Worsening Depression & Panic Attacks Prozac 18/04/2010 England Woman's Depression Worsens & She Has Panic Attacks on Prozac
Paragraph twelve reads: "The next day was a Friday and I started taking the Prozac extremely reluctantly. The side effects listed on the pack included headaches, dizziness, diarrhoea, nausea, vomiting, abdominal pains, dry mouth, loss of appetite, anxiety, sleeplessness, nervousness. If I am anxious now, I thought, how anxious will I be on Prozac? If I wake at four each morning now, and toss and turn for many of the hours that follow, will I get any sleep on Prozac?"
Paragraph fourteen reads: "By Monday I could not move. I felt sick, heavy as a rock, everything ached, and my head swam. I had the pains and sort of breathlessness associated with heart attacks and I was, of course, crying. I rang work to say I had some sort of bug and that I hoped to be right the next day. Speaking was an effort. It was hard convincing myself that the advantages to leaving the house and seeing the doctor outweighed those of staying inside where I wanted, desperately, to be, but I knew I needed to seek advice. Dr Fahey offered, again, to sign me off work; my response, again, was an adamant no. I was going into work as soon as I could."
Paragraph 20 reads: "After the second visit to Dr Fahey everything changed. She made me realise that whatever self-deceptions I had entered into, the reality was that I had not been into work for several days, nor was I currently fit to go in. She signed me off for two weeks and gave me tranquillisers to moderate the increasingly severe panic attacks. She advised me strongly to leave London. The idea of being on my own without work for two weeks was unthinkable, unbearable. Amanda was off to visit our parents in the country and taking the children with her. My brother-in-law Neil was staying at home an extra night then would join her there. Amanda's suggestion was that I drive to be with Neil and then the following day he would drive us both to Suffolk to be with the whole family."
Woman on the vergeShe was a media executive at the top of her game. But a debilitating midlife crisis forced Camilla Nicholls to hit rock bottom. In a searingly honest account, she details her nervous breakdown – and her tentative steps back to recovery
It all started slipping away from me in July 2000. Depression had been part of my life for a long time, but that summer it ceased to be under control. It was shortly after a married friend's party that I had the first significant "What is the point?" conversation.
Every guest had brought with them a child, or a swelling stomach. Hardly a conversation was had at head height; we were all dipping and bending or squatting to catch half a sentence with someone too heavy to stand for long. There was no chance of eating as little hands pawed at the snacks, and pregnant women, picking through the non-pasteurised, took precedence around the table. Sentences were left hanging in the air as parents attended to toddlers' or babies' urgent needs.
My friends will bear testimony that I am very fond of children. But I was bitter because, aged 39, I had no partner, no prospect of a partner and, more significantly, no prospect of motherhood. Maybe the party felt harder to cope with that day because my hopes had just taken a severe knock. I had been told by an unsentimental doctor's receptionist that I was peri-menopausal (ie approaching the menopause) and the possibility of my bearing children was lodged somewhere between zero and infinitesimal.
The "what is the point?" conversation is the one for friends and family to look out for as a first clue to depression. This is not the "what is the point?" response of a child to doing homework or cleaning a bedroom; it is, rather, "what is the point of my being alive?" For depressives the feeling is often heightened when the reasons for depression are not obvious to themselves or, more importantly, to others. This leads to the cajoling (or worse, hectoring) question: "What have you got to be depressed about – you have a great job/partner/house/body?"
I come from a small, loving, middle-class family. I was not brought up to follow a particular religion, although as a child my grandmothers took me, and my only sister Amanda, to Sunday services at the local church in the Surrey town where we spent all our youth. What my parents did adhere to with near religious fervour was the observation of good manners. A framework of politeness in all situations was my firmest mould. Now, grown up, approaching a milestone of middle age, it was safe to say on paper I had more than most: a well-paid, challenging job in the media, to which I was virtually married, a lovely house without an enormous mortgage, often exciting relationships, great friends and I remained close to my stable family. And yet by August 2000 my predominant talent was for crying.
I wish when I had first asked "What is the point?" I had been advised to seek medical help urgently. I was talking to my friend Amy, who was no stranger to depression herself, so I may have acted had she done so. Instead, Amy told me a story of finding love herself, unexpectedly, and how it could happen to me. She may even have taken the phrase "You often find someone when you are not looking" for another turn. What I do vividly remember is putting my feet up against the cool marble side of my fireplace, saying "I just cannot see the point any more", and crying.
