My psychiatrist did not want to give me any antidepressants because of the possibility that they could trigger a full manic episode. So far I have had only hypomanic episodes and only once came close to being manic. But once was enough. That episode sufficiently terrified me that I was willing to go along with my psych about not taking antidepressants.
However, after the last five weeks of depression I finally gave in and asked if I could be prescribed an antidepressant. After some arguing, in which I said that I cannot pull myself out of depression on my own and that I had never been able to do so in the last three years, my psychiatrist reluctantly agreed to give me a prescription.
The factors that tipped the decision were my ability to stabilise my hypomania (I can recognise the very early signs of hypomania and use non-drug methods to effectively control it) and the extraordinary speed with which I react to antimanic drugs (Tegretol takes effect in 30-40 minutes).
My psychiatrist figured that basically I would be able to detect the early warnings of an impending manic episode and be able to take drugs to stop it in its tracks, or at least slow it down enough that I would be able to get to a safe place or contact her. The prescription was not happily given – I was still asked if I wanted to take Prozac along with Haldol (haloperidol), a tranquilising agent. But I wanted to see the effect of Prozac on its own – it helps later on in trying to disentangle the effects of drug combinations – so I passed up on the Haldol for now. I agreed with my psychiatrist that we could add in Haldol later if I needed it.
Prozac is supposed to take effect in 3-10 days. However, with my usual drug sensitivity, the effect kicked in early, within two hours in fact. So how did it feel.
I felt light, as if the air was made of something thinner than air, or as if I had been wading through water all the time and now was walking on dry land or as if I had had weights on my hands and legs and had just taken them off.
Everything was easier to do. It was different from being hypomanic. When I am hypomanic I have lots of ideas on things to do and lots of energy to do it with. With the Prozac my energy didn’t increase and I didn’t have the urge to do everything. Rather, I carried on no different than before, but everything I wanted to do was possible. Basically what the brain told my body to do, my body did without resisting or being sluggish about it, as is typical in depression.
I felt light.
If I had to translate this into medical terms I would say that depression usually slowed down or inhibited my psychomotor functions and Prozac removed the inhibitions and let my body respond properly to my mind’s direction.
This was not a mental perception – the effect continued into the following morning 14 hours later. I got up in the morning and did all those things that I would usually not do (make the bed, wash dishes, shave) on a morning. It was so surprising that C. noticed the difference and told me that the Prozac was probably kicking in. And I could feel the difference. No so much that Prozac was adding energy or direction, but more that it was removing barriers. There really was no inhibition that is so common with trying to do basic things when I am depressed.
This feeling of normality was also qualitatively different from being on Tegretol. Tegretol brings me off my hypomania, makes me calmer and brings me down to something approaching normal. However Tegretol seems to create a link directly between what I am thinking and my actions – I think of something and I act on it. There is always the sensation that the Tegretol is sitting on my shoulder like a guardian angel and pointing me in the correct direction to do the correct things. It is wonderfully effective, but the it does get heavy having someone on your shoulder all the time.
The Prozac seems to dissolve my sluggishness. I can think better. With depression, I have a difficult time holding together complex ideas or schedules that have many pieces. With the Prozac, I can cope with these thoughts. More than that, manipulating ideas is not inhibited – I can look at an idea in different ways or think about how I want to reschedule the rest of the day without becoming stuck.
Prozac itself doesn’t make me feel happier, regardless of the hype. What I am though is delighted that I can actually function normally. Any happiness I get is the usual satisfaction of achieving things. However this compares dramatically to the frustration that depression causes when I can’t get things done. There is a world of a difference between the two.
The effect of the Prozac started wearing out after 20 hours. This is not supposed to happen. Blame either my peculiar metabolism or the fact that I may be on the very edge of a working dosage so that the daily dips in the Prozac level in my body drops me below an effective dose. Who knows? But I’m beginning to feel a bit as if I am sluggish again.
After a few weeks of slipping into mild depression but no mania, I am beginning to realise that Prozac has two effects. The first one is that it dampens my cycles – I don’t get as depressed as I used to do, but I don’t stop cycling. It means that the depressions are milder, which I find useful, but I don’t actually stop being depressed. The second thing is that it has stopped all of my manic symptoms. That is not supposed to happen with an antidepressant, but that is how it works with me. Go figure.
As a result I have increased my dosage to two 20 mg tablets, one in the morning and one in the afternoon. Of all the drug combinations this has worked best with me.
