DavidfromTexas

[DavidfromTexas]

@Altostrata

@manymoretodays

@ChessieCat

@Dejavu

 

Since you guys seem to know a lot about the issues here, I wondered if you might be able to explain something to me, dealing with serotonin in general. 

On this site I have read that the “chemical imbalance” is a myth. 

 

A little backstory: When I was first diagnosed with severe OCD and Anxiety as a kid, it really was severe. I could not function doing every day kid things. I was just transitioning from elementary school to middle school and my mom was having so much trouble even getting me to go to school. The fear that my OCD and Anxiety had latched onto was the fear of throwing up. I was DEATHLY AFRAID, after an episode where I threw up on a plane during an out-of-state school trip (incidentally it was the first trip I had taken without either of my parents).

 

I understand now that this is an actual phobia, but when I was diagnosed it was because of the lack of serotonin in my brain that caused me to obsess and worry about the possibility of these things happening. I drove myself (and my parents) absolutely crazy with the incessant worry and truly deathly fear that I was going to throw up or get sick from something or whatever it was. So it seems to me that I truly did have issues with OCD and Anxiety and it wasn’t just a phobia, though I know that emetophobia IS a thing.

 

Through my years of experience, and being sick a couple times since having not killed me, I have been able to (very uncomfortably) get through being sick and learned that it’s not the end of the world. My brain and experience and knowledge seemed to have worked together to help me mature in this regard, though I still get really anxious when I know I’m about to be sick. It subsides afterward however. 

 

MY QUESTION IS: Is the suggestion on this site that “chemical imbalance” is a myth saying that serotonin deficiency does not exist? 

Because to me, it would seem that serotonin deficiency is very real. Otherwise  what would be the cause of my obsession and anxiety issues?

 

Also, serotonin supposedly plays a role in ejaculation response, a deficiency causing it to happen prematurely, which is something I’ve been dealing with whenever tapering or completely off the meds. 

If serotonin deficiency isn’t real, then what would be causing THAT to happen too??

 

Its kinda nerve-wracking to think that what I thought was the problem my entire life is not the problem, and I am left with no idea what could have caused the problems I originally experienced and have continued to experience at times throughout my life. 

 

(Sorry for the long posts, I appreciate your patience)

[Altostrata]

4 minutes ago, DavidfromTexas said:

I understand now that this is an actual phobia, but when I was diagnosed it was because of the lack of serotonin in my brain that caused me to obsess and worry about the possibility of these things happening.

 

The "lack of serotonin" theory was NEVER TRUE.

 

Nobody knows the cause of your irrational fear when you were a child. It could be that if it wasn't branded as a psychiatric disorder, you might have grown out of it. Please consult a psychotherapist for the answer to this question.

[Onmyway]

Hi David, 

in your case, I think what you need to look for is proof, evidence that lack of serotonin causes OCD. That is impossible to do because we can't measure the level of serotonin in the brain (there is no way to do that yet) and there are no established normal levels of serotonin in the brain i.e. levels of people who do not have OCD. So serotonin deficiency causing OCD is a theory that has no proof or support. 

Low serotonin causing depression is also an unproven theory. There are in fact serotonin lowering drugs that treat depression as well as serotonin enhancing drugs. 

 

There are lots of proposed mechanisms for OCD. You can look on pubmed. Some look at genes, others look at brain structure. OCD is treatable and in certain cases curable with CBT. 

 

Hope this helps

[manymoretodays]

Hi David,

And oh my.  This one, your case, is close to my heart as it involves Cymbalta.  I had a dear friend on it.  Then not on it.  And could not help very much at that time.  Not that I did not try to.

Differences though too, between you and that friend.

One similarity though, was something that you noted in your initial post......as to why you got started on the medications in the first place.

 

It's just that there has been so little real evidence as to the whole "serotonin deficiency" myth.  Really.  I have not found any.

What you might consider putting your attention towards, would be trying some non-drug coping, and many do find help, with the right therapist to guide them.  And maybe once you find someone you trust, there might be things you can talk to them about in confidence and all.  That offers some of us relief.

 

I'm so sorry for your relationship loss as well.

 

It is nerve wracking, when ones' previous paradigms begin to shift to another.  Can you let your discovery feel freeing, rather than so scary and unmanageable.  I mean well, believe me.  And I do not mean to underscore what you are going through now.

 

Middle school and that whole transition can be tough for many.  It was for my SUN(son) and though the memories are more distant for me now, I do recall it being hard for me as well.  I think what saved me, was that we had moved the year prior to my entering junior high school, into a neighborhood that had a whole gaggle of girls my age, who took me in.

So......that being said.......as you can, I would encourage you to try and get out there, in your ground life, and find people with similar interests with whom you might pursue friendships with.  Even people in relationships, those committed special relationships, have to do this.  Find some outside friends and co-horts.  We exist in communities best.  Be that online or offline or wherever.

 

So, back to the similarity to my friend.  Are you really quite the perfectionist in having order around you?  I do know, that he got so much relief from hiking.  Yes, hiking.  That could be modified to even some basic walks.  You could add in taking pictures and finding some lovely scenes or nature to absorb in.

 

I think, that yes, there is a really good chance that you might benefit from this small reinstatement.  And if, after a week's trial......perhaps going on up to the bead equivalent of 2 mg. might even help.  We have had some who benefited greatly from updosing or reinstating similar medications. 

 

Oh.....and I have to agree with Alto too.......or I do agree with what they said on not overthinking it.  Lot's of people do this with the beads.  And some have had really good results.  Even for just what you refer to as the "emotional".  I can't guarantee the outcome on the PE, only that again, more people improve with the sexual dysfunction effects than do not.  And given your age and all.......I feel hopeful.  And honest to Pete......when the right relationship does come along for you, it may, in itself, not be such a big deal.

