chemical imbalance and medications

Again with Harvard Medical School...

"Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It's believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different."

Public Med Health states... 

"The main aim of treatment with antidepressants is to relieve the symptoms of depression, such as feeling very sad and exhausted, and prevent them from coming back. The medications are designed to restore emotional balance and help people to get on with everyday life. They are also taken to relieve symptoms such as restlessness, anxiety, sleep problems and suicidal thoughts."

I take antidepressants. I have for over 20 years. I do NOT take the same medications that I started out on. It has taken all this time to find a combination that works for me. Some have worked for awhile, some not at all. But it is important to note, that medications are essential for some people. And not only taking medications, but taking the RIGHT medication at the RIGHT dose! Here's an example from my own life, recently. 

As most know, in early 2016 I was diagnosed with breast cancer. I dealt with it as best as I could. I was on medication. I believe it helped. Let me tell you, though... dealing with cancer for someone who already suffered from depression was a HUGE fight! That didn't include all the ways that the treatment makes you feel. Losing my breasts, not being able to do reconstructive surgery, losing my hair, going to chemo, the way the chemo makes you feel... It goes on... 

Well, my cancer was hormone initiated. Because of that, after all the "treatments" were done, my treatment was not done. I was told by my oncologist, that I would need to take medication for the next 10 years to prevent relapse. That I have to try to stop the hormones from attacking my body. I had to take these medications. Well, I was placed on a medication that you cannot take certain antidepressants with (Selective Serotonin Re-uptake Inhibitors aka SSRI's). I was taken two different types of antidepressants, Effexor 150mg and Wellbutrin 300mg. (I had also been on an antipsychotic during chemotherapy because it affected me so dramatically, but was able to stop that sometime after chemo stopped). Wellbutrin is a SSRI. If I continued to take the Wellbutrin, it would reduce the efficacy of the medication I would need to take to keep cancer away. Ok, I thought, so I stop the Wellbutrin. I contacted my doctor and went in to see her. We discussed this. She provided me a plan to wean off the Wellbutrin (don't EVER try to go cold turkey off a drug! it can be dangerous!) and to wean onto another 75mg of the Effexor. (for the record, Effexor, while an antidepressant, is NOT an SSRI) Sounds good, I thought. This will work! I'll be fine! I'll continue on my antidepressants and will take meds to fight cancer relapse and all will be well. I was wrong. 

For MANY years I had been on Wellbutrin. Of all the meds I have ever been on (and I have been on more than one antidepressant simultaneously for MANY years), when Wellbutrin was added to my treatment regimen, I improved and became more like the Sara that I knew from years ago. But I had cancer and to this point had beat it. I didn't want to relapse. This was important! I had to keep that fight going! I was increasing the other antidepressant and I knew it would all be fine. 

Looking back, I see the beginning of the decline. It was not fast, at all. It was slow. But it was a slow, constant slide. I blamed other things... it was still winter and I didn't have a job. I was sick. I started working again, and that was exhausting me. I had put on a lot of weight fighting cancer and was struggling getting it off. My blood sugars went crazy while fighting cancer and it was hard to get that under control. My dad was in a nursing home. The list went on... Regardless, the downward slide continued. 

I would talk to people, some could tell, some couldn't. Some people just thought I was tired. 

Life threw more at me... My dad was declining. He was told he would have to start dialysis. I knew my dad. He wouldn't want that. I spent some time talking to him about this and told him it was his choice and I would support him regardless. I told him, if he didn't want that, I would recommend hospice. After deliberating, Dad choose hospice. He wasn't on hospice for a month and he died. The nursing home called and said he was going (couldn't believe it! He was FINE the day before!) and we rushed over. Dad was gone. This was the last member of my nuclear family. Mom died in 1996. My baby brother died in 2012. Now, dad was gone. I am the literally the last of the Thomas's. My dad was an only child. My brother did not have any kids... It's me... of course, my kids have the Thomas in them, one child more than the other. But it's me. That was a heavy blow. There was a lot that surrounded his death, funeral and such that I won't go into here, but it was not an easy time. Those things have continued. 

I noticed a further decline in my mental health. However, was that unexpected? I just lost my dad. But unlike when I lost my mom, grandma and brother, this was different. Maybe it was just because this death was different... I kept on. 

Then, one month to the day after dad died, my dog died. That was it. She was 13 and as healthy as a 13 year old dog could be. She went to the basement one day, laid down and died. She knew. She NEVER had gone to the basement in her entire life. 

To say my heart was broke is an understatement. I considered calling off from work. My heart hurt so bad. Actually hurt. The pain was so much. I told Brad that night that I was done. I was just done. I didn't want any more of anything. Life was too much and I didn't want any of it anymore. I wasn't sure what that meant, but my heart was too hurt to go on. 

It was all going to be ok, I was sure... I went to my doctor and got started on anxiety medication now (in addition to the antidepressants). We were going on vacation in a couple weeks. Going to the ocean. My favorite place. Warmth. Sunshine. Water. We got to the ocean and it was rainy. Eh... ok... the next day, we got to the beach, a thunderstorm came. The next day, more rain. The next day, more rain. It would quit raining in the evening. That's lovely. But no sunshine or warmth. Put 7 people in a condo, ages from 3 - 52. Not fun. Especially when one is pretty badly depressed, one doesn't do well with children, 2 do not have kids, 2 ARE the kids and one that just isn't sure what he wants. It became too much. Too much. The trip that I thought was going to help heal me, cause my decline to accelerate. I became dead inside. 

