IMRare: GABA isn't working right, not sure which drugs help and which ones hurt

[IMRare]

Hello all. I have the privilege of experiencing some rare, severe side effects and paradoxical reactions to drugs because I'm just special like that.

I already know I'm neurodiverse because I have ADD inattentive and Adderall classically has a mild calming and confidence boosting effect due to my thoughts being streamlined (de-cluttered) and increasing my eloquence. In other words, I have much more trouble sitting still (not enough to be labeled hyperactive but it is a struggle) and finding the right words without it. However, sometimes when the half life is exhausted, it can cause a rebound anxiety effect and I wish I knew why. Overall, it seems to be trustworthy and beneficial.

 

In 2019 I suffered from an acute and severe CPTSD trigger after a physical and verbal assault incident that left me unable to handle normal everyday tasks like driving (I couldn't stop screaming if I drove more than 5/10 minutes) working (couldn't trust myself to maintain emotional regulation, I unfortunately targeted my anxious anger at several dear friends and yelled at them for no reason, I felt like I couldn't predict what would trigger it and could easily be fired), and just being a person basically. My doctor wanted to try mood stabilizers but I said no way because of side effects. Which is ironic because the other option was clonazepam which after being in my bloodstream constantly for about seven months led to severe depression and sleeping nearly 3 days in a row. Fun! I got locked up not because I was suicidal, but, STG, because they wanted to monitor me 24/7 while I detoxed from the benzodiazepine. Ha! Thanks! What a horrible chain of events was started by that.
 

I was experiencing emotional dysregulation, irritability,  and insomnia from the stress of, oh I don't know, being involuntarily committed? That's not stressful, right? That shouldn't affect your mood or sleep, right? Especially right before a major holiday, right? According to the in nuthouse psychiatrist, I should have been sleeping like a baby, because everyone else who came there didn't have a problem sleeping! Seriously, eff that. She basically told me my anger and distress were weird and wrong and labeled me as bipolar despite the fact that my severe depression was a SIDE EFFECT and I was locked up because THE DRUG I WAS ON, CLONAZEPAM, HAD SUCH SERIOUS SIDE EFFECTS THEY WERE WORRIED I COULD HAVE A SEIZURE AND DIE. But nah, it was all me, right, so she labeled me bipolar although before this I had never had any mania or anything other than mild/situational depression. GREAT START!

 

So what did they put me on to stabilize me which I detoxed (over about 7 days) from clonazepam? Zyprexa and lamictal. Zyprexa was a horror show, you block dopamine and histamine and all I wanna do is eat and sleep and rest. I gained 20 pounds, an insult I will never forget and which makes me supremely skeptical of any medication that causes weight gain. It is MESSING UP YOUR METABOLISM and yet does anyone order any tests to check how your hormones are doing if you gain a lot of weight or can't stop eating? NO. Because that makes sense, it's totally normal to have your entire body doing weird stuff it never did before because prescription drug side effects. Lamictal seemed to work at first, which makes sense because it kind of does the opposite of clonazepam, from what I remember about it without looking it up. I'm not sure if the zyprexa's 5HT3 antagonism or lamictal's brakes on the clonazepam gas, if you will, helped me to feel calm and in control of my emotions. But it didn't last!

 

I stopped zyprexa after about one month and tried to lose weight using ketosis, the only way I have been able to lose weight since I was on lexapro years ago (which I think damaged my thyroid because weight gain correlates with the time I was on the drug, gradually, about 50 pounds over about a year and a half, and then suddenly with 50 pounds in three months). I used to be able to count calories and exercise and use traditional diets, but Jenny Craig nor working out nor low calorie diets have budged the scale for years and years. Only keto. So when I didn't lose any weight after one month of the keto diet on only lamictal (a few weeks after stopping zyprexa, having been on lamictal about two months) dieting identically to how I had done it up to my time of hospitalization which had led to a 50 pound weight loss, that should have been a major red flag. Yet whenever I brought it up to my doctor or psychiatrist, they either told me I was wrong and not dieting right, or that it must be something else causing it because lamictal didn't inhibit weight loss.

