Wednesday, 23 August 2017

Twenty Milligrams

Just over a year ago, I lowered my daily dose of Prozac from 60 to 40 milligrams a day. This was with the doctor's permission, following a terrible mistake I made in 2012 when I decided to stop taking the medication altogether, which felt great for a couple of months and then - disaster.

I've been taking Prozac now for twelve years and I don't think I'm exaggerating when I say it saved my life. It's for a form of Obsessive-Compulsive Disorder known colloquially as "Pure O" or more formally as Primarily Obsessional Obsessive-Compulsive Disorder.  Simply put, left to its own devices, my brain devises the most appalling, terrifying thoughts about the sorts of things I could do to myself, and loops them indefinitely to the point where I can think of nothing else but how to stop thinking them.  Unlike with more typical forms of OCD, I haven't developed ritual behaviours that act as temporary relief from the thoughts (this is the standard obsessive-compulsive cycle, stereotyped in such memes as the hand-washing, doorknob touching, crack-in-the-pavement avoiding neurotics of lazy Hollywood scripts and insensitive internet memes.  Tip: if you ever hear anyone say "I'm so OCD", that means they're almost certainly not).  The compulsive element takes place almost entirely inside my head.  It's an "invisible" illness, probably just because it isn't as easy to ridicule.

I first developed the condition in my last year at university, when it became so severe that continuing my studies became impossible, and I had to take a leave of absence.  After about six months of (excellent, and increasingly unavailable on the NHS in these conservative times) psychiatric treatment, involving a certain degree of guinea-piggery as I popped the pills they told me to, which provided little actual relief apart from excessive sleep it emerged that Prozac was the drug for me.  I started on 20mg, moved on to 40, and finally to 60, by which time life became liveable again, and on which I stayed ever since.

More or less, that is, until I decided like an idiot in 2012 that I didn't need it any more, and stopped taking it; and then, as I said, disaster.  Prozac stays in your system for a long time, but as it worked its way out the dark thoughts came flooding back again.  That was that, back on the Prozac again.  And so it was.

Eighteen months ago I made the decision to try and start living my life, which is where this blog began.  After working and working and working a job that became a kind of life all of its own - a managerial position, working mostly at night for an out of hours crisis service (empathy, and all that) I came to the obvious realisation that this was no way to be (obvious things are often too obvious to see) and gave up.  From now on it would categorically be work to live, not live to work.  I've had some success with this approach, fairly limited so far, but it's rarely been less than a joy.

Part of the process was finding out if I could "get by" on a lower dose of medication.  Although as I said, Prozac saved me, it took a lot away from me, too.  Creativity, energy, the intangible joy of being young and present and alive.  I hoped some compromise might be possible.

It was.  I felt better, overall, on 40mg than I did on 60mg.  A few dark thoughts surface from time to time, but they're nothing I can't handle.  So last week I took another step and asked the doctor if it might be OK to drop down to 20mg.  And here I am.  I'm recording this here to keep myself accountable, focused and perhaps even sane.  If it doesn't work, it doesn't work, and it'll be back up to 40mg again.  But so far, so good.

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Over the edge of the map
On Getting a Life
A Smaller World (Part One)


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