The Saga of Remeron/mirtazapine

I mentioned in my last post that, despite my distrust, I tried prescriptions, plural. But, I spent the whole post whining about Prozac. The other one I tried was remeron. Let's talk about that.

About ten months after my experience with Prozac, I was referred to a mental health clinic. I was well into my second year being unemployed so I had to go on the first available Sunday and their community clinic. In other words, I showed up for the first come, first serve, free service. You just try to find more depressing circumstances!

Anyway, the psycho-whatever guy took in my story. I know, sounds irresponsible to not remember for sure what his title/position was, but at this point in my life I was emotionally and physically exhausted. Also, I liked and trusted the doctor who referred me to him. We’ll talk more about her later.

I was so in the depths of it at this time that walking to the end of the block was a major accomplishment. Driving the fifteen miles or whatever to this guy’s office was nothing less than herculean.

So, I told him about my struggle with depression. In those ten months it had become so much worse. After Prozac, the episodes of heavy limbs, crying helplessly and days of endless sleep continued to come and go. I’d have a good week then two days of useless paralysis.

I put it to him plainly. I was ready to try another prescription. I had two conditions: 1) Don’t say the P word and 2) I wanted the meds that had the lowest incidences of sexual dysfunction associated with them.

Sidebar: Sex is incredibly important to my new wife and me. We met some months after my divorce and her separation on one of those hook-up apps. It was literally meant to be a one-night - well, one-morning - stand. Turns out, we’re still standing.

So, back to it. He, the psych-whatever guy, totally understood. He listened to my whining and worries and suggested Remeron (mirtazapine). Said it had one of the lowest incidences of sexual problems and was good at smoothing out one’s depression/emotional issues.

In an FAQ on the Mayo Clinic's website they list mirtazapine as one of the antidepressants with the lowest incidence of sexual problems. However, they don't go so far as to say that there are no sexual problems associated with it. A study published by the National Institute of Health in December, 2005 reported that patients suffering from sexual issues while on other antidepressants saw improvement when they tried mirtrazapine

We filled the prescription and, after staring at the bottle for about a week, I finally started in with the recommended dosages. I stuck to it for two weeks before my wife asked why we weren’t having sex anymore. I hadn’t even noticed but we’d gone from twice a day and ten on the weekend to maybe once a week. MotherFuck! (Well, actually, quite the opposite.) I hadn’t even noticed.

The standard information/disclosure information about mirtazapine says nothing about the possibility of sexual side effects. Whether it was real or some kind of messed up placebo thing, I'm obviously in the minority or their studies sucked. 

We tried paring it down. Half a day, then half every other day; no joy. Having no libido and disappointing my partner is no solution to depression. At least in my world it’s not.

So, I’ve let mirtazapine go, too.

Tried Prescriptions

I know. The original point of this blog was to chronicle my battle with depression without prescription drugs. Well, since we last spoke I broke down and tried a couple of prescription antidepressants. Let me tell you about that.

First, a few background details that may or may not be relevant and may or may not be further explored later. As you know, I’m not a big fan of prescription drugs. Obviously, they have their place but I think today’s western society overuses them. From antibiotics to emotional and mental medications, I think that patients and doctors alike are too quick to turn to them. This isn’t either parties’ fault, the system has simply been set up in such a way that there’s not enough time in the doctor/patient relationship to explore slower – even if more effective – solutions. Also, there’s the pharm industry… There are a lot of rabbit holes to fall down here. Point is, I’m more reluctant than the average patient to accept prescriptions. Let’s leave that there for the moment; maybe we’ll get into it later.

I may be a bit paranoid in this area. For a more balanced view of the issue of prescription drugs in the US, check out this article in the Washington Post from November 2015. It points out that, among other things, prescription drug use is up possibly due to increased advertisements and an aging population. Happily, it also mentioned a decrease in antibiotic use.