 

Alrighty.  Looks like some other posts might have been offered to you as well.

 

You might find just getting outside, and then around others, as tolerated, helps a ton now.  See what they are up to, the others, go to a bookstore, or coffee shop even.

 

And hang in, patience, patience, patience.  Your un-patienting is not going to happen overnight.  And that's kind of a pun.  Those two sentences.

 

L, P, H, and G,

mmt

 

And oh my gosh.  Looking at your notes again.  See!  You do good while you are at work.  I'm only guessing, but are you at least in proximity to others while there?  And focusing out a bit.  Walk.  Hike.  Nature.  Report back.  Add in some music sometime too.  Just really listen to some.

 

Edited July 29, 2019 by manymoretodays
addenum

[DavidfromTexas]

2 hours ago, Altostrata said:

 

The "lack of serotonin" theory was NEVER TRUE.

 

Nobody knows the cause of your irrational fear when you were a child. It could be that if it wasn't branded as a psychiatric disorder, you might have grown out of it. Please consult a psychotherapist for the answer to this question.

 

That is quite devastating to think about. I know that in my case I cannot regret using the medication to help get through those times, because at that age I was completely inconsolable and non-functional when I was having issues. There was just no way I would’ve had the patience and will power required to. And unfortunately my family and the people around me had never dealt with anything like this before, so they had no idea what was going on. And so we listened to what the psychiatrists said. 

 

A psychotherapist is someone who works with patients using Cognitive Behavioral Therapy, right?

I have never done any cognitive behavioral therapy since I was mostly stable on the drugs, and was unaware that CBT was really the best option. 

I will have to read up a lot more on the details of CBT, but isn’t it mainly focused on providing you with tactics to deal with the symptoms of your OCD/Anxiety? Can working with somebody really help treat you well enough to have a perfectly normal life, or even be cured??

[Onmyway]

Hi David, 

so first of all, I am not a psychiatrist  but your childhood story seems to be that of a phobia indeed rather than OCD. However, I don't know the rest of your symptoms so can't really say it is or it is not. It is important to know that either way, most anxiety issues are treated successully through exposure. The idea is that as you get exposed to that which you fear, you realize that the anxiety subsides, so you realize that it is not as threatening. I think it's called exposure-response-therapy ERP. The other thing about OCD, if that is indeed what you have, is that it is often episodic - it wanes and waxes, so you may have it and it might go away by itself and come back again (or not). One thing to remember is that as you go through withdrawal you might get some OCD emotional spirals. They will go away. Even people who were not put on ADs for OCD get some of these symptoms. It's WD. Best thing to do is distract and wait.   

 

Working with a psychotherapist can really help to deal with emotional symptoms now or later. Look for someone who specializes in CBT specifically. There are people who specialize even narrower into OCD. Look up online. In the meantime, you can also look for books in your library. There are many CBT workbooks. The most well known one is "The Feeling Good Handbook" by D Burns.  There are some in the "For Dummies" series that I like.  I can't recommend one as you might prefer a different style of writing than me so it might be a good idea to go and check some out in your local library or in the bookstore.  It's important that YOU like the style so you can get into it and work through it. It is important with CBT to do the exercises. I can't stress that enough! Just reading through will have some benefit. Doing the exercises will really help. There are also online CBT courses but I don't know if there are any for free. CBT is different from going into your therapist's office and pouring your heart out. In CBT what happened to you in the past becomes less important and you focus on how to deal with the present. And you work through it. 

 

Having said all that, if you tend to go into emotional spirals during wd i.e. a small negative emotion can become overwhelming, I would NOT suggest doing exposure therapy during withdrawal. You would usually do that under the guidance of a psychotherapist anyway but therapists may not realize that WD can have the effect of intensifying emotions. You can work the part of CBT that deals with managing thoughts and behaviors and worries during WD though. ERP can wait until you are done with the drugs. 

What I am trying to say is that, even though the serotonin theory is perhaps bogus there is hope in other, gentler ways. You can treat anxiety and its many forms, you can manage many of the symptoms, you can get other help. The future is not bleak. I know from experience that it looks that way when you are in the middle of wd emotional spirals but you are not doomed to anxiety or depression or OCD because the drugs are bogus. There are many many ways in which you can deal with these issues. It is harder in wd because of the chemical component but that will get better too. I'd suggest you start with basic CBT (not ERP) now and repeat it after withdrawal. It usually runs about 12 sessions with a therapist.  

 

As for dealing with the past, there is a great thread in one of the forums here on acceptance. I go back to it often. The past is unchangeable. Unfortunately, we were put on these drugs by doctors who often themselves believed the drugs work. We can't take that back. There are people to be angry at but that anger will not help us now. Your goal now is to recover and live your future better in spite of this. And that is also possible. Just will take time and patience. And lots of hope. 

 

[DavidfromTexas]

Ok. I get what you’re saying. I still don’t know that I don’t actually have OCD. When I was a kid before the meds came along I DID go through periods where I had to have everything neat. Though those days are long gone. The “obsessions” focused on germs most of the time since I was trying to prevent getting sick, so I would avoid touching things, I washed my hands too much, which I am doing a lot recently as well. My skin has been very dry lately.  But I’m not “obsessing” about these things in the way that I used to. I DO feel that I might be obsessing about other things now though...the loss of the relationship, and now the anti-depressant issues...

 

So maybe I do still have OCD but it just centered mainly on my emetophobia from the beginning because of that traumatic experience I had. I don’t know anything now lol. 

 

I DO know that now I want even more to be off the meds than I did before, and I know that it’s still gonna take a while since I’m just now trying to reinstate.

