Posted by kavinsky99 on February 16, 2014, at 17:02:18
Hello.
I'd like to start saying I know I should seek advice from a trained phsychiatrist. I have. Been having monthly consultations with a psychiatrist for 3 years now. And got opinions from other 5 psychiatrists. Two different GPs (regular one stopped working after having her baby) also help monitor my treatment and also saw a neurologist a few times.
>>>>>> You can also just skip to the bottom of this post, to go where I talk about the issues I would like to see fixed in my brain and discuss them in a more sucint and objective manner. <<<<<<<<<
Anyways, my current mental issues are:
I've had a very tough life, filled with abuse. Both my parents are mentally ill (both of them have both bipolar and borderline personality disorder. Yeah, no mistake there. And I know how bad and not that unlikely that is.) and never sought treatment. No need to get into specifics, but I'm really lucky to have literally survived many occassions, specially from early childhood to mid adolescence.
And unlikely as this seems, my mother used to force me into psychiatrical wards and treatments based on lies she used to tell doctors, since I was a very young. I really don't believe I showed any symptoms back then, aside from anxiety and stress (but very in tune to the abuse I lived every day in my home). Alas, I was diagnosed with every kind of schizophrenia, with bipolar disorder, depression and whatever other symptom my mother decided to tell doctors I had. This may sound unbelievable to you guys, but in my country, psychiatry in state facilities and some privately owned hospitals is very much like it used to be in the early to mid 20th century, filled with ignorance, violence and abuse.Now I seem to suffer from what is mainly the results from a lifetime of severe stress and some form of PTSD, stemming from way more than one occasion. Also considering the possibility of being on the bipolar spectrum, though I never experienced true mania.
If fitting into a diagnosis makes it easier for you, the most aproximate ones I've found are: CPTSD, GAD, depression and possibly ADHD and bipolar II.Now, please, allow me to breakdown the symptoms from each "diagnosis":
CPTSD: I have neverending, repetitive, intrusive and crippling thoughts of bad moments or things that I've been through. Sometimes memories, other times the memories "insert themselves" in the moment/current task I'm on, projecting a critic voice. It's as if I'm carrying it all with me all the time, memories from people who hurt me and the bad emotions associated with those moments. 9 out of 10 times, it's with the abuse suffered with my family or in psychiatrical hospitals in the hands of psychiatrists or psychotherapists.
Most days, it's just flashes here and there. Other days, I actually enter in discussion with these thoughts and these people, mainly trying to argue with them and do justice/protect myself, in a mix of memory and fantasy. And rarely, there are days where I feel like I'm truly reexperiecing those moments again, with very vivid memories.
Although I may argue with the thoughts, see and hear everything very vividly, I know it's all in my head, so I don't think it's a form of psychosis. My psychiatrist thinks it's more of a PTSD and OCD without compulsions type of thing, specially since it's all marked by very intense anxiety. When I'm anxious, those thoughts tend to appear more... And whey they do, I get even more anxious.
GAD: I feel very, very anxious all the time. I worry a lot and usually plan way ahead even for the most common day to day stuff. Being always prepared is important to me. I feel like most of the time I'm in an extreme hurry and feel unable to just be in the moment. I keep trying to get things done fast, or done with it already, to keep moving. But it actually causes a bit of frenzied behavior that is not only unpleasant, but very irrational. I still don't know if it's pure anxiety or a type of hypomania where anxiety is very present. I also have panic attacks daily if I'm not on the right medication.
Depression: I have it all: Cognitive difficulties, extreme unpleasant emotions of sadness, frustration and anger, dulling of emotion and thought overall, lack of appreciation for things, a temper, insomnia (usually find it easier to sleep during the day, but not more than 4 to 5 hours a day), oscilations in appetite (from voracious to never hungry that can't keep down a meal), aches and pains all over the body (usually due to muscle tension), etc.. However, I don't seem to feel much apathy, low self esteem and lack of energy. On the contrary, I feel very apart from the rest of humanity, usually, so I don't feel bad or good about myself, I just don't care much. And when anxious/depressed, my energy feels neverending. Mentally, can't do much aside from recycling the same old bad memories and thoughts. But physically, I notice I can go entire days doing nothing but working out, running, biking, etc.. This also makes me suspicious of actual bipolar disorder.
