Wednesday, March 14, 2007


Better Living Through Chemicals

    In February of last year I wrote a post in which I came out against the use of antidepressants by caregivers. Thus, it is with a bit of chagrin that I find myself now writing a post admitting that, about a month ago, I decided to try consciously using chemicals to realign my neurological chemistry.

    A couple of months ago an excellent, long time friend of mine decided to try prescribed antidepressants for a limited period in order to realign his neurological functioning. I expressed critical interest and asked him to keep me posted, in part because he is meticulous with such requests, so I knew I'd get a blow by blow description, and in part because, well, I closely identify with some of his perspectives and wondered how they would be affected. As he was being switched from one medication to another he mentioned to me that his therapist described him as "severely depressed, just functioning well". I shivered. It sounded like a fairly accurate description of me. As his dissertations continued, he admitted that despite some unsettling side effects (acute "fogginess", "apathy", physical fatigue; I quote the two out of three because his definitions of these are other than those typically assumed), he was pleased with the results. His descriptions provoked me to question my insistence that caregiver depression, an implicit aspect of caregiver burnout, is best addressed by the society surrounding the caregiver, chiefly so that those of our current assumptions about caregiving which lead to high levels of frustration, anger and depression can be swept out of the picture.
    Although I have not changed my view on this, waiting for the delivery of these enlightenments and corresponding actions within society has become yet another exercise in Waiting for Godot for me, in which society plays the part of Pozzo and all those associations for and advisors to caregivers play the part of Lucky.
    After multi-faceted consideration of what my friend was telling me (which did not include, at this point, his personal definitions of "fogginess" and "apathy") coupled with my own circumstances and my own preferences for neurological alteration, I reconfirmed for myself that the hammer-to-head effect of prescription pharmaceuticals is contraindicated for me. My ability to care appropriately for my mother would be severely hindered by fogginess and increased levels of physical fatigue. Further, I remain uninterested in developing an apathetic response toward those societal forces which conspire to destroy the spirit of everyone compelled to provide care for others. But, I decided:    Maybe, I thought, a little gentle chemical provocation might be in order, here.

    Many years ago, soon after it became apparent that I should become a full time, in-home caregiver to my mother, if for no other reason than to seduce her from drowning in sleep (at that time her increased sleep was not due to CRF but, I think, boredom and mild depression over feeling as though she was no longer completely capable of independent activity, that she needed the boost provided by a life companion), St. John's Wort was introduced to this country in a flurry of excitement (no doubt part of the PR campaign engineered by the pharmaceutical company responsible for obtaining permission to distribute it) and in the form of a pilled, packaged preparation commonly sold OTC in Germany (and probably other western European countries). The hype was compelling. I read lots of literature on that preparation. It occurred to me that this might be exactly the gentle chemical provocation that could jump start me into meeting what were then the requirements of my personal full time caregiver journey and, as well, might help nudge my mother out of the cloud inactivity (both physical and mental) that had descended upon her during the last six months or so of me working full time outside the home. I saw to it that she and I stuck with it for at least 90 days. At the end of 90 days, although we both noticed that our companionated life had picked up, neither of us felt that this was due to taking St. John's Wort. We strongly suspected that the 90 days of pill-popping corresponded to the period of time it took for us to readjust our lives to being each other's companions. To test this theory, we stopped taking the pills. A few weeks later, during a day spent with MPS in which I was experiencing somewhat more than mild frustration and taking it out on her, MPS commented satirically that I ought to consider taking St. John's Wort. I responded that both Mom and I had, not so long ago. "Well," MPS responded, "I guess that stuff doesn't work, does it!?!" This further confirmed my mother's and my decision not to look back after our trial run with the herb.
    Since that time I've become more savvy about alternative medicine, including a variety of herbal preparations and the best types to ingest to induce desired effects. One of those lessons was that tinctures prepared from extracts are usually the most effective means of using herbs. Thus, I decided, perhaps if I consider taking such a preparation of St. John's Wort and consult with an alternative healer well-versed in herbal therapy, I might have more success with it. That's how I started, a little over a month ago. Since that time I've:    The dose I'm currently taking:    I should probably note, here, that I am not administering St. John's Wort to my mother at this time. I am not convinced that she needs it and, as well, I am leary of how it might interact with her current medications, supplements and health conditions.
    I should probably also note that, while I should have marked the exact day I began, I didn't. I'm not concerned about this.

