Friday, December 22, 2006

Battle of the Effexor

Oh well, just checking in to update anyone who reads this. I more or less lost the battle of the Effexor. I had to go back on it, back up to 150 mg a day. This is a third of what I had been taking, so it is better, but the withdrawal just never went away while I was off it. I was miserable for a couple of months straight. Maybe it is the PTSD and depression returning without the meds, but I don't think it was. A lot of the stuff I felt was not related to the PTSD or depression, but after feeling like hell for a couple of months, I did get depressed. Anyway, my psych doc says we can try again down the road, going even slower on the tapering off, but I am feeling better again and in no hurry to go through that again, even if it means staying on the drug. Within two weeks of going back on it, I was better again.

Thursday, August 10, 2006

Joy of Meds: Effexor withdrawal (and oh yeah, Blogspot sucks)

Grrrr...I spent a whole morning on this post and blogspot went down for maintenance and ate the whole thing when I tried to post. When they came back up, I could only recover about half of it. Bastards.

First the good news: I have been doing pretty well lately, well enough to slowly come off some of the meds I take. All has gone fairly smoothly. I went from 140 mg/day of Geodon to 40mg. When I went lower symptoms came back, but getting rid of that and the Seroquel was like coming out of a daze. Friends noted a definite change in personality for the better, I seemed more alive and engaged, both subjectively and in the eyes of others. I reduced the trazodone (for sleep) to where I usually take half of a 25 mg tablet, occassionally taking the other half if my head won't shut down for the day and keeps spinning, a trauma response in some ways but also I think a symptom of a busy life. Wellbutrin went from 450 mg to 300, where I am leaving it for now because it seems to help more than some of the others, and Naltrexone, which I use to fight some of the addictive thinking and compulsivity involved with self-harm stuff, is next on the block but currently at 100mg and holding.

Everything has been more or less fine until the Effexor. If I had known what the withdrawal was, I don't think I would have gone on it even though I was pretty desparate for some relief at that time. I was on 450 mg/day, pretty much at the top end of what can safely be prescribed. My psychiatrist, who I work with on the meds, said withdrawal can be tough, but at first it was fine. I got down to 75 mg/day over the course of the better part of a year, knocking it down by 37.5 mg every few weeks. In going from 75 mg to 37.5 mg, I felt a little achey in the joints and feverish, but it passed after a few days.

Then when I made the last step down to zero, it made me really sick. I had brain shivers, or brain zaps -- sort of like an electric short circuit going bzzzzt in your head with the attendant feeling, or like the sound some modems make when they are connecting (more on other people's experiences of Effexor withdrawal are here and here). For about a week I slept for 16-20 hours a day, and I was very low energy when awake. Fortunately, I don't have fixed hours at work in the summer so I could do this. I ran a low grade fever, felt constant nausea, felt dizzy, like if I closed my eyes I would fall down a dark hole. This was different from the top-o-the-elevator, car-with-no-brakes feeling and or the world-dropping out from underfoot feeling: It was a visceral, bodily sensation of falling rather than a PTSD-induced feeling of unsafety, sort of vertigo without the heights. Also experienced headaches along with the feeling of having a wet blanket over my brain, sort of like in the cartoons where they show the little fizzy bubbles above people's heads. Consensus seems to be that the severity of the withdrawal symptoms is due in part to the short half life of Effexor (several hours as opposed to weeks for Prozac). To quote Iggy Pop, "no fun."

I did some research and found out what I experienced, along with a couple more, are pretty common withdrawal symptoms from Effexor. There are some suggestions for alleviating them, including tapering off the Effexor in smaller increments than 37.5 mg. This was my psychiatrist's suggestion, but I had already gone through the worst of it by then, and was not experiencing a re-onset of the symptoms the Effexor was supposed to treat (PTSD-related anxiety and depression) so I decided not to go this route as it seemed like it would only prolong the misery. Another option was to take a dose of Prozac, which has a longer half-life and masks the withdrawal. I didn't like Prozac at all when I took it, so I nixed this. A third was to take the anti-flu concoction Benadryl. I was a little skittish about this as a recovering addict, as twenty some-odd years ago when I was in rehab, they said to stay away from anything with antihistimines because of speed-like qualities. I tried it anyway and so far have not broken out on a crystal meth rampage :) -- and it seemed to help a little.

I seem to have made it through the worst of it, though still a bit dizzy and have the wet-blanket-over-the brain sensation a little. I think that about covers most of the stuff blogspot deleted.

Sunday, May 07, 2006

safety and the familiar

My partner is out of town and I've been staying up late catching up on work. I got caught up so I decided to do something different and go out. I realized walking down the street that I have become a creature of habit because of the PTSD. I have a safe set of things that I do and seldom step out of them, which is strange because I used to be quite adventurous.

I realized that as soon as I got out in an unfamiliar time with unfamiliar people (I went out by myself) in a setting I no longer frequent, I got anxious and unsettled. The old feeling of being worried that the next step will be right off the world into some crazy traumatic space came back, like I had a feeling that I wouldn't be welcome -- these spaces are for other people, not for me. I wasn't doing anything dangerous, just going to a club to listen to some music and take in the scene. I don't drink or anything, so no worries about things getting out of control either.