 

But the fun doesn't stop there! Even when lamictal was still "helping" me, the stage was being set for all sorts of bad things to happen. Other than ketosis not working, which I think has something to do with lamictal binding much more nondiscrimatorily than it should have and hogging receptors, other drugs started not working too. From my recollection, I definitely remember these altered drug reactions: Adderall induced panic attacks and crippling fixation on tasks where I could not stop, visteral became completely useless as a panic attack medication, caffeine induced severe debilitating OCD, and benydryl didn't work correctly as a sleep aid. Propranolol, recommend to me by a friend, was way too easy to take too much of, and easily made me lethargic and my blood pressure plummet. I think this is because lamictal is, in and of itself, a weak beta blocker. Sometimes I took clonazepam for a really bad freeze state, but that seemed not to work either. A few months after starting lamictal the pandemic hit and I found out I was eligible for medical marijuana. Thank goodness because I believe the activation of GABA by lamictal lowered my dopamine release/receptors and if I had not been able to boost my dopamine, I would have been so bad off, but also maybe I would have realized it was the lamictal before the super bad side effects set in.

 

About two years after I noticed I couldn't go into ketosis (and about a year and a half after figuring out I could but only with intermittent fasting at least 16 hours), my life got turned upside down and inside out, aka my stress reached new heights. What do they suggest you do in that situation? Increase your meds! I was like no thanks, I already can't lose weight, but I developed frequent migraines (had not had for almost a decade) and crippling panic attacks which I now recognize as severe, debilitating OCD. When I did increase my dose a few months after dealing with that crap and being laid off because I called off too much, it got 10x worse and I could barely function. That's when I suspected oh hey, it might be this drug I'm now taking more of that is ruining my life. And hey, it was hard to find, but my symptoms were there in the body of research. I wasn't wrong or mistaken. Migraines, severe ocd, ineffective ketone production: all correlated with lamictal use. I tapered off of it over a few days, way too fasr, because I just wanted my life back.

 

Things have gotten better, and one good thing to come out of this is realizing I have OCD, just not severely like I did on lamictal. ERP has changed my life for the better. But something is still wrong with how I react to medications.

 

When I first went off of lamictal in July 2022 I tried ketosis but found that it gave me diarrhea and indigestion like all the fat was too hard on my body. I now believe this has something to do with lamictal's effect on some pancreatic b-cells. Luckily I did not push myself and took a break from trying to be keto. I had a rough start a few months later where I had trouble keeping my blood pressure up (had to drink soup all day, so much soup) and then after another break for several months I was able to have a much easier time of going into ketosis with just some insomnia, not excessive soup drinking. That is encouraging to me and shows me I am on the right track.

 

i also began trying Adderall and visteral again after a few months and found they worked correctly. Propranolol no longer incapacities me if I accidentally take a little too much. It's refreshing.

 

However, there is a new kid on the scene and I wonder if I messed something up (or am still messed up from lamictal). I accidentally discovered zofran took 90% of my OCD symptoms away after taking it for nausea (which I get easily when stressed). I was like a person in a wheelchair who took a drug and found out they can now use a cane: it felt miraculous. But! It didn't help my insomnia and I took hydroxyzine to fox that...which was a horrible idea. I swear I ran it through the interaction checker, but I must not have because I had a very bad reaction, almost like being poisoned or overdosing despite taking low doses of drugs hours apart and not in combination with alcohol. But I suspect that because I had 2-3 drinks several hours before taking half a hydroxyzine and then 2mg of zofran the next day on top of Adderall and caffeine, the alcohol somehow concentrated one or all of the above via inhibiting CYP2D6 (and maybe other cytochromes, but I am almost certain I am a natural poor metabolizer which is why I only need low doses of  drugs that use it as a substrate and those doses seem to last a long time). After taking a small amount of propranolol to help calm a panic attack induced by a 20 oz diet Dr Pepper, my eyes developed pinpoint pupils, my fingers and toes turned blue, and my face was white as a sheet getting out of a hot bath tub. Based on my lay person research it seemed like either an overdose caused by drugs acting on the same things (maybe too many g proteins being bound up) or an excess of acetylcholine activity. I wasn't sure which one so I took half a primatene and two robotussins and went to the er. Other than peeing too much, pain and cramping in my back over my kidneys, extreme thirst, some shortness of breath, the blue toes and fingers, painful constipation for two days, increased heart rate, increased hypertension (30 points elevated above my normal level) and being in the prediabetic blood glucose fasting range (mid 100's, mine is usually not over 95), my labs and ekg were all normal, just like they have always been if someone looks at me during a panic attack. I discussed the possibility of acetylcholine with the dr and he was like nah. I still don't know what went on there, but either the robotussin or primatene seemed to work (my money is on robotussin) because despite no treatment my fingers and toes went back to normal over the next few hours and my pupils didn't remain tiny. Ever since then, I have not taken visteral or desired alcohol.

