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Two parter...1. How do I know if I actually need medications? How can I tell if they have an effect on me???? (Sorry, long) (lemmy.world)
submitted 1 month ago* (last edited 1 month ago) by dingus@lemmy.world to c/mentalhealth@lemmy.world
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First...I am NOT an anti-meds person, but I don't believe that everyone should just be on them. My friend has schizophrenia and absolutely needs her meds. It's scary when she's off them because of how negatively it impacts her life.

I called out of work one day due to having an issue and in desperation made a same day appointment with a psych NP. I was surprised at how immediate and quick she was to be like "hey sure yeah you can try meds if you want". They diagnosed me with the generic "depression and anxiety" and when from there.

Well the NP immediately quit after that and they transferred me to a new NP, who has continued to prescribe different meds for me. I also recently started therapy.

With the first med I tried (an SSRI), I continued to have my episodes, so I initially thought it had zero effect. In retrospect, I do think it slightly lowered my anxiety (but not enough to really do anything). Coming off them was unpleasant and I had another episode that may have threatened my job. I'm not sure if the episode was related to the med reduction or not.

My NP specifically stated that I do NOT have bipolar disorder, but that she wanted to try lamotrigine with me. I have been slowly over many months titrating up to my therapeutic goal dose and reached it a couple weeks ago.

She also recently prescribed me PRN propranolol which I also don't know if it has any effect. I very rarely get panic attacks. My NP's idea was that if I have a stressful that happen that day to take it so I am theoretically less inclined to have an outburst of some sort later. Again, I'm not sure if this is really doing anything for me. I don't notice an effect.

I know propranolol is preventative instead of used during or after, but I can't always predict when a trigger may occur.

My episodes generally begin with a trigger. So if there are no triggers, I have minimal/no issues. The triggers are not 24/7 and there are sometimes many weeks in between. So how tf am I supposed to tell if the medication does anything???

My issue: extreme negative emotions/spiraling generally tied to a trigger; can cause me want to self harm or do dangerous things, can sometimes cause outbursts at work which threaten work interpersonal relationships and my job. For the most part, my episodes occur outside of work and I am usually (but obviously not always) able to keep it together). So it can be very distressing and unpleasant to live with...but again it's not 24/7.

Sorry that was long!!!

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[–] givesomefucks@lemmy.world 5 points 1 month ago* (last edited 1 month ago) (1 children)

Panic attacks are just an adrenal response you don't want or isn't really needed...

Proponal blocks adrenaline. But stays in your system like 36-48 hours. So your doc likely already talked to you about how you need to take it as directed and let it build up.

You'll know proponal is working, by doing something that normally gets your adrenaline up, and realizing while you're still enjoying it, it's a calm enjoyment and you're not all hyped up from adrenaline.

They would have started you on a very low dose, and it's 100% normal to need to bump it up. Even if it works at first, you'll probably need to bump it up as your body gets used to it. Everyone's different, but think of it like 1mg blocks X% of your adrenal system, so dialing in your dose is just finding out how much to block to stop an adrenal response from crossing the threshold to a panic attack.

But there's very few side effects, and long term it's good for your heart.

Obviously you should be asking your doc, but this is America and doctors are expensive.

Edit:

If it's just "as required" it'll kick in within like 5-15 minutes, if you start freaking out, pop one.

And it'll stop it because it literally stops (some, depending on dose) adrenaline from working in your brain

[–] dingus@lemmy.world 1 points 4 weeks ago* (last edited 4 weeks ago)

So I kind of uncommonly get mild panic attacks. They happen I guess, but not to the frequency that I would necessarily find the need to try them. By the time I am panicking, I already calm down on my own before the time it would take to take the med and for it to kick in. She isn't necessarily prescribing it for panic attacks, but to help prevent a big reaction from me later when I am having a stressful day. Yeah it's just as needed as opposed to daily. Supposedly it will take around 30 minutes to kick in.

