Experiences and Thoughts of Psychoactive Medications.

I DO NOT have experience of illegal drugs thank God. My only experience with that terrible underworld is having been approached twice by suspicious individuals on bicycles with bags under their crossbars. I have been on various different prescribed drugs however, regularly and at high doses, so that I can write of my experience with those. Specifically the psychoactive drugs I have taken are Risperidone, Quetiapine, Citalopram, Amitriptyline, Sertraline, Propranolol, Diazepam, Zopiclone, and Promethazine. I have also, in common with most people, indulged recreationally in alcohol and tobacco. Few people recognise that caffeine is also a drug, and I once thought I would experiment in a binge of coffee to see if it would sharpen my mind — it did not; in fact, I have never felt so ill in all my life. People die yearly of caffeine overdoses, it is not an insignificant substance, so I am bemused to notice that it is given very comfortable treatment in general. Of course it is a staple of the 'tapped in' yuppie who, like the idiot he is, wanders about with his hand around a brown cup talking into the æther, certainly convinced of the awe which all around him must experience at his proximity. Most commonly it is said of coffee and tea that they are purely health-giving — they are not, although in moderation they are almost harmless. Yet insomnia, irritability, anxiety, tremulousness, headaches, and gastritis, are not possible side-effects but certain side-effects for anyone who drinks large and regular amounts of them. Naturally energy drinks are even worse, but at least one of them runs a first rate Formula Un team with the proceeds.

   It is well said that all drugs are poisons with desirable side-effects. I shall write firstly of my experience of the so-termed antidepressants. I was first instilled with one of these when I was sixteen and I cannot remember the name of it, I think it must have been Fluoxetine, but it does not signify, anyone who reads the literature on these drugs must realise that they all have the same mechanism of action. There are only very minor differences in their pharmacokinetics, so that I can at once refute a common misconception that one S.S.R.I. may work better than another for someone with depression, it will not. A person may think it works better and that is the only difference. The antidepressants are wonderful placebo drugs, they do just enough to deceive the mind into thinking they work, and this hope may be enough to support a person through the worst. However, they have bad side-effects. Excessive sweating, dry mouth, blandness, trembling, and diarrhoea, are common and in my experience do not go away in time. The only way for these side-effects to end is to stop taking the drugs, which is much easier than the prominent literature would have people believe.

   Amitriptyline I was put on for a month or so for migraine headaches and it did nothing for them, probably because they were caused in the first place by excessive alcohol and tobacco consumption. Not that I would have anyone believe that I was a chain smoker, I am too asthmatic to smoke, all I did was to take nasal snuff more or less regularly for a year or so. I very much liked the scents and the feeling of neural stimulation they gave me, but of course they must have contributed to my headaches, fool that I was. I am of the opinion that migraines are no mystery but are caused by increased vascular pressure in the cranium, both nicotine and alcohol cause this to an eminent degree. Therefore Propranolol probably is the best curative for migraine, but in my experience it is better to remove the cause of the hypertension than to attempt to resolve it by medication; stress, alcohol, nicotine, and any other adrenaline-working substance, excessive salt, or excessive eating generally. I used to take quite large amounts of painkillers for these headaches, I am of the 'in for a penny' class of thinkers, so I would take three Paracetamol with four Ibuprofen tablets and wash them down with a clarifying quantity of port to fix my headaches. It worked for the moment, but I do hate the dusty taste and smell of Paracetamol in the stomach, and I can speak with certainty from experience that these painkillers cause rebound headaches ten times worse if taken excessively.

   Citalopram I was put on for the worst bout of depression in my life, when I could barely eat and truly longed for death. It worked as a placebo up to a point, though causing unpleasant side-effects all the while, but this culminated in a terrible episode of psychosis. I have read that S.S.R.I. drugs can cause or contribute to psychosis, as excessive serotonin is thought to be the main cause of the delusions and hallucinations of pyschedelic drugs. S.S.R.I. drugs do not release serotonin however but only inhibit its absorption; still, it is a fact that most antipsychotic drugs block serotonin as well as dopamine. Why then are they often used adjunctively with an S.S.R.I. to treat major depression? The answer is simply that most doctors have no notion whatsoever how the drugs they prescribe work, their knowledge is largely anecdotal. So in their literature, the B.N.F. or some other formulary, it is said that an antipsychotic can be used adjunctively for treatment-resistant depression. But as observed, antipsychotics do the exact opposite of antidepressants! I brought this up with several doctors who put me on an antipsychotic drug after my bout with psychotic depression, and none of them could answer it. That is because there is no answer. Serotonin levels have no correlation with depression or anxiety at all. If they did S.S.R.I. drugs could be used pro re nata for the alleviation of occasional melancholy. A drug could be taken, serotonin levels would increase (for they do increase within half an hour), and sadness would be alleviated. This however does not happen because sadness is not caused by serotonin deficiency. Often it is asked, why do S.S.R.I. drugs take so long to be effective? Six weeks is the minimum term to wait and some people claim six months is the really effective period. Can anyone think of any other drug which takes six months to begin to be effective? This is the surest indication that these drugs are duds, they are grenades without explosives in them. They claim the credit for the work of Time. The only attempt at an explanation of this phenomenon is, and this is not well known, that they downregulate the secretion of serotonin! How extraordinary! This then is the real explanation for the effectiveness of an S.S.R.I., that they reduce the natural production of serotonin as such serotonin is supposed to cause negative feedback! This is also a ventured explanation for the effectiveness of atypical antipsychotics in treatment-resistant depression, that they reduce the negative feedback of serotonin. Was there ever a more confused explanation for a mechanism in all of biology?

