In my previous post of May 10, I shared how I used mindfulness meditation to cope with suicidal pain. Now I would like to expand that blog and share other coping strategies I used to keep myself safe.
My journey into the dark night of the soul was launched by an adverse reaction to the antidepressant Effexor. Taking this medication triggered a maddening condition called Akathisia–a syndrome characterized by inner restlessness and agitation. (In ancient Greek the word means “the inability to sit still.”) Within hours of injesting the drug, I felt as if someone had injected me with six intravenous cups of expresso. My body was possessed by a chaotic force which led to me shaking, twitching and pacing back and forth across the room.
What made my predicament situation even worse was that my experience was discounted by the psychiatric community. One psychiatrist after another insisted that taking 37.5 mg of Effexor could not have created this level of distress. They were wrong. In July of 2009, the Journal of Psychopharmacology reported that Prozac and other SSRI medications can in fact induce Akathisia, along with feelings of suicidality.
Over the next few days and weeks, the Akathisia anxiety attacks increased in their intensity, and were followed by periods of dark, “black-tar” depression. As the Akathisia-depression cycle progressed, I remembered Nietzsche’s words: “The thought of suicide is a great consolation; by means of it one gets through many a bad night.” Realizing that I could always terminate my life when the agony became intolerable granted me a sense of peace and relief. Ending the nightmare was the better than living in the eternal hell of an agitated depression.
I knew I was serious about killing myself when I drew up a will, named my brother the executor, and sent copies to him and a good friend. I wanted to put my financial house in order before I died. Having taken care of my remaining fiscal responsibilities, I spent countless hours deliberating on the most efficient way to terminate my existence. My first choice was to use a gun, because it seemed so quick and final. Then a crisis counselor told me about a man who suffered irreparable brain damage when he shot himself in the head. “I wouldn’t try it,” the counselor warned. “You might end up a vegetable.”
My next plan was to jump off a building. But after picturing myself walking to the ledge and looking down, I remembered that I was afraid of heights. Also, a friend had asked me an unsettling question—“What if, halfway to the ground, you change your mind?”
Finally, I resolved to take an overdose of the antidepressants and tranquilizers that I had saved up over the past few months. This also frightened me, since I didn’t really want to die. (In his book, Why People Die By Suicide,” Dr. Thomas Joiner says that those who kill themselves develop a certain “fearlessness” about death. This was definitely not me.)
Moreover, I was concerned about the people I would leave behind. I knew that if I killed myself, my friends and family would not only be grief-stricken, but angry and guilty as well. “Why should I drag all of these people into my nightmare?” I thought.
My concerns about the impact of my death on others were shared by a fellow depressive.
“Don’t do it!” Dennis cried emphatically, when I told him of my plans.
“Why not?”
“My brother offed himself twenty-five years ago and I still haven’t forgiven the bastard. Don’t make your friends and relatives go through what I did.”
Later that day, I reported this conversation to my therapist Pat.
“Do you have any moral beliefs that suicide is wrong?” she asked.
“No,” I replied. “I don’t believe it is a sin to commit suicide. I can’t see why a loving and merciful God would punish someone for wanting to end his suffering.”
“I’m sorry to hear you say that,” Pat responded solemnly.
“Why?”
“Studies have shown that people who lack a moral or religious belief that suicide is wrong are more likely to act on the impulse.”
Pat’s analysis was true. Without a clear moral reason not to kill myself, my resolve to avoid suicide was only as good as the kind of day I was having. When graced with five or six hours without symptoms, I would think, “Maybe I’m in remission,” and hope for the best. Too often, however, the respite would give way to a downturn in mood or a return of anxiety, which brought with it an inner voice of doom that said, “Madness or suicide, it’s yours to decide.” My choices seemed clear—either spend the rest of my life in hell (I believed I would live out my days in a state mental hospital), or put an end to the pain. Both outcomes were unacceptable, but I could not imagine a third alternative. In my anguish I cried out, “God! Show me another way—or at least give me some hope that another way is possible.”
