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DavidfromTexas
Posted (edited)
17 minutes ago, Dejavu said:

You mentioned at the beginning of your thread that you were seeing a therapist each week. Are you still doing so?

 

I have been most weeks, I've only been to her about 4 or 5 times. But with the new things I have to consider, like possibly moving back home for a bit, I am having to put that off for now. Plus, I have been paying for her out of pocket, and I need to get some more money in. She only does talk therapy, and while I think it's good to be able to tell somebody else my deepest struggles, I think bringing up the other issues I've been dealing with (relationship, mistakes) on top of the issues now with the meds, has been making me even more upset and anxious in the end.

 

My understanding of a CBT Therapist is that they combine this classic talk-style therapy with the CBT and coping skills. Am I correct on that?

Edited by DavidfromTexas

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Dejavu

Yes, your money would be better spent in CBT therapy in my opinion. Meanwhile, check out the free tools available to you.

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DavidfromTexas
Posted (edited)

Ok, will do.

 

I have a question about reinstatement... and I know there is no real solid answer because everybody is different.

 

BUT--since I took my first dose of the medicine again 22 days after coming off of it, am I wasting precious possible reinstatement time right now on such a tiny dose when my goal may be to get to a higher, more comfortable dose close to where I was before coming off? OR does the fact that I am taking any of the medicine AT ALL mean that my body will have already started re-adjusting to it, allowing for a climb up over a long period of time to be effective without worrying about it being too long from the original CT date in July?

 

Most of the people asking about reinstatement in the topics here are concerned with the time period of being able to come back off of it. BUT ME, at this point I am just wondering about both...coming off AND the possibility of being able to stay on it effectively IF I am able to get to a dose that works for me. I'm scared now that I will have NO CHOICE but to come back off, even if I decided staying on would be better for me.

 

The idea of losing precious reinstatement time is what makes me even consider making a small jump by a couple/few beads, to get to somewhere like 5 mg quicker.

 

Edited by DavidfromTexas

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ChessieCat
Posted (edited)

Already answered meaning that the information that we have (are able to give you) has already been provided.

 

Edited by ChessieCat

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DavidfromTexas
Posted (edited)

You said most of the reinstatement topic applies to updosing. Mainly focusing on keeping things slow and steady, and to avoid kindling. But that doesn't specifically address the question I was asking. It's just hard to imagine that a dose as low as I'm on could be making any real difference...because what happens if it is NOT making a difference in my CNS? That would mean taking it super slow from such a tiny tiny dose could be wasting precious time. I know we're not supposed to deal in what if's, but it is important to think about, because it could be a big deal. If being as cautious as humanly possible in order to avoid kindling is the best idea, no matter what the drawbacks may be, then I'll just have to stick to it.

 

I don't want to upset you guys or get in trouble. So I will do my best to leave my specific questions unanswered. Thank you.

Edited by DavidfromTexas

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eymen23
Posted (edited)

David, 

 

Sorry you have found yourself in this challenging situation. 

 

Reading your introduction thread, I see you are asking variations of many common questions, and unfortunately they do not have any definitive answers. 

 

It is often good to be analytical and try to understand the logic behind things, but once that behaviour becomes too pronounced, it tends to become more disabling than enabling. I have seen the phrase ‘paralysis by analysis’ and find the term to be quite fitting here. 

 

You seem to be concerned about wasting time on what most would consider a tiny dose of drug, on the basis of ‘what if’ it would be better moving up the dosage more quickly. We have advised you using the collective experience of many moderators and forum members, who went through this process before you.

 

Experience tells us that it’s best to reinstate very small amounts of the drug, before waiting and up-dosing slowly if necessary, as people’s nervous systems often become hypersensitive in withdrawal syndrome, and too much drug too soon, can have very unfortunate consequences that lead to greater difficulty in the long term (severe adverse reactions that create the need to completely discontinue the drug and then suffer the consequences of withdrawal syndrome with no drug whatsoever). 

 

You are worried that by taking things slowly you may lose the ability to stay on a dose of the drug that you find helpful, and will need to come off. It’s our experience that this is more likely to happen if one moves things along too quickly, as if you really aggravate your nervous system, it may stop tolerating psychiatric drugs at all. 

 

Of course, we can not possibly know everything and what is best for everyone. Unlike most doctors and psychiatrists, we will never claim to always have the right answer. We have provided you with the best of our knowledge and experience, and it is your choice as to how you proceed. 

 

At some point in the near future, you are going to have to make a decision about how you would like to proceed and then buckle up for the ride. It’s my experience, that if you keep worrying about ‘what if I’m doing the wrong thing’, you’ll never give anything long enough nor enough commitment to get anywhere. 

Edited by eymen23

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DavidfromTexas
Posted (edited)

Hi, @eymen23

 

Thanks for your thoughts.

 

Edited by ChessieCat

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eymen23
Posted (edited)

Hi David,

 

What I can tell you is that I have always been known to be analytical, and to have the ability to ‘overthink’ situations to the point of becoming overwhelmed. So far in my taper, things have always worked out best when I’ve been slow, patient and trusted the process. Panicking and making rash decisions makes things more complicated, not less.

