I’m not OK

This is a story about mental health. My mental health. It was inspired by a post by Rob Campbell a little while ago about his struggle with mental health. It carries the same warnings you would expect about any writing on mental health. And the same warnings you’d expect about any writing from me – it’s long and boring.

I knew something needed to be done, not some day but right then.

For years I had wrestled with how I felt. Or to be precise, how my head felt.

I had good periods and bad periods but for over a decade I had suffered from what I can now, and only now, describe as poor mental health.

But there, standing in tears in the toilet of the English Pulman Train last October as it transported us in some style to Bath on a belated birthday celebration for my Wife, I finally knew I needed help. Real help.

Because if you can feel in such despair on an occasion like that, when by every objective measure you are fortunate and successful, you must accept that you have a problem.

I had sought help, made cries for help, employed all sorts of tests and cures before – MRI scans, cognitive tests, neurological assessments, hormone analyses, tests for dementia and lots of therapy. But every time, everything and everyone said I was just fine.

No one could or would accept that I was not OK. That to my mind, my mind had stopped working. That I was in emotional pain and believed that I could no longer function properly.

But the week after that trip to Bath, instead of hiding what I was going through from the people that paid me, I came clean with them. I went to our Head of Talent and asked for her help.

And within a couple of months, I had both a psychiatrist and a therapist, a diagnosis of cognitive depression and medication to treat it. And almost immediately I started to get better, properly better. Better than I had been for years and years.

And though I am paranoid about triggering myself by doing this, I want to tell you about it all. Partly to record the journey I have been on for myself, partly to help anyone that might be suffering in silence and partly to show that none of us really has got our shit together and many wrestle with mental health issues.

While I love the openness to mental health that has developed in recent years. I love that this taboo is being broken down. I love that our employers are aware of mental health issues and are prepared to support us with mindfulness, exercise, coaching and the like.

I also want to make it clear. If you are not well and you know that you aren’t, you should get help now.

And get real help.

But I am getting ahead of myself. So, let’s go back nearly 15 years. Buckle up, this is not a short story.

How it all began

I can’t tell you exactly when it all started. Because who really admits or can recognise that they are entering a mental health episode? But I think that it really began in about 2008.

I had just started a job that felt overwhelming, the Chief Strategy Officer of Saatchi & Saatchi, an agency that at the time was in real trouble. Turning it around took enormous energy from the entire leadership but for me it was my first properly big job and I think I was incredibly intimidated by the scale of the task.

After six months I was feeling burnt out. Tired yes but more than that, an impenetrable fog had descended over my mind and wouldn’t go away. I felt exhausted.

If I say I felt that I had stopped being clever I sound like an arsehole, I know I do. But if you are a strategist like me, that’s literally all you have. Seeming clever every day is what stands between a successful life with the ability to support others and, as far as I saw it, the abyss.

A holiday seemed like the obvious answer but when, after two weeks away, I returned feeling no better, things got dark. I was foggy almost to the point of pain and I was losing my drive.

And while I was not overtly suicidal, I was utterly preoccupied with the point of my life, especially if I was no longer able to make my brain work. People were depending on me, those in the agency of course but also my family. If I couldn’t do what I was paid to do, then the whole house of cards I had built over my adult life would collapse.

The unpalatable truth

There was actually a very simple answer to what was going on.

But at the time I felt it was so simplistic and obvious that it couldn’t possibly be the problem.

The long-term relationship I had with the mother of my children was collapsing in slow motion and the fallout was descending on the two people I loved the most in the world – my boys. The pain and grief of leaving them combined with the sense of loss of the story I had written for my life was tearing at my heart and at my mind. This was not what I had planned at all.

I know this sounds ridiculous, but I have only been able to accept this as an explanation recently. Partly I genuinely regarded it as too obvious an answer. And partly I felt that I didn’t deserve to make that the answer, that it wasn’t fair to blame my breakdown on others or external factors. This was my problem. Of me. For me. No one else.

And maybe it was more satisfyingly complex than this. But recently I have felt it’s time to embrace the thing that was staring me in the face.

This trauma might be the catalyst but that doesn’t help understand what we happening to me and how to resolve it.

It’s all in the mind

I can’t really describe what it’s like inside my head when I’m feeling ill. My mind is cloudy, I can’t remember things, I can’t think properly, the pressure builds in my head like a tight band has been wrapped round it and I feel almost physically sick. Nothing interests me, noting motivates me or drives me. I don’t want to do anything that I don’t absolutely have to do. I can’t speak because I can’t think. I don’t know what to think, I’m not thinking anything. I can’t pick up the phone or write an email and so I can’t get things done. I don’t want to have fun, I am moody and miserable. Horrible to be with. And I feel absent from the world I’m in like I’m watching my life as if it were a programme on TV.