I’m hoping I can stabilize on a really low dose, but how will I know if I need to updose? I mean, it could turn out that the low dose is working even though I still have OCD tendencies and emotional spells because that might just be who I naturally am. 

 

I guess the only thing I can really do is give it time, and while I am giving it time, find someone who seems to be good at CBT and start working on it. 

[DavidfromTexas]

@manymoretodays I see that you were on meds even longer than me. It seems quite a few people on here have been on them longer than me. 

 

I would like to know, it’s been nearly 3 years since you’ve been completely off medication?? How are you doing, and have you been able to cope to life well using CBT or other methods since being off??

 

I know the time I have been on meds is shorter than you and some others here, but what makes me nervous that my situation might not work the same is that I was on the drugs from such a young developmental age. 

[Onmyway]

Yes, the neatness, washing etc sounds like OCD but as you noted, you don't have them now. They may not return. And i they do, you will cross that bridge then. The obssessiveness may be part of the OCD but it may be also just WD. I'd wait it out. I think with WD the idea is, are my symptoms bearable and allow me to continue my everyday functioning (keep a job, not burst into violent rage, get out of bed, eat, feed myself etc.) Is the updosing making life bearable for you? 

 

My view, and this doesn't have to be your view, is that WD is going to be tough and I will need to suck it up for a while. I have accepted that it's going to be uncomfortable for a while - a year perhaps, or two or more. So the goal is not to get miracles now but to live through it. I can't advise on whether you should updose or not as you have  the same info that I do from reading the threads here. I reinstanted at 2.5 mg and it sucked for  4-5 months non-stop. Then I held for a while and things became a bit better. Now I am cutting again and preparing for it to get worse. I hope it is bearable! 

 

(Also, I am sorry if I am getting some of your things wrong. I only read your question about the serotonin and after, not your whole thread). 

[Onmyway]

I need to call it a night soon, but one of the tenets of anxiety management (esp OCD) is the need to accept uncertainty. intolerance to uncertainty that starts the cycle. (What if there is a germ on my hand? What if I don't get better? What if I left the stove turned on?) One of the exercises you can do is to try to accept that you can't know the future. There are multiple such mini exercises in detail. Another one is to refrain from seeking reassurance (which you are trying to do). Try to see what happens if you don't ask the questions or don't look up any more info online. Nobody knows what your case will be. It could be much easier or much harder or just like everybody else's - unpredictable. It is impossible to know. It sucks but that is the reality. No power on earth can tell you how it is going to be for you. No amount of searching the internet will give you the answer. Worrying will not help change anything. Life is uncertain and will unravel in front of you as it goes along. Have you considered that it might just turn out really really well for you after these drugs? 

[DavidfromTexas]

5 minutes ago, Onmyway said:

I need to call it a night soon, but one of the tenets of anxiety management (esp OCD) is the difficulty in acceptance of uncertainty. that starts the cycle. One of the exercises you can do is to try to accept that you can't know the future. There are multiple such exercises in detail. The second one is to refrain from seeking reassurance (which you are trying to do). Try to see what happens if you don't ask the questions or don't look up any more info online. Nobody knows what your case will be. It could be much easier or much harder or just like everybody else's - unpredictable. It is impossible to know. It sucks but that is the reality. No power on earth can tell you how it is going to be for you. No amount of searching the internet will give you the answer. 

 

You are so right about this. Reassurance is something I always needed when dealing with OCD or OCD-like obsessing/symptoms. 

 

Thank you for your thoughts. I will really try to not dwell on the future, and I will try to just live life while executing my plan step by step at the same time. 

[Onmyway]

5 minutes ago, DavidfromTexas said:

 

You are so right about this. Reassurance is something I always needed when dealing with OCD or OCD-like obsessing/symptoms. 

 

Thank you for your thoughts. I will really try to not dwell on the future, and I will try to just live life while executing my plan step by step at the same time. 

It will be hard but everytime the impulse comes try to resist it. You might not always be successul in resisting it but every time you try you are building that muscle. If you resist in spite of the anxiety you will realize that the anxiety does subside the way that you realized that when you  threw up nothing horrible happened. And so it is with CBT, you build those mind  muscles and things become manageable. Not always easy. But manageable and eventually normal. 

[DavidfromTexas]

Thank you, @Onmyway  

[DavidfromTexas]

@Altostrata Is it generally accepted that anti-depressants act by blocking the receptors in the brain though?

[ChessieCat]

From this topic:  Why taper paper: dose-occupancy curves

 

On 4/22/2019 at 6:10 AM, brassmonkey said:

 

Most psych drugs work by changing the levels of a specific neurotransmitter in the body. They usually increase the amount of the neurotransmitter by shutting down the receptor that absorbs it. This is called "down regulating" and a receptor that is down regulated is referred to as being "occupied".  These charts show the percentage of receptors in the body that are "occupied"  at a give dosage of the medication.  The percentage is on the left scale and the dose is across the bottom. Both charts are showing the same thing but the one on the left show the affects of the listed strength of the dose while the one on the right shows the affects of how much of the drug ends up in the blood from taking that dose.

 

If you trace a line up from the 10mg mark on the bottom of the left chart to where it hits the curve and then over to the left it shows that at a 10mg dose 55% of the receptors in the body have been down regulated (shut off).  Do this again for 20mg and you will see that 75% of the receptors have been shut off.  As you can see the higher the dose the more receptors are shut off, but because of the curve of the line the more you take the less affect it has.