 

I remember being super keen to start my taper back in December 2018, but I had not long switched to a new generic and was experiencing waves. I knew the drug was causing adverse reactions though and I was desperate to start reducing my drug burden. I was very close to making a 10% reduction despite having just switched generic (without any cross-taper), but I decided to trust everybody here and after 2-3 very difficult weeks I had my first window.

 

I eventually made my first 10% reduction in a much more stable place, and when the waves from that reduction inevitably came, I knew 100% that it was from the drug reduction and not the generic change. If I’d have gone with my original impulsiveness and consequently felt awful, I’d have never known whether it was the new generic or the reduction and I could well of made another rash decision like change generics back, and started a very vicious cycle. 

 

Slow and steady wins the race. 

 

Edited by eymen23

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Dejavu
Posted (edited)

I am weighing in again because I really want to help you, David. But I'm going to be blunt here. Do you see a pattern in your behavior?

 

1. You re-ask the same questions in slightly different nomenclature.

2. You get a flurry of answers along the same lines as before.

3. You are advised to avail yourself of the myriad methods of calming your overly analytical and obsessive thoughts.

4. You invariably respond "will do," but you do not, and then instead proceed to ask more of the same questions and engage in the same circular pattern.

 

I am not trying to be critical or harsh. I am trying to get you to recognize that this pattern of behavior is not helping you, and it is exhausting and frustrating to the mods who are spending time answering the same questions over and over, and giving very sound  advice which goes unheeded. I know this is not intentional on your part, but you need to realize that your need for constant reassurance is not okay and does nothing to help you. I know from painful past experience that it is also a miserable way to live. The good news is that it can be changed (I am living proof). The bad news is that no one can do it for you. You've got to take control of your thoughts - pronto.

 

Please read the thread regarding non-drug coping tools in it's entirety before you post again. It has been sent to you 3 times by 3 different mods. I would like you to choose at least one of the suggestions provided therein and put it into practice immediately. I highly recommend You Tube guided meditation videos on overthinking and anxiety. And if I were you, I would also search for free CBT courses online, if you cannot afford live therapy at this time. Taking control of this aspect of your journey will go a long way toward your recovery. The choice is yours and yours alone.

 

Edited by Dejavu

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ChessieCat
31 minutes ago, Dejavu said:

And if I were you, I would also search for free CBT courses online

 

I've just found some videos on the getselfhelp.co.uk site which I hadn't found before.  I haven't watched them.

 

 
It would be great if you could check them out for us and assess them to see how helpful they may be not just for yourself but for other members, then we can let the SA community know about them.
 

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DavidfromTexas

Ok, awesome! Thanks for that guys. 

 

@ChessieCat I am at work tonight but will start watching tonight and over the next few days. I am eager to start my therapy. 

 

That said, I have been researching the difference between CBT and DBT, and it seems DBT is basically CBT but with an added focus on social interactions. I’m wondering which one would be better for me to start with. I’ll do a search to see how many DBT counselors are in my areas (LA or Houston), I may just have to go with the classic CBT if DBT is not as prevalent. 

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ChessieCat

I've just had a quick look at what videos there are on that page.  Some of the videos are the short version and are titled as that.  The longer versions are further down the page.

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Guilietta

Hello David - I hope you are less anxious (and feeling better) today. I know it is around 6 a.m. your time. I sent you an email message so I didn't have to jump in on this thread as I am not one of the moderators. I want to weigh in too since I am on the same road with duloxetine, etc. First - so you do not feel quite alone -

 

Here's how I've been: I slept really poorly last night and the night before last. I have had a fair bit of anxiety after being without for several days. That's a bummer but one tries to ingore it (and use some kind of background noise to distract - whether TV, music or white noise...).Awoke this morning with anxiety, etc. I wonder that even though I am decreasing slowly - is it too much? See my personal email for more info. I want to be off this poison too but am proceeding along the no harm route.

 

I tend to over-think things - and that is counter productive to anxiety. Two things on my mind which have been bothering me greatly - I turned into CBT - they may fall into the cognitive distortion of catastrophizing. I also have to ask myself 'what is the likelihood of x happening'? That might be just one of the ways you use your thinking part of the brain to retrain the fear/anxiety part to stay in the back seat.

 

CBT vs DBT: what I have been advised to manage anxiety, panic, etc. is CBT. This is the recommendation / gold standard from a leader in the field of psych (take it for what it's for). We all here have issues trusting the medical community - certainly I do.

 

I am livid that I (and all of us) have to deal wtih the consequences and difficulties in getting off these toxins. In the end - I believe I will be better off and maybe I'll sleep better and that's a win all by itself! 

 

Hang in there.

 

G.

 

 

 

 

 

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eymen23

Hi David,

 

I’m pleased to see you are seeking additional therapy. I hope this helps you in dealing with difficult symptoms and provides you with the resilience required to trust in this challenging process. 

 

Based on the discussions yesterday, it’s important we are clear in regards to what assistance we can provide you going forward. We understand that you are going through a difficult time and are trying to arrive at a decision that you feel is best for your health and well-being, however, for you to continue receiving hands-on support from the staff here it’s important for you to respect the ethos of the site and our harm reduction methods. 

