Edmunds: prolonged Wellbutrin withdrawal

[Edmunds]

Thanks again to @Altostrata and @ChessieCat for your recent support.

 

I spoke to the integrative psychiatrist I've consulted with a few times. I would like to report to SA the conversation I had with him this morning. I would appreciate any comment on this conversation you would care to offer, though you may not wish to, which is fine. You have always been clear that members must make their own medical decisions.

 

This psychiatrist is entirely in agreement with my desire to stay off any new ADs and to taper slowly from the 2 mgs of liquid fluoxetine I'm currently taking. I told him that SA recommends only magnesium and omega-3 as supplements. I told him that I take them, plus D-3 and Inositol (the later recommended by him). He disagrees with the magnesium and omega-3 limitation. Rather he recommends that to help with my constant anxiety I should consider taking two supplements:

ashwaganda, especially for cortisol regulation, and 60 ml of CBD. (I tried CBD briefly a couple of years ago, though without effect one way or the other). I told him I am loathe to taking any substance, including supplements, that is just going to set my recovery back. He believes that that should not happen. He has consistently deferred to my wishes and takes a very different and much more flexible approach than any mainstream psych I've consulted in the past, all of whom have nothing on offer but ADs.

[Altostrata]

We can't predict how you will react to ashwaganda or CBD. Suggest you sample them one at a time in very small amounts.

[Edmunds]

@AltostrataThanks for your advice about ashwaganda and CBD. I will try the ashwaganda at 1/2 caplet per day. I will defer the CBD for how.

 

I must add thanks to you for helping organize and participating in the protracted withdrawal seminar this morning. It was excellent, and I look forward to the next session in March. Also, I shared the articles in Therapeutic Advances and Psychology Today with my integrative psychiatrist.

[Edmunds]

@Altostrata @ChessieCat

 

I'm checking in to say I've been holding at 2.0 mgs of liquid fluoxetine for 9.5 weeks. The past week has been tough, with anxiety, DR, fatigue, and early morning cortisol spikes. I've been trying ashwagandha for a little over a week, half a caplet for six days, then a full one since then, once a day. I will stay at that amount and see if any good comes of it.

 

I've been doing Somatic Experiencing (SE) therapy. My therapist for that, as well as my regular talk therapist, both think that I have a lot of bottled up psychic energy from long term complex trauma in childhood and later. But so far I come out of the sessions feeling somewhat worse than when I arrived! This may be the energy being released--heightened anxiety, crying, lethargy, but I'm taking the therapists word for that. The last time I had a few hours of a slightly open window was a week ago.

[JesusSavemefromWD]

Hi,

if u had a window u will see improvements fast. I only had a 5 mins window about a month ago my during which I was able to recognize myself in the mirror (I couldn’t connect with myself at all due to DPDR) and now a month later i can constantly recognize myself at 50% capacity compared to 0% a month ago! 
I am not sure I believe so much in this inner energy theory therapy but u know better than me if it is helping u or not. I personally think it is just ur brain naturally healing with time. 
You are very strong and I admire u for going through this 

[Altostrata]

Thank you for watching the withdrawal seminar. What was your psychiatrist's reaction to the papers?

[Edmunds]

@altostrata

 

I haven't had a chance to talk with him yet. I will early next month. Thanks for asking.

[Edmunds]

19 hours ago, JesusSavemefromWD said:

Hi,

if u had a window u will see improvements fast. I only had a 5 mins window about a month ago my during which I was able to recognize myself in the mirror (I couldn’t connect with myself at all due to DPDR) and now a month later i can constantly recognize myself at 50% capacity compared to 0% a month ago! 
I am not sure I believe so much in this inner energy theory therapy but u know better than me if it is helping u or not. I personally think it is just ur brain naturally healing with time. 
You are very strong and I admire u for going through this 

Thanks for that message. I'm so pleased to hear that your DP is letting up. I have not suffered the same symptoms you have, and mine are no doubt easier to bear. For me the DR, anxiety, fatigue, distress, and cortisol spikes all go hand in hand. I know well that they are all part of withdrawal. I spent a good part of the morning sobbing over the feelings of distress and DR. Regarding Somatic Experiencing, the jury is still out. I'm doing it partly because my experience with DR goes back long before I took any ADs--to age 19.

