These days, attempting to navigate my way through life feels like swimming through quicksand. As I slowly recover from the aftermath of my run-in with psychiatry, I can only conclude that they are capable of being evil, legal drug pushers. What would compel a so-called “doctor” to prescribe a new class of drugs (SNRI) at 33.33% over the FDA recommended maximum dose for over a decade and expect no negative consequences?
This “doctor” was in no uncertain terms gambling with my very sanity. When he began prescribing, he wrote, by his own hand, in my medical record, “Imp. No current MDE,” or “Impression, no current major depressive episode.” At the time, I was a 38-year-old man in my prime who truly had it all. What in Dr. Michael’s (not his real name) training taught him that it was alright to prescribe an ungodly amount of medication at up to two times the FDA recommended maximum? What protocol was he following that indicated it was okay to treat his patient as a lab rat?
I recently asked Dr. Michael in an email what guidelines he was following that made him think it was a good idea to prescribe the antidepressant Effexor at doses over the FDA maximum for such a long period of time, among other questions. Because he would not respond by email, he sent me a typewritten letter by mail that was obviously coached by a legal professional. In his letter reads the following:
“While I prescribed Effexor XR to you in a dose over the FDA suggested maximum, the doses that I prescribed were within the range that psychiatrists in practice use. I was guided by my clinical judgement and consultation with colleagues who specialize in psychopharmacology, who made clear to me that doses over 225 mg per day are acceptable if the trade-off between benefit and side effects is carefully taken into account.” (Dr. Michael had me on a dose of 300 mg per day for a decade with doses initially as high as 450 mg per day.)
He had responded with the “Everyone’s doing it” defense! I believe that doses of Effexor specifically (and antidepressants in general for that matter), should NEVER be prescribed over the FDA recommended maximum except in the case of severely depressed inpatients as stated in the drug labeling.
When I began punching my wife in the face while I was sleeping, maybe I should have seen the writing on the wall. Maybe this was all my fault. Within the first year of overdosing on Effexor, my whole body started violently shaking and twitching in my sleep. It progressed to swinging my arm and knocking over a lamp on my night table. During the second year was when I began having vivid violent dreams and frequently touching, slapping and on more than one occasion punching my wife in the face while sleeping. You would think this would be an indication to Dr. Michael to lower the dose, but instead he recommended adding Klonopin or Wellbutrin to quell my sleeping disturbances. It would appear that once the psychiatrist has gotten a foothold, once you are hooked, they are loathe to let you wiggle off of that hook.
My wife made me sleep with my head at the foot of the bed because she was afraid of what I might do to her in my sleep. I put up with all of this because the Effexor was beginning to take hold of me. Its power was ascending in a linear trajectory over time. In the third year the drug continued to wield its power in ever-increasing strength; I was not willingly going to make it stop, and Dr. Michael was more than willing to provide it.
Did we not learn from Peter Kramer’s “Listening To Prozac” at the dawn of the SSRI era that the effects of these drugs strengthen over time? From my experience, it takes much longer than psychiatry believes for the full effects on the human psyche to become apparent. They measure the efficacy of these psychotropic drugs on an initial reaction within weeks while ignoring the changes that occur over months and years. A study in nonhuman primates has shown a significant increase in the volume of the anterior cingulate cortex, a region of the brain, in depressed subjects given sertraline (Zoloft) for a time period analogous to five years for humans. The study also showed a decrease in volume of the same brain structure along with the hippocampus in non-depressed subjects. These areas of the brain are critical in a wide range of higher brain functions that influence behavior. What could this study demonstrate for my situation, given that Dr. Michael stated that I was not depressed at the beginning of treatment and anything but depressed throughout the duration? It may be difficult to draw definitive conclusions from this study, but what is clear is that only god can possibly know the dangers of the long-term use of modern antidepressants and its effect on the brain and on behavior.
Perhaps in the third year of treatment at 300 mg per day of venlafaxine (Effexor), Dr. Michael should have at least raised an eyebrow when I reported an “absence of negative feelings,” that I was “more assertive” and that I “yelled at boss.” At this session Dr. Michael noted there was an incident of “touching (not punching) wife in sleep.” What should have been early alarm bells going off as the medication began to radically change my behavior only resulted in Dr. Michael reporting, “Imp [impression] Doing (for him) quite well.” How condescending! I was a self-made millionaire with a family I treasured. I was truly living out my dreams when I was forced to see Dr. Michael, referred to him when my primary care physician no longer wanted to prescribe the standard dose of Zoloft that had served me well.
In the fourth and fifth year, I reported that I had begun taking on risk in my stock portfolio. Dr. Michael noted that I had leveraged my account with $800,000 in margin debt where I had never used margin before. A telltale twitch of my eyelid that began around this time and would not go away now seems like an ominous warning. Severe constipation as a side effect of the medication led to rectal bleeding resulting in anemia which necessitated a colonoscopy. The first reports of irritability and marital conflict occurred during this time, and I continued to hit my wife in my sleep.
