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Neuroplasticity and limbic retraining


Healing

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I bought the DNRS. Have been working on it (I must admit sometimes I did not give my very best).  Trouble is with some brain blips/neuro-emotions they come so quickly and unexpectedly, so painfully that you do not even have time to react and put the positive re-wiring thoughts into practice. BUT successive thoughts during the day can be "rewired" and it worked today as I went shopping. You are confronting your stupid negative emotions and "rewiring" them with relaxing positive emotions. I will not give up and I will keep you informed - if you wish. I also do a meditation from Joe Dispenza. I love his voice and the way he encourages me. I hear his voice inside me - "Change, this is really who you are" during the day.

 

Mole

 

November  2016 Panic Attacks, severe nausea

December  2016 short stay in hospital

                           Citalopram 20 mg 

January      2017 tapering Citalopram due to side effects: hallucinations, no sleep

                            Psychologist refuses to help me                        

January - 

August        2017 Using water method, reducing by approx. 10% 2-3 weeks 

                            At 1 mg Citalopram Withdrawal symptoms including dizzyness, neck pains, 

                            diarrohea. 

                            Supplements: Fish Oil Omega, Vitamins, Ashwagandha and now Magnesium

                             

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  • 2 weeks later...

@Mole25  

Please keep us posted about DNRS.  I'm considering trying it, but not sure if I'll be able to focus enough.  I'd love to hear your experience with it.  

Between 1988 and 2003 was on many different meds including Tricyclics, MAOIs, SSRIs, SSNRIs, and mood stabilizers, some helped but not for long.

2003 went off MAOIs and started taking Effexor XR at 450 mg.  

2012 added buspar to augment the Effexor (cannot recall exact dose) stayed on a few months with little effect.

2013 added Ritalin to augment the Effexor, no noticeable benefits so dropped that too.

2014 lowered dose of Effexor to 300mg and started adding Viibrid with negative effects so dropped Viibrid and went back to 450 of Effexor XR.

2015 added 2 mg Abilify to augment the Effexor, slight benefit at first but no lasting effects.

March 2016 tapered off Abilify in about 2 weeks.

April 2016 began to taper off Effexor XR, from 450 to 0 in about 8 weeks total. Somewhere around 37.5 had a serotonin syndrome episode and had to raise dose again for about a week until I started dropping again.  Now i know the entire taper was way too fast.  

May 2016 started taking Lexapro, increased from 5 mg to 10 mg within 10 days.

Tapered off Lexapro starting in September of 2016, dropping at various rates...quicker drops at first, then slowing down to .5 mg drops every 3 weeks or so.  Took last dose on 2/8/17.

 

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Hello all - I'm a newbie here but I have also been doing the Annie Hopper DNRS program.  I started last year and did not have the self-discipline to do the daily one-hour practice, but I've had some problems with my last dose reduction and decided to take it up again.  It does seem to help.  At the very least the visualization practice (where you visualize past and future good events) gives me a short vacation from my monkey mind, and I think the good vibes seep into the rest of the day a bit.   

Started .25 mg. clonazapam Oct. 2016

Started 10 mg. Celexa Dec. 2016

Started 10 mg. amitriptyline January 2017

Also took 60 mg. Dexilant Oct. 2016 through April 2017, successfully tapered off

Stopped Celexa successfully Oct. 2017

Fast taper of amitriptyline Dec. 2017, had major WD symptoms and reinstated at 10 mg. Jan. 2018

Slow amitryptyline taper started Mar. 2019, reduced from 10 mg. to 0.93 mg. currently

Also still taking .25 mg. clonazapam daily in late evening

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I attempted this program and while it does seem to work for some if we have complex trauma and histories of being labeled psychotic, schizophrenic, or bipolar it's likely not going to work in the same way. Those of us that have psyche's like ours can't deny the dark stuff. She literally tells you what you are allowed to think and feel and it was not something my body and nervous system could tolerate at all. I've had to go the total surrender route. I actually got kicked out of the community message board for honestly sharing my experience. I'm not fond of the system. That said, if it works, it works...just want to let folks who are sensitive in the ways that I am be aware that that might be an issue...(we are all different and that includes those who loosely fit into the category I made at the top) !! 

