The Moment of Truth

Those who read my posts in the past know that I battled with depression and anxiety disease. It got better with the years as I developed strategies for my life but, to be honest, I wasn’t sure how much it been due to the fact that I was still using antidepressants. Up until now, I was still using Doxepin, a tricyclic antidepressant medication used to treat major depressive disorders, anxiety disorders and trouble sleeping. I’ve never been a great fan of the idea but if you’ve been in a position where things can’t get worse, you start to experiment. And honestly, in retrospect, it was the right decision to start taking the Doxepin pills back then, just not the way my doctor wanted me to take them. I tested 100mg and it basically did put me to sleep 24 hours straight and the few minutes I was awake I felt like my depression got a thousand times worse. In other words, I absolutely couldn’t get out of my bed anymore. If you feel like getting out of the bed is worse than starving (not being able to go to the kitchen), then you can be sure your doctor did decide for the wrong dose.

But I didn’t give up and as soon as I found the energy, I did my own research and decided to give 20mg a try. My doctor didn’t like my rebellion against his suggestion but eventually gave in. And see there, after 2 weeks of taking 20mg each evening, my anxiety symptoms basically disappeared and not just that, my mood stabilized and it felt like it’s worth living again. Every other improvement after that have happened due to life strategies I developed, at least that’s what I thought so far. But if I would be 100% sure about that, I would have discontinued medications on my own by now. So, there was still some kind of fear that my issues could get worse again if I discontinue the medication even if my doctor thought 20mg would already be a homeopathic dose. The thing is that I find it worse to get all those symptoms back than taking this type of medication. Anyway, my whole situation improved in such a way over the years that I gave discontinuing a serious thought. During the last two years, I thought I might do it soon, just not now. And if so, very slowly by reducing the dose further over time because discontinuing too fast after so many years can have serious side-effects.

What I didn’t know was that I might be forced to discontinue the medication earlier than I wanted. That’s what I learned yesterday when I visited the community pharmacy with my new prescription. There is a serious supply bottleneck for Doxepin. That happened in the past too but it was always possible to get a generic drug, which means another brand with the same pharmaceutical ingredients. So, it never really mattered that much, because it was all the same. But yesterday, I was standing there trying to get my medication and they told me that there is a supply bottleneck and that it’s not possible to get any of those brands. I visited a second pharmacy, a third pharmacy because maybe any of them would still have them in stock. Vainly. Then I just learned that it’s not just with antidepressants but the same with certain medications for high blood pressure, cancer treatment and so on.

So, today I did spend time to read the medical news and tried to understand the issue. And it turns out, it’s another effect of capitalism, deregulation or liberalization. The government does not have control over the pharmaceutical industry anymore. Germany was once a nation where the medicine was produced but like with everything else, that is not the case anymore. Our medicine is now produced in Asia because it’s cheaper for the pharmaceutical industry. And thus, production is not as diverse anymore as there are just a few manufacturers. If one production line has a problem, it’ll have an effect on the international market. That happened recently with Ibuprofen, where a manufacture burned down and international demand couldn’t be satisfied anymore, thus pharmacies ran out of it. Now it happens with many more medications. The fact that German health insurance funds asking for rebates makes it worse because now the medicine is sold to countries where the pharmaceutical industry can earn more. Welcome, enjoy the world of never-ending maximization of profits. Not even our health system is safe of this evil monster anymore. By the way. Our hospitals are affected as well. I’ve read that they can’t get all anesthetics anymore, especially Propofol which is one of the most used anesthetics.

Talking about myself again, I visited another pharmacy today, the fourth as the last try and heard the same stuff again and they told me that they tried to get Doxepin for 3 weeks without a chance. They also told me that it will get worse in the future as we barely still produce medication on our own. That’s about what you can take from news articles about the issue as well. I am done with this, it’s a true shame how far we have come. For me, this is the moment of truth. I might battle with severe withdrawal symptoms soon but after that, it’s maybe a chance to see how it is with my health. I usually took 2 pills of 10mg in the evening but yesterday I went down to 1 pill to stretch the time a bit and to be able to get away from it slower in hope that it will give me fewer withdrawal symptoms. I still have 5 pills, that means 5 days. Since Doxepin stays in the system for a while, it might take some weeks until I see what will happen. The best case would be that I realize I don’t need antidepressants anymore, the worst case is of course that things will get tough again.

I don’t want to compare diseases with each other. When I told a pharmacist today that I’ve read in the news that people with blood pressure or cancer are affected as well, she replied: “Many people rely on their medication, you too, it’s a shame that you’re put into the situation and I as a pharmacist feel like people don’t trust me anymore”. I am a calm person and try to understand the root of the issue by doing my research but not everyone is like that. I can just imagine what doctors and pharmacists go through right now because they’re the persons who interact with people and some might be understandably upset. As my mother and grandparents rely on medication for high blood pressure, I forewarned them that they might run into the same issues I ran into with my antidepressants.

