Zoloft

The increase in anxiety after dropping the Mirtazapine quickly became intolerable. I have grown weary of the daily struggle to go about my life. It feels like every moment of the day when I am outside my home is a battle. It’s not quite that bad in reality, but anxiety attacks were become a daily occurrence, and after a while the fight simply wears you down. It was becoming obvious that things were getting worse, and the rate of decline was accelerating. It was time to put the brakes on. This is where I was when I called the doctor last Tuesday to ask for a Zoloft prescription.

The Mirtazapine Experiment Concludes

When last I found time in the chaos to write in this space I had just been handed a prescription from Mirtazapine and was preparing to embark on yet another pharmacological experiment with this chemistry set I call my body. I was hopeful that it would be the last piece of the puzzle, but I am sorry to report that yet again the downside outweighed the benefit and that three weeks later I am no further ahead for having endured the mind numbing fog of these damn pills. I suppose to say I am not further ahead is not completely accurate, I have succeeded in eliminating one more drug from the list of viable options.

Choose Your Poison

It has been a month since I maxed out my Wellbutrin dose. Within several days of increasing the dosage I began to feel a little better, and that mild improvement has remained though I don’t think I gained much more after that first week. Over the past month I have been able to better manage my anxiety, or more accurately there has been less anxiety to manage, so I have felt better, but not as good as I would like to feel. I have been tossing around trying the Zoloft experiment, but the Mrs. and I have been talking more and more about a second child. The likely Zoloft side effects could make the conception process  a lot more work than fun.

Tweaking the Meds

On Monday I had an appointment with the doc that manages my medication. I went in having firmly decided to do something with the drugs. My world is definitely getting smaller and the process seems to be accelerating somewhat. There was a time when I eagerly sought opportunities to do things that I now find uncomfortable and anxiety provoking. I have been troubled by these changes as they have reached a point where they are really chipping away at my identity, and I had come to the conclusion that it was time to put the brakes on this process.

Still Working On My Anxiety Management Plan

The chaos of the holiday season has left me little time to think or write over the past month. A few ideas have run through my head, but finding the time to put them to words has been near impossible. As the first week of the new year comes to a close I find myself with a little time and it has occurred to me that I have reached something of a milestone. It was at the end of December 2011 that I took my last Klonopin. I have now been flying without my anxiety safety net for an entire year.

Wandering Through The Haze

The last couple weeks have been a confusing time for me. I have found myself in somewhat unfamiliar territory emotionally and physically. About three weeks ago I made a casual observation that my mind had become somewhat muddied. My cognitive processes seemed much slower and my memory had gone to pot. I was having a great deal of trouble recalling names from the previous chapters of my life, and I couldn’t seem to remember to do anything. Theses memory problems were most troublesome because I work as a salesman and forgetfulness is bad for business, but as time passed they worried me a little more.

Along with the mental cloudiness my temper was getting much shorter and as time passed my wife and I barely spoke without ending up making some sort of short, frustrated, and angry comment toward each other. About a week ago I began to notice I was doing things that made no sense, like forgetting steps of repetitive tasks I have completed thousands of times, and was becoming distrustful of myself which in turn was causing a marked increase in my anxiety levels. I had just come to the realization that I was beginning to slide downhill quickly when this weekend the tension with my wife exploded into a real open argument. She basically asked me what the hell was going on that I was repeatedly doing things that made no sense, or failing to do things that were obvious. It seems the greatest source of frustration on her part was that I had turned into a complete idiot.

Wellbutrin Doubts Answered

I took Wellbutrin for years. It was originally prescribed to try and mitigate the unfortunate personal side effects of the SSRI medications I was taking and it just never really went away. In the back of my head I was never really sure it was doing much of anything. A couple times over the years I would get fed up with the side effects of the SSRI and stop it. This always led to a slow decline in the stability of my mood. The first indicator that something was wrong would be chronic stomach upset. Before my actual mood deteriorated I would get tired of feeling sick all the time and end up back on the SSRI.