    Once I began taking St. John's Wort, I stopped casually thinking about it. This was easy for me to do, considering all the other things I have to think about during any particular day. The only circumstance which caused me to occasionally consider whether it was affecting me was my continued, sporadic conversation with my excellent friend comparing and contrasting his prescription antidepressant experiences with my herbal antidepressant experiences. "Sporadic", by the way, translates into approximately once a week. Following are some of my formal observations:    Over the next few weeks I wondered if I was understanding my friend's terminology for his experiences. He spoke of a return to "happiness". I rarely use the word "happy" (or derivatives thereof) to define felicitous, euphoric states of consciousness, even though I frequently experience(d) such states, pre- and post-St. John's Wort. I tend to consider and identify them as varieties of flow experience, which seems to me like more accurate terminology than the word "happy". I wondered if he was referring to states that I had not stopped experiencing; thus indicating that he and I were hoping for and experiencing, different antidepressant effects.
    Upon my request he provided me with a wonderful explanation of not only what he means by "happiness", but "fogginess" and "apathy" as well, since I'd expressed concern about the latter two effects prior to my decision to try St. John's Wort. My distinct concern about "apathy" was based on an episode of Sex and the City in which Charlotte finds herself involved with a man who is on Prozac. Aside from the sexual side effect with which she finds herself dealing, my recollection informed me that her partner not only wasn't concerned about this, but, more alarming to me, not concerned about much of anything, which I interpreted as the apathy response. As well, in an earlier conversation, my friend mentioned that his therapist alerted him to the possibility that, as a side effect of Prozac (I believe he has sinced switched to another antidepressant, although not for this reason), in particular, he might "stop giving a damn about anything." He speculated that this would please "the government".
    As it turns out, his experience of "happiness", which he likened to feelings he'd had when he was a child but not since, are experiences I've never stopped having. His definition of "fogginess" is strictly mechanical and similar to what I'm experiencing, although the volume of my experience is so much less than his that I'm only barely aware of it. His definition of "apathy" does not include a lack of concern for those social concerns he entertained previous to embarking on the antidepressant road. It involves, rather, not stressing about the effects of the "fogginess". He admitted, in fact, that, if anything, his social concerns are now more, rather than less significant and that he feels freer to act upon them than previously.
    In response, I told him that my hopes for St. John's Wort were primarily to become more effective in my life by getting out of my own way. Last night, during private consideration, I further amended this hope to include increasing my desire to be more effective. Both appear to be happening. In comparison with what he told me, I responded thus, based on a little over a month's use of St. John's Wort:    About a week after this discussion, just a few days ago, I delivered to him the following report:
    I just went through my first bad day on St. John's Wort...successfully. It was a really bad day, no doubt about that. This time, there was a cause, my inability to publish on only those journals which were housed on my domain server. It wasn't a random bad day. I don't seem to be having those anymore. I also noticed the following differences:
  • Although it could have involved me screaming through live chat at my domain ISP, I was able to control myself.
  • It took three previous days of publishing problems for me to have a bad day because of it.
  • Although I did all I could to see if I could solve the problem myself while they were also trying to solve it (something I usually do; sometimes I'm successful; this time I was not), I never became frantic. I anticipated the frenzy, but it never occurred.
  • Despite the fact that it was such a bad day that I indulged in some typical bad day behaviors like insisting on watching Sex and the City all day and serving what we call "junk food" (a household with a diabetic is stocked with junk food that is only borderline junk food), I also found myself writing two warm, friendly emails (something I would never have previously thought to do during bad days) to a couple of strangers who happened upon my site over the weekend.
  • I did not indulge in plotting the destruction of the world or certain people in it and didn't fantasize about owning a gun and randomly shooting strangers passing by on the street, which are among my usual "bad day" thoughts.
    Thus, this bad day was almost revelatory.
    I can tell that I'm still in for some effects. I continue to slow mentally, although it doesn't yet feel like what I would describe as fogginess. I'm noticing that I'm forgetting relatively insignificant things, like, for the past couple of nights I've set up the dishwasher then forgotten to activate it. Napping seems to have become an every other day habit, which feels weird. Awakening from naps still feels like coming back from the dead, but that effect is no longer as pronounced when I awaken from night sleep. While considering the sleep circumstance, it occurred to me that it's possible that SSRIs of any type interfere with REM sleep, just like marijuana does. I've noticed that I no longer remember my dreams. It feels rather as though I'm not dreaming. I don't think this is true, but the effect may be because I'm either not having as many as I should or the dreaming process is interrupted.
    Overall, I'm pleased. I think, this time, I'm taking a form and dose of St. John's Wort that is doing something neurological and, overall, I like what it's doing.
    I continue to contend, in conversations with my excellent friend as with myself, that I'm willing to accept that I may be experiencing more of a placebo effect while on St. John's Wort than an interactive effect. I'm undisturbed by this, as I've always been undisturbed by possible placebo effects. I don't care, frankly, if it takes a inactive substance to trigger self-chemical-neurological realignment and produce particular effects. If I have to trick myself into retreating from the edge, I'm more than willing to do this.
    My only concern is the possible development of a "happy idiot" effect, for which I continue to watch but has yet to occur.
    Will I continue to report on my experiences with St. John's Wort? Definitely, I expect the conversation between my excellent friend and me to continue, as needed. Whether I'll mention any more here, except, perhaps, when I stop using it, is debatable. I will, of course, if I notice anything that significantly alters my companionship/caregiving adventures. As well, I think it important to reiterate, I still look with a wary eye on the current activity of antidepressant pill pushing upon harried caregivers. I consider it an easy and dangerous social fix for problems that need to be addressed through changes in societal attitudes about and circumstances regarding caregiving. I am a bit more understanding, now, about the need for individual caregivers to assent to such personal fixes for caregiver frustration, stress, depression, burnout. I am also better informed about the possible definitions of antidepressant induced apathy and relieved that this apathy doesn't always deliver unprotesting subjects to their governmental monarchy; it might, in fact, sometimes, increase protest and effective action against prevailing government and societal strictures. I continue to contend that if we don't fix the society, we won't fix the problem; we'll just mask it and allow our society to become less, rather than more, human friendly. This is why I chose a gentle personal fix. This is also why I am determined to stop that personal fix if I notice that I'm becoming immune to observing the abysmally skewed caregiving atmosphere in this society and others. My hope is that, as I perceive myself as more effective and more interested in being effective, my personal fix will enhance my ability to trigger and cooperate in societal fixes (other than tainting our water supply with SSRIs). Maybe this is already happening to me; at this point, it seems likely. If so, praise the gods and pass the pill plate a few more rounds, please.

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