 

After I was on ADs for nearly a decade without much help (after being diagnosed repeatedly with depression, which was never correct), I took Prozac for a second trial and after some months started feeling much better. Unfortunately, my psychs advised me to just stay on 20 mgs of Prozac because that's what was making me feel better. So I did that for 17 years, never being told by anyone that I might be just fine if I tapered off the Prozac. Then in 2013, amid some stressful events, the DR and anxiety came back. That led to the psychs leading me by the nose from one dose to another of Prozac and then on to a whole series of ADs and related meds. I have to admit that after I started taking a combo of Effexor and Wellbutrin in late 2016, I started feeling somewhat better in terms of lower anxiety, better enough for my wife and me to do some traveling. But then in May 2019 and because the DR was still with me as a serious annoyance, if nothing more, I decided to get off those to pills and try Prozac again. After my psych tapered me off Effexor and Wellbutrin one after the other over 3 weeks each, that's when the trouble started! I was having daily surges of anxiety and heavier DR when in September 2019 I discovered SA and started my long journey of recovery.

 

I hope you have some emotional support from family and friends. I've been so fortunate in that respect.

[JesusSavemefromWD]

I am really sorry u have suffered for so long , I can’t even imagine how hard must all these years have been. What I would like to tell u is that if your brain was capable in the past to function without generating DPDR, that is a strong indication it can do it again at some point. Pay attention in any short windows even 5 mins windows that ur DP might be reduced or completely gone and at that moment talk to your self into believing that this short window will get longer and longer. That’s what happened to me...5 mins windows which I used them to convince myself and my brain that if it happened once it ll happen again and again and then permanently repaired.  Unfortunately I am in this battle alone, my mom lives in another country and she is very sick so I have kept this nightmare a secret from her so I don’t hurt her and make her sicker, my two boys are too young to understand/support me, and my husband gives me the space to recover but nothing more than that... at least now he believes me that this is a Zoloft side effect....in the beginning (being a physician himself and having blind trust to doctors and medications) he was telling me that it can’t be Zoloft and that I have developed some kind of mental  disease. 😤

[Edmunds]

I'm sorry you don't have all the support you would like on the home front. Yesterday, my wife mentioned that my situation was indeed very hard for her, partly because there's so little humor in our household at present! But last afternoon and evening I had something of a window, ironically during hours when we had a sudden power blackout. Like windows I've had before, it doesn't relieve the DR, but the anxiety drops away much to my surprise. Also, this morning my cortisol spike was light. Otherwise, the usual symptoms are back. But as you say we must hold our little windows close to our heart.

I know it must be cold and dark where you live. My worst past experience with DR/anxiety was many years ago when we lived through a winter in Montreal. Our children had a wonderful time there.

[Edmunds]

@Altostrata and @ChessieCat  I'm holding at 2 mgs of liquid fluoxetine for 10.5 weeks.Today has been especially tough with distress level remaining very uncomfortable all day. It might help if I knew that on days like this, when I'm feeling like I'm just getting worse, my brain might be finding new pathways, and when it's finished with this current round I might have a window lasting longer than a few hours every couple of weeks! Possible?

 

My spouse and I got the first Covid vaccine two days ago. I wonder that that can upset the CNS temporarily?

[JesusSavemefromWD]

This is how it’s been for me, every time I feel horrific , there is a small improvement showing up next day. 
We don’t know much about covid vaccine but I don’t think u should worry about it. Vaccines have been safe for years and most of them don’t cross the blood brain barrier so don’t reach the brain 

[Altostrata]

I guess it's possible you have a reaction to the vaccine, but this probably will go away in a little while, as waves do.

[Edmunds]

@JesusSavemefromWDI wouldn't call it a window exactly, but the "anxiety ache" dissipated for several hours yesterday. (DR does not ever ease up so far.) But then anxiety was back today more intensely than usual. Of course I'm grateful that window cracks do open occasionally and I can remember and record them.

[Edmunds]

My integrative psychiatrist has just recommended my trying cranial electrotherapy stimulation (CES) for anxiety. He recommended the Alpha-Stim product. It's expensive, about $800, but you can return it if no good results within 30 days.

[Edmunds]

Tagging @ChessieCatI've now been holding at 2 mgs liquid fluoxetine for just over 12 weeks

 

Yesterday I had an MRI test. I did not do this because of my prolonged withdrawal recovery but in connection with potential outpatient eye surgery to correct what has become serious esophoria--double vision. The neuro-ophthalmologist wanted the MRI before making a decision about the surgery. My anxiety level was not high before or during the MRI even though the machine shut down because it overheated. We had to try twice to complete the final 4 minutes of the test! It was after my wife picked me up and we started home that my distress level started going up. The rest of the day it was high, though nothing I haven't experienced before. Pretty distressed this morning. I'm hoping that this MRI has not caused a significant setback.

