A Month of Heart Attacks: Withdrawing from Antidepressants

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A Month of Heart Attacks: Withdrawing from Antidepressants

By Victor Yocco 08/24/18

My doctor tells me not to worry. The medication is safe. I worry he doesn’t know what he’s talking about. I worry this was a big mistake I made at 18 and am paying for the rest of my life.

Image: 
Man sits on bench in park, clutching heart.
One man's account of his struggles on and off anti-depressants.

My obsessions start as small thoughts. Random sparks catching kindling in my mind, eventually blazing into a wildfire. I’ve always been this way. I couldn’t run for fun, I had to run marathons. I couldn’t go to school for one degree, I had to get my PhD. I couldn’t write a few articles related to my work in digital design, I had to write a book. I couldn’t drink a little bit of alcohol, I had to drink until I passed out. This same thinking led to my decision to stop taking my anti-depression and anti-anxiety medication.

I began taking medication to treat depression when I was 18. Melancholy was my constant companion the last two years of high school. It stuck around after my graduation as well. Depression had me incapacitated and numb to self-improvement. My first adult visit to a general practitioner took me 30 seconds to describe how I’d been feeling for years. I left with a prescription for Zoloft. 

I didn’t start taking the medication immediately. I was smoking and drinking to self-medicate. Taking a pill seemed weak. I grew up as part of a generation over-exposed to and under-educated on anti-depressants. Particularly Prozac, which seemed to enter the lexicon of my peers overnight in the early 1990’s.

“Quit being a spaz! Take a Prozac.” we’d tease each other. Even worse, “Her parents put her on Prozac.” we’d whisper in the hallway. We didn’t know what that meant. Only that being on Prozac meant you weren’t normal. Commercials and TV shows told us it was used for depression. You had a mental illness if you were depressed. Mentally ill people are crazy.

I knew crazy was bad. My father had a mental illness. He took lithium for a good part of my childhood. He hallucinated aliens were sent to kidnap him. He was crazy. I constantly worried this secret would be exposed. I was the son of a mentally ill man.

I struggled with what the decision to take medication would mean for my future. What would my future partner think? What would my future children think? Maybe I’d only need to take if for a few months, I thought. I wanted to feel better. I wanted to live up to the potential I’d always been told I had. I decided to take the medication.

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Medicated

Zoloft worked. I could get out of bed easier. I could deal with the ups and downs of everyday life. I functioned. My thoughts dwelled less on negative aspects of life. But the stigma of taking medication for a mental illness was always present in my mind. The elephant in the room when I was getting to know new people. What if they wanted to get closer? Would I have to disclose I took medication? Was it worth it to cultivate relationships if I were going to lose them? Or, should I stop taking the damn medication?

Over the next 15 years I ran through the alphabet of anti-depressant/anti-anxiety medications. Zoloft stopped working at low doses. Larger doses left me unable to sleep. It was on to Paxil, Wellbutrin, and finally Effexor. I constantly questioned my decision to take medication. During this time, I moved from Maryland to rural Ohio, I got married, had kids, got divorced, worked multiple jobs while attending school, and eventually enrolled in a PhD program. I promised myself I’d stop taking medication when life settled down.

My quest to live medicine free started in May of the last year I was getting my PhD. I always feel positive in springtime. Sunshine removes my spirits from winter’s chest of darkness. You should stop taking medication, an inner voice whispered. At first a dew-covered bud, the thought bloomed alongside my uplifted mood. I have to admit these thoughts were assisted by the confidence of nightly drinking. Soon it was all I could think about. I’m a man earning a PhD. I’d been through marriage, divorce, and poverty over the years and not cracked.

My life wasn’t perfect. It never would be. I had two kids with my ex-wife. She had custody. Worrying about them was my most ingrained behavior. But I should be able to handle things. I’m a good dad. I didn’t need medication to stay that way. The pills were a crutch. I’m strong. Medicine is for the weak. These thoughts cycled in my head for weeks.

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Unmedicated

I didn’t contact my doctor when my Effexor prescription ran out. I went cold turkey. I immediately found, to my surprise, my depression wasn’t as severe as it had been when I started taking medication. I also found out the medication had been masking crippling anxiety I’d developed.

