Antidepressants: friend or foe?

I have a little friend called Citalopram. We have a strange friendship. We have had our ups and downs, and on occasions I’ve doubted whether I need him in my life. Not only that, I hope we’re not going to be friends forever. I’d rather we remain friends for the next few months and then, when spring arrives, we might be able to go our separate ways and bid each other an amicable farewell.

The problem is, it’s hard to say goodbye to Citalopram. After a couple of attempts, I’ve had to concede that actually I do need him. He’s just a tiny, white, oval-shaped tablet – considerably smaller than Paracetamol – but he is a powerful little chap.

Now that he and I are friends, I find it hard to admit to him that once I had quite a prejudice against him, and others like him. Antidepressants. Ugh.

In early 2010, I had to face up to what was happening to me. I’d been getting headaches every day for two or three months and was getting struck down by minor ailments on a regular basis. I was clearly stressed out and had lost my perspective. I wasn’t looking forward to anything and was experiencing some horribly dark moods. The only thing was, I was afraid of going to see the doctor about it, because he might ‘put me on tablets‘.

I don’t know why I didn’t trust these ‘tablets’. I didn’t even know what they were, but presumably they were going to alter my mind, and that just didn’t sound right to me. The irony was that I was having to take Paracetamol at least once – often twice – a day for my headaches. I had no problem taking on a headache with medication, but this was different.

It’s obvious now that my mind needed altering, because my nemesis and shadowy alter-ego, Paul Brookes, had crept into my brain, staged a hostile takeover and needed sorting out. When I did go to see the doctor, he confirmed what I’d suspected but hadn’t really wanted to accept. I had depression.

One of the standard ways of treating depression is with antidepressants, like Citalopram, which is what I was prescribed. You can take it in various doses. I started off on 20mg, a fairly low dose.

“What’s happening to me?”

The first night I took Citalopram, something scary happened. I got up to go to the toilet in the middle of the night. The next thing I knew I was lying face down on the bathroom floor, feeling very strange and extremely queasy. I hadn’t a clue what was going on. I managed to crawl to the bedroom, where my wife found me. She realised I had fainted and luckily for me she was very calm and knew what to do.

I still felt unwell the next day, and had to make two phone calls:

1. to my doctor: he said the fainting episode might not be related to the antidepressants. It’s apparently not uncommon for men to get up during the night to go to the toilet and then faint, because their blood pressure suddenly drops. That’s how I remember the explanation, anyway. The drop in blood pressure might have been a result of taking antidepressants, but might have been nothing to do with it. Whatever the case, it has not happened since, which is quite a relief.
2. to my manager at work: this was more than the average “I’m ill and not coming to work” phone call – it was a revelation that I was mentally ill, and one of the first times I’d had to discuss it with anyone outside my family. Fortunately for me, she was very understanding and supportive. I had to take two days off, but was back doing my job just as well as usual the following week.

Since then, I’ve had a rollercoaster relationship with Citalopram. The 20mg dose didn’t seem to work, so my doctor upped it to 30mg – one 10mg tablet and one 20mg. There was an improvement and the headaches gradually disappeared, but although we were treating the symptoms, only counselling could get to the heart of the causes and help me to deal with them.

Early in 2011, I was feeling good. By the time I’d finished my course of counselling, I was feeling ready to reduce my dose of Citalopram. You can’t just stop taking it by going ‘cold turkey’, I’ve been told. The consequences do not sound attractive. So I dropped it to 20mg after talking to my doctor.

It was at this point I learned how big a difference antidepressants can actually make, because I soon found my mood darkening again, just by dropping 10mg of Citalopram. Within a week, I’d gone back up to 30mg. Once things had settled down again, and I’d been feeling great for a few weeks, I tried 20mg again.

Victory?

This time, there was no backlash from Paul Brookes. I was fine on 20mg – yippee! I could sing Jimmy Cliff’s ‘I can see clearly now’ loudly and confidently in the car, knowing I was at last on the way to getting myself off my medication. I started dreaming of cold beer, a cheeky whisky, or maybe a glass of wine one evening. Citalopram and alcohol don’t mix well, I understand, so I have been teetotal since the day I took my first pill.

As summer 2011 neared its end, I dropped my dose again, down to 10mg. Was the end of my Citalopram odyssey in sight?

Alas no. I’d dropped my dose as a particularly busy and stressful season kicked off at work, and I needed my little friend to help me fight the re-emergence of Brookes. My doctor said I should stay on 20mg as my stable dose through the winter, which I was happy to agree with.

This time, though, my little sidekick was no match for the sinister powers of Brookes, who rose from the shadows and gave me a good beating, this time resulting in three weeks off work and a return to 30mg of Citalopram.

I’ve learned a few things from this unfortunate adventure:

• Depression is an illness, which you can treat with drugs, just as you would with any other illness. And, like other illnesses, people recover and no longer need those drugs. The same will happen for me – just not quite yet.
• Citalopram is a powerful drug. You might think it’s not doing anything, but it is. I only really recognised this when I tried to come off it. It needs careful management and close consultation with your GP.
• I need Citalopram at the moment, and don’t see this as failure or weakness. It is a necessity, and the alternative is much more damaging.
• Antidepressants are my allies. Citalopram has complemented my counselling, curbed my anxiety, banished my headaches and cured my insomnia.

So I have accepted Citalopram as my friend. I’ll be glad when he’s gone, but only because that will be a clear sign to me that I am better. In the meantime, he’s my companion on the road to that promised land.