Second, my wife doesn’t necessarily agree with me on this.I’m not saying she’s trying to shove a pill down my throat every time I feel a little ouchy, but she’s seen antidepressants help people in her life before and she didn’t like to see how much I was suffering. Besides my natural proclivity to depression, having lost my job and my home left me in a pretty bad place. So, when I needed to get a prescription re-upped – heart thing, not gonna fight that one – she came along with me to the clinic to talk about these squishier issues.

The nurse practitioner we saw was compassionate and took the time to listen to my story. She patiently asked questions and encouraged me to tell her everything. It was painful. Anyway, after it was all said, she proscribed Prozac. Obviously I knew about the big P. It’s an old drug and I’ve heard a lot of people have been helped by it. After some convincing I decided to give it a try. (Not much convincing, mind you. When you’re as low as I was then it doesn’t take much.)

It was a disaster. I took the prescribed dose for three days. It shut me down. I mean it literally turned me off. I’ve told this to doctors since and, save one, I can see clear skepticism in their eyes. But that’s what happened. I stopped functioning. For a week I could only get out of bed to urinate or vomit. The rest of the time I slept all day and all night. I was in a black/grey fog. My arms and legs felt like great weights that were impossible for me to lift. Had it not been for my wife – then fiancé – keeping me hydrated I might not have come out of it. Dramatic, I know, but it was really that scary. Aside from a few auto and flying incidences, my lucid moments during this episode were some of the most terrifying I’ve encountered.

According to this study published in JAMA in June, 2018 "between 2005 and 2014, the estimated overall prevalence of US adults using medications with depression as a potential adverse effect was 37.2%.The adjusted percentage of adults with concurrent depression was higher among those using more concurrent medications (eg, estimated 15% for ≥3 medications)."

Obviously, I dropped the Prozac after this. The incident left me with a strange side effect. My left ear was completely plugged up. My right ear was, too, to a degree, but at least I could hear out of it. The left? Nothing. Strange, right?

Still Pursuing

It’s been a while…again.

A lot has changed in my life since I last published an honest post; although, to be honest, none of these posts are entirely honest. They may be more or less true chunks of my reality but to call them honest is probably a stretch.

But you already knew that, I’d wager.

Okay, to summarize: I lost my job, twice; I got divorced; I moved four(?) times; my car blew out its engine and the truck I bought to replace it was stolen a few weeks ago.

In other words, I now have legitimate real-life reasons to be depressed. No longer am I a guy with a chemical imbalance; I’m a guy with real problems and I honestly don’t know what to do about them.

For a while there St. John’s Wort was doing the trick. Regular doses kept my keel more or less even. When the ship started to list, however, it didn’t seem to be enough.

Well, hang on. There are a few positives I forgot to mention. Most significantly, a few months after the divorce I met a beautiful woman. We hit it off and got married way too soon, but we’re in our forties and we know what we want and what we’re doing. So far, so good. And, one of those moves I mentioned took me out of the backwater village that I endured for over 20 years for my ex to a proper city where I’m much happier.

Anyway, back to the listing ship. When I was laid off from my first job I started to slip. I managed to hang on for a bit but after about six months of job searching it got bad. I went to the doctor and, for the first time in my life I went on prescription antidepressants. Prozac, to be specific, and it was a disaster – wouldn’t be the last. It completely put me on my back. For a week I couldn’t wake up, much less get out of bed.

That’s where it started…again. Looking back, some of the best therapy I got was from writing this blog. Maybe it can help me again so I’m going to try to pick it back up. I know I’ve made a lot of vague allusions here. We’ll get into to some of them later. Some of them, I’m just going to let drift. You’re welcome to take the ride with me.

Hi!

I'm thinking I'll take this up again. A lot has changed with me and a lot has remained the same. You can expect the same incoherent, navel gazing posts as before. Right now I'm just doing some housecleaning; this post is mostly just a test to make sure that everything looks ok. If you happen to notice any problems or have any suggestions for future posts, please let me know.

Following up...