 

always trust YOUR experience. I experienced them as subtly violent as I was told my experience wasn't okay. 

Everything Matters: Beyond Meds 

https://beyondmeds.com/

withdrawn from a cocktail of 6 psychiatric drugs that included every class of psych drug.
 

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So sorry to hear about your experience with this.  I did find their forum to be weirdly restrictive. I look at the program as just a very structured application of cognitive behavioral theory.  So I use the parts of it, especially the visualization practice, that I think are helpful.  I hope they did honor their money-back guarantee for you.

Started .25 mg. clonazapam Oct. 2016

Started 10 mg. Celexa Dec. 2016

Started 10 mg. amitriptyline January 2017

Also took 60 mg. Dexilant Oct. 2016 through April 2017, successfully tapered off

Stopped Celexa successfully Oct. 2017

Fast taper of amitriptyline Dec. 2017, had major WD symptoms and reinstated at 10 mg. Jan. 2018

Slow amitryptyline taper started Mar. 2019, reduced from 10 mg. to 0.93 mg. currently

Also still taking .25 mg. clonazapam daily in late evening

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Over the years I put together my own program that basically rewires my brain. I'm largely down-regulated now. I still have some  existential Terror but all the crazy really nuts out of control terror is mostly gone. I'm limited in all sorts of other ways but a good part of the worst ugliness is gone. 

 

I simply couldn't use other people's programs but I certainly borrowed little bits and pieces from hundreds of things I looked at and read and that is why my work is called "everything matters"zz I Incorporated a lot from all different places but made my own process.

 

Everything Matters: Beyond Meds 

https://beyondmeds.com/

withdrawn from a cocktail of 6 psychiatric drugs that included every class of psych drug.
 

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Ah - you're from BeyondMeds.  Duh!  I didn't look at your signature before, but I actually found SA through your website. 

 

After being treated with antibiotics and PPI's a few years ago, my gut has been in a downward spiral.  PPI's started causing insomnia and anxiety, and from there the psyche meds started.  I was actually doing pretty well until I tried to get off amitriptyline, and have been sick ever since after reinstating (about the last 18 months).   I just starting to taper slowly but had a recent diagnosis of SIBO - I am sure that the GI doc I see next week will recommend antibiotic treatment.  I can barely eat, can't take supplements, and I don't think I can tolerate antibiotics at all.   So I can really relate to the hypersensitivity issues you discuss there.  Thanks for all the work you have put into your website - it looks like a labor of love.       

Started .25 mg. clonazapam Oct. 2016

Started 10 mg. Celexa Dec. 2016

Started 10 mg. amitriptyline January 2017

Also took 60 mg. Dexilant Oct. 2016 through April 2017, successfully tapered off

Stopped Celexa successfully Oct. 2017

Fast taper of amitriptyline Dec. 2017, had major WD symptoms and reinstated at 10 mg. Jan. 2018

Slow amitryptyline taper started Mar. 2019, reduced from 10 mg. to 0.93 mg. currently

Also still taking .25 mg. clonazapam daily in late evening

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  • 8 months later...
  • Moderator Emeritus

Great Video around neuroplasticity!  Thank you @JoJo90

 

 

Edited by manymoretodays
added direct link to youtube video, took out quote from member post

Late 2023- gone to emeritus status, inactive, don't @ me, I can check who I've posted on, and I'm not really here like I used to be......thanks.

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016.  And.....I quit smoking 11/2021. Lapsed.  Redo of quit smoking 9/28/2022.  Can you say Hallelujah?(took me long enough)💜

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider.  My success story:  Blue skies ahead, clear sailing

 

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5 hours ago, manymoretodays said:

Great Video around neuroplasticity!

