medication. For me, third time lucky, but for you it might be more or less. It's a process, not a quick fix. But stick with it, for your sake and for the sake of everyone who loves you, which is a number more than you can even begin imagine.

Look after yourself. Give yourself a break. Look out for each other. Always try to be kind, especially to yourself. Trust people to help you. Get help if you need it. Reach out. You are worthy of kindness and support, and don’t convince yourself you’re not. Trust me on that!

Help is available from your GP, and from brilliant charities like Mind and Samaritans.

That's all I've got. Take care xx

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