 

i took a break from zofran for a few days because I wanted to detox from visteral and that because of the red exclamation mark interaction warning I found but the relief from OCD was so important and such a relief that I only lasted a few days before taking zofran again. On zofran and visteral, I noticed I was frequently bloated after eating, could not lose weight, did not produce ketones, and got headaches and nausea after a few hours without any potassium supplementation. This all leads me to believe these two drugs together raised serotonin enough to trigger increased angiotensin and therefore increased aldosterone, decreased insulin, and led to excess potassium excretion.

 

A few weeks before going to the emergency room, I had also completely stopped taking medical marijuana.

 

Since also stopping hydroxyzine,  alcohol, and every other not 100% necessary drug (basically Adderall and levothyroxine) I regained the ability to go into ketosis, stopped bloating, and did not need to constantly ingest potassium in my water. However, I have experienced debilitating freeze states.

 

When I say freeze state, I think I basically mean a paradoxical benzodiazepine reaction with maybe some issues of the adrenal-kidney-pituitary system and disruption of circadian rhythm. While not on zofran but on metronidazole (CYP inhibitor) I experienced a debilitating panic attack after taking my normal dose of Adderall and nothing made it better. I tried potassium (in case of low potassium/ mild alkosis) and baking soda (high potassium/mild acidosis) but neither seemed to work which led me to believe it did not have to do with my ph. I then tried a propranolol to see if beta blocking would work. It did nothing. A few hours later I tried 1mg zofran. Did nothing. Then a few hours after that (about 6 hours after propranolol) I took half a trazadone to see if alpha blocking would help. Nope, still had shortness of breath with movement, lightheadedness, dizziness, and hyperventilating with exertion like running.
 

Now I believe this is the same thing that happens during a paradoxical benzodiazepine reaction: excess gaba in the blood, probably caused by too much serotonin or something. Because when I took half a clonazepam (.5) about 24 hours later, after only taking levothyroxine and a cup of coffee which did not seem to affect anxiety, the next evening when the "panic attack" would not let up, BOOM it worked for maybe 1/2 hour before things got debilitating.

 

I found myself in a restless, agitated, moderately emotionally dysregulated state. In a word: uncomfortable. I could barely function because the psychic pain felt too extreme, and no wonder when I experienced shortness of breath and lightheadedness when I got up and moved around. You wouldn't feel like doing much either! It was HORRIBLE, I missed out on wages and hanging out with friends. I talked to two pharmacists, the on call doctor from the office that prescribed the antibiotic, an telehealth urgent care, and I called the ER to see if they could run any tests based on my symptoms to see about a bad reaction to benzodiazepines. Everyone was like shrug, just stop taking the medication if you think it is doing this. The ER nurse did not know of any tests that could be run. Poison control knew of no cures. But that didn't mean there wasn't help. 

