MEMOIR: MEDS (UPDATED)
Clomipramine is an antidepressant medication, part of the tricyclic family of antidepressants. They are a family the way the Addams Family is a family.
I took Clomipramine for about 30 years. It kind of worked okay. It was the Uncle Fester of the tricyclics. You could imagine it with a lightbulb in its mouth, all lit up, but only sometimes. I was never happy with Clomipramine. It seemed to only work when it felt like it. My doctor thought it was good enough, and was always very loath to adjust it or change it. I was always asking him, please, please, change it, do something.
And then, in 2016, he did. Lesson: it pays to nag.
He put me in hospital. And so we set off on a grand adventure, trading function versus side-effects.
You want to be able to live your life, do your job, look after your family, maybe even enjoy yourself a bit, without finding yourself tangled up in a sticky web of nasty side-effects that make your life worse than the condition the meds are supposed to treat.
Last year, every time the doctors proposed a new medication for me (and there were many, many medications) there was a fact-sheet about it for me to inspect, and amongst all the facts and figures there was always a discussion of common, less-common, and rare side-effects that had cropped up during testing and trials, some of them guaranteed to be terrifying. So right away you’re thinking about trade-offs and compromises. You might get at least some of your life back, but at the cost of some other part of your life. Take your pick. And be aware that any given drug will only tend to work on about fifty percent of patients who receive it anyway.
Such as me and the great hope that was Zyban. Once I was installed in the hospital, the staff started reducing my Clomipramine dose, doing it over several days. This created some emotional turbulence with withdrawal symptoms, which they moderated with tranquilisers. Then it was time to start on the Zyban. The doctors had talked this up. It was new and exciting. It was an Italian supercar of a drug. Its biochemistry was amazing. It did so many clever and subtle things at once, it was like nothing else. I was going to love it. It sounded fantastic. And I was already feeling sufficiently unglued and stressed out, heading for a full depressive crash, that I would have tried anything if I believed it would help.
The night I had my last Clomipramine was a special occasion. I’d been on that stuff since about 1986. About the same time I was getting together with Michelle. I’d left university just the previous year. The Space Shuttle was still flying. I was in my twenties. I saw the last Clomipramine tablet in the little plastic cup, and wished I’d had my iPad with me so I could take a photo of that last tablet. It was lights out for a huge phase of my life. Every night for thirty years I’d swallowed ten of these little bastards, and while they’d done an okay job of moderating the worst of my depressive cycles, they had side-effects I wouldn’t wish on my worst enemies.
I started the Zyban, and within a couple of days felt pretty decent, even fine. I thought, this can’t be the new drug already, can it? Some drugs come on very quickly, I was told. So who knows? I thought, all chuffed.
That weekend I went to a writers’ group meeting at Edith Cowan University in Mount Lawley. Right away, as soon as I arrived, I felt brittle, antsy, irritated, aware of noises, some in particular. Every chair I sat on seemed made of broken glass and spikes. Wherever I sat it wasn’t quiet enough. There were people talking and eating, and wandering about the stacks. I kept having to change desks, trying to find a quiet spot, and I couldn’t believe there was this much noise in a library, especially a university library.
I ended up sitting in the lobby of the library, heaving with tears from the stress of a few people talking and eating and walking around. Michelle came and got me. Two dear friends stayed with me while I waited for her. On the way home I felt hollowed out, raw inside, undone and broken.
Back in hospital after weekend leave, feeling like a failure again, I saw my doctor, and told him about my experience. He concluded that the Zyban, far from kicking in early and being great, was in fact having no clinical effect whatever. I was not in that lucky fifty percent who felt the Italian supercar thrill of the fabulous drug.
But this meant that I had no effective defense against depression. For the first time since my breakdown when I was sixteen, I was alone and naked far out at sea—and going under.
People get concerned about taking medication for psychiatric conditions in a way they don’t get concerned about taking, for example, painkillers for a headache, or cold and flu tablets when they’re under the weather. I think they worry that the psychiatric medication is going to profoundly alter their personality, their sense of who they are. And to some extent, with some medications, that can happen.
I’ve never worried about that. I’ve always seen medication as a corrective to a distortion caused by the illness. As something like using corrective lenses to fix bad eyesight. Taking the right medication, for me, has enabled me to feel more like myself than less like myself. When the stuff works well, and since my time in hospital my new medication has worked extremely well, it feels even like I’ve been upgraded to a higher, better version of myself. I feel like I can think more clearly, more creatively, and certainly more productively, than I ever could before. I tend to think of my former medication regime as like a nasty, dirty, noisy diesel engine, spewing out soot, rattling and banging, compared with the silent, efficient molten salt solar tower I’m using now. It’s as transformative as that—at least for me.
But I remember the bad old days, most of my life, in fact, starting from my first diagnosis right up until I left hospital for the final time in 2016. All that time running under a crap diesel engine. When D20 discharged me in 1981 it was hard. The new existence. Eighteen years old, diagnosed as psychotic, on medication forever. Doomed.
