Over the past couple of months I’ve had three sets of symptoms: intense intrusive thoughts/fears about death, depressive symptoms, and my usual religious OCD obsessions and compulsions.

I know how to handle my usual OCD, and to some extent I am familiar with intrusive thoughts, as my OCD took this form when I was a teenager. But I don’t know how to handle depression. I feel frustrated because people’s advice for how to deal with it is to talk to people, have therapy and so on. But I already do this – all through this period I’ve talked to my loved ones and increased the frequency of my therapy sessions. I’m also quite good with being kind to myself – a side effect of 10 years of therapy for OCD is that I learned how to reduce self-criticism and increase self-care. So why am I depressed? The most likely answer is brain chemistry.

There is some debate in popular culture about how useful antidepressants are, and whether they are doing what we think they are doing. But to look at it from a neuroscientific perspective, the generally accepted thinking is as follows: neurons communicate with each other across gaps called synapses. This communication is done by neurotransmitters. These are released from neuron 1, travel across the synapse, and are taken up by neuron 2. Any neurotransmitters that are left floating in the synapse are taken back by neuron 1. One of these neurotransmitters is serotonin. It’s theorised that a feature of some mental health conditions is that neuron 1 is too keen to take the serotonin back. This means that neuron 2 doesn’t manage to get enough of the serotonin. So the way SSRIs are thought to work is that they keep the serotonin in the synapse for longer. This gives neuron 2 a better chance to pick the serotonin up.

My best guess for what happened, based on my own knowledge and discussion with my psychiatrist, is that after 7 years of the SSRI sertraline, my brain got used to dealing with sertraline-enhanced levels of serotonin. When that sertraline was taken away, my brain didn’t immediately spring back to “healthy” use of serotonin. Instead it ended up with depression-like levels of serotonin transmission, which in turn led to depression symptoms.

Depression over the past few days

The last few days have been a little easier in terms of depression symptoms. I don’t think I’ve cried in the last few days – prior to that I was crying every day. Crying every day was strange for me – even before I started antidepressants this wasn’t something I had experienced. When I was having a hard time with life events I would cry quite a lot, but that was in response to what was happening – this recent crying could be triggered by anything and was linked to my general mental state rather than external circumstances.

The change seemed to come when I got a good night’s sleep. Before that I’d been having trouble sleeping, and was only sleeping for short periods at a time. I think my new SSRI (fluvoxamine) might be starting to work as well. I got up to 150mg on 10th October, and 200mg on 15th October. I’m continuing up until I get to the maximum of 300mg. This is because you have to be on high doses of antidepressants when treating OCD. But to be honest at the moment I want it to reduce the symptoms of depression, reduction in OCD symptoms would be a bonus.

In contrast to the experience with clomipramine I haven’t had any obvious side effects from fluvoxamine. The difficulty sleeping might have been related, and I also had some headaches (although that might have been due to lack of sleep).

Getting from three to two

As I said above, I’m used to coping with OCD; I’m not used to coping with depression as well. Since the depression has lifted slightly I’ve had a little spark of hope that I can deal with the intrusive thoughts – they are scary but they are something I’ve dealt with before, and I have strategies for how to approach them. I’m leaning on my new SSRI to help with the depression – if it doesn’t then I hope I can go back to sertraline and that will help with the depression instead.

Having all three of the symptoms I mentioned above has been horrible and incredibly difficult to cope with. The past few days have been a bit easier, I’m hoping this sticks. Sleep seems to be important so I’m trying to prioritise that.

Last week (4th October) I had an appointment with my psychiatrist, the first chance I’d had to see her since I got very ill at the beginning of September. I told her about how much I’ve been struggling – the constant intrusive fear, feelings of terror, and frequent periods of crying. I keep feeling that I can’t cope and I’m finding it very difficult to keep pushing on each day. I haven’t felt this bad for this long in at least a decade.

We discussed the fact that since I came off sertraline at the end of June I haven’t been on a high dose of an antidepressant. I did get up to 200mg of clomipramine but only stayed on that dose for a week as it was causing light headedness and I didn’t think it would be safe to drive for long periods of time.

It turns out that taking away a high dose of antidepressants seems to have resulted in my brain getting depressed. Although it sounds kind of obvious when you think about it, I (and presumably my psychiatrist) hadn’t anticipated that this might happen – to the extent that I’ve had depression in the past it’s generally been in response to trying to cope with OCD, rather than as a condition in its own right. (I was coping with severe OCD whilst I was on sertraline, but I wasn’t depressed).

The psychiatrist told me that 2 months is a typical length of time to relapse with depression after stopping antidepressants. She also told me that the fact I’ve been feeling worse earlier in the day than in the evening could be a symptom of depression know as diurnal mood variation.

Right now I’m fed up and desperate for this to stop. But when I spoke to the psychiatrist I did feel hopeful – she seemed fairly sure that the horrible time I’ve been having has its roots in brain chemistry. That suggests we can put it right by improving the brain chemistry.

Risk something new or go back to coping?

You have to build up antidepressants slowly, and it takes time for them to work. So I’ve had to choose whether to go for a new SSRI which might help my OCD, or whether to go straight back to sertraline, which wasn’t helping my OCD but which I now know seemed to be keeping me “ok” in terms of not feeling “wrong” in my head all the time/having depression.

Someone recommended fluvoxamine, an SSRI I haven’t tried before – they had found it very helpful for their OCD. So I’ve decided to go for fluvoxamine. It’ll take about a month to build it up to a high dose, and I’ll have to wait another month or so after that to see if it helps my OCD. If it doesn’t then I will have to come off fluvoxamine and build up sertraline again. I don’t want to live like this for another 2+ months. But I feel like I should keep fighting and try the fluvoxamine in the hope that it could help with my OCD. If I went straight back to sertraline I could be fairly confident it’d reduce this new form of persistent suffering, but I’d be in the same place OCD wise.

I’ve just taken my 4th dose of 100mg fluvoxamine. I can go up to 150mg in a couple of days. So far I haven’t noticed any change mental health wise, though I’ve been having a lot of trouble with insomnia. Insomnia is quite common for me but this has been particularly bad – the past couple of days I’ve spent about 4 hours trying to get to sleep. I know serotonin (which SSRIs work on) is connected to sleep, so I’m hoping that the extra insomnia is a sign of something happening serotonin wise, even if it’s not a good thing yet.

Writing this blog helps me feel a bit more like me, so I’ll probably be updating more regularly over the next few weeks as I try to carry myself through each day. Thank you for reading!