Are Dugs Always Bad?

This blog post is slightly different to my usual ramblings about poopy nappies and Paw Patrol, in that as much as we love our small humans (and love to hate them), sometimes we – parents and non-parents alike – struggle, and require help. More specifically, this is an article about drugs and the biological, physical, mental and social misconceptions often associated with them. Anyone who watched the TV show South Park in the late 90s will remember Mr Mackey insisting that “Drugs are bad (m’kay)”. But are drugs always bad? Now, I’m not talking about the “fun” recreational drugs – although that could make childcare more interesting – but more the prescribed medications such as antidepressants and anti-anxiety drugs.

Over the past couple of years, I have suffered with pre-natal depression, postnatal depression, chronic anxiety, panic attacks, eating disorders, self harm, CPTSD and suicidal tendencies. There were many contributing factors to these, some of which I was aware of, some of which I subconsciously denied and some of which I have only just come to learn were root causes. During this time I tried to reach out to people I thought were friends but got rejected. My subtle cries for help were not picked up on and I was left feeling isolated and alone. During this period of being mentally overwhelmed, I made some really poor decisions, and although I take full responsibility and accountability for my actions, I have since learnt that my actions were driven by trauma, which wasn’t all my fault (as I was led to believe), and that I needed help. 

What is Trauma?

Trauma may be caused by a single event or ongoing events over an extended period of time, and can happen directly to you or someone you are close to, or indirectly e.g. you may be a witness to a traumatic event. Events may include things such as being in a serious accident, being assaulted, being involved in a war, being involved in a natural disaster, or abuse of any kind. Trauma affects several different brain structures, including the Amygdala (fear response),  the hippocampus (memory), and the PreFrontal Cortex (reasoning & problem solving). I could talk for hours on the neuroscience and psychology of traumatic effects and the brain, but I realise that not everyone is as sad and geeky as me, and the majority of my readers may just want to watch the new season of The Apprentice or MAFS (good shout by the way). So in brief, traumatic stress can cause overactivity of the amygdala, a shrunken hippocampus, and less active prefrontal cortex, resulting in anxiety, insomnia, irritability, flashbacks, nightmares, panic attacks, memory issues, poor concentration, trouble making decisions, difficulty learning new things and extreme fatigue.

Drugs

Several trusted family members suggested that I should talk to a GP about possible medication, but I was so against the idea for a long time. There existed a massive Cognitive Dissonance in my head, whereby I had no problem with other people taking medication for mental health needs, in fact I respected and admired their bravery. But I thought that if I “gave in” to drugs, that I had somehow failed, was weak or was otherwise incompetent. I’d firstly have to admit that there was a problem, and then that I wasn’t ‘strong enough’ to deal with the problem, and both of these things came with a sense of shame and embarrassment. I was afraid of the social stigma associated with being on antidepressants / anti-anxiety medication, concerned that it could impact any future career prospects, and also worried that I would be seen as a bad parent. I was also worried that I wouldn’t feel anything at all – that I’d be emotionally numb – and that would be like cheating, as I deserved to hurt as punishment for my mistakes. Above all, I was so emotionally low that I saw myself as bulletproof; it didn’t matter what the world threw at me at that point, it couldn’t get any worse. And that was comforting. The risk with building myself back up was that I became vulnerable to being knocked down again, and I didn’t know if I had the strength left to pick myself up one more time.

Why am I telling you this? Because I’ve since learnt that lots of people feel this way – parents and non-parents alike – but suffer in silence because of the social stigma that surrounds mental health issues, because they have become isolated from friends and family, or because they have tried to reach out but their attempts have been brushed off or minimised. Worldwide, around one in four people will suffer from a mental health problem during their lifetime, yet roughly 60 percent will not seek help.

Luckily, this was not the end of my story. At the bottom of my second spiral, I felt I had nothing left to lose and finally agreed to make a GP appointment. I was pleasantly surprised that the Doctor believed me (I think I held a preconception that I’d somehow have to prove myself), was sympathetic and was non judgmental. I was prescribed Sertraline (Zoloft in the USA), which I was advised may take up to 8 weeks to have an effect. I saw an effect after just 3 days, which I think shows just how dire the situation was. For the first 2 weeks, apart from giving me the sh*ts, I became unable to cry. It was like someone had turned off my emotions. I felt like I was in a glass box – I could see all of my problems; I was still aware that they existed – but I didn’t feel anything towards them. Imagine having Botox then trying to frown… I just couldn’t. I was emotionally numb. Some people describe antidepressants as allowing you to “see things more clearly” or “giving you mental space to breathe”, and I suppose in retrospect,  that was what it was like.

