News Day Tuesday: New drug for PTSD!

a cure for what ails you, medication, News Day Tuesday, ptsd, three hopeful thoughts

News on mental illness (aside from the usual stories about police brutality and the fact that mental illness physically alters your brain) has been somewhat scarce lately, readers. However, I did manage to scare up an article about a new drug for PTSD called TNX 102 SL, which is absorbed sublingually (under the tongue, like lorazepam and other anti-anxiety meds) and reportedly helps with some of the more disruptive symptoms of PTSD, like arousal/startle response, anxiety, and negative thoughts.

The drug is related to a muscle relaxant called Flexeril. I’ve heard of muscle relaxants being used to treat startle response in the past, but I’ve never tried anything of the sort before. I typically rely on lorazepam to control acute symptoms, like when I’m out in a crowded public space and begin to feel the good old irritability and hypersensitivity to sound kick in.

I’m pretty excited that new treatments are even being tested for PTSD, honestly. The startle response is definitely the worst symptom for me–any sudden noise, no matter how small, can provoke an ear-piercing shriek and a huge bump in my heart rate. And because I have chronic pelvic pain that’s partially caused by trigger points, the instinctive tensing makes the pain multiply, which makes me more miserable, and it becomes this whole endless cycle that’s really hard to break.

I’m also hopeful that some new treatments that help with sleep but don’t leave me a groggy mess the next day will pop up. I sleep very lightly now and have a hard time falling asleep. I usually use either lorazepam (if the insomnia’s not too bad, though I need at least two milligrams to get a good night’s rest) or quetiapine/Seroquel if I’m really sleep-deprived. However, even though those drugs work in the short-term, I end up sleeping way longer than intended and am basically a zombie the next day.

Readers, what do you think of this drug, given what limited information we have so far? Would you try it? What do you use to cope, either medically or psychologically?

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Anxiety blues.

a cure for what ails you, anxiety, medication, ptsd, rapid-cycle bipolar disorder, relationships

The last few days, I feel like I’ve fallen down a sort of anxiety-hole, and it’s really bugging me.

Yesterday was wonderful–we went to Canton and had delicious pie with a friend of Paul’s from college and her lovely fiancee, then took a walk in a nearby park. There was a hiccup where he snuck up on me and startled me a bit, which in addition to a ton of people being around (it was, after all, a beautiful day) kind of made my PTSD-radar go “ping!” I think that’s what set it off.

When we got home, I had a minor annoyance/setback when I learned that my venlafaxine, which I’m almost out of, was ready–but my new insurance, for some reason, was still pending and the Rx was pretty far out of my price range. After waiting in a crowded pharmacy for close to an hour, my brain didn’t take the news particularly well and my anxiety went up a few more notches.

I had taken a couple of lorazepam throughout the day, which I normally don’t have to do, and while I was nice and chilled out by that evening, I woke up this afternoon (after fourteen hours of sleep, which is highly unusual these days) feeling groggy and depressed.

Days like these, I feel the old blues and hopelessness creeping back in. I am in a gorgeous city and a new apartment with someone I love, yet I still get sad and anxious. I’ve come to realize that it’s part of the illnesses and that these things will be with me for the rest of my life. I suppose I’ve taken the good days for granted, so this one blindsided me a little.

I took another nap, woke up, finished my Theories paper, and am feeling quite a bit better. Still, it’s something I’m going to mention to my new psychiatrist (once I find one in the area, haha). The lorazepam does wonders for me in terms of calming my anxiety and the irritability that comes with it, but I often feel a little down the day after taking it and I’m wondering if there are other things I could try.

Needless to say, I also have to find a therapist to help me with quite a few things–after all, I just went through a huge move and am dealing with all sorts of new feelings and worries about being so far from home for the first time in my life.

What helps you unwind, readers? How do you shake off the blues?

Transition.

a cure for what ails you, major depression, medication, ptsd, rapid-cycle bipolar disorder, three hopeful thoughts

At this point, I can’t say that I’m cured or that my bipolar is in remission, but something feels different. My mood swings aren’t as intense as they were before, and “Flat/numb” has replaced “Depressed” as my default mood state. I still can’t remember the last time I felt truly happy without also feeling some underlying negative emotion, but I actually feel hopeful.

My PTSD is still pretty bad. There’s some parking lot construction going on right outside our apartment, and when I had to walk past it yesterday to get home, I flinched, jumped about a foot, and had to clamp my hands down over my ears to get through the unrelenting roar of construction equipment. I felt embarrassed and remember thinking, “Normal people don’t act like this.” But I’m trying not to judge my reactions and emotions. My therapists over the years have all encouraged me to just experience them without having a knee-jerk response and assigning a morality to everything.

My derealization/depersonalization is present, as always, and I’ve been having unnerving spikes in severity that have unusual triggers…if I have my head turned or tilted a certain way and I say something/something is said to me, for example, the detached feeling increases tenfold and sticks around until I finally go to sleep. It seems to only happen in the late afternoon/early evening, but I’m still not sure what to make of it. But in spite of this, I feel like I’m finally starting to recover. I’ll deal with the emotional bit first; then, I’ll try to tackle my dissociation.