Meeting a Guardian Angel
Aside from my therapist, there were few people with whom I could discuss my suicidal struggle. Suicide is a taboo subject in our culture. Even good friends would flee from my presence if I brought the subject up. Only those people who were specifically trained to treat major depression, or who had “been there and back,” could deal with my extreme condition.
One such person was a social worker named Judy. Having attempted suicide herself, she knew firsthand what goes on in the mind of a suicidal individual. Judy saw her clients, many of whom were in severe crisis, out of her small Victorian home, nestled in the Columbia River Gorge, twenty-five miles east of Portland. At our first meeting, she got right to the heart of the matter.
“Suicide is not chosen,” Judy said emphatically. “It comes when emotional pain exceeds the resources for coping with the pain.”
While speaking, Judy showed me a picture of scales to illustrate her point.
“You are not a bad or weak person,” she continued. “Neither do you want to die; you just want to end your suffering.”
I nodded in agreement.
“Your problem is that the scales are weighed down on the side of the pain. To get the scales back in balance, you can do one of two things: discover a way to reduce your pain, or find a way to increase your coping resources.”
I explained that reducing the pain seemed impossible.
“Then let me give you a coping resource,” Judy said, as she handed me a pamphlet titled “How to Cope with Suicidal Thoughts and Feelings.” I read it briefly and felt a mild sense of hope.
“One more thing,” Judy added. “I know you think that killing yourself will end your pain. But according to what I’ve read, consciousness continues even after death. Some people even believe that we reincarnate and return to earth in order to work out issues that we didn’t resolve in this life. If you decide to take an “incomplete” in the school of life, you may have to return and take the class all over again. Perhaps there is no easy escape.”
“What other option are you suggesting?”
“Stick around until you get better.”
“Beating Michael Jordan in a one-on-one basketball game would be more likely.”
“Crises, including suicidal ones, are time-limited,” Judy countered. “Eventually, something’s got to give. You will be around to experience the next chapter of your life, provided you don’t kill yourself,.”
“That’s easy for you to say, but you’re not in this hell. My intuition is telling me that I’m stuck here forever.”
“Cognitively, you cannot help but think ‘I am permanently frozen in horrible pain.’ This is what depression is—a failure of the imagination. The chemical imbalance in your brain is preventing you from envisioning a positive future. Nevertheless, I want you to at least make room for the possibility that some unexpected good might grace your life.”
Sensing that I was stuck in unbelief, Judy leaned back in her chair and recounted the following parable.
According to an ancient tale, a Sufi village was attacked and captured by a group of warriors. The king of the victorious tribe told the vanquished that unless they fulfilled his wish, the entire village would be put to death the following morning. The King’s wish was to know the secret of what would make him happy when he was sad, and sad when he was happy.
The village people constructed a large bonfire, and all night long their wise men and women strove to answer the riddle: what could make a person happy when he is sad, and sad when he is happy? Finally, sunrise dawned and the king entered the village. Approaching the wise ones, he asked, “Have you fulfilled my request?” “Yes!” they replied. The king was delighted. “Well, show me your gift.” One of the men reached into a pouch and presented the King with a gold ring. The king was perplexed. “I have no need of more gold,” he exclaimed. “How can this ring make me happy when I am sad, and sad when I am happy?” The king looked again, and this time he noticed that the ring bore an inscription. It read, This, Too, Shall Pass.
“It is an immutable law of the cosmos,” Judy continued, “that the only constant in the universe is change. Haven’t things happened to you that you never would have predicted?”
I nodded my head as I recalled the many experiences, both good and bad, that life had unexpectedly brought me.
“Since you cannot know your future with absolute certainty, allow for the possibility that a healing may be waiting for you around the corner. Pat tells me that you have already created a survival plan for yourself.”
“I use it to get through each day.”