 

As staff, we don’t judge members for the decisions that they make, but given the number of members here and our limited time as unpaid volunteers, we must prioritise our efforts for those that are most open to our suggestions and willing to stabilise and/or taper via the harm reduction methods documented here. 

 

We want to be clear that if you do make any drastic increases in your Cymbalta dosage or decide to use additional drugs to control your symptoms, we will need to withdraw the amount of staff time currently provided to you.

 

Sadly, there have been several notable members that failed to heed our advice and found themselves in very difficult situations as a result. Although we strongly sympathise with those experiencing difficult symptoms, we have to limit our energy supply when it’s clear those symptoms have been to a large extent, self-inflicted.

 

Please think carefully about your drug regimen and dosages, being mindful of what I have said above. I really hope that the additional therapy allows you to minimise your difficult symptoms, without the use of additional drugs. 

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DavidfromTexas

FRIDAY AUG 9 (day 16)

 

12:00pm Woke up. Went to the restroom, just a little bit of the same from last night

12:30pm Ate a peanut butter and jelly sandwich. I am noticing that I do get hungry, but after I have started eating I start to lose my appetite a little. I am able to finish things small like a single pb&j sandwich no problem. But I used to eat a couple sandwiches and then maybe some chips at the same time. 

4:00pm After reading about psychiatrists like Dr Shipko and his somewhat negative leaning ideas about the possibility of recovery from withdrawal/ being able to get off psychiatric drugs, I started becoming obsessed with the negative thoughts that I might never get any better, and that I might not be able to go back on the drugs either. I started to feel really anxious and panicked for a while after this. 

6:15pm Decided to join my roommates in going out for happy hour to try to distract myself (I drank Sprite and water). Had a rather small “dinner” of 4 small tacos, was starting to lose my appetite by the end of it but I finished them. 

8:00pm Back home after going out with the roommates, watching some comedy and movies. I have calmed down a bit from earlier when I felt on the edge. Ate a tasty little wrapped sausage thing and afterward a banana. 

11:45pm Experienced my first two instances of ringing ears (tinnitus?) within 15 minutes of each other. Assuming this is a new withdrawal symptom popping up even though I am already back on the meds. The sensation began each time as a swift “swoosh” feeling from one side of the head to the other, then the ringing showed up in my right ear. Lasted for less than a minute. Wondering if this is not necessarily a withdrawal symptom, but maybe due to me up-dosing the medicine 3 days ago?

12:50am Took 8 beads (1.33mg) duloxetine 

1:20am Going to bed

1:55am Not fully asleep yet. Starting to feel differently as I get close to sleep than I normally do. Slightly clammy/sweaty on my head and back of neck

 

 

SATURDAY AUG 10 (day 17)

 

11:30am Got out of bed after lying half awake for a bit. Went to the restroom, much more solid than yesterday. 

I have woken up with a touch of the chills...I say “chills” as opposed to “tremors” because I actually have goosebumps and feel like it’s cold in here, but I know it can’t be cold enough for that. 

1:00pm Ate lunch 

5:00pm Got to work

5:15pm Ate dinner at work

12:30am Off of work. Again, I feel much more at ease, almost normal after working all night

12:45am Ate with a co-worker after work

12:55am Took 8 beads (1.33mg) duloxetine

1:45am Back home

3:00am? Went to sleep? I don’t remember the time I finally went to bed. I do remember I was lying slightly half awake with subconscious racing thoughts for a while (till after 4) until I finally fell asleep for good

 

 

 

About the “chills”. I usually get hot MUCH easier than I get cold. I used to wake up shaking in the middle of the night in my adolescent and teen years and my Mom would most of the time help me calm down and stop shaking to fall back asleep. I always thought that the shaking woke me up for some reason, which then made me anxious...but maybe I have anxiety in me even when I sleep that caused me to wake up shaking in the first place. Or maybe it’s the cortisol spikes talked about here. But I’m not sure if cortisol tremors are usually accompanied by goosebumps and actually feeling kinda cold...

 

 

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DavidfromTexas
Posted (edited)

@eymen23

 

Ok, I understand. I will follow the suggestions you guys have given and not make any huge changes in the medication. 

 

I am wondering at what point you guys advise to take a step back down after up-dosing?

 

I seem to be getting worse, even though all day yesterday I pretty much stayed off of the site compared to other days. I felt much better after work last night, like I have in the past. But I am beginning to obsess over thoughts and images that pop into my head involuntarily and am struggling to let them go. After this occurred when I woke up today around 11:30, I continued to watch a lot of the videos on that page that @ChessieCatlinked to about CBT. I watched several and tried to implement the information in them, and have been trying all day since, even now that I am at work. 

The images that popped into my head while I was half asleep were disturbing because they involved a loved one of mine, someone I’m very close to. And even though I have really tried, I have been unable to forget about that/ let it go because I’m scared it is telling me something about myself. I do not want to completely lose my mind. 

I know it is brand new and it will take time to learn how to use the CBT well, but today since it is brand new I am not being able to cope with this obsession and ensuing panic over these thoughts that haven’t left me all day. It’s terrifying me. 

