Choose Your Insanity, Part II

Common Side-Effects of Antidepressants

Image result for medication side effectsCome imagine with me a resilient fellow, named Sebastian, with recurrent, severe depression. In his mid-40’s, he is active when he can be. With a wife and six children in the home, he tries to be the best husband and father he can. He has experienced what it means to be untreated and under-treated for severe depression and has suffered the consequences. Now that he has found the right cocktail of medications to keep him from suddenly plunging into darkness, he has discovered a new form of insanity.

Antidepressants can bring with them their own set of issues. The side-effects can range anywhere between slightly annoying to extremely agitating. What happens to you depends on the type of medication you take. Sebastian takes a SNRI (selective norepinephrine reuptake inhibitor), two atypical antidepressants, and an alpha blocker for nightmares.

Common Physical Side-Effects

One of the first side-effects our fellow had was blurred vision. He was driving his children to school one day when it happened. He could no longer see things in real proportion. Sebastian’s poor daughter had to take a quick lesson in driving a long wheel-base van. Fortunately for our fellow, it lasted less than two weeks, but it can drive one crazy during the experience.

Dry mouth is another ongoing problem. He often wakes up with no liquid in his mouth, parched lips, and an awful taste that he thinks surely his wife and children can smell. If he does not take a drink first, one of his medications will stick to the top of his mouth and stay lodged there until some flood of fluids carries it away. Sebastian has discovered the only remedy is to keep something in his mouth throughout his waking hours. Copious amounts of water, flavored drinks, or hard candy help. See what our fellow has to look forward to every morning.

Sebastian has tremors, too. They can be mildly irritating or outright disabling. He tries to be somewhat of a handyman about the house, but often finds he has to make several attempts to get a screwdriver in the slot, hammer a nail, or put something up that requires a steady hand. He is especially embarrassed at supper. He sometimes spills his drink and when he tries to eat, there may be nothing left on his fork by the time he gets it to his mouth. Our fellow feels like a little child that needs a large bib and someone to feed him.

Other physical side-effects can be headaches, dizziness, sweating, nausea, constipation, diarrhea, joint pain, muscle aches, and skin rashes. These are often mild and temporary and “many people build up a tolerance to these early side-effects, and they rarely require discontinuation of medications.” (Dr. Madhukar Trivedi, MD.)

Issues with Sleep and Weight Gain

Sleep is quite an adventure for dear Sebastian. Without medication, he has terrible insomnia. (Sometimes anti-depressants can cause insomnia. Go figure.) When he does sleep, he has to take a “no dream” pill to prevent nightmares and acting out. It does not work all the time. Sebastian will flail about with his arms and legs, hitting and kicking imaginary people or things. At other times he screams, cries, sounds like a baby, makes speeches, or carries on a normal conversation with an unseen person. His lovely wife has to be a brave woman to sleep next to him. His sleep disturbances can contribute to irritability and anxiety. Trouble sleeping can cause Sebastian to be fatigued and drowsy during the day. Our fellow would either be taken to jail or declared legally insane if the right people observed his behavior while sleeping.

The inability to sleep also contributes to suicidal ideations. Although suicide is a slight risk affecting about two to four percent of those who take anti-depressant medication, it is a grave concern. Those who already have a plan to harm themselves may be the most vulnerable. Anti-depressants may give them enough energy, which was in short supply before, to carry out their plan.

Weight gain can be a late arriving and long lasting side-effect. It is one of the major reasons people either stop taking their medication or insist on a change. Sebastian has lost a significant amount of weight. He looks good and feels better about himself. However, the last 20 pounds he wants to lose has been tortuous. He has cut his food intake so severely that he wonders how long he can maintain his restrictive lifestyle. But, it is necessary if he wants to reach his goal. Our fellow is fighting the good fight against increased appetite and weight gain, but he wonders how long he can maintain his restraint without a complete breakdown.

Sexual Side-Effects

Sebastian is young and healthy enough to act on his sexual desires, but the medication prevents performance. Sexual side-effects from anti-depressants are long-term. Like weight gain, sexual dysfunction is a major reason people stop their medication.  Sebastian has experienced it all – difficulty getting an erection and maintaining it, trouble with decreased orgasm or none at all, and a decline in sexual desire. After all, why would you be interested in sex if you cannot perform? Sebastian has tried several things, but has not found anything that works consistently. He and his patient wife try to schedule a night for intimacy. On that day, he does not take his medication. Sometimes it works and sometimes it does not. The lack of medication during the day can leave him feeling sad and blue, and without any sexual desire. At other times, he is still unable to achieve or maintain an erection, or have an orgasm. Our fellow has a God given natural desire, but the inability to carry that desire to fruition is maddening.

I have often told my children that the most difficult decisions in life are not between good and bad, but between good, better, and best or bad, worse, and worst. Sebastian has found this to be true in regards to untreated, under-treated, or treated depression. The choice comes down to which form of insanity do you want to experience. Our long-suffering fellow has chosen to be treated for his recurrent severe depressive disorder and learn to live with or manage his side-effects. To be untreated or under-treated has caused too many adverse consequences that he does not care to repeat. Furthermore, the risk of suicide without proper treatment is too great for Sebastian.

