Side Effects – Do I want to know?

Magicians who work with hypnosis and suggestion will often say that some people are more susceptible than others. The same is true of the placebo effect and it’s antonym – the nocebo effect.

I first heard of nocebo through a youtube video, it started out by pretending to be about frequencies of noise, and stated that it would play a sound that was beyond human hearing but caused ear pain and headaches. As soon as the sound was played I covered my ears, such pain! My husband looked at me like I was mad. He felt nothing. He was incredibly smug moments later when the video announced there had been no sound. I was shocked, but I had felt it! How could I have had pain in my ears at that exact moment if there was no secret pain sound? The answer was simple, nocebo. The idea that by telling someone “this will hurt you” it will hurt them.

I was not surprised that I was susceptible to the nocebo and my husband was not. I am quite a gullible person generally whereas he is always the sceptic. When I’ve walked into work and someone has asked “Are you okay? You look a bit ill” I will quickly think “actually I don’t feel that good”, whereas moments before I would have said I was fine. My husband however is ever the contrarian, “you’ll like this film” almost always ends up with “this is rubbish”.

So armed with this new knowledge that I am susceptible to negative as well as positive suggestions I have taken to avoiding things that will negatively bias me. A major one is that I do not read the side effects leaflets when I get a new medication. How will I know if I am really having a side effect or just experiencing a nocebo? There is no way to know, so by avoiding reading about them I guarantee that anything I feel is real. It’s a weird feeling questioning your own reality and I try to avoid it wherever possible.

Recently though I had a genuine side effect. I have recently made a change from citalopram, my antidepressant since 2016, to mirtazapine as after 3 years I wasn’t getting much of an effect anymore so I made the long and stressful change over. This transition meant weaning off of one and onto the other across a couple of months. After a week of the full dose of mirtazapine I started having an insatiable hunger. This was around the time I posted about trying to lose weight, so at first I thought my cravings were a reaction to trying to eat less. However no matter how much I ate I was still ravenous. One day I literally ate until I was sick. It was awful!

When I went to the doctors for my fortnightly check in I mentioned that I was having issues with eating as I was worried I had developed an eating disorder (I have previously had issues with food as a teenager). The doctor was surprised and we talked about possible causes and then suddenly she said “AH HA! It’s the new drugs!”, it turns out the group of drugs that mirtazapine belongs to are known for causing ravenous hunger, particularly cravings for carbs (something I did not need help with as I am already a pasta addict).

This caused me to reflect, when I had approached the doctor about changing antidepressants, we had selected mirtazapine as it helps with sleep, and I had been having bouts of insomnia. Would I have gone with it if I had known this side effect though? Probably not. So should I have done more research into the options available and what potential pitfalls I might experience? I don’t know is the honest answer. As someone who is highly suggestable reading all the side effects would have meant I was looking out for them and potentially willing them into existence. However the trade off is I am now having to work around a very unhelpful side effect because I wasn’t educated in the risks.

Is ignorance bliss? Or does being armed with the facts alway help, even if, like me, you might end up experiencing a nocebo effect?

Make your senses happy

There are certain things that I always find comforting regardless of my mental state. They might conjure memories or just be inexplicably reassuring.

When having a panic attack they suggest focusing on one thing for each sense to bring you back. One thing you see, one you hear, one you smell, one you feel and one you taste.

Can the same use of senses lift us up when we are depressed?

Touch

For as long as even my parents can remember I have had a strong attachment to satin ribbons, the softer and silkier the better. Rubbing satin is very calming to me and as I child I collected anything I found that had that satin texture. I would suck my thumb and rub the “silky” to feel calm. I’ve long given up the thumb sucking, but even now I keep a few of the softest ribbons I collected in a draw. Just rubbing one between my thumb and forefinger gives me a feeling of peace.

Sound

The opening song to the little known film Cats Don’t Dance (it’s really hard to find but so worth seeing) is my go to “cheer up” sound. It’s an upbeat song and singing along to it always gives me a feeling that I can take on the world

Smell

This one was harder to think of, but the smell that comes to mind when I think of a happy feeling is hay. Specifically the warm hay smell of a guinea pig. We had many guinea pigs growing up, and although I was never as attached to them as some of our other pets, their warm hay smell is very comforting. Walking around a pet store, I always take a deep breath when I get to the rabbit/guinea pig area. That mix of hay, sawdust and animal just smells like happiness some how.

Sight

I’m doing these easiest to hardest and it’s a toss up between the final two. My initial answer was Bill Wurtz history of the entire world, I guess. A YouTube video that I have watched countless times to distract me, but I think that’s more the sing song nature of it (especially as I’m singing “the Cambrian explosion” to myself as I type) so I’m not going to count it as sight.

Instead I’m going to say two screen shots I’ve saved on my phone. I’ve had them years so I don’t know where they originate (sorry to original posters for not giving credit). They both cheer me up in different ways. The first gives me a feeling of inner strength, and the second just makes me smile.

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I highly recommend saving little things like these on your phone for when you need a little pick me up.

Taste

I have an unhealthy relationship with food so this takes the cake (sorry couldn’t resist) for being the toughest to think of. What food would I always be happy to eat? I love chocolate, but it doesn’t make me happy per se.

I actually took a few days to think about it and the constant in my life, the thing that can make me eat things I hate – is ketchup. Good old tomato sauce. So although a little bit of it won’t relax me, it does give me the power to do things I can’t otherwise. That knowledge makes me happy in a different way to the others, but it is happiness.

What makes your senses happy?

It’s actually been interesting to compare how I feel with others. I asked my husband about his 5 choices and he had different ways of thinking. His touch was a good hug, and his sound was my laugh. I realised that I hadn’t included people anywhere in mine!

So what are your 5 choices? Can you use them to lift you up when you are down?

Depression vs my other conditions

I’ve had mental health issues since I was a teenager, but have only been honest and open about them since my early 20s. I’m now in a place where I am happy to talk to anyone about my CFS and anxiety, but my depression slightly less so.

So why am I more ok with some mental health issues than others? I feel comfortable with my anxiety because it feels reasonable, everyone worries, I just do it more. It’s easy to explain and relate to. My CFS is less easy to explain or relate to, but it’s so much a part of my everyday that I’ve become comfortable with it. It’s a disability and it’s not going anywhere so I’ve accepted it to the point where I don’t think twice about talking about it.

My depression is different. It isn’t there everyday in the same way, it lurks in the background then strikes out of nowhere. I can’t explain it as well, because I don’t really get it myself. I’ve always been lucky to have a lot in life, I know depression doesn’t care about that – it’s the great equaliser, but I am always are of how unreasonable it seems.

Recently I had a big hit of depression, for two days I could only cry and wish it would all end. If that was my anxiety I could take action to reduce it. If it was my CFS I would do stretches or pace myself around it. For depression it was a frightening loss of control. I had to wait it out because I’m already on the max dose of antidepressants and the doctor just called it “a blip”.

I think, being a control freak, that’s why I feel uncomfortable about my depression. I have to ride it out, and no amount of positivity can drag me out of that cave. It’s the condition I deny with “no really I’m fine” because I don’t want to admit how much it frightens me.

Talking about it online is a lot easier than in real life when I was stood in the middle of work balling my eyes out for reasons I couldn’t explain. It’s not embarrassing when I’m unseen. I’m not ashamed of my issues in person either – but it really is awkward sometimes!

I’m not sure what my point is with this one, I guess I want you to know it’s ok. It’s not just you. Even if I seem like I’ve got it all together most of the time I have my struggles too. As a community we have each other and we understand each other.