Jump to content
CrazyBoards.org

Recommended Posts

Hi folks,

"merry holidays" (lol). So here's my current state of play. There are a lot of variables in play which is something I strive to avoid but then life (and things like not getting divorced or fired) get in the way:

  • I'm tapering off of Wellbutrin XL. It's 6 days since my last 75mg XL dose (before you cry "it doesn't come in 75mg doses!" I was taking 300mg WB XL / 4. Not ideal, but such is life).
  • I'm tapering off of Mirapex. I've been on 0.125mg since the 14th (10 days).
  • I started L-Methylfolate at 10mg (perhaps foolishly - that's a high dose) on the 16th (8 days ago) on the basis that I might have MTHFR mutations. I am shortly getting MTHFR tests done.
  • I started Rexulti 0.5mg 19th (5 days ago). This was reduced to 0.25mg on the 22nd (2 days ago. See below as to why). 

In summary, a whole shitload of changes all happening in parallel which is exactly what I try to avoid but as I said, shit happens.

So here's the real deal. For the last month at least I've been experiencing incapacitating anxiety. The kind that has you in the foetal position in bed, waves of anxiety radiating out from your gut/stomach to each limb. Physical weakness, shaking, incoherence, the works.

Naughtily I'd previously ordered Valium online an less-naughtily I've got 0.5mg Ativan off of my PDoc. Neither touches the anxiety. This a.m. I tried 25mg Valium and 1mg Ativan and collectively they helped maybe 10%. I was still completely dysfunctional.

The only thing I've found so far that helps substantially is 2+ large whiskies. Within 20 mins of taking them, I feel human, capable, anxiety-free and "alive". Not high or anything - just "human".

Without context, that sounds terrible and the easy reply is "you are an alcoholic, go get treatment". But that's BS. Why? because:

  • 15 years ago I went 18 months dry and it didn't help at all. I was more depressed overall from missing out on all the social engagements. (I was like 25).
  • In Feb I went inpatient where they declared my alcohol intake "the problem", made me abstain for 3+ months and guess what? it didn't help my depression at all
  • I don't wake up crazying alcohol
  • I don't want to drink alcohol
  • I've taken many, many other med regimens where this incredible anxiety is not present e.g. SSRI's , TCA's, MAOI's. It seems something particular to either (or both Wellbutrin and Mirapex).

As of tonight I'm dropping the Mirapex, even though it's a tiny dose and my PDoc wanted me to remain upon it. Tough shit.

As of today I dropped my L-methylfolate intake from 10mg to 2.5mg since I've read that a long-term starvation of L-methylfolate (such as my postulated situation), followed by a "downpour" of l-methylfolate can make you feel even worse. So I'm toning that down.

Finally, my questions:

  • why is it that only the alcohol is relieving this incapacitating, incredible 10/10 strength anxiety? (and I have 20+ years of anxiety to know when anxiety is worth a 10/10 rating)
  • am I exhibiting alcoholic tendencies? i.e. am I an alcoholic
  • are my proposed actions (dropping L-methylfolate dose, stopping Mirapex, reducing  Rexulti dose) along the right tracks?
  • any other advice?

Curled up in bed throughout Christmas, in bed, with 2 young kids is killing me. Concurrently so is the prospect of requiring alcoholic rehab.

Some subjective insight would be a golden Christmas present from you to me.

Thank you, Pete

Link to post
Share on other sites
1 hour ago, sming said:

I started L-Methylfolate at 10mg (perhaps foolishly - that's a high dose) on the 16th (8 days ago) on the basis that I might have MTHFR mutations. I am shortly getting MTHFR tests done.

It's commonly started at 15 mg all the time, so really that shouldn't be a problem.

1 hour ago, sming said:

Naughtily I'd previously ordered Valium online an less-naughtily I've got 0.5mg Ativan off of my PDoc. Neither touches the anxiety. This a.m. I tried 25mg Valium and 1mg Ativan and collectively they helped maybe 10%. I was still completely dysfunctional.

How long did you try this combo though? Did you take the Valium daily and let it build up in your system? Valium works best when taken daily around the clock, and Ativan when taken for breakthrough anxiety on top of long-acting benzos (or by itself).