 

Unrelated to that, I've not ever experienced insomnia in connection with withdrawal, but the past few nights I've awakened during the night and had a hard time getting back to sleep. Maybe this won't be a pattern. The DR coupled with both double and blurry vision is the most distressing symptom.

[Edmunds]

@Altostrata and @ChessieCat

I have a taper and stabilization question. I've been holding at 2.0 mgs liquid fluoxetine for more than 12 weeks after updosing from 1.8 mgs last November. The updose did not alleviate my symptoms of moderate but very uncomfortable and chronic anxiety coupled with dense derealization. Also fatigue and moderate morning cortisol spikes. On the other hand, the intensity of the symptoms has changed very little in the past 12 weeks. I've seen no significant improvement but the symptoms have been very consistent (other than occasional surges of anxiety, for example, after last Sunday's MRI, and up-and-down short anxiety spikes in the morning). Should I consider resuming my taper, that is, going back to 1.8 mgs fluoxetine, or should I just hold at 2.0 until I get some signs of real improvement? Thanks so much for your advice.

[Edmunds]

@Altostrata@ChessieCat I have another question. Might I explain a really nasty anxiety attack this afternoon by the fact that my wife and I went to my daughter's house for lunch to celebrate a grandchild's birthday and that despite my recent efforts to cut way back on added sugar I ate one and a half large frosted ones!

 

In the past few months I've had chronic moderate anxiety and heavy derealization but few abrupt intense anxiety attacks. The one this afternoon, however, was a whopper. After an hour or so it abated somewhat but I'm still feeling pretty awful. Might I blame the cupcakes?

[Maxx]

Hi Edmunds, 

I was reading about Ashwaganda. Like you, I'm really wary of taking anything that might further upset my CNS, but tempted by the idea that it might help. 

Have you had any beneficial effects?

best wishes, 

Maxx

[Edmunds]

Hello @maxx. Thanks for the contact. I’ve been taking ashwaganda for about a month now. I have no evidence that it has made me feel worse, though not significantly better either. I hoped it would help with my early morning cortisol spikes. But that hasn’t happened yet. I want to give it a couple of months since the literature says it may need to build up for a month or two to be effective. My withdrawal symptoms have been endurable in recent months but very uncomfortable, mainly gnawing anxiety much of the day and derealization, like being in a fog of disconnection from the external world. The two symptoms are entangled with each other, I know that. 
We live in LA but have lived in England, and we’re serious Anglophiles. I look forward to the day we can visit again. 

[Altostrata]

On 2/10/2021 at 10:19 AM, Edmunds said:

I've seen no significant improvement but the symptoms have been very consistent

 

What is this consistent symptom pattern?

 

You will need to learn to listen to your body. If you find you react badly to a sugar overload, you might avoid eating that much sugar in the future. You don't need to confer with us about listening to your body!

[Edmunds]

Thanks @Altostrata for your reply. I'm holding at 2.0 liquid fluoxetine since mid November 2020

You ask me about my consistent symptom pattern. The main symptoms I experience are:

-Heavy derealization all the time--the invisible disconnect between me and the external environment.

-Very uncomfortable anxiety feelings that continue with minor ebb and flow throughout the day.

-Cortisol anxiety spikes starting between 5:30 and 6:00 am and abating somewhat after I get up.

-Continuous mental fatigue.

 

I would say a gradual if only moderate intensification of these symptoms since I reached 1.8 msg of fluoxetine last August 26. On your advice I updated to 2.0 on November 16. That hasn't helped. Windows have cracked open slightly a few times for a few hours.  But that's all. This seems like an unending wave, all very discouraging. I function reasonably well at home but try to avoid contact with crowds, stores, etc because of the combination of anxiety and derealization.

 

Last summer, thinking I could get away with it and not understanding the perils of tapering at low doses, I tapered from 6 to 1.8 msg way too fast. Would you say that I'm very likely continuing to pay the price for that sorry decision nearly six months later?

[manymoretodays]

@Edmunds

Hey there,

This is your introduction topic, for posting about your situation, and questions around your case should go here.

On 2/5/2021 at 2:54 PM, Edmunds said:

My integrative psychiatrist has just recommended my trying cranial electrotherapy stimulation (CES) for anxiety. He recommended the Alpha-Stim product. It's expensive, about $800, but you can return it if no good results within 30 days.

