OCDetox Part II

So it's been a few weeks since my last entry, and I think most of the physical insanity of Paxil withdrawal is now behind me. Whew.

The bad news is, ALL of the mental and emotional insanity is front and center. I described it to my doctor like this: It's as though almost every era of my OCD has come back to me, in full force, and I experience each one at different points throughout the day. What's gone, for the most part, is the OCD of my childhood: the ritual counting, tapping, stepping into rooms a certain way, and a certain number of times, the obsessive thoughts about needing to inform my family somehow that it was MY thoughts that caused my great aunt to die...this is the era that appears to finally be gone. And thank god, because walking around with shit like that in my head as a first grader was nearly unbearable.

But present are the rest of the "eras of OCD" - and they're not much prettier. I'm writing this down today not because I want sympathy or pats on the back. I'm writing it down because maybe I can show this to the people in my life who have no way of understanding what the hell is wrong with me at any given moment, and who are almost forced to think, "you're being ridiculous." Of course I'm being ridiculous - OCD is possibly the most absurd mental illness there is. It defies logic 100% of the time, and without proper chemical intervention, even the most intelligent, sensitive human being is almost incapable of fighting back against his or her own brain. 

For example, I KNOW what I'm doing when I'm sobbing uncontrollably while drying my hair. I KNOW that I'm not literally the most disgusting human being to ever walk the face of the earth (and I know that it wouldn't matter even if I were). I KNOW what it is when I look at myself and think, "you are fooling the world when you dry your hair and put on makeup and turn yourself into a barely-presentable human being, and you should leave the house right now, as you are, so the world will know you are an ugly sham of a person." I know what this is...but without the brain chemistry tweak I spoke of in my last entry, I can't fight it.

"Can't" is a poor word, I know that. The last thing I want to do is come across as some asshole martyr. I know I have a wonderful life, and that there are people on this earth who truly suffer. It's Veterans' Day today, and I know those men and women have sacrificed in ways I cannot imagine. But OCD doesn't give a shit about any of that, and that's why I'm writing. I'm writing because regardless of how keenly aware I am that my "problems" are a speck of dust on the surface of the earth, there's something in my brain that won't allow me to balance what matters and what does not. 

I said there was a silver lining, a GOOD reason why I'm off the meds wagon right now. I'm going to have a baby. And I want nothing more than to start enjoying that feeling and that knowledge - I'm clinging to the idea that one morning I'm going to wake up and feel like a human being so that I can appreciate what's happening in this body I so love to loathe. But I'm not there yet.

I'm writing because I don't know how to make sense of this for some of the people in my life. I don't know how to convey the fact that in the morning, I'm sick because I'm pregnant, but also because I'm filled with dread over things I can't possibly explain; because I'm being revisited by anxieties I thought were "cured" long ago; because the OCD of my 20s is back in full, unstoppable force. I don't know how to convey the fact that in the evening, I'm nauseous not just for hormonal, pregnant reasons, but because the OCD of my 30s is strangling me; because I'm paralyzed by the deluge of thoughts that someone I love is going to die and I can't prevent it, or that something horrible is going to happen and I'll have no way of making it stop.

How do I possibly put all of this into terms that would make even a little sense to someone else? 

My doctor said that if she were smart, she'd write a book about pregnant women and OCD. I told her, you read all the time about pregnant women and depression...but there's very little out there about pregnant women with OCD who, almost 100% of the time, have no choice but to stop taking their trusty meds and ride out the storm. And storm is the wrong word. It's a fucking volcano, and it feels unstoppable. The anxiety is bad enough - but there's another layer of anxiety that comes from the inability to explain what in the holy hell is wrong with you. I don't just have crying jags because I've got extra hormones running around - I'll cry because the earth is being removed from under my feet and I don't know what the hell to do about it. How do I explain that to someone?

How do I explain that I'm not just being vain when I look at myself and wish I could break everything in a 10 foot radius (most especially the mirror)? It's not because I'm getting fat that I hate myself. It's because I AM THE MOST DISGUSTING THING TO EVER HAVE LIVED. Well, according to my brain at the current moment. Explaining that to someone is impossible. So I write.

My doctor has seen this many times, and although I don't wish this upon anyone, it's a relief to hear those words. She said, "I know it's not happening to me, so maybe it seems easy for me to say this but...we're GOING to get you through this." I believe her. I have to remind myself of this many times a day, but I do believe her. 

She also said something with which I could probably sum up everything I've just written: "The worst part of this is believing you've been cured of something, only to find that you have not, and that it's all right in front of your face again, worse than ever." She's very right. On top of the insane hormonal changes of the first 3 months of pregnancy, there's an enormous beast making things infinitely worse. My OCD was very well managed for a good 10 years - to the point where I felt, "I don't really have a problem with this anymore." But take the meds away, and add a pregnancy, and wow...I have a HUGE problem on my hands. That is a terrifying feeling, and it's devastating to come to terms with the fact that the OCD brain is one that's always going to need a little tweaking. It's humiliating to admit that I NEED that little pill every day, just as it's a relief to know there IS a little pill that helps so much.

