Adventures with Benzodiazepines and SSRIs

[David Baxter PhD]

You don't seem to understand how these medications work. They effect you gradually and cumulatively, and while you should notice some diofference within 4 to 6 weeks you may not experience maximum effects for up to 6 months or more. Just follow your doctor's recommendations and leave the dose where it is until you see him again.

 

[AmZ]

You don't seem to understand how these medications work. They effect you gradually and cumulatively, and while you should notice some diofference within 4 to 6 weeks you may not experience maximum effects for up to 6 months or more. Just follow your doctor's recommendations and leave the dose where it is until you see him again.

OK, don't get annoyed with me
I was just referring to feeling any sort of relief/difference within those 4-6 weeks, which I so far haven't. As I am still new to this and trying to learn, I just didn't know what the protocol is and wondered if after being on 75mg for 4 weeks and 150mg for 2 weeks, so 6 weeks total, would be enough in order to see that maybe the dosage could be raised again if I felt no relief at all.
I can have patience here if needs be - Of course I would just prefer to feel a bit better within the least waiting time necessary with the medication to start with.

 

[Retired]

As David has explained Effexor gradually resets the deficiency of serotonin and norepinephrine, the neurotransmitters thought to be responsible for the illness of depression. Our brain chemistry responds with gradual change which is why, as patients we need to be patient and persistent when it comes to treating this particular illness.

By combining psychotherapy with medication therapy you are receiving the best combination of treatment. Studies show combining psychotherapy with medication, while complying with the instructions of your therapists improves the chances for successful outcome.

Along the way, it might not be unusual for the doctor to modify the dose of medication or even to switch to a different compound, so you should not be surprised or alarmed as this might be required as you make progress.

 

[David Baxter PhD]

OK, don't get annoyed with me

I'm not annoyed.

I was just referring to feeling any sort of relief/difference within those 4-6 weeks, which I so far haven't. As I am still new to this and trying to learn, I just didn't know what the protocol is and wondered if after being on 75mg for 4 weeks and 150mg for 2 weeks, so 6 weeks total, would be enough in order to see that maybe the dosage could be raised again if I felt no relief at all. I can have patience here if needs be - Of course I would just prefer to feel a bit better within the least waiting time necessary with the medication to start with.

1. There is no real protocol though. Since people respond differently, one makes decisions as time goes on according to how the patient is responding.

2. It's really not true that you've felt "no relief". If you go back and re-read your threads, you may be able to see that. One thing I often say to clients is, because the effects are gradual and cumulative, it's not like you'll wake up one morning and say, "Hey! I'm cured!". It's often the case that people who know you well will notice changes before you do. They're subtle in the beginning.

 

[AmZ]

I'm not annoyed.

Sorry. I guess I'm just a bit :wacko: right now.

Thanks for the reply and I totally understand what you are saying. I don't expect to just wake up one day and be all better, or even a lot better. It's just because I've been feeling gradually worse so it's tough.

 

[Retired]

In many ways our bodies recover or repair themselves gradually over time, so the effect of the improvement is not dramatic. Take a broken limb that requires six weeks to heal, and then several weeks of physical therapy. There might be set backs during that time, feelings of improvement and sometimes sensations of discomfort. I think psychological improvement is in some ways similar.

 

[AmZ]

Yea, I've got some fixing and healing to do
I agree. Even if I just take the repressed thoughts about events in my life, they are in my sub-conscious mind (and damaging me, without even knowing) way far back and hardly think about them - But when I do, they make me extremely anxious, angry, etc etc... Even just in processing these and releasing them properly and trying to get over them and rationalize them for the future, will, like you say, make a psychological improvement in the healing process.
My mind really needs some re-training to say the least. Also with the the OCD and thought processing.
And with the help of the medication of course will help me along the way.

 

[AmZ]

Another month has gone by and you know what that means? Back to the psychiatrist tomorrow.
I spoke with him today and am happy that he said he is now passing me on to a new and permanent (and more accessible) psychiatrist in their out-patient department rather than the current psychiatrist who works in the emergency department.

So, 150mg of Effexor for a month now, and it's just so difficult to see if it's doing anything or not, let alone to move the dosage, I just don't know. I'm not stressing about it, but just asking for any tips or advice anyone may be able to offer, or at least write and think it out here to get some understanding on it.
I've been feeling worse and worse because of the therapy. Then the anxiety went off quite a bit and is better in general, and including the OCD, is less than it was compared to a few weeks ago. But I think it's because I am feeling more depressed and less anxious as to why that side of things have been better. The only reasonably OK days I have had were last week, which was at least mostly due to me totally covering over and ignoring my true feelings, thoughts and emotions because of how painful Monday night's session was. Then obviously got to the end of last week and hurt myself, and still have very bad urges to do it again. My mind is blank and not feeling much asides from finding it difficult to breathe properly all day and very jittery/jumpy with loud/unexpected noises...

So, yeah, lots of things are changing and nothing is really staying the same or at least in a cycle so that I can speak in general, so when the psychiatrist asks me tomorrow how I have been feeling compared to last month, I can't really answer, because I feel different than a month ago, plus new things have happened and come about etc etc.