What I will say is I have a very significant and predictable and prolonged stressor for several days out of the week that occurs in the evenings. One day, I took the propranolol in the morning and was still very on edge in the evening. But I noticed that today, I took it a bit later in the day and was a smidge less on edge in the evenings. But I was also very tired today which also just decreases my anxiety lol. But I will keep testing. I probably need to try taking it closer in time to the known stressor, but not too close such that it doesn't have time to work.

Daily I am taking lamotrigine right now. Not sure if it is doing anything at all for me.

[–] illapa@lemmy.world 3 points 1 month ago* (last edited 1 month ago) (1 children)

Are you doing therapy? I’ve found that meds can be useful (when you need them to regulate your brain chemistry), but at the end of the day you want to build skills for resilience in stressful periods of life. My first therapy goals were (are) identifying my triggers and expanding my window of tolerance to be able to work through them

[–] dingus@lemmy.world 3 points 1 month ago (1 children)

Yeah I started maybe like last month. Have been on the meds for like 6 months.

[–] flambonkscious@sh.itjust.works 2 points 1 month ago (1 children)

Awesome - I suspect that's going to be a huge part of the 'way through' (in a long term sense). The quick fixes just aren't there, in my experience.

After years and about 5 different therapists, I still don't really know how to judge how well it's working (the client therapist relationship), but it takes time for each of you to click together, as well as time for them to be more insightful about how you respond and what approach or tools will benefit you specifically.

Its good when it's working - hang in there!

I had years of SSRIs and SNRIs and eventually decided the side effects weren't worth the benefits for me. But life had improved by then too, so I wasn't completely white-knuckling it. Hard to say how much was circumstances changing vs my responses and thinking patterns.

The reality is we're messy and it's ALL intertwined...

[–] dingus@lemmy.world 1 points 4 weeks ago (1 children)

Tbh I never entirely wanted to be meds long term...because I think 1. My life stress is just incredibly high right now and 2. My issues could eventually be mostly greatly reduced (but never entirely resolved) by therapy.

But therapy is a slow as fuck process and I'm wondering if I'm in a state where meds are "needed" as an adjunct to therapy and how to tell they are even working.

I tolerated SSRIs just fine tbh. Was exhausted initially, but once I got used to them I felt totally normal. The presence or absence of sexual side effects were not something I would ever be able to ascertain because I had never had a libido or the ability to feel sexual pleasure my entire life even before trying SSRIs. But I know it's one of the most significant SSRI side effect for many.

While the SSRIs did seem to marginally help in certain areas, they didn't at all touch on my main issue or make me more resilient to it or make it easier to tackle or anything.

I'm in therapy now to help with the mental side of things. I know that ultimately that will work best.

But yeah it's gonna take a damn long time...so I just don't know how to know if in the meantime if meds are needed for me as an adjunct treatment to therapy or how to know if they are doing anything.

[–] flambonkscious@sh.itjust.works 2 points 4 weeks ago (1 children)

Its a quandary for sure. Technically it's a discussion between you and the psychiatrist who's trained in how the meds work (not your psychologist/therapist who typically has no training with medication)

In my experience, I had a huge blind spot regarding their efficacy. It was my partner that people were listening to which I found really strange

[–] dingus@lemmy.world 2 points 3 weeks ago

Yeah lol I have heard that often it's a lot better for family/friends to be able to tell than yourself! I live alone so I don't have people to really notice that haha.

Like I have a friend with schizophrenia. When she sometimes decides she doesn't need any meds anymore, it's VERY obvious!!

[–] SoleInvictus@lemmy.blahaj.zone 2 points 4 weeks ago (1 children)

No apologies, it was very thorough but not rambling. Plus sometimes you just need to let it out some and that's okay!

If you don't mind my asking, what types of things are your triggers? Is there a theme?

[–] dingus@lemmy.world 2 points 4 weeks ago* (last edited 4 weeks ago) (1 children)

Yeah there is a theme.

