Shoot the Damn Dog: A Memoir of Depression (20 page)

In pre-launch drug trials, nineteen per cent of the people taking Venlafaxine gave up because they could not tolerate the side-effects.

I stopped taking the pills. This is the worst possible thing you can do although I did not understand, until I did it, quite how bad it could be. You should discontinue any antidepressant slowly, a fraction at a time. Every box of SSRIs carries a warning. Every medical textbook tells you so. Every psychiatrist will advise you never to stop abruptly. So will I.

Don’t do it.

At the time, I was in no mood to listen.

I called my psychiatrist. He said, ‘It’ll have to be brief. I’m with somebody.’

‘I want to stop my medication. I intend to stop, as of tomorrow morning, which means I took my last dose this morning.’

‘It is severely contraindicated.’

I said, ‘I’ve already told you that I feel poisoned. I hate them. I’m shaking so much I’m starting to convulse.’

‘Come and see me and we’ll talk about it.’

‘I don’t want to take another pill. I think that if I take another pill, I’ll die.’

‘That’s very unlikely but if you stop abruptly, you may go into discontinuation syndrome. You could have a relapse.’

‘A relapse?’

‘Of mood.’

I laughed.

He sighed. ‘If you really want to stop taking them, cut down to 200 milligrams from the 300 you’re on. But no more than that. That’s far more than you should. And let me know how you get on.’

‘OK.’

The next morning, I went cold turkey. I knew that I might face a worsening of depression. I had no idea that I would have to face an extreme physical withdrawal. I had been told that SSRIs are not addictive. That, as I discovered, is quite wrong. Any drug that creates a dependency is addictive. Any medicine that creates withdrawal that extreme should be classified as a class A drug.

Hell is too kind a word.

I’ll leave the description to the Internet which is these days filled with postings about the terrifying consequences of coming off antidepressants. Here is the most lucid, from Wikipedia, and, interestingly, the emphases are not my own. Sadly, it was not available when I discontinued the drug. If it had been, I might have felt a little better, knowing that I was not alone. As it was, I simply felt that I was becoming even madder.

A week later, I went to see my psychiatrist.

‘How are you?’

My back felt like it had been broken. Electric shocks were running across my face. Every time I heard a loud noise, my body jumped in sympathetic response, as if the startle reflex was wrongly wired. My head, arms and legs hurt. My vision went in and out of focus so walking had become a serious problem. I had terrifying nightmares, when or if I finally fell asleep. I shook all over. I could not eat, because of the extreme nausea. I was hostile, paranoid and very, very angry.

‘Terrible,’ I said. ‘I stopped the medication.’

He looked, momentarily, horrified. ‘All of it?’

‘Yes, even the sleeping pills.’

‘That was most unwise. Then I should think you are feeling ill.’

‘You never listen. I told you how I was feeling on Venlafaxine. I told you I felt I was being poisoned. I told you I was shaking uncontrollably. And all you did was precisely nothing.’

‘I didn’t tell you to stop taking your medication. I told you it was a very bad idea and to reduce it, if you must. Venlafaxine is an excellent drug. People tolerate it very well. It’s helped millions of people, including patients of mine.’

I handed him a thick pile of paper, articles printed off the Internet about the adverse reactions that people suffer with Venlafaxine. It is a journalist’s most tiresome habit. All medical practitioners hate it.

‘This is for you. It’s about the people who don’t tolerate it, who it doesn’t help.’

He put the papers to one side without looking at them.

That gesture infuriated me. It had taken all my strength to research the drug and why, perhaps, I was feeling the way that I did, and he simply ignored my efforts. ‘You’re supposed to be a doctor and listen to your patients. Instead, you behave like the patronising male scientist confronted by the hopelessly deluded madwoman. I have been telling you the truth, my truth, and you can’t even listen.’

‘You’re being irrational, Sally.’

‘Don’t fucking tell me what I’m being. What’s rational about a psychiatrist who can’t listen? A psychiatrist who answers his phone when he’s with a patient? What if I was suicidal? What if the patient you were with was suicidal? How is that supposed to make us both feel? That you care? That you’re not interested if we kill ourselves? And you’re supposed to be a doctor of the head?’