 

The curve tells us several things.  For one thing it shows that the larger the dose the less cumulative affect it has, so in reality a very high dose is not much more effective than a lower one.  But more importantly it shows that at the lower doses (10mg and below) a very small change in dose will result in a very large change in occupancy. A large decrease in occupancy means that there is a lot of healing to be done and a large increase in symptoms is most likely.  The curve also shows why it is so important to go slowly at the lower doses as a very small change in dose causes a very large change in occupancy.

 

These charts are one of the bases from which we worked out the 10% taper rule.  The curve line for a 10% taper very closely matches the curve for occupancy.  By removing the occupancy in a controlled manner we can allow the body to heal itself while the drug is still having an affect and keeping WD symptoms at a minimum. It's like playing Jenga and only removing blocks from the top of the stack.

 

 

             

[manymoretodays]

15 hours ago, DavidfromTexas said:

I know the time I have been on meds is shorter than you and some others here, but what makes me nervous that my situation might not work the same is that I was on the drugs from such a young developmental age. 

Hi DavidfromTexas,

Yah, I'm doing good lately.  I did lot's of the CBT, DBT, groups, etc. while I was medicated and "invested" in my "illness".  Also saw a psychologist a couple of times, as well as psychiatrists, and LCSW. 

What's interesting, is that although it helped a little bit, during all those years I was medicated.........it's like I hit pay dirt since tapering off my medications.  Meaning, I don't do much of that stuff formally anymore......CBT, etc...............but I use bits and pieces from all of it I suppose, in my daily practice of Living Life now.

Yes, David Burns stuff is great.  Ccat gave you lot's of links back a page or so too.  You could do the UK online CBT even.

I used to resist a lot of it, think it was really dumb stuff and maybe that's where you are now.  I don't know.  I've got a really good library of self help stuff.  And do think it's good to do some of it, say CBT, with another, initially.......whether that is a professional or peer counselor. 

My best help always came from non- professionals, or maybe it was the understanding that they(non pros) offered me, that made the difference.

 

Yah, I'm older than you.  Definitely NOT retired in any formal sense, however.  I work hard, and do many things.  It took awhile though.  To get back.  And while I feel pretty good......I do hate hesitate, to say I am fully healed, or that I am completely there.......  Because, of course, I am not.  Still searching, learning, and growing and some iatrogenic(treatment caused) fall out to deal with from time to time.  Add in normal aging stuff as well.

I granted myself a time period, after I first got here, and got hit with the same feelings that you are having now.  I mean it wasn't a time set in stone, just time to begin to learn what I needed, and how to give that to myself. 

I actually think that there is a lot to be said for human development, in adulthood, that has never been formally addressed.  Maybe that's a starting point for you too, revisiting some of those stages of development for yourself......on up to adulthood.

 

Of course, your situation is a bit different than many others here.  Be it age, or social standing, or what drugs you've withdrawn from, or basic make-up.  Factory setting-basic make-up.  One thing is certain.  Or was for me.  That belief and faith that I could heal or begin to heal......that faith in my body, so to speak.  And then faith otherwise, in Something, has sure helped.  Catching the yuck type attitude too.......I mean, for me helps........yes, this is serious business here, but if I find myself getting too, too, mired in the dark and gloomy and hopeless........I just know I best step back for a few.  And can.  Then I can lighten up a bit. 

Oh, neuroplasticity and epigentics too.  We've got bits on each of those areas that you might explore too.  When you feel more settled, just use your main browser.....and put in survivingantidepressants.org and then the topic of interest and you'll find what is here, on site.  Personally, I think change is possible, and inevitable.

 

I hope that helps and answers your last inquiry.  Yah, maybe my life experience helped me somewhat.  And our priorities going forward might be a bit different.   I think you can and will improve and get better David.    Healing at any age says I!  I think we all have the natural capacity for healing.  We do.

 

Best,  And hope it's a good one today for you,

L, P, H, and G,

mmt

p.s. edited to add a few thoughts, and a long one, so thanks for the space

Edited July 29, 2019 by manymoretodays
additional

[DavidfromTexas]

When feeling incredibly emotional while going though possible emotional withdrawal, is it still therapeutic to let yourself cry? Or should you try to stifle it as much as possible?

 

I know in more normal circumstances crying is supposed to be more therapeutic, but I don’t know if the same applies when you’re dealing with emotional turmoil

[ChessieCat]

deep-emotional-pain-and-crying-spells-spontaneous-weeping

 

I think crying can be good for us, even during withdrawal.  I think that trying to stifle it would be more stressful on the nervous system.

 

However, it is important not to get caught up with the second fear, or fear of the sensations.  Please go back and check the information and links in a previous post I made here which explains this and other things.

 

[DavidfromTexas]

You know, my crying isn’t actually spontaneous, it happens after being unable to stop ruminating about all the troubles I’m experiencing, and the pain I feel from wishing I could go back to easier times. 

 

And when I cry it comes in short bursts, even if I do just let it come out. And then after probably 15-20 min or so I am able to decide “okay, I cried about it, now I have to try to let it go and calm down”. Whether that’s to go to sleep or get on with my day and what I need to do. 

 

I seem to cry ONLY when I have enough time to think about my situation, but when my mind is COMPLETELY occupied with something else that I am doing, I don’t just spontaneously cry. 

 

Similarly, I have not so far had any actual panic or anxiety “attacks” (knocking on wood) where I cannot breathe or something like that. 

 

My emotional state has simply been great sorrow, and then anxiety and underlying panic that hasn’t caused any full-blown attacks. Only more emotions. 

[ChessieCat]

What you describe is the same as many other members describe.  And many of us go through stages where we look back on our lives and wish that we could go back to the easier times.  When we are in the tough time it is easier to recall the good times and of course we want to be there, and we probably forget about the tough times we have been through in the past.  And that is not only for people going through AD WD, regular people who have never been on psychiatric drugs can go through the same thing.