It’s shit.

And really the only way I have to cope with it is alcohol. For that evening it makes it all go away. Lightens my mood. Stops me dwelling on the implications of failure. To be clear, I never became an alcoholic I don’t think, but drinking became a problem because I was using it to numb the pain, lift the cloud and also to avoid sorting myself out. Every night I told myself that the next day would be better, I would ‘shake the etch-a-sketch’ of a new morning and all would be good.

But by the end of my shower ithe fog would be back. Every day for months and then years. Perhaps three in total.

The clouds part

And then it went. Just like that.

In truth I now think that the difficulty in motivating myself hung around for years later, that lack of drive. But the cloudiness lifted, and I could perform again. It was a wonderful feeling.

The problem was, I had no idea why the episode had stopped. Nothing seemed to explain why I had got ill in the first place, and nothing seemed to explain why it had suddenly disappeared like an occupying force that steals away in the dead of night.

It’s true that things were changing in my life.

I had met someone new, she is now my wife, and I genuinely felt that I had been given another chance of happiness. She met me when I was in the midst of everything and not only accepted me as I was but has always been supportive even when I have been tough to be with.

The relationship with my boys was wonderful and close. And though the experience was coloured with guilt I was undeniably a better father to them, and I felt good about that.

And there were many other changes from the sublime to the ridiculous that at times have all qualified for serious consideration as ‘reasons’. I had my eyes lasered, so I felt more connected to the world, given it was literally less blurry. I had started going to the gym and running, significantly increasing my physical exercise. And with weight training I had upped the protein in my diet. Maybe one of them had helped me, maybe all of them. Who the fuck knows? I certainly didn’t.

All I really understood was that it had gone, and I was fucking glad to see the back of it. I enjoyed a few very productive years, building my career, building back my life and seemingly functioning.

The end of the world

Then things started to go wrong again.

There was a very public incident followed a little later by lockdown and the isolation and detachment that this created. I didn’t fare well. As a natural introvert I found it easier and easier to slide out of view and into the shadows. I lost so much of me and I lost many of the things I valued about the connection and community of the place I worked. And I was missing being live and on ‘stage’ in a business that’s about performance not powerpoint.

As we went through multiple lockdowns things got worse and worse. Every day, was about getting to the end of the day and every week was about getting to the weekend. The same old thing showing up in the same old way.

By late 2021 and that train journey I was in deep trouble again.

I made new cries for help all of which were brushed away as ridiculous. And I had more MRIs, more cognitive investigations, more hormone tests. All telling me I was absolutely fine.

That is when I decided to make it my employer’s problem. Or should I say, my employer’s problem as well as mine.

Not unreasonably I felt that a poorly functioning me wasn’t just and issue for myself but also for the agency that depended on me. Perhaps it was time to call it and come clean. At least to our Head of Talent to whom I will always be indebted for her support and action. I don’t know that every employer would have been as brilliant as mine and I wish I had had the courage to talk to them earlier.

And that decision unlocked everything.

Specifically, it unlocked the medical insurance that my employer provides. I realise that this places me in a highly privileged position and I’m not sure that I would have got to the same outcome through my doctor. In fact, I know I wouldn’t have. I’d tried. I’m not proud to call on private medical insurance, for most everything I wait in line but in this case going private made all the difference. And I needed something to.

After some mental health triage, I was given both a psychiatrist and a therapist.

My psychiatrist diagnosed me with cognitive depression, and I burst into tears. Not because I thought this was bad news but simply because she was the first person that didn’t think I was fine and should keep calm and carry on.

She started me on a course of Serotonin and Noradrenalin Reabsorption Inhibiting antidepressants (SNRIs), in this case Duloxetine.

SNRIs essentially block receptors for both serotonin and noradrenalin that would otherwise absorb them, making these magic potions more readily available. As we know serotonin helps you stay positive while noradrenalin forms part of the ‘fight or flight’ response and increases alertness. This is the wonder combination that acts to make me feel positive as well as ‘making my brain work’, clearing away the fog and removing the pressure.

I was started on a sub-clinical dose of 30mgs with two warnings.

I would feel a bit weird for the first week and then in the second I would feel worse than I had ever felt, before then seeing the benefit. And thank goodness for those warnings because I don’t know if I could have coped with that second week otherwise. It was really difficult, especially at work. If you have used these drugs you will know.

And the truth is I didn’t start right away. In fact, I kept the pack of pills unopened for almost a month before beginning them. I was so paranoid about taking antidepressants. I thought that they ‘stopped you feeling’ or ‘numbed’ you and I was also scared of becoming addicted to them or having to be on them for the rest of my life. Let’s face it anti-depressants don’t have a great press.