A strong feeling of sadness about my childlessness had persuaded me to seek the help of a psychotherapist, Judy, in the autumn of 1999 and I had been visiting her regularly since. Judy, like the majority of therapists, took the month of August as holiday, leaving me and a whole host of other therapy regulars in a limbo land of summer anxiety. I looked to herbal drugs – St John's wort and others – to boost my spirits and, as ever, I threw myself into the full responsibilities of my job.
What I was far from realising was that none of these tactics were enough. Therapy alone cannot conquer a depressive illness, and neither can herbal drugs. Making work the focus of your life is certainly not the answer. I felt under-appreciated in my job, believed that my contribution counted for nothing. I felt my body had let me down, and that I was useless physically as well as professionally. The feeling was exacerbated when the last person with whom I had had a physical relationship (and with whom I was still involved) took up with someone more than 10 years younger. I found out, painfully, through a third party. This was when my emotional strength started to give out.
The crying got worse. At work, tears would inconveniently start to fall down my face in the middle of writing an email or at the point of making a phone call. In the past many had taken refuge in my office seeking privacy, a shoulder, advice, a place to scream, and now the adjustable blinds became an essential masking tool for my own distress. I frequently took time out to weep in a neighbouring colleague's office. She began to beg me to seek help, but because I was in professional mode, I assured her I was really working hard in therapy and a day didn't go by without my taking the St John's wort. All would be fine.
Finally, I began to realise that taking pride in hiding the fact that I was on the emotional skids was not a good end in itself. I rang my GP, Dr Fahey, a plain-speaking, wise Irish woman. I was brave, then sniffled, then howled, and she said there would be a prescription for me at the surgery that night for Prozac. She assured me I could ring if I felt I needed to talk before our appointment in a week's time, and then she asked if I wanted time off work. My response was an emphatic no. "I have to keep going into work. Work is what I do."
The next day was a Friday and I started taking the Prozac extremely reluctantly. The side effects listed on the pack included headaches, dizziness, diarrhoea, nausea, vomiting, abdominal pains, dry mouth, loss of appetite, anxiety, sleeplessness, nervousness. If I am anxious now, I thought, how anxious will I be on Prozac? If I wake at four each morning now, and toss and turn for many of the hours that follow, will I get any sleep on Prozac?
The first night, I was lucky – friends invited me to stay, friends who understood. But on Saturday, as I prepared to leave, I began to sink at the thought of being alone. My friend was pregnant and to make more demands on her and her partner felt wrong. We stood on her doorstep and she held me close, hugging me and asking if I would be OK. "Yes," I lied, then, more truthfully: "I have to be." But I cried all weekend.
By Monday I could not move. I felt sick, heavy as a rock, everything ached, and my head swam. I had the pains and sort of breathlessness associated with heart attacks and I was, of course, crying. I rang work to say I had some sort of bug and that I hoped to be right the next day. Speaking was an effort. It was hard convincing myself that the advantages to leaving the house and seeing the doctor outweighed those of staying inside where I wanted, desperately, to be, but I knew I needed to seek advice. Dr Fahey offered, again, to sign me off work; my response, again, was an adamant no. I was going into work as soon as I could.
Everyone has different experiences of how they interact with family while in the grip of a depressive illness: some gain no support, some seek no support, some have in mind that individual members of their family are largely or totally responsible for their illness. Despite our lifestyles being completely different, my sister, Amanda, was the one I could turn to at any time.
I was struck by an inability to talk to my parents. I simply could not pick up the phone, or see them. I keenly felt the weight of their love, and therefore the weight of their disappointment that I was childless, partnerless. I saw my own confusion and grief reflected back at me. Eventually I began emailing them messages telling them a little – oh, such a little – of what I was experiencing. I am sure it was partly a result of the good manners they themselves had instilled in me that I made this faint but direct contact. My preferred position was really to remain silent. What child wants to tell the parents that gave them life that they want it ended?
By the time I returned to Dr Fahey three days later Amanda knew that something was really wrong. I had told her that I found eating difficult and that I was afraid to leave the house. I was ringing work each day to say I still had not improved enough to go in. Mornings are the worst time for depression and I was piling on the agony by setting myself the unrealistic target of going to work and then feeling a failure when I was unable to meet it. Dr Fahey advised that I cancel the regular appointment with Judy, my therapist, for that week. At first I suspected professional competitiveness ("I'll save you" – "No, I'll save you!"), but she was trying to prevent any further introspection on my part. I could not see how I was going to get the few miles across north London that the visit required anyway.
