Antidepressants and The Tell-Tale Heart

We have slightly detoured from the Persecution theme. The detour came after a lawyer, a woman, representing a company that markets escitalopram said it wasn’t appropriate to compare the lack of consent in pharmacotherapy to rape. This gave rise to a Consent-Rape mini series of posts which this two-part post continues. Persecution will resume very soon.

This post feeds into a series of posts about antidepressant withdrawal on RxISK – see Antidepressant Withdrawal: A Prozac Story and the dangers of letting a strange medication into your life – see Saving Grace.

Perhaps linked to the Rape theme, in healthcare at least it seems to be mostly women who stand up to power, who want to reclaim the streets or in this case our clinics, and whose oratory echoes great men who have spoken out in other settings. But no-one has made a movie of their march from Selma to Montgomery yet…

Like many of us I have an Achilles heel. For me, that topic is familial mental health. This is due to my father who had a breakdown when I was a teenager. He behaved erratically, desperately for a few weeks, and then disappeared into the local mental health hospital, before re-emerging tearful and vulnerable.

This was frightening to witness, difficult to understand and – being a teenager – embarrassing. Due to my parent’s subsequent divorce I became estranged from him for years and those memories of his mental health deteriorating, leading up to his business collapse, divorce and losing our home are traumatic ones. They made me susceptible to suggestions of hereditary mental illness. Usually reasonable, I am quite the reverse around this topic, and easily frightened by it.

Becoming depressed?

Twelve years ago, I was exhausted and tearful and had moved from a town where I had employment as a teacher to an idyllic rural location away from my family… the ripples of divorce and my father’s behavior yet again having caused problems for me in my thirties.

Once away from my home town and in the sticks, I no longer needed to work as the mortgage was paid off and I had no money worries. My husband had a good job and commuted to the city. I had the children to ferry around and care for and a beautiful home, but family events preceding the move had got on top of me and the empty days provided too much time for reflection. I went back to bed a lot during the day and became exhausted and tearful. “I think you may be depressed” said my kind and gentle husband, “let me take you to the GP”.

A diagnosis of mild anxiety/depression with no suicidal thoughts was confirmed and a course of antidepressants – escitalopram 10 mg – followed during the six week wait for counselling. The drug was new to the market. It felt like little light bulbs were exploding behind my eyelids when I took it. I couldn’t shut my eyes or sleep through it but I felt my fatigue lift. How, I wondered, could one little white pill cut through the exhaustion and make me feel like this? It was obviously exactly what I needed. This was depression for sure, what luck it had been spotted.

When I went back to the GP to tell her that I couldn’t close my eyes, she reduced the dose by half and added to my notes…”bipolar?” She put me back up to 10 mg after a couple of weeks and this time there were no exploding light bulbs. I felt energised, happy and well. I could put up with the dry mouth, lack of orgasm, funny feelings in my brain like zaps and bloated stomach and tummy pains which developed – I put this down to IBS.

Six weeks later, counselling passed in just 2 sessions. I told them I felt great and told them a little of the events leading up to moving house. I was rewarded with a gentle smile and a letter to my GP which said there was nothing significant wrong. I was discharged. On reflection, I think the counsellor was quite right… it was just life getting me down and I needed to recharge my batteries and deal with the crap rather than “medicate” it. But I could have done with some talk therapy to uncover the misinformation that my “Achilles heel” was causing.

I went back to my GP. She felt I looked and sounded so much better that it would be a good idea to keep taking the drug as depression could be long lasting. Eight months’ worth of pills were prescribed. I was happy to take them as they made me feel better.

Hints of withdrawal

After eight months, I stopped, following GP advice – dropping a pill every other day over two weeks. The exhaustion and tearfulness returned pretty quickly. I went back to the GP. “Ah yes, the depression hasn’t gone yet,” she said. “I’ll re-prescribe your drug, but this time NICE suggest that in the case of a relapse you should stay on the drug for a year. You may not need to though, so don’t worry.”

….and so the roundabout turned. Every time I tried to come off the drug, no tapering, as I knew nothing about this, I had what I now know are withdrawal effects… they got worse each time and I found I was emotionally labile, flying into rages, driving erratically and susceptible to the slightest stress. I believed myself to be mentally ill and getting worse. I needed that drug to keep my children safe from my mood swings as I was a monster when I stopped. I feared I was an unfit mother. I drew comparisons with my father.

My periods became unmanageable. I bled so profusely that I couldn’t leave the house. My stomach blew up with painful IBS type symptoms and I collapsed one day, without warning, whilst on the loo, waking up on the tiled floor with a banged head. It didn’t enter my head that any of this could be caused by the drug. I put up with it, passing off the collapse as an embarrassing incident probably linked to constipation.

