To Medicate Or Not To Medicate; That Is The Question

[Mishka]

Alright, I'm not sure where to start with this, but the best place to start is usually at the beginning, so here goes.

About five years ago I started seeing my first psychiatrist for an eating disorder and depression. He sat down with me for five minutes before diagnosing me with EDNOS and depression, prescribed me a low dose of Lexapro and referred me to one of the eating disorder specialists that worked at his practice. Two weeks later when I went in to see her things hadn't improved so he upped my dose. When that didn't work he added Abilify. When Abilify didn't make a difference he upped the dose of both meds. Somewhere in that span I got my PTSD diagnosis. With all of the med changes things got fuzzy and I don't remember most of year and a half. I know that I was put on a high enough dose of Risperdol that I peed the bed every night for a couple weeks before I convinced him to take me off of it (apparently the bed wetting normally just happens with small children and he didn't believe me since I was 18). I was put on Zoloft, Zyprexa, and Adderal all at the same time which caused me to have suicidal thoughts. I told the therapist and she sent me to the ER which sent me to a residential center run by the same psychiatrist who had prescribed me the medicine that had sent me there. I barely remember being in the hospital, but I know that they put me back on Lexapro and Abilify and gave me sleeping pills since I couldn't fall asleep on my own. I pretended to be fine so I could go home after the 5 day mandatory stay and the psychiatrist put me on Saphrys. The Saphrys made me actually pass out like I had been put under anesthesia, so on my own I started weaning myself off of everything (which was probably not the greatest idea in retrospect but it worked). So over that year and a half I was put on Lexapro, Abilify, Zoloft, Zyprexa, Sertraline, Resperidol, Adderal, Saphrys, Vyvance, and Ambien and all at doses that were way too high for my metabolism.

Anyway, I started having actual feelings again after I got off of the medicine and I can remember the time since then better than I could when I was medicated. I lost the 50 pounds I had put on under all of the medication and started seeing a new therapist from a different practice. I realized that the psychiatrist I had been seeing had almost a monopoly in the town I live in and found reports online similar to what I'd been through. The guy was getting paid by drug companies to prescribe patients meds that weren't working, and had ended up fueling suicide for multiple patients.

I've been off of medication for a couple years now, but lately I've been having intense panic attacks, I haven't been able to sleep without having nightmares, I have a hard time falling asleep at all, and I dissociate so much that I can't remember entire days of the past week. I'm anxious about getting back on medication since the last time things went so horribly. I don't know if I can trust another psychiatrist knowing what I now now.

Has anybody found a medicine (or medicines) that have worked for any of those things without making you so groggy you aren't "all there"? Or has anyone figured out other coping mechanisms that work better?

Sorry for the novel, any feedback would be great.

 

[Seasounds]

Sorry you went through such trauma, while dealing with educated medical professionals.

1. I get by with pediatric dose of lexapro 1.4 mg. It does nip the anxiety enough to prevent me from disassociating. I still can get overwhelmed, but that is where I use non-med therapies-slow breathing, internal locus of control-choice, boundary-decision making, Alexander technique-stops tension that exacerbates anxiey cycle. If all fails, I will use kava kava -herb tincture for anxiety ( I'd use L-tryptophan except it interacts with ssri.)

 

[Hashi]

I do think medication can have a place. For me that has only ever been short term. For someone else it may be longer term. I have to say that I would think it's only advisable as a crutch, so we need to be working on better coping skills as well as taking medication, rather than taking medication instead.

Or has anyone figured out other coping mechanisms that work better?

Yes tons. If you search the site on coping, grounding and safety you'll find a lot of information. I'd suggest having a good look through this and really practising the ideas that resonate, before you consider going back on medication.

I'm a bit concerned that you seem to have mentioned only medication. What else are you doing/considereing, with a therapist or on your own?

 

[MissMacD]

I can't take medication because I've had so many extreme side effects in the past. Diet, exercise and regular therapy and medical care have kept me on board. I don't really have a choice when it comes to medication. I choose to take good care of myself and to not let myself slide too much because I know the consequences. What I want more than anything is to have the most functional life possible with my trauma. I've had enough crappy times and some goodness is the least I deserve.