So for three days my sister and Judy coaxed me, by telephone, out of the house. A 20-yard trip to the newsagent was fine, a trip to M&S was less successful. I made it to the shop, but halfway round I froze. All that food, all those people. I loaded up a basket then had to leave it mid-store and struggle out of the shop to lean against the wall and gasp. I clutched at my chest, I thought something might rupture.
All this time I kept thinking I would be back at work any minute. That I had to be back at work. It was essential that people did not know there was anything wrong. And, really, there was not anything wrong. I was barely eating, I could barely leave the house, but I was surely fit for work. Surely.
After the second visit to Dr Fahey everything changed. She made me realise that whatever self-deceptions I had entered into, the reality was that I had not been into work for several days, nor was I currently fit to go in. She signed me off for two weeks and gave me tranquillisers to moderate the increasingly severe panic attacks. She advised me strongly to leave London. The idea of being on my own without work for two weeks was unthinkable, unbearable. Amanda was off to visit our parents in the country and taking the children with her. My brother-in-law Neil was staying at home an extra night then would join her there. Amanda's suggestion was that I drive to be with Neil and then the following day he would drive us both to Suffolk to be with the whole family.
At their house that evening I crept into my nephew's room, in his narrow bunk bed and under his Star Wars duvet. I gasped and sweated through the night. In the morning, Neil appeared with some tea and suggested we have breakfast. Fine, I said, yes. Then I realised I might split in two if he left the room. I gestured that I could do with a hug – and then I started the real drop to the bottom. It was as if my chest was going to be rent in two.
As Neil pulled gently away I kept up appearances and said I would be down for breakfast in a minute. I got as far as the bottom of the stairs and realised I could not breathe, was going to faint, and sat there bleating for Neil like some injured animal. You need to eat, he asserted. You need some sugar, something. It had been so long since I had eaten properly my throat was constricted; my head, heart, lungs felt squeezed. And the panic was rising: what if I never eat again? What if I have to stay in this state? What if? What if? I began to hyperventilate. Neil collected me up and calmly set me on the sofa. He found some dextrose tablets and crammed them into my mouth, he lifted my feet above my head and he repeated over and over again that this was the worst, it would get better. But when I could speak I just begged him tearfully to ring my doctor, to get me to hospital, to put me out of my misery. To stop everything, to make it stop.
When Neil felt the panic attack had subsided enough he did go to the phone. He did not ring my doctor, nor the hospital, but Amanda, who got in the car and came back to be with me. In the following days I frequently asked if I could be taken to hospital. I wanted, demanded, a lobotomy. I wanted something to stop the pain, the panic, the screaming, the crying, the darkness. I wanted some peace.
Amanda and Neil withstood my pleas and I am glad they did. I am not sure I would have survived hospital. And I could not give up with my niece, Jessica, and her brother, Alexander, around. "What is actually wrong with you?" 12-year-old Alexander asked repeatedly in the first few days, until my sister took him to one side and gave him an explanation in her determined and straightforward way. I was relieved. I did not know how to answer him, I did not want to scare him and I did not want to lie. But apart from this one small challenge the children were nothing but help to me. They would appear in the morning and scramble on or into my bed and tell me what lay ahead for them that day. And when there is someone so trusting asking you questions as if your opinion still mattered and telling you stories as if it was still important to impress you it is hard to plot and plan death, or much harder anyway.
Amanda brought me breakfast in bed before she left for her teaching job. Breakfast was a small glass of orange juice placed in the centre of a plate with toast fingers arranged around the glass to look like a flower or a sun – something hopeful. I did not feel worthy of such treatment and it would make me cry. Neil worked from home so I was never alone, and Amanda would ring me when she got to work, in her break and at lunchtime.
If my illness put a strain on Amanda and Neil's marriage or their family life as a whole they did not say. To help the days pass I did my best to read carefully selected books – nothing with relationships in, nothing about family love. I met Neil for lunch in the kitchen. I had become, as my mother was to remark unforgettably, "a vegetable". Most evenings were spent inert, watching the family life go on around me. I listened to the children's music practice and I made occasional attempts to help with homework. I should have known that a night of fractions with Jessica was unlikely to be good for either of us. I had to leave her with her homework book pages rubbed raw and almost transparent to howl in the bathroom. She clearly felt this was a topsy-turvy world of role reversal. Wasn't the child supposed to be in tears of frustration not the adult?