“Good. Then stick with your strategy. Instead of fretting about the future, simply create the support that you need to stay alive, one day at a time. Please repeat this statement: “I am creating the support that I need to stay alive, one day at a time.”
“I am creating the support that I need to stay alive, one day at a time,” I said meekly.
“Good! Now I want you to repeat this statement every day. It doesn’t matter whether you believe it; keep saying it anyway. I know that you are going to live.”
In addition to her counsel, Judy gave me her phone number as well as the number of the National Suicide Prevention Lifeline (1-888-SUICIDE) and said that I must call anytime I was in danger of harming myself. She also gave me a number of Internet sites on suicide prevention that l now list on my website.
Judy came to me in my darkest hour and presented a vision of healing to me that I could not see for myself. She believed for me what I could not believe for myself. Although her faith in my restoration did not remove my physical and psychological pain, it did give me a reason to hang on. And hang on I did, until one day the miracle I had been hoping for occurred.
The circumstances of Douglas’s recovery from this depressive episode can be found in a previous Mad in America blog dated March 5, 2013–“My Story of Recovery: Prayer, Community and Healing.” More information about Douglas’s approach to alleviating suicidal pain can be found at http://www.healingfromdepression.com/suicidal.htm
My sympathies to you, Douglas, and thank you for hanging on…
“What made the situation even worse was that my experience was discounted by the psychiatric community. One psychiatrist after another insisted that taking 37.5 mg of Effexor could not have created this level of distress. They were wrong.”
The “psychiatric community” is witless to their own interests when they make these routine denials that psychiatric medications may induce unforeseen adverse reactions…
They will maintain with great stridency that these medications NEVER produce adverse drug reactions. NEVER, in practice, despite the “Precautions” provided? Akathisia, rage, suicidality, delusional syndromes, nah, “it’s all in your head!”
So… we might as well just dispense them in vending machines, right? Why not! Just such a proposal has been made!
Congratulations, you psychiatrists who have rooted your raison d’etre in biological psychiatry… by taking this attitude that psych meds are all “safe and effective until proven otherwise in clinical studies”, you have rendered yourselves entirely redundant.
sincerely,
– bonzie anne
– http://gravatar.com/bonzeblayk
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Douglas,
Glad you were able to find a ‘guardian angel’ who could help during a dark hour. And glad you’re still here. I believe in ‘guardian angels’ – in human form and in spirit.
My best,
Duane
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Great post Douglas, I think your right on the money, using meditation to ground your chaotic thoughts and feel your inner nature. An instinctual nature which certainly does feel like possesion when we are confused by tales of myth & legend, which project our own nature onto external reality.
Having faced that same internal compulsion to escape so many times, I now understand the impulse as a need to escape the trauma conditioning within my nervous system, and I sooth the impulse and its stimulated chaotic thoughts, with a more mind-less meditation, which grounds my mind within its creator, my body. Please consider my experience with suiciality and the impulse to escape a trauma conditioned trap;
I’d been thinking about using a rope, when the aftermath scene of who would find my body came to mind.
“Would it be the Princess or the cleaning lady?”
“I can’t do it here!” I told myself. Then I started thinking about doing it somewhere I couldn’t be identified, no documents found with the body. I thought about taking a trip up country, to the other end of Thailand, thinking if I found a rural area with limited police resources, maybe they’d just cremate the body and forget about it?
“Be better for the Princess and my boys back in Australia,” I thought, “I’d just be missing.”
“Jesus! I haven’t thought about suicide for at least four years!” Burst into awareness.
“What the hell has triggered this?”
“Your depressed!” Another inner voice advised.
The flight of thoughts went on for at least ten minutes I’d say, until a sudden sensation of fatigue deepened my breathe.
“Soften,” I said to myself, triggering a practiced shift into feeling for tensions around my heart. It broke the thought bubble state long enough to bring a more balanced mind/body awareness.