Eventually, I saw a different GP who looked at my notes, scoffed and said, “what on earth are you on these for?” By then I was sleeping more than I had been sleeping when first put on the drug, I had gained weight and although calm I was very lethargic and didn’t have much energy. I was no longer energised. I accepted that I needed to come off the drug. I had been on it for 5 years.

My world was turned upside down within weeks of the quick taper as per packet instructions. I became that rage filled, over-reacting, crazy woman I had come to fear. I mentioned the rages to my GP and a look of concern crossed her face… but it was too late. I’d been off the drug for some weeks. I wasn’t going to go back on it. Enough was enough, and the doctor had told me I didn’t need it.

Under the ribs lies a tell-tale heart

Following an argument which made me anxious, I felt something lodge in my chest. Some hours passed but the feeling wouldn’t go away. I rang an NHS out of hours advice line who told me they thought I’d had a heart attack. I thought this was ridiculous, I was too young (43) and had no indicators for heart disease. After a lengthy chat and some scare tactics, I agreed to go to A&E when my husband got home.

In A&E I was placed on an ECG and kept in the cubicle for a very long time. Eventually I was told I had an arrhythmia and a slow heart beat. I had a positive troponin test for heart attack and was kept in. I remained in hospital for 2 weeks. I was terrified.

No one knew what was going on – the doctors gave me heart attack drugs which caused my blood pressure to plummet. They gave me zopiclone to make me sleep at night and gave me various diagnoses from heart attack to sick sinus syndrome. My anxiety went through the roof when I was told I would need a pacemaker as my heart was going too slowly and I was at risk of stroke.

I was sent for a scan of my arteries – no blockages – and then discharged back to my GP’s care. She didn’t know what to do with me as there was no diagnosis and my pulse was very faint and arrhythmic. When I mentioned the antidepressants role in all of this, she said “maybe….” She placed me back on an antidepressant – citalopram 10mg this time which she said was half the strength. I can’t remember if it helped or not, I was in such a mess.

Two weeks later I was back in hospital again with the same problems. They took me off the citalopram – saying antidepressants were no good for the heart….you don’t say!! I was put on the stroke ward but they couldn’t cope with me there as the bell attached to my heart monitor, which indicated that my pulse had fallen below 30 went off all night and my blood pressure plummeted.

They tried felodipene to help the pumping action of my heart and my pulse increased to about 45 but my legs stiffened and I couldn’t walk. God knows which other heart drugs I was on – they were swapped around like smarties. The stiff legs weren’t possible apparently – I was told I had to keep taking the drug for 3 months.

My mood by then was frankly on a rollercoaster and I threw an embarrassing tantrum unable to put up with not being able to walk. I called my husband and discharged myself despite nurses trying to persuade me I was in danger of stroke and should stay. When I got home I panicked and realized that I had over reacted to stress and was an emotional wreck. I broke down, but refused to go back. I felt like no one could help me and no one understood.

My GP was furious with me and I was placed back on the antidepressant again. She took me off the felodipene though and suggested “I put it to one side….” This felt very wise.

When your problem doesn’t fit their boxes

I got referred to an electro-cardiologist who put me on a tilt table which is designed to induce faints in people with certain heart conditions. My heart stopped after 10 seconds of tilt and I lost continence. I woke up shaky and afraid.

I also had a cardiac stress MRI which consisted of a drug being administered that made my heart race. Afterwards, in a hotel room, I kept losing consciousness and was in a mess. The procedure had obviously been too much for my heart.

I felt at risk from the men in white coats who thought they knew everything, but didn’t think to listen to me. They knew best… but clearly knew very little.

A fainting condition was diagnosed caused by an arrhythmia – neurally mediated syncope.

“But I’m not fainting” I said.
“It’s your autonomic nervous system which is faulty causing low blood pressure and an irregular heart beat which causes you to collapse”.
“But I’m not fainting and my blood pressure is normal”.
“Your blood pressure was really concerning in hospital and you felt faint during an exercise test” they said.
“Yes, but they took me off the antidepressant and gave me loads of heart drugs which lowered my blood pressure…” I argued to no avail.

The condition was treated with 6 teaspoons of salt per day and 2 litres of water to increase blood pressure. My blood pressure went through the roof to hypertensive levels. This was not expected, as low blood pressure typified the condition.

I was also told that my veins were dilated and that this was causing “low blood volume”. I was offered Prozac which I refused. I didn’t want any more drugs. Later on I was told that the same hospital were using Prozac in patients with congested arteries as it helped with vasodilation. The exact opposite of the use proposed for me.

The consultant was puzzled by my blood pressure reaction as it didn’t fit the diagnosis of neurally mediated syncope, neither did the night time dips in heart rate. Heart rates usually dip in fainting conditions when you stand up… not at night in bed. But this was ignored and my protests that the diagnosis was wrong were ignored.

After 6 months my GP suggested coming off the antidepressant again…

Continued in Antidepressants and The Tell-Tale Heart – Part 2.