 

I find it better to compare how I am feeling now with how I felt at my worst then I find it easier to notice the improvements.

 

It is good that distraction works.

 

It's good that you can have a cry and then say enough is enough, no more.  That's CBT/cognitive behaviour therapy in action.  I've nicknamed it "change bad thinking".  So for example, instead of thinking/saying things are bad it's going to be like this forever, it is better to think/say things are bad (external stressors or being sick), or I feel bad, at this time but I will try to get through the bad period (day/hour/minute) as best I can (non drug techniques:  distraction and/or self care) until things improve.  

 

It is good that you don't spiral into the second fear, which leads to panic attacks which can be very hard to work through.  I understand because I've been there, done that.  And spiralling into the depths is very taxing on our nervous system and can take some time to recover from.

[DavidfromTexas]

SUNDAY JULY 28th (Day 4)

 

11:30am Woke up, slept whole night though minus restroom breaks, did not still feel tired

12:30pm Ate some cereal and a banana

1:30pm Worked on vocal exercises for the first time in a LONG TIME. Was feeling rather nice, wanted to get to try to record some vocals afterward, but my roommates came back home. 

3:00pm Did some more reading (I think). I am having trouble remembering what times I did things today because I was supposed to work but was called off, luckily. 

4:00pm Went for a run around a few blocks of the neighborhood for no more than 10 minutes. (I have been a soccer player my entire life, but have had a 2 year recovery since fracturing my foot, so now I’m trying to get back to where I can play again. I have missed it.)

4:45pm Had a long conversation with Mom after running. Told her so far I was feeling a little better today (she is my closest support, located 1,000 miles away unfortunately)

6:00pm Ate a DiGiorno pizza that I baked, sat down and watched an old favorite movie of mine with my roommates. 

8:00pm After dark was when I started getting a little more down today. Once again it had to do with discussions on the site and the revelation that I was essentially tricked into going onto meds 20 years ago and that if I had just been able to give CBT a try I might have grown out of my issues with no drugs (though in my heart I believe I would not have been able to cope without them at that age and in my state)

9:30pm Ate a single slice of Turtle Pie, it was good 

11:00pm Typing out these notes and going to see if I can rent a movie to watch until I go to sleep

1:20/30am Took 1mg dose. 

2:00am Went to sleep. 

 

 

MONDAY JULY 29th (day 5)

11:00am Woke up, slept though the night, minus a period where I was half asleep but a little restless. This happens to me sometimes. Especially within the last year and a half. 

12:00pm Ate lunch. Also called a psychopharmacologist I had been hoping to get in with, found out they’re not taking any new patients, and my mood went really down from there. Seems anything new that I discover that can be deemed as a bump in the road or a setback really gets me down. 

2:30pm Got to work, and for the first 4 hours or so of work I was still really down. It was slow so I had more time to think about the bad things. By the end of the shift again I felt better. 

11:00pm Got home from work. Had a slice of pizza and a salad (I’m always hungry when I get home from work.) Watched a little tv for a couple hours before finally going to bed. 

1:20am Took 1mg dose. 

2:00am Went to sleep

 

 

I don’t think I am seeing what I would call improvement yet. After 5 days. 

Granted, things got the worst for me after I discovered this site last week and all the scary information that might pertain to my current situation. So perhaps since the initial shock of that wore off it has been very minimally better, but not enough to really notice. I think it’s best if I can stay away from the information for a good period of time, perhaps the better part of a day, but my ruminating doesn’t go away still and I end up checking the site for more info or asking questions Im thinking about. I am having windows and waves within each day, some times however brief are better than others. But it was already like that before I started my reinstatement attempt. 

 

If it’s been the better part of a week and I haven’t seen a noticeable improvement, should I wait much longer before trying to go up to maybe 1.5 or 2 mg? 

Since I already have at least a tiny amount of the drug in my body, shouldn’t the process of re-acquainting with the drug have already began, so it’s not like waiting longer to updose would mean im losing more of my chance to reinstate?

This is making me wonder, again, if what I’ve been experiencing is more my normal reaction than due to withdrawal. Because withdrawal seems like it would respond to a much tinier dose like the one I am trying now, and so far I don’t think it is. 

 

Also, does the size of the dose matter when it comes to achieving steady state of the drug in your body? For instance, is my 1mg being absorbed quicker than if it were 20mg with more beads to absorb??

 

Last question: If I take my dose at some point within the same hour from day to day (for example, 1 day at 1:15am, the next day at 1:45 or 2:00), is THAT okay? Like an hour fluctuation?

[DavidfromTexas]

I am wondering about Magnesium supplementation...since it can have effects on mood wouldn’t it be NOT recommended to supplement with Magnesium while on SNRIs?

 

I thought I had read before that it can have the same consequences (like serotonin syndrome) as combing different anti-depressants. Maybe I’m mis-remembering. 

 

If I AM wrong, and combining magnesium with SNRIs is fine, which form would be the best form to take? (There are so many, I don’t know which to even choose.)

[Onmyway]

Hi David, 

 

I'm sorry you are still going through the emotional spirals. One thing that worked for me in the beginning was that I let myself feel what I was feeling without worrying about whether it was OK or not. I cried when I wanted to cry, I let fear be when I was fearful. In the end emotions dissipate. What do you think will happen if you felt sad for a week or a month? Or anxious for that amount of time? You will be OK. It won't be comfortable but you most likely will be able to tolerate it. So what ChessieCat is saying is don't worry about your feelings for now. Let them be. 

 

I think you will definitely benefit from a CBT workbook now. A lot of your emotions start from your thoughts. Learning about how to deal with them might help. 

