Adventures with Benzodiazepines and SSRIs

[AmZ]

Thanks Daniel, much appreciated.

Sorry, that was me at my worst negative-wise. Sometimes I have these thoughts and often when I look back at them, I know that they are far from being constructive. I guess that I just have these thoughts when things are at their toughest and I need to try to stay positive and not expect the worst - Like one of the links you posted says about the 'self fulfilling prophecy' - It seems like this is what I am all about. Whether it be that I wake up at 5am every day for the last 5 weeks and can't even get out of that cycle, I can't control it and tell myself that I won't do it the next day, but it just keeps on happening, even if I've only slept for 3 hours.

Even when I was 25 or so like you are now, I was told I could still have "adjustment issues" regarding the transition to adulthood. The late teens and the 20s can be the most stressful time in adulthood.

For sure. And even more so, for me, there have been things happen since my late teens that have made this even more difficult, including things that I have unfortunately 'done to myself' like moving to a new country at the age of 21 and trying to 'start a new life' and just having my sister here and knowing nobody else. But as tough as it's been, and now I can even see how it's also been a negative thing for me, I still wouldn't have changed it for the world, So I guess that's a positive - But there have been big pros and big cons also. It's been a tough adjustment, learning a new language, a new culture, new ways everything work (i.e. how to get to a psychiatrist/psychologist and also in finding one that understands where I have come from and other things). Adding on to that, I'm just confused and don't know what or where I want to go in life or what I want exactly. I think to be honest, I'd be the same if I was still back in England. It's what I've always been like.

Anyway, really trying to get out of this negative rut today and like you say, take every day as it comes and keep level headed.

TY.

 

[David Baxter PhD]

that was me at my worst negative-wise. Sometimes I have these thoughts and often when I look back at them, I know that they are far from being constructive. I guess that I just have these thoughts when things are at their toughest and I need to try to stay positive and not expect the worst - Like one of the links you posted says about the 'self fulfilling prophecy' - It seems like this is what I am all about

You should be a perfect candidate for CBT.

 

[AmZ]

After reading about CBT now and not knowing about it too much previously... You're right.

Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events

Even though there are also events and situations that are causing the anxiety, a lot of it is from my own thoughts/mood (going up and down - negative or positive) which either/and/or causes the anxiety itself or exacerbates it unnecessarily. It's still maybe 50% situation/event based, but probably the other 50% is my mood/thoughts that make it worse - I am sometimes my own worst enemy.

So far, the talk with the psychologist and my family have been all about how great and easy things will be for me, and will just take time i.e. to go and make friends... And that it's not so difficult to do. But I really feel a block there and a negativity about it and don't think the same way about it that everyone else does. In my mind, I 1. Don't think it's as easy as everyone says it is (I've been trying for months, if not years already to do many things [make friends & generally know what I want and what I don't in many aspects of my life etc]) and 2. My negative attitude towards it actually questions if the 'solutions' given to my problems will actually make me happier and more content.

Again, I'm my own worst enemy, whether I have reason to have the feelings or not, I tell myself that I am doomed somehow and that I'll never be able to get out of this situation. I don't know what will make me happy in life, what will help, what will not help, what I desire etc etc.

My Father questioned me today about the fact as to whether I actually needed to go to a psychologist because it all seems so easy as to what I need to do here... I didn't tell my Father that I was having more actually go on in my mind and that for many reasons, it doesn't seem as simple in my mind as everyone elses.

Next session will start off with me being honest with the psychologist of course and telling him these thoughts I am having.

 

[AmZ]

I don't know whether I am 'abusing' my medication or not. Or at least, if I am going in that direction...