 

Its been 4 or 5 doses since I went up to 8 beads from 6. At what point of intensity of the struggle do you guys suggest stepping back to a previous dose, as opposed to the worsening symptoms being just a normal part of withdrawal onset?

 

Thank you. 

Edited by DavidfromTexas

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Onmyway

David,

you need a specialist OCD therapist NOW.

 https://ocdla.com/ is one specialist center but there could be others. They'll help you manage things way better than anyone here can. Please take care of yourself and get professional help managing your anxiety. It will be worth the money spent. (Compared to just talk therapy).

 

Thinking of you,

OMW

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Lloyd

Hi David, intrusive thought is common with OCD and yes it can be disturbing. You need to know that the thoughts & images are not indicative of who you are and in no way mean that you are likely to do those things. It is very important that you understand this & be mindful of identifying what is intrusive thought.

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DavidfromTexas

Thank you SO MUCH, everybody, for all of your support. I know I have been a pain so far. 

 

 

SUNDAY AUG 11 (day 18)

 

11:30am Woke up with a bit of the shakes and anxiety. I had a disturbing intrusive thought pop into my head while half asleep and I freaked out about it for most of the day. 

12:30pm Took daily Vitamin D3 4,000 IU. Ate lunch (small salad with chicken)

3:00pm Got to work after having a terribly anxious day so far. Frankly, I have been terrified. 

10:00pm Somehow I was able to get through work, it was tougher than it usually is though. I felt only a tiny bit more at ease this night at the end of my shift, probably because the anxiety and obsessions had been able to dominate my thoughts even while working today. 

10:30pm Got home. Ate a couple pb&j sandwiches (I didn’t eat dinner at work)

11:00pm Followed the link onmyway left to the OCDLA website. From there I continued to do more research on OCD Treatment Centers and therapists. 

12:50amTook 8 beads (1.33mg) dose duloxetine. 

1:20am Going to bed. I will try to remember when (if?) I wake up in the morning with the shakes and anxiety that it is normal for what I am going through

 

 

Additional notes:

I became very hopeful, and dare I say relieved, after reading from multiple OCD Center websites that the EXACT obsessions and fears I have been experiencing are things that are very common in OCD and things that they treat a lot. 

I realized I have options and should be able to get plenty of help, even if my OCD is super stubborn and I need to go to more than one place in order get a firm handle on it. There are options here in LA, AND there are options back home. I feel now like maybe I don’t have to change my entire life in order to get better and get through this, though the first order of business is learning to cope with this while remaining steady on my meds stabilization. I am SO ready to learn to put the terror of not being able to cope behind me.

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Onmyway
1 hour ago, DavidfromTexas said:

Additional notes:

I became very hopeful, and dare I say relieved, after reading from multiple OCD Center websites that the EXACT obsessions and fears I have been experiencing are things that are very common in OCD and things that they treat a lot. 

I realized I have options and should be able to get plenty of help, even if my OCD is super stubborn and I need to go to more than one place in order get a firm handle on it. There are options here in LA, AND there are options back home. I feel now like maybe I don’t have to change my entire life in order to get better and get through this, though the first order of business is learning to cope with this while remaining steady on my meds stabilization. I am SO ready to learn to put the terror of not being able to cope behind me.

 

It will take work but the skills will be useful your whole life not just during withdrawal. And there is no evidence that your OCD is more stubborn than anybody else's. 

You can do this! I'd make the call today, if I were you! I saw they have sliding scales and group therapy. You can probably afford some of those. If I were you, I'd stop the regular therapy and focus on this for now especially because you said that regular therapy is making things worse/not making things better. 

 

Cheering you on, 

OMW

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Altostrata
On 8/9/2019 at 4:13 AM, DavidfromTexas said:

Carbonated water? 

 

Drinking a quantity of water can get a bowel movement going. Or maybe the food you ate disagreed with you. We usually leave it to our members to manage these common situations.

 

On 8/10/2019 at 2:26 PM, Dejavu said:

Yes, your money would be better spent in CBT therapy in my opinion. Meanwhile, check out the free tools available to you.

 

17 hours ago, Onmyway said:

David,

you need a specialist OCD therapist NOW.

 https://ocdla.com/ is one specialist center but there could be others. They'll help you manage things way better than anyone here can. Please take care of yourself and get professional help managing your anxiety. It will be worth the money spent. (Compared to just talk therapy).

 

Thinking of you,

OMW

 

In general, it seems to me that you could benefit greatly from Cognitive Behavior Therapy to manage the anxiety resulting from your tendencies to perfection and over-controlling. You might also take up other self-soothing techniques such as

 

Non-drug techniques to cope with emotional symptoms

 

Easing your way into meditation for a stressed-out nervous system

 

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

Shame, guilt, regret, and self-criticism

 

Health anxiety, hypochondria, and obsession with symptoms

 

Ways to cope with daily anxiety

 

12 hours ago, DavidfromTexas said:

11:30am Woke up with a bit of the shakes and anxiety. I had a disturbing intrusive thought pop into my head while half asleep and I freaked out about it for most of the day. 

 

Please explain what this means. Did you wake up with shakes and anxiety or did they occur after you got this disturbing thought? What was the thought? Is this a common pattern?

