It is a tough one to get right, that is for sure, and a journey I am currently on. Each time I use anti depressants or other anxiety medication, I reach a point where you feel you are levelling out, and start to have the internal conversation about what percentage of it is you, and how much of it is the meds. Trying to remember what "normal" felt like before your last episode is tough. We all have a perception of how we think we behave, but it is not always the same as what others see in reality. This is why I find it important to have people around me who are not afraid to tell me what they see, rather than what they think I want to hear.
From my perspective I can make the following observations.
- I am sleeping much better than I have for a long time.
- I dwell on things much less.
- I feel vacant at times, unable to focus on company.
- Fatigue is a part of every day, especially when exercising.
- I feel calmer, and more at one with the world.
These are just the key points I can identify, and the ones which I have to consider when deciding the next step with medication. Some of them are unwanted, others much desired, what I have to do is determine the causes of them, and which I can trade. For example, sleeping better is massive for me, setting me up mentally for a good day. Not laying there over thinking for hours on end is wonderful. Fatigue on the other hand bothers me. Physical exertion which used to feel rewarding is now hard work, nausea inducing, and impossible to achieve the data I used to.
If the meds are causing both, do I sacrifice sleep for the sake of physical achievement for that short lived dopamine hit? Or do I keep the sleep pattern, and accept that my exertion levels are not what they once were?
Same for not over-thinking things vs feeling vacant. Can those around me accept I might tune out of the conversation, completely unintentionally of course, just because I don't want to over-think things as much as before. Which ironically is what I am probably doing right now, but I feel relaxed about it, and am not constantly thinking about it, so that is OK.
The biggest problem here of course is I am completely in the dark about what effect the meds are actually having, and what the impact of reducing and eventually stopping the Sertraline would be. As I said before, I have been through this process a number of times previously, but am almost completely ignorant to the actual impact. The only thing I can say for sure is I have never come off the meds too soon, and have always maintained a stable level following the reduction and subsequent stopping of the meds. Many happy years have gone by without meds, so I know it is something I am capable of doing, just not at what cost.
One interesting thing is my Garmin Fenix 6X Pro watch. Wearing it all day everyday, it records a number of metrics. Recently as I increased my activity levels again and noticed I was not 100%, I had a look back over the data, and was quite intrigued by what I saw. From a week or so after starting the medication, and again after increasing it, there was a notable drop in fitness status, max HR, max power, running pace etc. All of which I retrospectively put down to general fatigue, and mid activity fatigue. Simply not having the effort to give. Could this be down to the meds?
Chatting to a friend about this over the past week to try and get some outside perspective on it, I think the conclusion I have come to is my mental wellbeing is more important than ego stroking performance stats. If I can still enjoy a good bike ride, just maybe with 10% less effort, whilst getting a good nights sleep and waking mentally and physically ready, then it is a good trade. Finding new limits might take a while, but it is a change I am willing to embrace. Of course, that does not mean I am just going to carry on taking the meds. I have no issue with being on any form of medication, if it offers me an improvement of quality of life, and is required to maintain my state of mind. I have always felt this way about medication. There is a difference between necessary and just the norm.
The plan is to speak to the GP about reducing my dose first, then relying on people around me (as well as my Garmin) to tell me if things are changing, and if it's for the better or worse. As humans we are so adaptable to change, sometimes it is hard to spot the change, and be sure if it was beneficial. If all goes well reducing the dose, I shall remain on that for a while, then try lower or stopping, again with the input from the GP. There is also a second medication I am on, which again is starting to leave me wondering if I can change the dose, as all the indicators are showing that I am doing a lot better than I was before, so it will be an interesting exercise to reduce them both at the same time. Not that they are known to interact.
This time of year is probably the best for me to do an experiment like this. I said back last autumn when I started back on the anxiety meds that I would stay on them for the winter, giving myself time to level out, and get through the tougher time of the year with the cold and darkness, before trying to see how I would do without. I am aware of the impact the seasons can have on my mood, so probably best not to mess around too much.
Hopefully in the next week or two I will speak with the GP and get the ball rolling on this, maybe even be med free for the wedding in August, who knows. There is no rush, and in reality no NEED for change, just a curious mind in need of some answers.
Let's see how this goes.
Oh and note to self.... Blog more if and when off meds, so I you have something to look back on to see what the non-medicated normal looks and feels like.