Better living through neurochemistry

3T5A7975-(ZF-0037-19875-1-001)The point I knew I needed to go to the doctor was around the 18km mark of the 2016 Six Inch Trail Marathon. I came to the conclusion I needed to withdraw from the event once I had  reached the first Aid Station at 23km. I was far too tired than I ought to have been and was at least one hour slower than I thought I should have been. The training for Six Inch that year had been surprisingly difficult – both in effort expended, and in reluctance to train. I was tired and unmotivated all the time.

Monday after the race I went to the doctors and got an order for blanket blood tests – in essence, every single blood test that you could perform on a female. Anaemia and hypothyroidism run in my family, and the symptoms of those also mirror those of depression. Going through a checklist of symptoms I was ticking off a fair few. I had refrained from Dr Googling my way through my symptoms; the last time I’d done something like that was back in 2001 when I had reactive lymph nodes. Having presented with quite obvious sizable lumps in my neck, I was puzzled at my doctor’s insistence during the consultation that it was probably glandular fever. That was until l had researched my way to the non-Hodgkin lymphoma entry in the medical encyclopaedia at the public library, and upon reading that I decided that glandular fever sounded tremendous in comparison.

I had my blood drawn on Tuesday morning and the test results came back Wednesday afternoon. I was blood perfect; even my cholesterol. So that left depression as a likely probability. The doctor suggested that if the training regime to complete an ultramarathon wasn’t giving me the serotonin boost that I needed, it might be worthwhile looking into medication options, and also talking to a psychologist about what the trigger might have been to my general malaise. He suggested that I try and enjoy my Christmas holiday break – my office closes down for ten days over Christmas and the New Year – and see how I progressed afterwards.

I went back to work January 2nd, and felt pretty OK, but it wasn’t until I found myself crying for no good reason in the shower the morning of January 12th that I realised that my upbeat mood hadn’t lasted much more than that first day. I talked to Jeremy, sent a text to my boss telling her I wasn’t coming in and that I was literally taking a mental health day to see the doctor about likely depression, then made an appointment for that morning.

The doctor I’d spoken to before Christmas was on leave so I’d booked in to see another one – the female doctor at the clinic who’d helped me out with my multiple ear infections. She was excellent. She went through the paperwork for a Medicare mental health plan, which would subsidise ten psychologists appointments, and gave me a prescription for 10mg daily of Lexapro (escitalopram).

I went straight to the chemist to fill the prescription, then came home and took my first tablet. That afternoon I had an hour appointment with the clinic’s resident psychologist, and by the end of the hour she had me nailed. It was awesome. It felt like I’d been stuck on a trail somewhere in the dark, batteries dead in my headlamp, all the while knowing that there was a dirty great hole that I had to navigate around and being too afraid to take a step. She’d swung a floodlight on the trail, showing me the way through.

I’m a pretty introspective person, and for a while I’d had a gut feeling that something was wrong, but I’d not been able to put my finger on it. I’d mentally picked through my job description, trying to work out why I was unmotivated at work and what part of my job was I not enjoying. Perhaps a change in workplace was a good idea? I’d been in my current role since 2008. I hadn’t really realised that I was unmotivated to clean at home, because – well hell, in 2014 Jeremy and I had worked out that if both of us were training for Six Inch, the housework was going to slide. And why on earth would you question being tired all the time? See: training for an ultramarathon.

I’d wrecked my left ankle June 16th, the same day as shit went down at work. Jeremy and I had gone out that evening for a run to work out my emotions, and then I hit the deck courtesy of a heap of gumnuts dropped by the local flock of cockatoos. We’d booked a holiday to New Zealand for early July, and while there I wrecked my right ankle, basically through loss of proprioception in my left. My emotional vent was crippled, and my brain chemistry did not cope well.

The medication worked fast for me, the chemist and doctor had both said that it might take up to a month to work, but after three days on Lexapro I realised I’d not felt this good in quite some time. I had probably been self medicating with exercise for about 12 months or so, and then just when I needed running the most, it was taken away from me. I described it to people as “if perfect is 100%, I think I’ve been at 90-95% for a while, and when I wrecked my ankles I eventually tumbled to about 60%.” I was still functioning, I was still able to take care of myself, but I was not whole. I was not right.

