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. Continue reading

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. Continue reading

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 4th of July I was still struggling mightily to get a decent night’s sleep. The Friday before this past, the 6th, 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.

Weighing Changes

It has been ten days since I have taken any medication for depression or anxiety. I saw the doctor a week ago, and asked him how long it would take for the Wellbutrin to be completely out of my system. For some reason I need to know when it is really gone. He replied that it would take about two weeks. So by the start of next week I will be really living without anything flowing through my brain to keep things in check. By now I am sure that whatever the levels of medication are in my system they have become pretty low and things are going pretty well.

I found this visit to the shrink a little peculiar. After I asked about how long it would take to be completely rid of the drug he launched into this whole speech about how it shouldn’t be considered a failure if I need to go back on the Wellbutrin. He must have said it three or four times over the course of the appointment. He pointed out that depression is an episodic illness and in future years I may have a reoccurrence. At first I just figured he was trying to be sure that if things do slip I will not be afraid to seek some help and get back on the medication, but after the second or third time it started to sound like he was expecting failure. I am sure he is not but this is a sensitive time and I would have liked a little more positive energy from him.

He was curious about how I was feeling off both the Klonopin and at the reduced doses of Wellbutrin. How I feel is of course the best part of this so I have him the list:

–          My Energy levels are higher

–          I Have lost a bunch of weight

–          My Sex drive is through the roof

–          My General Outlook is brighter

Of course if you are going to look at one side of the coin you need to look at the other, and there have been some significant challenges as well. I have written about them here before and they continue to be a challenge. I am still learning to have a wider range of emotions. I never got angry before and I have struggled some to manage it. The truth is that “getting angry” could also fit up on the list of positives. I have learned over the last couple months that by offering an outlet to my feelings the angst becomes much more fleeting. I don’t harbor negative thoughts for hours or days. I let them out and they are gone.

Another change that could be on both sides of the coin is already listed in with the positives and that is the changes in my sex drive. I love having it back, but when I was just chugging along with limited libido frequency was a problem inside my marriage, and now that I am feeling better the problem has been magnified significantly. I had hope that things were getting better, and they did for awhile, but it continues to be a major concern for me.

The last negative is the general increase in day to day anxiousness. The Klonopin and even the higher doses of SSRI’s and Wellbutrin kept a lot of the anxious feelings in check, but they are now back at low levels. Sometimes this anxiousness builds up to the point of causing discomfort for me, but I have been able to manage it thus far. This is the one I need to watch the closest as it could turn for the worst the quickest. It is almost as if once my brain chemicals begin to flow a certain way they always take that path. Right now things are on and even keel, but if I let too much anxiety into my life I am concerned my brain will magnify what I feel out of habit. I am not sure this makes a lot whole lot of sense, but it is a concern for me.

If I were putting marbles on a scale the anxiety would be a Shooter while the others would be your regular sized marbles. Even so with sex and anger basically canceling themselves on both sides I think the scale tips pretty solidly to the positive side of the equation. I have been feeling good. I am happy. Most of all I am hopeful that this may be my new reality for awhile.