Sure enough there was a shit load of anger in my jaw, and I felt my lips pressed together with my tongue pushing against the back of my teeth. “Unspeakable anger,” came to mind and I whispered “soften,” out loud, falling into another wave of body fatigue.
It was enough to trigger the “whole body” sensation that I’ve been practicing in my efforts to re-adjust a lifetime tendency for dissociated mind space awareness, over and above awareness of sensations within my body. For a couple of minutes I did the deep breathe exercise which brings oxygen into my blood stream and the enhanced body awareness so lacking throughout my life. The added oxygenation of my blood and the rise in body sensation, stimulated a rate and temperature change of blood flowing through my brain, and a state shift in mind space awareness.
“Let go,” is the last thing I remember of conscious awareness before slipping into whatever proceeds REM state dreaming.
Read more here: http://bipolarbatesy.blogspot.com.au/2011/08/bipolar-disorder-suicide-ideation.html
More recently too, there was an old familiar impulse to escape, as bad news triggered body memories, in that strange unconscious way that the body keeps the score of real-life experience. As one of worlds leading experts on truma writes: http://www.traumacenter.org/products/pdf_files/Networker.pdf “The Body keeps the Score.”
Please consider;
Bipolar Dis-Ease – Its Trauma Reenactment Urges?
An overwhelming urge is seizing control of my limbs as I walk along the pavement. A large bus is rushing towards me, securing its passage through time just a few centimetres to my left side. I can’t believe how strong the physical urge is to step off the pavement and into its path.
In a by now well practiced mindful observation of inner sensations, I let the urge and the moment pass, yet can’t really comprehend the reason. For the life of me I can’t rationalize this apparent desire for death, this involuntary urge, with an everyday psychological explanation. I’m shocked anew, at the very nature of my own subconscious motivations, and just how powerful they can be.
All the learning, all my recently acquired knowledge about the subconscious stimulation involved in what’s happening to me right now, afford me no conscious control, in terms of prevention that is, with this reenactment of an original trauma. As I continue to drag myself along, feeling all the old familiar sensations of a depressive reaction, I can only take the opportunity to mindfully observe these overwhelmingly negative sensations. The weakness in my legs as I try to walk, a living example of the “freeze” reaction and a urgent desire for collapse.
“Did I set myself up for this,” I wonder as I continue along, rehashing the phone conversation and its “shock” affect. Only thirty minutes previously I’d received news that a job application I’d been 95% certain of succeeding in, had gone to another. I’d gone numb with shock as the affable human resources person went through all the appropriate responses, while delivering his bad news. For a good twenty minutes my reaction continued in shock mode as I stayed within my thinking mind, disbelieving of reality as I tried to fend of awareness of its implications. “I’m trapped in poverty now, my stupid desire to understand stuff nobody wants to know about anyway, will be the ruin of me,” I tell myself as the noise of the passing bus recedes.
I try to catch the double-bind though, aware that the thoughts are an avoidance of a felt-sense of what’s actually happening to me. I steal myself to really feel these sensations, as bad as they are, and not think. There’s an instant of sensation awareness that shocks me to the core, a violent collapse, a fall, falling straight down through the pavement in darkened despair, “or is it disappear?” I feel it in the pit of my stomach and my legs have gone to jelly as I struggle to stay with sensation awareness and not think. It happens in flash now, a confusing, crushing, drowning sensation that is instantly gone. Displaced by the automatic urge of my mind, in nature’s kind dissociation trick of “what was that?”