A little over a year ago I stopped the SSRI medications again and until recently my mood and stomach have behaved nicely. Over the winter I survived benzodiazepine withdrawals without the help of and SSRI and actually felt really good for awhile on the Wellbutrin alone. I suppose in hindsight I should have left well enough alone, but I had this nagging doubt that the Wellbutrin was doing anything and was excited by the prospect of a drug free existence. I worked my way off the Wellbutrin and by the end of May I was living with no chemical safety net. Within a month things started to decline. I was flirting with the idea of calling the doc when the recent insomnia hit and I had little choice but to do something.

About the same time the insomnia popped up I was beginning to lose myself in my own head. The anxiety was dripping off me. I worried about everything and just generally began to feel fearful. I was worried about the big questions in life. What are we doing here? What happens when we die? Big stuff with no real answers, but that caused me to spend way too much time in my head. I tried to stop myself from having these internal conversations, but my brain just went there on its own.  About a week after I started the Wellbutrin I noted a slight let up in the overriding sense of unease, but I still couldn’t get out of my own head. When I last saw the doc we increased the Wellbutrin dosage from 150mg to 300mg. About a week in I finally found some relief from these dangerous internal though patterns.

I guess the question is answered. The Wellbutrin is doing something. The question now is if it will be enough. I travel around and work with the public. Twice in the last week or so I have had a customer point out that I look unhappy. I don’t feel particularly unhappy. I am tired. Sleep has been better, but not perfect, and even when I get a good night’s sleep I feel tired in the morning. I know that is not a good sign, but there have been improvements in my sleep over the past week so I remain hopeful that the fatigue will pass. I have also experienced some of the milder side effects of the Wellbutrin restart which include occasional dizziness and feeling cognitively slower. Some of these symptoms are letting up, and I wonder if the fatigue may be part of that as well. In the past when I have taken SSRI medications I have felt pretty good. At this point on the Wellbutrin I wouldn’t say I feel good I would just say I don’t feel bad. I am most certainly not on solid ground

Breaking The Cycle

Disclaimer – I have said in the past that I have limited time to write in the summer. This was written in a small window of opportunity during which my 3 year old repeatedly got up from his nap and interrupted my train of thought. If I tried to proof it thoroughly it would never have been posted, Please forgive the typos, misspellings, and odd sounding sentences that are undoubtedly everywhere.

 

When I last checked in just after the 4^th of July I was still struggling mightily to get a decent night’s sleep. The Friday before this past, the 6^th, I again went to bed with the knowledge that the alarm would be sounding at 4:00am which is about the same time I had been getting to sleep. The pressure of needing to sleep was the trigger that set this all off in the first place, and predictably sleep that night was not going to come easy. The stressor had been needing to get some sleep prior to getting up early to go work with my father. This work is something I both enjoy and need for additional income. I had canceled the previous two times I was supposed to get up because of the insomnia. This time I decided to take a different approach. Going into Friday night I had slept reasonable for a couple nights. I decided that no matter what happened overnight I would get up and go fishing. The day we had planned was going to be easier than normal and the weather was to be ideal. I figured if I took away the sleep requirement for going it may help.  When sleep came hard I reset the alarm for 5:00 to give myself  a little time, but held firm on my commitment to get up no matter what happened. Some time after 3:45 I drifted off and I woke again before the alarm around 4:55 and got up.

The day started grey and foggy both in my brain and on the water. The drive to the boat was pretty bad and the first

Not my photo. No credit information available.

couple hours work were equally horrible. My brain was moving slowly but I was functioning. Finally around 9:00 the sunchased the fog away and the warm rays of my skin cleared the cobwebs from my mind. The rest of the day went pretty well. That night I stayed up until 10:00 and when I hit the pillow I could not sleep. I was very very tired and as we all know when you are that kind of tired the little voices in the back of your head get louder and more forceful. By 10:30 I was experiencing high anxiety and in pretty rough shape. Even my anxiety couldn’t overcome the level of fatigue I was experiencing and sometime after 11:00 I slept. It was a toss and turn kind of night, but I did sleep.