   That S.S.R.I. drugs reduce depression by promoting neuroplasticity is an explanation about as believable as it is vague, it may be true or it may indeed be exposed in the future for purest balderdash. Neuroplasticity is one of those plausible terms of the century which may, like the old notion of phlogiston, be entirely superseded one day. Frankly I fail to see what the term describes better than the words learning or adpatability, but perhaps I am simply ignorant. Anyway, I moved on to Sertaline because it is anecdotally considered to be better for people with autism (once again there can be no pharmacological basis for this, it binds to the SERT in common with every other medication in its class). Autism itself has no decided explanation or mechanism for its prevalence. Indeed, psychosis used to be a term given for all kinds of mental disorders such as autism, O.C.D., P.T.S.D., A.D.D., and A.D.H.D., nor will I consent to be told that I have a condition instead of a disorder. I should not cry at being called a retard but rather should I nod my head, if indeed I have a mental disorder at all. In the past I would have been called more simply, and perhaps more accurately, a lazy good-for-nothing.

   The Sertraline did little except inspire hope, and that is enough to justify its existence and prescription. I do not think these drugs are useless, nor do I think the many people who have made millions of pounds out of them are undeserving of their pay. Hope springs eternal in the human breast; Man never is but always to be blessed. If a drug's entire purpose is to provide hope that is as good a purpose as any other, only the actual mechanism by which it is claimed to work against depression bears no scrutiny at all. This is truer still for anxiety, an even more nebulous term than depression. I cannot speak for other disorders, but I very much doubt whether O.C.D. is actually helped by these drugs either, except perhaps by altering the object of the obsessions.

   Now I shall mention two drugs which actually do have an effect, Propranolol and Promethazine. These sound like extraordinary substances, but Promethazine is merely a common travel sickness pill and Propranolol simply reduces blood pressure. Of the two Promethazine is the more powerful, but I am anxious at the lack of knowledge about Propranolol. There are several sad cases of death due to Propranolol overdose, it seems to be one of the more difficult overdoses to diagnose. It is treatable if recognised — but only if recognised. Anyway it is a very mild anxiolytic or sympatholytic and I still employ it sometimes, although it causes weakness and breathlessness. Promethazine, the less understood ingredient of the preposterous mixture called Lean, is simply a first generation antihistamine. It gives me a numb feeling, sometimes quite an aversive feeling of tiredness, but it is probably the most effective anxiolytic I have tried. To some extent it is more calming than Diazepam, which I was also prescribed once at the lowest dosage. It is excellent for insomnia and altogether the most effective drug for mental distress I have taken; but that is not saying much. It is still not a cure by any stretch of the imagination, only a means of swamping angst with tiredness, and it also loses effectiveness over time; though not nearly as much as Benzodiazepines or Z drugs I gather. It does not cause addiction, but I am sure that in the long-term it can cause sleeping problems by not having taken one. Doxepin is even more effective as an antihistamine I understand, and indeed all the really desirable sedative effects of antidepressants such as Mirtazapine, and antipsychotics like Quetiapine, are due to their anthistamine properties. That is how far we have come in eighty years of chemical research, that a drug synthesized in the 1940s and used for travel sickness is our most effective and least damaging anxiolytic!

   Lastly, I will mention antipsychotic drugs. They are terrible miracles. Certainly they will alleviate delusions and hallucinations but it is at the expense of one's metabolism, one's creativity, and one's happiness. Risperidone was for me abject torture, and its litany of side effects is not to be underestimated. Akathisia or restless leg syndrome is one of the most unpleasant things anyone can experience, and I would like to have it forbidden as a form of torture in the Geneva Conventions. Quetiapine is a much less aversive antipsychotic and, as I have observed, contains some useful antihistamine properties. These drugs work for their purpose, but I am very sympathetic to those with schizophrenia who must take them indefinitely. I hope that future advances will find better solutions to this worst disease affecting humanity as it is sometimes called. As for depression or anxiety (perhaps two sides of the same coin), they are commonly the work of adverse events and hopeless thoughts so that, as Spinoza wisely would say, they are to be cured by their opposites: propitious events and hopeful thoughts. 

(The experience of music chiefly among them.)

    And dope fiends should read poetry and rock themselves in time to the metre till they have shaken themselves out of the funk and juju they call pleasure (in particular heroic couplet poems, i.e. Pope's poems, Goldsmith's The Traveller and The Deserted Village, Johnson's London and The Vanity of Human Wishes, Byron's The Island, Shelley's Julian and Maddalo, Keats' Endymion, as well as Crabbe's poems. The Rubaiyat translated by FitzGerald is also very effective).