(no subject)

[the_rck]

I suppose there’s a certain irony in the fact that every psychotherapist I’ve dealt with has insisted that medication must be the answer to my anxiety issues while almost every psychiatrist I’ve dealt with has said that medications, not having helped at any point since 1988, aren’t likely to do anything now and that psychotherapy is the only way. My current psychiatrist has basically looked at my history and my financial situation and concluded that, if psychotherapy was going to solve anything, it would have by now. Right at the moment, we’re trying to figure out if there are any good pharmaceutical options left.

I’ve had terrible experiences with SNRIs that make that whole class a bad idea.

Every SSRI I’ve tried has had side effects, ranging from the unfortunate to the truly unacceptable, to the point that I’m not willing to try another. I still have tremors from Prozac. My then primary care doctor insisted it couldn’t be the Prozac and that it was sure to help if we could get the dose high enough. Prozac never helped, and none of the others I tried did either. I’d have to dig through the copy of my records that I’ve got somewhere in the house in order to find out which specific other SSRIs I tried and what the side effects were.

I took Geodon for a few years, and that did nothing at all. I’m currently taking Wellbutrin, and, as far as I can tell, that’s not doing anything. We might try Abilify, but I’m not optimistic that that will do anything either.

My taking tamoxifen limits the options for other medications to try. Before my cancer diagnosis, we were talking about MAOIs, but I really would prefer not to go there. The dietary restrictions aren’t as bad as they used to be according to my psychiatrist (that’s not what I’m finding at sites like the Mayo Clinic and the NIH, however), but I really like being able to take OTC cold medicines, particularly sudafed. I took Nardil at one point and had an idiosyncratic reaction that meant that I couldn’t eat most fruits and vegetables unless they’d been cooked to mush, and even then, it was risky. I’m pretty sure that going on an MAOI would mean I eat nothing but bread and oatmeal and the like.

I’m very wary of the tricyclics because Elavil lowered my blood pressure dangerously and didn’t help with the anxiety.

I took Tofranil for years for, if I recall correctly, urinary frequency, an off label application. It didn’t do anything for my anxiety.

I took Klonopin for three or four years for non-specific myoclonus. It had no impact on my anxiety.

Neurontin kind of helped for the first three months I was taking it (for something else) because it put me in such a fog that I wasn’t aware enough of what was around me to feel anything at all.

Ativan helps a good bit, but I hate taking it because it’s an admission that I can’t manage some particular task. It’s also only going to continue to work if I only take it occasionally when I really, really need it.

CBT was horrific for me. It sent me into huge anxiety spirals because I kept digging and trying to come up with anxious thoughts I wasn’t having (as opposed to the somatic anxiety responses I was actually experiencing). Looking for anxious thoughts produced anxious thoughts which produced more somatic responses almost to the point of utter panic. Mostly, when I absolutely have to deal with something like riding the bus, I just turn off as much as I can manage and don’t think. My body still reacts to it, but my mind remains sufficiently functional that I can do whatever I need to do.

I tried exposure therapy for the agoraphobia for a while. The difficulty with it is that it’s very time intensive and never stops being time intensive because, the moment I stop working at it, the anxiety comes back. That’s one reason I’m really not looking forward to starting riding the bus routes I used to use regularly. The GAD is not really amenable to exposure therapy, and the few specific phobias I have aren’t worth the trouble to me to deal with that way.

Comments

[minim_calibre]

Weirdly, because its use as a mood stabilizer is for depression and not anxiety, lamotrigine has worked for me better than anything else.

[lunabee34]

I'm so sorry. This sounds so terrible to deal with.

*hugs*

[laurajv]

Ugh, that sounds horrible. I'm lucky that my damn anxiety and OCD is fairly responsive to medication, because I had to change meds around a bunch during pregnancy (switched to Atarax from Klonopin), and then again when my autoimmune issues messed with my brains (added an SSRI). If it wasn't responsive I'm not sure how I would handle it. It sounds so terrible.

[sylvaine]

Ugh, this sounds like a horrific mess to deal with *hugs*

[the_rck]

Interesting! Lamotrigine doesn't appear to interact with tamoxifen, but it does look like a-- how to put it? --difficult medication in general.

[the_rck]

Mostly, it's actually been irritating. I think I stopped thinking that any particular medication would help a long, long time ago. I keep trying because it keeps my long term disability insurance folks happier.

[the_rck]

Mainly, I've coped by making my life a lot smaller. I'm not unhappy, and I can manage to do the things I absolutely have to do most of the time.