 

This is a great video. Here is the link to Rosenzweig:

 

https://www.tutor2u.net/psychology/reference/rosenzweig-bennett-and-diamond-1972

 

The lack of empowerment and training children and adults, which continues to this day, is baffling. People should never be told they cannot attain something. We all should be able to attain or target our full potential.

 

I have seen that professionals focus on teaching work arounds - not necessarily exercises for developing the brain. For example,  telling someone with ADHD to use a daily planner to organize time and work - doesn't help grow the brain and adds to their frustration.

 

How did this woman identify what exercises to do?  😉  Did she simply start with things that were difficult for her?

 

 

Edited by Guilietta
simplify and format
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  • 3 years later...

https://psyche-soma-sol.com/

I have found this program, the author has plenty of free stuff on youtube (https://www.youtube.com/@happyandfreehealing).

I find her quite soothing and have been listening to her free videos from a couple days ago.

 

She seems to see her program has a hybrid consisting of DNRS, CBT etc. If anybody has tried the actual program please let me know! I am tempted to give it a shot.

December 2021 - Metoclopramide started. Akathisia symptoms start; Metoclopramide gets changed to PRN.

March 2022 - Akathisia diagnosed; Metoclopramide stopped; Propranolol 10mg x twice a day. Biperiden PRN (0.5mg to 1mg).

April 2022 - Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, immediate adr). Mirtazapine 7.5mg. . Discontinued Propranolol.

May 2022 - Mirtazapine upped to 15mg. Tandospirone cut to 2x 10mg. Low dose Depakote for the month; 100 to 200 to 100 to 0. Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone, Biperiden discontinued. Klonopin started PRN (0.5mg). 
September 2022 - Akathisia slowly starts improving, WD/ADR normal sets in in mid September. Hold for 4 months.
March 2023 - Off mirtazapine; no Klonopin for 5 months either! Started quercetin (250mg x 2) to soften the histamine rebound.

May 2023 - Stopped quercetin and changed from magnesium carbonate to oxide - reacted badly. Reverted back to carbonate. 
June 2023 - Added fish oil.
Current regimen: CALM Magnesium (Carbonate into Citrate) 175mg x2; Vitamin E 268mg x2; Fish oil (100mg Omega3; EPA 30mg; DHA 37mg)x2
Intro thread: 
https://www.survivingantidepressants.org/topic/27095-portuguesesea-metoclopramide-akathisia-and-mirtazapine/

 

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  • 1 month later...
  • Mentor
On 4/9/2011 at 5:48 PM, Healing said:

Mod note 2020, February:  Please also see:  Neuroplasticity- Norman Doidge MD, Interview

 

 

Highlights from an interview with psychologist Rick Hanson, Ph.D. (paraphrased) --

 

 

Contemplative neuroscience is the study of what happens in the brain when people are doing contemplative practices, how the brain changes with such practices. The field of contemplative neuroscience is just exploding, in tandem with the explosion of knowledge about brain science in general.

 

One of the enduring changes in the brain of those who routinely meditate is that the brain becomes thicker. In other words, those who routinely meditate build synapses, synaptic networks, and layers of capillaries (the tiny blood vessels that bring metabolic supplies such as glucose or oxygen to busy regions).

 

This happens in two major regions of the brain. One is in the pre-frontal cortex, located right behind the forehead. It’s involved in the executive control of attention – of deliberately paying attention to something. This change makes sense because that’s what you're doing when you meditate or engage in a contemplative activity.

 

The second brain area that gets bigger is a very important part called the insula. The insula tracks both the interior state of the body and the feelings of other people, which is fundamental to empathy. So, people who routinely tune into their own bodies – through some kind of mindfulness practice – make their insula thicker, which helps them become more self-aware and empathic.

 

 

One of the useful things we can do is use our attention. Mindful attention is something like a combination spotlight and vacuum cleaner that illuminates what it rests upon and sucks it into the brain. Neuroplasticity is turbocharged for whatever is in the field of focused attention. And while neurons that fire together do wire together in terms of unconscious, routine habits, the neurons that fire in the focal field of attention, particularly sustained attention – wow! – those neurons really, really wire together. It’s how Mother Nature wants us to learn from our conscious experiences.

