Wednesday 14 May 2014

Seven Steps to Stability - Step 3: The Meds

MHAW 2014
The third blog outlining my Seven Steps to Stability focuses on medication.  Now, any regular readers of my blog may be surprised with this given my general viewpoint of medication for mental health issues.  As yesterday's blog suggested, I always favour therapy ahead of medication, unless it's a particularly severe circumstance.

There have been times in my life when I've been close to needing medication just to numb the pain there and then; but I've managed to keep rational enough to realise that, if nothing else, the effects on your physical health that medication may have may do nothing but exacerbate health anxiety.  Plus I don't like the general concept of relying on medication, if I'm honest, as below will convey.

But, I have been taking one form of medication for a long time now.  I used to be on them for a good couple of years between what must be about 2006-9 or something like that.  I then came off them, but not surprisingly, after the March 2011 panic attack from hell and the subsequent decline in my mental state, I went back on them again.  Beta blockers, as I understand it, are generally used for people who have had or are prone to heart attacks to control blood thickness and heart rate.  Writing this is difficult by the way; analysing the heart rate and talking about blood often makes me feel faint, so I'll move on and accept that if you want to know more, look it up...

But they are, according to my doctor, often taken by people with anxiety.  They are often taken, for example, just before someone who hates standing in front of an audience is about the deliver a presentation.  I was basically told to have one when I felt I needed one in addition to taking a regular one per day.  I never did this and instead stuck to a regular routine, for fear that there would be other unwanted side-effects that I may notice if I took one just before, for example, a presentation - back to health anxiety again. 

At the outset, I was on 50mg strength, which is quite a significant amount considering I hadn't had a heart attack.  When I went on these again in 2011, I knew what they were about.  However, I made a fundamental error.  I took my first one at lunchtime whilst at work (I have a thing that I should always take them just after I've eaten, even now) and I nearly collapsed within minutes of doing so.  The reason?  The over-analysis of the effects it was having on my blood and heart, which I had massively exaggerated and which made me feel... well, faint, as explained above.  This was the only time that I was ever driven home from work early as a result of my anxiety condition, and it's all because my brain was playing tricks on me.

My tactic was to switch to having them at home - a safer environment at the time - and after a main meal.  I suppose you could argue that this worked, because I never had the near-fainting experience again.

So I started back on the meds probably in April 2011 and now, over three years on, I am still on them, albeit with a reduced dose from 50mg to 12.5mg.  Yes, the lowest they produce is 25mg so here I go cutting them delicately in half with a tablet cutter. 

So two questions remain: 1) What effect have they had on me, and 2) Why don't I come off them now when I'm, in comparison to 2011, a million times better?

To answer 1).  I think they have helped.  One of my big preoccupations - a cross health anxiety and panic disorder thing - was with my heart rate.  I over analysed it way too much and, of course, in doing so the likelihood of a panic attack increased.  One of my other CBT techniques (see yesterday) which I've purposely saved until today is to NOT CHECK yourself and for me, particularly the heart rate.  I learnt that checking got me nowhere and in fact dramatically increased my anxiety (this would also go with checking other body parts too).  But of course, this took a long time to get right (I still slip back sometimes), but to score it on the same scale as yesterday, not checking would get:

Implementation: 7
Time: A long time
Success: 9

Very successful, then.  But the beta blockers did make this easier; they effectively prevented my heart from beating as fast in unnatural situations, which meant my preoccupation gradually eased anyway.  So overall in this respect it has helped over time.

Where I think they have been more of a hindrance is twofold; one, regarding health anxiety. The so-called small side-effects have been large for me, such is the nature of the condition.  The second, similarly, is around what it actually does to you - back to the original reason I nearly fainted again.  I remember when I first started taking them when I was still having frequent panic attacks; my body felt like it needed a panic attack and the beta blockers were stopping them from going full blown.  I count this is a negative at first, because this was a really screwed up feeling, which then triggered - again - my health anxiety and made the panic attack last longer, albeit slightly less severe.  It was an odd feeling and one I know other people have felt too.

But overall I would say it has had a positive effect in just calming me down a bit and making it so the 'not checking' technique described above became easier.

To answer 2), why am I still on them after over three years - and now probably something like seven years in total.  The real reason - fear of coming off them.  Worryingly, they are like a comfort blanket.  I'm not even convinced I'd notice the difference if I stopped taking them - 12.5mg is minimal after all - but I have in my mind that the psychology of not taking something will tip me over the edge.  I've always looked for excuses for not testing coming off them completely, like 'oh I've got a lot of work on at the moment,' and I fear that if I do it will unnecessarily raise my anxiety again.  Why come off them when they aren't doing me any harm (if they might be doing me harm, please don't tell me, otherwise my health anxiety will kick in again).

The doctor is happy to keep prescribing them and, although I don't for one minute claim that they are mental health experts, at the same time they can't be too concerned that it is having an effect on my physical health, otherwise they'd try and talk me off them - I'd hope at least. 

But this is another reason why I'm not keen on perhaps stronger 'mental health meds.'  One could argue that I have become reliant on beta blockers just to keep me ticking over, to keep the lid on any boiling over, metaphorically speaking.  I would not want to become equally as reliant on a mental health medication and the easiest thing to prevent that is not to take anything in the first place.

My message would be this.  Medication has its place, there's no doubt about that.  But seriously think about whether any medication is right for you, and if so, which medication is best.  It might help in the short-term, but could end up becoming a dangerous burden in the long term.

My next Step to Stability: Friends

Best wishes
Al

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