I've lost my train of thought, but my hope is that I can print this out when I'm at a loss for words to explain myself...which is more often than I'd like at the moment. This will get better, and I'll be myself again eventually; I do know that, and it's what's propelling me forward when nothing else will do the trick.

OCDetox

When I decided to keep a semi-regular, semi-public journal that would (hopefully) force me to stay on top of my goals and stop being such a damn quitter, I had a certain type of quitting in mind - quitting exercise, music, ballet...all things I do, and should be doing, but which occasionally fall prey to my laziness.

This time I'm writing about something else entirely. For reasons I'll discuss in a future entry, I recently was forced - FORCED, I say! - to quit something. Some of you will instantly know the horror, and others will be blissfully unaware of the sheer wattage of suck, involved in what I'm about to describe: I had to quit taking Paxil.

Before we get into some details of the truly delightful process of paroxetine withdrawal, I'll back up...all the way to the mid-1970s. Functioning as a child with OCD was not an easy task. I was a very good kid - I have no problem acknowledging this, or stating it aloud. I don't think of that as any kind of personal achievement, or badge of awesomeness - it's a simple statement of fact. I was a good kid; I was kind and affectionate to everyone around me. But I was hiding something very dark, and it wasn't until I was about 11 years old, sitting in my grandparents' dining room and reading a magazine, that I was able to put a name to it. I was living with crippling obsessive-compulsive disorder, the kind you read about in textbooks.

There's a certain degree of humor to the OCD stories I've stockpiled from my youth, only because it's such a bizarre affliction that so often plays out in silly and ridiculous behaviors. I did all the weird shit you read about - counting things, checking them, retracing steps, touching and tapping things, clearing my throat a certain number of times - all in order to avoid persistent horrible thoughts. God only knows who decided this would be a fun disease to dole out to random embryos, but I was a lucky recipient, and boy was I in its clutches but good.

Without indulging in endless detail about my weird thoughts (the obsessions) and the batshit crazy maneuvers I'd engage in to combat them (the compulsions), I'll just say that this was something that plagued me mercilessly throughout my childhood, and well into my college years. And hiding it from the world was never easy. There's no way to re-enter a room 600 times while trying to have "only good thoughts" without someone noticing you're acting really fucking weird. But as anyone with OCD can tell you, you HAVE to do it...or very bad things will happen, and YOU will have caused them to happen.

When I was about 11 years old, I remember leafing through one of my grandmother's "women's" magazines, and one article in particular stopped me in my tracks and made my blood run cold. It was an article about obsessive-compulsive disorder, and it was simultaneously the most horrifying thing I'd ever read, and the source of the greatest relief I'd ever experienced. The good news was, there was a name for this insanity I'd been living with; the bad news was, I was fucking crazy.

I don't know why I didn't wave this article in the faces of every one of my family members and beg to be taken to a doctor immediately so that I could stop doing what I was doing to myself. Truly, I don't know (or remember) what stopped me from bringing this to anyone's attention and thereby, presumably, lifting the most gigantic burden I've ever carried from my shoulders. Maybe because it was so embarrassing, or maybe because I was afraid to acknowledge there could be something THAT wrong with me...? But I'm pretty certain I said nothing, and just filed away the knowledge that I wasn't completely alone in this, and that maybe there would eventually be a light at the end of the proverbial tunnel.

Most of my childhood and adolescence was SO happy - but I'm not sure I ever FULLY enjoyed a minute of it, because there was this horror bubbling under the surface at every moment. My weird, intrusive thoughts - almost always about bad things happening to people I loved - were ceaseless, and that wasn't even the bad part. The bad part was I was CERTAIN I was a horrible, evil person, and that those thoughts were my brain saying, "you WANT these things to happen - you should let your family know how evil you are so that they'll stop showering you with all this love." So my mostly-terrific growing up years were always clouded by this feeling of dread and awfulness that made it impossible for me to fully enjoy just EXISTING in the world. There was always something horrible that might happen - and if it did, it was most certainly my doing.

Disclaimer: I know we're getting a little personal here, and I'm okay with that, because I have about 13 followers on this blog. This stuff needs to get out of my system, and if you guys can take it, I can take it.

So although I was now armed with the realization that my weirdness had a name - and that there were PLENTY of other weirdos like me out there - the relief faded quickly, and I kept up my OCD ways until they morphed into other, more manageable forms of self-torture, eating disorders topping that list. Those years were nasty, but anorexia and bulimia seemed sane to me. I knew I wasn't healthy, but it never even occurred to me that all I had done was give the OCD a new face. 