 

Seems a whole string was over on a newbies topic, starting with this post ^

You'll find your posts and replies above now, right here where they should be

 

and I'm finding the following topics you might be interested in:

Alpha-Stim, Fisher Wallace;Sota Biotener, PoNS, and similar "brain stimulation" devices

Neurostimulation for withdrawal

 

It's not looking like there is any evidence that this would help with WD.  And might make things worse.  I don't know Edmunds.

 

So there is that ^.

 

And okay, best,

L, P, H, and G,

mmt

 

 

 

Edited February 15, 2021 by manymoretodays
additional

[Altostrata]

8 hours ago, Edmunds said:

Would you say that I'm very likely continuing to pay the price for that sorry decision nearly six months later?

 

Sorry, I don't know. We advise being very cautious in tapering to avoid these complex situations where there are no clear answers.

 

You seem to be having drug-related effects one way or the other. Have windows been more frequent in the last month or two?

[Edmunds]

Thanks for the quick reply. Windows, which for me means maybe an afternoon or evening when the anxiety surprisingly drops away, have been less frequent in the past couple of months. It’s been feeling like an endless wave, though I must say that despite the intense discomfort I forge ahead with household chores and work-at-home as best I can. 

[Edmunds]

@altostrata. You

On 2/15/2021 at 5:22 PM, Altostrata said:

You seem to be having drug-related effects one way or the other. Have windows been more frequent in the last month or two?

I answered your question by reporting very few, narrow windows in the past 3 months, even though the symptoms have remained about the same, maybe a little worse. Should I assume I stay with 2.0 mg fluoxetine on into the 4th month?

[Edmunds]

Thanks @Altostratafor recent replies. I could use some encouragement from a moderator. I’ve been holding at 2.0 mg of liquid fluoxetine for more than 3 months and feeling like I’m just getting worse. Windows have been fleeting and infrequent. Anxiety is more intense and persistent throughout the day. DR has me walking in a disconnected dream world, I’m having more sleep interruptions, and I have crying spells most every day. Though I’m 79 years old, my health is good other than this endless withdrawal and double vision for which I now need corrective strabismus surgery. I’m thankful every minute for my wonderful family, but I’m experiencing no jaggedly upward pattern after a year and 9 months of my psych taking me off Effexor in 3 weeks. No sign of gradually moving toward recovery. 
I’ve been trying 1 ml of CBD for 9 days. No indication so far that it’s of any use. Is it making the anxiety worse? I’m also taking ashwaganda, omega 3, magnesium, and D3. 
Two days ago my wife and I got second doses of Moderna vaccine. Maybe that also upset my fragile CNS. 

[Go2zero]

Dear Edmunds,

 

I read your message in the dread of Benesh. Your situation is other than mine, but there are a few things I can say about it.

 

You dropped the Fluoxetine/Prozac extremely fast. You should realize that the lower you go in dosage, the relative strength in blockage of the serotonin receptors increases extremely, compared to the dose. 

 

To give some figures for Prozac:

 

 

% of 1 pill(20 mg)	Dosage in mg Prozac	% blockage serotonin receptor (SERT)
100	20	78
50	10	72
25	5	62
12,5	2,5	48
10	2	44
7,5	1,5	37
5	1	29
4	0,8	25
3	0,6	20
2	0,4	14,5
1,5	0,3	11
1	0,2	8
0,5	0,1	4
0,25	0,05	2
0,1	0,02	0,9
0,05	0,01	0,5

 

For example, the above figures show that a dosage of 2 mg (1/10 pill) still blocks 44% of the serotonin receptors. Whereas a full pill of 20 mg blocks 78 % of the receptors. So a 90% drop in dosage (20mg to 2mg) creates a drop in blockage (SERT) of only 34 percentage points in blockage.

 

The further you go down in dosage, the more extreme you go down in SERT. Therefor it is so important to go slow and not jump to zero before you are nearly at zero. 

 

 

https://www.researchgate.net/publication/8583114_Serotonin_Transporter_Occupancy_of_Five_Selective_Serotonin_Reuptake_Inhibitors_at_Different_Doses_An_11CDASB_Positron_Emission_Tomography_Study

 

Here you can see the SERT figures of Prozac and some other SSRI's  in a graph 

 

 

What I notice personally, is that I cannot drop more then the effect of 1 – 1,5 % in SERT, since I came under a dosage of 1 mg Prozac. That means in practice that I may need still 1 year or more to go down from only 0,5 mg to zero.

