Mood Stabilizers, Concentration, And Weight Gain

[TheSpydah]

I saw the psychiatrist in charge of my legal case for the car accident that killed my partner and caused my PTSD. He doesn't specialise in PTSD, and he's actually a pediatric psychiatrist. We discussed some medication options, and he wants me on 10mg abilify twice per day and xanax 10 drops three times per day, and then to add an SSRI and some benzoadiazepam-like stuff if I don't sleep. He calls this the low dose.

I explained to him that there were two priorities for me to consider in the choice of medication.

1) regaining the ability to focus, because I am a teacher and an academic and I have not been able to work since the accident due to inability to read and write. The inability to focus has deprived me of any sense of identity and purpose. I can't even read to distract myself. I can't even watch a movie. Writing anything long (like this) takes me hours and countless pauses. And that's without even approaching complex/sophisticated reading materials. For a professional intellectual this is death.

[Ironically, my research involves bodies and trauma theory in literature...]

2) not gaining weight because since the trauma I have had sugar cravings that have made me gain almost 20 lbs in three months (I am 5 foot tall), and I have really hard time losing it, and that's even with running/walking over an hour per day, and on an extremely clean diet (but for the cravings, I eat mostly produce with small amounts of animal protein, and no processed foods ever, nor eating out). I have familiarity with diabetes from both parents, so I have reason to be scared. I am also an ex-athlete and dancer, who had become one by overcoming a disability caused by birth trauma - the first one I had in my life. The sudden changes in my body have worsened my depression and, specifically, my sense of helplessness.

Now I know everyone, especially doctors, write this down as "vanity and control issues." But I have gone from being offered a gig for fitness modelling to all my clothes being too small and my knees hurting if I walk uphill. Being heavier makes it harder for me to exercise, so I started exercising less AFTER gaining weight, which severely worsens my mood swings. I have also become weaker, which makes me feel more vulnerable and therefore more prone to dissociative events. I used to see my strength (NOT my looks) as the tangible proof that I had come to the world overcoming a trauma, and that gave me hope I could do it again. My strength was my safe space. Since gaining weight I have had increased difficulties feeling my limbs. I am disembodied 90% of the time. It's terrifying. It's not about vanity and control.

So I asked the doctor for treatment that could help me... just be me again. He said he would prescribe me something that would clear my head and help curbing the cravings and weight gain.

But... Abilify and Xanax??? Both of them seem to cause exactly what I am trying to avoid and what I am struggling with already.

It made me feel patronised, not listened to, and I have been feeling even more hopeless since - feeling like I don't have any chance to ever be the person I once was, like my PTSD has taken from me everything I was, and I have no hope of healing ever.

Has anyone here had success with mood stabilizers for their PTSD that did not cause weight gain OR poor concentration? Is there any hope I will ever be able to focus again without taking a bunch of meds, or is that my only option? I feel really hopeless and I have spent all yesterday evening weeping...

 

[joeylittle]

Has anyone here had success with mood stabilizers for their PTSD that did not cause weight gain OR poor concentration?

Remember, there's no medication that is specifically for PTSD; so, you are looking to take something that addresses the most significant symptom(s) with as minimal negative effects as possible.

Personally - I would avoid abilify. If you are concerned about weight gain, know that you can be prone to it, and aren't in dangerous crisis, there's no point in Abilify. Metabolic syndrome is too, too common there.

Have you taken a depression inventory test? And/or - did you and the doc talk about the cause for your inability to focus? For myself, when I have that problem, it's rooted in depression. But if you are scattered, your mind is moving too quickly to settle and/or you are highly activated, you'll need a different medical approach.

Benzos (xanax, ativan, klonopin, etc.) can be helpful for short-term management of anxiety, and hyper vigilance. Do you know if these are your main issues?

Antipsychotics as a class (of which Abilify is one) are all capable of causing weight gain - Abilify is just considered the least problematic; some people don't have a problem, and the reason for the weight gain is not understood.

Mood Stabilizers are also fairly notorious for weight gain.

Anti-convulsants that are used for anxiety (lamictal, topomax, there are others) are generally weight-neutral, or connected to weight loss. They unfortunately can cause the brain to get foggier.