“A body memory?” Springs to mind triggering a stream of thoughts about my birth, “how did I survive it, those three days waiting for birth, is that the great mammalian trick of feigning death, was that the urge toward the bus, or was that the undirected fight/flight urge of trauma exit energy.” Yet I know from experience that there is no point in a reasoned analysis right now. Know too, that there will be days of this depressive reaction to come, as the energies of traumatic reenactment wash through my nervous systems. Know too, that there will come a time for calm reflection and the positive processing of such a seemingly negative experience. Know too, that I wont be crippled with months of depression and a dreadful sense of hopelessness and helplessness, now that I’m not as ignorant of my internal makeup, as I once was. Neither am I as afraid of my sensation experience as I once was, nor desirous of staying with the denial inherent in my cognitive capacities, even if I do think I’m fairly intelligent.
http://www.bipolarbatesy.blogspot.com.au/2013/02/bipolar-dis-ease-its-trauma-reenactment.html
As Judy said “Suicide is not chosen,” Judy said emphatically. “It comes when emotional pain exceeds the resources for coping with the pain.”
And our unconscious nervous system reactivity of freeze/flight/fight, does its instinctual thing. Although I understand how some people may view such talk of our evolved nature, as an insult to a supernatural father figure. Perhaps, its time to consider how we project our own nature with a super-natural immagination, and begin to wind back centuries of religious superstition?
Best wishes to all,
David Bates.
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I’m glad you stuck around.
If you were having the akathisia side effect from Effexor why didn’t you stop taking it?
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I stopped it immediately, but the symptoms continued anyway.
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You stopped taking a drug that caused you restless akathisia feelings and the restless akathisia feelings continued?
Doesn’t make sense to me. That’s not how drugs work. You don’t take heroin and feel the euphoria for the rest of your life.
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My hypothesis is that the drug acted as a catalyst that pushed me over the edge. I already was highly anxious and was in an unstable situation. Just recently a man came to my support group who had taken a single dose of Vivitrol, which triggered an agitated depression that lasted a year. The nervous system can be quite delicate, and a powerful stressor can trigger a cascade of changes.
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Maybe. In relation to he man from he support group, If you think the way one feels in life over such a long period of time as a year is being driven by some cascade of changes from one single dose of a drug, that’s an extraordinary claim requiring extraordinary evidence.
I am glad you found a solution that works for you.
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Hi, Douglas! Thank you for sharing your experience(s) with SSRI induced Akathisia-a syndrome while taking Effexor. My 23-year-old daughter had suffered great trauma after finding her father’s body when he passed away unexpectedly a little over a year ago. My daughter was prescribed Effexor 37.5mg daily for depression about a year ago. I witnessed her experience symptoms such as: having a lot of energy and anxiety in the beginning. She seemed to believe that Effexor was working bc of her sudden onset of extreme hyperactivity that gave her the energy to feel like getting up and completing tasks (initially, her depression symptoms included: having no energy, tired, emotional etc). Along with her being extremely hyperactive, she started exhibiting high levels of anxiety with noticeable uncontrollable shaking, agitation, eye twitches, anger outbursts, aggressiveness, which was quickly getting out of control. As a concerned parent, I voiced my concerns about her behavior, which made her very angry, enraged, and she expressed her anger towards me through tantrums and outbursts of inappropriate behavior and vulgar language. She is 23 & has never behaved in such a manner. I wasn’t sure how to handle what was going on with her and her rather disturbing behavior. She was obviously struggling with something that was beyond her control or her ability to see how much her entire demeanor had changed. She talked to her Nurse Practitioner who then put her on Buspar for anxiety along with an increased dose of the antidepressant to Effexor XR 150mg!?!?
I’m somewhat familiar with medical/psychiatric issues due to having medical professionals in my immediate family (my mother is a nurse) and I am a medical transcriptionist. I also have major depressive disorder with anxiety and panic attacks… I had been put on Prozac in the early stages of my treatment. I am familiar with the signs and symptoms of adverse side effects. My reaction to Prozac was somewhat difficult to recognize for me. The mind is quite tricky sometimes & it was difficult for me to notice the warning signs until I shouted something out loud to the TV that was completely out of character for me (I was having homicidal ideations along with suicidal ideations). I have had suicidal thoughts from an early age but I have never had homicidal thoughts, never. And when I shouted something that is against everything I am against, it occurred to me then: Discontinue Prozac, immediately. Once I was stabilized after discontinuing Prozac, I was placed on Zoloft, which worked like a charm for me. That being said, I know that if it was difficult for me to realize I was having dangerous thoughts/side effects; it has to be very difficult for my daughter to even see, much less understand why she is behaving in such a manner. But I also know that there was a breaking point for her to go through before she would be able to come to me about her symptoms/side effects. She recently explained to me that she only takes Effexor to prevent the very painful and flu-like symptoms caused by Effexor withdrawals. I’ve read a lot of material about Effexor & the complications people suffer through even if they go just one day without it. I have never heard of such horrible withdrawal symptoms associated with an antidepressant… These withdrawal symptoms sound more like coming off opioids or heroine!