 

If you intend to go off Cymbalta, if I were you, I would not mess around with your current dosage. It seems you truly need to learn coping skills for your habits of mind.

 

 

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DavidfromTexas

@Onmyway that is my plan. 

 

I have already discontinued the talk therapy sessions and am taking a close look at each of these....

 

https://houstonocdprogram.org/

 

Advantages:

-In my home town, where my support system is. 

- It is an International OCD Foundation Treatment Center

-Multiple therapy options, including individual, group, intensive, residential (inpatient), and the Bergen 4-day Treatment intensive program. 

-Appears they treat all forms of OCD (including the issues I have been specifically dealing with)

-Most behavioral therapists are PhD’s

-With some of the treatment options, they bring your family every now and then to involve them in the process of either directly addressing particular obsessions or addressing how they can help support me, or both. 

 

Disadvantages:

-Do not accept insurance (though if I went home and got new insurance I might be able to bill for out-of-network). Prices for PhD-level therapists are $250/session. Licensed Professional Counselor sessions are $165/session. 

 

 

 

 

http://www.austinocd.com/welcome.shtml

Advantages:

-Highly regarded, was apparently considered the #1 OCD treatment center or in the top 10 treatment centers in the world for most of the 2000’s

-Is an IOCDF Treatment Center

-The Dr has specialized solely in the treatment of OCD for over 20 years (probably more now)

 

Disadvantages:

-Located 2–2.5 hours from home

-No longer operates as a “center” with multiple treatment options since Dr Mansbridge (the creator) “semi-retired”. He continues to see patients, but in more of a private practice setup

- ^^^ No longer does intensive treatment. 

 

 

https://ocdla.com/

 

Advantages:

-Here in Los Ángeles where I currently live

-Multiple treatment options

-They apparently “specialize” in all types of OCD...

-Low-fee/sliding scale options (though I hope that doesn’t effect quality of treatment)

 

Disadvantages:

-Away from my support system (in Houston)

-Not an IOCDF treatment center 

-No PhD’s on the actual treatment staff, mostly LCSW’s and some MFT’s. (I am not sure to what degree this would make a difference)

-Their site lists a myriad of types of OCD in which they specialize (like my issues with Pure OCD, Harm OCD, and Health/Anxiety OCD, among MANY others) which at first glance was exciting, but now seems like it may be too good to be true. They might use the exact same approach for all of these. 

 

https://www.shannonoflinnphd.com/specialties

 

Advantages:

-Located in Los Angeles

-PhD, lots of experience with CBT, Exposure-Response Prevention therapy, and ACT therapy. 

-Has good reviews

 

Disadvantages:

-For sure would have to pay out of pocket, around $200/ session

 

Other considerations:

-The Menninger clinic, which is now located in Houston. I believe it was originally in Topeka, Kansas. 

-There is is also an IOCDF treatment center in Florida that looks promising, it’s called the Center for Psychological and Behavioral Science. BUT they do not provide any temporary inpatient treatment, so I would need to be located there. 

 

 

I am checking on affordability and my payment options for the main 2 options, Houston OCD and the OCD Center of Los Ángeles. 

 

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DavidfromTexas
25 minutes ago, Altostrata said:

Please explain what this means. Did you wake up with shakes and anxiety or did they occur after you got this disturbing thought? What was the thought? Is this a common pattern?

 

If you intend to go off Cymbalta, if I were you, I would not mess around with your current dosage. It seems you truly need to learn coping skills for your habits of mind.

 

 

 

I am not exactly sure. I was still half asleep, BUT since I have been waking up every day now for the last week or so with some degree of the shakes (sometimes I can control them more easily) I assume they would have been there whether I had the specific image/thought pop into my head or not. Nevertheless, the shakes and anxiety did intensify a bit AFTER the thought too. 

 

The image/thought was about harm coming to my loved one, which then morphed into me possibly doing the harm, and then I freaked out about that even more. But I have discovered these are common kinds of intrusive thoughts/images in people with OCD issues. It really scared me because I love my family more than anything, they are my everything, and I would never want to do anything to hurt any of them. 

 

The “me doing the harm” has not been a very common thought/image, nor has the violent harm image in general, that’s what it really freaked me out, cuz I started fearing I was really going to lose my mind. But I have indeed always worried about my family and loved ones’ safety to some degree. Sometimes even when I was stable on the meds, I would get worried when I haven’t heard from them in a period of time that I thought I should have. 

Edited by DavidfromTexas

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DavidfromTexas

Somebody on here mentioned before that in my case perhaps Exposure therapy would not be best to do RIGHT AWAY, but I guess I will just see what the therapists/doctors think once I start therapy. It seems from all accounts that Exposure therapy is really helpful when doing CBT. 

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Altostrata

What do you mean by "the shakes"?

 

CBT can help you manage those spirallng thoughts. It also sounds like talk therapy might help you figure out your tendency to worry and need for control.

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DavidfromTexas
2 hours ago, Altostrata said:

What do you mean by "the shakes"?

 

CBT can help you manage those spirallng thoughts. It also sounds like talk therapy might help you figure out your tendency to worry and need for control.