The psychiatrist said to take between 2-3 pills a day, but today for example, I feel like I need more. I was going to take 1 at night and a half in the morning, then another in the afternoon if I felt like I needed it, but this seems to have changed a lot in the last 2 days. 2 days ago I took one before going to sleep (fine), then half in the morning (fine) and half in the afternoon (fine), then 2 at night before I went to sleep. So in that one day, I took 3. So that's within what was recommended. Last night, in all honesty, I was a little anxious but I used the medication more so that I would sleep good as I needed to get up for work in the morning. So again I took 2 before going to bed and slept good. Then I took a full pill in the morning (not the usual half)... Now it's the afternoon, I feel like I need and want more... But if I have 1 now, then I can't have 2 tonight, otherwise I will have had 4 today and that's not really a good pattern/direction I see this going in.

I'm sitting at work now and have slight anxiety. I'd only taken a full pill (0.5mg) this morning at 8am. Now it's 4pm. My feelings are mixed though as why I want to take more now... It's because of the slight flutter that I have inside of anxiety and also to best honest, I just want to totally relaxed and totally chilled out. (Even though I know that not even the average person feels this way all the time and I feel that I want to feel more relaxed than the average person - Like, a bit 'out of it').

It's more that I want it now, rather than needing it so much. Both, but still more wanting than needing.

 

[David Baxter PhD]

It is important that you do not take more than the amount prescribed. You'll just develop tolerance and need more and more as time goes on, which will reduce the effectiveness of the medication and lead you down the path of addiction.

The intent of this medication is not to eliminate anxiety but to make it more manageable, not to make you feel "stoned" but to make you feel more normal.

Be very cautious about this, AmZ. It's a slippery slope.

 

[AmZ]

Mmm, I know... It's not good.

I just have this want for escapism or something. I'm trying to be positive, but all I'm thinking about is about what's going on with me and what will happen this week coming. Tuesday morning I am going back to the psychiatrist to now get on an SSRI for "2 months, 4, 6 months, however long it will take" and Thursday I'll go back to the psychologist for an hour - It just doesn't feel 'enough' for me. I don't want to feel like this, I want to move things forward quicker than I actually can. Even now at work, I should be feeling 'busy' and it should be good that I am back to my life and functioning but my thoughts are driving my crazy here.

In the meantime, hence, why I'd just rather feel 'stoned' just to get through it that way. I know it's the cowards way out so I WON'T GO THERE...

I took half a pill, so that's 1 1/2 today and will take 1 tonight before bed, so 2 1/2 total... and that's it.

How does it work with the SSRIs? Are they taken the same way or more than once a day also? Am I right in saying that they stay in your system longer so that you once you take them for a couple of weeks for example, they are constantly in your system so it's unlike what I have where you need a little 'top-up' sometimes if you're on a lower dosage and the anxiety starts again a few/several hours after taking a dose?

TY.

 

[David Baxter PhD]

How does it work with the SSRIs? Are they taken the same way or more than once a day also? Am I right in saying that they stay in your system longer so that you once you take them for a couple of weeks for example, they are constantly in your system so it's unlike what I have where you need a little 'top-up' sometimes if you're on a lower dosage and the anxiety starts again a few/several hours after taking a dose?

Generally, you take the SSRI/SNRI once a day and you do not "top it up". These drugs have a gradual and cumulative effect and can take up to 4 to 6 weeks before benefits are noticeable to you, although it often happens more quickly than that and other people may notice changes in you before you do.

Again, the object is NOT to eliminate all anxiety. Everyone feels anxiety at times and the fight-flight reaction is necessary for survival. The object is to reduce the severity of inappropriate anxiety to make it more manageable, and that's where psychotherapy, especially cognitive behavior therapy, kicks in.

 

[AmZ]

Concurred.

At least if I could feel like I'm more 'leveled off' for the whole day then it would be better (I don't expect to have no anxiety at all, but like you say, just to take away the severe stuff). That's why a SSRI/SNRI sounds better than this whilst I work on my one-a-week-therapy-session in learning how to deal with the anxiety and work on my issues. This is part of the problem with the Alprazolam, after several hours it wears off that much that I feel like what I did before going on the medication and if it's too far on one side of not being bearable, so of course, I want to then take more. The difference between the first few hours of being on it and the following few hours is too different.