At 2:00am this past Saturday, I got a call from her very frantic fiancée, extremely upset, scared begging me to come over immediately to help her before she followed through with her suicidal attempt. He told me that my daughter had locked herself in the bathroom with a loaded .38 that she had inherited from her deceased father. It seemed as if my worst nightmare was about to unfold. I immediately jumped out of bed & drove to her house, praying and begging for mercy. My baby has been exhibiting very unusual behavior, sometimes acting like a mad dog; but she never told me she had been having thoughts of suicide which has been going on for nearly a year. She even said that something inside her head told her not to tell anyone, especially me, and she told me that she heard something telling her over and over to “just do it…” daily.
Once I had gotten to her house, it took many knocks on the door to get in. I could hear them both screaming at each other & I was literally on the verge of knocking the door down to gain entry. Finally, her fiancée let me in. I could still hear my daughter screaming and crying, inconsolably in another room. She was full of rage, anger and fear. My first thought was, “Thank God, she hasn’t pulled the trigger.” My second thought was to assess the situation, considering I was walking into my daughter’s home knowing she was somewhere in the house possibly still armed with a loaded gun. I had several scenarios on what might happen & with each scenario, I had a plan on how to react. Her fiancée gave me a hug & he was crying and trembling… I ask him in a low voice, “Where is my daughter & is she still armed?” He said that he broke down the bathroom door, got the gun away from her and unloaded it. He told me my daughter was in the den and she was unarmed. I calmly walked into the den where she was sitting, crying uncontrollably. It was at that time she finally told me that she had been having suicidal thoughts on a daily basis along with all the other side effects since she had been placed on Effexor and is only taking it to avoid the overwhelming withdrawal symptoms.
At this point, I insisted on her making a survival plan and she agreed. I have also insisted that she talk to her NP about her concerns about Effexor & ask for a plan to begin tapering down the Effexor with a plan to start
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Anonymous:
Drugs may effect long-term changes in brain function both through toxic effects and adaptation by the brain to changes in brain chemistry. The brain is a plastic organ: populations of synaptic receptors adapt to changes in levels of neurotransmitters and psychoactive chemicals that mimic them.
It’s a rather common consequence of drug use, both legal and illegal. This is why maintaining remission from drug addiction is such a challenge, and it is conventionally held that a year of sobriety is required before an addict will return to “something like normal”.
I suffered from premature ejaculation for two years following six months on Prozac. (No, I never experienced ANY sexual dysfunction prior to going on Prozac at age 40… ever.-) My akathisia from Prozac resolved fairly rapidly THANK GOD.
Sincerely,
– bonzie anne
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I remember reading an article by Dr. Joseph Mercola who said (paraphrase) that the possible effects of any drug are unpredictable.
It seems like this would be even more true for psychoactive drugs – ones that cross the blood brain barrier; ones designed to alter brain chemistry.
I’ve come to appreciate whatever claims someone makes in this area. These drugs injure – gravely, unfortunately.
Duane
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You may have just saved my life
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I know this is a real old article but I just had to write something, I was just prescribed effexor and am petrified of taking it, i have tried lexapro and sertraline …they all make me more anxious and depressed than I originally was. I am starting to think that there is nothing that will auiet my brain.
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