 

When I say “the shakes” I guess what I mean is tremors. Sometimes it’s just involuntary shaking that can occur when I move or shift my body, or when I breathe in or out, it differs on how exactly it happens.  Sometimes I actually get goosebumps and feel a little cold at the same time, but in the past I have never felt cold very easily so I am assuming it is all related. Usually I get HOT very easily. 

 

Anyway, I have been waking up with some degree of it every day so I can only assume it’s here to stay for the time being and is related to cortisol and waking up with an anxious feeling as well. I’ve been putting on a blanket to try to help calm it after it starts. 

 

But at least at this moment, it is only occurring when I wake up in the morning.  

Edited by DavidfromTexas

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Onmyway
2 hours ago, DavidfromTexas said:

@Onmyway that is my plan. 

 

I have already discontinued the talk therapy sessions and am taking a close look at each of these....

 

https://houstonocdprogram.org/

 

Advantages:

-In my home town, where my support system is. 

- It is an International OCD Foundation Treatment Center

-Multiple therapy options, including individual, group, intensive, residential (inpatient), and the Bergen 4-day Treatment intensive program. 

-Appears they treat all forms of OCD (including the issues I have been specifically dealing with)

-Most behavioral therapists are PhD’s

-With some of the treatment options, they bring your family every now and then to involve them in the process of either directly addressing particular obsessions or addressing how they can help support me, or both. 

 

Disadvantages:

-Do not accept insurance (though if I went home and got new insurance I might be able to bill for out-of-network). Prices for PhD-level therapists are $250/session. Licensed Professional Counselor sessions are $165/session. 

 

 

 

 

http://www.austinocd.com/welcome.shtml

Advantages:

-Highly regarded, was apparently considered the #1 OCD treatment center or in the top 10 treatment centers in the world for most of the 2000’s

-Is an IOCDF Treatment Center

-The Dr has specialized solely in the treatment of OCD for over 20 years (probably more now)

 

Disadvantages:

-Located 2–2.5 hours from home

-No longer operates as a “center” with multiple treatment options since Dr Mansbridge (the creator) “semi-retired”. He continues to see patients, but in more of a private practice setup

- ^^^ No longer does intensive treatment. 

 

 

https://ocdla.com/

 

Advantages:

-Here in Los Ángeles where I currently live

-Multiple treatment options

-They apparently “specialize” in all types of OCD...

-Low-fee/sliding scale options (though I hope that doesn’t effect quality of treatment)

 

Disadvantages:

-Away from my support system (in Houston)

-Not an IOCDF treatment center 

-No PhD’s on the actual treatment staff, mostly LCSW’s and some MFT’s. (I am not sure to what degree this would make a difference)

-Their site lists a myriad of types of OCD in which they specialize (like my issues with Pure OCD, Harm OCD, and Health/Anxiety OCD, among MANY others) which at first glance was exciting, but now seems like it may be too good to be true. They might use the exact same approach for all of these. 

 

https://www.shannonoflinnphd.com/specialties

 

Advantages:

-Located in Los Angeles

-PhD, lots of experience with CBT, Exposure-Response Prevention therapy, and ACT therapy. 

-Has good reviews

 

Disadvantages:

-For sure would have to pay out of pocket, around $200/ session

 

Other considerations:

-The Menninger clinic, which is now located in Houston. I believe it was originally in Topeka, Kansas. 

-There is is also an IOCDF treatment center in Florida that looks promising, it’s called the Center for Psychological and Behavioral Science. BUT they do not provide any temporary inpatient treatment, so I would need to be located there. 

 

 

I am checking on affordability and my payment options for the main 2 options, Houston OCD and the OCD Center of Los Ángeles. 

 

 

Hi David, 

I see you have done your research. In my experience with therapists, whether they have a PhD or not has nothing to do with their ability to do good therapy. Often the best therapists are those with whom YOU can connect. I would want to work with someone who has lots of experience (at least 5 years) specifically with OCD. I would not worry whether it is any specific OCD type - most patients have multiple types of obssessions anyway and the general OCD treatment is not that different across the different types of intrusive thoughts. CBT therapy is pretty standardized so while therapist talent may matter a bit, what the therapy is, will not change.

 

However, it is really important that you start this ASAP. So since you are in LA now, I'd start in LA and go as often as you can because you need help urgently from what I see from your posts on this board. Sliding fees do not mean that the quality is any lower - sliding fees depend on the ability of the patient to pay. Pretty much every therapist has such sliding fees. I'd call and schedule an appointment with someone *today*. From there you will see what they recommend. OCD can be attacked from multiple directions - ERP is only one portion of it and it can also be gradual for when you can handle it. But you need help NOW. You shouldn't be living with this much distress when there is help available. 

 

They might recommend that you do group  therapy in addition to seeing someone as you are in a crisis mode now. If you eventually go to Houston you can continue treatment there. Important thing now is to not paralyze yourself with analysis of what each center has etc. The research you did is important but the decision is simple - you need help now and if for some reason this center doesn't work or you move in the next month or two, you can change later. Please make the call today! Starting in LA and then continuing in Houston will not hurt you. Not starting today and obssessing about which center or which therapist or when etc. will leave you suffering like you are doing. 