Generally, how would someone like me be treated? I started the Alprazolam maybe 2 weeks ago, but only since mid-last week was I taking more than 0.25mg a day until now being on 1-1.5mg a day --- Will they probably say to me something like to take the Alprazolam for the first 2 weeks for example of starting the SSRI/SNRI and then stop the Alprazolam? How in this case do you know that the SSRI/SNRI has 'kicked-in'?

 

[David Baxter PhD]

When you see the psychiatrist on Tuesday, ask about switching back to clonazepam. It has a much longer half-life.

 

[AmZ]

When you see the psychiatrist on Tuesday, ask about switching back to clonazepam. It has a much longer half-life.

As in, for example, if I took one clonazepam in the morning, it would 'last longer' than one alprazolam would?

If this is the case, it's a shame I wasn't aware of it before, however the psychiatrist said that I should switch from clonazepam to alprazolam because the alprazolam makes you less sleepy and as I am a working and 'functioning person', the alprazolam is 'better' for me. Well, pros and cons... so I don't know in the end really what is best. If I can function properly, then of course, I'd prefer to take the clonazepam of course as it would be less milligrams per day at least! (And not to have the 'gaps of course.)

Do you have any rough idea also about the other thing I was asking about? As before, I of course am not taking what you say as the answer, but I just wonder generally how they work the two medications together and know that the second has started to work in order to come off of the first.

Thx.

 

[David Baxter PhD]

As in, for example, if I took one clonazepam in the morning, it would 'last longer' than one alprazolam would?

Yes.

If this is the case, it's a shame I wasn't aware of it before, however the psychiatrist said that I should switch from clonazepam to alprazolam because the alprazolam makes you less sleepy and as I am a working and 'functioning person', the alprazolam is 'better' for me. Well, pros and cons... so I don't know in the end really what is best. If I can function properly, then of course, I'd prefer to take the clonazepam of course as it would be less milligrams per day at least! (And not to have the 'gaps of course.)

Now that you've been on a similar medication for a while, it's quite likely that it wouldn't make you as sleepy now.

Do you have any rough idea also about the other thing I was asking about? As before, I of course am not taking what you say as the answer, but I just wonder generally how they work the two medications together and know that the second has started to work in order to come off of the first.

That would be up to your doctor. I think usually you'd be given the option of continuing the benzodiazepine on an as needed basis for about 4 weeks.

 

[AmZ]

Sounds good to me. Thanks Dr.

I hope that the psychiatrist recommends all of these things also - They really do seem to be the best plan of action. It's been difficult a bit with the psychiatrist because on one hand, he is of course the doctor and I am not, but on the other, there have been times where I tried to really explain why something wouldn't be good for me and he didn't recommend an alternative - i.e. taking the medication in the morning on an empty stomach and not being able to eat. Then I had to really push and say how about taking it at night and then at lunchtime the next day when I can eat, which I am now doing and it's been better in so many ways, like 100 times better. I think he just doesn't know me so much (sat with him once for 10 minutes and another for 5 minutes) so maybe he thinks I'm overdoing it or something or not understanding things.

Anyway, the psychologist last Thursday said that I should move asap on to a longer term med and I called the psychiatrist to say this today and he seemed fine about it - In the end, he doesn't know my 'problems' and the psychologist knows them more and can see that it's going to take more than just a few weeks on a Benzodiazepine and within that time, to not only work on all of my problems but be able also to learn how to stop the mini-panic attacks and for all of the stomach and physical problems not to return. I hope it won't be longer than a couple/few/6 months of course and then I can come off of the medication and things will be better.

---------- Post added at 09:19 PM ---------- Previous post was at 08:02 PM ----------

I know that I have enough things to deal with in therapy (and have only been once to the new psychologist!), with some things of course being more important to deal with now, and others, less important... But there is something that I don't think I've mentioned here before that I'm not sure if I should bring up with the psychologist at a later date, or even now, just so that he knows about it. I'm not sure it it's something I should deal with now, in case it would get worse in the future.