As the new week began sleep again became a more regular part of my life. Getting there was still a bit of a struggle taking an hour or two each night, I got a lot of reading done, but sleep was coming. When Friday rolled around I had a follow up visit with the shrink concerning my restart of Wellbutrin and the sleep problems. During the visit we increased the Wellbutrin dose from 150mg to 300mg, and talked about adding a drug to ensure nightly sleep. He indicated that my prolonged  use of the benzodiazepine Klonopin would likely make sleep aid such as Lunesta and Sonata ineffective. I found this an interesting observation and wished he had elaborated as to why.  In the end the conversation boiled down to two old antidepressants with sedative side effects Mirtazapine and Trazodone. I am not looking to take a lot of pills and was encouraged by the improvements to my sleep over the course of the week. The Mirtazapine was a drug I would have to take on a daily basis, but the Trazodone was something I could take an a more as needed schedule. I really wanted to see if my sleep kept improving so we decided I would take and prescription for Trazodone and use it if I needed it.

Friday night I was again facing and early alarm, and all day I was wrapped pretty tight about it. The week before I had proven that I could go fishing with no sleep so I again decided that I would gt up no matter quality of quantity of sleep I got. At bed time I could feel the anxiety in my body when we turned the light out at 10:00. By 11:00 I was no closer to sleep that when the light went out so I got up took some of the left over Buspar for the anxiety and read for almost an hour. Sleep finally came around 1:00, and I got up at 4:00 when the alarm sounded.

Yesterday we fished our biggest day of the season. I was on the water for over 11 hours in 90+ degree heat. My stomach gave me some trouble over the course of the day so I didn’t eat, but I drank about 50oz of water. I didn’t feel great, but I again functioned effectively on minimal sleep. I am hoping that by breaking the cycle of not going when I don’t sleep my brain will begin to realize that there is nothing to get all worked up over. By taking away the negative consequence (not going fishing) I hope that sleep will become less a big deal and therefore come easier on these nights. We will see what happens next week I guess. I would really like to keep those pills in the bottle.

A Better Day

I would like to tell you all that I slept like a baby last night, but I did not. I was tired and stayed up a little later than I should have watching nothing of any importance on the television. I think we were both mostly just putting off what has quickly come to feel like the inevitable pain of another sleepless night. I was feeling sleepy enough when we did turn out the light around 11:00 that I figured I would try sleeping without the prescribed pills that had done so very little the first night.

I don’t really recall much after the light went out, but I woke up around 1:15 and I remember thinking to myself “Christ it’s been two hours and I’m still awake”. I immediately decided to pop a pill, but as I walked to the bathroom I began to realize that I may have been asleep. I took the pill anyway and returned to bed. The next thing I know its 3:15 and I have definitely been asleep, but I need to use the bathroom. I returned to bed and slept through to 6:00. As the day winds down I am again feeling pretty tired, but it was nice for awhile today to feel human again. The sun was shining and I actually felt pretty good for a significant portion of the day.

A few days ago I mentioned that I had made the call about getting another prescription for Wellbutrin. Last Friday the prescription was filled and took the first dose. It has been seven days now and the stuff should be just about starting to take hold. It will probably be another week or so before it is at full strength, but maybe some of the lifting today has to do with the medication. Wellbutrin has never helped with insomnia in the past, but I have never had Insomnia like this in the past so maybe it will get better. The pills prescribed for sleep were actually clonodine which is a blood pressure medication rather than sleeping pills. Apparently is has a relaxing sedative effect without all the baggage that comes along with actual sleeping pills. After my recent experience with Klonopin I was relieved that they were “light weight” sleep aids, but of course they weren’t the most effective solution either. In the light of the day at this moment I am again hopeful that things are improving. I felt so good for a short period of time, and my fingers are crossed that I can get back there and maintain that place.