 

It’s totally understandable that the untrained mind is continually scanning for either something to want or something to fear – in other words, for a problem to solve. That’s why, as William James said, an education of attention would be an education par excellence. If we don’t have control over that spotlight and vacuum cleaner, then we pretty much have no control over how our brain is changing over time.

 

 

When we base our intention to pay attention on words such as "I'm paying attention," we are setting the intention "top down." This lights up the prefrontal cortex, the part of the brain behind the forehead where there are a lot of executive systems. When we base our intention to pay attention on breathing or an emotional sense of being, we are setting the intention "bottom up." This engages the limbic system, the subcortical regions underneath the cortex, which involve emotions. This may lead to more emotional rewards.

 

 

It’s important to calm down sympathetic arousal, and the way to do that is to activate the parasympathetic wing of the nervous system. This is the rest-and-digest part of the autonomic nervous system, the part that keeps us on an even keel. A great way to activate the parasympathetic system is through our exhalations, because the parasympathetic system handles exhaling. As few as three to ten long exhalations will light up the parasympathetic circuits and calm down sympathetic arousal. Similarly, because the parasympathetic system handles digestion, relaxing the tongue or the lips also helps to light up this system.

 

 

To be mindful, to overcome the constant hijacking of the monkey mind, we rest our attention on one thing, such as the sensations of breathing, a loving-kindness phrase, or a prayer. To hold that focus in the field of attention requires holding it in what’s called working memory. The neural substrate of working memory has a kind of gate that is either open or closed. When it’s closed, the contents of it stay there, and what that translates to in our experience is that we maintain steadiness of mind. We are able to stay with whatever we want to pay attention to. The way the gate works is through dopamine, a neurotransmitter that tracks rewards. A steady flow of dopamine keeps the gate closed. What pops the gate open is either a drop in dopamine, when a feeling of reward falls away, or a spike in dopamine, when new and sweeter rewards are introduced, distracting us from what we were paying attention to.

 

So, when you encourage feelings of well-being, you’re doing two things. You’re creating a steady flow of dopamine, which keeps the gate closed, and because you’re directing a highly rewarding flow of dopamine, you cannot get a spike of it. Those two things keep the gate of working memory closed and thereby steady the mind.

 

 

When you create a contemplative state and regard the field of awareness as boundless space (usually with eyes closed) this may activate lateral networks – circuits on the side of the head that are associated with mindful, open, spacious awareness. It moves people out of the conventional state of mind in which the circuits in the middle of the brain are busy planning, thinking about the past, using language, and engaging in abstraction, all with a strong sense of self, of me-myself-and-I. Although there’s a place for that, modern life overemphasizes the activation of these midline networks, and because neurons that fire together wire together, we get a strong buildup in those regions. So it takes training to stably activate the lateral networks. One of the ways to activate the lateral networks is through a panoramic view. There are a couple of others, such as not knowing and not needing things to make sense, but one of the easiest is cultivating a sense of boundless awareness – a bird's-eye, panoramic view.

 

 

These are just selected highlights. He describes a nice, low-key way to calm and focus attention in five steps about half way down the page --

 

http://www.noetic.org/noetic/issue-nine-april/self-directed-neuroplasticity/

This is brilliant— both fascinating and useful 

Edited by marconyc

2000–2015: sertraline 50mg, eventually up to 150mg for most of those years. Prescribed for dysthymia and generalized anxiety disorder. Two major attempts at discontinuing per psychiatrist's tapering advice were failures; each failure resulted in the dose being increased by 50mg. Those were my only increases in dose over the first 15 years

2000–2002: clonazepam .5mg 3x/day, then tapered quickly with no withdrawal
Jan 2015–Dec 2016: tapered sertraline from 150 to 50mg (relatively slowly from 150 to 100 and then pretty quickly from 100 to 50); severe withdrawal at 50mg
Jan 2017-Aug 2018: increased dose of sertraline from 100mg to 150mg to 200mg/day over the course of a few months per psychiatrist, who also added aripiprazole 1mg/day and clonazepam .5mg 2x/day