The Brain & Trauma – Why drugs can help

A useful way to understand how and why medications can assist trauma recovery is to refer to Paul MacLean’s “triune brain” (“3 brain”) theory. In brief, he theorised that the brain is made up of 3 main parts; the Reptilian brain (regulatory functions e.g. breathing & heart rate), the Mammalian / Emotional Brain (limbic system e.g. fear, arousal, anxiety) and the NeoCortex (cognitive & previous traumatic experiences). The 3 parts ‘talk’ to each other to respond to stimuli e.g. you’re confronted with danger (fear) and your limbic system tells your reptilian brain to increase heart rate. Alternatively, maybe there is no physical danger present, but you are watching a scary film – in this case your NeoCortex computes the fictitious scene as scary and tells your emotional brain to process fear, which passes on the message to your reptilian brain to increase your heart rate. It can also work the other way around, whereby your reptilian brain can affect your limbic system and NeoCortex, for example when we feel severe hunger, we make harsher moral judgments about people’s transgressions and we’re less charitable; this is often referred to as being “hangry” (hungry-angry).

A problem arises when there becomes a prolonged imbalance between the three brains, most commonly the overactivity of the Limbic (emotional) system. When we are in an emotional state of arousal, the decisions we make are sometimes out of character, impulsive or not ideal. Overactivity of the limbic system can prevent decisions from being made but also prevent processing of an event or memory due to the emotions triggered. Antidepressants work by effectively turning down the volume of the Emotional brain, to allow the person to function better, make less impulsive decisions and work through memories of traumatic events in therapy without becoming emotionally overwhelmed. This is what was happening when I felt like I was in my glass box – my NeoCortex was still processing the problems, but my Emotional brain had been switched off (or at least turned down). About 3 weeks in, I started having emotional flashbacks triggered by sights, smells, sounds, thoughts or memories. These were stored in my NeoCortex but without the flooding from the Emotional Brain (limbic system), I could process them without the Reptilian Brain kicking in with physiological signs of anxiety such as increased heart rate, digestive shutdown and hyperventilation. 

The Ins & Outs of SSRIs

The medication I was prescribed – Sertraline – is an SSRI (Serotonin Reuptake Inhibitor). Serotonin is commonly referred to as the “happy hormone” and is naturally produced by the body in pleasurable situations such as eating chocolate, when under the influence of recreational drugs or during sex. As the name implies, SSRI’s prevent serotonin from being reabsorbed and thus the person feels happier for longer (or to a greater extent). Imagine you are a bar-tender and you’re trying to sell your beer in a small town with few punters. By hosting a lock-in, you sell more beer, not because there are more customers but because the ones that you already have can’t leave, and thus continue to purchase your delicious liquor for an extended period of time.

Like any medication, there are side effects to sertraline; the biggest for me being weight gain. When I was at the height of my anxiety spirals, I went from 85kg to 63kg in just 3 months. My body was constantly in fight or flight mode, one of the side effects of this is digestive shutdown (loss of appetite and increased digestive difficulties). As the Sertraline started to reduce my anxiety levels, my digestive system and appetite started to return to a baseline level and within 3 months I had put 2 dress sizes back on. The kick in the teeth is that when I was at my emotional lowest, my body confidence was actually at an all-time high. I was chiselled, lean, and had abs to die for. But that was just it… if I had continued in that mental state, I probably would have died, one way or another. 

Extreme tiredness is also a common side effect; often I can’t keep my eyes open for love nor money by around 3pm. This has implications for my work and my ability to drive. Certain foods should also be avoided – unbeknownst to me, mixing grapefruit juice and sertraline can cause psychotic episodes! Lastly, accidental withdrawal is a big issue to bear in mind. I remember my good friend telling me that if I ever wanted to come off of the medication, to consult a GP and do it very gradually, over months. At one point, there was a mix up at the pharmacy and my prescription was 2 days late… I can’t even begin to describe the sweet hell that withdrawal entails. Everything you see in the movies about the sickness, sweats, headaches, shakes etc is true….. It’s like having the world’s worst hangover with the added burden of your emotional floodgates being opened and a year’s worth of bottled perturbation being released. Never. Again.

On Balance: Are Drugs Always Bad?

In short, No. But we do need to be educated about both the possible benefits and side effects of different types of prescribed mental health medication. There is still such a massive social stigma surrounding anti depressant and anti-anxiety drugs, and with 60% of those suffering from mental ill-health not seeking help, this could be a major contributing factor as to why. Of the 40% who do seek medical intervention, many of those will keep it to themselves, through shame, embarrassment or fear of social consequences. If we can learn to talk more, and diminish the taboo nature of the subject, then it will become evident that you are far less alone than you think.

One Comment Add yours

  1. Chris Humphrey says:

    For the first time since I was in my mid-teens a combination of talking therapy and medication has began to work in breaking the cycle of periodic depressed episodes that have black dogged my adult life.
    Thank you Kate for keeping this subject in the open. Stigma? None as far as I am concerned.

    Like

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