What is it like to be dead inside? You don't care. You don't WANT to care. The moments when you DO care are so incredibly painful. So painful that your heart hurts and to try to discuss it just causes tears to flow. No, not "cry", just have tears sliding down your face. I was not even surviving. I'm not sure I was existing, except to say that I still got up everyday and I went to work and did what I HAD to do. I ate. Too much. I slept. Too much. I hurt, ALL THE TIME! I truly didn't care what happened. You could have given me a million dollars and it wouldn't have mattered. I was dead. More dead than I have ever been. I went to open house with my grandson and somehow his name was left off the class list. I went to the office to figure it out and I stood there and cried like an idiot. If I went somewhere and things were not how they were supposed to be, I cried. and not like sobbing boo hooing. Just tears. 

I had labs drawn at my oncologist's office. When I checked out that day, I was told when my next appointment was. For some reason, they had two appointments for me on the books and THEY decided that these were duplicate appointments and THEY chose which one to cancel. That is not acceptable no matter what. I explained I could not do the appointment that THEY chose I should have, I could only do the one that THEY chose to cancel. They were rude with me and finally agreed to get me in on the day that I wanted, but they had to double book me and they were not polite about it. Tears, tears and more tears. 

The next week at my oncology appointment, I had told Brad he would have to do the talking because I couldn't. I wouldn't be able to speak. Things became too much. I started to speak. But it was quiet speech. It was difficult speech. This was because of the tears. Brad asked if I could change the medication I was on to prevent cancer relapse so that I could go back on Wellbutrin. We had discussed this at home and both felt that it was critical to my health that I go back on the Wellbutrin. My oncologist strongly did not want to change my medication. He spoke to us and said I needed to be on that med for at least 2 years. I said I HAVE to go back on Wellbutrin. He was at a loss. (throw in there, that during my exam, he was interrupted MULTIPLE times by a staff member that just needed his signature on things). He said that there was some research that stated I could be on the med I was on and Wellbutrin at the same time. He asked why I stopped the Wellbutrin. I told him, he told me I had to. That it would reduce the efficacy of the cancer med. He said, I really needed to stay on the cancer med, it was too soon to change, but I could do the cancer med along with the Wellbutrin. There were some studies that show you can do it. He told me I just needed therapy. He said if I switched medications, that the other medication put me at high risk for osteoporosis and bone fracture. I told him I didn't care. The medication I was already on, put me at high risk for blood clots and cause me to retain water. This all led to me having to wear compression socks every day and take lasix! I said I don't care about the bone loss. I NEED TO BE ON WELLBUTRIN!!  He gave in and changed me medication. I went to my doctor and asked to be placed back on Wellbutrin. 

Simultaneously, I went off of one cancer med and onto another and weaned back onto Wellbutrin. After a couple weeks, I started to feel again. 

I started coming back. It was like I had been encased in something and layers were being removed. Bit by bit, layers were being removed. As I could start to think again and become involved in life I started making decisions. I called and scheduled an appointment with another oncologist. Not one in the same practice. One at a different practice, at The Ohio State University, The James. 

I went to the new oncologist. I told her about switching cancer meds and that I didn't care if every bone in my body was broken, I was NOT going back off the Wellbutrin. She updated me on a couple things. One reason I thought I could switch meds, is that lab work showed I was post menopausal and the new cancer med I was on was for post menopausal women. She informed me that the previous medication can cause false results on that blood work. I needed to be off that medication for at least a month to get a true reading. She would see me in 3 months and do labs and we would discuss. 

More time has passed since that visit with my initial oncologist in September and starting back on the Wellbutrin in September. What have I learned? While science cannot prove the chemical imbalance alone causes depression, it CAN prove that it contributes to it. Knowing this and learning from my experience, I believe there is DEFINITELY something neurological going on with me! I need a SSRI antidepressant and in particular, I benefit BEST from Wellbutrin! 

Since September, I have seen such a change in myself. Yes, I did go to therapy for a short time to deal with cancer (following that oncology appointment). But I feel the biggest change started when I went back on my previous medication. Brad has said he has seen a glow return to me that he hasn't seen since cancer joined my life. I notice some of my sarcasm has returned. (I am who I am). I also notice that while things bother me, I also participate in happiness again. I am no longer dead inside. I am alive. I am here. 

For the record... I have had labs again and while I am on the border of being post menopausal, I am not quite there yet. Therefore, the cancer med I was on is not effective. The one I was on before would be. But, the nurse at my NEW oncologist's office told me, it will all be discussed. Apparently, I could be on the cancer med that I changed to but will need something additional to make it work, another pill or a shot... But they know I don't want to go back to the first med and I don't want to go off Wellbutrin. If I have to choose, I want QUALITY of life, not QUANTITY. If the risk of relapse is too high without the cancer meds and it means no Wellbutrin. I'll take the risk. I need my SSRI. I can't go down that decline again.