A Line of Deathless Kings (Citalopram)

A quick caveat: this is by necessity a very personal post, about my own personal experience. It should in no way be imagined that I wish to speak for all people affected by the issues I describe below, and I welcome anyone who's experiences are similar or completely different to share it, as the more we talk the more we understand.

In December last year I started on a course of Citalopram which is due to finish up around the beginning of June, although that's going to be reviewed by me and my doctor. I have mixed feelings about the next stage, but I'll come to them later. Citalopram is an anti-depressant and an anti-anxiety drug, one of several in the new(ish) class of SSRI antidepressants, which work - unscientifically speaking - by giving a sort of cushion to stop you going under, rather than by quashing all feeling whatsoever. Citalopram is a remarkably common drug, it seems. You probably know someone (apart from me, that is) who is taking it, even if you don't know that they are taking it, but chances also are that you don't know all that much about it.

I have been depressed probably for most of my life - it is hard really to pinpoint where it starts because it is hard to pinpoint when you understand that other people don't feel the way that you feel about things, that your responses are not normal as such. I wasn't really aware of depression as a way of explaining how I felt until I was a teenager. I've been lucky in that for long periods of time I've been perfectly able to cope with it; only occasionally have I found myself in need of outside help.

Sometimes I've been wise enough to seek it, and I've had a few bouts of counselling, and sometimes I haven't, and have ended up self-medicating with St John's Wort, alcohol or razor blades. At the end of last year, as I could see things quickly gathering into a dangerous swirl of Low, I talked to the doctor and we decided that, for me at this time, medication would be the best option.

This is the first time that I've taken any kind of mood stabilising medication and it's been an interesting experience but also one that I've found isn't really discussed very frankly - at least in terms of what it's like to be a person taking them as a means of getting on with ordinary life. That's not to say that I haven't discussed it with people, more that those discussions tend to be coded and limited. There's almost a secret fraternity too of mental health sufferers, carers and professionals, who share experiences and advice but who present a resigned front to the outside. This I understand - I too don't really like to talk about being depressed unless it's relevant, and to the vast majority of my dealings it isn't; while it may be a constant presence in my life I, and many other people I know in similar situations, do not want it to be their defining attribute in other people's eyes.

Except that there's more as well; because it isn't just similar to how I don't tend to talk to my workmates about my interest in gaming on the basis that none of them care, there is also the stigma attached, both to mental illness and to the taking of medication to control it. There's the worry that people will think you are unbalanced, and might snap; that if you let an employer know they might  not want to employ you as a possible liability; and even that people will think your mental health is their business, and that they will pile in with suggestions about how you can fix yourself with willpower alone, or dismiss you as weak for not being able to do so. Even amongst the ranks of the mentally ill there are hierarchies; the perception that taking medication is ostensibly failing is still present amongst sufferers, although not as prevalently as it is in society at large.

Telling people you love that you are going to start on a course of antidepressants was, for me, a horrible flashpoint, and one that happened, necessarily, with terrible timing. While I don't regret making the decision to inform people at the time rather than later, when I might have been a bit more stable, I do regret how I handled my telling. Unfortunately, as Christmas was nearing I was unable to hide myself away until the effects of the first few weeks had stabilised. In addition, I was in a terrible low point, and so my judgement may well have been affected. What was interesting, and difficult and even hurtful, was how being prescribed the drugs suddenly made my depression real. People who I thought had known I was depressed suddenly revealed that actually they had thought I was probably just a bit sad, that it wasn't a part of my life. Medication meant Depression, and so suddenly they were worried about me in a way they hadn't been before. Being medicated for something makes that thing real.

This is just a horrible situation to be in, because it hurts to cause worry to the people you love, but also it hurts to realise that the people you love thought before that you might have been over-reacting or complaining out of turn. The only solution was to talk and to discuss and to listen and to apologise - on both sides - and I do feel glad that I have been able to come through that, even if it was triggered by a period of very bad depression and a difficult decision as to how to cope with that.

There is a standard anecdote I have heard repeatedly, and in fact experienced to a certain extent myself - at least in terms of the sequence of events, although without necessarily taking away the same message. What happens is this: someone you know calls you in great distress, or meets up with you or whatever.  They are freaking out, and scared about what they may do to themselves, although they are demonstrably still them, personality wise, and they may even be more animated and engaging than you have ever seen them before. They tell you, maybe for the first time, that they are depressed and that everything is getting too much for them and that they need help. You talk to them and calm them as best you can, encouraging them to seek professional help and saying that you will see them again as soon as you can, often in a few days time. When you next contact them they seem suddenly listless and uninterested. You arrange to meet them and they tell you that they went to a doctor and have been prescribed with antidepressants, but you feel something is wrong. They seem somehow worse than they did those few days ago; now they are listless, unresponsive, zombie-like. This is disconcerting and sad - this once vibrant if troubled person is now no longer themselves - they are a husk, and this is what the drugs do.