  1. People getting upset with me, especially if it's not because something I did or if it's because of something I didn't intend
  2. Rejection from people I care about
  3. Someone stopping to criticize and nitpick me about dumb insignificant shit when I am working as hard as I possibly can and trying my best. My supervisor does this which is part of my issue with functioning at work
  4. Less common to cause a big outwardly external reaction, but more internal panic and/or sadness...failure/inadequacy at work related tasks that others do well

What happens is that I have periods of high energy low mood and low energy low mood.

The high energy low mood states involve things like distress, frustration, rage directed inward, impulsivity, urges to self harm, etc. These episodes are the most damaging to the self, my workplace, and my relationships.

Sometimes when I am in a high energy high mood state, a trigger can actually cause me to rapidly switch into a high energy high mood state.

In the low energy states, they are still extremely painful, but not really dangerous to the self. Sometimes I get in states where it actually feels physically difficult to move. Even getting out of a chair feels impossible like I am paralyzed or have 50 lb weights scattered across my body. Sometimes I end up sleeping excessively during these phases.

In between, I am totally normal!

Maybe it sounds similar to it, but I do NOT meet the criteria for bipolar disorder. I do NOT meet the criteria for hypomania, my "episodes" are almost always caused by triggers, and most of them are not long enough in duration to meet the criteria (although sometimes the low energy low mood states can last a few weeks). If rejection is reverted, the negative mood state can be relatively quickly relieved.

I also have significant baseline anxiety, but I've always been that way ever since I was a kid. The distressing and damaging parts to me are the mood episodes, not generally the anxiety (but it can be disabling sometimes). It is possible that some of my "episodes" might be triggered by anxiety.

[–] SoleInvictus@lemmy.blahaj.zone 2 points 4 weeks ago* (last edited 4 weeks ago) (1 children)

I was wondering! Your initial account really resonated with me, like something I could have written myself. The only confirmation I needed was if we had the same triggers, which we do. You react just like me too.

For my entire life, I've been extremely sensitive to rejection (and criticism, which is really just a type of rejection). Comments that could be perceived as criticism, no matter how implausible or nonsensical that criticism which be, would make me feel stressed or cause a sudden jolt of panic. Real criticism would cause me to stress and fret for hours or days, until I could appease the critic or fix the issue, even if it really wasn't an issue and they were just manipulating me. Direct rejection, like being turned down for a date, a breakup, being passed over for a job or recognition, or someone telling me they simply don't like me, would send me into an emotional tailspin for hours, days, or weeks. If any of this came from someone I cared about or was about something I was particularly sensitive about, it was so much worse.

I can tell you what causes it for me and what I've done in the hope it might help you, and feel free to ask any questions about anything. Literally anything. I know how awful this can feel, how it can make you feel like life is so unstable and you're turning into a crazy person that just can't cope. I really want you to find your way out of this, because you deserve to feel safe and empowered.

I'll keep this part shorter (for me, I talk a lot) and let you ask for any details you might like. You're welcome to message me if you want to take anything out of public view.

High level: I have hella ADHD as well as Complex PTSD from childhood emotional abuse and neglect.

ADHD comes with all sorts of fun issues beyond attention and motivation.

  • I have difficulty regulating my emotions, causing me to have exaggerated emotional reactions to...everything. I can be an emotional roller coaster some days, or just super happy or super sad others. Bipolar was also suspected but ruled out.
  • I have rejection sensitive dysphoria, causing an extreme emotional reaction to real and perceived criticism and rejection.
  • ADHD makes it hard to think through emotionally charged situations since I get so overwhelmed. I have difficulty working through my feelings, so they stick around longer than they might.

CPTSD largely manifests as a suite of unhealthy coping mechanisms and deep-seated beliefs developed as a child due to my parents' mistreatment of me. These center around having difficulty asserting my needs , issues with self worth, and a drive to seek the validation and acceptance I didn't receive as a child.