My medical record is littered with warning signs that I was headed to full-blown hypomania. I was slowly and progressively transforming into someone that in retrospect I no longer recognize. From the beginning I was constantly bringing up my intention of reducing the dose to Dr. Michael, but as the euphoria increased, and my inhibitions evaporated, I failed to follow through. The seductive power of the drugs that were changing my personality was overwhelming.
In the sixth year of treatment, I reported to Dr. Michael that I had blown through three quarters of a million dollars due to risky investments in the stock market. I was fired from a job on account of my behavior, however, at this time I was highly functioning and found a better job and was earning more money at work than I had previously made in my 45 years of life. At this time I began complaining to Dr. Michael of memory problems and cognitive issues and an “electric feeling” in my brain. These issues were apparently the precursor to a more acute phase of hypomania to come.
I canceled appointments with Dr. Michael, and did not reschedule. 14 months went by without a session. I had embarked on an antidepressant-fueled pleasure-seeking rampage of self-destruction. In the eighth and ninth year of 300 mg per day of venlafaxine my libido began to shift into overdrive. At 47 years of age I had developed sexual urges that I had not felt since I was a teenager. While driving in my Boston neighborhood I became obsessed with looking at women and felt an uncontrollable need to have them. My personality had transformed to where I felt an ease around women that I had never before felt. My inhibitions had completely melted away and the power I seemed to exert over women was intoxicating.
Among numerous other indiscretions, I started a deep, emotional love affair with a stunning 20-year-old college student who was three inches taller than me and twice as good-looking. Unbeknownst to her, she had fallen victim to my chemically engineered charms and was powerless against its spell. I felt completely immune to the consequences of my actions and did little to conceal them. This relationship would ultimately cause the break-up of my formerly fairy-tale marriage and cause my two young sons to grow up as children of divorce.
As my life began spiraling out of control, I called Dr. Michael with urgency to set an extra appointment. I knew I was in danger and not able to control my actions. This was the first time in our nine year professional relationship that I asked to see him outside of regularly scheduled sessions. Dr. Michael wrote in his notes of this session that I was “anxious, sl. pressured, looked distressed.” I told him in detail of the surge in my libido, that I “Have been feeling like an 18 yo,” about my relationship with the 20 year old and how I was caught drinking in my car with two young women by my wife. In Dr. Michael’s notes it states that I asked him, “am I manic? am I crazy? are the meds doing this to me?”
Dr. Michael stated, “This must be very exciting,” and he asked me to “describe the pleasure.” He noted that later in the session I again questioned the medication. “Re: meds: are they making [me] more excited? more risk-taking? more impulsive? less concerned w/ consequences?” His response to these questions was, “Possible—but it could be you.” Obviously it was foolish of me to turn to my well-paid legal drug dealer for help with my drug problem. I left the session with the man who knew more of my most intimate secrets than any other human being, the professional entrusted to keep me safe, feeling like I had been given the thumbs-up to continue partying like there was no tomorrow.
The party would continue for a time, but an inevitable crash ensued. As the intensity of the drug’s power over my mind continued upward over time, it transitioned from euphoria to agitation. In short order, I left my family, was fired from my job for uncontrollably screaming at my boss, and gambled away whatever money I had left in the stock market. A debilitating depression soon began, of a magnitude I could not previously have imagined. I had lost everyone and everything in my life. Throughout the ordeal, Dr. Michael never once suggested reducing the dose of venlafaxine, but as my situation deteriorated he recommended I take benzodiazepines and atypical antipsychotics; I declined. Luckily for me, I stumbled upon the definition of hypomania on the internet, and educated myself about drug-induced hypomania/mania, and decided to take matters into my own hands. I imagine scores of others have not been so lucky and in this situation have succumbed to psychiatry’s incessant drug-pushing.
I stopped seeing Dr. Michael, and began the grueling process of slowly withdrawing from venlafaxine of my own accord. I knew I was on the right track when, having halved the dose, a feeling of calm came over me. This was short-lived however, as when I reached 0 mg per day, I was overcome with unbearable withdrawal-induced anxiety that left me completely incapacitated and unable to even leave my home.
Having awoken from the horror of my drug-induced spell, I was forced to restart a similar medication at a low dose under the care of a new psychiatrist or I might not have survived. I had become an antidepressant junkie, but I was determined to get off of the psych drug rollercoaster that had nearly destroyed me. It turned out the new psychiatrist shared the same zeal for the prescription pad as Dr. Michael, and if I had followed her suggestions I would be on god knows what cocktail to this day. I am proud that I found the strength to resist and get off of the medication, a process that took a monumental effort and untold lost time.
I am now working on writing a detailed account of my experience with antidepressants, both the good and the bad. I have recovered from my ordeal and am feeling strong, though I still bear scars. I am seeking better employment in Boston currently; I am honest, hard-working, capable and intelligent—perhaps someone out there can assist me.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.