Flying over the Gherkin dressed as a zebra
The inside of brains, and a clever rabbit
For a few years now I have taken a daily dose of a Selective Serotonin Uptake Inhibitor. I’ve taken citalopram in the past but my SSRI of choice — not really — is Sertraline. I started on 200mg I think, went down to 100mg and recently reduced it further to 50mg. I take it because although my HRT has stabilised my unstable mental health, it is not perfect. (While I’m on this point, if I read another piece about a woman who went on HRT and then suddenly everything was 100% fixed and she was exactly herself again, I’ll eat a whole blister pack of Utrogestan. It’s a work in process not a magic porridge pot.)
I reduced it recently and would like to reduce it further for two reasons. One is private. The other is the dreams. My god, the dreams. They are not nightmares or not often anyway. But they are vivid and even worse, they make sense. It’s not like waking up and having a vague memory of having flown over the Gherkin dressed as a zebra or something. It is dreaming coherent but disturbing narratives that you clearly remember upon waking, night after night after night. “Blimey,” said my wise friend Elliot, “it’s must be like you’ve been at work all night.”
Maybe that’s why I am TATT (doctor language for tired all the time)?
Google SSRI’s and dreams and you will find headlines such as “why are my antidepressants giving me bad dreams?” But they are not necessarily bad. They are memorable which is worse. Here is the abstract from this 2013 paper called “Dreaming under antidepressants”.
Sleep related symptoms of depression include sleep fragmentation, early morning awakening, decreased rapid eye movement (REM) sleep latency, increased REM density, and more negative dream content. Most tricyclic antidepressants (ADs) increase total sleep time and decrease wake time after sleep onset, while many selective serotonin reuptake inhibitors (SSRIs) have an opposite effect. However, almost all ADs prolong REM sleep latency and reduce the amount of REM sleep. Case reports and research data indicate a strong effect of ADs on dream recall and dream content. We performed a systematic review (1950 to August 2010) about ADs impact on dreaming in depressive patients and healthy volunteers. Twenty-one clinical studies and 25 case reports were eligible for review and document a clear AD effect on dreaming. The major finding, both in depressed patients and in healthy volunteers, is a decrease of dream recall frequency (DRF) under ADs. This is a rather consistent effect in tricyclic ADs and phenelzine, less consistently documented also for SSRIs/serotonin norepinephrine reuptake inhibitors (SNRIs). Tricyclic ADs induce more positive dream emotions. Withdrawal from tricyclic ADs and from the monoamine oxidase inhibitors phenelzine and tranylcypromine may cause nightmares. Intake and even more withdrawal of SSRIs/SNRIs seem to intensify dreaming, which may be experienced in different ways; a potential to cause nightmares has to be taken into account. Though there are clear-cut pharmacological effects of ADs on DRF and dream content, publications have been surprisingly scarce during the past 60 years. There is evidence of a gap in neuropsychopharmacological research. AD effects on dreams should be recognized and may be used in treatment.
I agree with some of this. Not the bit about dream recall. I would bloody love it if sertraline damaged my dream recall. But “the clear effect on dreaming,” and the fact that SSRIs “seem to intensify dreaming.”
I have a theory about why the dreams are so intense and memorable. If REM sleep is compressed, which is what SSRIs do, then the brain is shoving everything it normally has more time to do into a shorter interval. So, clearer, more vivid, nearer the surface and more memorable. I definitely agree with the bit about “there is evidence of a gap in neuropsychopharmacological research.”
When I halved my sertraline dose to 50mg, I hoped the dreams would be cut in half too. No. No difference. I daren’t come off sertraline yet because I’m on book deadline and I can’t afford the upheaval that will certainly come with me coming off them. I’d like to try psychadelics or ketamine, both of which have been recently proven to be useful in treating poor mental health, but I don’t know whether they will work on hormonally related poor mental health. And when I applied to be part of a study on psilocybin, I was turned down because I admitted having had anxiety. What?
Curiously, the only other time I had dreams that were equally vivid and inescapable was on the Maersk Kendal.
The Filipinos gather around a table to Skype home and to talk; I check e-mails and wish I hadn’t. They are an intrusion into my ship brain, which has become different. It must have, because it regularly and routinely spits out dreams of such violence and vividness that I wake in my cabin in a daze, shaking the dreams off like sand. It is rare that I wake up without having dreamed a murder. The crew nod with recognition when I tell them this. They think it is the vibrations, that the noise gets into your head and shakes your thoughts.
Being on a container ship is like taking anti-depressants. Discuss.
Animal hero of the week: Dory
I am trying to avoid wartime bravery for a while. There is loads of it and animals in war are splendid, but well, no war this week. So instead, here is Dory, a 1.5 stone rabbit who became the first honorary animal member of the Rabbit Welfare Assocation.
In 2004, Dory was living in Cambridgeshire with Simon and Victoria Steggall. They had had the giant rabbit for only three months. Simon was diabetic, and in January that year, while watching TV, he began to fall into a possibly lethal diabetic coma. His wife thought her husband was sleeping, but Dory jumped on his chest and began licking around his mouth. Simon later remembered his wife telling Dory to get off the furniture. Then she realised the rabbit was telling her something, that her husband was dying, and she rubbed gel into her husband’s mouth to get his glucose levels down to a safer place. This didn’t work, but an ambulance crew arrived quickly enough to save him.
“I work for the ambulance service and I’m embarrassed that the rabbit spotted it before I did,” Mrs. Steggall said. She also told the BBC, "Rabbits are the most misunderstood of animals; people just dont realise how intelligent and sociable they are. Too often they are abandoned alone in a hutch at the bottom of the garden, forgotten and ignored, when in fact they make excellent house pets. Hopefully, rabbits such as Dory will help to raise awareness of rabbits and just how wonderful they really are."
As I still feel horribly guilty about my pet rabbit Flopsy, who we kept in a hutch in the cellar in about 1977 and who froze to death there, I hear you, Mrs Steggall.
The Lake Isle of Innisfree
I will arise and go now, and go to Innisfree,
And a small cabin build there, of clay and wattles made;
Nine bean-rows will I have there, a hive for the honey-bee,
And live alone in the bee-loud glade.
And I shall have some peace there, for peace comes dropping slow,
Dropping from the veils of the morning to where the cricket sings;
There midnight’s all a glimmer, and noon a purple glow,
And evening full of the linnet’s wings.
I will arise and go now, for always night and day
I hear lake water lapping with low sounds by the shore;
While I stand on the roadway, or on the pavements grey,
I hear it in the deep heart’s core.