This isn't a real post, just a follow up on the last one. That post was incredibly cathartic for me. Writing it was the last time I wept uncontrollably over the situation. I've squished out a few tears since but nothing like before. Clearly, I was angry at my wife over the situation and I still think that we had other options. But, that's in the past and I have to balance that against everything else. Dan Savage, who I think is incredibly wise in these things, talks about the price of admission. That is those things about your mate that you overlook or just get past in order to maintain the relationship. This has to be one of those for me. I'm not an easy person. But, I've found a person who is easy with me. I need to accept this price of admission. Actually, things have improved for me since I posted that last entry. Like I said, it was cathartic for me. My relationship with my wife has improved and I feel our bond is strengthening. Death happens. Life sucks.

Death and falling stars

I recently lost a close friend. Literally, as I typed that, a huge, fast burning, falling star appeared before me. I literally mean literally.

Let me tell you where I am as I write this. I’m in a suite – they keep calling it condo but, I’m pretty sure it’s a suite – on the beach in Destin, Florida. I’m on the balcony, smoking a rare cigar which I’m pretty sure is against the rules, listening to the surf. It’s just 5am and I’m recently awake. The sky is still dark so, instead of the gorgeous beach scene that I’m expecting any minute now, I’ve got the Milky Way which, is as good or better than most any terrestrial scene you can serve up.

I should be more content just now than I ever am. But, that’s not my MO. Looking back on life, thinking about some of the incredible things I’ve seen and experiences I’ve had, I know that at every moment I was always too much in my head. Look at me now. It only too me two an a half paragraphs to see a stunning falling star and then climb right back up my own ass.

I slept on the coach last night. When I went to climb into bed, after washing a good cry off my face, I found my wife on my side of the bed. Now, I’m not a dictator about things like this, but I’m also an extremely flawed man who has trouble dealing with change.

Oh, I said, I didn’t know we were switching sides, as I gathered my night-time things from the nightstand next to her head. She looked at me silently.

A sit-com rerun was on the TV so I tried to settle into that. No luck. I squirmed and flopped for about 30 minutes while she fell into a dead sleep.

I tried to sneak out without waking her. At the last moment she groggily asked what I was doing. Did I want her to sleep elsewhere? No. Okay.

Earlier last night, over dinner, her son asked why we had put the cat down. Her son, who is successfully carving out a career for himself in the Army, is treating us to this weekend. It’s my birthday now and hers in a week. It’s a sweet gesture that I don’t think he fully understands as his wife has been gently explaining the whole experience to him every step of the way.

My wife explained how Desi, a lifetime indoor cat, got fleas a few months ago. How? She’s not sure. (I brought fleas home from a temporary, outdoor job I had to take working with plants.) We tried and tried to get rid of them but nothing we tried seemed to work. The cat became more and more upset with the situation and stopped using his litter box. She decided the night that he peed in her gym bag, that he had to be put down. There was just no other choice.

His sister, Lucy, died a few years ago. She developed some sort of strangulation in her intestines and couldn’t eat. It was far too expensive and uncertain to risk surgery; she had to be euthanized. It was too much for me to take Lucy to the vet that day so my wife did. Later, she told me that she couldn’t bare to go with her into the room so Lucy died scared, confused, and alone in the arms of a man she’d never seen before. It broke my heart.

I vowed that when it came Desi’s turn, I wouldn’t let that happen.

It wasn’t Desi’s turn. There were still a couple of options that we could try. They would take time and patience and more cleaning supplies but I wanted to try. My wife didn’t. She was mad at him for peeing in her gym bag and was certain that he planned to ruin our couch, next. She woke me up in the middle of the night and told me that I had to take him to be put down the next day.

I explained the options we still had, she wasn’t interested. We argued. I pleaded for more time but, she said that if I didn’t do it the next day she would do it in three days. Three days wasn’t enough time for the other options to start working so, I knew that if I didn’t do it, she would send him back to the death room, alone like Lucy.

So, I got out of bed and went upstairs to the living room. I made a bed on the couch and Desi, as he usually did when I lay on my back, came and curled up on my chest. We slept like that. Then, the next day, I killed him.