SSRIs are functional for light depression, generally - if your inability to focus is happening because of depression, I wouldn't think an SSRI would be helpful. SSRIs handle the sads, the blues, overall heaviness.

SNRIs are probably more drug than you need, (especially if you did not have any of these issues to a degree they were impairing your functionality), prior to your PTSD diagnosis...

Wellbutrin is kind of special - a unique action that separates it from the other classes, weight neutral. But it contributes to agitation. As an adjunct med, it can be great. If you are having a high startle response, thinking fast, or have ever had a manic episode, you cannot take it. Also, if you are prone to seizures for any reason or have a seizure disorder.

Sorry - that's a book I just wrote. But any thoughts you have on the root cause of the inability to focus/speech issues would help. And bear in mind, I'm just one person on the internet. Hoping others weigh in with their own experiences.

 

[Panda Bear]

20mg of abilify seems like a lot to start with!

It will for sure cause weight gain, especially if you're having issues now. I take Abilify, but only 1mg...I'm a freak of nature.

Benzodiazepines are nice for short term usage and can address the anxiety and other issues you might have. But they make me foggy.

I take a drug called amantadine and it helps with the brain fog/lack of concentration. But it's being used very off label.

Joeylittle gave you endless and amazing advice, meds confuse me. I hope you can find an answer soon.

 

[TheSpydah]

Let me start by saying that I feel like I'm getting more help and information from people on this website than by all the health professionals I have seen - combined. I will never cease being grateful for finding this place, and to you guys specifically.

Additional info: I have a slight arrhythmia. My mum has diabetes. So did both my grandmas. My brother is prediabetic. Mother and two brothers struggled with obesity. I have very strong health reasons against gaining weight, and I feel insulted whenever this gets dismissed as vanity (also, if I may rant: I know that by conventional wisdom I'm way hotter now that I am curvier and less boyshly muscular, but that's the whole f**king point they are missing - I don't care about being sexy, I want to be strong and functional, it's not about vanity).

I do have a startle response to aural and kinetic stimuli (jolting and being hugged causes me flashbacks). It got worse about 6 months after the crash, when we had the memorial for my partner. It got even worse now that I have had to leave our home and go back to my country because I could not work/had to renew documents and have to live with my family (which was with me at the time. My father caused the accident that killed my fiancé.) A lot of the people around me are only barely beginning to understand what it means that I have PTSD. Which I may have had before/have been prone to from my childhood medical trauma and from abuse from peers and in relationships. So it has been the case that they responded in the worst way possible, i.e. by trying to contain me, even physically, when I had what they saw as "the crazies." As a result, I have spent the past few days before seeing the physiatrist having a dissociative episode after the other. I run away from / push away imaginary people who exist in my flashback and anyone who acts in ways that overlap with those memories - but I am not delusional, so to speak. I cognitively know it's not real, but my fear response doesn't give a fig and I act purely on terror, mixed with overwhelming guilt. I suppose I have both a hyperactive startle response and hypervigilance.

Poor concentration. My brain does not spin too fast. I've had that when I was hyperthyroid years ago (stable without medications now), and so I know it's definitely not that. It feels like every time I try concentrating my mind behaves like a frightened 4-year-old pulled by the arm and screaming "no no no I don't want to go." My eyes swim on the page and I can't remember things. Writing, oddly, is easier than reading. I don't know what's causing my brain fog. I get distracted/confused/forgetful very easily, which is vastly atypical of me. And it makes me miserable because I can't even district myself with a novel. Let alone do my job.

I am sure there are also psychological factors at play: my partner and I bonded strongly over writing and he was very invested in/supportive of my research - no wonder that is hard to pick up again... We also bonded strongly over food/cooking (he worked as a patissier for a few years) and over movement (we are both trained and have worked as movement educators). I don't think one needs a degree in psychology to see that things I might struggling with with my health, mental and otherwise, are connected to the loss itself (even beyond the trauma), and I would like my doctors to just take the time to listen, because I think that is relevant information if they want to heal the patient. But they don't.

I do have major depression, and may have had it before - although to be honest, if my therapist is right, and he seems to be the only person who looks at me as a whole person, then that is connected to a lifetime of traumas that no one ever treated and that were slammed into a pyre by the accident. I guess I was a high-functioning mental health patient (at one point I would have been a prototype of the saccharine success story of the disadvantaged wunderkind from a lowly background...), and self-medicated by being high achieving.