Both are being handled with medication, therapy, a shit ton of self-help books, and a gradually building collection of coping strategies and behavioral changes, like starting meditation, calendars and to-do lists, explaining my situation to loved ones so they understand and know how to react if I flip out, little letters and reminders I write for myself while stable to read in times of instability, etc.

I could write more, but it's already a ton. If you want to know anything, fire away!

[–] dingus@lemmy.world 2 points 3 weeks ago (2 children)

Yes I absolutely relate almost exactly to what you are talking about! It's frustrating because I feel like I feel these certain things so deeply and others just don't have that type of intense emotional pain that I do.

It's funny you mention ADHD because whenever I look up things like "emotional dysregulation" and "rejection sensitivity"...for some reason ADHD is one of the top results/conditions lol.

I relate to all of the ADHD related bullet points that you say, but I just don't really have core "symptoms" of ADHD. I have the same emotion issues, but I don't have issues with attention and etc. to my knowledge. I've always had issues with things like keeping up with household chores and staying neat, but beyond that none of the "core" features seem to fit me. My older sibling has very obvious ADHD though lol.

Dunno much if any of what I have is real trauma, but my therapist the other day that my frantic efforts to predict and prevent negative emotions from others is a "trauma response", but idk how much of that is true for me.

I'm guessing the main med helping you is some ADHD meds, right? Do you take anything else?

[–] SoleInvictus@lemmy.blahaj.zone 2 points 1 week ago (2 children)

Oh fuck me! Almost two weeks later... Sorry! Things have been hectic and I've been a bit overwhelmed, so I lost track of some things. Okay, most things.

Regarding ADHD, don't discount it or really any condition without digging deep into it with a professional. You might be surprised. Here's my experience.

I didn't get a proper ADHD diagnosis until my early forties. I was shocked as I was absolutely certain I didn't have it. Even then I didn't get properly medicated - my initial diagnosis had me on guanfacine as I wasn't seen to have many ADHD issues and they weren't severe. It made a huge difference and guanfacine barely does anything compared to other meds.

A few years later, I met with another psychiatrist who helped me realize I had several more issues than I thought and they "weren't too severe" because I was handling them through insane amounts of complex coping mechanisms and good ol' brute force. This explained why I was always emotionally and mentally exhausted, why I'd wake up and just sit in bed for hours despite not being depressed in the slightest.

If you had any childhood trauma, including emotional trauma like neglectful, emotionally absent, manipulative, and/or verbally abusive parents, I cannot recommend Pete Walker's "The Tao of Fully Feeling" and "Complex PTSD: From Surviving to Thriving" enough. I may have mentioned those before but they're my two go-to books out of the literally dozens I've read. The Tao of Fully Feeling is also just great for anyone dealing with issues with emotions.

I'm on on a few meds:

Jornay PM: time delayed, extended release Ritalin. You take it at night and it kicks in the next morning. On Ritalin, I feel 10x smarter and I can actually get moving to get things done! I don't have as many issues with sensory or mental overload and can earlier identify when that might be happening. I can better stay calm in stressful situations, mentally juggle complex thoughts, and keep track of more than one thing at a time.

Guanfacine ER: A blood pressure med that helps with the executive dysfunction aspect of ADHD. It makes my brain "quieter" and helps me with impulsiveness, anxiety, and emotional regulation.

Propranolol ER: a beta blocker that helps with anxiety and tamps down the somatic effects of anxiety and panic. SSRIs work great for my anxiety but they blunt my emotions. I'm working with my therapist on consistently feeling my emotions (I tend to repress, then have massive anxiety instead), so that's a no-go.

Bupropion XL: Originally I took this as an SSRI alternative for seasonal depression, but it's great for ADHD! It helps a lot with motivation and impulsivity.

Let me know if you have any questions on this or anything else. Just know you're always welcome, even encouraged, to bug the shit out of me if I don't get back to you in a timely fashion.

[–] curiousPJ@lemmy.world 2 points 1 week ago (1 children)

I'm not the person you have been responding to but thank you for the resources, I'll be checking them out as well.