My psychologist said in the last session that she would like to speak with the psychiatrist to discuss my medication. I like that she said that. I know that my current psychiatrist doesn't like the idea of this as a previous psychologist I saw had recommended that I change the Benzo, and when I asked the psychiatrist about this, he got pretty antsy about it and said that he is not there to discuss medication with me. HOWEVER, if my therapist speaks with the psychiatrist (and hopefully a new one, one that will also have more time and be more thorough etc), then I think it would be good, because she probably understands more of what is going on with me just after meeting with me for 6 hours, than I know about myself!

 

[Daniel E.]

So, yeah, lots of things are changing and nothing is really staying the same or at least in a cycle so that I can speak in general, so when the psychiatrist asks me tomorrow how I have been feeling compared to last month, I can't really answer, because I feel different than a month ago, plus new things have happened and come about etc etc.

A good psychiatrist will help elicit the necessary information. But if you aren't wholly comfortable yet with the psychiatrist, you may be more likely to sugar coat things.

Anyway, what works for me is mentioning how I feel, think, and act on my best days and my worst days. Personally, I still find there is lots of room for improvement, e.g. increasing global functioning.

 

[AmZ]

Well, I hope then now is a good time to change to a new psychiatrist.
Hopefully it'll go well tomorrow.
I Left early work again and went to my sister's because I knew what I'd do if I went home.
Couldn't stay over there as they have no room so just got home.. and have again done it within not even 5 minutes of walking in the front door.
Just couldn't control myself.
Anyway, grr, enough of me and all this ^&%$.

 

[David Baxter PhD]

Just couldn't control myself.

That is a glaring example of distorted thinking.

Of course you can control yourself. You made a choice to relinquish that control, either because you wanted or felt you needed to do it or because you convinced yourself it was inevitable. Either way, you chose to do it and then reinforced that choice via a reduction in anxiety or via some other mechanism.

 

[AmZ]

Yes, I agree.

I just posted that statement whilst I was in the distorted thinking stage and just did it a minute before.

Of course, now I can look back and think 'that is my hand doing that and I can control that hand as it's a part of my body and it's my brain I am in control of which is sending messages to that hand to move'...

Just a lack of control and distorted thinking at the time, like you say.

I've been thinking since Thursday that I don't want to do it again and how awful it is, amongst the urges to do it again and make it worse. Coming home tonight, I told myself that I don't want to do it and won't.. Then once I was home, it's like I just totally glaze over, my vision is blurry, my ears start to ring and it's like my mind and body are not connected - That's why it's so difficult to control, because it's not a planned out thing or something I tell myself, 'I'm going to do this now'.

Anyway... I know I need to seriously put a stop to this. I know it's awful and I don't want to do it. Just need to find a way out whatever changed in me in the last several days that brought me to do actually do this, which I never thought would happen.

 

[Daniel E.]

As you may have seen, there are lots of tips in the self-injury forum.

Also, a tip I have used, though not for self-injury: Make your environment in some ways more like a hospital psych unit. (At a psych unit, there aren't any sharp objects around, and, more importantly, one is usually not alone. So maybe that would mean spending more time at the bookstore and throwing out any object you have used in the past to harm yourself.)

 

[David Baxter PhD]

I suspect there is an OCD element to your self-injiry as well, AmZ. You start to worry/obsess about SI and you yield to it because you "accept the power" and thereby give power to the obsessive thought. Another strategy to add is to identify the thought as it occurs - "there's that though again" - and then remind yourself it has no predictive power and power over you - it's just a though - just because you think it doesn't mean you have to act on the thought. Let the thought pass through you. Neither dwell on it nor give power to it.

 

[Daniel E.]

Like watching a train go by:

If you wanted to figure out a way to have a thought stay in your mind, try to squish the thought and it will come back. If you want a thought to go away... this is going to sound like a miraculous event but actually it's a fact... if you actually look at a thought, just observe, just notice. Don't do one other thing with it. Just look at it. You'll be amazed. It's like a miracle. The thought will go away.

You know thoughts, sensations, feelings, emotions, you can think of them like they're cars on a train. And mindfulness practice is a little bit like sitting on a hill with a train track down in front of you and you're just watching the train cars go by. And one car may be a thought. Others may be emotions. Others may be physical sensations. Just watch the train. Watch them go by. They just sort of rumble past.

Now the secret is, don't get on the train. You know sometimes how if a thought goes by you and then you start thinking about something and a little while later you say 'What happened? What happened?' That's getting on the train. So the idea is don't get on the train.

The best reason for practicing observing is that it brings you into the present moment. It's especially useful if you're having trouble getting your mind off the past. Or, getting your mind off the future. Thoughts about the past are just driving you nuts. Thoughts about the future are interfering with your life. Try observing. You could observe anything. Observe yourself walking. Let's imagine your walking. Just be walking and observe.[SIZE=-1]

Mindfulness Video Part 2 - DBT Self Help

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[/SIZE]Other ways of dealing with anxiety:

Breaking the cycle of anxiety [In a nutshell, anxiety/depression causes contraction of the body (inactivity, silence, "paralysis by analysis", etc) while positive feelings are related to expansion of the body (movement, yoga/stretching, conversing, singing/humming, etc).]

http://forum.psychlinks.ca/anxiety-and-stress/

 

[David Baxter PhD]

That's a great analogy, Daniel. Consider it swiped for future use.

