This blog post in no way endorses the idea that you should stop taking your medication…in fact, just the opposite. Do not make any changes to your medication without the supervision of your medical provider!

Pastor Brad Hoefs, founder of Fresh Hope, talks in his book, Fresh Hope para la Salud Mental, about the importance of medication, and taking it as prescribed by your physician (medication is addressed in Chapter 5, pg. 120, of the book). I recently experienced a change in my medication, with the knowledge and oversight of my physician, but still experienced difficulty. I want to share that story: I feel like if it can happen to me, it can happen to anyone!

I alluded to it last month, when I talked about the tears that came unbidden, as I laid down on the massage table. Tears that seemingly came out of nowhere! In looking back at that situation, I can see now that they were an indicator of my turn towards a depressive episode, though at the time, I missed all the signs.

In fact, that calls to mind – how did I miss it? I’ve been depression-free for almost 7 years. I’ve written my Wellness Plan, I’ve led two Fresh Hope Support Groups in two different churches for a total of 7 years, and I’m the Hope Coach Trainer in English (6+ years) for the Fresh Hope Ministry. I’m up to my eyeballs in mental health information and know-how. So how did I not see my own decline into depression? How could I have been so unaware?

Well, it’s because the slide in a mental health challenge can happen subtly. And while I have a group of people who I know would support me in a mental health crisis, I didn’t inform any of them of the changes I was making in my healthcare. I had told my husband that my physician and I were stepping down one of my antidepressants, but I didn’t think to tell him to keep an eye on me, to watch me for changes in my behavior or mood. I didn’t even think about those things for myself!
Here’s what happened.

Once upon a time, about 17 years ago, I had a 10+ year experience with major depressive disorder, commonly known as depression. It was on and off for over 10 years – I became depressed, I started on a med, my mood improved, even sometimes to the point of “wellness” for several months, then it would begin to slide back down, we’d increase my med, I’d improve and be stable again for a month or two, then it would slide down again, we’d increase my med, repeat cycle. This went on for a year and a half, until the catastrophe of serotonin toxicity set in. Fortunately, the on-call psychiatrist recognized my symptoms immediately, and took me off the med that had been wrong for me all along. (That’s why it wouldn’t keep working.) Over the course of several years with this fantastic psychiatrist, we got me stable on a combination of medicines – a “cocktail” – that helped me begin to think clearly again. There was one med, in particular, which seemed to be helping the most. As time went on, we’d drop one supplemental antidepressant and try a different one, but there was always the base medication, “doing the heavy lifting.” At the time, I was told by several psychiatrists (we moved around during those years), that because I’d had so many depressive episodes, I’d be on antidepressants for the rest of my life. That was fine by me – I was finally doing well, and never wanted to go back into that dark hole of depression ever again.

Ok, so fast-forward to 2 years ago, when my psychiatric nurse (now my mental health provider), told me that I probably didn’t have to stay on meds for the rest of my life. Knowledge of mental health and my medications had improved over those years, and what the medical world used to think had since changed, and I probably didn’t have to be tied to antidepressants forever. But she left it up to me – coming off my meds was my decision. It took me several months to work up the courage, but with her help, I was able to wean off of one of the supplementals over the course of a couple of months. Then, after that was successful for 6+ months, she helped me come off the other supplemental drug, also a several-month-process. After a year, with the help of my psych nurse, I was only on the one medication – the one I’d started 15 years ago. And I was very reluctant to give it up. With her assurances, I knew intellectually that it was likely that I didn’t need it, but I was afraid to be without it. So I stayed on it until winter was over and spring had arrived. Then I told her I wanted to try coming off.

First, we tapered it to ½ of my original dose. That went well for a month. So she called in the prescription for ½ again – I was now on the lowest dose of a medication that I’d been taking for 15 years, originally at 4x the strength that I was now trying to remove completely from my life.

I started that lowest dose on a Sunday. By Wednesday, I was crying on the massage table. I told my husband the next day that my mood seemed to be low, I was feeling down, and that I wondered if it was the process of reducing my medication; I asked him to keep an eye on me. I mentioned to my Fresh Hope Group a few days later that my psych nurse and I were adjusting my meds, and asked them to keep me in their prayers, as I wasn’t sure if I had made the right decision. Two more days went by, and my mood just kept going lower and lower. I was now experiencing anhedonia – no desire to do the things that usually brought me joy. I was easily irritated, easily moved to tears. I reached out to my psych nurse, and through her assistant, let her know that I wasn’t doing well. She got back to me with the message that she usually recommends that a patient give it two weeks to let the med levels adjust, and since I’d been on this med for so long, it might even take longer. I didn’t last another day! I woke up the next morning, feeling so down that I told my husband I was taking 2 of the pills (so back up to the first drop level), and then I let my psych nurse know. She immediately called in the prescription for that higher dose. Within 2 days, I was feeling more like myself. Maybe it was placebo effect, I don’t know, but just the knowledge that I was not going to be in a downward spiral anymore had me feeling so much better!

A couple of days later, as my husband and I were out for a drive in a beautiful canyon in the mountains, I reflected on the previous 10 days. I could see very clearly, where I had been blind to it before, that I was definitely headed into depression. The irritable mood, the lack of desire to do anything, including getting out of bed or seeing friends or even being around people, the quick flow of tears, the deep sadness – all of it pointed to the downward spiral of depression. And I had missed it completely. I had not recognized any of the signs, until a full 10 days into it.

So what’s my point? There are several:

• When making a change to my medical care, I need to – at the very least – describe to a safe person (someone I love and trust) that I am making changes and ask them to “watch” me for signs of changes in mood or behavior.
• Even with the help and supervision of my mental health provider, coming all the way off of my medications was not right for me.
• It’s critical to have a good relationship with my medical care team, and to have open, easy, and quick communication.
• My support people are my team – they are people who want to help me, and I need to trust them, even as I communicate my desires to them. Together, we make decisions – not just me, but with their input.

I thank God for His presence and protection. Presence: He is with me – He never left me, even when I started experiencing the depressive thoughts. Protection: He didn’t allow the depression to get out of hand and He gave me quick medical responses from my psych nurse to get me back on track.

No matter where I am in my mental health journey – from surviving to thriving – He cares and watches over me. And that never changes. Thank You, God!

Peggy has been involved with Fresh Hope as a Group Facilitator for over 6 years and as the Hope Coach Trainer for over 4 years. She can be reached at peggy@freshhope.us