Ok, I have to face it. Methotrexate and depression. Methotrexate causes depression. Serious depression. After three or four weeks of 0.8ml injections (equivalent to 20mg oral) I start to spiral down. I don’t want to accept it. I want to tell myself that its mind over matter. And I can overcome these feelings. They are just feelings. Feelings mean nothing without action.
But you can’t control your feelings. You can’t just stop feeling something, much as you might want to. And it’s a constant battle fighting my own negative emotions.
I am completely anal. I have spreadsheets where I document my medications, dosages, possible side effects and my pain levels. And I have documented my life with methotrexate many times. My life with methotrexate and depression. When I took the tablets, it caused immediate depression. Entirely dose dependent, I could sort of tolerate 7.5mg. But after a few weeks of only 10mg the depression, anxiety and suicidal ideation took over and I had a psychotic break. I spent time in the psych ward. I was given heavy duty anti-psychotics and my GP didn’t think I was coming back from there.
Two weeks later, once the methotrexate was out of my system, I was fine. All the doctors were astounded. They thought my mental state was due to prednisone. Psychotic breaks are a well documented side effect of prednisone. It’s also a known side effect of methotrexate, its just considered very rare.
I don’t believe the link between methotrexate and depression is that rare, its just under-reported, and perhaps disbelieved. Now I am sure it is absolutely a side effect, and as I search google, I find more and more people reporting same.
I was under a lot of emotional pressure at the time. Methotrexate can’t create emotions, it acts more as an amplifier. It brings negative emotions to the fore. My normal state of being is to be a ridiculous optimist. I am usually positive and happy. Genuinely happy. I tend not to dwell on things I can’t change. I focus forward and keep moving.
Methotrexate turns that around. Every morning I wake with a crushing pain in my chest. It feels like grief. My heart races, I have panic attacks and this sense of impending doom. I want to cry all the time, and just curl up in bed and hide from the world.
Of course I can’t do any of that, so I just tell myself that it’s mind over matter, and force myself to get up, keep going, get things done. But it’s exhausting. And it’s a lie.
I switched to injections, because the side effects are far less, and the drug is better absorbed. I am now taking the equivalent of 20mg, and have been for four weeks. But I have to stop. The mood crashes are getting too much. I can’t live this way.
But I don’t want to stop, because methotrexate gives me 30-40% improvement. That’s the best response I’ve gotten from any drug. There’s a reason why methotrexate is the gold standard treatment. Most people do get benefit from it.
And 40% might not sound like much, but when it’s the difference between between being mostly bedridden, or having a few functional hours a day, being able to do light workouts at the gym, taking 5mg less of prednisone daily, and 10mg less of oxycodone daily, on average, that’s a pretty big deal. So I keep trying to take it.
I am one of the most determined people you are ever likely to meet. The same determination that allows me to work out through the pain allows me to get up and keep faking it and pushing the depression and anxiety to one side. No one can tell from my behavior what I am feeling. I appear completely normal.
But I don’t feel normal. I don’t feel OK. It’s getting too exhausting dealing with these feelings. And it’s getting worse, I’m struggling to keep going. Even though my pain levels are lower, I don’t want to go to gym. I don’t want to see people. I’ve almost completely stopped eating, I just drink wine. Which I shouldn’t be doing AT ALL.
Downward spiral. I recognize it. But I don’t want the crippling pain to come back. For the pain to be constant again. The knives in every joint, the screwdrivers prising my joints apart, the deep, aching pain that never, ever stops.
I’m afraid of the pain. The pain IS that bad.
I spent most of last year on my couch. I don’t want my life to be that again.
Right now my pain level is about a 4. I used to live at 7s and 8s, and that was a good day. I still have those days, but only one or two a week rather than every day. Most nights are still bad, but some nights I sleep. I still have fatigue, but that body-made-of-lead-wading-through-a-swamp feeling happens less often. My hair has thickened up. My muscles don’t feel like they are going to melt down when I ride a spin bike. I have some strength and stamina. I can lift light weights. I can do yoga. I can have a life.
But the signs are all there. It wouldn’t take much to tip me over. And there’s no one here to watch me. No one here to catch me if I start to fall. And sometimes other people get hurt. I definitely hurt myself. I can’t think clearly and I become self-destructive. And people get caught in the fall out sometimes. I never hurt people intentionally. Except myself.
And I only do this when I’m on methotrexate.
My blood work came back yesterday. My liver has recovered, but my doctor told me yesterday my white cell count is getting too low. I had already taken my shot. But I should lower the dose for that reason alone. Or maybe stop it completely for a few weeks. Let my immune system recover.
So it can attack my joints again full force.
Maybe there’s a balance point. Where I can tolerate the side effects, and still reap some benefits. But 20mg is definitely too much. So I’ll try 10mg for a few weeks. And wait and see.