My psychiatrist closed his eyes. I could see him counting slowly to ten. Or, perhaps, a hundred. He opened his eyes. ‘We appear to have a breakdown in communication. Would you rather see another psychiatrist?’

‘Yes.’

‘In the meantime, I would like you to take a very small dose of an SSRI, to see if we can relieve the pain. You are in severe withdrawal. It might help.’

It didn’t. A tiny dose of SSRI brought on such severe diarrhoea one hour after taking the pill, that I was trapped in the bathroom for three hours. I managed it for five days, and then I gave up. I called my psychiatrist.

‘That sounds very unpleasant. Can you manage to come and see me? I’d like to talk to you.’

I went.

‘How are you?’

‘Very close to suicide.’

‘I’m sorry.’

I shrugged, ‘Me too. And I’m sorry I shouted. I was unforgivably rude but I was, in non-psychiatric parlance, beside myself.’

‘I meant that I was sorry that I didn’t listen to you. You’re right. I believe you were at grade A toxicity.’

‘Being poisoned, you mean?’

‘If you like, although we would not phrase it in that way.’ He went on. ‘I’ve recently set up a new practice. I’ve taken too much on. After our…’ he hesitated, ‘conversation, I’ve halved my workload so I have more time for my patients. And I called another psychiatrist, to see if she could take you on. Unfortunately, her books are filled but I could try somebody else if you like. In the meantime, because I really think you need to be under proper care, would you like to go on seeing me?’

I looked at his mobile, which was lying on the desk.

‘Is your mobile switched off?’

He smiled. ‘Yes.’

‘I really don’t want another psychiatrist. I just want to get better.’

‘I know.’

I switched to another drug, Amitriptyline, part of the older family of antidepressants known as tricyclics. Some people find them hard to tolerate. So did I, but they were better than Venlafaxine. The side-effects are unpleasant and include dizziness, blurred vision, shortness of breath, severe constipation, weight gain and all the usual pleasantries of psychopharmacological drugs. They are also fairly sedating, which helped with the insomnia and, at the right dose, are analgesic, which helped with the pain from SSRI discontinuation syndrome from which I suffered, very badly, for another three months and less badly for a year.

Every twenty minutes, I would have to lie on the floor for five minutes, to stop the world spinning around or jerking, abruptly, out of focus, and to try to control the pain. My back still felt as if it was broken, and I suffered from intense flu-like aches in my arms and legs. As I stared up at the ceiling, I wondered how my life could have collapsed into such utter disintegration.

I am a believer in alternative medicine, particularly since conventional medicine had done so little to help me, so I took myself off to see an acupuncturist, who said he could help me through the withdrawal. I would arrive, my whole body twitching. It was as if my skin had been turned inside-out, leaving the nerves exposed. Any loud, or even not so loud, noise would make me jump, then I’d break out into a sweat as electrical impulses shot through my system. According to my psychiatrist (himself a believer in alternative therapies), withdrawal from the drugs had sent the sympathetic nervous system, which regulates the fight or flight mechanism, into overdrive.

‘I’m just going to put a needle in your back,’ the acupuncturist said. ‘You may feel an odd sensation.’

My whole body lifted off the bed, electric currents shot through my arms, legs, back and head. ‘What the fuck was that?’ I yelled.

‘That’s where the drug is lodged, in the spine. It will help the body to speed up withdrawal but it’s rather a severe treatment. We can’t do it very often, at the most, every two weeks.’

By the time I left the acupuncturist, my body had settled. I could walk down a street without jumping out of my skin, or feeling as if I was about to faint from shock. The effects lasted for about three days but bit by little bit, the drug began to leave my system.

I was unlucky in having such a severe adverse reaction to Venlafaxine. I am unlucky in not being able to tolerate antidepressants. I use the word unlucky carefully. It is a lottery. I was one of the losers. There are winners—those in whom the drug creates an effective remission—but there are no sure or safe bets. There is no way of knowing how somebody might respond or react to a drug, before they take it. The only way of knowing is in the doing. Unfortunately, that takes time. Unfortunately, and in a spirit of grotesque irony, the side-effects of the drugs mimic the illness they are treating. Even more unfortunately, that leads psychiatrists and doctors to believe it is simply the illness reasserting itself and to dismiss the concerns of the patients they are treating. In all the law suits against drug companies with regard to suicides caused by an adverse reaction to an SSRI, the defence is always that it is the illness and not the drug that is at fault.

