I made a huge and entirely preventable mistake when I got home in September of 2020. I decided to wean myself off my SSRIs (antidepressants/anti-anxiety meds), which had been prescribed to me just before leaving to Barcelona in 2018 (but definitely not for the first time).
I made the decision to stop without consulting a doctor. I made it because I was tired of taking a pill every day just to feel and be normal. I made it because I didn’t really believe the meds were helping me too much, or doing anything at all – I was taking them and yet I still didn’t feel okay, let alone “normal”. I made it because I thought I was ready. Because my psychiatrist, when prescribing them, had said “these will help you in Barcelona”, and I was back from Barcelona now, so I thought I could stop. That rookie mistake almost cost me my life, but it brought my attention to something I strongly doubt I would have noticed otherwise.
When I started to crumble mere weeks into coming back, I blamed it on the pressure of re-assimilation. After being all on my own and living entirely independently in a foreign country for 2 and a half years, I was bound to have a reaction to coming back to my old and very busy and very full-of-people life. But the depressive episodes I started to experience were far too intense, and far too frequent and debilitating. And the thing that scared me most about them was that they came out of nowhere. I had nothing to trace them back to. Nothing particularly painful or distressing would cause them. One day, I’d be laughing with my family and friends with an almost ease, and the next: I’m a mess. That terrified me. I didn’t know when to expect the depression or the rage or the tears; they came out of nowhere. Everything was suddenly triggering, and my skin was constantly on fire. When you don’t understand what is happening to you or why, it can be horrifying. I thought I was losing my mind. And in many ways, I was.
One of the worst parts about what was happening was that I could feel myself disappointing the people who loved me. The people I loved. I’d have all my friends over, in my little room in my family house, and I wouldn’t know how to speak to them. I would sit silently, overwhelmed and anxious, one wrong word or move away from exploding. My friends would ask me what I wanted to eat and I would get so irritated I would snap and say something cruel. My mother would ask me to come sit with her and it would take all my energy to sit with her without suddenly starting to cry. “You’re different since you’ve come back” is something I had to hear almost daily. And I was. I knew I was. I was so different I could feel the people I cared about reassessing our relationship, taking a step back.
I didn’t know what was happening to me, but I knew there were some things I could simply no longer tolerate. One of the biggest was the obsession with diet talk and thinness and beauty and how it seeped into nearly every single conversation with my friends. It was too much for me to handle, even though in the past I admit I must have contributed to such conversations sometimes. But now, I was noticing everything. How my friends’ obsession with the thin ideal was starting to trigger me, how it was taking me back to a place of body-hatred I thought I was past. When they talked about fatness (their own or otherwise) with repulsion, I felt shame again. And that made me awfully angry. I thought back to all the work I’d done on my self-image and self-love and felt it all slip away from me. In the past, these conversations happened around my thin(ner) body, so I could lie and tell myself it was well-meaning, nothing harmful! But now my fat body was right there with them in the room while they engaged in casual fatphobia and I didn’t know how to react. When I gathered the strength to do it, I tried to share how triggering that was for me, but it fell on mostly deaf ears. It was still keto this, cheat meal that, “I deserve these fries because I worked out today”, “I feel so fat!”, all day every day. And the isolation that created for me was incredibly heart-wrenching.
Another was how empty and shallow my relationships began to feel. I would push myself so hard out of my comfort zone and through incredibly painful depressive episodes just to be around my loved ones, but then I was an irritable mess in the room, bringing everyone down. This hurt because I defined myself by my love for my friends. I put a lot of effort into creating and maintaining my friendships, a lot of work. But some friends mistook my sadness and anger and silence as anger at them, or as a newly-acquired boringness, or as sudden rigidity and/or an annoyance. I was no longer the “fun” friend. I was also no longer the “mom” friend either (signature me!), who was available to them at any given time for comfort or safety or a good time. I didn’t take care of them anymore the way I used to, or cater to their needs and whims (I could barely take care of myself!). I didn’t debate them on demand like I would before.
I started saying “no” to a lot of things, and that made me difficult. I was difficult to be around. I was suddenly very quiet, all the time, and when I spoke I had nothing good or interesting to say. At the beginning of my meltdown, I remember having an emergency session with my therapist, and through sobs saying something to her like “I have this nagging feeling I can’t shake that I’m gonna lose a lot of people by the end of the year”, and I was right. I said that to her sometime in January, some couple of months into me being back. By October of that year, almost half my friendships had dissolved. There was some hurt and betrayal and a lot of grief, but eventually it was best for all involved. We simply no longer got along. And that’s okay. Friendships end.
Pivot: remember when I told you at the end of Part 3 how I noticed a pattern and everything made sense? Let’s go back to that. And to the beginning of this essay, where I told you I stopped taking my SSRIs. I’ll tell you how those two things are connected.