I didn't take any psychoactives while I was pregnant or while I was nursing. Cordelia was three or four when I started seeing a psychiatrist again (and that was more because I needed to for long term disability documentation than because I expected medication to help).

[the_rck]

It's not really all that bad. This is stretched out over nearly three decades which makes it a lot easier to deal with.

[minim_calibre]

Well, The Rash is the big one, but it's comparatively rare, and if one doesn't get hit with that, it's actually got a pretty low side effect profile.

[lunabee34]

*nods nods*

[rachelmanija.livejournal.com]

Is this something where you'd like a mention of a class of medication you may not have tried or even discussed yet? It's something that's used for anxiety, but not that commonly because it's off-label. I thought of it because you mention somatic anxiety responses, and it's specifically used for that. No idea if it would actually help or if you could take it safely, of course.

[kelsusie.livejournal.com]

have you tried buspar? it was a miracle drug for my cousin and hubby. hubby tried abilfy and it didn't help a bit, he currently takes wellbutrin, buspar, and celexa.

[ayebydan]

I have gone through years of this so if you are saying this and looking for suggestions then I have some but I don't want to presume so let me know :)

[the_rck]

With the caveat that I may decide that the advice isn't useful to me for whatever reason, I'm open to it.

I sometimes panic and respond irrationally. If I do that, I apologize in advance. It'll be me rather than something you did, and the best course is to avoid engaging further until I've had at least an hour to put myself back together.

[the_rck]

Buspar was one of the first medications I tried. I have a friend who's a psychiatrist, and he told me that Buspar is generally something that they try early because it has almost no side effects. It's just not commonly effective and wasn't for me.

[the_rck]

I don't mind a mention. It may be something my psychiatrist brought up for me to consider. We had a discussion last July where she wrote up a long list on a white board of the different options and the pluses and minuses. Then, in August, I got the cancer diagnosis, and suddenly, trying a new medication seemed like the very last thing we should do. I've forgotten most of what she said because, well, other more immediately important things taking space in my head.

[ayebydan]

I understand :)

I have read the posts up to and including this over the past few days and have had thoughts but could never put them together but now I'm going to try, with agreed reactions and such :)

I did a lot of 'step therapy' which is similar to exposure but much more restrained. It takes the therapist out of it and focuses on yourself. For example, you set yourself to walk to the front gate/door/garden/open space from your home. You then work on the next space after that whether it is a bus stop of a shop but you don't look to engage in it. I found that vital, the not needing to interact part. I always felt I could do certain things at times, for example you can get C to school. Sometimes your own goals are more important than anything that any professional can set you?

I also tried to combine hobbies. For example, I love adult colouring or colouring. I read you struggle with control and I'm lucky I recovered but I know that feeling. I bought myself children books with wide lines. When I had energy I walked to buy them and when I felt weak I bought online.

I found peace in online puzzles, whether that was online crosswords or jigsawz or anything else.

There are also many online 'fancom challenges' like hogwartsishome or xland for various shows. hogwartsishome for example spans from reading peopel's apps ( a page or so) and deciding which house they belong in, to writing fic, doing puzzles, writing drabbles, fic, make icons or banners or fanmixes. That is a hih example but many other fandoms have similar and I found that great when I struggled to focus for long. I picked and choose what I wanted to take part in.

I read you can crochet for a time. Can you knit? Knit weird and different squares at whatever time and then when you have more concentration sew them together for blankets!

I find fun in organizing my food cupboards. It sounds boring but if you decide on a system and take a few days to bring it together it can be so awesome!

Also, there are online games. Old school games are mostly available on pc these days with a bit of googling and it might even be a cool thing to share with Cordelia?! Pokemon games are on emulators and they take hours to complete but can be stopped and saved at any time if that helps. Prf Layton games are full of puzzles and I got a lot of fun as a kid helping mum try solve them. She got lots of fun doing themselves.

Are your motor skills enough to do cross stitch? I found that very therapeutic too.

These are just a bunch of things I did. :)

I did see you mention pets though. Is there a way you and Cordelia could get one together? A pet is a brilliant way to teach a kid responsibility and you could work it that she 'cares' for it while you get comfort with it, at least when Cordelia is away. :) Expense is important without doubt but there are many cheap pets.

[rachelmanija.livejournal.com]

Beta blockers. On-label use is to treat heart problems and high blood pressure (so they may affect your blood pressure) but they are also used off-label to treat anxiety with prominent somatic symptoms.

There's also old-school medications like Valium. They're not preferred nowadays because they're considered to be more addictive (though many current medications are too) but they're still prescribed for people with no addiction history or addictive personality, so if that's you… (I'm on Valium now. I'm not sure how helpful it actually is, but I had adverse reaction or no response to the more obvious drugs.)

