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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Christ_empowered on January 17, 2012, at 0:36:25
Its a strange kind of nervousness. Like I'm raw, somehow; uninsulated. That's strange because I'm on a whopping 30mgs Abilify daily. That was to keep the agitation down. I dropped the 200 Lamictal a little while ago. Now my face is turning red all the time, I'm anxious in public, and I feel...well, I feel a little nervous. Being in public is almost impossible.
So, what should I do? I'm not supposed to see the shrink until February, but I'm anxious NOW. But I don't know that I should medicate everything away. She said no to an antidepressant before, and I dropped the Lamictal.
I don't know if I should even treat this. I was in 23 hour lockdown a couple years ago in jail for over 7 months (I got those charges expunged, thank God). That screwed me up. Then 1 year of hyper-socializtion in a Christian rehab program. Then 1 more year of social isolation, living alone in an apartment in a dusty, small southern town. Now, I have almost no social life, but I do actdually see and talk to people and I don't freak out as much.
Still, I don't want to be a masochist and suffer and suffer. I see a counselor, but its one of those relationships where they throw feel-good platitutdes at you and hope you get better.
I don't know. Benzos are out, because the public health shrinks can't prescribe them and I don't have the $$$ to see a private practice shrink who could hook it up. I was thinking Remeron, since it would help me set (and keep) a bedtime. But I'm already overweight. Celexa helped before, rather quickly, too.
HEEEEELP!
Posted by papillon on January 17, 2012, at 2:52:00
In reply to I feel so...nervous, posted by Christ_empowered on January 17, 2012, at 0:36:25
Hi CE,
I am sorry to hear that you are feeling this way.
When I am feeling really anxious or distressed I try to do some of the self soothing and distraction techniques that I've learnt in Dialectical Behaviour Therapy.
I might distract myself by naming in my mind 5 things I can see, hear, feel, taste, smell. Then 4, 3, 2, 1... - this I find really helpful in moments of intense anxiety or distress. You can do it anytime, anywhere, and no one needs to know.
I might also distract myself by doing easy/repetitive chores or errands, though the latter may be problematic for you.
I might self-soothe using the 5 senses by watching a candle flicker, having a warm bath, treating myself to something yummy (and eating/drinking it mindfully), listening to music, walking or stroking my dog. You might find comfort in praying and reading the bible, maybe talking with someone from your rehab program?
I know these suggestions may sound trite, but if you can shift your focus (even if only partially) just for 1 minute, 5 or 10 minutes at a time, you may find that you are better able to handle the (freaking uncomfortable!) feelings and the intensity may even drop. String them together and you'll find that you've got through the last half hour, couple hours, morning, day... in a better state than you otherwise would have and all in a healthy manner.
It helps to practice these techniques when you're not in a crisis, but you can start right now, wherever you are.
This website might give you some ideas: http://www.dbtselfhelp.com/index.html
I found it through google and only took a cursory look, but what I saw looked good. There would be others.
Posted by Phillipa on January 17, 2012, at 9:14:49
In reply to Re: I feel so...nervous, posted by papillon on January 17, 2012, at 2:52:00
CE you took yourself off the lamictal? Weren't you doing well? On the combination before? Does you doc agree on being off the lamictal. You made a wise choice by sticking to the abilify. Your experiences must have been very painful. Some I knew of but not others. Hope some good advise is given. Phillipa
Posted by creepy on January 17, 2012, at 12:49:23
In reply to I feel so...nervous, posted by Christ_empowered on January 17, 2012, at 0:36:25
Thats a pretty activating AAP for a lot of people. Maybe you need something else with it?
I got an extreme anxiety reaction like that with a couple meds I tried. Feels like everyone is watching you so you start to stiffen up and make mistakes and it becomes self-perpetuating.
If I was put in jail I would certainly go crazy. It brings back all the PTSD for me.
Posted by torrid2 on January 17, 2012, at 16:20:39
In reply to I feel so...nervous, posted by Christ_empowered on January 17, 2012, at 0:36:25
do you think talking to your father triggered this?
Posted by torrid2 on January 17, 2012, at 16:26:36
In reply to Re: I feel so...nervous » Christ_empowered, posted by torrid2 on January 17, 2012, at 16:20:39
that was sleepy girl I was thinking of not you sorry for confusing you two
Posted by SLS on January 17, 2012, at 17:32:26
In reply to I feel so...nervous, posted by Christ_empowered on January 17, 2012, at 0:36:25
I could see how dropping the dosage of Lamictal too quickly would produce some transient anxiety and perhaps some dysphoria. I guess you can add back some Lamictal or just ride it out.
