Archives for Medication
It's no big secret or anything. Anxiety meds can make you sleepy. Like, really sleepy. From my bottle of Zoloft, an SSRI used to treat my panic disorder: "May cause drowsiness." From my bottle of Klonopin, a benzodiazapine my doc has me using to counter the anxiety that sometimes occurs while titrating an SSRI upward: "May cause drowsiness." Drowsiness achieved, people. Complete and utter drowsiness. So, how can I cope?
Years ago, before panic attacks became one of my defining characteristics, I decided I wanted to be one of those crunchy mothers-to-be who avoids all medication at all cost. I'd be growing a tiny human inside of me, after all. I vowed, early in my twenties, that even Tylenol wouldn't even be allowed. Oh, the naivete of my youth. It's been a long time since I've posted a med update, and that's sort of been an intentional choice. Months ago, I started a short series about withdrawing from Celexa, an SSRI drug used to treat depression -- but I'd been taking it off-label for panic disorder for about 2 years. I'm no stranger to SSRI withdrawal, so I was careful to perform a very slow taper. SLOWLY BUT NOT SURELY Things were looking sort of bright on about half my original dosage until I tried to go and pick up a crate a vegetables a mere 2 miles away from my home: It was Tuesday, and I was driving my car to pick up my CSA share — a box full of veggies from a local farmer — just across the bridge from where I live. Easy. Close. A simple task. Agoraphobically, I’ve never really had a problem with bridges before. (And, architecturally, I’m fascinated by them!) But on that day, in the middle of this unremarkable concrete bridge, I felt a small twinge of fear brewing in the basement of my stomach. Something felt wrong — indescribably and uncomfortably wrong."
Feeling sick? You're probably not alone. It's that sneez-y, cough-y, mucus-y time of year. Delicious! So, if you're anything like me, you have an anxiety disorder and you hate being sick. In fact, maybe being sick in and of itself elevates your anxiety level. Throw some cold meds into the equation and you might really end up feeling bonkers. Medicines for cold and flu can be very powerful, and the side effects of their active ingredients can sometimes include disconcerting side effects, like dizziness or wooziness. (Think Sudafed, for example.) And that sucks. Because getting relief for a cold is awesome...unless the price for that "relief" is more than a tablespoon of anxiety. In yesterday's post, I wrote about how I often take smaller doses of OTC cold medication than the bottle recommends. The meds still end up working (to a degree), and save me from some of the side effect-related anxiety. But what if you're too scared to take any cold meds? Are you doomed to suffer?
'Tis the season, I suppose, for phlegm-y illnesses. Today, one of my most-read blog posts is this: "Cold Meds Got You Anxious? Know Your Ingredients!" It's a must-read for those of you who: have an anxiety disorder plan on getting at least a head cold before winter's end tend to react with heightened sensitivity to medicines I'm a huge advocate of understanding what you're putting into your body -- whether it be food, meds, or whatever else. I ask my doctors a billion questions every time they prescribe me a new drug, and I'm one to "test" new meds in a safe place (i.e., my home) to gauge my body's reaction before I begin taking them as directed. CONTROL OVER ANXIETY And why? As I'd mentioned in the above-linked post, understanding your body's reaction to a medicine gives you a sense of calming control: ...[G]etting to know the ingredients in your cold medicine gives you a greater sense of control over your illness. Knowing the effect that a specific medicine has on your body can be comforting — instead of attributing a mild sense of wooziness to an impending panic attack, wouldn’t it be nice to sit back and say with confidence that you KNOW diphenhydramine (an antihistamine) makes you feel this way? You know it’s the medicine, and it might be uncomfortable — but it doesn’t signify anything. Isn’t that a comforting thought? If you get to know how each of these ingredients personally affects your body, you can more easily come to terms with how they make you feel. I won't rehash the entire article for you here, but my intention today is sort of similar -- instead of talking about which cold med ingredients have certain physiological effects, I'm going to talk about ways you can reduce anxiety when you're feeling sick.
A few months ago, I started tapering down my dosage of Celexa. I'd swallowed 30 mg each and every day for at least a year and a half, but not long ago, I decided it was time to stop. And it wasn't because my anxiety was letting up -- not in the least -- but it was because I wanted to try and get pregnant before I ended up stealing one of the many adorable babies that my close friends seem to be popping out these days. Tick, tick, tock. CUTTING DOWN THE DAILY DOSE Earlier, I wrote about my first dosage cuts. Cutting down to 25 mg and then to 20 mg resulted in some withdrawal side effects, but they were mostly tolerable. Nothing to write home about, really. I had high hopes. I remained on 20 mg for a longer-than-usual period of time. Part of it was fear of the next dosage cut's inevitable side effects -- years ago, when I withdrew from a nasty little SSRI called Paxil, I quickly learned that the withdrawal effects became more pronounced the closer I got to zero milligrams. Two Sundays ago, I decided to make the next cut -- from 20 mg to 15 mg. I would have preferred a brief hiatus at 17.5 mg, but measuring out seven-eighths of a pinky nail-sized pill would be, frankly, a pain in the ass.
