The below is a list of symptoms that I have experienced since starting to take Venlafaxine (75mg) from 15 June. It is redacted in places, for either personal reasons or to help the ‘flow’ of this post, but essentially this is from a list I have been maintaining with the intention of showing Dr C when I finally see her again on 8 September.
- Significant increase in (hypo?)mania – I am very much the ‘life of the party’, very confident (at times to the point of arrogance, or being very over-talkative)
- Significant increase in mixed episodes.
- In both of the above obviously fragmentation, pace and disorder of thoughts are of increased severity.
- Rapid cycling between (hypo?)mania and depression at times (ie – changes once or twice a week – occasionally more often, occasionally less so).
- Significant increase in compulsion to (and execution of) self-harm. Execution of ‘creative’ cutting reduced a little after the initial six or so weeks, but is still sometimes happening and I still feel the compulsion strongly and with great frequency. Any lack of execution of cutting is mainly due to environmental factors or preventative measures I have previously taken (eg. hiding knife). Head-banging, hair pulling, scratching at self all still very frequent.
- Severe restlessness – compulsion to head-bang, to pace, get up, sit down, get up, sit down – noticed usually in tandem with severe anxiety and/or mixed states, but not necessarily limited to this (this was present before Venlafaxine but it was much less frequent and much less severe).
- Psychosis – Increased and more severe delusions (frequency – circa once a week? Though hard to say) – eg sun (watching me), signs (sending me messages), iPod (reading my mind/mood), severe paranoia (trust issues even worse – everyone is out to get me). Some hallucinations are of similar frequency as before, but are more vivid – shapes especially clear. Now also hearing voices/whispers which are very audible – as opposed to nebulous – at times (obviously unaccounted for). The frequency of the voices – there are no hard and fast rules, some weeks this is frequent, some weeks there are none at all. No specific time. Content is not ‘demanding’, it just says stuff like saying my name, asking what I’m doing – it is meaningless ‘small talk’. The shapes are there most (but not all) nights as before, same nebulous form as previously, except sometimes with greater clarity.
- Amnesia – eg. ending up in places with no idea how I got there or forgetting long discussions usually related to being mental. Frequency of this is hard to determine – at a guess once a week? It depends – sometimes no such amnesia one week, sometimes several instances thereof.
- Increased mood swings, independent of mania-depression-mixed states – eg. extreme and uncontrollable irritability, anger, frustration, lethargy, anxiousness (again, these mood swings have been strongly present long since taking Venlafaxine but seem to have increased since taking it).
- Constantly exhausted – even more so than previously – except when I’m in a ‘manic’ state during which high energy levels are present.
- Fantasy world is still there but seems less intense than previously – not sure whether this is a result of tablets or psychotherapy though?
- Terrible forgetfulness – I go to do something and literally five seconds later I’ve forgotten what it was or what I went to do. As with anyone this happened the odd time in the past but for me it is now several times daily.
- Horrible, vivid nightmares when I do manage to sleep. Once or twice a fortnight. I very rarely had such dreams before taking this tablet (approximately once every few years). They focus mainly around my being attacked (physically or sexually) or painfully trying to kill myself – despite suicide ideation this is not pleasant at the time!
- Suicide ideation seems increased to others (though not necessarily to me).
- Others say ‘default’ mood is slightly improved but not still not to extent they would have hoped. My own view is mixed. I still feel profoundly depressed most of the time, but perhaps the intensity of that profundity is very slightly reduced (not always – but I think in the main). Furthermore, given the substantial increase in (hypo)mania, depression occurs less frequently – but is felt very strongly when it does due to the strong divergence in mood. Mixed states, which are now very common, are probably the worst state as when I am very depressed I don’t have enough energy to self-harm or seriously consider suicide, etc – in a mixed episode I do.
- Others describe lows / mixed states as being of considerably worse severity.
Symptoms with No Change Since Taking It
- Still feel depressed though as stated others comment that I seem to them to be less depressed during ‘normal’ periods and own view is that it may be very marginally improved at times.
- Insomnia in a similar state, though general exhaustion and lethargy increased. Difficulty falling asleep – if and when I do, wake up frequently, even with medication (without sleep is usually non-existent beyond maybe half an hour or so).
- Dependency / abandonment issues unchanged.
- Narcissism, entitlement – though self-hate has definitely manifested more significantly since onset of psychotherapy (apparently unrelated to medication).
- Misanthropy. Mistrust of people. Abject terror of work, work-related issues, going to unfamiliar places – I fall about in a mess even thinking about this stuff. This is all the same as before. Despite all this, I experience a lot of paradoxical loneliness.
- General levels and frequency of inappropriate anger is similar to before, though outbursts seem to be increased (as stated above).
- Self-analysis, overthinking.
- Dissociative symptoms – depersonalisation and derealisation seem mostly unchanged (apart from the development of amnesiac occurrences – presume this is related to dissassociation in some way?).
- Continued personification of inanimate objects, feeling sorry for such things – no such sympathy or empathy for people (in general).
- Fixation with death (as distinct from specific suicidal thoughts) is ‘stable’.
- Complete and utter lack of motivation – no interest in everyday activities eg tidying, dressing,cooking etc. Same as before.
- Utter inability to concentrate or focus for anything more than a few minutes, except when mood is strongly elevated (and certainly not always then either). Very easily distracted, little ever gets done (applicable at all times).Memory rubbish too. Need to sit and plan things to have any grasp on them.
- Eating problems similar to before.
- Obsessional behaviour continues.
- Black and white thinking and behaviour.
- Post-morteming behaviour.
- Other issues that I can’t think of.
In short, I think Venlafaxine could, potentially, help me with my depression – but the dosage would have to be increased, as the small improvements made in that regard are simply not sufficient to keep me sane. More importantly, though, Venlafaxine is not only not helping all my other symptoms, but either it is making no difference or, more commonly, it is in fact increasing them. I have described some of the horrors elsewhere on this blog. The past few months have been fucking horrendous, by and large. This is particularly the case, of course, as regards the bipolar symptoms.
As you can see from the link at the top of the page, Dr C refused to give me mood stabilisers when I last saw her as she believes that BPD is my primary diagnosis, and NICE advise against the use of them and anti-psychotics in BPD (though this seems to be the mainstay of treatment for borderline in other countries!). That’s all well and good, but of course Venlafaxine is notorious for increasing or inducing manias and mixed states to those predisposed to them. Given that circumstance, you would have thought that she would either have had the decency to listen to my plea for mood stabilisers at the time, or at the very least had her SHO keep the fucking July appointment that they cancelled. If I, a complete psychiatric novice beyond my explorations on the internet, am aware of Venlfafaxine’s notoriety in this regard, surely a consultant psychiatrist, who herself diagnosed me with an illness on the bipolar spectrum, should have taken some bloody consideration of this?
In any case, I have forgotten to bring all my medications, including the bloody Venlafaxine, with me to an overnight visit to my mother’s house. I am well aware of how hardcore missing doses of Venlafaxine can be, plus I also don’t have my sleeping pill so no doubt insomnia calls. I’m sure, ergo, that tomorrow morning’s session with C will prove interesting…