1 hour ago, sming said:

The only thing I've found so far that helps substantially is 2+ large whiskies. Within 20 mins of taking them, I feel human, capable, anxiety-free and "alive". Not high or anything - just "human".

Alcohol hits different GABAA subunits than benzodiazepines do. Alcohol hits GABAAα4 and GABAAα6 subunits, which benzos can't hit, whereas the benzos hit GABAAα1, GABAAα2, GABAAα3, and GABAAα subunits, the anxiolytic response supposedly being responsible for the α2 and αsubunits. A benzo with high affinity to these subunits, if you use a benzo for your anxiety, would be ideal. Supposedly, these include:

  • diazepam (Valium) (high α2 and α3
  • clonazepam (Klonopin) (high α2 and α3
  • lorazepam (Ativan) (high α2 and α3
  • alprazolam (Xanax) (high α2 and moderate α3)

Other possibilities for anxiety include (which I'm sure you've tried all of them except maybe a few):

  • hydroxyzine (Vistaril, Atarax) (yeah right...)
  • buspirone (BuSpar) (yeah right...)
  • quetiapine (Seroquel) (may have already tried this)
  • olanzapine (Zyprexa) (may have already tried this)
  • aripiprazole (Abilify) / possibly Rexulti (brexpiprazole) (which you're starting)
  • meprobamate (Miltown)
  • prochlorperazine maleate (Compazine)
  • trifluoperazine (Stelazine) (my favorite!)
  • imipramine (Tofranil) (may have already tried this)
  • doxepin (Sinequan) (may have already tried this)
  • low-to-mid-dose (25-100 mg) chlorpromazine (Thorazine)
1 hour ago, sming said:

As of today I dropped my L-methylfolate intake from 10mg to 2.5mg since I've read that a long-term starvation of L-methylfolate (such as my postulated situation), followed by a "downpour" of l-methylfolate can make you feel even worse. So I'm toning that down.

It could be that you have some other genetic mutations that make you intolerant to methyl donors, which would make your dopamine levels skyrocket (COMT and VDR genes I believe), which would possibly explain the elevated anxiety.

1 hour ago, sming said:
  • why is it that only the alcohol is relieving this incapacitating, incredible 10/10 strength anxiety? (and I have 20+ years of anxiety to know when anxiety is worth a 10/10 rating)

I think I might've explained this above when explaining about the GABAA subunits.

1 hour ago, sming said:

am I exhibiting alcoholic tendencies? i.e. am I an alcoholic

I'm not sure what defines an alcoholic, but I would guess if it is inhibiting your daily functioning, you would be an alcoholic; however, there is something called a "functioning alcoholic."

But it does sound like you're self-medicating, which is very dangerous, and could lead to alcoholism if you're not already there.

1 hour ago, sming said:

are my proposed actions (dropping L-methylfolate dose, stopping Mirapex, reducing  Rexulti dose) along the right tracks?

Yes to the L-methylfolate if you can't tolerate methyl donors.

Possibly to the Mirapex, but Mirarpex at low doses shouldn't cause anxiety, it should reduce it actually. Low doses of dopamine agonists agonize the presynaptic dopamine receptors preferentially, meaning they will suppress dopamine release. Higher doses will agonize both presynaptic and postsynaptic dopamine receptors, so you will actually feel the effects of dopamine in the absence of dopamine itself. I.e., low doses of dopamine agonists should relax you (act like a dopamine antagonist in a way).

Reducing the Rexulti dose should act more like a dopamine antagonist to my understanding, and subsequently act to reduce your anxiety.

If there's any way you can get in touch with your pdoc ASAP, I would do so.

Best of luck to you! Keep in touch/update us on your status. PM me if you want/need to. I may not know what to say but I'll listen.

Edited by mikl_pls
  • Like 1
Link to post
Share on other sites

I have a similar situation with alcohol, though for me it's not anxiety it's anhedonia and energy. Alcohol has more of an effect on my depressive symptoms than any med I've tried so far. I've noticed that over the years from social drinking. Like you I don't crave alcohol or have trouble reducing or even stopping drinking. I try to be cautious about alcohol because I have plenty of alcoholics in my family line. I think everyone should be cautious with it, really, but I understand what you are describing

  • Like 1
Link to post
Share on other sites

Drinking on meds can do a number on your liver.  I strongly recommend getting your enzyme levels checked the next time you have a physical.  I had to learn this one the hard way. 

