Medication For Functioning?

[danny33]

Hi everyone

I have a question and i hope someone may be able to give me some advice.
I have delayed onset ptsd and its reared its ugly head over the past 18 months with horrible anxiety, panic and obsessive thoughys. I am on the medication merry go round as well as having therapy. I have discovered that tricyclic antidepressants work well for my anxiety and panic but so far they have left me either flat and emotionless or generally feeling ill, and not my myself.
I have a job tht i used to love, 5 kids a wife and lots of hobbies that i no longer enjoy because i feel constantly unwell and everything is so much more difficult feeling cruddy all the time. I have little quality of life now and i remember and miss the me from 2 years ago.
Life is so hard with this illness.

I guess what I'm asking is how should I feel on a medication if its working right? And should it make every day life much easier?
I'm not asking for miracles, just stability while i try to get better through therapy.
Any opinions on this gratfully recieved.

Dan.

 

[joeylittle]

The way I think about my meds, @danny33, is that they make it possible for me to use all the coping skills in my arsenal. Without them, or when they aren't working properly, my skills are harder for me to use - varying from a little harder to barely can, if that makes sense.

The more I read, the more I think that it's just not the right thing, using antidepressants on PTSD. Especially not tricyclics. I say this as a person who was first diagnosed with depression, so I was medicating for that before my own delayed-onset PTSD. You are describing the side effect of anhedonia/blunted emotional affect, and for someone with depression, that is sometimes a tolerable side effect because the alternative is extreme, unmanageable sadness.

But you are taking the meds to manage the anxiety, panic, and obsessive thinking symptoms of PTSD. It strikes me as something like using full anaesthesia in order to put five stitches into a cut on a leg. Will it work? Sure. Is it way too much of the wrong thing? Yeah. Would local anesthetic be a better choice? Yes.

I would never say that meds make things easier, because this disorder is just not easy. You can't expect them to made you feel significantly better. But they should make you feel less worse, maybe even neutral. It's finishing off the trauma therapy piece of it that will bring you through this, in the end. You seem to have a grip on that concept.

Two things come to mind. First, have you tried backing down your dose on your current med? You just might need to keep adjusting it. Next, have you and your doctor discussed other short-term ways to manage your anxiety, in terms of meds?

 

[danny33]

Thankyou joeylittle :-)
I am cross tapering to amitriptyline at the mo and its horrible. I think i have perhaps been looking for to much from medication I'm also taking mirtazapine which has done absolutely nothing to help.

I guess right now I'd rather be a bit flat then full of anxiety. Its so damn hard. I'm not sure how long I can keep battling this in this way.

Dan.

 

[Born to Run]

Danny, sometimes it takes time to find the right medication, and you may need to try another, as it is so highly individual how they work. If you say you do not feel like yourself and generally ill, that is not good and not what you would want to be side effects. I tried two SSRI's -for depression- before I found the one (Zoloft) that kept me feeling normal and myself without the deepness of the depression. Prozac made me feel disoriented, not myself and totally miserable. The illness is hard indeed, and for me medication certainly has made it easier. It is symptom treatment only though and therapy will eventually be the only way out.
Maybe you could talk with your therapist about your medication? It is really very individual.

 

[joeylittle]

@danny33, I'm absolutely 100% not a doctor, but I think you should talk to your doctor about SSRIs and clonazepam or lorazepam. Again: I am not a doctor, so honestly - take it with a grain of salt. But there are so many options for medication, and you are in the zone of "not used much anymore" and "we think it also does this". I think it is worth pushing back, at least making sure your prescribing doc understands how you are being flattened. Sometimes it means getting into a much more detailed convo with them about exactly what and when you need help managing the symptoms for - like, are you at a baseline of anxiety you can manage using CBT, but you have spikes occasionally? Then you might want to just medicate the spikes.

These meds really do a number on your body, and if they aren't helping in the way you need them to be, it's worth shaving them back to zero and starting over. (This is assuming that you are functional without them, just functional with a whole lot of suffering.)

 

[danny33]

Thanks all.
I do struggle with functioning without something to help me anxiety joey, but thts mainly because I obsess tht i will become crazy or suicidal without it.
But man I've been even iller then normal today, i guess that is to be expected with changing meds. Surely I won't have to feel so poorly forever? :(
I have tryed 2 ssri's but they have made my anxiety unbearable. Will all of the ssri do this before they settle down?

 

[Born to Run]

Yes, I agree with joeylittle to discuss with your therapist the use of a benzodiazepine. A former psychiatrist I had quite some time ago prescribed me the SSRI for depression only and a benzo for anxiety, but I generally have low anxiety. Only here on this forum did I learn that SSRI's are now prescribed for anxiety as well. Even though I have low anxiety, the SSRI never did anything for my anxiety. Please keep trying what works best for you.

 

[joeylittle]

I have tryed 2 ssri's but they have made my anxiety unbearable. Will all of the ssri do this before they settle down?

If that was your response to 2 of them, then probably, that's what they will do. Again - I'm totally not a doctor. But that makes sense as to why you are now in the tricyclics. Your other basic drug-class option (as far as antidepressants that also treat anxiety go) is to look into the SNRI class. My personal experience with those is on a few of them; duloxetine was the one that actually worked on my anxiety faster than my depression. It is a good short-term drug, in my experience, and works on anxiety at low doses. And do ask about benzos - they are addictive, which is why they aren't always the first line of drugs prescribed, but for some people, they make a big difference. You might also ask about dronabinol (Marinol) and nabiximols (Sativex). I'm not sure dronabinol is available in the UK, can't find that question answered properly in a search. Nabiximol should be. Your doctor would have to be thinking progressively, as these drugs have secondary actions for anxiety, they aren't primarily used for that.

You're keeping yourself together about all this, which really is great. Its a hard and frustrating process. And I expect you don't have a choice, really, as far as your doctor goes, in the UK. But I hope the one you have is willing to work with you on this.