As he lay on that steel table, being held down by me and one of the nurses, or whatever they are in a vet’s clinic, I scratched him in all his favorite places and bawled. I kept saying, Desi, my love, a thing I used to say all the time, and I’m so sorry, a thing I’d rarely had to say to him before.

He craned his neck around, looking at the room and trying to understand what was going on. Finally, he found my face and stared in my eyes while the needle went in and he quickly drifted away.

That was well over a month ago and I’m still not close to being over it. I thought I was until last night when I heard the situation described so breezily. It was all I could do to keep from bawling uncontrollably right there at the table in the highly recommended seafood joint that the daughter in law so carefully picked out for us.

I’m aware of the thing with pets and I hope and believe that most of you have stopped reading this by now. No one really wants to hear about the death of another’s pet. Desi wasn’t a special cat to the rest of the world. He only knew about five people and, as far as I know, only two have cried at his death, my wife and me.

My problem is, I don’t know how to get around this. I thought I was getting there but I’m not. I can’t forgive her for forcing the situation and I can’t forgive myself for allowing her to do so. I didn’t get up and move to the couch last night because I was on the wrong side of the bed. I got up and moved to the couch because, since Desi’s death, I haven’t been able to sleep in the same bed as her without chemical assistance.

I want to recover from this. I don’t know how.

Trying it the Nerdist Way

I've been away. Long time readers will know that I do that. I won't make any promises that I'm back to updating regularly. But, for now, here's a post.

So, my life has continued to crumble. Just when I think I can't mess things up any worse than they already are, I find another thing to ruin. I'm still married. I'm stunned that my wife puts up with me but she does. I am so not the person that I was when we met but, I can still make her laugh and I suppose that's something. Oh, and there's all that love and commitment stuff...

My book deal, the thing that defined and sustained me for quite a few months, fell through. It was mostly my fault; it was like I set myself up to fail in horrible slow motion just so I could watch the train wreck frame by frame. There were a few contributing factors that were beyond my control. I haven't really given the whole situation a good, hard study and I probably never will. Chances are I just used those factors as excuses. Anyway, I now owe the publisher my advance back so, yippee!, more debt.

Finances are a huge problem for me at the moment. When the book deal collapsed, I started looking for work in earnest. I had been casually dipping my toe in the job pool before then but, when it all came down in December, I cranked up my job hunting dial to eleven. Even so, it took me until the end of April to land a job. It's seasonal work and ends in June. Luckily, I found another job that I start in a week so that's something. Still things are eye-ball poppingly tight and everything feels like an upstairs stumble to the next payday. Plus, this is not where I was supposed to be at this point in life.

I'm still writing. Financial desperation makes it difficult to keep a positive voice. Magazines have stopped buying my work. No doubt the editors can smell my desperation in my pitches. I've still got my regular online gigs which pay pretty well. The jobs I took, both the seasonal and the new one, are part-time so I've been able to keep up. So, I'm hoping that in a month or two my finances will be back in shape and my writing won't stink quite as much.

Which brings me to the title of this post. I'm reading my first self-help book. It's called The Nerdist Way. I didn't set out to find a self-help book as most of them seem like hooey to me. I came to it simply because I'm a fan of the author, Chris Hardwick. As you may have guessed, he is a self proclaimed nerd and one of the guys out in front of the nerds-are-cool movement. I'm pretty nerdy myself - I know, shocker, right? - and am pretty tuned into most of what he talks and writes about. In many ways he's like me except successful. So, when I learned about his book I thought I'd give it a try.

It's pretty good. I'm only a few chapters in but I have to admit that I'm feeling a little inspired. The book isn't about depression; it's about embracing our nerdly qualities to succeed in life. And I could do with a little success just now as it seems like everything in my life is covered in an oily, black sludge of depression.

It's going to be a long and horrible road up out of this pit. I don't know if I can do it but, with the new job and a bit of nudging from Hardwick, maybe I can turn this train wreck around. (I realize the metaphor makes no sense whatsoever but just roll with it, okay?)