[–] SoleInvictus@lemmy.blahaj.zone 1 points 1 week ago

You bet! Let me know if you have any questions.

[–] dingus@lemmy.world 2 points 1 week ago

Are you ok at least? I know you said you were trying to get out of an abusive relationship?

I mean I've never had an issues with attention so it just doesn't make sense to me. Obviously I have emotional problems, but that would be my only "ADHD trait" which is shared by many "conditions". What other traits do you have?

Yeah some of my online friends seem to think I have a lot of trauma. But the weird thing with that is like... doesn't literally everyone? Why would some be more effected than others? Some people are horribly abused and it makes sense...but many of us have a lot "milder" traumatic experiences.

I have been consulting ChatGPT (lmao) and it seems that guanfacine is the most common indicated thing for emotional dysregulation in complex trauma. I had never heard of it before.

Yeah thing is I'm totally fine when I have no triggers. But when I do, I go from 0 to 100 and have a hard time getting out of it (whether it's an activated state more damaging to the self or a low energy state where I have a hard time physically walking or moving). I think my baseline leans normal to slightly depressed.

How do you feel about taking so many meds? I'm already a bit turned off from meds. I have always been of the opinion that while some people really do absolutely need them that a lot of people are over medicated.

After my negative experiences I kind of want to stop trying meds but I'm afraid to get off them after my last experience. I had a reaction in SSRI withdrawal that severely threatened my job. And now my provider has me on lamotrigine, but research that I've done seems like it does nothing for emotional dysregulation.

Do you know how much I would have loved to be blunted on SSRIs lol? My issue is too many and too strong emotions, so feeling less would have been helpful!

Oh and why are you taking both guanfacine and propranolol? They both seem to cause a "body calm", so it seems odd you're prescribed both.

Sorry for the long response lol

[–] SoleInvictus@lemmy.blahaj.zone 2 points 3 weeks ago (1 children)

Just wanted to let you know I haven't forgotten you. I'm extricating myself from an abusive relationship, so life is a little tricky. I'll start writing you a proper response tomorrow.

[–] dingus@lemmy.world 2 points 3 weeks ago

Jeez I'm so sorry. Please be safe. :( I'm happy you're getting out of there at least.

[–] fracture@lemmy.blahaj.zone 2 points 4 weeks ago (1 children)

i think propranolol is a pretty good choice for your situation, actually, i think, if the dose is high enough, and you can tolerate the effects on your blood pressure, then it can probably be very useful after a trigger? it depends on how you take it / the formulation, the short acting works for around 4 hours, but you can get extended release versions too

i took propranolol regularly for a couple of years for essentially the same thing, managing triggers. it was an effective way for me to deaden the intensity of feelings and be more productive handling them, although prolonged use eventually led to that sort of zombie lack of emotions effect. still, it did me a lot of good for the time i was on it

really, unfortunately, you have to evaluate the meds based on how you feel normally on them and when you encounter a trigger. it sounds like your triggers can get quite bad, so intentionally testing it doesn't seem like a good idea (if you're even able). you might just keep the propranolol on hand if it happens

in terms of data, i would look at the severity and length of the episodes where you encountered a trigger. ostensibly, the medicine should make it less severe and easier to pull out of. and if it's not after some time, then it's probably worth switching

[–] dingus@lemmy.world 3 points 4 weeks ago (1 children)

I think what people are seeming to miss in my novel is that I am currently on 2 meds... lamotrigine daily and then propranolol as needed. I'm glad you had a good experience with it. Interesting how you ended up feeling like a zombie on it because it effects more of the physical side of things. I think my propranolol dose is pretty low.

[–] fracture@lemmy.blahaj.zone 2 points 4 weeks ago

ah, sorry, i saw it, i just don't know anything about lamotrigine. and the same stuff applies with it; you'll probably have to wait till you encounter a trigger and just gauge how bad it was and how long it lasted to see if it helps 😅