Even so, my breath grew short and I had the top of the elevator, hit the brakes when your not driving feeling pretty bad. I practiced a mini version of my grounding excercise and tried to get back into my body and settle down. I just focused on breathing. Once when I was in the same room as someoone awful from my past, a friend just whispered to me to breathe. I think I had a mini-epiphany. When I dissociate, the first thing to go is I stop taking in the normal amount of air. It is like going underwater.

Focusing on breathing helped a little and I began to feel a better. Being outside helped, and I walked in the wrong direction, thinking the club I wanted to go to was somewhere else (I guess I don't get out much) and I think just walking helped. I hadn't been out all day, and a lot of the time, I think if I didn't force myself, or my partner didn't, I'd just hide out at home and never go anywhere because it is safe.

So my adventure was fine. The music wasn't so great, but I did something out of my usual routine and not only got through it, but even enjoyed it a little and learned a bit about how sheltered I have made my life. That has been crucial to my getting better, the feeling of having a safe place, a home. When I was in treatment for the PTSD, we decided that safety was the first thing I needed, before I could work on anything else. It makes perfect sense. I think a lot of Americans feel entitled to it and take it for granted for the most part, but the world I lived in wasn't safe and I no longer trusted any situation when the PTSD got bad. Everything was dangerous. Going out a little while tonight made me realize how much I depend on the safety I have established in my life, the familiar, home. Maybe I can extend that space outward little by little and slowly move back into the rest of the world without such a sense of foreboding anymore if I am careful and go little by little.

Wednesday, March 15, 2006

Writing when things are ok for once

I'm still really busy with work and it is still crazy, but I've kind of made my peace with it for now and have gotten back to my regular work, which I like, and am just trying to stay out of the s***storm (see "Still here, still have ptsd"). The Grateful Dead had a song with an appropriate line about getting through such things: "aint no luck/I learned to duck." And no, I don't think I could be considered a deadhead. At least not lately. But sometimes when I am in the right mood I can listen to some of their stuff and enjoy. I used to like them a lot more.

So my ptsd on a good day is pretty mild. I feel a little off from the meds I take (still slowly lowering the doses on them) but that is normal. My hands are not very steady. That is from both the ptsd and the meds I think. But I am in the present. I am not obsessed with the traumatic past. I'm in my body and able to function. That is pretty amazing considering how awful the symptoms used to be.

I guess I should be grateful for all this, and to some extent I am. But I am not grateful for the traumatic events that led to the destruction of a good chunk of my life. I don't get all yippy-skippy with joy when things are going well. I've seen the bottom of that drop out in an instant and always remain a little detached and skeptical. I guess that will never go away. Maybe its normal, a reality check. When the ptsd was bad, I'd get terrible lows. But I am not after equally ecstatic highs. I'd rather go along kinda steady and ok. That is good enough for me and more than I would have expected if you had asked me a couple of years ago.

Tuesday, February 28, 2006

Still here, still have ptsd

Hi, it has been a while since I last posted, but I am still here. Lately I have been very busy with work. I pointed out a BIG problem there recently, and instead of dealing with it, the folks responsible decided to blame the messenger, scapegoating me as a distraction from the real problem. Getting blamed for stuff that I didn't do is a real trigger for me, and I woke up today crawling out of my skin, which I haven't felt in a while. For a little bit, I even thought I might go into a flashback or have a little non-epileptic siezure again. I was as close to that as I have been in quite a while. I was dissociating and feeling very much out of my body because of the skin-crawling feeling and another feeling that I have described as being in an elevator that is hitting the top floor all day. Another way I have come to describe it will make sense to drivers maybe. The feeling is like when you are a passenger in the front seat and somebody doesn't hit the brakes at a time when you would. That moment of feeling out of control, of not being in charge of yourself as you hurtle through space and time, of hitting the imaginary brakes and finding them not there, but all day, not just for the moment: that is my most common everyday experience of ptsd at present, some days worse than others and today, with the skin crawling and dissociation, pretty bad at the start.

What to do? I have a nice view out the window of my home that I find centering and comforting, so I sat and looked at that while I had my morning cup of coffee before going to work (cutting back on caffeine helps a lot! I used to drink a lot more coffee and it is no help for ptsd at all). At work I did my grounding exercise a couple of times through then got started with my job. After a while of engaging with that (I quite like my work, even when things are rough like at present) I slowly settled back into my body and the jitters and skin-crawlies subsided. Now my main goal is to stay out of the path of the mudslingers at work to keep the triggering to a minimum.

I still have plans for more posts, just no time to write them. I want to put a sticky post at the top of the blog with a sort of guide to all the previous posts so people can find resources quickly. I also want to talk a little about a couple of therapeutic techniques I have been working with, EMDR and a related practice called DNMS. I have had mixed, but overall useful results with both, though I remain a tad skeptical, which is an old defense that results from previous betrayals by therapists. I have since learned how to protect myself better when choosing therapists.