ptsd and meds

[2/2010: one reader asked for people to share what has and has not worked for them concerning meds. If you have had good or bad experience with any particular prescribed meds, share it in the comments please.]

I've been some sort of human guinea pig for the better part of a decade. After one trip to the mental hospital I went on Prozac when that first came out. I didn't like it and quit after a few months. At the time I had no insurance to speak of and didn't trust the mental health profession at all. A few years later, I was trying to get things under control and got diagnosed with Obsessive Compulsive Disorder (OCD). They put me on a clinical trial for a drug that was used for something else altogether. I got markedly suicidal, and when I reported that, the doctor would interpret his questionaire number scores and say I was improving, completely ignoring what I was saying! I discontued the drug and the trial. A year or so later, I went to a shrink. The shrink sent me to a psychiatrist, who was this guy who smoked in his office. He barely even met with me and put me on Zoloft. I took it and got suicidal. He upped the dosage, things got worse, so he upped the dosage again and things got worse again. He wanted to up it some more. At this point I quit...He wasn't paying any attention to what was going on with me, just following some formula with the drug being pitched by the pharmaceutical companies that week.

A few years later, right before the ptsd got really bad I decided to go back into therapy, this time with a psychiatrist so he would actually listen to what I was saying. The guy wanted to put me on Celexa and pulled out this tinker toy model of a neurotransmitter reaction (serotonin reuptake inhibition, to be exact) that was right out of the Parke Davis sales kit. It was like Amway or a tupperware party or something. He turned out to be a real jackass and I cursed him out and left mid-session after he did something really unethical concerning my privacy.

After that the ptsd kicked in with the flashbacks and all the other stuff I described yesterday. I didn't want to take any drugs at this point, but we were desperate. My wife did some research and found out some stuff about picking psychiatrists and psychologists and called around, interviewing some people. We finally found a good psychiatrist and therapist. The psychiatrist actually listened to what I said about the previous drugs and tried one that acts on something other than serotonin. So we started with effexor. No side effects from this, but not much in the way of front effects either. I had done some research and suggested we try Naltrexone, a drug used to stop cravings in addicts, thinking that some of my problems (picking and ripping out skin, compulsive masturbation) were maybe related to addiction problems) It helped with those things a little, but not with the main problems.

Then I went to the treatment center I mentioned yesterday, and there they slowly got me on a total cocktail: Effexor, Naltrexone, Wellbutrin, Trazadone to sleep, and zyprexa, an anti-psychotic that finally helped with the flashbacks. Later, we switched the zyprexa to geodon, a related anti-psychotic without some of the side effects. Then a year or so ago, we added seroquel to the mix at night and I worked my way off the trazadone. That helped with the intrusive thinking. So until recently my drug cocktail looked like this: 450mg Welbutrin, 300mg Effexor , 100mg Naltrexone, 140mg Geodon, and 100mg Seroquel. I finally started to get some stability.

My favorite discussion of the drugs is the two anti-psychotics, because the doctors always said it like one word: It is an anti-psychoticbutyournotpsychotic. The flyers for these (the seroquel and the geodon) are kinda scary, because the FDA hasn't approved them for anything but schizophrenia, so that is all they talk about. A little searching around on the web showed anti-psychotics were being tried for ptsd as a "second line" if serotonin-reuptake inhibitors like Prozac and Zoloft didn't work.

Lately I have been trying to cut down some of the dosages. We started with the Geodon, because that made me dopey and gave me a real flat affect. Got that down to 20mg, but the ptsd, depression, and anxiety started to come back so the dose went back up to 40mg. That seems ok. Now We are trying reducing the Seroquel, the other real powerful one. I am down to 50mg on that and so far so good.

[update...Feb. 2010. I am off the Seroquel, but had to reintroduce the Trazodon...I know split the lowest dosage pill (5MG?) in half and take one of those to sleep. Just can't seem to sleep otherwise. I take Seroquel about once every three months or so if I have a really bad day and I'm having intrusive thoughts that won't stop through non-chemical means. Most recently, I phased out the Naltrexone, which seemed to make no difference. Earlier, when I tried to get off Effexor, it was a disaster, so that is staying for the foreseeable future. You should read the two posts on Effexor (Battle of the Effexor and Joy of Meds: Effexor withdrawal) BEFORE going on it, though, so you know what you are in for. So now the cocktail is 40mg Geodon, 150mg Effexor, 300mg Wellbutrin, and 2.5mg Trazodone.] Mazeltof!

What is it like taking so many drugs? My sex drive changed a lot...It kind of went to hell for the most part, but the compulsive parts stopped too, so its a mixed bag. It takes me a year to pee -- no water pressure, -- and I am constantly mildly constipated (sorry for the details). People have noticed I am a lot livelier since cutting down on the geodon, so that is good. Ultimately I'd love to be off them all, but that might not work, and at this point I am willing to face that rather than facing a return to the worst of the ptsd symptoms.

It kind of sucks to have gotten sober for so long and then be reliant on drugs to be able to function, but that is the way it goes. Anyway, any 12-stepper who actually reads the literature knows that if a doctor tells you to take a medicine that you take it, as directed, which is what I do. Some 12 step folks think it is cheating or a cop out, but they don't have to scrape me up off the floor after a flashback either so they can go s....well never mind.

For me, the point of all this is that it paid off to be persistent in finding good people to help me and to have some really supportive people around. I have been really lucky that way. 12 step people talked about being there, but weren't. I was sober for a long time and it freaked people out that I was having problems. Some of them were nice and understanding, but the people that took care of me for real had nothing to do with 12 step programs. They just talked the talk with me and seldom came through. I don't want to get too down on the program, because it did save my life earlier, but it also really screwed me up in terms of trauma and recovery from it. Maybe I'll go into that some other time.

Also, I am privileged. I am at a point in life where not only do I have people that care about me enough to give me the support I need (a lot less these days), but I have insurance to cover the therapy and the real expensive drugs, and found the financial wherewithal to go to treatment even when it wasn't covered by insurance (even though we went into lots of credit card and family debt...my wife's family...my family wouldn't acknowledge that there was a problem). If I hadn't gotten those things, I'd probably be dead, locked up, or homeless. So I am pretty privileged to be walking around and functioning like a regular human being, and I think about that when I see people who are homeless or down and out. That's something I'll have more to say on at some point.

Anyway, if you have read this far, thanks! Let me know that you read it, ok?