 

Turns out if you look at the research and the way receptors work there IS a treatment for excessive GABA. Options include: increasing dopamine which sort of is like a sewsaw relationship to GABA (hello old friend medical marijuana), negative allosteric modulator zinc, and  the big baddy in absinthe, and blocking the receptors with thujone (more readily found in sage and also in rosemary and oregano, but it is very hard to determine how much you are ingesting or to even know what a therapeutic dose would be). I think inhaling toulene might also work, but that appears to be riskier than chewing on some herbs from the spirc rack. Although that may explain why I have always thought certain chemicals like old school nail polish, old school paint, and heavy duty glue smell great.

 

i took a large (for me, 5/6mg) dose of medical marijuana (1:1 cbd hybrid, I have bad side effects from indicia and tolerate sativa well), chewed on some oregano, and took about 44mg of zinc gluconate. And after nothing had helped my panic attack from Saturday afternoon to Monday afternoon, I felt functional again. You could say it is placebo, but I had plenty of chances to let in the placebo effect and had no relief, so I do think there is validity to my hypothesis.

 

That was one week ago. Since then I have been continuing to use medical marijuana, about 1.5mg twice or three times a day. I tried not taking Adderall for a few days and do not take zofran regularly. However, I am still experiencing severe insomnia (i am afraid to take anticholinergic medications after what visteral did) and lost several days to a panic attack. It is like after a few days, medical marijuana is either not blocking gaba in a beneficial way (maybe it is blocking too much and allowing it to build up in my blood stream?) or I have a tolerance to the low doses, but it basically stopped working like it should a few days ago.

 

I read that ethanol can causes changes in GABA receptors that mean they are not as reactive to GABA but when they do react after the resistance induced by ethanol wears off they react harder? I don't know, I was feeling clueless so I thought I would try it. Did not take zofran or Adderall, just medical marijuana and two cups of coffee. The next day, it does seem to work (I am not hungvoer today, but classically hangovers have always quieted my anxiety and increased calm and creativity). But! I feel like I may be setting myself up for rebound side effects because I don't want to or intend to keep drinking every day.

 

I just want my life back. I want to understand what is causing my increase in freeze states and hyperventilating panic attacks. If there is a way to snap out of it using food or medicine, I want to know. If tapering off certain medications could get GABA back to a good place, I want to know and make a plan to do that. I have no idea how to talk to my psychiatrist or doctor about these things, what tests (if any) could elucidate my hypothesis, don't know whether zofran is causing weird side effects independently or if my brain was already set up by lamictal to react weirdly, and am terrified to try any drugs that raise serotonin or GABA, directly or indirectly.

 

Years before I was locked up, I had bad reactions to two drugs that act on GABA while I was taking buspirone and strattera (which was also the only time in my life I got migraines with aura until I went on lamictal). One, levaquin, blocks GABA and made me severely confused and out of it which I quickly figured out and switched to another antibiotic. The other a few months later, lunesta, increases GABA and made me suicidal, agitated, restless, jittery, emotionally volatile, and completely unable to function. I knew it wasn't real, but the intrusive thoughts and agitation never quit. I had to put my whole life on pause for several days while I went around asking for help at my therapist, doctor, emergency room. Just got a lot of shrugs. I finally decided to go cold turkey off of all medicine and what do you know, the weird side effects went away. I reintroduced buspirone and strattera and whatever else allergy or vitamins I was taking and when none of them led to the side effects, I knew by process or elimination it was lunesta and vowed to never take it again. I stopped buspirone and strattera later after figuring out neither of them were really doing anything and being gaslit into believing I didn't have adhd (I DEFINITELY do, thank goodness for my therapist encouraging me to try a different medication after strattera did nothing and vyvanse made me feel like I was dying- finally I got relief from Adderall).

Sooo yeah, here's what I take:

- Levothyroxine once a day (no observed negative side effects, tests indicate it is necessary, and if I don't take for a few days I experience mild hypothyroid symptoms like some strange soreness, tingling, and palpitations)

- Adderall twice a day 15mg. Increases calmness, eloquence, focus, alertness, and virtually eradicates silly mistakes. Necessary for my job. Notice, on occasion (unsure which conditions) a mild withdrawal syndrome about an hour or two after the drug's 4 hours half life passes that includes shortness of breath, increased heart rate, and increased anxiety. Does not happen all the time but happens enough that it is a problem. Taking half a pill (7.5) helps reduce the severity of "withdrawl" and reduce symptoms. Other than this, insomnia is the only negative side effect I experience from Adderall. However, when combined with caffeine and zofran, it is easy to trigger hyperventilating panic attacks even in the absence of anxiety.