Because it contains  acetaminophen, drinking on top of the Percocet is a particularly bad idea.  

  • Like 4
Link to post
Share on other sites

I agree with the above posters. Drinking on psych meds is not good. Regular drinking can worsen depression and undo everything the meds are trying to do. I speak from experience on this.

I'm not a prude, and I think it is fine to have a drink or two on occasion, e.g. New Year's, if your doctor approves it. But to develop a habit of drinking as a way to self-medicate is bad for all the reasons listed above. Be VERY careful about mixing alcohol with benzos because that is a dangerous combination.

mkl_pls listed a number of meds that can be used to treat anxiety. You have quite a few options so the situation is not hopeless. Get together with your doctor to come up with a med or med combo that works. In the long run, you will be much better off.

  • Thanks 1
Link to post
Share on other sites
On 12/24/2018 at 1:47 PM, mikl_pls said:

It's commonly started at 15 mg all the time, so really that shouldn't be a problem.

I dunno, I've seen quite a few resources saying otherwise. FWIW I agree with you, I don't think it's the L-methylfolate either but I'm just covering all my bases.

On 12/24/2018 at 1:47 PM, mikl_pls said:

How long did you try this combo though? Did you take the Valium daily and let it build up in your system? Valium works best when taken daily around the clock, and Ativan when taken for breakthrough anxiety on top of long-acting benzos (or by itself).

I have (unintentionally) been taking the Valium daily as it happens. I didn't want to but the anxiety has been so intense, I've just been so, so desperate for any relief I can find.

On 12/24/2018 at 1:47 PM, mikl_pls said:

Alcohol hits different GABAA subunits than benzodiazepines do. Alcohol hits GABAAα4 and GABAAα6 subunits, which benzos can't hit, whereas the benzos hit GABAAα1, GABAAα2, GABAAα3, and GABAAα subunits, the anxiolytic response supposedly being responsible for the α2 and αsubunits. A benzo with high affinity to these subunits, if you use a benzo for your anxiety, would be ideal. Supposedly, these include:

  • diazepam (Valium) (high α2 and α3
  • clonazepam (Klonopin) (high α2 and α3
  • lorazepam (Ativan) (high α2 and α3
  • alprazolam (Xanax) (high α2 and moderate α3)

well hitting different "subunits" (that's a new one on me) could explain it but I am already taking Valium and Ativan to almost zero effect. It's bewildering.

On 12/24/2018 at 1:47 PM, mikl_pls said:

Other possibilities for anxiety include (which I'm sure you've tried all of them except maybe a few):

  • hydroxyzine (Vistaril, Atarax) (yeah right...)
  • buspirone (BuSpar) (yeah right...)
  • quetiapine (Seroquel) (may have already tried this)
  • olanzapine (Zyprexa) (may have already tried this)
  • aripiprazole (Abilify) / possibly Rexulti (brexpiprazole) (which you're starting)
  • meprobamate (Miltown)
  • prochlorperazine maleate (Compazine)
  • trifluoperazine (Stelazine) (my favorite!)
  • imipramine (Tofranil) (may have already tried this)
  • doxepin (Sinequan) (may have already tried this)
  • low-to-mid-dose (25-100 mg) chlorpromazine (Thorazine)

I have actually taken buspirone before (many years ago) and I think I did quite well (certainly not horribly) on it. It might be worth a mention. TCA's zombify me even at low doses unfortunately. I will go through the others - thanks for the list, much appreciated as always.

On 12/24/2018 at 1:47 PM, mikl_pls said:

It could be that you have some other genetic mutations that make you intolerant to methyl donors, which would make your dopamine levels skyrocket (COMT and VDR genes I believe), which would possibly explain the elevated anxiety.

That's possible. The anxiety had started before I started taking L-methylfolate so this is unlikely but I'm not ruling anything out. Medically I'm a freak (numerous, very low frequency, disparate medical conditions).

On 12/24/2018 at 1:47 PM, mikl_pls said:

I think I might've explained this above when explaining about the GABAA subunits.