Then in March this year I took the plunge.

The Drugs do work

The warnings were incredibly accurate. The first week was super weird, I was incredibly wired and very bubbly, almost like I was taking pills – which of course I was. And then there was a massive crash in the second week that felt truly ghastly. I couldn’t think, I could hardly talk and functioning at work that week was phenomenally hard, I remember being in client meetings wanting to make a point but being unable to speak as if someone had wired my jaws together.

But then things started to change.

In weeks three and four I felt amazing. Positive and happy as well as super productive. And it wasn’t simply my professional life that was benefiting.

In fact, it was my personal life that changed first. I was less grumpy and exhausted at home, so I was more pleasant to be around and I started actually doing the things that I promised I would do but could never find to energy to complete. More than that, the daily pattern of the medication in those early months, was very much weighted towards the end of the day. In other words, I was ‘coming up’ in the afternoon and evening meaning my family got the best of me and not the worst of me. How many of us can truly say that we keep the best of us for the people that matter most?

I did have a set back after about a month and for a month. Not a full return to where I had been, but I could feel the ‘edge’ coming off the medication, the clods and pressure coming back. Just when I had been shown the light and a way through all the shit, the solution was being taken away from me. It felt crushing.

I experimented with the time of day that I took the pills. The medication is absorbed by the intestine and not the stomach and so there are at least two hours between taking them and the effect kicking in. Then they peak at roughly six hours and have a half-life at about 12 hours. Taking them at breakfast meant that they were having an effect in the second half of the day. So I tried taking them before bed and in the middle of the night. Even though today the effect of the medication is far more consistent over the day, I still take my pill at around 3am.

After a month or so feeling off the pace, my psychiatrist advised me to increase my dose to 60mgs and that is what I have been on ever since. I had to endure the initial effects of the increased dose for about three weeks, effects that were very similar to those I had experienced to begin with but since then the result has been transformative.

It’s hard to precisely describe how I feel, to describe what’s different.

The cloudiness and pressure in my head have largely gone, or at least I rarely experience them. I have far greater mental acuity and clarity and my mind is far more active rather than being in a state of suspended animation all the time.

I am more mentally alert and excitable, in that I get ideas into my head and become excited by them. And I am more productive because I am thinking more but also because I feel driven to achieve things that merely clogged up my to-do list before.

And I dream. I dream in the literal sense, that I will come back to shortly. But I also have dreams, ambitions, long term plans. That’s so different for me. To see the future as full of possibility rather than a profound risk to my house of cards.

As a result, I believe that I have gone back about 15 years, possibly longer. In that I feel the way I last truly felt in my thirties. This medication hasn’t simply taken away the pain it has restored something in me.

Restored something of me.

You see that’s how I feel about SNRIs, that they restore the chemical balance I am missing or is out of whack, rather than change me in any fundamental way. I’m me but me as I was in my late 30s. I feel unstoppable.

Tell me something I don’t know

Maybe you know all this. Maybe its completely obvious. Maybe every psychiatrist deals out  duloxetine willy-nilly to every patient they meet.

And now I am open and out about my medication lots of people tell me that they used it, they know someone that uses it, their kids use it or their partner. So, in a way I can’t help feeling that I am a little late to the party. And I apologise if all this is bleeding obvious.

But here’s the thing. Not once in the decade or so that I was in poor mental shape and even while I was undergoing all those weird and wonderful tests, did anyone seriously suggest anti-depressants or more specifically SNRIs.

And until I was prescribed them had never heard of either duloxetine or SNRIs. All I knew was to be scared of the word antidepressant.

Perhaps at the heart of this is the reality that few people actively share their experiences with antidepressants. I mean if they work for you why ever tell anyone you needed to use them to sort yourself out? I get that.

So, if I am evangelical and this is a bit tedious for those of you in the know or perhaps in the profession, I can’t help feeling there are people out there that are suffering and need to know there are really good solutions. People that deserve to understand what can be done for them.

The side effects suck

Of course, the drug is not without its downsides.

I’m sure everyone’s side effects are different but there are definitely side effects. And for me it’s not the odd headache either.

For a while the medication made me dizzy, most commonly after taking them and this was one of the reasons to take them in the middle of the night – to have that happen while I am sleeping. This dizziness has dissipated.

For all my energy and positivity, I get hit by incredible fatigue a couple of times a day, like hit by a bus fatigue. Coffee helps to get through these periods when I am at work and on weekends, sometimes I have to succumb to a disco nap.