[the_rck]

Your step therapy sounds like what I mean when I talk about exposure therapy. I've never done it with anyone else involved except as a sounding board if I needed one to help me plan/prioritize.

Well, the problem with a pet, beyond the care it would need, is that I'm allergic to cats, dogs, rats, mice, ferrets, rabbits, guinea pigs, hamsters, gerbils. If it's a furred animal that people keep as a pet, I'm allergic to it. Scott has allergy problems with feathers, so a bird's not an option.

Also, anything we got that needed a cage or aquarium or the like would have to live in the basement or in the middle of the floor in Cordelia's bedroom (the basement is a lot more likely).

Cross stitch is beyond me at this point in terms of dexterity. Also, that and knitting (which I used to do a very little) both have the same problem that crochet does-- I can't talk to people or watch TV while I do it because my eyes won't do that any more and haven't for many years. I also infinitely prefer crochet to knitting because, when I make a mistake crocheting or when the hook slips out, it doesn't catastrophically unravel the length of my project. (When Cordelia was smaller, there was also the fact that crochet hooks tend to be less dangerous than knitting needles.)

I'm not actually enthusiastic about any fandom that's large enough to have a community. Back in the day, Weiss Kreuz and The Pretender probably were, but neither of them are big now. I'm kind of into The Librarians, but that's Yuletide eligible. It's been kind of a frustration because I'm vaguely interested in a vast swathe of things but I'm not interested enough to want to do something with any of them. I used to link find for Metanews, but that was pretty unpleasant by the time I had to give it up for health reasons. I was doing 20-30 hours a week, and we couldn't find anybody to help, just lots of people to complain that we were doing it wrong.

[the_rck]

Valium is horrible. I took it for about twenty four hours for muscle spasms in college, and it sent my anxiety through the roof because I couldn't think or feel alert enough to respond to (purely theoretical) danger.

Even when I'm not on medications that preclude alcohol, I can only drink it in very small quantities or in a space I consider safer than usual. I did a bit with it because I discovered early on that a single wine cooler could completely disrupt a building anxiety headache that wouldn't be touched by Tylenol or naproxen. When I was in college, though, and first trying alcohol, my first reaction to it was to get considerably tenser physically. I learned the balance point where it could be helpful later.

I like Ativan much better since it's a set dosage and easy to carry in my purse. Under normal circumstances, I can go a year or two on thirty tablets, but this last year has been a lot tougher in that direction. I just got a new prescription with the last one having been in late November (while I was doing radiation).

I seem to recall that there was some reason or another why I was supposed to be cautious of beta blockers, but whoever told me that, it was so long ago that I don't remember anything except this mental don't-do-that sign that comes up when they're mentioned. It might be related to asthma or it might be something that came up during that weird six month period when I tested positive for RA or it might relate to some medication I don't take any more.

Hm. That might be an appropriate thing to use Google for. Hopefully, I can find a website that isn't completely wingnut (and hopefully, the wingnuts will be obviously so).

Blood pressure is an issue in terms of mine tending low. Before the whole cancer thing got started, I was generally 90/70. At this point, I'm generally 110/70, and I freak out a little bit because, to me, that sounds horribly high.

[the_rck]

And the Mayo Clinic says that beta blockers aren't generally used for patients with asthma because they can cause severe attacks. Given that there isn't currently a rescue inhaler medication I can use safely, avoiding attacks is very, very high on my list of priorities.

[kelsusie.livejournal.com]

Well shoot! Hubby can't take Ativan or anything related to it, it messes him very badly. He'll stand up and just pass right out! He has Atarax for when he has a panic attack but he hasn't had one in months (knock on wood).

[rachelmanija.livejournal.com]

Oh, too bad. Yeah, they definitely sounds too risky for you.

[ramenkuri.livejournal.com]

I'm glad your current psychiatrist seems sensible. I am no help with this, unfortunately.
I wish my mother in law would see a psychiatrist; right now her primary care doctor prescribes her anxiety medication, but it doesn't seem to be helping her much, and I can't tell that her doctor spends any time on this topic.

[the_rck]

My psychiatrist was recommended to me by a friend who was in the residency program with her. He thought I'd get along with her, and he commented that she'd bought a house which he took as a commitment to staying in the area, long term.

I think that a lot of primary care doctors don't realize that it takes a lot of trial and error to find the right psychoactive for a particular patient. They're all better than placebo, but there's not a single one that's universally effective.