 

[Tolkienian]

I'd say that if you're having panic and dissociation issues as you work through things, medication is a perfectly viable option. I do have a great (and very reassuring) psychiatrist, though, and I'm so very sorry that hasn't been your experience. One option is to get medication like Xanax that you wouldn't take unless you had a panic attack. I'm on Ativan, and that was crucial for getting me through the period where I was having 2-3 panic attacks every day. Much better now, thankfully. It gave me the mental distance I needed to process without dissociating.

Another idea (if you go with Xanax or Ativan) is to take one before you panic, so you know exactly how it will affect you.

A third idea is to ask your therapist (you mentioned one, I think) for recommendations, either for a psychiatrist or for medications.

A word of hope: It's taken me a while (just under 2 years) and several different drugs (Zoloft, Lexapro, Wellbutrin, Prozac--aka most of the antidepressant classes available), but I'm finally getting the right dosage, and life is so much more doable. My mom (who also has depression and comes from a traumatic background), though, has come off of medication after several years and is doing very well.

So either way, the choice is yours, and there is hope.

 

[franciemarnie]

I like the reference in your title to Hamlet. It really is about whether To Be (as you are) or Not To Be.

I went with Not To Be for 25 years because I didn't know I had other options, and also I simply couldn't function at the end of my 20's.

Only you know how disabling your symptoms are. There are so many coping mechanisms out there, but sometimes you need a little help.

Whatever you do always keep in mind that your symptoms are communicating internal messages borne of the trauma and it is important to listen to what your body is saying versus shutting it down or burying the discomfort. Unless they are dealt with, they will not go away.

When I got off meds finally in my 50's, it was all still there underneath - all the symptoms which had only been camouflaged by meds for twenty some years. Finally I had to deal with them.

That said...what I'd give for a pain pill tonight! (I know that isn't the category of drugs you are considering. Just saying....)

 

[Mishka]

@change - Thank you for the good ideas with the supplements, I'll look into that. What is the "Alexander Technique?"

@Hashi - I'm not currently seeing a therapist because the last one I didn't feel like I could be completely honest with, even though she was great and I liked seeing her. I'm trying to find one that seems like a fit. Right now I'm just taking things day by day and exercising more often which seems to help. I don't necessarily want to go back on medication, but I'm afraid I'm going to lose myself if I don't. Then again I'm afraid I'll lose myself if I do.

@MissMacD - I definitely see where you're coming from.

@Tolkienian - I forgot to list Ativan! I took Ativan for a while and I think it worked well. That's a good idea, I had forgotten about that option. I'm glad that medicine has been working for you. Maybe I just need a decent dose.

@franciemarnie - Thanks, I'm glad you appreciated my reference hah. That's another thing I'm afraid of - masking everything and still having the same problems festering deeper down. I don't want to be completely numb and not be able to feel the good things when they happen or gain weight again.

You all made really good points and I have a lot more thinking to do. I think no matter what it's going to suck to deal with the source of all of the symptoms. I know that I need to just do it and not mask everything. At the same time I'm afraid everything will bubble up and take over completely and I'll lose my mind and not get better at all. Thanks for the advice.

 

[Hashi]

Hi @Mishka, whether you take medication or not I think you need more coping skills than exercising. You don't need to be seeing a therapist for that, in fact they're things to practise on your own anyway. As I mentioned, you can find lots of suggestions by searching the site.

 

[TeaLeaf]

Only you know how disabling your symptoms are. There are so many coping mechanisms out there, but sometimes you need a little help.
Whatever you do always keep in mind that your symptoms are communicating internal messages borne of the trauma and it is important to listen to what your body is saying versus shutting it down or burying the discomfort. Unless they are dealt with, they will not go away.
When I got off meds finally in my 50's, it was all still there underneath - all the symptoms which had only been camouflaged by meds for twenty some years. Finally I had to deal with them.

VERY well said. Especially the part about going off meds and the symptoms still being there, that has been my experience as well. I have been on varying doses of lexapro for well over a decade, currently on 2.5 mg and hoping to transition off in the next few months. The higher the dose I take, the less I feel the pain of my trauma but also the less I am able to process and develop new coping skills because of how numbed out the meds make me feel.

That said, at some points my suicidal thoughts have been so strong that all I could do was increase my medication dose so I didn't end up killing myself.