Yesterday before I went into bed, it felt like a bad movie. I grew up in Germany and you always could get any kind of medication if your doctor thought you’d need it. So, I fell asleep and dreamed that a war broke out and that I couldn’t get my medication anymore. When I woke up, I realized the part with the war was just a dream but not the part with the medication. So, let’s see how discontinuing my medication works out for me. At a dose of 10mg, I only have 5 days ahead until I run out of supply…

antidepressants - pills

19 thoughts on “The Moment of Truth

  1. A moment of truth indeed! Exercise and running may be one of your closest allies in the weeks to come!
    By the way, have you tried small doses of lithium orotate? I’ve seen a lot of anecdotal evidence saying it’s a useful daily supplement at even low doses of 5mg..

    1. Yes, exercise always had a great effect, as far as I experienced maybe even a greater effect than my pills, but how can I know when I didn’t try without the medication. I will see, maybe I get through this. While it’s bad that I have to quit before I wanted to do it on my own, I hope it’s a positive fate. Maybe I learn that I don’t need the meds anymore. That would be ironic but cool. I hope that’s the outcome and not that it gets worse again, because if I think back, uhh… no, I don’t want to experience all that again.

      I am reading a lot about medicine but haven’t heard yet about lithium orotate supplements. I gonna do my research and see what I think.

      1. Some people have reported surprisingly positive results with lithium. Certainly worth a look. I remember reading that heat stress (sauna) has a positive effect as well.

    2. Yes and sun exposure. That’s why it’s usually more likely to relapse during autumn or winter. Vitamin D is very important. One of my doctors even suggested that sun lounge during these times can stabilize mood.

  2. First of all, I want to say that you seem to have done a very good job of managing your illness and developing ways of coping with stress and anxiety. I think you have given yourself a good chance of managing without the meds if you have to. But. You shouldn’t have to be forced into doing this because of the situation. It should have been something you were able to do in your own good time. It is appalling that people might not be able to get the medication they need because of the way the pharmaceutical industry works. I know our American friends will have horror stories about the cost and availability of drugs they need. I hadn’t heard about these shortages here yet but then I don’t take any meds myself. Naomi takes tablets for her blood pressure so I should ask her what she knows about it. I can imagine how upsetting it will be for people who need their medication and can’t get it and for their families. As you say it is the people behind the pharmacy counter or the doctors who will take the brunt of this not the people responsible. It really does make me feel that the world is going backwards in many ways.

    1. Yes, it happens both, at the perfect and worst time. Perfect time because I feel really stable for quite a while, probably also due to the exercising and other things. But it’s still not the perfect time to quit because I was currently planning some things for my life… I actually wanted to write about this but things are not set in stone yet. But in short, I was planning to go back to evening school to get more qualification and after that, I might want to do a job re-training because I am going circles with what I have done previously and I’ve never been happy with my field, and the unhappiness was also part of the whole deal with my diseases. So, if I’d do that in August, I’d have preferred it to quit medication after those plans. Even if I’d call myself ex-social-anxiety-warrior…. going into a classroom full of 30 people or so is very risky with my history, especially if I pay for classes with my own money. Meds would have helped.

      If I now find out that I don’t need them anymore, fine. That would be ironic but pretty cool. But as you said, it’s bad that it happens under these circumstances. Yes, we go backward in many ways. I am generally not an enemy of capitalism per se, but I don’t like a completely unregulated system either. The government should make sure that certain things are available. This includes water, energy, medication and a lot of other basic needs. That’s how it has been and that#s how it should be. The fact that such important manufactures like the pharmacy can produce in foreign countries while profiting from out markets is a no go for me. They need to be put on a leash. And ironically, people always argued “then they just sell somewhere else”…. but ironically that happens right now and not because of regulations but because of deregulation, and it never happened back then. The fact that our health insurance funds saved until things broke, that is another part of the story. Like some news articles state, we need to spend the money that is saved in health insurance, on top of that we need to create incentives again for those who produce and sell in Europe and make it harder for those corporations that don’t, especially in those important areas. It’s visible right now what happens when corporations can do whatever they want, and when maximum greed takes over. Sadly it’s visible in many fields.

      Yesterday and today I saw a few people behind the pharmacy counter and they all looked bewildered and said it’s never been that bad. And yes, they take the brunt 😦 Some of them said to me, we’re not even in a crisis but many meds are unavailable as if we’d be.

        1. Yes. Talking about the program, it’s still not sure yet. I will write a post about it later this year. There is still time to decide because it would start in August. But I gathered many information’s already. I would only be able to participate if I succeed in a A1 English test but that shouldn’t be a problem 😀

        2. I checked some online tests to estimate my English level and it seems A1 English is easy for me. I tested different online tests and got 100% correct in each of them. I also tried some evaluation tests and I got C2 results, which is far higher than A1. But with speaking I am probably rather at B1-B2 level because I am shy with English speaking 🙂 Anyway, all that means, I definitely should not be afraid to participate in the selection process of the evening school.

  3. I hate the idea of taking drugs for any longer than a couple of weeks because there is always a price to pay and that price is your overall health. I have read a lot about health and about mental health. I even worked at a place that made natural herbal products. One thing I learned is that depression and anxiety can be caused by a nutrient deficiency. Often, lacking certain minerals, especially electrolytes, can cause communication problems in the brain. Omaga 3 is also good for the brain. Perhaps a doctor can test for mineral deficiencies.