Recently on my blog, a commenter named Ted posed the following question in the comments to this piece about how I'm preparing to withdraw from Celexa: You’ve left one relatively major part of your Celexa experience off your blog… was it an effective treatment for you? Did it reduce your anxiety and panic attacks? I think ignoring, or at least not writing about, whatever positive effects the therapy had for you for the past year does nothing to help those of us who read your blog. Focusing only on the negative/potentially negative withdrawal effects doesn’t speak to your whole experience with the medication and what symptoms the medication may have alleviated so that you could pursue better long term cognitive management of your anxiety disorder. What a good question, Ted. This deserves an entire blog post and not just a comment reply. DID IT WORK? In short, I don't think so. Undoubtedly, it did something -- like Paxil, it blunted my emotions (although in a more subtle way) and stripped me of my drive. But did it help to reduce my panic attacks?
I made my first dosage cut about two weeks ago. Before we talk numbers, I just want to reiterate something -- the word about. Yeah. See how I've used it in the opening sentence? About two weeks ago. Why the lack of specificity, Summer? you're asking. Well, it's simple: I plumb forgot to write down the date I began splitting my pills. Oops. It's been something of a happy accident, in truth. When I withdrew from Paxil, I documented everything in strict detail. I was on the lookout for brain zaps, nausea, and fatigue. My nervous system, already hypervigilant by default, kicked into overdrive to help me to track my withdrawal side effects. Was that a twinge of dizziness? Did my stomach just turn? Why did my heart just flutter? I feel warm. Am I warm? Remember, there's a difference between "vigilance" and "hypervigilance", and that difference is usually a panic attack. The former is healthy; the latter is dysfunctional. (Too damn bad the latter comes so naturally to me.) VIGILANCE: TO ACCEPT OR REJECT? Don't get me wrong: There are still benefits aplenty to journaling one's efforts to withdraw from an SSRI. It's a great way to track your symptoms and learn to predict how you'll feel on day 3, day 4, or day 5 after a dosage cut. It's sort of like the menstruation tracker of the mental health world (sorry, men; I mean no alienation), only we're replacing abdominal cramps with brain zaps. (And, unfortunately, we're keeping most of the other unpleasant period-ic artifacts, but without all the blood. Which is, well, one strangely optimistic way of looking at SSRI withdrawal...right?) My point is this: I've forgotten to keep a detailed journal -- in part because life is keeping me busy with life-y things like work and buying a house and stuff -- and I'm wondering if I've suffered less because of it.
Earlier, I wrote about how I began to struggle with panic attacks again — in a pretty severe way — about three years after withdrawing myself from Paxil, an SSRI medication that treats anxiety disorders. Then, after some heavy-hearted contemplation and a few shed tears, I threw up my hands and swallowed my first Celexa pill. I felt terrible about doing it. Even with the first pill, I knew I was taking out a loan -- a loan with interest. Celexa would give me a break from all the anxiety, I reasoned, but just like with Paxil, there will come a day during which I'll have to pay it all back via the horrors of SSRI withdrawal. I felt ashamed when I began taking the Celexa. It wasn't the "I'm ashamed I'm on psych meds" shame that no one ought to have; it was more like "I'm ashamed because I'm doing something I'd promised myself I'd never do again" kind of shame. And now, I (and only I) would be responsible for whatever might happen. With Paxil, I was uninformed. With Celexa, I knew what I was getting into. And I didn't feel like I had a choice in the matter. SO, WHY ADMIT ALL OF THIS NOW? The reason I've now decided to, uh, "come out" about my current SSRI use is this: my husband and I want to make a baby soon.
The scene: late summer, on a leave of absence from my cubicle-farm workplace. The culprit? Panic. Really bad panic that was keeping me, for the most part, stuck in my apartment. Most days, I was too scared to even drive down the street to Walgreens. I had been relying on Xanax to treat my panic attacks as they happened. I'd been diligently working through Dr. Edmund Bourne's Anxiety & Phobia Workbook (which I would honestly recommend to anyone who suffers from frequent panic attacks), but not seeing any immediate benefit. I'd been doing therapy and trying to eat normally again. At only 95 lbs, an all-time low for my adult life, I felt unhealthy and deflated. "Why don't you just try Celexa and see what happens?" my family doctor said at my next appointment. "If you don't like it, you don't have to continue taking it." Yeah. I've heard that story before. Cough cough PAXIL cough.
Earlier, I wrote about how I began to struggle with panic attacks again -- in a pretty severe way -- about three years after withdrawing myself from Paxil, an SSRI medication that treats anxiety disorders. I had a full-time "big girl" job in a customer service call center that, over time, began to painfully grate on my nerves. After successfully transferring to a new department (yay!) where my workday was less hectic, I found out that my entire department was being laid off -- except for me and about 8 other employees -- and we were all magically being transferred back to the nerve-grating department from whence I came. The anxiety was unbearable. Couldn't sleep; couldn't eat. I felt stuck. Even Xanax didn't help. And that's when I found myself on the Med-Go-Round again. I took a leave of absence from work and went to my doctor. In the exam room, I cried as he signed my LOA paperwork. "I think you'd feel much better if you tried some medication other than Xanax," he said. His concern was genuine. "Instead of treating your panic as it happens, we should try to prevent it." I refused. I said I just needed to rest and let my body and mind unwind for awhile. Next appointment: "I still think you'd feel much better if you tried some medication. Why don't we try an SSRI?"