 

Re:  magnesium

It's OK to take while taking an SNRI unless you have some reaction to too much of it - like stomach upset etc. Look up online what forms are best. I am taking magnesium glycinate but magnesium citrate is well as well. 

 

Regarding ruminating about the past. I don't think you were tricked into taking the drugs. I think the adults that made the decision genuinely thought that it was the best decision at the time. CBT may or may not have worked. It's harder to do with kids. 

 

Regarding all the information here. I will summarize the majority of it for you below and maybe that can help you stop reading for a bit. 

 

1) Withdrawal WILL suck. You might get physical and/or emotional symptoms. They are not the return of your "original" issues. They will pass. They will feel scary for a while, but will get better.  (Note: WD doesn't suck for everybody but for some of us it does and it is what it is. Thank our unlucky stars). 

2) Nobody knows how long you will suffer. It may be years, it may be months, it may be less. 

2a) Nobody knows how severe your symptoms will be. It can be mild/it can be severe/it can be emotional only/ or physical only or both etc. 

3) Reinstatement of a small dose may or may not help with symptoms. It is the only thing that is recommended on the site to  take off the edge. Reinstatement of a small dose is supposed to make things bearable, not cure all the wd symptoms. 

4) Reinstatement of full dosage may work but it may also have the opposite effect. Reinstatement is riskier the further away you are from your original 0 dose. 

5) Windows and waves. No rhyme or reason when they happen or how long they take but there will be an upward trend over time. This is healing. 

6) Recommended supplements: Magnesium and Fish Oil; Potentially activating supplements - B vitamins, vit D. Overall, be very careful with supplements. If sleep is an issue, a small dose of melatonin 0.3 mg may be helpful. More is not always better. 

7) Non-drug techniques for dealing with emotional symptoms - check out the links from earlier; Distract; Change the channel; CBT; Claire Weeks; breathing exercises; I'd recommend start practicing those NOW. 

8). Withdrawal may make you sensitive to medicines/supplements/stressors - be careful with those but it doesn't apply to everybody 

9). Some people have much more severe issues in wd (reactions to histamine/akathisia/suicidality/extreme sensitivities etc). You don't seem to have them so at this point no need to know or read about them.

10) The past is the past, you can't change it, you can't fix it. Coulda, woulda, shoulda not helpful. 

11) Take good care of yourself. Be kind to yourself. Do as much of your previous life as you can. Don't withdraw from the world if you can help it (i.e. if people are not making you more anxious). 

12) Be careful with exercise. For some people it makes things worse. But unless it makes things worse for you, do it, it improves mood. 

 

Hope this helps a bit. 

Remember, you will get through this! It will suck for a while but you will get through this! 

 

[DavidfromTexas]

@Onmyway thanks so much for all your help and for this summary breakdown as well!

 

So to clarify, I am attempting reinstatement because I thought the goal with that was to stabilize—getting you to a point where youre close to being back to normal so that you can eventually do the long slow taper...

 

Also, I take a rather large amount (5,000 IU) of Vitamin D3 daily because of a vitamin d deficiency that showed up in my yearly blood test a couple years ago. I have had my blood tested since being on it and the levels are reading back to normal. So it looks like I’ve got a vitamin d3 deficiency...but does “activating” mean possibly interfering with the anti-depressants? Should I not be supplementing with Vitamin D3 even if I have a deficiency? (The doctor that told me to start taking them knew that I was on Cymbalta, and at that time it was a much larger dose of 60mg I think.)

 

That said, I have been reading about the vitaminD3 and D2. Is it worth getting BOTH versions tested next time to make sure I’m not having issues turning D3 into D2?

 

Edited July 31, 2019 by DavidfromTexas

[Onmyway]

Hi David, 

Re vitD - activating I think means it causes anxiety/restlessness in some people. If that is not something you struggle with, then I'd continue to take the D vitamin. Otherwise, I'd stop it and see if it makes a difference. If your values are normal for D3, I wouldn't worry about D2 unless you know you have an issue with it. Maybe spend a bit more time in the sun if your values are not normal and you can't supplement. They don't seem to increase anxiety for everybody so if you don't have that issue, then no reason to think about it twice. Alternatively, you can stop supplementing and spend 20-30 min in the sun every day during the summer (legs/arms). See if that helps.

 

I think stabilize means to basically be functional - be able to keep a job, relationships, eat, keep food down, not be bed bound with physical or emotional symptoms (akathisia/suicidality/extreme insomnia/extreme anxiety/DP/DR/dizziness and lots of other bad things) and not have these symptoms change often or get consistently much worse (they do vary in intensity, that's OK). I don't know what your current symptoms are. But from my understanding here reinstatement or not you are not going to feel normal for a while.  I also note that you have gone up and down  on your meds quite a lot so you do need to stick to one thing - whatever you decide. I or others won't know what the right decision is for you. You'll have to make it. Whatever you choose to do now, reinstatement or not, I think you need to wait for a few months and see how you feel then. Withdrawal will suck for a while.  It is within your abilities to tolerate some of that distress. (If things get overwhelming, i.e. if you feel suicidal or can't think you can tolerate the way you are living a minute longer, then that's different and we can think of strategies then but from my understanding, that's not where you are  - pls let me know if I am wrong). 

 

Here are some ideas on distress tolerance: https://www.getselfhelp.co.uk/docs/DealingwithDistress.pdf

 

I know for those of us on drugs we were led to believe that any uncomfortable feeling is abnormal and should be medicated but EVERYBODY has uncomfortable feelings some times in their life, some quite often - everybody gets sad, angry, anxious, fearful. Those are normal feelings. They are not always comfortable but they are also not harmful; in fact they are often useful - they help us deal with everyday life - find what we really care about (sadness), stand up for ourselves (anger), help us be vigilant to danger (anxiety). It is part of being human. Our feelings are not the enemy and they will not hurt us for feeling them. It is a common worry that then feeds anxiety. 