I’ve also been having mild headaches since I started taking Prozac. The headaches are very mild and can often be forgotten in daily activities, but they don’t seem to quite go away. The headaches are not a bad tradeoff for a productive day. And I could always take Advil or Tylenol if I wanted.
However, I have found out that if I let the Prozac wear off (it takes 24 – 36 hours with my 100 mg / day dosage), I get very bad headaches, and feel very very nauseous. It’s pretty bad and it is definitely something to avoid.
On a related issue, I have also found out why Eli Lily and Co., the maker of Prozac, has labelled each of the pills “Mon,” “Tue,” etc. I have found out that I don’t usually forget to check to take my tablets. What I forget is whether I have taken the tablet today or not. The times I don’t take my regular dosage usually happens because I thought I had taken them earlier in the day (obviously I don’t use those convenient labels). Recommendation – definitely take your tablets on the days that match the labels. You’ll save yourself some confusion and probably a nasty bout of headaches and nausea.
One person has written to say that they are forgetting a lot of things. This hasn’t been my experience, but I wonder if it could indicate that the Prozac is causing mild mania, and it’s attendant memory problems. It also fit in with the person’s feeling happy as well as their improved sex life.
My sinuses have also acted up slightly. Like the headaches, the effect is quite mild but noticeable. The result is that my sinuses seem to be draining more frequently resulting in the disconcerting sensation that I am having a nosebleed (no bleeding occurs at all), and that I am more stuffed up at night so I snore more – C. has complained. Ah well, nothing comes for free. I eventually checked with a doctor and was told that Prozac does tend to make your nose stuffy.
I also tend to have a dry mouth – or at least a medicinal taste in my mouth. It doesn’t really bother me since all of the medications leave a medicinal taste in my mouth and I’ve gotten used to them.
At the higher dosage (20 mg, twice a day), I have also noticed that my eyes tend to blur slightly for short periods of time, usually when I am changing focus from near to far objects (or vice versa). The effect doesn’t last for more than a few seconds and has no real impact except to scare me a little. I did get my eyes checked and was told that Prozac does cause blurred vision – however, as long as it isn’t much of a real nuisance I can ignore it.
Alcohol and Prozac react very badly. I almost inevitably get nauseous when I drink alcohol. The effect is inconsistent – sometimes all it takes is half a beer for me to feel sick and sometimes it may take two glasses of wine. However it seems that the emptier my stomach or the stronger the alcohol, the faster I feel nauseous. The nausea remains for at least two hours and I have decided that much as I like wine, I don’t like it enough to put up with feeling ill. I now drink mostly soda water.
I also tend to eat less when I am on Prozac. It’s actually reached the point where I have to think about eating – I hardly ever get hungry. I like it because it works great for getting rid of my excess pounds, but I worry that I might not be getting enough vitamins and minerals. The effect fades with time though.
I have been told that I toss and turn more in bed, but I don’t find that that translates into any difference in the quality of sleep for me. I have marginally more trouble getting to sleep, but that has translated to my taking about two minutes to fall asleep rather than thirty seconds, not any kind of problem at all. I also seem to awaken a bit more easily, but again it doesn’t seem to impose any problems.
Apparently, Prozac can also cause sleepless nights or wake you up very early, particularly if it is taken on evenings or nights. It hasn’t happened to me, but I have had that effect with other antidepressants. When this has happened, I have taken the tablets in the mornings or around 5-6 pm instead.
Since I have started on the Prozac, my body temperature seems to have risen slightly. At the very least my hands and feet are warmer than when I was depressed. This doesn’t seem to be an effect of the Prozac itself. C. and I have noticed that when I am hypomanic I seem to radiate more heat than when I am depressed (I’ve never read of this effect anywhere and I am trying to document it). But we both take my apparent warmth as a sign that the Prozac is making a difference.
The Prozac does seem to work but it does not work fully. As a result the net effect is that I still cycle, but my depression is milder and I spend less time overall depressed. Since the Prozac on the whole leaves me feeling better than I was before, then it’s a step in the right direction. Prozac does have side effects which may be problematic. I’ve decided to accept them, but for anyone, it would be a decision to balance whether the side effects are a good price to pay for how they are feeling and what they can now do.
Regardless, because of Prozac’s potential to trigger a manic episode, I will follow my psych’s advice and keep Tegretol (or any other antimanic drug such as Depakote or Lithium) on hand in case I go very manic.