Sebastian is right. Although the medication side-effects can be nearly intolerable, death is too great a risk to take with the other choices.

May God be with you.



Compassion: A Life Lesson

Compassion can be defined as seeing a person(s) in need and finding a way to help them. It was one of the essential characteristics of Jesus during His ministry on earth and has been a mark of the Christian faith going forward.

Image result for giving meal to homeless man I learned and observed compassion from my family. My great-grandmother had nearly one hundred foster children come through her home. One became mayor of the town some years later. Grandma took in and adopted a boy that was abandoned on her doorstep by his mother. She was also known as the “bread lady.” On Saturdays she purchased all the bread she could squeeze into her car and distributed it among the poor. My mother fostered teenage girls and it was not unusual to come home from school to find a man sitting on our front porch eating a meal my mother had prepared. Dad was known as the “candy man” at the large orphanage at the edge of town where he regularly visited and distributed treats to the waiting hands of children in residence there. My father also hired men who were too proud to ask for a handout, but needed help. He paid them more than the job was worth, thus preserving their dignity and helping them get through a rough patch. My first opportunity to help someone in need without prompting or assistance from an adult was in fifth grade. That year our local school district began the effort to integrate physically challenged, but mentally capable children into a regular classroom. I eagerly volunteered to help one of the guys during recess by pushing him in his wheelchair out on the playground. It was a rewarding experience.

Coming from a family like mine, compassion can become an obligation of tradition to which one might have no personal connection. But, I have discovered there is another teacher of compassion beyond our family of origin – life experience. There are some who may become bitter, cynical, crass, and hardened as a result of the vicissitudes of life, but for many of us it softens our edges and makes us more thoughtful and tolerant of others. Here are three lessons in compassion I have learned along this pilgrim pathway.

  • It is easy to hold dogmatic positions until it happens to you or someone near you.

I believe in absolutes, but my list of always right and always wrong has become much more narrowly defined. You have the luxury of a long list of unbendable rules until life happens. It is quite simple to question the genuine faith of a person who does not attend Sunday school, Sunday night, or mid-week church services until you live in a community where those choices are severely limited or unavailable altogether, not to mention the obstacles of poor physical or mental health, familial obligations, or other hindrances.

A theology of the family can be rigid until you or a loved one goes through a divorce. It is only then that some of the idealism must give way to realism. You still do not deny the way it ought to be, but you find yourself learning to live with the way it is.

While teaching a college level Old Testament course, the subject of capital punishment came up for discussion. One young man was adamant that everyone who murders another person should be put to death. Several times I tried to guide him toward a more nuanced position, but he grew all the more vociferous and dogmatic with each effort. At last I closed the subject. Several hours later he sought me out and profusely apologized for his words. I thanked him and expressed appreciation for his demonstration of sorrow. Did my argument persuade him to make such a sudden change? No. It was being made aware of my experience that caused a rethinking of his position. You see, at that time I had a close relative awaiting trial for murder.

  • It is easy to judge others until you become the one being judged.

“Alcoholics and addicts are that way because they choose to be that way.”     “Why don’t homeless people get a job?” Or, “Why don’t poor people just get a better job?”      Here’s a classic, “Mental illness is all in your head.”

How quickly we judge what we do not understand. I am ashamed to confess that I was critical of twelve-step programs without having read the twelve steps. Only when I started going into jails, hang-outs, under bridges and cliffs, and into the hovels and shelters people called home did I realize what a devastating illness this disease of addiction was. Some had lost everything – property, family, job, freedom – and still could not quit. The physical and mental chains were so interwoven throughout the critical mass of mind and body that to stop instantly meant certain death or such anguished and intolerable mental pain as to drive one mad.

Homelessness and under-employment have a myriad of causes. Five different times in my life I have been homeless for various reasons. After I got out of jail no one would give me a job or a place to live. I called a place in San Antonio that advertised they could get a place to live for anyone with a record. When all was said and done the kind lady told me, “There is nothing I can do with nine misdemeanors.” Is it any wonder that people commit another crime just to get back into prison? They need a place to live. At least they know there they will have three hots and a cot. On the outside there are a thousand obstacles and even more uncertainties.

  • It is easy to have answers for others’ problems until you become the one doing the questioning.

“Why did it have to happen to me?” That question makes a religious leader, physician, or counselor tremble. Many times there are no fixed answers or ready solutions. Sometimes situations do not present themselves as right or wrong, good or bad. Often the choice is between good, better, and best or bad, worse, and intolerable. You learn to trust God, believe in yourself, and allow others to help you make an informed decision with the options before you.

As a seventeen year old college freshman  in Cincinnati, Ohio I saw my first prostitute standing on a street corner. At that time I judged her prospects slim-to-none for finding a paying john because of her large size. Today, I would look at that same woman braving the cold winter with a barely there short skirt and four-inch spiked heels and wonder what drove her to such desperation and compelled her to sell her dignity and risk her safety for a pittance of what she is truly worth. Today, I would listen to her story and try to help her find a way out if given the opportunity. Today, this old fat man would choose compassion learned through the sometimes hard experiences of life.