 

I can't stress enough the need to not change things with the drug for a while after the numerous ups and downs with cymbalta in the last couple of years. Make a decision and stick with it. You will start feeling better and stabilize if you don't change things. (not normal for a while but better!)

 

You mentioned voice exercises. What kind of music do you sing? What do you like to do other than work? What strategies do you already have to get you through difficult times? 

 

 

[DavidfromTexas]

Hi @Onmyway  

 

Thanks for the input on the vitamin D. I know it stays in your body for a LONG time so maybe I’ll just cut my dose down to 3,000 IU and see if that makes any difference in my anxiety, though I’ve been taking at least 4,000IU for almost a year now. 

 

From YOUR description of stabilizing, I would describe myself as already there. I do not feel good by any means, but I do not have the physical symptoms, I am not suicidal (I actually am AFRAID of ever feeling like that), and no matter how hard it has been I have remained completely functional—I can get to work and make it through my shifts even if I’m feeling really really down, I am not at all bed bound because of the emotional turmoil I’m feeling (the closest I‘ve been to bed bound was over the last few months when I isolated myself in my room at nights and watched movies by myself). And sometimes (though not recently) I have slept the day away because I was so down and depressed, but it was always a choice...not because I couldn’t get myself out of bed if I really tried.

THAT is what makes me wonder if what I’m doing now is right. It hurts, a lot. But its all emotional, and so I am able to fight through it in order to remain a functioning human being in the end. I think the biggest driving emotion behind my turmoil right now is FEAR. 

 

As far as what I do outside of work, I can really only rely on myself right now. My girlfriend was also my best friend, she was my only support here. All my other friends have relationships of their own that keep them busy. 

I WOULD be playing soccer more if I hadn’t broken my foot 2 years ago. I am still trying to come back from that one. 

 

I first moved here for my dreams of Acting and Music (overall pop, w/ some R&B flare sometimes), but I never got started (that’s a whole different issue). And just as I have become more motivated than ever to give it a REAL try,  this latest bombshell has hit me, and I’m afraid it may be what finally puts the nails in the coffin for those dreams and sends me back home to my family and support. The career path(s) I chose are incredibly difficult, taxing, and stressful on their own. And when you add a struggle like this on top of it, I just don’t know if I’ll be able to do it. 

 

I went to see the normal psychiatrist today. Told her everything thats been going on and about all my discovered knowledge. She said she doubted anything as low as 1 or 2mg would help me feel better, she said she would have recommended starting out at 5mg or so. 

Soooo I guess all I can do is what you say, stick to what I started. I can’t afford to keep finding new doctors and trying to get the best opinion, I just gotta go with what I got. I just hope I won’t have to updose too far in order to feel improvement. I would love to be able to stabilize on a really low dose so I don’t have far to come down to 0. But I know I don’t get to choose that. 

Edited July 31, 2019 by DavidfromTexas

[DavidfromTexas]

8 hours ago, DavidfromTexas said:

 

Also, does the size of the dose matter when it comes to achieving steady state of the drug in your body? For instance, is my 1mg being absorbed quicker than if it were 20mg with more beads to absorb?

 

Last question: If I take my dose at some point within the same hour from day to day (for example, 1 day at 1:15am, the next day at 1:45 or 2:00), is THAT okay? Like an hour fluctuation?

 

@Onmyway Since you are so incredibly helpful, do you have any thoughts concerning this?

[ChessieCat]

Taking the dose within the hour is okay.

 

Regarding the steady state, dose doesn't make any difference.

[DavidfromTexas]

Hey guys. So tonight will be my 7th dose. I haven’t noticed any difference in my emotional state really. I have my okay times of the day and then my bad times. But I feel like it’s been pretty much the same, possibly even getting slightly worse because the pressure of reinstatement expectations and the nerves are building. 

 

When I saw my psychiatrist she said she would have originally suggested trying 5 mg to see if that made a difference. That would be a 4 mg jump so I am hesitant. I am thinking I would like to do an up-dose that’s more than just 1 mg, cuz I’m not sure how long I want to have to feel like this. So I was thinking maybe up-dosing to 3 mg first? Or should I try 2 first? I just don’t want to lose my time window where reinstating is possible. 

 

When up-dosing, do you have to up-dose in increments as tiny as when you taper??

 

Or do you think this is a good time to try switching to a low dose of Prozac? Since I’m on almost nothing of Duloxetine at the moment?

Edited July 31, 2019 by DavidfromTexas

[ChessieCat]

SA recommends small updosing.  So you are currently taking 1mg.  We would suggest going to a total dose of 1.5mg or 2mg.

[ChessieCat]

1 hour ago, DavidfromTexas said:

 

Or do you think this is a good time to try switching to a low dose of Prozac?

 

It is generally better to stay with the drug that your brain has adapted to.  You need to be patient.  It's only been 1 week.  I realise that it probably feels much longer.  You are still very early on in the reinstatement process.

 

Switching to a different drug can make things difficult.  You might still get withdrawal symptoms from the original drug which the new drug doesn't "cover", you might get adverse effects from the new drug (my personal experience with Prozac was that I ended up with weak muscles and had difficulty walking.  If I did a Prozac bridge I would probably assume that it was withdrawal from the first drug).  And most drugs have start up effects and then there are the regular side effects.

 

Please read this topic especially Post #1:  The Prozac switch or "bridging" with Prozac

[ChessieCat]

8 minutes ago, ChessieCat said:

SA recommends small updosing.  So you are currently taking 1mg.  We would suggest going to a total dose of 1.5mg or 2mg.