 

Thinking of you, 
OMW

 

 

 

 

 

 

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DavidfromTexas

@Altostrata

 

I am not sure at this point what my goal is anymore, with regards to coming off or staying on the meds. I will have to see after a while of being in CBT and seeing how I feel. When I was on the meds for years I was stable and living a “normal” life with hardly any issues. Since things have started getting worse for me over the last couple weeks I have definitely regretted coming off the medicine, both making the drastic ill-advised drop off of it AND perhaps my desire to try to come off of it at all. 

Edited by DavidfromTexas

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DavidfromTexas

Other factors may include how serious the withdrawal symptoms are and if they ever go away.

 

For instance, I have just realized this morning (which you will see in my notes that I will post later) that I have not been waking up with my normal morning erections (morning wood) when needing to get out of bed for my first urination of the day. It has been absent for at least the last week. 

 

I know from reading the sexual dysfunction thread that people have had varying success/failures with regaining sexual organ function, including erectile function.

 

I am not sure if this is something that will last forever for me, and I know theres no way to know the answer to that before I decide whether or not to stay on the medication for good. I know for me personally, being on the meds did not hinder my erectile function, if anything it helped it. But now might be a different story. I am trying not to be greedy since I do not know how much worse things are going to get before they start getting better...the first priority is getting back to feeling better and stable again. Then at that point I will have to assess and come up with a plan for any lingering effects. 

 

Additional Info...just a few months ago I finally decided to stop visual stimulation use for good (Im assuming everybody will know what I’m referring to here).  I know, I should’ve done it MUCH sooner than that, but t was something I grew up with from adolescence and a habit I never got rid. SO I am hesitant to try things to test out my erectile function, since I am abstaining from both sexual self-gratification and using visual stimulants, as they are a drug themselves. 

 

So I am not sure what to do in that arena. I don’t wanna test anything that might require action in my brain while it is trying to heal these other issues. And I’m also scared of what the result might be, maybe it won’t work at all for me right now. 

 

Edited by ChessieCat
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Guilietta

Hi David.

 

Have you looked at PsychologyToday for a listing of CBT providers? You can search by what insurance they may take and where they focus.

 

General https://www.psychologytoday.com/us/psychiatrists/tx/houston

 

You can select therapists, psychiatrists, support groups and treatment centers.

 

On the left sider of the page you can select what insurances (if they accept) and what services you need (for example, CBT).

 

https://www.psychologytoday.com/us/psychiatrists/cognitive-behavioral-cbt/tx/houston?sid=5d52d303453f0

 

Note that the listings may not be current, practices may be full, and not everyone responds if they are not taking on patients. However - MANY do. They would LIKE TO HELP YOU.

 

Teaching hospitals in particular may have programs and I would contact them. They may also accept insurance. With CBT there is homework, etc. CBT is not talk therapy per se. Use the free services on AD to start. You might also search youtube for CBT, medidation, etc.

 

Hang in there.

 

G.

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Altostrata
20 hours ago, DavidfromTexas said:

 

When I say “the shakes” I guess what I mean is tremors. Sometimes it’s just involuntary shaking that can occur when I move or shift my body, or when I breathe in or out, it differs on how exactly it happens.  Sometimes I actually get goosebumps and feel a little cold at the same time, but in the past I have never felt cold very easily so I am assuming it is all related. Usually I get HOT very easily. 

 

Anyway, I have been waking up with some degree of it every day so I can only assume it’s here to stay for the time being and is related to cortisol and waking up with an anxious feeling as well. I’ve been putting on a blanket to try to help calm it after it starts. 

 

But at least at this moment, it is only occurring when I wake up in the morning.  

 

Does this sensation last for only a few minutes? You might benefit from a weighted blanket.

 

20 hours ago, DavidfromTexas said:

@Altostrata

 

I am not sure at this point what my goal is anymore, with regards to coming off or staying on the meds. I will have to see after a while of being in CBT and seeing how I feel. When I was on the meds for years I was stable and living a “normal” life with hardly any issues. Since things have started getting worse for me over the last couple weeks I have definitely regretted coming off the medicine, both making the drastic ill-advised drop off of it AND perhaps my desire to try to come off of it at all. 

 

David, please let us know when you want to taper. We don't offer psychotherapy here. You're welcome to discuss your issues in Symptoms forum topics such as Health anxiety, hypochondria, and obsession with symptoms  or

 

We're not going to discuss your sexual symptoms in any great detail here, either. Sexual dysfunction is a very common side effect of taking antidepressants and other psychiatric drugs and can appear as a symptom during tapering or after you go off the drugs, when it is called PSSD.

 

We don't know of any instant fix for drug-induced sexual dysfunction, either. If it's a side effect of the drug, it usually goes away when people go off the drug, or it can last a long time after.

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DavidfromTexas

MONDAY AUG 12 (day 19)

 

10:30am Woke up to urinate. This happens most nights either in the middle of the night or sometime in the morning before I actually am getting up. I have just realized I have NOT been getting my normal morning erection (morning wood) that I almost always get when I have to pee in the morning. Wondering if this is the onset of another symptom. I will be leaving it out of the notes unless the situation changes. 

11:15am Woke up with a small amount of the shakes. Tried putting a blanket on to see if that would help me go back to sleep for a bit, before finally getting out of bed around noon. 