    1. Back then, my overall health was worse without the drug, which is why taking them was a trade-off. I actually don’t even know if I would have made it that far without them. Back then I was non-functional, couldn’t even get out to go shopping and needed help for that and many other things. If you have to decide between not living and living, I think drugs are a great trade-off even if they have side-effects. Because you need to ask yourself in that case, what is worse, the side-effects or the symptoms of your disease. I decided on the latter back then. Especially as I went through all tests back then and got tired of visiting doctors because they were of no help. So, I wanted to function again, and couldn’t take the symptoms any longer.

      As you said, it can be caused by a nutrient deficiency, while “can be” is the point here. Over the last ten years, I’ve read so many studies about the topic that I know it’s not that easy. There can also be a genetic component and predisposition. It can also be about habituation/experiences. It can also be about stress induced by the way of life we are living (forced to work in fields you hate, getting burned out, existential fears and whatnot). It can be caused by cases of intolerances (yeast as an example), it can be caused by other hidden diseases (heart problems to name only one example out of hundreds). It can be caused by a ton of things.

      But I still agree with you that you can make some changes in lifestyle to get positive effects. Stopping smoking, stop drinking alcohol, reducing sugar intake and caffeine, all that helped me a lot. Being educated about how the disease works (biochemistry), exercising (jogging or whatever) and and and. I still don’t know what was the cause in my case and I probably will never find out, nor did any doctor help me to look any further, I just learned to live with it and can now reduce medication to 10mg and maybe even discontinue it. Time will tell.

      But if I notice the disease gets worse again, I have zero issues to take 20mg each day again if there is no shortage. Because then again, the symptoms of the disease are far worse. And apart from that, even if I take medication, I still live far healthier than most people around me. I barely know people who do exercises, I do know a lot of functioning alcoholics, smokers and so on. They live such an unhealthy life, that I could probably quadruple my dose and would still be better off than them.

      I don’t want to downplay what you wrote, but after 10 years of being on the search for the causes, I just came to terms with my disease and that helped me a lot more than looking any further if it might be a deficiency or whatever because visiting a doctor and asking him/her to take a second, third or seventh look feels like begging for help at some point. And when you make progress without them faster than with them, it’s probably time to just accept the conditions and continue to find ways to live with it and experience progress on your own.

      I am pretty sure, if I would have been wealthy, they would have found the cause. But I’m not… thus I just have 2 minutes to explain my issue, and another 2 minutes to get some basic checks to eventually get told again: “It’s just your psyche”.

      1. I hope I didn’t sound like I was telling you what to do. I certainly don’t know enough to do that. I don’t like taking drugs but I understand why people do sometimes. For example, I have a headache right now. I don’t want to take Ibuprofen but if my headache doesn’t get any better soon I will because I think the side effects are not as bad as the headache.

        1. No, it’s ok. Your comment didn’t appear like that. And you’re not wrong with that… nutrient deficiency is a thing and can cause very similar symptoms but so can many other things. I myself, for example, had nervous convulsions in the muscle behind the eye for a very long time and thought it would be a symptom of my anxiety disease. It actually fortified panic because when you get that outside, it’s horrible because you can’t see anymore, you get tears due to the convulsions, it feels like getting an epileptic attack. And I felt vindicated when I’ve read that eye convulsion can truly be a symptom of anxiety disease. But then I found an article where the author/doctor wrote that this can also be caused by a magnesium deficiency. So, I tried to increase magnesium intake and see there, at least the eye problem disappeared and only comes back if I am short in magnesium.

          So, generally, “things to try” tips can actually help people. I was just pointing out in my reply that I walked through life with my issues for over 10 years and tried many things of which some worked, others not and got a decent overview of which symptoms are caused by what and how they’re related or not. I’ve read a lot, to the point that my doctor is sometimes shocked that I didn’t study medicine lol.

          Talking about medication… yeah… your example is great. I refrain from taking Paracetamol or Ibuprofen but if the headache is that heavy and doesn’t go away, it happens that I take one. That’s exactly the same with antidepressants. It has a bad name but it shouldn’t because it helps a lot of people. The constant high level of stress in my body could have very well killed me in the long run. Those pills got me back down to earth, no heart-racing anymore, no acid reflux anymore, no stress feeling in the stomach anymore to name just a few effects of regular panic attacks. So, I balanced reasons, when it was about medication.

        2. You make a good point. Stress is like a toxin and can very easily make you sick so the medication might hurt you less than the stress. I am just happy that you have found some improvement and that you were able to get down to just 20 mg.

        3. I’ve been using 20mg already for quite a while and my doc always said that it is already a homeopathic dose or a “child dose”. Now forced to go down to 10mg due to the mentioned shortage of medication in Germany. But so far it works. It’s the smallest dose and now I think I can discontinue in the future. I will see.

          Yes, stress is the worst thing and can cause many more problems.

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