 

For every SSRI these figures are different. For example, the Effexor you took before, drops down much faster in SERT, because of its short half times. Therefor withdrawal effects are mostly much more extreme than with Prozac which has a very long half time.

 

I show this, to point out how important it is to go down slow. And even slower when you get under a certain dosage, which is different for every SSRI. And everybody may react differently as well. Therefor it is so important to listen to your body and start to stabilize as soon as withdrawal effects become too heavy.

 

It is just a part of the story for you probably. I cannot say much about your DR. I have had DR  a few times when I stopped at a too high (however low) dosage. I was not aware then that one really has to go to nearly zero before jumping to zero.

 

One other advise I can give is for your anxiety. I found that essential Lavender oil helps me a lot against anxiety. If you want to try, buy organic quality. Put 2-3 drops in a glass of water and drink it. For me this helps perfectly. Result within 15 minutes and no side effects. Just use when needed. 

 

[Edmunds]

@Go2zero Thanks so much for that thoughtful and generous message. I suppose there are others like me who can't quite get, or don't want to get, the detailed news about tapering. I find it interesting, and I'm certainly grateful, that my struggle with Effexor and Wellbutrin after the first six and four months respectively following the 3-week tapers were not as miserable as many members have experienced. Lots of anxiety, intensified derealization, and fatigue but never brain zaps, burning arms, or so many other awful symptoms that people have experienced. (By the time I discovered SA, I was past the opportunity for reinstatement of either drug.)

 

By January 2020 I felt that the anxiety at least had calmed down somewhat, so with SA's advice, which I failed to follow properly,  I started the Prozac taper. I had come off Prozac back in 2015, following continuous use since 1997 and convinced myself that that was pretty easy. What I did not take into account was that I immediately went on Lexapro, then Cymbalta, then a plethora of other drugs, as my signature indicate. I started the Effexor and Wellbutrin in late 2016. From about then until May 2019, when I went off the Effexor, I did feel significantly better than I do now, not much anxiety and lower level derealization. But the DR was always there, and that decided me to try switching back to Prozac exclusively under the supervision of my psych at the time. She told me that 3 weeks of tapering would be no problem. I had no idea what I was in for. and that of course is when the Effexor/Wellbutrin WD started.

 

I wonder sometimes if my symptoms, which have not changed drastically in intensity in the past year, are still to be attributed to the rapid Effexor and Wellbutrin withdrawals, not just my much longer but still way too short taper from Prozac. Or are the symptoms to be attributed in part to the fact of my having an SSRI or other AD stuffed brain most of the time since 1987!

 

The chart you sent me was enlightening. Thank you. I know I have to stay on 2.0 of liquid Prozac longer. I posed one question to moderators that got no reply. How do we know when we are stabilized? It doesn't mean, as I understand it, that we feel significantly better but that the pattern of symptoms stays about the same. The latter has been true for me for many months, though there are enough times that I feel as though I'm getting worse and having so few windows that I cant' see risking any taper yet, even though I had been at 1.8 mg and up-dosed to 2.0 without much effect last November. Any thoughts?

[Maxx]

Thanks for getting back to me about the ashwaganda.  hmm, I still feel so awful, I don't think I'll risk taking anything else right now. I really hope you find it helps eventually. 

Maxx

 

[Edmunds]

@Maxx I don’t think that after several weeks of trying it, the Ashwaganda has done me any good. The 6 am cortisol spikes haven’t changed, and anxiety intensity goes up and down during the day. I will talk with my integrative psych about it tomorrow. Certainly piling on supplements beyond magnesium and omega 3 is not a good idea. 

[Go2zero]

Hi Edmunds,

 

Looking at your posts and history, I get the impression that your nervous system has been so much and often triggered that you have become very sensitive to any changes in medication. Where you could quit or change meds rather easy in the beginning of taking meds, your sensitivity for that has increased extremely after all those changes. 

 

This is what lots of people experience (me too) after all those many changes in meds and dosages and attempts to stop.

 

What I also see in your posts, is that you tapered the Prozac extremely fast. One should not taper more than 10% of the LAST dosage. But I see that you tapered 10% of the initial dose. That is really asking for trouble.

 

As you can see in the table of my last post, you went down in serotonin blockage from 78% (20 mg Prozac) to 44% (2 mg Prozac).

 

So by going down 90% in mg’s you did not reach half of the serotonin blockage of the full dose of Prozac. That is the mean thing with this kind of medication. The difficult part is in the last mg’s. Most people think they can jump to zero then. But most of the tapering still has to be done!