- Scott
Posted by phidippus on January 17, 2012, at 17:55:51
In reply to I feel so...nervous, posted by Christ_empowered on January 17, 2012, at 0:36:25
I suspect you are suffering from Akathisia, which presents as an inner restlessness and anxiety. High doses of neuroleptics can cause this. A couple things can help: Propanalol, Cogentin or Artane.
Eric
Posted by Christ_empowered on January 17, 2012, at 21:02:14
In reply to Re: I feel so...nervous, posted by Phillipa on January 17, 2012, at 9:14:49
hey everyone. I feel better today. I even went grocery shopping. I was nervous and awkwared, as usual, but it didn't phase me: I got in, got what the food I needed, and got out. That was my big accomplishment of the day.
I probably should have stuck with the Lamictal. I just don't know what to do. I don't feel like I'm descending into the pit of paranoid sadness (at least, I don't feel that way RIGHT NOW), but I don't feel terribly calm and socially competent, either. Then again...there isn't any magical social skills pill I can take. So I don't know.
In other news, I'm having odd fits of anger relating to my mistreatment at the hands of past psychiatrists and counselors. Not much I can do about it. I already went to the Medical Board against one shrink and tried to lodge a HIPPA complaint against another. Maybe dead roses would do the trick? LOL. Seriously though--one of my friends has suggested that I write a book about my madness, and I've started. I've got a bit less than 10 pages so far, and its not terribly well-written, but its something...
Posted by SLS on January 18, 2012, at 7:33:55
In reply to Re: I feel so...nervous » Christ_empowered, posted by phidippus on January 17, 2012, at 17:55:51
> I suspect you are suffering from Akathisia, which presents as an inner restlessness and anxiety. High doses of neuroleptics can cause this. A couple things can help: Propanalol, Cogentin or Artane.
>
> Eric
I find that it helps to use a strict definition of akathisia to diagnose it properly. The Barne's Akathisia scale is often used. Without rocking, pacing, weight-shifting, along with the extreme inner restlessness, I don't think akathisia should be so quickly diagnosed. Less severe presentations are difficult to separate out from anxiety or agitation.
- Scott
Posted by Christ_empowered on January 18, 2012, at 8:54:21
In reply to Re: I feel so...nervous, posted by SLS on January 18, 2012, at 7:33:55
Akathisia is fairly constant, right? Or no? My anxiety ebbs and flows. I read somewhere that Remeron can help "normal" anxiety and akathisia. Too bad is a horse tranquilizer AND a fatty pill AND my shrink seems anti-ADs for me.
Posted by SLS on January 18, 2012, at 8:59:17
In reply to Re: I feel so...nervous, posted by SLS on January 18, 2012, at 7:33:55
> > I suspect you are suffering from Akathisia, which presents as an inner restlessness and anxiety. High doses of neuroleptics can cause this. A couple things can help: Propanalol, Cogentin or Artane.
> >
> > Eric
>
>
> I find that it helps to use a strict definition of akathisia to diagnose it properly. The Barne's Akathisia scale is often used. Without rocking, pacing, weight-shifting, along with the extreme inner restlessness, I don't think akathisia should be so quickly diagnosed. Less severe presentations are difficult to separate out from anxiety or agitation.
http://logarithmic.net/pfh/akathisia
- Scott
Posted by SLS on January 18, 2012, at 9:01:30
In reply to Re: I feel so...nervous, posted by Christ_empowered on January 18, 2012, at 8:54:21
> Akathisia is fairly constant, right?
The cases that I have witnessed were chronic and unabated all day long.
- Scott
Posted by morgan miller on January 18, 2012, at 16:40:29
In reply to I feel so...nervous, posted by Christ_empowered on January 17, 2012, at 0:36:25
CE, I think a 5 mg dose of Lexapro might be a good idea. Or just go back to the dose you used for Celexa.
If you want to benefit from therapy, and are willing to do the work, you need to see a Phd that practices psychodynamic therapy. Would your parents be willing to help you pay for this if you find someone good that you like?
Sorry you are dealing with this discomfort, it definitely sucks.
Morgan
Posted by jono_in_adelaide on January 18, 2012, at 17:04:59
In reply to I feel so...nervous, posted by Christ_empowered on January 17, 2012, at 0:36:25
I found risperidone 1mg at night very calming, might be worth looking at.