If it's something that doesn't bother me now but that I have had since I was 15 or so, so for around 10 years already, should I just leave it? I have this OCD type thing that gets worse I've noticed when I am stressed or anxious. Sometimes it happens every day and sometimes, I don't have it for a month or so. On average I have this OCD thing maybe a couple of times a week, and at worse a few times a day. Even when it's at it's worst, it doesn't overly bother me, perhaps just a little.. But 10 years and it hasn't really gotten worse.

 

[David Baxter PhD]

Definitely mention it to both the psychiatrist and the psychologist.

For the psychiatrist, it may well affect the choice of medications (e.g., Luvox or fluvoxamine is an antiobsessional and may be better for treating your form of anxiety and depression thatn others). For the psychologist, it will affect how s/he approaches therapy, including CBT.

 

[AmZ]

Thanks, will do.

I just never really questioned it before, but now with all of this happening in the last few weeks, it makes me wonder if it's connected and/or means that in some way, my mind works in a different way which can be seen through the OCD thing.

My OCD 'thing' started when I was 15 I think, and I can't say that unsurprisingly, when I think about it, it started during/after the first of the event/s that happened in my life which has/have been an accumulation up until now and of which I am now processing in therapy. Did that sentence make sense? I mean, that prior to the age of 15, I don't really have any issues from my childhood that bother me, plus I didn't have this little OCD thing. Only at the same time of something happening at the age of 15, did the OCD thing 'come-on' - Not that I remember exactly of course according to the month etc, but definitely we're talking within a few months of being 15/16 and this thing happening, did it start.

I don't want to make more of a big deal out of it than it is, but of course, even if it doesn't really bother me 10 years later, it probably all ties in a lot more than I realize.

I do this thing with 2's, 3's 5's and 10's (to make 10's and only of equal numbers/totals) -- For example, I touch my thumb on my index and middle finger, and that equals 3 (2 fingers and thumb = 3). But that is an odd number, so I can't finish there. So then I touch my thumb with my index finger so that equals 2, now I have 5. I then do that again once so it equals 10. I just tell myself in my mind that I need to total 20 or whatever, so in this case, will do it again twice, and that's mission completed. Anyway, most of the time it's with my hands, but sometimes with other things like my teeth. Like will close my teeth/jaw together on one side twice, then the other twice and then my whole mouth once... So totaling 5. Then again, to total 10.

Anyyyyyyway... Yes, that sounds quite OCDish now I write about it!

For someone that has a physical OCD thing that has ran for a long time, but that never got worse over time and was never diagnosed - Does it mean that if they are OCD with doing something physically, then mentally they will also do things like this with their thoughts? What is the connection, if anything in general?

Thanks again for answering my questions - seriously appreciated.

 

[David Baxter PhD]

You already do that with your thoughts. It's evident in your posts.

 

[AmZ]

Haha... OBSESSIVE and COMPULSIVE... Oh dear. Totally true.

How I don't see these things, I don't know!

Obsessive of course in terms of being obsessed - State the obvious. Well, some of the seemingly obsessive posts etc are a general kind of feeling of wanting to talk about things and get advice and get things moving forward. But those things don't necessarily come from being obsessed with something in the first place. However, the obsession of some things that go around in my mind, I do see get made worse because I get obsessed with them and drive myself crazy about them. I still think it's still partly a normal process though that a lot of people come to forums like this and do... Just a little more obsessive perhaps

And in terms of being compulsive, I see that too, and really, if I even think of today at work when I posted about the need for medication, it's these little switches in my mind that last for a few minutes maximum when I get a compulsive urge to do something or a need for something. Literally, the outcome of these two minutes or so end up in me either going ahead with what I was thinking of doing or not doing it (normally in the case of it being a bad idea). The 'decision-making' about the outcome of the thought (do it or don't do it) doesn't last longer than these few minutes.

