6 posts in this topic
Not sure if this is the right area for this but just thought I'd try here. Does anyone know how a medication like Risperidone works for bipolar? Is it more the Dopamine receptor antagonist or is it the 5-ht2a antagonist, that works for controlling bipolar disorder? I know there are other antagonists for the serotonin receptors but the 5-ht2a seems to come up a lot. One of the reasons I ask is because I was put on Risperidone and cymbalta (while in a psych hospital) and being diagnosed supposedly with bipolar/mixed state.(Even though I feel depressed alll the time) Straight SSRI/SNRI medications alone tend to give me a somewhat agitated euphoric feeling when I would yawn...not sure why, and its tough to explain. I don't feel good off of any SSRI's alone that I have tried and would just leave me the same... more Anxious and depressed. I didn't stay on that combo long because I landed in the ER because I couldn't settle down at night to sleep (literally flipping around in my bed)and cause my heart wouldn't stop racing.(my guess from the norepinephrine).
While I did notice positive things from it in the beginning like I felt better about myself and wanted to socialize more, which is strange for never feeling like that ever. Anyways, if I was diagnosed bipolar why would a doctor stick me on an SNRI while on a medication that should control it alone like RIsperidone? Wouldn't that just in turn make me manic from all the extra serotonin? It just doesn't make any sense to me. That's what had me confused on which serotonin receptor is at work to stop manic episodes, and level you out. With the new psych doctor Im seeing, I don't have a full diagnosis yet, but was put on Seroquel XR at 50mg, and guess work my way up. The mental health person who did my partial diagnosis(before being able to see my new psychiatrist) said that it was more towards major depression/social anxiety disorder though. I had the genetic test done from 'genomind' to try to find a medication that wouldn't give me so many issues. (been on about 14 so far) My old doctor had called them and they recommended that but I was afraid to keep taking a AP due to the side effects. No I have accepted it and giving it another try.
Still dont feel anything from it but I figure cause Im not upto the target dosage. The new doctor is trying to get a hold of the company to see what other medications might help. So, if anyone who understands this better, please feel free to explain how this med combo works, and all the receptor stuff. Sorry for rambling on as well.
I'll try to make this relatively brief, but the context may be longish. I hope this isn't TL:DR because I am really hoping someone will give me some advice (and comfort).
My immediate problem is that I keep having sudden, intense, unignorable panic attacks, with my whole body and my mind overcome by a feeling that I am imminently going to leave my body. This is sometimes accompanied by a temporal distortion, feeling as if the present moment is a very slow-motion recall of a past moment of my life--that I am in the process of dying, and reviewing my life. Then my mind kind of goes into a loop thinking about how "now" is always slipping into the past, and how my childhood and everything in the distant past is just barely more than a dream to me. The feeling is as if everything--my whole life--is happening in a moment and also coming to an end in that same moment, and that the more I realize that, the more I realize I'm dying or dead. This is a new phenomenon, but I know where it began.
Here's the overall mental (and physical) health context:
I know that I have severe lingering anxiety and depression from my adolescent years. I am gay, and I was severely abused by my peers in school, going from a happy childhood to an entirely alienated, friendless, and abusive adolescence (7-12th grades). I developed a deeply entrenched suicidal pathology over those years and in any little uncomfortable situation from that time forward, I began to default to "I can escape this by dying." I made progress after high school, dated (sort of, but never developed any real romantic relationships). I have bad acne scarring and other scarring (I'll get to that) all over my body and these have been hurdles I've never overcome self-esteemwise--and as a result, I've never been able to get close to anyone romantically. I avoided drugs all throughout my youth, but that changed recently because... In my early-mid 30s, I developed a severe neurological disorder of unknown origin. After about three years of intensive medical visits, multiple sclerosis, ALS and other disorders were ruled out. But the symptoms persisted--from partial paralysis to cluster headaches to excruciating nerve and joint pain, fatigue, and panic attacks that I had never had before. I started drinking a lot after this happened, and also started seeing a psychiatrist (at a neurologist's recommendation). For a time, I was having mental visions of my body going over the edge of my apartment building roof, just playing on a loop. It terrified me. My shrink put me on Zoloft, Klonopin, and Wellbutrin, and after about a year she also put me on a low dose (25mg) of Seroquel to help me sleep. Several years later, she told me that I have an adjustment anxiety disorder and possibly bipolar II, but nothing extreme like bipolar I, borderline