Posted by Phillipa on January 18, 2012, at 18:23:47
In reply to Re: I feel so...nervous, posted by Christ_empowered on January 17, 2012, at 21:02:14
CE glad you were able to go to the store and accomplish what you needed to do and feel better also today. Maybe your brain is clearer today hence remembering what happened in past? Phillipa
Posted by SLS on January 18, 2012, at 19:45:41
In reply to Re: I feel so...nervous, posted by morgan miller on January 18, 2012, at 16:40:29
> If you want to benefit from therapy, and are willing to do the work, you need to see a Phd that practices psychodynamic therapy.
What is your rationale for suggesting psychodynamic therapy over other psychotherapies?
- Scott
Posted by morgan miller on January 19, 2012, at 1:53:28
In reply to Re: I feel so...nervous » morgan miller, posted by SLS on January 18, 2012, at 19:45:41
Hey Scott..I explained why in a thread in the psychology section-I will have to go back to look and see which thread it was, it was just a few days ago.
It's the use of empathy and compassion, and the strong bond that is formed between patient and therapist, that sets psychodynamic therapy apart from psychoanalysis. A good psychodynamic therapist with a PhD in clinical psychology will be able to do so much more for a patient as far as helping them to peel away layers and connect with deep internal conflicts and buried emotions that are still driving one's behavior and impacting neurochemistry. This process is not easy and can take a fairly long time. The only real solution is often the most difficult and time consuming one.
Posted by SLS on January 19, 2012, at 5:41:31
In reply to Re: I feel so...nervous, posted by morgan miller on January 19, 2012, at 1:53:28
> Hey Scott..I explained why in a thread in the psychology section-I will have to go back to look and see which thread it was, it was just a few days ago.
>
> It's the use of empathy and compassion, and the strong bond that is formed between patient and therapist, that sets psychodynamic therapy apart from psychoanalysis. A good psychodynamic therapist with a PhD in clinical psychology will be able to do so much more for a patient as far as helping them to peel away layers and connect with deep internal conflicts and buried emotions that are still driving one's behavior and impacting neurochemistry. This process is not easy and can take a fairly long time. The only real solution is often the most difficult and time consuming one.Thanks for answering my question. I was wondering why you didn't consider interpersonal psychotherapy (IPT) modalities. I find IPT to be very helpful while not having to commit to such a protracted process as is psychodynamic therapy. They aren't totally dissimilar.
I'll go over to the Psychology board and look for your posts.
- Scott
Posted by morgan miller on January 20, 2012, at 22:09:03
In reply to Re: I feel so...nervous » morgan miller, posted by SLS on January 19, 2012, at 5:41:31
> > Hey Scott..I explained why in a thread in the psychology section-I will have to go back to look and see which thread it was, it was just a few days ago.
> >
> > It's the use of empathy and compassion, and the strong bond that is formed between patient and therapist, that sets psychodynamic therapy apart from psychoanalysis. A good psychodynamic therapist with a PhD in clinical psychology will be able to do so much more for a patient as far as helping them to peel away layers and connect with deep internal conflicts and buried emotions that are still driving one's behavior and impacting neurochemistry. This process is not easy and can take a fairly long time. The only real solution is often the most difficult and time consuming one.
>
> Thanks for answering my question. I was wondering why you didn't consider interpersonal psychotherapy (IPT) modalities. I find IPT to be very helpful while not having to commit to such a protracted process as is psychodynamic therapy. They aren't totally dissimilar.
>
> I'll go over to the Psychology board and look for your posts.
>
>
> - Scott
>I guess I never considered it because the therapist I saw used some interpersonal therapy strategies along with psychodynamic therapy, and CBT when necessary or appropriate. Actually, the work done in group therapy, even one with a psychodynamic approach, is heavily dependent on interpersonal therapy. I believe an experienced therapist that can incorporate psychodynamic, interpersonal, and cognitive behavioral approaches to their practice is going to give a patient the best chance at making progress.
I get a bit frustrated when people do not take the time to deal with their inner conflicts in a way to make it possible to get better. I understand why many people avoid doing this, it just frustrates me.
Posted by papillon on January 21, 2012, at 6:49:25
In reply to Re: I feel so...nervous, posted by Christ_empowered on January 18, 2012, at 8:54:21
Hey CE, how are you today?
Posted by Christ_empowered on January 21, 2012, at 10:42:23
In reply to Re: I feel so...nervous, posted by papillon on January 21, 2012, at 6:49:25
Feeling good, thanks. Have apt. cleaning to do, a friend to meet up with. Relatively boring, normal stuff. The rage has passed, for now.
This is the end of the thread.
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