I don’t want to be angry at my previous self because she didn’t know any better, but stopping my SSRIs when I did was… not very smart. Things went downhill from there really fast. You know about the depression and the anxiety and the difficult conversations I had to have with family and friends to keep myself from losing myself. All those goddamn boundaries! I thought I was overwhelmed and sad because I felt isolated and alien and exhausted from all that emotional labor, and that was a big part of it, sure. The confusing part was the rage I started to experience. Now, I’m comfortable with rage in the right setting. Context matters, and anger can be right and righteous. But this rage would implode inside of me out of nowhere. I was angry, all the time – at everyone. And because I was angry, I couldn’t speak, because if I spoke up I would say something hurtful, and I didn’t want to hurt the people I loved.
I’ve mentioned silence and not speaking a lot since I’ve started writing this series. I’ve done that because silence is really, truly excruciating for me. Those months where I couldn’t speak came after years and years of me suffering writer’s block after the death of my father (in 2015), and compounded that immense pain. Reader, you are reading an essay series of mine, so you have some idea what words mean to me. But let me elaborate briefly: I am an incredibly expressive person and words are my weapon of choice. They always have been. When I was very young (I’m talking 7/8 years-old) and got into fights with my mother and couldn’t confront her face-to-face (because I’d lose my voice, see?), I’d write her long extensive letters of apology or sadness at the injustice I’d thought I’d suffered. I’ve been a writer for most of my life now, and a spoken-word poet, so I don’t just have the need to write, but also the need to read it out and perform it. Words have always mattered to me. They have been my lifeline and my saviors. And silence was starting to kill me.
The depressive episodes and the rage and the silence led to isolation and shame and a lot of suicidal ideation. I won’t pimp my pain out, but I will tell you it hurt. A lot. And it made me feel extremely alone, so much so that I would turn my phone off for weeks convinced no one would give a fuck. Which made people angry at me. Which in turn made me angry. It was a vicious cycle. And no one was happy, least of all me. I was suddenly Crazy, with a capital C. Watch out, she’s gonna explode!
But I was lucky to have my therapist. She knows and I know that I couldn’t have survived those months without her kindness and love and her availability in my emergencies. She stuck with me and validated all my pain and hurt, even when that meant just an entire 50-min session of her watching me sob, wordless and without explanation, through video. (Thank you for always making me feel seen.)
My mother was my anchor in a lot of ways too. I will admit, with shame and a lot of regret (because I was wrong, so so wrong), that I thought my mom would be my biggest obstacle when I came home. I thought it was with her that I’d have to have all those difficult boundary-setting conversations, that it was with her where the struggle would be. But to my surprise (and I will never again be surprised by her love), she was the one who gave me the most space and unconditional love. Every single boundary I set, she accepted – at face value. Every request I made – for privacy, or help, or space, or love – was granted, no questions asked. She accommodated me so much, I’m getting teary right now just thinking about it. She accepted it all. I don’t know what I did to deserve a mother who, in a time where I felt all my friendships and siblings slipping away from me, showed me love and understanding and respect and compassion. She could see that I came back different, but she was ready and willing to accommodate the new me anyways. No questions asked. With love and open arms. She even got me new size 14 clothes so I’d be “comfortable in my new body”. My god, the ways she saved and loved me. (May I never breathe a day without you, mama. I love you so much.)
So I had some okay(-ish) days sometimes. Days I could semi-function, anyways. Somehow that was the most confusing part. Because I didn’t know which days I would wake up and want to call up my friends and which days I’d wake up crying and wanting to die. It was the perceived randomness that freaked me out. I didn’t know when the next episode was coming, but I knew I only felt “okay” about one week a month (at most). The rest: a mess, a bitch, insufferable, sobbing non-stop, beating myself up for texting my therapist on her holiday. In one of those emergency sessions, sometime in June, in passing, I say to her: “I don’t know what’s happening to me, but it’s starting to feel cyclical”.
For some reason, my own thought sticks with me, and weeks later I am analyzing my period app data and trying to figure out a pattern – trying to figure out if when I said “cyclical”, my mind had noticed something my conscious self hadn’t. My mind does that sometimes. And I notice a correlation between my period dates and my episodes at their worst – a very strong and significant one. And I google “severe depression around period”. The first result:
Premenstrual Dysphoric Disorder: Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS).
Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMS causes bloating, headaches and breast tenderness a week or two before your period. With PMDD, you might have PMS symptoms along with extreme irritability, anxiety or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life.
How is PMDD managed or treated?
Your healthcare provider may recommend one or more of these treatments to help manage PMDD:
Antidepressants to help manage your brain’s serotonin levels.
First thought: holy shit! Second thought: how the fuck has no one ever taught me about this? Third thought: how exactly am I gonna get an official diagnosis when I can’t function or trust doctors enough?
Things made sense: I had been treating a condition I didn’t know I had, PMDD (that “activates’” or “develops” at any point in life, apparently), with my SSRIs. And when I came back to Riyadh and stopped taking them, the re-assimilation without the support of the SSRIs was a deadly combination for me. Of course I crashed. Of course I crash cyclically.
Convinced I’d solved the entire riddle of me, I send my therapist a text saying: “I think this is what’s going on with me. Can we discuss on Thursday?”
Within minutes: “Yes, let’s. You shouldn’t have to suffer like this.”