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!!!
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?
Yeah there is a theme.
- 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
- Rejection from people I care about
- 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
- 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.
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!
I think those kinds of mental problems are purely psychological. I know why it feels like something physical: it’s completely uncontrollable, seemingly irrational, pointless and harmful behaviour, but I believe this just means you’re not conscious of what is going on deep in your mind and that all of those behaviours actually stem from your real, perfectly rational needs - those needs are just in conflict with what the conscious part of you wants. People might be depressed because deep inside they’re deprived of creative and meaningful relationship with the world or be anxious because they lack the sense of the self and thus feel absorbed by the reality. In both cases, the resultant behaviour becomes obstruent to what the day-to-day part of ourselves needs (to study, to work, to be productive and successful etc.) A panic attack doesn’t particularly help at a job interview after all. So we never bother to actually think about those deep struggles and they remain a subconscious, disintegrated part of us, that appears as an external force to what constitutes our conscious self. This is when it is easy to think of your problems as just brain malfunction. But brain malfunction doesn’t cause existential struggle. You might loose your sight and hearing, memory and other cognitive abilities but it’s always something broader and more primitive than concrete, complex experiences that we call mental problems.
So I believe what would actually help is a deep dive into the realms of your subconsciousness to discover the hidden needs behind your panic attacks and depressive moods. Once you realise them, it will be easier to fill the gaps in your life. Neither meds nor “correct your negative thoughts” kind of therapy can do that. They leave the problem itself untouched.
P.S. I myself used to be very depressed and anxious. Suicidal thoughts and the feeling of the vanity of existence wouldn’t let me. Meds didn’t really help. Only after I realised my deep conflicts and started to change my whole life, did I get any better. I found what I needed to break through the alienation from life and now, although still struggling at times, I have a very strong sense of purpose in life and I actually feel self-actualised.
Well I mean I certainly know that they are psychological and not physical, but I think some people can still need them for psychological reasons if that makes sense.
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 idk if in the meantime meds are needed as an adjust treatment to therapy or how to know if they are doing anything.
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
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.
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 😅
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
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.
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
Yeah I started maybe like last month. Have been on the meds for like 6 months.
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…
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.
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