12:00pm Took Vitamin D3 4,000 IU. Going to be leaving out the bowel movement details unless it is explicitly diarrhea. 

12:30pm Ate lunch, 2 pb&j sandwiches. 

So far I am having a better day, feeling more optimistic, despite other symptoms that may be presenting 

6:00pm Got a sharp pain in the center of my chest for a couple seconds, then it disappeared. I’ve had this rarely happen before and I usually equate it to gas or something, I’ve never looked into it

12:00am Leaving work. Got another of those short sharp pains in the center of my chest, right about where my heart should be

1:20am Took 8 beads (1.33 mg) Duloxetine 

1:25am Had another short sharp pain in the chest

3:20am Lying down to sleep

 

 

TUESDAY AUG 13 (day 20)

 

7:00am Waking up every day with numbness in pinky fingers and ring finger. I have had this issue on a daily basis for the last several days. I sleep on my stomach, and the numbness occurs any time my arms are stretched above my heart up by my head. I usually sleep with my arms under my pillow but it apparently happens when they’re off to the side of my pillow as well with no weight on them. 

11:00am Woke up for good. Almost no tremor, BECAUSE I put an extra blanket over my window. Once I got up to go to the restroom I had very light and brief tremors. I will purchase some blackout curtains. My anxiety and tremors usually hit at the exact same time when my body wakes me up in the morning. 

11:30am Vitamin D3 4,000 IU

1:20pm Attempted to eat a pb&j sandwich and an apple. Finished the sandwich but could not finish the apple before losing my appetite. I used to eat MUCH more than this. I am already nearing 10 pounds below my normal average weight over the last couple years. 

5:30pm Talked to Mom for a while, got a little worked up. I do still get emotional about what’s happening, but now it usually requires thinking about it nonstop for a little bit before it gets me to that point. But that hasn’t been a problem because I’ve been having obsessing issues. 

7:15pm Ate some pasta w/ chicken. Video call with Mom

8:00pm Tried to relax for the rest of the night and get my mind off of my obsessive worry about the safety of my family. Unsuccessfully. I had this overwhelming feeling of doom that I was unable to shake until I finally decided just to sleep around 3am

1:15am Took 8 beads (1.33mg) duloxetine

3:00am Went to bed

 

 

WEDNESDAY AUG 14 (day 21)

 

4:00am Woke up. Still worried about family’s safety. Called Mom to talk to her for a bit. 

5:00am Went back to sleep

11:30am Woke up. Not much tremor, the extra light blocked from the curtains I got may have helped, though the light still woke me up after only maybe 6 hours of sleep. 

12:00pm Vitamin D3 4,000 IU

12:30pm Ate lunch (2 pb & j sandwiches)

5:30pm Caught a day-of flight home. Need to be in a more comfortable spot and with my family to try to get back on track and start some serious therapy. 

11:30pm (9:30PT) Ate a late dinner after flying home. Will be accounting for the 2-hour time difference for the first few days I’m here. 

3:15am (1:15PT) Took 8 beads (1.33mg) duloxetine

6:00am (4:00PT) Ate small breakfast sandwich

6:30am (4:30PT) Finally went to sleep

 

 

THURS 8/15 (day 22) First Full Day Home

 

12:00pm Woke up for a little, tried to go back to sleep to get more rest

2:00pm Woke up for good. Not much tremor, it only came when I got out from under the covers because it was actually pretty cold in the room. I have hung a comforter over the window in the bedroom that it blocking a lot of light.

2:30pm Ate lunch

7:00pm Ate dinner

8:15pm Enjoyed some ice cream for dessert

11:00pm Obsessions bothering me a good bit after watching a dramatic and dark show on tv, feeling sensitive to them now

2:30am Took 8 beads (1.33 mg) duloxetine, used clear gelatin capsule

2:50am Went to bed 

 

 

FRIDAY AUG 16 (day 23)

 

12:30pm Woke up. Not from my body waking me up, but from my phone dinging. 

Light tremors when out from under the covers. Going to turn up the temperature on the a/c and see what happens the next few days. 

1:00pm Ate lunch (spaghetti left-overs)

6:30pm Ate Dinner

8:00pm Relaxing at home for the rest of the night. I get the most stressed out and anxious when searching for providers or anything to do with the issues I’m dealing with. 

1:45am Took 8 beads (1.33mg) duloxetine

2:00am Went to bed 

2:00-5:00-ish am Could not find a sound sleep. I wasn’t really anxious, but my mind would not settle enough even though I wanted to sleep

 

 

Additional notes: 

I have felt a frequent, very slight light-headedness most days. It feels no more intense than it has felt in the past when my body has told me it needs more nutrition. Perhaps it has to do with the fact that I have been eating less because my appetite has been smaller. Not sure how to get around this...maybe I should drink a protein shake at some point during the day, or eat more frequent, smaller meals almost like snacking throughout the day. For the time being, it doesn’t bother me that much.

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ChessieCat
5 hours ago, DavidfromTexas said:

12:30pm Woke up. Not from my body waking me up, but from my phone dinging. 

 

Easily fixed, put it on silent or turn it off.

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