Currently, I’m sweating and shivering, and I feel like have the world’s most sudden-onset case of the flu. It’s entirely my own fault; I forgot to take my pills last night. I stayed up late in a fit of enthusiasm for playing videogames, and I tumbled into bed in such a hurry that I forgot about the pill organiser patiently sat on my windowsill. I’ve taken them now alongside the set for this morning as a catch-up, but it will be several hours before the symptoms go away.
I take a variety of pills, but I know exactly which one is causing the shakes: quetiapine. I loathe quetiapine. I hate having to take it, because not only does it involve this insanely rapid withdrawal crap, but it also makes it impossible to wake up in the mornings, and it’s caused me to gain nearly 25kg in just six months. And I have no idea if I should be taking it at all, or if it’s doing any good.
I originally began taking quetiapine over a year ago, in a tiny dose as an antidepressant augmentation and a sleep aid. I didn’t really notice any side effects back then, although my depression was unmanageable and in a self-destructive tailspin, and I wasn’t in a fit state to notice very much of anything. This all came to a head when my case manager prised the truth out of me that I was acutely suicidal and intending to kill myself that same day, and I was encouraged to volunteer for hospital admission in that politely worded tone of voice that makes it perfectly clear that if I fail to “volunteer” then there will be sectioning and coercion following shortly after. I was in the hospital for two months, during which the psychiatrist I saw made two recommendations at once: ECT and a massively raised quetiapine dose. Over two weeks he raised it from the tiny antidepressant-augmentation dose up to the heavy doses they use to combat psychosis.
When I was discharged, I was told that if after six months I’d had no relapses, then the quetiapine could be gradually reduced again. Trouble is, it’s been six months now, and I’ve had no medication reviews – nor have I got anyone to ask for a medication review. My GP has firmly said all along that she’s not qualified to handle polypharmacy psychiatric medication, and that it’s solely in the hands of the psychiatrists at the personality disorders service who have taken care of me for the past ten years or so. That’s all well and good, except that the only person I see with any regularity is my case manager, who is wonderful but who isn’t a psychiatrist. I could ask to see one of the psychiatrists attached to the service, except that I won’t be a patient with them for very much longer. Budget cuts mean that they’ve got to severely slim down the services they offer to the point that my case manager doesn’t feel that he’ll be able to take care of me effectively any longer, and he’s currently putting through a referral to the depression specialists – which could take months. So right now, I don’t have anyone monitoring my medication which means that there’s no-one to prescribe me quetiapine in anything other than these huge pills, which I can’t subdivide into smaller doses. Snapping them in half is hardly scientific, and anything smaller just reduces them to powder. The god-awful withdrawal is enough to deter me from attempting to just quit them cold-turkey (I stuck it out for three days once, and I felt like I was dying) so for the forseeable future I’m stuck at the high dosage along with the weight gain and the morning-zombiehood.
The most annoying part is that I don’t even know if the quetiapine is doing me any good at all. It’s true that I’ve been mostly stable (if miserable) for the past six months and that I’ve only gone on a poisons research spree once or twice in that time, but since my hospital admission involved both the introduction of the quetiapine and the ECT at the same time, how can I know whether this period of stability is attributable to the ECT, or to the quetiapine? It’s possible that the ECT worked a miracle “cure” the way it’s supposed to, and the quetiapine’s doing nothing. Or it’s possible that the ECT was a failure and the quetiapine is responsible for saving my life. Changing two things at once is an appalling way to conduct an experiment, and it’s not possible to disentangle the two effects. The scientific method demands controls and only changing one variable at a time for this exact reason.
If the pills are responsible for my still being alive, then I’ll grudgingly deal with the side effects. But if they’re doing nothing productive, then I resent having to take something that makes me feel like a stoned beached whale and regularly makes me sick if I forget them even once for just twelve hours. Once, I forgot to refill my prescription and ran out of pills on a Friday. By Saturday evening I was so ill that I ended up having to see one of the emergency doctors at the hospital in order to get a dose to last me until the Monday. When I’m in a depressive fog, organisation and preplanning are not things I am good at. It’s inevitable I will screw up sometimes, and every time I do the withdrawal is way too severe a punishment for the actual transgression.
Carriction 