I'm not sure what defines an alcoholic, but I would guess if it is inhibiting your daily functioning, you would be an alcoholic; however, there is something called a "functioning alcoholic."

that's my thinking. It's enabling my functioning, rather than inhibiting or hindering it.

On 12/24/2018 at 1:47 PM, mikl_pls said:

But it does sound like you're self-medicating, which is very dangerous, and could lead to alcoholism if you're not already there.

I know :(

On 12/24/2018 at 1:47 PM, mikl_pls said:

Yes to the L-methylfolate if you can't tolerate methyl donors.

Possibly to the Mirapex, but Mirarpex at low doses shouldn't cause anxiety, it should reduce it actually. Low doses of dopamine agonists agonize the presynaptic dopamine receptors preferentially, meaning they will suppress dopamine release. Higher doses will agonize both presynaptic and postsynaptic dopamine receptors, so you will actually feel the effects of dopamine in the absence of dopamine itself. I.e., low doses of dopamine agonists should relax you (act like a dopamine antagonist in a way).

Well I've stopped the Mirapex just to "clear house" as it were. Since ceasing it a few days ago I've noticed the anxiety "wave" hit incrementally later in the day each day which is interesting. It's even failed to hit so far and it's midday, which hasn't happened for months. 

On 12/24/2018 at 1:47 PM, mikl_pls said:

Reducing the Rexulti dose should act more like a dopamine antagonist to my understanding, and subsequently act to reduce your anxiety.

If there's any way you can get in touch with your pdoc ASAP, I would do so.

Best of luck to you! Keep in touch/update us on your status. PM me if you want/need to. I may not know what to say but I'll listen.

I am seeing him in ... like an hour so I will discuss all this with him. Many hearty thanks again mkl_pls, you're a Godsend!

On 12/24/2018 at 3:35 PM, Ion said:

I have a similar situation with alcohol, though for me it's not anxiety it's anhedonia and energy. Alcohol has more of an effect on my depressive symptoms than any med I've tried so far. I've noticed that over the years from social drinking. Like you I don't crave alcohol or have trouble reducing or even stopping drinking. I try to be cautious about alcohol because I have plenty of alcoholics in my family line. I think everyone should be cautious with it, really, but I understand what you are describing

I've been through that situation too. For a few months last year, I'd be feeling severely depressed and anhedonic, have 2 drinks and BANG I'd be feeling "human". Not high, just human. And then it just kinda stopped helping so I stopped the drinks. I'm such a fucking enigma it's not even funny.

On 12/24/2018 at 4:09 PM, Iceberg said:

be careful with alcohol + benzo obviously 

noted. I desperately wish there were viable alternatives ?

Link to post
Share on other sites
On 12/24/2018 at 4:53 PM, Velvet Elvis said:

Drinking on meds can do a number on your liver.  I strongly recommend getting your enzyme levels checked the next time you have a physical.  I had to learn this one the hard way. 

Because it contains  acetaminophen, drinking on top of the Percocet is a particularly bad idea.  

Noted. I've had full panels done fairly recently as well as MRI's and X-rays (for my functional chronic GI pain) and my liver is A-OK thankfully. Thanks for the heads-up.

Link to post
Share on other sites
On 12/24/2018 at 9:44 PM, jt07 said:

I agree with the above posters. Drinking on psych meds is not good. Regular drinking can worsen depression and undo everything the meds are trying to do. I speak from experience on this.

I'm not a prude, and I think it is fine to have a drink or two on occasion, e.g. New Year's, if your doctor approves it. But to develop a habit of drinking as a way to self-medicate is bad for all the reasons listed above. Be VERY careful about mixing alcohol with benzos because that is a dangerous combination.

mkl_pls listed a number of meds that can be used to treat anxiety. You have quite a few options so the situation is not hopeless. Get together with your doctor to come up with a med or med combo that works. In the long run, you will be much better off.

I know but what else do I do? I'm even more depressed if I don't drink on meds. I've been dry for 1.5 years and I was just way more depressed. I've been inpatient and then dry for 6 months and I was just more depressed. What do I do?