Not sure if this answers all the questions... thank you again. I really appreciate it.

 

[joeylittle]

I do have major depression, and may have had it before - although to be honest, if my therapist is right, and he seems to be the only person who looks at me as a whole person, then that is connected to a lifetime of traumas that no one ever treated and that were slammed into a pyre by the accident.

I'm glad you at least have a T that you can count on.

I hate to say this, but you probably want to look for a new psychiatrist. There are good ones that will look at your whole history, and really think about the most minimally invasive way to address your symptoms. Of course, they are MDs: they want to help, and their tool is pills. But not all of them over-medicate.

Unfortunately, some of it will have to do with knowing how to present your symptomology. But your two posts here indicate that you've got a decent handle on what's what, so you will be able to give a good overview - the challenge is just to find a psychiatrist that wants to hear the whole picture. And, because of your concerns about weight gain (which a good psych will not chalk up to vanity), your options are going to be limited and might require some clever off-label ideas.

Regarding the depression: depending on how one looks at it, it may not matter at this point whether it was really developed in response to early trauma or not. There's some evidence that indicates depression as progressive, when left untreated. If you are a woman in your mid-to-late 30s, you grew up as a functional depressive (as you said, managing it with behavioral techniques), and then this major accident occurred - you'd be statistically very likely to hit a major depressive episode. I'm not saying you did or didn't, it would be hard to tease it out with the concurrence of PTSD. But, it would indicate that there may be a depression you are in that would respond to simple (SSRI) intervention plus cognitive therapy.

From your post, it sounds like the anxiety symptoms are very active.

If you want to start slow, and you feel good about your ability to manage addiction behaviors, I'd recommend you start by having a low-dose regular or PRN (as needed) benzo prescription - probably not Xanax, something you can function on, something like Ativan. Use it for two weeks, see if it is helping, and see how addressing the anxiety affects the inability to focus. It might end up being all you need for the time being, especially if you can make headway in therapy on solidifying grounding skills and anxiety management, even trauma processing.

If it's helping some things, but not helping others, you could then start a low-dose short-term weight neutral option like prozac or zoloft. These were never meant to be taken long-term, but are often useful as an adjunct support to therapy when wrangling major life events.

So, in the outline above - best case is you figure out within 2 weeks that you can do OK on occasional benzo support (but you want it to be occasional, not regular). Medium case, is you'll figure out after 6 weeks that you instead (or also) need a SSRI, and the plan is to work on the trauma, get stuff on a better footing, and then come off of it. Worst case is you'll know you are dealing with something bigger than those things can handle, and you'll need to try a different approach. But throughout, you will have avoided taking something that induces metabolic syndrome, and you'll learn a heck of a lot more about how you are, in general - because time and regular therapy is the backbone of all of it.

And discontinuing an SSRI after short-term use isn't associated with discontinuation syndrome (basically, an awful physical experience that occurs when getting off of some psychotropic drugs).

Does your T work with any psychiatrists specifically that they like or can recommend? That can be another way to get some leads. But, if your current psych is willing to go the slow, layering-in route, you can at least get started while you are looking for another one.

 

[TheSpydah]

My T is in the US, and I was forced to relocate to the place where the accident happened because of my inability to work/support myself financially (which sure doesn't help), so he does not have a contact here. I am stuck for the time being, and I need to find a new therapist as well as a psychiatrist (agree with you 100% there. Glad I'm not just being whiny). I think my situation is worsened by the environmental situation I am in. I have lost the place my partner and I called home, I'm back to where he died, I have no job and zero opportunities for career development, no friends, and no sources of entertainment here. I am back living with my parents who were involved in the accident and for whom I don't manage to have any feelings. Even without PTSD I can't imagine it being conducive to feeling better as everyone assumes it's going to be for me...

 

[joeylittle]

I think my situation is worsened by the environmental situation I am in.

Most definitely. That's just a whole hand of very, very difficult cards you are holding.

Long shot: any chance your old T would work over Skype on a sliding scale (non-insurance) for a predetermined period of time to help you bridge this upheaval?