Found SA; Aug 2018-May 2023: Slowly tapered off clonazepam and abilify from 2018 to 2020; sertraline 200mg/day (200 mgai)

Taper: May 2023, 200 mgai; June 2023; 190 mgpw; July 1, 185 mgai; July 29, 181 mgai; Aug 27, 178 mgai; Oct 31, 175mgai; Dec 1, 171mgai; Jan 21, 2024, 168mgpw

 

 

 

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On 7/30/2023 at 5:20 AM, marconyc said:

This is brilliant— both fascinating and useful 

The link does not work! Could you repost? Very curious about doing more limbic exercises! 

December 2021 - Metoclopramide started. Akathisia symptoms start; Metoclopramide gets changed to PRN.

March 2022 - Akathisia diagnosed; Metoclopramide stopped; Propranolol 10mg x twice a day. Biperiden PRN (0.5mg to 1mg).

April 2022 - Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, immediate adr). Mirtazapine 7.5mg. . Discontinued Propranolol.

May 2022 - Mirtazapine upped to 15mg. Tandospirone cut to 2x 10mg. Low dose Depakote for the month; 100 to 200 to 100 to 0. Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone, Biperiden discontinued. Klonopin started PRN (0.5mg). 
September 2022 - Akathisia slowly starts improving, WD/ADR normal sets in in mid September. Hold for 4 months.
March 2023 - Off mirtazapine; no Klonopin for 5 months either! Started quercetin (250mg x 2) to soften the histamine rebound.

May 2023 - Stopped quercetin and changed from magnesium carbonate to oxide - reacted badly. Reverted back to carbonate. 
June 2023 - Added fish oil.
Current regimen: CALM Magnesium (Carbonate into Citrate) 175mg x2; Vitamin E 268mg x2; Fish oil (100mg Omega3; EPA 30mg; DHA 37mg)x2
Intro thread: 
https://www.survivingantidepressants.org/topic/27095-portuguesesea-metoclopramide-akathisia-and-mirtazapine/

 

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  • Moderator Emeritus

It may be because it was posted back in 2011?  They seem to time out after awhile.  Try googling it.  And check Everything Matters: BeyondMeds, GiaK's site.  There might be something compiled there too, or working links.  I'm on my droid.....awaiting tech support on my desktop PC malfunction....or would do it.  I may be a couple more days......   Yah, I love this stuff.....neuroplasticity and limbic retraining... 🙂 @PortugueseSea

Edited by manymoretodays

Late 2023- gone to emeritus status, inactive, don't @ me, I can check who I've posted on, and I'm not really here like I used to be......thanks.

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016.  And.....I quit smoking 11/2021. Lapsed.  Redo of quit smoking 9/28/2022.  Can you say Hallelujah?(took me long enough)💜

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider.  My success story:  Blue skies ahead, clear sailing

 

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@manymoretodays

 

Oh my Lord, I am so silly xD.

 

Thanks! Will do! I think I have stabilized enough to start working on this stuff!

I really think part of my symptoms are learned fear behaviors and want to focus on teaching myself to relax. Haven't felt fully relaxed since this whole ordeal started. It's a key piece of the puzzle it is, I reckon!

 

Bless you manymoredays! 

December 2021 - Metoclopramide started. Akathisia symptoms start; Metoclopramide gets changed to PRN.

March 2022 - Akathisia diagnosed; Metoclopramide stopped; Propranolol 10mg x twice a day. Biperiden PRN (0.5mg to 1mg).

April 2022 - Tandospirone 30mg (10mg 3x day), Quetiapine 25mg (only taken once, immediate adr). Mirtazapine 7.5mg. . Discontinued Propranolol.