Rather embarrassingly, I have also got a rash from the medication, this arrived a few months into using it and shows no signs of going anytime soon. It itches like hell, and I am trying to manage with antihistamines but it’s a pisser.

My dreams are insane and memorable. Not bad and never nightmares but rather exhausting in their own ways.

Oh yes and there is the snoring, the side-effect most injurious to any close relationship. Something that was annoying for everyone but rare is now a nightly occurrence. The snoring sucks.

All these effects are consistent with the use of SNRI medication, though I can’t absolutely say for sure they are side effects, maybe I would have experienced them anyway. But they are a price I am happy to pay for what I have gained. Even the bloody snoring.

The only thing I haven’t mentioned is drinking. When I had my very first check in with my psychiatrist, I asked her whether the effect of the drug would ever dissipate. She replied “only if you drink”.

As a result, I have now been alcohol free for nine months. And in a way this has been the toughest ‘side effect’. Without a doubt I was drinking too much for my own liking, partly out of habit, partly as a result of ‘lockdown’ and partly for the reasons I mentioned at the start. However, I have never intended or wanted to be alcohol free. And from time to time, I find it extremely taxing being dry. But so far, I have stayed off the booze.

Maybe it wouldn’t be so bad if I had the odd drink. Maybe the warning is a bit extreme. Maybe, for the joy of getting a bit pissed at a party the odd set back would be a price worth paying. But I’m not ready to try yet. Nothing about a delicious glass of Bordeaux or a pint of Beavertown is good enough to want to welcome back my illness. Nothing.

It’s good to talk

If I had written this account, a few months ago I would have left it at that. The story of my illness and the way in which antidepressants have restored me to my full self. Because a few months ago I would have denied that therapy, while helpful, was playing a significant part in my mental health.

Remember, my treatment was part medication and part therapy. But I had experienced therapy before and I had felt it useless, because alone it was incapable of resolving the problems I was having with my brain. So, while it was interesting this time round, to begin with I felt it was the drugs that were doing all the heavy lifting.

Today I am not so sure.

Though I was a little cynical about therapy I did take it seriously. And I resisted every attempt to give me CBT, which I feel is the workplace cure-all, instead of ‘proper’ therapy. I have nothing against Cognitive Behavioural Therapy, I have seen it work wonders on other people and some of my best friends are CBT practitioners (literally). But I always knew that I needed therapy to help me understand and unpick some deep-seated parts of my character and behaviour and to come to terms with the breakdown of my relationship and the impact it had on others.

And with the medication dealing with the immediate problems I was facing, I had the space and time to use therapy for more fundamental work. Therapy combined with medication has proved a powerful combination and has enabled me to build on the solid foundations that the drugs provided and really get to grips with the behaviours and perspectives that are a problem for me. They are great together.

I’m doing OK

My understanding is that I will be on duloxetine for another year, making it about 18 months that I will have used it, before gradually coming off. The idea is that over that time it will have permanently rewired my brain, reducing the number of serotonin and noradrenalin receptors I have so that I absorb less of the magic potions and there are more available. That’s how I understand it anyway.

But the fact is that if I needed to be on these drugs for the rest of my life, I would be just fine with that. If I could never drink again as a result, I would be just fine with that. If I had to find other ways to manage the side effects, most especially the snoring I would be fine with that.

I never want the hell in my head to return, ever.

I wasn’t OK. For years I wasn’t OK. At times I was ill in a way that no one would accept or understand. But that is no longer the case. It’s tentative and I live in absolute fear of losing what I have built back but most of the time I am pretty good.

Now I am energised. Now I am sharp. Now I have drive. Now I can think clearly. Now I am positive. Now I am looking forward to the next half of my life both personally and professionally.

Now I am happy.

And while I appreciate the new climate around mental health, the fading of taboo and in particular the efforts our employers are making to understand the mental toll of life. I am happy because in the end I broke down and demanded real help.

And so, this is ultimately what I want to tell you. Meditate, listen to headspace, take up a hobby, get a pet, try and manage your work life balance better, do yoga or go to the gym or run 5k, whatever works for you to give your mind a chance to recover from the shit we go through.

But for the love of fuck, you deserve to feel happy. Not fleetingly happy but genuinely happy. You deserve to be free of the demons that shit on your life every day. You deserve to wake up and feel OK with and about yourself. And if at any time you do not, get help. Real help. And don’t just cry for it, people aren’t listening because they have their own issues to deal with. Demand a psychiatrist as well as a therapist. Own that word. And don’t be afraid or ashamed.

Sometimes we lose ourselves and we need help restoring normality and that is not just fine its probably absolutely fucking normal.

I am clearly no expert on this subjecrt but you know where I am if you need me – huntingtonr@me.com