I know how it feels to be told that it’s all in your mind.

It drives you mad.

New Year came. Tom and I spent it together. We were plainly, lyrically happy. And plainly, undeniably drunk.

‘Will you stop disappearing,’ I said. ‘And can we be together now?’

He kissed me. ‘Yes, I’ll stop disappearing and we can be together now.’

We did not mention reality. Reality, on that New Year’s Eve, seemed like another country.

I decided that I would be better. I would leave depression in the old year, where it belonged. I put my flat on the market. It was beautiful but to me it felt like a prison, a place I had come to hate. Depression had seeped into its walls like a chill, grey mist. When I put my hand to the surfaces, they felt damp. Nobody else could feel it. But I could.

The first person who came to see the flat put in an offer.

I accepted.

A friend, Lulu, called.

‘How are you?’

‘I’m fine.’

She sounded amused. ‘Fine as in the weather? How are you really?’

I laughed, taken aback.

She said, ‘I heard you hadn’t been well. I wondered if there was anything I could do to help.’

‘That’s kind of you but I’m—. Well, I’m trying to get my life back on track.’

‘It’s hard, isn’t it?’

Something in her voice, a note of complete understanding, pulled me up short. We had known each other for years, although not terribly well. Our kids were friends so our relationship had always revolved around them. I knew, though, that she had battled depression and recalled, distantly, that she had once had a problem with alcohol.

‘Yes. I think I may—. I don’t know why I’m telling you this, but I think I may have a problem with alcohol.’

Her voice did not skip a beat. ‘Let’s have lunch.’

Before I left the flat to meet her, I drank a bottle of wine to give me the courage to say what I knew to be true but that I found hard to admit, even to myself. ‘I have a problem with alcohol.’

She looked lovely, in a flowered dress of silk crêpe de Chine and a turquoise cashmere cardigan. Her cheeks were pink, her mouth painted a perfect red. As I bent to kiss her, she smelled of roses and clean, fresh air. Her eyes were clear and sparkling. I couldn’t believe she knew how I felt. I couldn’t believe she’d ever had a drink, let alone a problem and so I said nothing.

We chatted inconsequentially, about mutual friends, her business, our children, the property market.

Suddenly she said, ‘Tell me about drinking too much.’

I shrugged. ‘I drink too much, end of story.’

‘Shall I tell you about my drinking? Would that help?’

‘If you like.’ I was awkward, unused to somebody being so open about drinking. I kept mine a secret, even from my closest friends. I liked to drink alone. That way, I could drink as much as I liked. That way, I was the only witness to my shame. And I was ashamed. Alcohol does that to you.

Lulu said, ‘Every night, I promised myself that I wouldn’t drink the next day and every morning, when I woke up, I promised myself that I wouldn’t drink that day. As I left the house to go to work, I promised myself, again, that I wouldn’t drink that day. As I stepped into the off-licence, I pretended that two miniature bottles of vodka didn’t really count as a drink. If I drank them on my way to work, it would level me out sufficiently to get through the morning. Any more, and I’d be a wreck. Once I had drunk them, I swore that I’d never drink again.’

I said nothing. Those promises were familiar territory. I had made them myself, countless times.

‘I’d get through the rest of the day somehow, but my mind was always fixed on alcohol. Perhaps if I just had one drink, after that I could stop completely. Just one couldn’t hurt, could it? Then I would decide that, no, I would be good. I would go home, have a bath, make myself something nice to eat and have an early night so I’d be fresh for work the next day.’

She looked at me, her eyes clear.

‘I knew that was what I was going to do. But I still stopped at the off-licence and bought myself a bottle of wine and got straight into bed without washing or eating and I drank until I passed out.’ She grimaced at the memory. ‘I don’t even like the taste of alcohol.’

Nor did I. In fact, I’d come to hate it. But I loved the effect, the way it stopped the pain, stopped me feeling.

She said, as if reading my mind, ‘I drank to change the way that I feel.’