May 2022 - Mirtazapine upped to 15mg. Tandospirone cut to 2x 10mg. Low dose Depakote for the month; 100 to 200 to 100 to 0. Mirtazapine cut back to 11.75mg (3/4 of a 15mg pill).
June 2022 - Mirtazapine updose to 15mg. Tandospirone, Biperiden discontinued. Klonopin started PRN (0.5mg). 
September 2022 - Akathisia slowly starts improving, WD/ADR normal sets in in mid September. Hold for 4 months.
March 2023 - Off mirtazapine; no Klonopin for 5 months either! Started quercetin (250mg x 2) to soften the histamine rebound.

May 2023 - Stopped quercetin and changed from magnesium carbonate to oxide - reacted badly. Reverted back to carbonate. 
June 2023 - Added fish oil.
Current regimen: CALM Magnesium (Carbonate into Citrate) 175mg x2; Vitamin E 268mg x2; Fish oil (100mg Omega3; EPA 30mg; DHA 37mg)x2
Intro thread: 
https://www.survivingantidepressants.org/topic/27095-portuguesesea-metoclopramide-akathisia-and-mirtazapine/

 

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  • 1 month later...
On 2/9/2019 at 6:52 PM, GonnaBeOk said:

I just recently ordered (and finished watching the DVDs) for Annie Hopper's neural retraining DNRS program. I'll be starting the program within the next day or so.  I'm 52, and essentially cold turkeyed a decent dose of Prozac after long term use. Hell ensued, and here I am.  The program is very "structured" in that she insists you practice for an hour per day at least, as well as implement other helpful strategies ALL DAY (as you catch yourself in the negative loop) in order to get out of rumination and negative thinking.  There's a very specific order (during the one hour training round) to how all this is done in order to allow for positive brain changes over time.  So, I'm going to give it a really good go. I assume I will be doing it for years.  I've got a lot going on besides withdrawal, but withdrawal is the worst of it all.  I'm choosing to believe this will help tremendously.  When one purchases the program, they are allowed access to the members forum, which is quite inspiring, and a great place for positive encouragement.  Many people have healed from all sorts of things (but of course drug withdrawal is it's own animal), and there are also a few people I've seen in the community who have experienced withdrawals and are trying to get their lives back. Their argument (when I've asked if it works for withdrawal) is that it is definitely a limbic system dysregulation disorder, so yes it is appropriate for that.  If anyone is interested in trying her program, she offers a money back guarantee after 6 months (I do believe it will take much longer than that. Let's be realistic, right? ). I've been implementing a few concepts here and there over the past few days, and it has definitely giving me hope and interestingly enough, I haven't had a crying jag for 3 days (although the horrible anxiety/depression is still always present. But I'm functioning on a better level already.).  Some helpful adjuncts that she recommends have also been presented in this forum, but the key to success over time is the actual DOING of the specific step-based, systematic one hour per day (EVERY DAY) program, in order to encourage consistent brain re-wiring over time. It takes (as she states) "boot-camp" commitment. I believe that our bodies are designed to heal.  So, I'm going for it.  If you are interested in more information you can google "DNRS Annie Hopper" (I have no affiliation with them). Btw,  some good suggestions, ideas, etc. for generating neuroplasticity have been mentioned here on SA. For me, the "program" idea resonated, as well as their support forum and the depth/intricasy of the specific structure and layout of the program (which I can't go into detail here). I'm unable to answer specific questions about the program, as I will be busy pouring my energies into healing, but please check it out if you're interested. 


how are you doing ? 

5/10-viibryd 15 to 10 start 10 prozac

5/17-adrenaline surges, panic, viibryd to 7.5

5/20-stopped viibryd ?serotonin syndrome

5/23-stopped Prozac as symptoms continued 

6/2-reinstated viibryd 5mg

6/7-10 mg-better x 1 week only

6/13-15 mg-same thing

6/22-20 mg-same thing but akathesia went away

7/7-viibryd 25 mg split 15 am 10 pm
7/7-started Lunesta to sleep, 0.25 Ativan prn.

7/27-started propanolol 10 mg BID
8/1-viibryd reduced to 10 mg am 10 pm

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