ADHD: I am very restless. - VERY -. I can't keep my mind on one subject/task for too long. I usually find myself doing a thousand things at once. For example, as writing this, I had to slowly turn off music, tv show, Facebook chat, mmorpg and cake baking in the oven. I hadn't even noticed I was doing so much at once, but as the task to write here gets more demanding, I turn off stuff around me and slowly move into one thing. I notice when I find myself in a calm environment where I have to focus, my mind tends to drift to dark places. The bad memories/intrusive thoughts come down like thunder. I usually feel desperation coming when I can't find distractions, as I know my mind will be at the mercy of my horrible thoughts and feelings. I find it hard to read books, follow plots or study something. It's actually very hard, and it's concerning me a lot. I wish to get back to school, but I literally CAN NOT learn anymore. When I do calm my mind to be able to focus, nothing sinks in. Literally. My memory is really bad, also.
Bipolar II: As I said above, both my parents have bipolar disorder. My father usually is severely depressed, going manic for a few days every few months. My mother is usually slightly manic all the time, going full manic 2 times an year for a few weeks and then severely depressed afterwards.
This gives me quite a strong genetic and behavioral reason to develop bipolar disorder.
And all my symptoms could fit the diagnosis I said before bipolar, but Bipolar II ALONE COULD BE all of that: The repetitive bad memories with a critical tone, the severe anxiety, depression.
I don't exclude the other diagnosis, as they could be overlapping with bipolar disorder just as well.Now the reason I'm writing all of this is to actually seek advice on which medications to choose and which ones could be best for my issues.
I've tried a lot of them, and here's my review of each one I've tried (you can skip to the bottom if you're not interested, as you can still suggest any medication here and I'll take it into consideration just as well):
Antidepressants:
Lexapro (Escitalopram), 10mg, then 20mg, then 40mg: Caused the apathy SSRIs usually cause. Intensified irritability and feeling of neverending energy. Didn't work very well for neither depression or anxiety, so I didtched it.
Zoloft (Sertraline): 12.5mg, 25mg, 50mg, 100mg: Best SSRI I've tried. Didn't cause TOO much apathy, but now that I look back, it did seem to cause what could be TRUE hypomania during the first 2 months on the 50mg range. Felt very motivated, chatty, full of self confidence and somewhat agressive. Helped calming my mind from the bad negative thoughts. After that, I just started feeling very, very relaxed. No apathy, almost no physical symptom of depression/anxiety, rarely the bad racing thoughts came up. Felt like my mind was "moving" again, able to be in the moment and think and feel new things. Sadly, it started to cause severe weakness, dizzy spells and I thought I was passing out, but it turned out I was just "going blank" while totally conscious.
Buspar (Buspirone), 5mg, 10mg, 15mg, 20mg, 30mg: Felt like a softer SSRI. Good to aleviate anxiety and the physical symptoms of anxiety, such as muscle tension, teeth grinding, etc.. Seemed to give me an even worst boost to physical energy and cause a LOT (and I mean A LOT) of anger. Haven't touched it since I had serotonin syndrome. Now I limit myself to just one serotonin booster a time.
Effexor XR (Venlafaxine), 75mg, 150mg: Worsened anxiety while somehow causing more apathy. Severe gastrical distress and muscle tension. When I got on the 150mg dose, I turned out to be very, very irritable and hostile, fighting with my girlfriend for no reason. Maybe if I stayed a while longer and on a higher dose, it could be better. Not sure I wanna try that, as most people agree Effexor after 150mg when norepinephrine kicks in) is one of the most sure ways to cause a manic state, and that may be very well what I had, since that level of irritability is not normal for me.
Trazodone, 50mg, 100mg: Took it just three times, then serotonin syndrome hit me. Never touched it ever since, so I can't tell how good it is.