 

So, if you go down to fast in this phase or jump to zero, extreme withdrawal effects may occur. Like derealization, heavy insomnia, anxiety, depression and much more.

 

It may not be nice to read, but you still have a way to go with tapering Prozac with a SERT of 44% ! That is still a very high blockage of the serotonin receptors. Not something to go down very quickly with a very sensitive nervous system. When I read about your DR and anxiety, I would be extremely careful. 

 

Nobody can tell for sure what will be the best advice, but if I were you, I would keep stabilizing on the 2 mg of Prozac, until feeling really better. Going up in dosage is not an option either in my opinion. The destabilizing effects on your nervous system may be much worse than any possible positive effect of a higher dosage. And to increase the SERT to a level that might have effect, you will have to go up quite a lot… Not very advisable with an oversensitive nervous system.

 

And when you will be able to taper further after longer stabilizing, you will have to go very slow. Again, a SERT of 44% is still very high and not something you get away from in a short time. 

 

Did you think about the essential Lavender oil I suggested? With me it really helps very good when having anxiety caused by withdrawal.

 

 

 

 

 

[Edmunds]

Thanks @Go2zero for another informative message. I will certainly stay with 2.0 mg of Prozac as long as it takes to feel I'm making some progress.

 

I spoke with my integrative psychiatrist this morning. He recommended a brand of lavender oil called Lavella. He said the dosage recommendation is 80-160 mg a day, which sounds like a lot more than you take--2-3 drops in water. In any case I hope to get some before the day is out.

 

With @Altostrata advice I updosed last mid-November from 1.8 to 2.0 mg Prozac. We thought it was worth a try. But it might have jarred my CNS a bit more, as you suggest an update might do. (it can be hard to accept how at these relatively low doses a change of a few drops can effect us!) I'm ready to taper for a long time, though it would be nice to do it when symptoms are showing some signs of retreating.

 

I was pretty distressed yesterday morning facing a consultation with an ophthalmology surgeon about strabismus surgery to correct misalignment of my eyes, a malady that can be age related. But the consultation went very well. I appear to be a good candidate for the surgery, done as an outpatient and taking about an hour. That news raised my spirits significantly for the rest of the day.

[Go2zero]

1 hour ago, Edmunds said:

I spoke with my integrative psychiatrist this morning. He recommended a brand of lavender oil called Lavella. He said the dosage recommendation is 80-160 mg a day, which sounds like a lot more than you take--2-3 drops in water. In any case I hope to get some before the day is out.

I see this Lavella oil is in capsules. And yes quite high dosed as it seems. I prefer a 10ml bottle where I can dose as I want myself. I think that a too high dose of any supplement should also be avoided. With drops you can start with 2 drops. With no or too little result one can take 1 drop more and find the lowest dose that works fine. A good brand in organic quality is Doterra. But in my opinion avery quality brand in organic quality is good.

 

Please report what your results are with the Lavender oil. With me it works very good. I haven't heard much of it before I started with it. If more people on SA would have good results with lavender oil, this might be something to advice to more people here.

[Edmunds]

That's more good advice from you! Of course you are right about starting any supplement slowly.

[Edmunds]

I’ve been holding at 2mg liquid fluoxetine for nearly 3 1/2 months. Yesterday I had gnawing anxiety and blurry vision all day, and this morning the anxiety has reached near panic level. Panic attacks are not something I’ve much suffered. I think two factors may be contributing to the state I’m in. one is that dear friends invited us to dinner this evening, now that we are all double vaccinated. I want to go, my wife hopes I can go, and I don’t want to disappoint my friends. But my thoughts are telling me I can’t handle this yet. I will cry, fall apart at the dinner table, yadda, yadda. So I’m stressed about going and that has triggered nasty unrelieved anxiety. The second factor is that I’ve provisionally committed to outpatient surgery on the muscles controlling my eye alignment to correct, maybe completely, a long developing condition of double vision. I really need this surgery. Corrective lenses don’t work any longer, and the condition obviously contributes to my withdrawal anxiety, which already involves heavy derealization. But the stress of doing, or rather thinking about doing, all the things I have to do to prepare for this surgery scheduled for March 25 has yesterday and today really ramped up my withdrawal anxiety. At this point in the day, I’m still hoping the anxiety will back off somewhat, as it sometimes  has in the afternoon. So I’m agreeing to wait a bit before canceling our dinner date, almost the first in a year. But I don’t want to cancel at the last minute. If I have to postpone the surgery I will, but I surely don’t want to.