I and every psychiatric patient I knew at the time walked around looking like we’d all just escaped from a car accident. We all looked stunned, shocked, confused, kind of angry and nervous. We were hesitant and shaky, and we all had dry mouths. The blunt instrument medications we were on then were no Italian supercars. They were East German Trabants by comparison, belching out foul exhaust and barely functional. We were, as a group, either really fat and sluggish and prone to shaky-handed, sad-eyed smoking, or nervy, edgy, jittery and thin to the point of emaciation, and also inclined to smoke. We could barely function, let alone embrace the artistic, creative life. It was all some of us could do to make a cup of tea.
Medication has improved greatly. The Italian supercar drugs work a treat for the people who respond to them. The non-medication treatments work well, too, for some patients. I tried the transcranial magnetic stimulation but I couldn’t tolerate it. You have to lie perfectly still, in one position, with your head just so, for an hour, every day for three weeks. There is also the noise it makes. Many patients are fine with it, but I, with my noise anxiety, could not stand it.
It took me a very long time, back during those Years of Hell, to get used to the idea of taking medication every day, and to take so much of it each day. When I was eighteen I was taking about ten or twelve different pills each night. They all did something important. But it was hard to remember to keep taking them. With other things, like a course of antibiotics, you’re lucky if you can remember to take all of those, and that’s only two weeks, but this was every night forever. It did my head in, that forever. That I would never be well, not properly. I would always, as I came to see it, walk with a limp that only I noticed, but which I always noticed.
What helped in the end was coming to see the illness as no different from something like diabetes. When I found out what diabetes patients go through day to day, and across their whole lives, it resonated with me, and helped me very much. I could see my own chronic illness in context with another chronic illness. It helped to diffuse some of what at the time was still a heavy and suffocating stigma surrounding anything to do with mental illness. Nobody talked about it, but some people, once in a great while, simply disappeared, or died “and police report there were no suspicious circumstances”. It took me a long time to understand this bit of code.
Another thing that caused me problems when it came to taking medication as a teenager was my dad, who was generally against medication for anything, and would wheel out the old chestnut, “pills for dills with aches and ills”, which was to say, only an idiot takes pills. The rest of us are too smart for that. And he would use that to justify not taking anything for himself, and that undermined my own efforts to keep at it.
The most serious problem I had, as a bipolar patient with psychiatric medication was this: when on a manic cycle you feel so ridiculously great, at least at first, for a while, maybe at least a few days to a week, is that it’s like your whole brain has gone somewhere nice on holiday and is lying by a pool sipping cocktails and wearing sunglasses. You feel crazy-good, and you’re obviously not remotely sick, can’t you tell? So why do I need to take these stupid pills?
When you feel so fantastically upbeat, so cheerful, full of mad energy, hardly needing to sleep or eat, the last thing you want to do is take pills. And yet that’s exactly when you need to take them. I have had the conversation with my mum where she tells me the fact I feel so fine only proves how sick I really am.
I went into the hospital to get off the Uncle Fester of the tricyclics, Clomipramine. My doctor and his team went through several different replacements, trying to find a new drug that would,work as well as Clomipramine, but which would bring with it a much less nasty side-effect profile. We tried all kinds of things—so many I don’t remember them all. I do remember the misery, the crying, the constantly dashed sense of hope.
In the end, after I had spent a total of five months across three separate hospitalisations, one of my doctors told me they were not only running out of ideas, but they were up against the question of whether they were starting to actively cause harm.
So they had one last suggestion. “We want to put you back on a tricyclic,” the doctor told me. Yes, the Addams Family of psychiatric drugs. I couldn’t believe it. When I spoke to my senior doctor, and expressed my concerns, he understood my frustration, but he explained that my problem was that I had “treatment-resistant major depression”, and that for such a serious condition you need a heavy-duty drug, a weapon, something proven. All the drugs I’d tried up to this point, all the modern Italian supercar drugs with their fancy biochemistry and low side-effect profiles, were simply not up to what I needed. I needed something like a Monster Truck.
And, as it happens, there are tricyclics and there are tricyclics. This new one was Nortriptyline, which you might think of as the “Gomez Addams” of the tricyclic family. It’s the “good” one, with the most benign side-effect profile.
It works terrifically well. But it is a typical psychiatric drug, and then some: it really wants you to gain weight. (I have more to say about this later in the book. But my doctor putting me on Nortriptyline has had enormous consequences, and changed my life.)
That aside, it’s working well. I feel fine, even better than fine. I’m functional without serious compromises. I’ve gone up a level. I’m no longer, as of eighteen months after leaving hospital, “in recovery”.
It’s all working, at least for now. I’m having to take a great many little tablets every day, including four different psychiatric medications altogether that do different things. But the main driver of “how I’m doing” from day to day is Gomez himself, the Nortriptyline. The difference in how I feel now from how I used to feel under the Clomipramine is stark. Like the difference between old black and white standard-definition TV and 4K UHD TV on a screen as big as your wall. The difference is breathtaking. Because I remember those Clomipramine days, years. It was like living in Cold War East Berlin. And it seemed normal.
Where do I live now, in my head, on these meds? I don’t honestly know. But the sun shines, the sky goes on forever, and the gum trees smell of lemon.