A Familiar Theme Reoccurs

A common theme throughout this blog has been the seemingly endless parade of shitty decisions that land at my feet. These are the kinds of things that have to be decided on for life to move forward, but which have no clear cut right and wrong choice, or if there is a right choice it comes with consequences that make it difficult to bear.  The past couple weeks have seen a reoccurrence of this theme in ways that I had hoped I would not deal with again.

When I last wrote on this blog I was struggling with a professional decision. I had been offered the opportunity to work on the water again, but I would have been gone a great deal and missed some important family events. Of course this sacrifice was going to be rewarded with a salary the likes of which I had never seen before, which would have solved a lot of our day to day struggles around here. The very moment I was made aware of this opportunity I shook my head and mumbled something about “timing”, another theme I seem to see a lot of, and wished to myself that this had a popped up two or three years ago. At the end of the day taking the job was going to involve giving over a little more of myself than I was willing too at this time. I have mixed emotions about turning down the opportunity. I have never in my life been presented with an opportunity that I was so uniquely qualified for. It was bizarre how the job requirements matched up with my experience and qualifications, and I think I would have liked the job. Even my wife couldn’t honestly say we had made the right call as she watched the prospect for that kind of income vanish.

One of the reasons for turning down the job that I didn’t talk a lot about, but was always there under the surface, was my health circumstances. I have already seen what happens when I am put in situations I am not comfortable with when my head isn’t quite right. I had real concerns that making a change of this magnitude where a significant amount of the control I have over my schedule, and therefore what I must do when I am not feeling well,  would be turned over to a relative stranger may not work out well. I have been struggling with my medication free existence and am looking to get things on an even keel not turn them upside down. At this point as long as I don’t lose my curret employment I think the decision was right for now, and I even managed to turn it down while keeping the door cracked for any future possibilities.

My mental health has been anything but predictable over the last few weeks. I introduced my readership to my not so good friend Freddie some time ago, and as always he has remained steadily in the background, while occasionally stepping into the forefront trying to steal the show. Other than off and on feelings of general unease, and one horrible timed night of insomnia (I doubt very much the timing was coincidental), much of the flat out feelings of anxiety have been reasonably controlled. Of course “reasonably controlled” is a far cry from where I was just prior to stopping Wellbutrin and I was certainly hopeful that things would be better than that.

The last several days has brought with it a change that has proven to be the proverbial straw that broke camel’s back. I have seen a return of the gastro intestinal symptoms that have always been the weather gauge of my mental state. Long time followers of this blog my recall that when depression and anxiety first appeared in my life in a debilitating sort of way the first symptom was actually stomach upset for which I was subject to countless horrible tests to determine that nothing was wrong with me. It was an awful time I hope to never repeat. I am now on at least four consecutive days of stomach pain and gas with significant diarrhea for the past two days. It has reached the point where I have begun to worry about leaving the house or going on the boat with my father, which means it has reached the point where I am no longer going to deal with it. I made the decision this morning to make the phone call, and I have spoken with my shrink’s nurse. I requested a prescription for 150MG of Wellbutrin XL. I am not happy about this and am not terribly confident that it will even work. In the past when the stomach upset really gets going the only solution has been the SSRI type drugs, which come with their own problems that I will magnify other ongoing challenges I am dealing with making them less than ideal. It is my hope the Wellbutrin combined with my improved diet (down 30 pounds now) will settle things down some, of course the probably means a semi permanent goodbye to my new friend the mocha latte.

I am still waiting for the call back from the doc saying that the RX has been called in, but I don’t anticipate there will be a problem. It will be hard to swallow that first pill. I wrote here when I stopped taking the medication that the doc pissed me off a little by preparing me for the possibility of going back on them. I knew it was a possibility and while he was trying to be helpful his words are doing nothing make this easier. The decision has always been mine not his, and sometimes making the right decision is the hardest thing to do. There really should be no down side to this. I should feel better with minimal side effects, but there is something about having been completely chem free and having to go back that really sticks in my throat.