My Other Half has been a mechanic and drag-racer for many years. When the race-car, below, is having a rare spot of bother, he doesn’t tiffle about with several things at once to try to effect a combi-solution, despite the well-meant ‘advice’ of less experienced onlookers.
No, he adjusts one thing, the chief thing he thinks may be causing the problem, then tests the car up the track, keeping all senses alert for any results. If the problem has been solved by adjusting that one thing, then there is no need to fiddle around with another several.
So when, after almost four years on the anti-depressant, Mirtazapine, I was feeling Very Much Worse instead of better - and people have suggested all kinds of possible remedies (‘try acupuncture’, ‘try jogging’) many of which I tried at the same time – my psychiatrist saw fit to suggest I come off it, I was more than willing to see what happened by simply removing that one thing from this particular bipolar’s equation. I thought perhaps a long journey along the road of Finding Out What’s Wrong might ensue and braced myself accordingly.
I’d been feeling very, very down and extremely irritable – not clinically depressed – for no identifiable reason, other than the weight gain I’d had since using them. But I had assumed that that was all Lithium’s fault. I knew from researching it that Lithium can have a tendency to cause weight gain, through lowering metabolism and increasing appetite, a double whammy, whilst being the most effective mood-stabiliser I’ve ever had. Weight-gain is not the most appealing side-effect when I live in a society, and I know I shouldn’t give a damn but I do, where the Biggest Single Crime a woman can commit is to… gain weight! Magazines, services, clubs and products make very handsome profits out of those who fall by the wayside, or, ahem, weigh-side.
But I certainly was not “fat and happy with myself” or brimming with serene self-esteem. Far from it. And I did tell/moan/whinge this to my doctor, psychiatrist, CPN and anyone who’d hear me, really. My inner self had nothing in common with this ever-expanding, outer self. I had never been 3.5 stones overweight in my life before, not even at the end of my second pregnancy. I was dieting away on a regular basis. Might lose 6lbs in one week (that was the Practically-Starving-Myself VLC “diet”) and then carry on to find no more weight loss at all. And starving, to boot.
I do not recommend regular swimming sessions (to up the exercise, as “they” were telling me) on a stomach that is gnawing away at itself. And in any case, once I’d gained over a stone, despite anything I did to try and prevent it, the very idea of exercising a body that has to use the last-occupant’s extra, infirm-person’s bannister to haul itself up the stairs, is anathema. An effortless walk would have been good progress.
Unsurprisingly, my sciatica – caused by carrying bags of gravel after watching too much Ground Force and then weighing my normal 9 stones – was much worse. Our bedroom was no sensual haven when the only scent wafting from me towards my OH was Deep Heat. Gaining a pound a month regularly for four years leads to extra expense. Twice a year, I would have to buy clothes in new, larger sizes until last month the last thing I bought for a special occasion was the safe but entirely unflattering bell-tent.
If all this had been caused by my recklessly eating on a weekly basis the kinds of fatty, beige food that groans on tables while Gillian McKeith reels in horror, I wouldn’t mind. But it hasn’t, I haven’t and I’ve spent much of the last three years – after the first stone – on a diet of some kind.
Of course, I am happy with myself as a person (me and my Inner Goddess, ha) but, when you are not the person you recognise in the mirror each day, the person you’ve never ever been nor want to be, your sciatica’s up, your clothes are black and baggy after a lifetime of bright, fitted numbers, your mahoosive, pregnancy-worthy hooters in their ill-fitting bras are sore and uncomfortable and it’s not the person you’ve known for many years, you can’t help but feel almost worse than you did before all this started.
I was already coming nicely to terms with the facial skin cancer op of last year, which initially left me looking as though someone had, finally, smashed me in the face with a baseball bat. It’s calmed down now and I don’t mind it and glasses hide it, a bit. But it’s become nigh on impossible to hide the fact I’ve turned into a combination of Giant Haystacks’ and Hagrid’s mothers. I have quite enough stigma, ignorance and discrimination to contend with here, without adding fat-slob weight prejudice into the mix.
And although, physically, everything ached and hurt, my emotions were mostly quite numb. I wasn’t laughing, hardly at all, which is very unlike me. I didn’t feel vital, connected, alive – as though a great barrier reef made it impossible for my emotions to engage in a normal way. I haven’t cried for, ooh now let me see, four years. Again, I thought it was the price I’d have to pay for being on Lithium, described to me as the “Rolls Royce” of mood stabilisers. But give me a Pontiac Firebird any time.
