Confused About Medication

[Upside Down Eagle]

I am in a dilemma about taking SSRI's.

My doc prescribed Paxil to me after having a chat with her about the horrible PMS I've been having. The PMS is pretty extreme, it causes violent rage, anxiety and the urge to harm myself.

The thing is that I am learning to deal with the rage and the anxiety in a constructive way -calming myself rather than hurting myself for it -but obviously it wasn't going very well yet because when the hormones take over I lose all self control.

I am worried that the SSRI's will inhibit my growth and my learning trajectory. Right now I can feel the anxiety but it's like it's buried under a deep pile of snow (being the SSRI). I am wondering if that's a good thing, because if I don't feel my normal emotions, then I am not really "dealing with it" either. I am just letting it sit there.

I am in the process of finding a therapist (after a long break of no therapy). But I don't expect to find one immediately, as I'm really searching for someone that has experience in the trauma field and that I can feel more or less comfortable with.

Not sure what my question is here, really.
Maybe I just wanted to express the thought and see what you think about it.

 

[Friday]

Could you ask for a short acting anti-anxiety med to use as a safety net for when things get bad? Instead of a maintenance medication that needs to be taken daily.

 

[Upside Down Eagle]

I do actually have those, (I mean calming meds against anxiety) sitting in the drawer for "emergency" situations. I use them seldom, only when I get the urge to self harm or get suicidal.

The problem with that is that the anxiety pretty much settles in in one second. I can be perfectly fine, in a social situation, and then come home and suddenly get a huge outburst of rage and beat myself, and then take the medicine (when it has already escalated). I am not so good at predicting when I am going to be fine or not, so I usually take the "emergency" meds when it's a bit 'late' (when I have already self-harmed).

The upside of the SSRI is that it calms me down pretty much all the time, so there is no escalation. But I find myself wondering if I can actually work on my problems when my problems are buried under the medicine. :confused:

My doc will call next week, to see how it's affecting me, so I can still discuss this with her...

PD the SSRI is calming me down, but it is also giving me an amphetamine-like tension in the shoulders and the jaw... and keeping me awake at night. Not sure that works to my benefit... probably not.

 

[Neverthesame]

PD the SSRI is calming me down, but it is also giving me an amphetamine-like tension in the shoulders and the jaw

I know what that is like. For some strange reason my meds make me clench my jaw all the time. I even broke a tooth a few months ago. Since then I now compulsively hold my tongue between my teeth. Helped quite a bit. When I start clenching my jaw. A sharp pain reminds me to relax.

Have you tried different types of anti-depressants? ie, SNRI, Tricyclic, MAOI or a different SSRI?

With regards to Paxil. If you have not done so already, please look up the adverse effects before taking it. Particularly the "discontinuation syndrome". Paxil was the first anti-depressant I was prescribed many years ago. I was told by the Dr. I was seeing at the time that Paxil is harmless, works great, non-addictive. That was a complete lie. That medication was extremely expensive for one. It caused me to sweat profusely when I was concentrating on anything (yeah, I know. That was bizarre) When I went off of it months later, I suffered the most horrible withdrawals. The two most frightening symptoms I experienced were, feeling like I was losing my mind and suicidal urges. I can't describe what it was that made me feel like I was losing it, just the feeling I got. The suicidal urges would come on suddenly, yet also unlike other times I have felt that way. It was a feeling of, "OK. Time to go". There was no fear, no particular reason. It required no thought. In fact I was perfectly fine with it. Just a sudden powerful desire to die. Ended up in hospital after my first suicide attempt shortly thereafter.

I am sorry for writing a novel. I don't want to frighten you either. You may have a totally different reaction to the drug. I just strongly recommend not taking that particular drug if you are wanting a medication to use short term.

 

[Upside Down Eagle]

I clench normally too, and have chipped off parts of my front teeth because of it. I wear a protective thing now at night, but the meds seem to worsen the clenching quite a bit. I'm considering stopping with this medication if it's going to cause insomnia problems like now.

Thanks for the warning. I've been on this brand before, that was seven years ago, and I had no addiction problems afterwards. They did tell me that it could be addictive so to stop gradually -I stopped just like that, in one day (I know, bad idea). But it worked out fine. I even got a high out of it because all of a sudden I could really feel my emotions again.

Edit: I'm on a low dose -20mg -and not going up from here. I don't know if that makes a huge difference, but that could be it too...

 

[joeylittle]

The upside of the SSRI is that it calms me down pretty much all the time, so there is no escalation. But I find myself wondering if I can actually work on my problems when my problems are buried under the medicine.