The thing is, you talk to people after they tell you this, and ask how the person in question is doing now, and more often than not the person is doing fine. They are getting on with their life, they are almost certainly still taking the medication, they just don't talk about it so the abiding impression that people have of the medication is the crash at the start, not the life afterwards. I'm not saying that being on medication in either the long or the short term isn't without its problems, or that it helps in every case, just that once it is working then, like a prosthetic leg you might not even know about it unless you already know its there. Here's how it was for me.

The first week was very weird and very tough. If it hadn't been one of my busiest weeks at work I would just have taken the whole thing off work. The main initial effect of the drugs was nausea and lethargy: I was shattered, I felt sick to my stomach and I could feel a sort of dull, fuzzed out pulse through my nerve endings. Initially it didn't really stop any of the sadness, the anxiety, the fear or the intrusive thoughts and violent hallucinations of self harm. It did make me too tired and unresponsive to argue with them though. (I'm informed that this is one of the real dangers with starting antidepressants, and especially mild ones such as St John's Wort when one is already suicidal - as it can take the edge off just enough to give you the motivation to act where before you had only despondency.) As it was, I held it together at work by concentrating on the job and trying not to talk to anyone - the rest of the time I didn't have a clue.

My overriding memory of that week is a single day, driving back in the dark over Ditchling Road past Hollingdean golf course with Brighton and the sea rising before me, the 'wubwubwub...' of the Citalopram pulsing through me as I listened to the album A Line of Deathless Kings by My Dying Bride. I'd like to say I felt something profound, but I didn't, I just seemed to understand an album I'd never really got before, that I'd always felt was a harsh band with the edges filed off. If Turn Loose the Swans is life with depression, then  ...Deathless Kings was life on Citalopram, fuzzed-out, unfamiliar, but no less complex, deep or heavy for all that.

We allow musicians and poets to inform us probably more than we should on the subject of depression and medication. The popular discourse is hijacked by the outspoken because no-one else wants to talk about it. The problem is that we can't deny the medium or the voice to those who do want to provide an outlet for their pain, but at the same time it becomes distorting. There is also the danger that depression can become too closely conflated with bi-polar disorders - for the afflicted artist the period of mania is often their most creative, that the corresponding period of depression is one of true sight and that they are both an integral part of a cycle that they feel unable to break for fear of breaking the whole creative machine. They tell us that the highs necessitate the lows, that to deny either is to deny life and because their talent is to create realities with their words we believe them; that the drugs which even out both to a flat normality rob you of the power of either state.

I can't speak for people with mania because I don't have it, but I can say that you can have depression without it, and that the things that you see in that state aren't truth. I've always had a cycle to my depression, that's roughly a month in length and I've found that I am able to do most of the creative work I have wanted to do when I'm not at my lowest - which means that maybe one week in four has always been a write-off. I've never had the week of high output that supposedly makes up for it, though, so frankly, why should I put up with that lost week just to be more 'true' to myself?

After the first few weeks the weirdness subsided, although a general nausea remains. As does a static-electric awareness of my nerve endings that I more commonly had, although more severely, in my lowest moments. When I do start to feel anxious I feel it more as a wave of nausea than a wave of self hatred, which is different, not entirely pleasant, but feels maybe like something I can cope with more easily. It doesn't mean that I never feel down, just that it's sort of cushioned and modulated - coated by lethargy instead of hatred. I have visions of cutting myself but rather than having to fight it, I just feel too tired to try and they pass, as quickly as they did before but without the same sense of terror. Interestingly, the first really bad low I had I was completely unprepared for, as it was outside of my normal pattern, but I was able to weather it fairly well. I can't drink as much as I did before, but then that's probably no bad thing.

There are other side effects, although for me they seem worth it in the long run. I had terrible eczema for the first month or so, but it's died down now - again it's similar to what I get ordinarily when I'm stressed. I've put on weight, although I was doing so anyway ever since I started a desk job five years ago.

There are also those effects linked to sex drive and performance - skip to the next paragraph if you don't want to know. Depression anyway can mess up your sex drive, and I'm used to periods of not being interested. Citalopram has, as with other things, evened those periods out. In general though, it  hasn't stopped my desire, but it has messed up some of the machinery. Everyone wants to last longer in bed, and with the drugs I'm on I do. It's just that sometimes now I can't finish at all, or at least it feels like I'm almost there, but nothing comes out. It takes getting used to, these not-quite orgasms, but sex with a partner needn't be so proscriptive, and intimacy is still an awful lot of fun. The biggest effect it's had on my sex life is masturbation, which now can descend quickly into more of a chore than an act of enjoyment.

It's a strange thing to come to terms with the new way that your body reacts to things, and to change your old trusted patterns, no matter how much pain may have been wrapped up in them, for the unknown new. But now that I'm used to it I'm not sure that I want to go back, which is a decision I will have to make soon. Did I think more clearly beforehand, or is that nostalgia? Is my ordinary, low level, cope-able-with depression a better way to live than this? At the moment I just don't know.