I decided that I needed to be kind to myself this year – I had to practice self care. For running, that meant I needed to be able to choose my running activities without guilt; I had to stop putting pressure on myself. I had re-injured my right ankle January 7th – not to the same extent as I had back in July 2016, but enough for me to recognise I had to withdraw from Lark Hill, and at that point I decided that any running events in the near future would be entered fairly late in the game – it eliminated any training pressure that I might feel, or the chance of training guilt weighing on my mind.

The two things I kept doing was parkrun and Tuesday night darkrun. I enjoy both; neither of them generate that pressure that I was trying to avoid. At darkrun there is a regular group of people who run intervals, and have ‘warm-up’ runs ahead of the darkrun session so their evening totals can be 12-15km, but at the other end of the spectrum there are people who just run their Tuesday evening 5km. And parkrun is parkrun – the closest you get to pressure with parkrun is what you put on yourself: beating your PB, or some secret parkrun racing where you decide you have to beat a fellow parkrunner, who is probably entirely oblivious of their nemesis status.

When I filled that first prescription of Lexapro the chemist advised me that from now on any non-steroidal anti inflammatory drugs (NSAIDs – ibuprofen, celebrex, voltaren etc) were out of bounds. They slow down kidney function, which means that the Lexapro could stay in my kidneys for longer than it ought, causing damage. Any sports injuries would have to be treated only with ice, heat, painkillers like paracetamol/acetaminophen and what I not-so-kindly call unicorn fart cream; the herbal concoctions that tend to have lots of menthol or melaleuca.

With only really being able to take paracetamol for sports injuries I generally live with the pain until it just becomes a bit too much, at which point I’ll take two paracetamol and see how I feel when they wear off. There’s the issue with painkillers that if I can’t feel the injury then I have been known to make them worse because I’m no longer getting that “oooh, don’t do that!” sense, whereas with mild NSAIDs like ibuprofen it decreases the pain because it decreases the swelling, but there is usually some residual pain that can be felt.

I remember in 2015 when we thought I’d developed a stress fracture in my foot but it turned out that I’d torn my peroneus brevis. I was prescribed celebrex; a strong NSAID and an absolute wonder drug. It took the inflammation down so much that I felt no pain, and I could stand with full weight on a foot where hours previously I’d only been able to tentatively touch the ground with my big toe. I was advised that it would take 2-3 days for it to work out of my system when I took my final dose, so after 3 weeks I stopped taking the single daily celebrex. Three days later my entire body ached, because the celebrex had stopped everything else from hurting too, so I’d not noticed my hips and glutes tightened, and the subsequent pressure on my lower back.

Ten months into no NSAIDs I feel like this is the strongest and most injury free I’ve been in years. I was never a frequent ibuprofen taker if I could avoid it, but now that I need to deal with inflammation without medication I’ve found myself more aware of and feel more connected to how my body feels. I’ve been combining this awareness with the techniques that I learnt from Lauren Shelley; the pilates moves, the self massage for runners, and the rule of thumb with my body that if something hurts, it’s rarely the part that aches that is the problem, it’s usually bodyparts adjacent that are the culprit.

When I went to the doctors in June for a repeat Lexapro prescription the doctor went through the standard form depression diagnosis questionnaire with me and said that I no longer exhibited signs of depression. He said it was up to me whether I started to wean myself off the medication (going cold turkey off Lexapro is a very bad idea). I said that I’d like to stay on it for a while longer, until I felt properly re-settled back at work.

The idea of the slow wean did percolate in my brain for a month or so until I had yet another revelation early morning in the shower: I’d signed up for the 2017 Rottnest Marathon when entries opened in November 2016, and I’d also entered the 2017 Six Inch Trail Marathon. Lexapro was the thing that had restored that interest in exiting the house for a run. It had restored my energy levels to the point that I’d not feel worn out after Tuesday night darkrun. Lexapro was the thing that made it so much easier to discern the difference between a simple desire for a lazy day on the couch and the constant flat exhaustion of depression. Who on earth would think it was a good idea to wean yourself off this in the lead up to a marathon and an ultra marathon?!

One thought on “Better living through neurochemistry

  1. Pingback: Sensibly stupid – the Rottnest Marathon | Not Travelling at Speed

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