 

[AmZ]

Thanks Daniel.

I suspect there is an OCD element to your self-injiry as well, AmZ. You start to worry/obsess about SI and you yield to it because you "accept the power" and thereby give power to the obsessive thought. Another strategy to add is to identify the thought as it occurs - "there's that though again" - and then remind yourself it has no predictive power and power over you - it's just a though - just because you think it doesn't mean you have to act on the thought. Let the thought pass through you. Neither dwell on it nor give power to it.

Yes, there is that also no doubt. I don't know if it makes it 'worse' per se, but my mind has been flooded with the obsession of hurting myself in the last few days, just constant thoughts and visions in my head. Previous intrusive thoughts however have been a little less 'real', even though, at the time I think that the event or thing I am visioning is actually going to happen, even if it's the most ridiculous thing, it's like I'm having a premonition that it will happen for sure. Now with this, I guess it's just been a whole lot more real because it's something connected to my own feelings, emotions and body. Not only have I had an urge regardless of the OCD to injure myself because of how I just blocked out all that we'd spoken about in therapy and I was feeling numb, ONLY after I did it for the first time have I now had the constant obsessions about it and the compulsions to do it again another couple of times.

Before I did it the first time, I wasn't having these thoughts, like I'd written in a previous post, I was just opening a pack of food and just weirdly glazed over and pulled up my sleeve and did it. So I think it started differently to how it is now. Regardless, now it's definitely just like the other OCD things I have so will get working on things tonight. At least I feel for now, that even though I know I only did it last night.. I seriously don't want to do it again and I will fight with all of my might not to and even write the reasons down on a flash card and carry it around with me so that I can knock some sense in to myself when I start to maybe get the urge.

Think I just still need to process a lot of anger and hurt and pain I still have which came up in last session about my upbringing. To be honest, I can remember 3 times where I hurt myself as a teenager. Once at 13, smacking my arm on a tree branch because I decided that I wanted to break my arm. At 15, burning my hand with a lighter badly on purpose (scar still there) and at 19 or so when I started to study art and in our tool kit was a craft knife. I remember sitting opening it and started to use it on my hand and it was pretty bad. All of this goes back years more than I ever realized.

 

[Retired]

Have a look at this resource page to see if some of the strategies presented might be useful in your dealing with intrusive thoughts.

 

[Daniel E.]

Similarly:

In the 1970s researchers carried out experiments where they asked some people with OCD and some people without OCD to list their intrusive thoughts. They could find no difference in the types of thought reported by those with and those without OCD. The difference is that people with OCD have more frequent and distressing thoughts than others because of the meaning they attach to the thoughts and the way they respond to them.

http://forum.psychlinks.ca/obsessive-compulsive-disorder-ocd/24305-key-cognitive-errors-in-ocd.html

Clark points out that OCD patients must learn to view their unwanted thoughts as insignificant, meaningless, and requiring no control efforts. Following this concept of normalizing obsessive thoughts, I would suggest that referring to obsessive thoughts as “intrusive” is illogical and counter-therapeutic. The word “intrusive” has a pathological connotation, but most thoughts are intrusive, that is, they come to the thinker unbidden. Very few thoughts are produced intentionally. Pointing this out to patients and not referring the obsessive thoughts as “intrusive” helps to normalize patients’ appraisals of their thoughts and of themselves. Instead of referring to unwanted thoughts as “intrusive,” I refer to them as “silly.” This adjective is more benign that “intrusive,” further helping to depathologize unwanted thoughts.

David Clark's Cognitive Approach to OCD

 

[AmZ]

Thanks for the links and tips guys...

I am doing these things in therapy and for my homework... But even after 3 sessions of 2 hours each, 6 hours hasn't been enough to really get in to much at all because there is always new and other things to deal with that come up/about!

I know it's going to take time and a majority of my savings to really start to not only gain the tools, but put them in to place and action properly.

The 'meeting' with the psychiatrist was, well, not a meeting at all. He told me to come after 2pm, so went at 2.30pm. The nurse called his office and he said he couldn't see me today because he's too busy (!) so anyway I knew I was going to see a new psychiatrist so just went to the reception and made myself an appointment for another 2 1/2 weeks time (the earliest they had) - So will just stay at 150mg I guess for now until I see the new psychiatrist. Then knew I only had enough meds for the next 3 days, I told the nurse this when I'd arrived so by the time I walked back to the nurse, the psychiatrist had come along and wrote me out a prescription for a months worth of medication.

Will see what happens, but I'm not sure about the new psychiatrist. I asked and they said she doesn't really speak English so well and there is nobody else that does in that clinic.
My psychologist had mentioned in the previous session that she can recommend me some English speaking psychologists that she knows of, so I may end up going that route.