I wanted, right then, to change the way that I felt, or how she was making me feel. Even thinking about it made me want a drink. What could be the harm in having one drink, to make me feel better? Perhaps she didn’t know what she was talking about. After all, it wasn’t as if she had been drinking that much. I knew people who drank far more and they didn’t think they had a problem. ‘It doesn’t sound too much, a bottle of wine and two miniatures a day.’

‘It’s not how much you drink. It’s how you drink. And why.’

‘I only drink because of the depression. If it wasn’t there, I wouldn’t drink,’ I laughed nervously. ‘Or I wouldn’t drink so much.’

‘I know. I’m a depressive. Manic, actually. Bipolar. It gives you a real thirst.’

I laughed.

‘Seriously, though, a drink doesn’t make it better. It only makes it worse. How much are you drinking?’

‘A bottle of wine, perhaps two a day.’

‘Can you stop?’

‘Yes, no,’ I sighed. ‘I don’t know.’

I thought of my psychiatrist. ‘You must stop drinking, Sally. You’re not giving yourself a chance. You’re taking antidepressants with one hand and a depressant with the other. You’ll never get better if you keep drinking.’

I sighed. ‘No. Well, I find it hard to stop. But I’m not an alcoholic.’

Lulu’s smile curved. ‘What’s an alcoholic?’

‘Someone who sleeps on a park bench? Who passes out? Who gets violent? Who can’t hold down a job?’

Lulu’s smile curved even higher. ‘I am an alcoholic.’

I looked down at my hands.

Her voice was gentle. ‘Sal, I know exactly how you feel. I tried doing it on my own too, and it doesn’t work. We need help. We cannot do it on our own.’

‘But you look so well, and happy.’

‘I go to AA. It works, I promise you. Why don’t you come to a meeting and see what you think? I’ll look after you. It’s not scary. It’s only the thought of it that’s scary.’

I shook my head. ‘I don’t know. Maybe I can stop on my own. I’ve done it before.’

Lulu got up and hugged me. ‘We’ve all done it before. We’ve done it so many times we’re sick and tired of feeling sick and tired. We all think we can do it on our own. It’s just that we don’t have to. We don’t have to be alone.’

I nodded. For some reason, I wanted to cry. ‘OK.’

‘I have to go now. Call me,’ she said, and I watched her walk up the road, her flowered silk skirt swinging.

I bought a bottle of wine on the way home. I drank it and then I went out and bought another. I drank that until I stopped feeling anything at all.

Tom started to disappear again. I felt him slipping further and further away from me. I wanted him back, wanted the intimacy we used to share so easily. I felt as if we were standing on either side of a huge chasm, both unhappy, both unable to reach the other. I started to blame him for destroying the thing that we had. It never occurred to me to blame myself. I was the one reaching out. He was the one who was refusing to take my hand.

He sent me an email.

I started to drink a little harder. My loneliness grew, until it seemed unbearable. I was never going to get out of this place, was never going to be able to connect. Everything was in pieces, and I could see no way out.

The person who had put in an offer on the flat wanted to move very fast. Could we complete in four weeks?

‘He’s fallen in love with it. He says it’s perfect.’

I thought of the damp walls, running with tears. But they were my walls and my tears.

‘I don’t have anywhere to go.’

‘I’ll help you look,’ the estate agent said.

‘OK, but it must have a garden.’

‘In the meantime, can you get on to your solicitor so we can start the ball rolling?’

‘Of course.’ I didn’t have a solicitor. Panic rose, acrid in my throat. I had to find a solicitor, and somewhere to live.

‘Four weeks?’ I said.

‘You can always rent.’

‘That means moving twice.’

‘He’s come in on the asking price. In the present market, it’s a great deal. I’m not sure you’ll get another offer like this. You might have to drop ten thousand and that’s going to cover rented accommodation, and more.’

I sighed. ‘OK.’

When I put down the phone, I felt very tired and very alone.

‘My name’s Sally, and I’m an alcoholic.’

The words stuck in my throat. Fifty people were looking at me.

‘Hi Sally,’ they chorused. ‘Welcome.’

Lulu, who was sitting next to me, squeezed my hand. ‘Well done,’ she whispered.

I sank lower in my seat. ‘Everyone’s looking at me.’

‘They always do that with a newcomer. They want to remember your face, so they can help you.’

‘Oh, God.’