personality, etc. My health continued to decline and I was drinking even more and wanted to change my life, so after being more or less bedbound (able to work, but that's all--my social life came to an end because of fatigue and pain), I spent about 18 months reading about ayahuasca (a potent psychedelic plant medicine) and took a leap of faith in trying it. It's the first drug I had ever taken, and I did it as a last-ditch effort to regain my life, or at least to come to terms with dying--at that time, my declining physical health really made me feel like I was dying. And I was praying for that, to be honest, because of the pain. My first ayahuasca experience literally severed my interest in drinking alcohol. Since I took ayahuasca, I tend to become nauseated at the thought of being drunk--the thought of it--and I have never had more than three drinks at one time since then--and that's only been once or twice. Shortly after having taken ayahuasca, I was re-diagnosed with Lyme disease, as well as bartonella and babesia coinfections. My doctor explained that Lyme can cause inflammation of the brain and CNS and very often causes severe panic attacks as a result, besides the depression and anxiety that come with being so ill. After about six months on antibiotics, my physical and mental health problems improved 80-90 percent, with intermittent flare-ups. My psychiatrist, who I've seen monthly for six years now, has told me that she has witnessed a remarkable change since I began treatment for Lyme and has since reclassified my diagnosis and told me I've developed a "melancholic" personality, but that I'm not mentally ill in any profound or serious way. She's now encouraging me to be more outgoing. I didn't take ayahuasca for years until this winter. My father had a major heart surgery and I was scared to death about it, and I thought ayahuasca might help me come to terms with the life-or-death consequences. I took it shortly before his surgery and the experience, unlike previous enlightening and life-affirming ones, was terrifying. I had hallucinations that I'd never had before, and I felt (and still feel--the sensation was so real) that I actually died during the experience. And it was terrifying because 1) I didn't want my life to end and 2) I was in this timeless void in which everything was just pure information, and I flashed back and forward on my life and other lives and saw some horrific things--and in the end, it was just too much to handle. I could not believe it when I actually awoke the next morning. When I did, I didn't believe I was alive for the entire day until I finally told a friend what I had done and she confirmed that I was really there. I was grateful for everything, even gravity. So this last ayahuasca experience was life-affirming in the sense that it "scared me straight" and made me want to just live my life. Just live, live, live. Unfortunately, I am still often very unwell because of Lyme disease--but I am better than I was before I found treatment. Now I WANT to live--and paradoxically, that's where my anxiety is coming from. I am no longer afraid of people, but I am profoundly afraid of dying. I got a medical cannabis card because I had read that cannabis can help people who have Lyme. I had never tried marijuana before. I got two tinctures, one very low in THC and high in CBD--and so it should have little to no psychoactive effect. The first few times I took it (a half dose), I felt a mild temporal distortion and relaxed. And then the couple of times I took it after then, this tiny amount of cannabis sent me back into that ayahuasca void and I was certain that I was dying and dead. And since then--it's been a few weeks now--that feeling has occurred spontaneously without any trigger. I'm almost certain I will never take ayahuasca or any form of cannabis again. I'm back on my psych meds, but my psychiatrist prescribed a quick-acting benzodiazepine to treat my severe impromptu panic attacks--and taking it just seriously amplified my panic attack. It's that same thing: a feeling that I am imminently going to separate from my body, and like time is collapsing in on itself. I've even started questioning the reality of the world vs. a "Matrix"-like holographic/imagined reality, and I am so afraid of my death now that it's got me on edge ALL the time. I've never in my life been afraid to die in any conscious way. In some ways, I actually interpret this as a positive thing because at age 38, with a chronic illness that causes a lot of real life challenges, I have never wanted to live more than I do. Yet, in keeping with that, I am afraid that I'm going to lose this life and the people I love. Have I developed some type of dissociative/depersonalization disorder? I keep feeling like I am jumping outside of my body's time, and like I am in extreme denial about no longer being alive, and I'm afraid that at some point I'm going to let go and just zip away from this world. And of course, I know that I am going to die just as everyone else does and there's no way of knowing when it'll happen. But I am scared to death that it's going to happen any time now, and it seems that even benzodiadepines intended to calm panic actually contribute to it now. I feel like there's no way out--but the last thing I want to do is commit suicide, so I guess that's the silver lining?