(I'm not berating your response at all BTW, I'm just relaying my life experiences) It's like when each and every new doc tells me that taking percocet is a bad idea. I ask them what else I should do and they have no response. It's a known, horrible, dangerous, bad solution. But it's my only solution right now ?

2 hours ago, Juniper29 said:

I'm guessing you've tried gabapentin, but if not that's another option.

Yep, for my Chronic Pain. I haven't tried it for anxiety. It's worth adding to the list - thanks.

Link to post
Share on other sites
5 hours ago, sming said:

I know but what else do I do?

You work with your doctor to find a solution. The solution is likely not going to be a single med but a cocktail that addresses your symptoms. I encourage you to again look at the list mkl_pls posted before saying there is nothing else to do. In the long run, drinking is only going to make everything worse including your health.

Also, the fact that you are on Percocet is all the more reason to abstain. Narcotics plus alcohol is a dangerous combination that can kill you.

Link to post
Share on other sites
25 minutes ago, jt07 said:

You work with your doctor to find a solution. The solution is likely not going to be a single med but a cocktail that addresses your symptoms. I encourage you to again look at the list mkl_pls posted before saying there is nothing else to do. In the long run, drinking is only going to make everything worse including your health.

Also, the fact that you are on Percocet is all the more reason to abstain. Narcotics plus alcohol is a dangerous combination that can kill you.

The last thing you do is use the most toxic and deadly of the licit and illicit drugs as a coping mechanism. It is insidious, it numbs or masks the pain while it kills you.  

Link to post
Share on other sites
On 12/26/2018 at 2:57 PM, Iceberg said:

Trintellix? (For depression not so much the anxiety...but one clearing up might help the other) 

It's top of my list should the Rexulti not work out. Could even add it to the Rexulti. Thanks for the shout.

Link to post
Share on other sites
22 hours ago, jt07 said:

You work with your doctor to find a solution. The solution is likely not going to be a single med but a cocktail that addresses your symptoms. I encourage you to again look at the list mkl_pls posted before saying there is nothing else to do. In the long run, drinking is only going to make everything worse including your health.

Also, the fact that you are on Percocet is all the more reason to abstain. Narcotics plus alcohol is a dangerous combination that can kill you.

I am and will. I appreciate the input but I know that a single med almost certainly isn't going to do it. I do have 23+ years of TRD under my belt. 

I've seen/perceived my recent "splurge" into heavier drinking as basically a period of respite from the grind of TRD. I know that long term very-heavy drinking is a horrific idea and it wasn't my plan (apologies if I'm being inconsistent. I'm not in a good way. Obviously). It's mainly been to experience life for a short while, really. Like actual occasional enjoyment and the possibility of experiencing positive emotions.

As it happens, yesterday my anxiety hit a new (recent) high (alcohol or wellbutrin or mirapex-related, I don't know) at 1pm. Necking 2 large whiskies resolved it within 20 minutes but its intensity was astonishing and disturbing. Then the anxiety returned 5-6pm ish and that's when it struck me that this is a situation out of control. 

So despite my earlier stance I've changed my mind and am stopping drinking. It's gotten too heavy and with too serious effects and ramifications.

I was due to go upstate NY for a few days with my family today but instead told them about the situation, have tossed all my booze and am going to ride it out at home for the next - hopefully - few days. 

As I lamented earlier in the thread, this (going booze-free) condemns me to a shit - and I mean truly shit - daily life but it's gotten out of hand.

I guess I just have to hope and pray that some med combo semi-clicks for me for a decent period sometime in the near future. Great.

 

Edited by sming
Link to post
Share on other sites
22 hours ago, notloki said:

The last thing you do is use the most toxic and deadly of the licit and illicit drugs as a coping mechanism. It is insidious, it numbs or masks the pain while it kills you.  

the Percocet is prescribed but I take your point. Sadly after 20 odd years of truly TRD I'm very OK with the killing bit. Quite rationally I have almost no hope.

21 hours ago, Iceberg said:

Also, to add to the above point, if something dose happen and they find you've been long term compensating with alcohol you might end up having a realllllyyyy hard time getting scheduled meds 

Fair point. I dramatically reduce the amount I say I drink compared to what I actually do drink. I'm surprised I haven't been pulled up on this from my urine tests at the pain clinic, actually.