I was sitting in an AA meeting because I knew that my drinking was out of control. I could pretend to my friends that I did not drink too much, because I kept most of my drinking a secret by drinking alone. I could pretend to myself that a bottle or two of wine a day was not excessive. But I could no longer pretend that I could stop drinking for more than a couple of weeks. I always went back to it and that failure, together with the knowledge of what I was doing to my brain, made me feel worse than ever. The guilt and the shame were appalling and, every time I felt them, I simply wanted another drink. I was trapped in a vicious circle. So I called Lulu and asked her to take me to a meeting.

We sat in an old church hall, on moulded grey plastic seats arranged in a semicircle to face a low table. Behind that sat two people, a man and a woman. The woman was young, with long straight shiny hair and a wide smile. She wore skinny jeans and a leather jacket and a red cashmere scarf, which she kept winding and rewinding around her neck. ‘It’s fucking cold in here,’ she said. ‘Is anyone else fucking cold?’ Then she clapped her hand to her mouth. ‘Fuck,’ she said, ‘sorry. I gave up swearing last week.’

The man sitting next to her, who was wearing a black baseball cap pushed low over his eyes, patted her gently on the back. ‘A day at a time,’ he said, grinning.

‘More like a minute,’ she said. ‘OK, everyone, welcome to the Monday night meeting of Alcoholics Anonymous. My name’s Sarah and I’m an alcoholic.’

‘Hi Sarah.’

Sarah said, ‘The format of this meeting is that the speaker will share his strength, hope and experience for fifteen to twenty minutes and then there’ll be hands raised for sharing until the last fifteen minutes when we’ll slow the meeting down for anyone in their early days to come in and share. It was suggested to us that we sit back and relax and listen to the similarities, and not the differences. And now it gives me great pleasure to introduce our speaker, Chris.’

‘My name’s Chris and I’m an alcoholic.’

‘Hi Chris.’

Chris leaned back in his chair and threaded his hands over his chest. ‘Yeah, hi,’ he said, affably. ‘I have to tell you that this was not my idea. It was never my idea to end up sitting in a church hall with a bunch of drunks. It was never my idea to be a drunk. I wasn’t a blackout drunk. I never went to prison or lost my job or lost my house or ended up in any of those places that alcohol took so many of us to. I was a high-class drunk, I wasn’t like you.’

He grinned. ‘I was special and different, or so I thought. It took me a long time to understand that a drunk is a drunk. It doesn’t matter where they come from. It only matters where alcohol takes them, which is to the bottom of a bottle, staring into the abyss.’

A few people nodded, some yawned. Others had their eyes shut but I could tell, from the quality of attention, that everyone was listening.

Chris shrugged. ‘I drank for a simple reason. I wanted to stop the pain. My pain was, you know, heroic. Nobody else could understand my pain. That’s why I drank. I couldn’t connect with other people. I looked fine on the outside, life and soul and all that, but on the inside, man I was a mess. I didn’t tell anyone, I thought I could fix it myself. But I couldn’t and the place it took me was where I always knew I was going to end up, on my own. In the last few years of my drinking, it was just me and a bottle. I didn’t answer the phone, I didn’t go out, I just sat on a sofa with the TV on and,’ he shrugged, ‘I drank. I was looking for the solution in a bottle and we all know what a shit answer that is. But I wouldn’t be told. I thought I was better than that. I thought I was special and different because nobody could understand my pain. It was only when I got to these rooms that I understood that I wasn’t special or different or that my pain wasn’t special or different. It was, like…,’ he stretched the word out for emphasis, ‘normal.’

A few people laughed.

I didn’t. I knew what he was talking about. They say in AA that you don’t hear what you want to hear. You only hear what you need to hear. It takes you a while to understand that. It takes you a little longer to be honest enough to admit it and even longer to accept it.

‘How was that?’ Lulu said afterwards.

‘It was—interesting.’

‘Interesting good? Or interesting as in, I don’t know what to say so I’m just going to say that to shut you up?’

‘The latter.’

‘Don’t worry. It gets easier.’

‘Sure.’

‘What are you going to do now?’

I just wanted to get out of there, to get home and be on my own. To try to stop the pain that nobody else understood. Except they did which, somehow, made it worse. Now, I had no excuse. Now, I really wanted a drink.