Soon after that subsided, I thought I was totally fine...until the intrusive thoughts started to return with a vengeance. This time there was no ridiculous counting or tapping or "undoing" steps - but the self-destruction was just as palpable, and it all culminated in a doctor finally saying, "maybe we should try a low dose of something that will tweak the brain chemistry into place."

It took a few rounds with a few different prescriptions, and a few different doses, but once the Paxil kicked in, I'm almost certain a choir of angels chimed in. I resisted the idea of taking any kind of DRUG because come on - drugs are for crazy people. But the thing is, no they're not. Look around you on any given day, and you'll find any number of perfectly normal, functioning human beings who are taking some form of anti-anxiety or anti-depressant medication - sometimes for disorders much more severe than mine, and sometimes just for that little brain tweak, like the one I needed.

I think the shame was minimized for me by the fact that these awful symptoms and behaviors were something I'd been dealing with literally since about age 5. I knew I hadn't done something to force myself into a life of weirdness - there was brain chemistry involved here, something that was completely out of my control, and very easy to remedy. What a relief to realize there was a little quirk going on in my brain that was making this stuff happen, much like any other ailment that simply requires the right remedy.

For the following decade, up until a few weeks ago, I'd been taking a popular SSRI class drug called Paxil, which "corrects" the flow of serotonin in the brain and causes a person with OCD to, in layman's terms, cut the shit. It's always advised to continue therapy, or at least continue talking to someone when you're on any kind of medication - but at some point in the past several years, it became unnecessary. I was fine.

What the almighty "they" don't tell you about in much detail is what happens when you need to STOP taking this stuff. And I can see why. Anyone with a passing familiarity with Paxil - now the most notorious of the SSRI class drugs, particularly in terms of withdrawal - knows you need to taper off of it slowly. You DON'T just stop taking it. But there are instances in which tapering off slowly isn't really an option.

I naively thought the 2 days of blinding headaches and weird rushes of blood were going to be the bulk of it, and that once I endured that, I'd be in the clear. I have never been more wrong about anything in my life. A few weeks into the cold turkey detox, and I'm experiencing just about every symptom that ever lead to me taking this shit to begin with. Plus a host of physical side effects that would be enough all on their own. 

Some people say the symptoms of paroxetine withdrawal can mimic those of heroin withdrawal. AWESOME. That's exactly what I wanted to hear. I should clarify that I'd called my doctor's office the moment I realized I needed to get off the Paxil. However, they couldn't see me for several weeks. With conflicting doctors' advice, and based upon my own instinct, I felt I really had no choice but to do the ill-advised abrupt quit.

After the headaches, things were okay for a couple weeks...until the barrage of megasymptoms flooded in. Mercifully, my appointment was approaching. When it finally arrived, the NP asked me to remind her what dose I'd been taking when I suddenly quit taking the Paxil. Her facial expression and "phewwww" sound simply underscored the knowledge that I'd made things very, very difficult for myself, and that this was going to be an extremely long month or two.

She said something about a car going from 0 to 60 instantaneously, but I've formulated what I feel is a more accurate analogy. The instant switch from 60 mg of paroxetine to 0 seems more like the act of driving 60 mph in your car and hitting the brakes on a dime, with no warning, in the middle of a busy street. There's an almost 0% chance of avoiding serious and violent aftershocks if you try this. But here's where the analogy fails: if you pull this 60-to-zero shit in your car, you're going to get hit very hard, probably more than once, and so are the cars around you. Many other people are likely to get hurt. The brutality of the aftershocks will be severe...but they'll come quickly, and the mess will be available for viewing within a minute. Not so if you're doing this with a drug. You're going to feel violent ripples for what seems like an unbearable amount of time (even if it's not, really) and you will be the one to absorb all the shocks. Not other cars, not highway dividers. All you.

It's become necessary to remind myself that this is going to pass, as the doctor and every one of my friends has advised me. I have what I will wager are the greatest friends and family in the known universe, and there's never been a moment at which I've been any kind of "danger" to myself or anyone else. So I have all the necessary tools to ride this out. But it is not a ride I'd ever recommend to anyone. And it underscores the need for a little more research into SSRI medications and other drugs that, when used correctly, can be a genuine blessing. Over the past few years, Paxil has raised some questions, more so than its probably-safer counterparts. Perhaps this is something that warrants a little more attention than, say, the 759th boner pill on the market. 

I'll leave you with this: there's a silver lining to this long-winded story, and a method to my madness in deciding to discontinue this drug in the worst way possible - and I'll get to that part soon. If you're still reading by that time, then cheers - I thank you for sticking with me :)