There is one thing that most, if not all people who take medication for a mental health illness, like depression or anxiety, dread. That’s a change of medication. I have been through this process several times over the last 20 years, so know first-hand how difficult it can be.
A few weeks ago I was forced to change the medication I take to manage my anxiety disorder, as it is no longer being manufactured worldwide. I have been on this drug for over 10 years and although it has some annoying side effects, it has been very effective at managing the symptoms of my anxiety. I certainly would not have chosen to change it.
I started the process of transitioning to the new drug with some awareness of the difficulties I would face. I knew I would probably get some headaches, nausea and maybe some dizziness. I also knew it would take about 4 to 6 weeks to transition to the new medication. I was not prepared though, for how dreadful I would feel, physically and emotionally, and how long it would take for me to start to feel better.
Here are the plans I put in place to prepare, my experiences along the way, and my tips for those of you who are changing medication for anxiety or depression.
Plan to spend more time in bed than you expect
I worked with my doctor on a 4-week transition plan, with a weekly change in dose. The old drug would be reduced each week, while the new drug would be added and increased. This was always planned for the end of the week so I could spend a couple of days relaxing at home or in bed if I needed too.
This worked quite well for the first couple of weeks. But as I started to feel the withdrawal effects from the old drug gradually leaving my system, combined with the side effects of the new drug, I became very unwell.
I started getting massive headaches that would not respond to pain killers. I was constantly queasy, which made it very difficult to eat. I love eating but I couldn’t even bear the sight of food at times. I lost about 3 kgs in a 2-week period. As I wasn’t overweight to begin with, this was a huge amount of weight to lose so quickly.
By week 4, I had to spend several days in bed and several more doing very little. After 8 weeks, I am finally starting to feel physically better, but I still haven’t felt well enough to return to my normal exercise routine and my appetite is only just returning to anywhere near normal.
My learning from this experience? Plan plenty of time off work and be prepared to need lots of bed rest. Also make sure you have lots of snacks at home, as it can be difficult to eat normal meals.
Tell a few people in advance so you can get support
It can be really hard telling people that you have an anxiety disorder or other mental illness and often it isn’t appropriate or even necessary. But sometimes it is helpful to let at least some people know.
I did tell a couple of people about the medication change in advance, so I could change appointments if needed. This definitely made it easier when for example, I needed to cancel my appointment with my personal trainer at the gym. I didn’t need to explain why I was feeling unwell.
Fortunately, I am self-employed so didn’t need to talk to a manager about having time off work and I was able to shuffle my workload so I could rest when I needed to. These can be very difficult conversations to have at the best of times, so plan to have them well before you change medication.
Be prepared for the underlying anxiety symptoms to resurface
I naively thought that because I was changing between similar types of drugs, I would not have too much trouble managing my underlying anxiety. I have been very wrong about this. The new drug works very differently. It is nowhere near as calming and my anxiety has increased significantly. Over time, this will be managed as we find the dose that works for me, but in the meantime, my anxiety levels are higher than I would like, I am struggling to sleep, and I am generally feeling exhausted by the process.
Fortunately I have learnt a lot of skills over the last 30 years to better manage the anxiety and sometimes obsessive worrying that comes with it. I am spending time doing mindfulness activities like crafting and walking the dog as a way of relaxing and giving my mind a break.
Make sure you have done some work to develop a few skills to help you manage your anxiety before you change medication. This could include getting some CBT (cognitive behavioral therapy) to help with the worry and obsessive thinking that can be part of anxiety, as well as incorporating mindfulness into your daily activities.
The importance of good support
Everyone struggling with a mental illness needs good support people around them, including a good doctor. I am incredibly fortunate to have a really supportive wife who is also a mental health nurse and a skilled therapist.
I found my mood dropping and by week 4 of the transition. I was slipping into the dark black hole of depression. I was able to talk to my wife about how wretched I was feeling. She recognised the danger and between us we worked with my psychiatrist to quickly increase the dose of the anxiety medication I was on. My mood immediately improved.
It is important to reach out, ask for help, and tell someone you trust how you are feeling, particularly if you find your mood dropping or your anxiety getting out of control. It is a scary and potentially dangerous time, so have a safety plan in place just in case you need it.
The potential impact of changing medication must never be underestimated. Sometimes we strike it lucky and have a relatively easy transition. Other times though, it can make us feel truly dreadful. From my recent experiences, I believe it better to plan for the worst and hope for the best!
To find out more about how you can manage your anxiety? check out our online courses.
Jane Hurst, PhD
Instructor, Walking Tall Online
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