I wasn’t a stranger to the nausea and dizziness that accompany the first 72 hours not taking Effexor. I’d missed doses more than a few times. Forgetting to take medication for a day or two was not unusual. I’d realize I’d missed a dose when my gums would start feeling numb near the end of the day. Not taking a dose for another few hours would lead to what I called the snaps in my head. Bright pops that brought me in and out of reality. Micro explosions of light going off behind my eyes. I imagined it was my synapses going nuts. I have a powerful imagination.

I figured I’d get over the brief withdrawal period and move on to whatever normal was. I powered through work keeping to my daily routine with manageable discomfort. Kind of. I laid my head on my desk quite a few times as the snaps passed over in waves.

A few nights into my new life as an unmedicated, unstigmatized member of society I woke from an unsettled sleep. My first thought: my finances are in ruins! I had gone to bed thinking about bills I had coming due. I would need to dig into my savings. This fact disturbed me. But by no means would I have no money.

My worry about finances had festered and grown while I slept. I felt it crushing me. Sitting on my chest. I inhaled and exhaled through my nose counting 10 second intervals. My brain wouldn’t stop. My body was exhausted. I looked at the clock. 2:15. More inhaling and exhaling. I fell back asleep.

I woke again at 3:15. I felt pricks of stinging pain throughout my brain and body. As if fire ants had been biting me in my sleep. I’d stood in a fire ant nest once as a teenager. My legs burned for days. The pain I currently felt wasn’t enough to distract from the panicked thoughts – I’m going to be poor. How will I survive? How will I pay child support? I’m going to go to jail. I inhaled and exhaled slowly.

I woke up hourly for the remainder of the night. My eyes popping open as intense fire-tingles raged throughout my body. Repeatedly falling back asleep while trying to assure myself dipping into my savings wouldn’t lead to my financial demise.

The next few nights unfolded in much the same way. I broke the cycle with a binge drinking session that left me passed out and then hung over the next day. The alcohol washed away my anxiety. My anxiety resurfaced as vomit in the light of day.

Still, I refused seeking more medicine. I was going to be normal. Not weak. This pain was temporary. Being strong and off medication would last forever. I knew I’d feel better once I had a few weeks under my belt.

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A Week Off Medication

I’m having a heart attack. This is it. I’m going to die. I was staring at a murder mystery show on Investigation Discovery. I’d stopped taking medication a week ago. Constant noise comforted me. Living alone, I craved hearing voices. I kept talk radio on, or the TV set to this channel constantly playing murder mysteries. My favorite. The show did not comfort me as I thought I was dying.

I’m having a heart attack. The thought grabbed my throat, choking me. I’d never felt powerless over my survival. I’d been feeling tight in my chest all day. Sure, I’d been lifting weights and doing pushups throughout the week. This tightness was coming from deeper than my muscles. Tightness that started to burn. This is what dying feels like. Battery acid surged up my esophagus.

Should I go to the hospital? I thought. No. Hospitals are the only thing I hate more than dying. I felt a surge of adrenaline as I imagined dying alone on my living room floor. It was still a better option than dying in a hospital room. Surrounded by the nauseating smell of sterilization and cleaners. Hospitals crystalized the concept of mortality. I stayed away at all costs.

The pain in my chest continued through the afternoon. I’d been invited to meet up with a group of friends for a sushi dinner to celebrate a birthday later that night. I wanted to live long enough for that. I’d go to the hospital if I still felt chest pain after dinner. 

I looked around the table at dinner. Everyone else seemed so happy. I’d been able to choke down a few edamame. I felt terrible. Maybe I should mention the fact that I was having chest pain. My jaw felt tight. My arm tingled. Classic heart attack symptoms. I knew this from WebMD and numerous medical-topic message boards I’d checked out to see what my symptoms meant. Unfortunately, I could make my symptoms match both a drop-dead heart attack, or a panic attack, depending on which outcome I thought it should be.

I didn’t bring up my troubles over dinner. Verbalizing a fear was often the final step off a cliff into a panic attack. I’d learned that from my previous experiences with milder anxiety. Expressing my fears made them real. Bottling them up kept my mind racing, too busy for full blown panic. I kept my mouth shut and avoided eye contact with my friends.

My chest still hurt after dinner. I didn’t go to the hospital. It must be something else. Surely a heart attack can’t last hours. I fell asleep convinced I’d never wake up. But I did, again and again. My chest still hurt a week later. I started referring to it as my week-long heart attack with my inner-voice. A week later it became my two-week heart attack.