The psychiatric team came over; they were certain I shouldn’t come off Lithium and I agreed. OH and I know that all kinds of mood-swing mayhem could ensue and I didn’t want to tempt fate. Prior to Lithium, it was like a personal performance of Final Desination – that one with the broken rollercoaster caused by a single loose bolt or screw. That was my mood-swings.
The Psychiatrist then hit me with the new bombshell that they don’t tend to prescribe other antidepressants or antipsychotics or tranquilising meds on top of Lithium “these days”, if they could help it. If the mood-stabiliser, i.e. Lithium, is doing it’s job, they now believed that it should be left alone without medical company. Unless in an emergency, I gathered. Oh. I know psychiatry is a new and constantly developing branch of medicine but this was news to me, someone who keeps an eye on the latest news from Mind or Black Dog Tribe, Time To Change, Sane, Mental Health Research UK or MDF, The Bipolar Organisation.
Furthermore, he leaned forward with a smile to finally give me the shocker that not only did Lithium lower metabolism and increase appetite, as well as cause an unquenchable 24/7 thirst. So did Mirtazapine!
Considering my love for research and that I’d already researched Lithium, I never once thought to Google Mirtazapine or check it out in any way. Call myself a writer? Granted, when prescribed it by my former Shrink in South London, I wasn’t sleeping well. Then I was having suicidal thoughts over a long period so the dose was upped. So I probably wasn’t in much of a fit state to research anything and we were grateful for any help. It did help. But to be left on it for quite so long when “now we know differently” initially felt a bit much.
Mirtazapine being an anti-depressant, I was thinking it purely acted on that part of the brain that was defective in depressives and left it at that. Wrong. The Shrink said it acts on every part of the body, like any other drug, and affects metabolism (the thyroid? He pointed to his throat. Maybe hypothalamus?) and causes massively increased appetite.
Now we’re talking serious appetite, here. It’s the kind of appetite that would lead a girl to Greggs, buy eight donuts and eat the lot. Then tackle a bargain bucket from KFC and still be raiding the fridge later. That sort of appetite.
The Shrink said they even give it now to anorexics and elderly people who can’t gain weight! Well, cheers, I was thinking, a bit ungracefully I know because at least he’d finally identified why, as I told him “I’m not clinically depressed. I’m pissed off! I’m not the person I was! And it’s not my age!” When did they not hear me complaining about weight gain? Why did they decide to keep the secret from me for as long as possible? Maybe they’d only just found out themselves, I had to tell myself. Before I either hugged the Shrink, or ate him.
So I’m on Lithium that causes much bigger appetite but then a lower metabolism. Clearly, the only safe way is to binge-eat salad and I tried it. Let me tell you, salads, cabbage soup and ‘piles of veggies’ lose their appeal on the 237th day of the year. I speak as a non-vegetarian who wouldn’t mind a bit of bread or meat every now and again, that is.
And, as I learned that Mirtazapine does exactly the same thing in terms of affecting weight, I found to the tune of about a pound a month that I’ve been taking both - I was only too ready to agree with Shrink to come off the things.
That’s where I’m at now. Waiting for Mirtazapine to leave my system. It’ll be interesting for me/us to see any changes of benefit, especially in the appetite/weight-loss department. I wonder whether also I’ll see a return of my emotions, feelings, that feeling of properly engaging with the world and finding myself sharper of mind again. Hmm. Time for some research, I think.
But it comes to something that being listened to, understood, my views respected and responded to have had a positive effect on my mood and self-esteem, more than anything in the last four years. That’s apart from Lithium itself which, I agree, is quite the wonder drug for me. To be very down, and angry, like some sort of eternal, internal hornet, whilst on antidepressants (chiefly because of the horrendous weight gain they’d induced) was the biggest indicator I could have had that it was surely time to come off. Mirtazapine had done it’s job, thank you very much.
It’s all different strokes, naturally, and, just as one brand of spark-plug is top choice for my OH yet it’s another brand for another racer or mechanic, so mental health solutions and results are as different as there are patients. But that’s my story and I hope I’m feeling more like myself again very soon. I hope I recognise that woman when I find her.
Please comment, especially if you have any experience of Mirtazapine and/or weight gain and/or Mirtazapine-Lithium combo effects. I’d love to hear your experiences and views.