Any words of advice for this crazy person? (Aside from "don't do drugs"! I am fairly certain I never will again.)
I've recently realized that I have been for many years (decades?) settling for just "good enough" results from my medications/treatment. I suffer from MDD that has been my constant companion since adolescence, ADD Inattentive-Type, and PTSD (with a side of insomnia) from a horrific experience with Anesthesia Awareness during major surgery. I was completely conscious/aware, and able to hear, feel, and smell every second of the painful surgery, but was unable to move or communicate because of the paralytics that were administered. And I thought I had issues before that nightmare.
Anyhow I think I've been settling for two reasons:
As a teenager and young adult I saw how my mom suffered every time her pdocs changed up her cocktail. I guess since she never told them, "yes, this is the right treatment for me, I feel great", the well-meaning doctors were always trying something new, with sometimes terrifying results. I still remember her pleas and prayers that they would just leave her medication alone (they did -- eventually). We don't share a diagnosis, but I can see now how her experiences might have instilled in me the perhaps subconscious propensity for settling for treatments that offer only so-so results, for fear that the new, unknown medication(s) would make things worse. Before I became a stay-at-home dad I worked in a demanding, executive level position. Fear of changes to my medications, or rather the possible unpleasant side effects of new medications -- and the possible impact on my job kept me telling my pdoc everything was fine. What if I got so discombobulated I needed inpatient treatment? What if I freaked out at work? Besides, my consistent schedule and support system at work and home allowed me to get by with coping mechanisms honed over the years. I had external, structural, and social crutches to augment my half-assed medication.
Cue Music and Begin Cheesy Movie Montage Segment:
Met and married a wonderful guy Bought and renovated an awesome house Fostering (adopting soon) a bright healthy toddler Left the rat-race to be a stay at home dad End Cheesy Movie Montage Segment
My crutches are gone. There is no one to cover for me or pick up the slack. I can't reschedule things I don't have the energy for, or delegate things that make me anxious. I can't sleep half the day if I need to.
It's me, my kiddo, and my broken brain.
Now, because I've had a big life change, I know some might suggest that perhaps not "doing what I love" or "contributing" has worsened my depression. I can safely say that isn't the case. I have always hated working. If you'd asked a young me what I wanted to be when I grew up, I might have said "retired". I worked because I needed to, was fortunate enough to have some marketable skills and did well for myself, but the moment I no longer had to work, I was out of my office so fast I left a puff of cartoon smoke behind. I do not miss working and I do not feel any less worthy/valuable on account of it. And yes parenting is hard, but I never expected anything less.
I think I simply have more time "in my head" and without the distractions and crutches I've realized that I've never truly had a good handle on my mental illness, and I'm scared. Worst of all I realize I am to blame. Every time I told my doctor my symptoms were better controlled than they were in reality I was doing myself a disservice.
I know I need a serious cocktail change. What will happen? Will I get worse? What will I tell my pdoc -- that I have been lying for years?
I don't remember exactly when this has started up but I've become pretty bad at getting any sleep at night and if i do it's 1-2 hours max. It's interfering with my life because not only do i stay up all night, but I'm usually up during the day because of events or me trying to get this pattern back on track. But when night time comes around I find that I'm wide awake and have a hard time sleeping. And then I get anxious because i know I should be sleeping because it's going to be hard to carry through the day with any activities. (I do get a bit tired in the afternoon)
For example, right now, its 3:54 AM and my family planned a fun day trip tomorrow, we'd be leaving the house around 7:30 AM and be gone all day. I'm feeling quite anxious because i got 2 hours of sleep the night before this, and today I've only napped for 30 minutes. I don't know what is up with me. My family doesn't know, they've mentioned my eyes being darker than usual but i shrugged it off. And I haven't taken any meds, I'm not a fan of them but if I have to I just might.
Sometimes I get really bad anxiety when I have to go somewhere. I went to a play once and could not handle the anxiety. I had to take .5mg clonazepam to calm down. Basically I felt like everyone was watching me, like the orchestra section was staring at me.
I just could not get comfortable without a med.
Is this plain anxiety, or something else? I go to an event like this and I feel like the spotlight is on me and everyone is staring at me. I'm not even in the play.
Move to the anxiety section if need be.