Medications: Lorazepam, 1 mg tablets*, 37.5 mg Effexor, 400 mg lamotrigine/Lamictal.

* I think it’s important to note that I can’t remember the last time I actually needed one of these.

Some of my best friends are pharmaceuticals.

abuse, endometriosis, major depression, medication, rapid-cycle bipolar disorder

I look at the clock. Seven hours left. I count my pills again. Today is the ninth, which means that I have another eighteen days until I can get a refill.

I have 18 oxycodone left and another flare-up is just getting started. This leaves me with one pill per day; unfortunately, I often end up taking two, the maximum dose I’m currently allowed. One pill lasts only a few hours and then the symptoms–the overwhelming, uncontrollable tightness in my lower abdomen, the stabbing pain, the feeling that my ovaries have literally been set aflame–begin to fade back in until they’ve become a deafening roar, preventing me from concentrating and leaving me barely able to move. I cannot focus on conversation when I’m in this state; everything is too loud and I want to scream at everyone to shut up and leave me alone to die in a heap on the floor.

Eighteen days.

I will admit that in the past, I’ve taken opiates for less-than-severe pain flares because my mental state needed a serious boost, and if there’s a drug that’s great for doing that in the short term, it’s oxy. With the pain gone, I become gregarious and upbeat, able to focus and get my work done, to handle–and even enjoy–the company of others. Please note that I am not advocating opiate abuse–it’s ridiculously dangerous and it’s way too easy to build up a tolerance. Also, the damned things are so difficult to get even with a legitimate prescription that it’s hardly worth blowing through your supply in the interest of having a good time.

Since the introduction of lorazepam into my medication stash, I haven’t abused my oxy in the name of keeping my sanity. The benzos flood my system and fill me with a lovely tangible warmth. My lower belly finally relaxes. My hands stop shaking. There are no more tears and the world appears to slow down. My head becomes quiet and I can once again focus without wanting to burst into hysterical crying over a misworded email or the memory of some shameful thing that happened to me fifteen years ago and happened to surface as a matter of coincidence.

In moments of extreme pain when there is no one around to distract me, I sometimes drink heavily. There are other substances too, of course–there always are when you’re self-medicating, an endless stream of chemical friends to fill the long lonely hours. I cannot remember the last 24-hour period where I hadn’t taken anything, but I am still holding down a job, maintaining relationships…I figure I’m okay. It’s a temporary fix, I tell myself, just enough to get me through until the real problem (my chemical imbalance) can be corrected.

These drugs, they keep me safe from myself. They take me from “She’s all messed up” to “This girl is fucked in the head, but she’s still fun to be around, at least.”

I’m switching to a new doctor this month and am somewhat horrified at the prospect that I may not be able to continue my painkillers–until they find a cure, or at least better treatments, for endometriosis, I’m stuck battling this horrible disease with opiates. It’s not ideal by any stretch of the imagination, but it is my only option for now. Two years after my diagnosis, I’ve reached the end of the line. No more options except another surgery, which will help me for another year at most before things return to how they are now. In fact, surgery could actually make things worse.

I know a lot of people think of medication–whether it’s antidepressants or the long-term use of painkillers–as a crutch, as if “mind over matter” could cure all of our ailments. They’re entitled to their opinions, certainly, but for my part, I’m just grateful for modern medicine and the fact that there is something, anything, that can take the pain away, if only for a short while.

Another new beginning.

medication, ptsd, stigma, therapy

I’ve decided to use my writerly skillz to document my latest round of treatment for the PTSD and major depressive disorder with the end goal of potentially selling excerpts or actually finally finishing a “book.” I realized that a memoir in the traditional sense would be the wrong move for me right now, since there’s no real resolution yet and I’m not ready to relive all the trauma. I also thought that writing it while I’m undergoing treatment–almost like a diary, but more polished and meant for others to read–will help me gain new insights into my conditions and my treatment as well as helping others understand what living with these disorders is actually like (hint: it’s a daily struggle). Below is the small bit I’ve written so far. As always, comments and questions are loved!

I meet Susan for the first time on a cool, rainy day in early June. We make polite small talk for a few minutes before she asks why I am here. My voice is robotic and well-rehearsed as I summarize nineteen years of trauma in under a minute.

“You’ll like Susan very much,” the on-call therapist had said to me over the phone a week before, trying in vain to calm me down during my first-ever panic attack. And I do–she is young and stylish, hippie-chic in her embroidered flats and colorful scarf. She gazes at me with concerned eyes as we begin discussing my dissociative symptoms. She asks me to describe what a typical episode of derealization is like versus depersonalization,  how long they typically last, how I know I’m having one. I explain the unnerving disconnect from my surroundings and between my mind and body from the moment I wake up each day until I go to bed late each night. This disconnect, this disquieting dreamlike feeling that has existed in varying degrees each day for the last year, is back in full force as I ghost my fingertips over the creamy leather of the armchair, my brain taking a second or two to catch up with the physical sensation, just as it always does.