Remeron (Mirtazapine), 15mg, 30mg, 45mg: This one has to be my favorite. If there's anything close to a happy pill, it's Remeron. Felt relaxed all the time, slept very well, had no physical symptoms of anxiety or depression, could think more clearly and felt very motivated to do stuff. And when I did, I didn't got bothered as much by intrusive thoughts. All around, a fantastic medication. However the weight gain was severe. I couldn't stop eating. Funny to mention that while on it, I took several cooking classes (super Remeron motivation PLUS hunger! haha). However, when bad days happened, they were severely bad. I also noticed that, even feeling good, my goals and behavior were just as (or more) frenzied and erratic than usual. I felt motivated, but couldn't find a focus, and kept initiating a lot of things and then going to something else. Sleepyness and difficulty concentrating were also a factor for stopping it.
Antipsychotics:
These were taken as enhancers to antidepressants or ways to reduce ammount of racing/intrusive thoughts.
Risperal (Risperidone), 0.25mg, 0.50mg, 1mg, 2mg: This one was tricky. Seemed like every dose was a different drug. When I mixed with anything else, it also felt different. However, I noticed while on it, I felt like some days were really good. Just gave me a very relaxed, optimistic feeling about life. No bad thoughts, no anxiety, no extreme moods. Though somedays, I noticed it causes some really bad case of the blues. Between 0.25mg and 1mg was best, with some anxiety in between doses. At 2mg, I noticed my mood became just absolutely dreadful. I think if it didn't cause so much lethargy, I would kill someone or myself. Just bad, horrible mood of anger. Dysphoria in a pill at 2mg.
Zyprexa (Olanzapine)0.5mg, 1mg, 2mg, 4mg: Lasted about a month on it. Very odd feeling of being spaced out/out of touch with reality while on it. A lot of dizzyness in the mornings. One day I remember looking in the mirror and not being able to recognize my own face (I know how weird this is, haha. Never had this happen again on any drug) . My mind became noticeably sharper and calmer, though. Gave me very good insights about my own feelings. That's why I quit it, to be honest. Couldn't handle to see my life and myself in such a filterless way. That and gaining 30 pounds in less than a month. My mood felt low after quitting it and took months to go back to normal (which is already low).
Abilify (Aripiprazole), 7.5mg: Took it just once, hoping it would be the perfect antipsychotic - that would obliterate anxiety, calm my intrusive thoughts, help with depression and not harm cognition (or even improve it!) thanks to it's unique dopamine partial agonism and not cause any weight gain. Well, turns out I took one pill, ate my whole kitchen and then fell asleep for 12 hours... of which I woke up 4 times feeling wired like as if I did cocaine. So I never tried it again.
I also took several different benzodiazepines. My favorite for daily anxiety maintenance is bromazepam. Alprazolam for severy anxiety and to help sleep.
And as a final entry, I would like to add lithium, of which I took 75mg to 900mg daily. By far, the medication I most enjoy and would never be without it. Levels my mind just enough to feel somewhat normal every odd day. And I feel the longer I take, the better I do/feel overall.
Now, for a conclusion, I would like your input for medications that best and safely fit my diagnosis/possible comorbities, according to my issues, that I will describe here in a more objective manner:My main goal is to seek relief for all the symptoms described above, but while retaining a few capacties or gaining new ones:
I wish to see obliterated:
Depression;
anxiety;
negative critical thoughts that "talk to me" in my mind;
intrusive flashbacks that pop up constantly;
overall agitation;
insomnia;
I wish to see improved:
Overall cognition (bad memory, poor concentration, difficulty to (re)learn even the simplest things, poor criativity, difficulty forming sentences sometimes);
focus: both on the big picture in life projects, and on the ability to actually read a line on a text book and be able to absorb it. I have an impulsive and frenzied attitude towards life, I rarely finish anything I start and keep trying new things all the time.;
ability to "be in the moment", with no judgement coming from my own mind. to just relax and enjoy myself, letting life happen.
I appreciate any input. Be it medication, behavior change or technique, natural supplementation or anything.
Sincerely grateful.
poster:kavinsky99
thread:1060760
URL: http://www.dr-bob.org/babble/20140214/msgs/1060760.html