 

- Zofran, as needed, 1mg once or twice a day. Constipation, drastic reduction in OCD intrusive thoughts, and emotional stability are the major side effects of zofran. The next day after taking it I experience tinnitus and mild headache upon waking that fades and completely goes away within about an hour or two. I am not sure about potassium but I definitely think it blocks magnesium in my body. If I don't supplement with magnesium while taking this, I don't poop. It seems to be effective at a very low dose (higher doses can make me too silly, almost like the classical marijuana high) and the anti-OCD effects last a lot longer (about 24 hours) than the drugs half life, which is 4 hours. No other drug has substantially affected my OCD. I think because my OCD is rooted in an exaggerated response to disgust and perceived pain, and whatever zofran does to antagonize 5HT3, it basically pushes out whatever neurotransmitter that is signaling for OCD and also sending my emotions on a rollercoaster. It is so refreshing to have emotions run sort of in the background so you have them and feel them but they don't dictate everything you do. When this drug is working correctly I feel stable and ready to take on the day and don't  overthink EVERYTHING which means I actually do stuff and don't excessively avoid things. It is LIFE CHANGING and actually I wish I could try granisetron because it is even more narrow. I am trying to limit my use of zofran so I can poop and also in case it is causing or exacerbating my debilitating freeze states/GABAergenic agitation aka benzodiazepine paradoxical reaction. How, since it doesn't work on GABA? By raising serotonin, which increases GABA activity/transmission.

 

- Nicotine gum, I am so addicted to it. Sometimes lately it's like I can't get enough and chew back to back pieces, which is not normal a little usually goes a long way. Would like to taper off, but it's not a priority.
 

My psychiatrist prescribed trintellix because it antagonizes 5HT3 like zofran (but so does zyprexa and lamictal?!?!?!) but after trazodone did nothing but possibly set me up to have a paradoxical reaction, and visteral probably sent me to the emergency room, and it acts on the NET like Adderall, and had a half life of 66 hours...um...no thanks! I have not mentioned that Lexapro led to intrusive thoughts of self harm I did not have at baseline that I not recognize as OCD but over the 4/5 years I was on it was told was a personal failing of my own willpower because I couldn't make them go away. Aren't families fun? 

 

Currently, I am also taking:

- medical marijuana edibles (1.5mg) two or three times a day, trying to taper off since they don't seem to be work

- One or two cups of coffee a day (get a horrible headache if i don't ingest enough caffeine), trying to taper off because other than increases awakeness there are no apparent benefits, just increases chance of increased heart rate and hyperventilating panic attacks.

 

- I've been eating carbs and sugar, stress eating is my number one vice although I usually don't eat a lot of sugar (right now I am, which I KNOW is not good for my anxiety). Trying to taper off of sugar and carbs to get back into ketosis.

 

- Having an occasional drink. After a long time of not drinking started again yesterday to see if it would help. Of course, not a sustainable treatment or one that can be used while driving or working so it's pretty useless. Would prefer not to drink.

 

- Trying not to take anticholinergic drugs, but did take a certizine a few days ago after having an allergic reaction to cats. Certizine is a metabolite of hydroxyzine, so I have no idea if that could be affecting GABA, but medical marijuana did seem to barely work after taking it.

[FireflyFyte]

Hello IMRare,

 

Welcome to SA.

 

Please summarize your drug history in your signature by following the instructions at  How to Summarize Your Drug History in Your Signature. You may need to be on a computer to do this.

 

We are a site dedicated to helping people safely taper off of psychiatric medications. We cannot advise on what medications are/are not safe for you, this is something you should discuss with your doctor.

 

Thanks,

 

Firefly