When Susan speaks, her voice is solemn. “Well, it’s not great.”

I force a laugh in an attempt to chase away the sick churning that has started in the pit of my stomach at her words. It doesn’t work. “Yeah, that’s probably really bad,” I agree, trying to keep my voice casual.

“No,” she replies gently. “I meant that the prognosis doesn’t look great. A whole year of these dissociative symptoms without a break is pretty extreme.” I bite my lip and flick my eyes toward the ceiling, struggling to steady my breathing and ward off tears. This helps me calm myself and I fix my gaze once again on hers, fingers interlaced around one bare knee.

I mention a therapist I saw in June of 2012 who was disturbed by my “flat affect” and thought that any sign of emotion–even uncontrollable sobbing, which I frequently did in her office–was good. She pushed me to reveal too much too soon, and instead of having a dissociative episode that lasted a day or two, I’ve been plagued by feelings of unreality ever since. There is no relief for me, and in this moment, I feel that there never will be, that there is no hope, that the only escape from all this numbness will come when I finally kill myself. But I convince myself that I need to stay positive and tell her that while I understand the prognosis is grim and I understand that we could potentially make things much worse, I still want to try. Any chance at relief is better than living like this.

Susan explains that my defense mechanisms, which were very helpful and kept me alive when I was a child, were likely highly triggered when I was forced to relive the trauma in one massive chunk during therapy. This, she says, is what will make our therapy difficult. She will need to be constantly vigilant, always looking for “cracks” in the facade, little slips of the tongue or small clues that give her an opening into my psyche. If she can get in that way, she says, we can work around the defense mechanisms enough to make progress. As she speaks, I imagine her as a cat burglar dressed in black, shining a tiny pen light into the darkest recesses of my mind. The work will be very slow and therapy will be very difficult, but I mustn’t get discouraged. And above all, we need to trust each other. I need to tell her when I’ve had enough, or perhaps set a limit–fifteen minutes of talking about one topic before “changing the channel” to avoid triggering my defenses is one suggestion, and I readily agree to it. I am so desperate for relief, any relief, that I am willing to agree to anything.

The next day, I see my psychiatrist again. I tell her in a flat, quiet voice how I feel I’m having a relapse of my depression; the Effexor doesn’t seem to be working all that well, and it’s been a year since I last had a complete absence of dissociative symptoms. As I recite these facts, my eye are fixed on the large digital scale sitting in the middle of her office. We talk about different treatment options–she is in favor of Abilify, but I balk at the drug when I learn that there is no generic equivalent. I’d been on Cymbalta for a few months in late 2012 but after I reached my maintenance dose, it stopped working, which was probably just as well; I couldn’t afford the $40-a-month price tag on top of my other bills and medications. We settle on risperidone, which my psychiatrist tells me is a “mood stabilizer” that should help alleviate some of the dissociative symptoms as well. Since it is to be taken at night, she says it may even help me sleep, though she warns me that it can cause weight gain.

She invites me to step onto the scale when I confess that I don’t know my weight; at this point, I haven’t weighed myself in several months, knowing from years of experience that it’s unlikely to go down no matter what I do. Besides, I have just gotten comfortable in my own skin again and don’t want to get hung up on a three-digit number when I have more important things to worry about, such as my rapidly declining emotional state.

I watch, mute, as “154.5” pops up on the little screen in fat black letters. I look at her and shrug, and this time I don’t even have to feign disinterest because for the first time in four years, the number means nothing to me. I sit through a brief lecture about how I’ll need to be re-weighed when I come back in a month, because even a few pounds gained can be a red flag that my body doesn’t like the drug and is likely to put on even more weight if I remain on the risperidone.

She explains that sometimes it takes a while to find the right combination of medication. I nod, we chuckle–silly brain chemistry!–and she sends me away with three prescription sheets and a lopsided little smile. I realize that I’ve just been prescribed an antipsychotic, but it doesn’t bother me. My interest in psychology began when I was a sophomore in high school and continued all the way through college; the term “psychotic features” and the names of various drugs don’t feel scary or threatening, but instead seem like familiar old friends. It occurs to me that perhaps I should be annoyed that my doctor didn’t simply call a spade a spade, but I have other things to focus on, such as navigating through the fog that descends every morning when I wake up.

I begin to see my defense mechanisms as a dragon, something living in the darkest recesses of my mind that I must be very, very careful to tiptoe around; I know from years of experience that waking them up, no matter how innocent my intentions, can have severe consequences.

I spend the day after my psychiatry appointment walking around in a daze. As I apply my makeup before work on Friday morning, I watch my husband in the mirror and jokingly tell him that it feels like being high without the benefits of actually being high. He smiles, but there’s something serious in his eyes; he knows it’s not a joke at all and that this weird detached feeling has become my new reality. It’s difficult for me, but it’s more of an annoyance than anything–something else to deal with. I can’t imagine what having a sick wife must be like for him. I worry that I’m turning him into a tragic Leonard Woolf type, but I feel helpless to stop it.