While the family watched TV I tended to lie behind it as it continued to induce a state of panic. I tried to hold on to vestiges of my own lifestyle. Neil recorded The Sopranos for me, but I managed no more than a few minutes. It did not induce panic, but anguish. Mine was no longer the life of a sharp, media-savvy woman with sophisticated tastes – after all Amanda had to gently chivvy me to wash my hair. I found that Alan Titchmarsh and other toilers on the land and in the kitchen posed no threat. Being so far removed from my former life made them oddly bearable to view.
Outside scared me. I felt flimsy and exposed. I did not want to be seen or heard. When Amanda was home I followed her round like a shadow, always keen to be in the same room, always keen to be held. I ate a little more food and gained some substance, I had a few more hours' sleep a night. Armed with a mobile phone and a huge send off from Neil one day I left the house to buy a paper. It is several hundred yards to the paper shop from their home, but it felt like a major adventure, and as I paid for the paper I felt a surge of spirit, a lightheartedness I had not experienced for some time.
And then my mobile rang. It was one of my friends, and I was able to share my achievement with her: I had made it to the paper shop on my own. She was so delighted she asked if I had planted a flag there. It was great. But the next day I wept over our celebration. How pathetic. I was a 39-year-old woman, a senior executive at a national newspaper, someone who at the office made hundreds of decisions a day, a woman with a reputation for being scary, and the biggest achievement of that week was leaving the house and handing over loose change to buy the newspaper for which I was still officially the spokesperson.
When the next visit to Dr Fahey loomed I decided I should venture back to London a day or so earlier, the logic being that if I could not be on my own in the house then I should not be going back to work. And going back to work was my goal, and what I expected my doctor to be helping me to do. It was a disaster. The appetite which had been coaxed into some sort of life in the bosom of my sister's family disappeared. There was no room in the house that I could settle in. I could not sleep. I used the time to make my will to plan which friends of mine struggling with infertility I would endow with financial gifts when I was gone.
Dr Fahey was prepared to give me a very, very limited supply of sleeping tablets but "not enough to kill yourself with". I think I smiled at that. "Do you ever think of killing yourself?" she asked quickly. "I rarely think of anything else," was my response. "And how would you feel about seeing a psychiatrist?" Fine, I said, fine. They would make a home visit. Fine. On returning home I panicked. Was I going to be sectioned?
I immediately rang my friend Roger who had had a hand in sectioning someone in the past. His advice was that it takes two to section. If I saw two through the fish-eye in the door then I should not let them in.
A short time later my doctor rang and told me that there would probably be two people who would visit me, a psychiatrist and a psychoanalyst. Two? I started to shake. "Will they take me anywhere?" I asked coyly. "I do not know," my doctor replied. "Only if they think it is necessary." As soon as I put down the receiver there was an incoming call from Siobhain, a lawyer as well as a friend, who, alerted by Roger, was offering to come and be in loco parentis to prevent a sectioning. And then Martin, the psychiatrist, rang. "I will be with you in half an hour."
Perhaps I could convince them that I was not mad. The lethargy which almost permanently overwhelmed me was temporarily thrown off as I set about making my house look sane. I made piles of paper, I cleaned the tea mugs, I folded the rug under which I spent most time. Then I had an inspiration. Recycling. If I put some paper in the recycling bin it would look as if I was investing in the future.
When Martin arrived on the doorstep he appeared to be on his own. I made tea for us in a scene straight from a badly acted kitchen drama; the spoons and china clattered as I tried, unsuccessfully, to keep the shaking under control. We sat in my living room. I questioned him. "Are you really on your own?" and "Are you going to take me anywhere?" He stated reassuringly that there was no one waiting outside.
Things got better after that. He gave a name to what I was suffering – a serious depressive illness – which at its worst was a killer. He identified a singular problem and spoke it out loud. "So you feel you are incapable of doing anything, of being good at your job, of holding down a relationship, of being a mother, and now you cannot even kill yourself, is that right?" So right, so right, I could not speak. This was a jam I could not see my way out of – and I was not at all sure that Martin, or any other well meaning person, could help me out of it either.
It was months into my illness before any of the professionals ventured to use the term breakdown. It was several more before I learnt that this was not a cause to feel ashamed.