 

Please do not take the dose your doctor suggested.  We have members here who have panicked and taken too high a dose and ended up much worse, taking them a long time to stabilise, and some have never stabilised and then had to taper anyway.

[DavidfromTexas]

Ok. It’s such a small dose I’ve been on I wonder if my brain is even registering that it’s getting it again, if it’s even making a difference in being able to prevent things from getting worse

[ChessieCat]

The medical profession and pharmaceutical companies think in terms of "therapeutic dose" which is an arbitrary term.

 

SA prefers "lowest effective dose" which can vary depending on the individual.

 

These drugs are strong.  You have experienced withdrawal symptoms which can sensitise the nervous system.  The information SA provides is based on observing and working with thousands of individuals, as well as a lot of research and personal experience of the site's founder, Altostrata.

 

Please read back through Post #1 of the reinstatement topic because it provides an explanation of why to make small increases, including the following:

 

On 10/9/2012 at 10:17 AM, Altostrata said:

 

Avoid kindling, start low to see what you need. You can always increase if necessary. If you've been off the drug for a month or more, many people can find some relief from antidepressant withdrawal symptoms by reinstating as little as 0.5mg-5mg. Do not start at a high dose, your nervous system has been sensitized by withdrawal and you may make it worse, which is called kindling -- see a fuller explanation below. 

 

 

The fuller explanation:

 

On 10/9/2012 at 10:17 AM, Altostrata said:

 

Additional reasons to reinstate only a partial dose
Reinstating at a low dose reduces the risk of severe adverse reactions, such as kindling, in case reinstatement does not work.

• Experiencing withdrawal may have sensitized you to drugs and a larger dose may cause an outsized adverse reaction.
• If you had adverse reactions while you were taking the drug, a low dose may not trigger the adverse reactions but still reduce withdrawal symptoms. Adverse reactions tend to be dosage-related: The higher the dose, the worse the reaction.
• These drugs are vastly more powerful than they need to be; often reinstatement at half dosage AT MOST is sufficient and many people do well with a lot less. You want to be taking only the lowest dose EFFECTIVE to reduce withdrawal symptoms.
• Your receptors may have adjusted somewhat (upregulated) during the time you were tapering or had withdrawal symptoms.
• If you can stabilize on a lower dose, you have less to taper when you finally do go off.
• You can always adjust the dosage upward if you find you need to. After reinstatement, most drugs take about a week to reach full effect. Wait until you see the full effect before you make an increase -- and then make only very gradual increases. 

 

[DavidfromTexas]

TUES & WED NOTES (day 6 & 7)

 

I did not keep detailed notes for these days, and at this point it is too late for me to remember exactly what I did on these days. BUT my general notes for both days were that they were overall not very good. After waking up I would pretty soon start thinking about my troubles, even while preparing for things that I had to go out and do during the day. On these days I talked to my Mom (as I have been every day, especially lately), and had instances where I broke down and cried. The overall negative feelings that came out of these 2 days were “overwhelmed” and “hopeless”. 

 

I will say, the majority of my despair in these 2 days was due to ruminating and remembering about my lost love, and the meds issues were only secondary. I was struggling to let go of the pain from not having somebody like my ex-girlfriend here for support, and that led to me going over all my regrets and how I should’ve done things differently and could have prevented this entire situation right now. 

 

The night time hours on both of these days were a little better because I was able to hang out watching movies/tv with my roommates. 

 

It is being alone and having nothing that needs to get done that is proving to allow for my rumination and depression, but as we all know, we can’t be with others at absolutely every part of the day...

 

I am trying to give as much detail about my feelings as possible in my daily notes. At this point, most of the days seem the same. 

 

I might go up to 1.5 mg (9 beads?) tonight since I am not sure that waiting a few more days at 1mg will end up making a difference. 

 

 

 

Edited August 1, 2019 by DavidfromTexas

[DavidfromTexas]

@Altostrata

 

I have developed real seasonal allergies since living in Los Ángeles. I believe I have always had a problem with post nasal drip to some degree, but things like that were increased when I moved out here 7 years ago. Also, the last couple years I have definitely sneezed much more than I ever used to before. 

The ENT may say he wants me to take Claritin every day to help abate allergy symptoms. Would this be a problem to take it every day long-term along with the other meds I’m taking (Duloxetine and Vitamin D)? I may be dreaming, but I thought I remembered seeing something on this site about anti-histamines interfering with anti-depressants or neurotransmitters somehow. 

I would also just like to avoid taking too many daily medications. 

 

If he suggests daily continued use of an Anti-histamine like Claritin, should I refuse it and just put up with the extra sneezing? It’s not like I have sneezing attacks, they only ever come in 2 or 3 sneezes and usually a max of twice a day. But there are some days I don’t sneeze at all. 

 

He originally had me on Claritin after noticing a huge amount of fluid drainage, and that combined with the cyst in nasopharynx led him to believe I may have allergy issues. He mentioned wanting to do a blood test for allergies. I’ve never had one of those done, so I wonder what we’ll find out. 

 

Instead of taking antihistamines, I have read about people taking a combination of daily Vitamin C and Zinc at the same time as taking Anti-depressant meds daily. Is this an issue as far as interactions would go?

I am wondering if the best option during reinstatement and subsequent tapering would be to limit to only ONE daily medication (the anti-depressant) and of course my daily Vitamin D. Meaning, NO daily allergy meds, NO vitamins (besides my necessary vitamin d), NO minerals like Zinc and Magnesium. Is this the best plan?

 

I would like to avoid making the whole situation more complicated by adding multiple medications/vitamins. 

Edited August 1, 2019 by DavidfromTexas