Link to post
Share on other sites

Skol Lager? Skol!?! That stuff is fucking awful. I can understand how drinking can make you feel more human. I drink for the same reason. I'm not an alcoholic in the sense that I wake up in the morning needing a whiskey, but I don't have a healthy relationship with alcohol. It's not good to need a couple of drinks in order to feel human. There's always a danger that it can become alcoholism, but like me you sound like you're self medicating, and your drinking is a symptom rather than the illness. I've been doing this for many years without turning into Nic Cage in Leaving Las Vegas. But that doesn't make it OK.

You'd probably like to feel human and alive without needing a couple of drinks. I know I would. Don't let it get out of hand and don't drink Skol for fuck's sake.

Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

  • Similar Content

    • By lisa2712
      It seems the only time I'm happy or relaxed is when I'm eating junk food or drinking alcohol. Can anyone relate? Why do I need these drugs to feel happy in life? Why do I have to be numbed out by a drug to feel happy? 
      My mom (who I live with) watches how much and how often I drink and discourages me from drinking, because she's afraid I'm going to use it as a crutch or as an unhealthy coping mechanism to try to cope with my life and social anxiety. BTW my mom doesn't drink, and my dad barely drinks. 
    • By browri
      For those taking Rexulti, I'm curious: Do you take your dose in the morning or at night?
    • By l'appel du vide
      Hello everyone, I hope everyone's December has been off to a good start. I am back, on the med merry-go-round and also sober from opiates.... Again (16 days as of now).
      So I was taking wellbutrin as an add on to my Prozac, and it really didn't help and might have made me worse, losing dramatic amounts of weight, a lot of intrusive thoughts, very depressed (though that's probably just it not doing much for it. And getting off drugs.) so I'm now on the Rexulti starter pack.
      I'm here seeking others experiences with abilify and rexulti, since they are both dopamine partial agonists and 5-ht1a partial agonists, amongst other things. I'm very nervous about taking an antipsychotic for depression, though... And just want to know of other's experiences starting these medications. How were the side effects? If you had any, did they eventually go away? Did you gain weight?
      I appreciate anyone who shares their experience. I've asked about these meds before, but I'm so nervous about it I just want reassurance. A lot is changing around me. Thank you all so much, and I hope the holidays have been treating you well.
    • By tangela
      Just thought I would share some experience with Trintellix.  I started 2-3 months ago on 5mg.  mainly for anxiety and depression.  I also take a variety of meds to help me sleep.  Trintellix can be really nauseating when you start (for at least two weeks)  When I moved up from 5mg to 10mg - I became comatose. So, I went back to 5 and it's been great-  It' gives a little boost of energy- similar to vyvanse.  It helps me not to go home and cry everyday.  :-)  I seem to eat less- in terms of general snacking.  What I have found with this med - is even at this low dose- you metabolize alcohol more quickly.  2 drinks can = drunk.  And, if I have a drink and get a little stoned- I'm up vomiting all night.  Just putting the warning out there-  not drinking is the way to go on this med....  wondering if anyone has had similar experiences...  
    • By abrooksIN
      I will try to keep this brief.  I was always depressed and my senior year of college (a year ago) I had a major psychotic break where I literally thought I was flying through the universe.  I was hospitalized in for two weeks, and I have been trying to fine tune my meds.  I am working closely with my Pdoc, but am getting very discouraged.  Any input would be appreciated.
      Lithium is what brought be out of my mania, and I have been on 900mg er every since.
      I have gone thru Latuda. Could only get to 60 mg.  I took with food, but still felt ill most of the time.
      Cannot take Lamictal due to headaches.
      Tried Vryalar and I felt like I was crawling out of my skin.
      I am now up to 4mg of Rexulti as of last weekend.  My Paranoia is the highest it has been since my hospitalization.  Saw my Pdoc Friday and he said too soon to tell on the increased dosage and I can go from 7. out of 10 to 3 out of 10 in a matter of minutes.  He added a small dose of Lexapro to help with my depression.
      Rexulti has been the best drug from a side effect profile.  If I could rid myself of the paranoia I would almost be normal.   
      Does anyone have any suggestions?  Really appreciate it.
×
×
  • Create New...