My personal, totally non-medical, opinion: anti-depressants, mood stabilizers, etc. should only be used when they are necessary in order for you to do the cognitive work you need to do in order to address your issues. There's way too much drug in there, much more than you need from what you've described (low dose or no) - I don't mean you don't need help, but the issue is hormonal and periodic. You are looking for relief, but you are already able to function and address many of your issues with your brain just as it is.

Especially if what you are feeling is a soporific effect - that 'buried under snow' feeling - and I'm assuming that's continuous? Compare that to what you know about basic anxiety meds - I don't know what you take, but if it's any kind of benzo, it works and then it's gone. Super-short half-life. And in small doses, not as blunting as SSRIs. Yes, tolerance, yes, addiction - but simpler neurological action, less brain-changing.

I always go for the least brain-changing possible, I guess is what I'm saying. I know you've said you don't want to do birth control, but have you investigated any other kind of hormonal imbalances/thyroid stuff that maybe could be addressed in a more targeted fashion? Or, have you yet tried taking a low-dose of a long acting anti-anxiety when you know your cycle is going to hit?

Finally, do you feel like you have the strongest emotional regulation tools you could possibly have? That might be a really good thing to focus on first in therapy, or even find a more immediate way to address those kinds of things through online DBT or mindfulness work.

 

[Upside Down Eagle]

Thanks Joey, your response gives me a bit more insight, as I'm still pretty confused about it :D

I usually try to steer clear from the anxiety medicine that doctors have prescribed me (though that prescription dates more than a year back). I used oxazepam back then, but I completely hate that stuff, makes me feel crappier than anything. Seroquel helps better with me when I'm anxious at night and can't sleep, but both are the kind of remedy I take when I've already gone "berserk".

I know you've said you don't want to do birth control, but have you investigated any other kind of hormonal imbalances/thyroid stuff that maybe could be addressed in a more targeted fashion? Or, have you yet tried taking a low-dose of a long acting anti-anxiety when you know your cycle is going to hit?

Maybe it would be a good idea to discuss the hormonal balance thing further with my doc, because I do seem to have a problem with it. The long action anxiety medication sounds good too. I think I was a bit too quick to say "yeah okay" when my therapist suggested SSRI's because I have had good experience with this in the past and maybe wanted a "quick fix"... :oops:...now I'm not sure whether to discontinue immediately or wait until she calls... (I've been taking it for 4 days...).

Finally, do you feel like you have the strongest emotional regulation tools you could possibly have?

No, not at all, but that is a real good question and I am in the middle of looking up a therapist specialized in trauma nearby. It might take a while though, because I found several, and I want to get an informed opinion of them before I actually choose.

 

[Upside Down Eagle]

When my doc (whoops, I said therapist...) started talking SSRI's, I was kinda thinking that I could take it just a little while, versus taking it all the time, based on information like this:

"Selective serotonin reuptake inhibitors (SSRIs) — Selective serotonin reuptake inhibitors (SSRIs) are a highly effective treatment for the symptoms of PMS and PMDD. The SSRIs include.... and paroxetine (Paxil®). Studies showed that SSRIs reduced the symptoms of PMDD significantly compared with placebo; between 60 and 75 percent of women with PMDD improve with an SSRI. It may not be necessary to take the medication every day. Taking the SSRI only during the second half of the menstrual cycle may be sufficient."

I also saw some peeps on the forum who said they only take it only during the second half of the cycle. But then other sites say that you're supposed to take it for months or even a year.

 

[joeylittle]

Remember, I'm not a doctor, not a doctor, not a doctor -

Oxazepam is usually used to help with sleep - not fall asleep but stay asleep - it doesn't reach peak efficacy for 3-4 hours, and would never be super-helpful in a crisis. It's also useful as a 'take it regularily and keep it in your system at a low level' drug, but I don't think so much as a 'take it every once in awhile' drug. Low-dose seroquel can be awesome for sleep, if you can tolerate the 'hangover' (or don't get it).

But it would be worth asking your doc about other anti-anxiety medications; you should also go ahead and do your own research. I don't know what is most commonly used in your country, and I'm sure it's not the same as the US.

PS: this is a pretty nice overview of everything, and I find the source reliable- http://womensmentalhealth.org/specialty-clinics/pms-and-pmdd/

 

[Upside Down Eagle]

Thanks!

I've had no problems falling asleep since my last crisis -and now because of these SRRI's :facepalm:
It seems like a good idea to do a bit of research. The problem with the doc is that she said "there were no other options" and I always go "oh. uh... okay". Instead of finding out more for myself...

Maybe you are not a a doc but you seem to know more about it than her :D. To be fair, I was seen by a doc who is "in training" though...