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?

Self harm – it’s easier than you think

Usually I take the time to make a pretty heading for these posts, but this is an ugly topic and honestly I’ve sat on this post for a week building up the nerve to press publish.

Self harm is a difficult topic to discuss, even in the already awkward area of mental health. Someone who hasn’t ever cut themselves may wonder how anyone gets to that point, or judgemental people (like the first doctor I even confessed self harming to, 5 years into my destructive habit) may say that it “doesn’t count” unless you really go for it and leave scars.

The truth is it’s actually really easy to self harm. You might have done it yourself without realising.

Self harm doesn’t mean picking up a knife and cutting your body, it means hurting yourself. That might sound a bit obvious, but when you really stop to think about it there are a lot of ways to hurt yourself.

An example that comes to mind is a friend who had been through some traumatic life events and was struggling to process them, they carried a lot of (unjustified) guilt and so they drank. They regularly got black out drunk and ended up in dangerous situations. In short they caused themselves harm. They self harmed.

Now many people would not get to such an extreme point, but the truth is this:

Every time you do something that has a negative effect on yourself you are causing yourself harm.

Are you staying in a relationship that makes you miserable? Maybe you are doing that because you don’t really believe you deserve happiness?

Are you eating excessively or avoiding it as much as possible? That probably stems from negative emotions just the same as if you picked up a weapon and injured yourself.

Are you putting up with verbal abuse from someone in your life? Letting them use you as an emotional punching bag? By choosing to let that happen you are choosing to be in pain.

You might read some of those and think “I don’t have a choice but to put up with this or that” – well that is pretty much how people who physically hurt themselves feel. It is an addiction, a crutch or a reflex. It is really hard to not fall back into the habit when you are feeling worthless or angry or sad.

Last week for the first time in 10 years I fell off the wagon and self harmed, but honestly when I sat back and thought about it I’d been doing it for weeks. Eating junk food until I felt sick, avoiding things that make me happy, I’d been beating myself up in other ways long before I touched a blade.

Yet others treated this action much more seriously. I think we need to rethink that. Of course traditional self harm is serious, but that doesn’t mean other forms of it are less so. My GP and my local mental health service had been very dismissive of my distress up until that point, and I don’t think that teaches us a positive message. You can kill yourself with smoking or cholesterol after all.

I guess my take away from this is to consider the the choices you are making and the emotional reasoning for them. If you think you are making bad choices for yourself, talk to someone because it is just as serious as the big scary “self harm”.

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.

A bad week

You won’t be getting a full post this week, my catch up with scheduling posts coincided with a bad week.

However despite my focus on positivity and recovery I’m not going to shy away from owning up to the tough times, the times I don’t succeed. Because we all have them, and it is nothing to be ashamed of.

This week I’ve cried hysterically at work, at home while brushing my teeth, and at the doctors during two useless visits. I’ve had shooting pains, joint pains, migraines and just generally felt really rubbish.

The road to recovery is not smooth, there are potholes and wrong turns.

But I know not to let this week define me. One bad week doesn’t mean I should give up. Next week will surely be better, and the fact this was only a week rather than a month means I am miles ahead of where I was a year ago.

It’s okay to not be okay sometimes, it’s okay to find it all a bit much. Just don’t let that drown out all the good you’ve accomplished.