My Life on Stress Leave

Part Three: Rollercoaster

The goal, as I was being told, was to reset my nervous system. My clinicians explained that my stress-response had become dysregulated. In other words, I had been operating at such an elevated stress level for so long that I had fried my system. This all made sense to me in theory, but in reality I struggled to understand what was helping and what was hindering my progress. I had to rethink all of my tendencies, my habits, my instincts. I had to redefine healthy. One aspect that was especially difficult for me to wrap my head around was exercise. Being physically fit has always been very important to me. Exercise has been a constant priority in my life. Not only have I loved the physical benefits, it has also been one of my most trusted mental health tools. I had never considered the role exercise was playing on my nervous system. When I’m wired, angry, irritated, frustrated or when my brain feels foggy, my go-to outlet has always been exercise, most often of the high intensity variety. It helps to settle my mind, to calm me down, to help me feel more in control. However, I see now that while they have helped in the short-term, these high intensity workouts may have been working against me in the long-term. All those years of activating my stress-response during intense workouts likely contributed to a cortisol imbalance, and over time probably wreaked havoc on my nervous system. In essence, my main stress outlet was stressing me out. This was a harsh realization. I knew I had to decrease my high intensity workouts and incorporate more calming forms of exercise, but it was so counterintuitive. Low intensity exercise has always been a struggle for me. It feels inefficient and tends to heighten my anxiety, not relieve it. Retraining my mind to look at low intensity workouts as anything other than a waste of time has been challenging. And this is just one example of my “healthy” habits that I had to re-evaluate. I am also learning how to prioritize rest over productivity, redefining balance in all aspects of my life and trying to understand how to find comfort in being less invested. 

While redefining healthy was certainly challenging, the medication piece was the most frustrating. After being on 50 mg of sertraline (which is considered the lowest therapeutic dose) for about eighteen months, I had weaned myself off of it earlier in 2023 because I was tired of the side effects and noticed that it didn’t seem to be helping anymore. At that time I had been reluctant to try increasing the dose out of fear of also increasing the side effects. In the fall of 2023, after being off medication for the better part of a year, I had to restart it and I was resentful. I despised the adjustment periods after starting, and then increasing, medication. I hated that I had to put myself through that again. The initial 25 mg actually went quite smoothly, as did the 50 mg a couple of weeks later. Perhaps this was due to my body being familiar with the low dose, or maybe it was simply because I was already in such a dysregulated state that the side effects weren’t as obvious. The real turmoil began when I made the jump to 75 mg. It was awful. That drugged-out, debilitating feeling that had accompanied past medication adjustments came barreling back. Some side effects returned as well. I remembered why I hated this process so much. This time was especially horrendous because it included insomnia. I have never been a great sleeper, but I had never experienced true insomnia before either. For an entire week, I didn’t sleep more than a couple of hours a night. And that was in small increments, never all at once. I have never felt so completely destroyed. I was so tired, basically on the brink of sleep at all times but never actually able to drift off. It was torture. I felt completely removed from myself, like I was watching a bad movie. After six or seven nights of essentially no sleep, with the help of dual release melatonin and changing the timing of the sertraline from evening to morning, I started sleeping for a few hours at a time and eventually I was more-or-less sleeping through the night again. Shortly after, my nurse practitioner recommended that I increase my dose again, to 100 mg. I refused. I was too shaken by the last increase to even consider it. I stayed on 75 mg. I continued to sleep through the night and the intensity of my other side effects subsided. After about a month, I had much more resolve and agreed to up my dose to 100 mg. I had trouble sleeping again, but thankfully this time I was able to drift off and stay asleep for a few hours at a time and my sleeping pattern returned to normal within a few days. The other side effects gained a bit of traction, but nothing compared to the intensity I had experienced with the jump to 75 mg. A couple of weeks later, I agreed to go up to 125 mg. That increase was similar to the previous one and 125 mg is where I have stayed. 

Throughout this process of counselling, medication adjustments and re-evaluating, the fluctuations in my mood and mental state were surreal. Everything seemed to change almost instantaneously at times. I would be feeling relatively at ease, even motivated or optimistic, and then something would shift. For what seemed like no reason at all, my world would come crashing down. Sometimes the downward spiral was gradual, slowly sinking over the course of a few days. Other times, the deterioration was rapid. Within a few minutes, I could go from hopeful to hopeless, bright to dark. The darkness could last for hours, days or weeks. It was different every time. My energy level followed the same pattern, or more accurately, lack of pattern. I felt like I was getting nowhere, spinning my wheels and just trying to hang on. 

As the weeks went on, amongst the darkness, little glimmers of hope emerged. There were days when I wanted time to slow down so I could hold onto that hopeful feeling and do something productive with it. Christmas was a very welcomed distraction. I normally take two weeks off over the holidays anyway, so for those two weeks, it no longer felt like I was stuck in the purgatory of “healing”, it felt like I was on vacation. It was glorious. No appointments, no obligations, no guilt about being useless. I was able to let it all go, if only temporarily. Unfortunately, what goes up must come down. The first week of 2024 was rough. 

Even though it was explained to me that this reset would be a slow process, I didn’t expect it to be such a standstill. Every time I felt like I was finally getting somewhere, the rug was pulled out from under me. My clinicians were telling me I had to be patient and not be so hard on myself. I thought I had been patient. My leave hit the two month mark and I felt I had nothing to show for it. According to the initial plan, I was supposed to be back at work by this point. Instead, my nurse practitioner recommended at least another month off. Although hearing this felt similar to being cut from the team or losing out to another job applicant, essentially being told I wasn’t good enough, I also couldn’t deny that going back to work seemed impossible. Once my return to work date was officially pushed back, I actually felt a strong sense of relief. The pressure to hurry up and get better eased. It was in the few weeks that followed that I started to turn a corner. It was still messy, it was still confusing and frustrating, but it was also a bit brighter. 

My deadline came and went. When I woke up that morning, I was fairly certain that I wouldn’t act out my plan but I definitely still thought about it. I felt like I had finally started to make some real progress, which was enough to convince myself to keep going, but that day was tough. I was in a weird mood all day, my mind was racing. It was hard to ignore the voice inside my head, the one telling me that this was the day I had been patiently waiting for, my chance to finally escape. I felt like I was wasting an opportunity, worried that I would regret not following through. I had to actively talk myself out of it. For a few days after my deadline, I wondered if I had made a mistake by sticking around. It took about a week for those questions to quiet down. It was then that I found some clarity. With my deadline behind me, I felt like my escape plan was no longer an option, at least not for the immediate future. It was as if I didn’t have any other choice but to forge ahead and create a better existence for myself. It was time to make some changes.