I was unable to sleep for more than an hour straight during this time. I’d stopped worrying as much about my finances. I was dying of a heart attack! I worried I’d never wake up. I also found other things to worry about. This wasn’t hard for a divorcee with two kids. I stayed up worrying about their future if I were to die. About our future relationships if I were to live.

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Five Weeks Off Medication

It was 11 pm. I was dying. I stood in front of my bathroom mirror. I stared at my bare chest. I watched my chest muscles pulsing in rhythm with my heart. Was this normal? I’d never noticed before. Never had a reason to. I imagined my heart fluttering to a stop.

The joke was on me. You really can have a heart attack lasting an indefinite period of time. Four weeks to be specific. I knew this was the grand finale. Time to go to the hospital.

I called up the girl I’d been dating for a couple years while I walked to my front-door. I’d made her aware of my panic and that I’d stopped taking medication during the first week I’d stopped. She was concerned I wasn't doing well. She said I should take medication. I should look at it as part of who I am. I take antidepressants, like a diabetic might take insulin. She didn’t like who I was when I didn’t take medication

“I’m having a heart attack.”

I slid down to the floor with the phone at my ear.

“What? Are you OK?” she asked.

“I don’t know. I’m so confused.”

I laid down with my head on the ceramic-squares making up my front doorway. They felt cool. So refreshing. My mind stopped racing. I caught a whiff of lemon scented floor cleaner. A familiar scent. Not one I usually found pleasant. Tonight was different. The scent smothered me in comfort while the floor’s coolness eased my tension.

“I need to hear your voice.” I mumbled. “I’m so tired.”

I rolled my head to the side to distribute the coolness across my forehead. “Will you keep me company for a bit over the phone?”

I woke up at 3 am. The phone had fallen from my hand. The screen was lit. I was still on a call with my girlfriend. The timer stated 4 hours and 24 minutes had elapsed.

“Hello?” I asked into the phone.

Nothing. I hung up. I couldn’t believe she had been kind enough to keep the line open. I noticed my chest felt better as I slunk up the stairs to bed.

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My Last Day Off Medication

I made an appointment to see my doctor as soon as the office opened. I couldn’t handle what my life had become. I was falling apart in ways I didn’t know were possible. A constant feeling of having a heart attack. Fixating on small problems until I can’t see a way past them. I was used to overcoming adversity daily in my medicated life. I couldn’t face an uneventful day without a panic attack while unmedicated.

“It’s going to take a couple of weeks to really feel the effects.” my doctor said. He scrawled Effexor XR 150 across his prescription pad.

“I think I can handle it.” My body flooded with a sense of relief. I knew I’d feel better the next day. The placebo effect is strong with me.

I stayed at the pharmacy while they filled the prescription. I took the pill while downing a bottle of acai berry juice. Promotes heart health boasted the bottle’s label.

Just in case, I thought.

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Six Years Later

I’ve continued taking Effexor. I frequently think about stopping. I’ve expressed my concerns to my doctor each time I’ve had my prescription renewed. My doctor tells me not to worry. The medication is safe. I worry he doesn’t know what he’s talking about. I worry this was a big mistake I made at 18 and am paying for the rest of my life.

I’ve spent over 20 years on some type of anti-depressant/anti-anxiety medication with only the one month break. I’ve spent more years alive taking medicine than not. I wonder what the medication is doing to my mind. Will I have memory loss at an early age? I wonder what the medication is doing to my body. Am I poisoning my liver?

It’s been six years since my month-long heart attack. It’s been six years since I stopped taking medication for slightly over a month. I haven’t had any more everlasting heart attacks or phone calls lasting till 3 am. I haven’t fixated on a small problem like my finances until I become incapacitated. I haven’t had my body feel like fire ants had spent the night gnawing on me. I am functional. I love my job. I am remarried with another child. I am generally happy.

Anyone taking an antidepressant has been told it takes more than medication to properly treat a mental disorder. Counseling, behavior modification, meditation, and other self-help activities need incorporation into your life. However, I use medicine as my main line of defense against depression and panic attacks.

I understand the importance of going beyond medication to treat depression and anxiety. I know and occasionally practice many anti-anxiety techniques. Nothing I’ve committed to doing on a regular basis. Perhaps I’d try harder at these activities if medication wasn’t such an easy and accessible option for me. I feel good most days. I love many more aspects of my life than I don’t. The medication seems a fair price to pay.

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