Should I feel doomed here? How can I now control myself in not again becoming more anxious about more of these things coming out? I'm trying to see these things as positive things, but I'd rather than 1. They didn't exist in me in the first place and 2. If they already exist, I'd rather that these 5 weeks of my life just never happened so that I can just continue with my finger tapping and hope that if it's been 10 years already and it doesn't bother me, I'll deal with it for the rest of my life... MMM, concerning the anxiety thing, well, even that is still a shock that all of that happened... Couldn't really stop or control that one.

I am just still so shocked at all of these things coming out about me, I really am. Now they are so obvious to see when you just said that for example... 5 minutes ago, I honestly didn't even see it about myself!!

My oh my.

 

[David Baxter PhD]

No, you shouldn't feel doomed. For one thing, OCD has its positives too - did you see the movie The Aviator? That was before any effective treatments for OCD of course but look at what he accomplished with the perfectionism and the attention to detail.

The best book for OCD I know is Brain Lock by Jeffrey Schwartz. Get a copy of that and David Burns' The Feeling Good Handbook or When Panic Attacks (I'm not saying you have panic disorder but it's a good book about applying CBT to anxiety).

And, as I said above, let your psychiatrist and psychologist know so they can take it into account in your treatment plan. The key is learning how to manage your symptoms and, in the case of anxiety, to stop fearing the anxiety, and, in the case of OCD, to learn how to stop giving the thoughts power.

The root of all anxiety disorders including OCD is fundamentally the inherent uncertainty and unpredictability of life, and the OCD symptoms represent your attempts to impose greater certainty and predictability and safety on a world which doesn't seem to be any of those things.

 

[Daniel E.]

How can I now control myself in not again becoming more anxious about more of these things coming out?

One way is focusing on the solution, not the problem. There are a number of ways to feel, think, and behave anxiously. But the solutions tend to be often quite similar, e.g. CBT and ACT:

What struck me most was the philosophy of ACT, which is “control is the problem – not the solution.”

http://forum.psychlinks.ca/obsessive-compulsive-disorder-ocd/14997-getting-your-act-together.html

 

[AmZ]

No, you shouldn't feel doomed.

Thank you.

For one thing, OCD has its positives too - did you see the movie The Aviator? That was before any effective treatments for OCD of course but look at what he accomplished with the perfectionism and the attention to detail.

Never saw the movie - But maybe you have given the ending away haha.... Mmm, or maybe not. I'll have to watch it maybe, as long as it won't be a bad thing for me to watch!?

Talking about "positives", you make me remember and laugh about when I first got sent to the psychiatrist when I had taken myself to the ER on that fateful day about 4 weeks ago.
Two things he said to me that still make me laugh. Imagine this coming from a highly educated person, that when I walked in, he was (literally) reading Shakespeare, and when I asked if he spoke English, he said (in better English than me, and I am English) "If you please, and I if am forced, then we can speak in English, but sometimes less words are actually better", he then proceeded to tell me that the fact that I was sent to him and in this situation is a sign that I have a higher level of intelligence than the average person so there are "positives" to my 'condition'. Marvelous, thank you. That's like when I was told as a child that the gap in between my two front teeth (before it closed naturally) was a sign of intelligence also LOL. Yes, make me feel better.

The key is learning how to manage your symptoms and, in the case of anxiety, to stop fearing the anxiety, and, in the case of OCD, to learn how to stop giving the thoughts power.

For sure. Now I see that even though I do have things to be anxious about in life generally, still a lot of my anxiety is caused by 'being anxious about being anxious', which is where the obsessive thing comes in to it I guess.

My psychologist and psychiatrist are going to be very impressed and surprised when I see them this week and are no doubt going to wonder how I have manged to come to all of these conclusions 'myself' haha. I'll maybe keep it 'light' to start with lol and give the basics and let it go on from there...

The root of all anxiety disorders including OCD is fundamentally the inherent uncertainty and unpredictability of life, and the OCD symptoms represent your attempts to impose greater certainty and predictability and safety on a world which doesn't seem to be any of those things.

Well, you just couldn't have said it any more better or clearer than that... That's me totally. And that's how it started when I was 15.

One way is focusing on the solution, not the problem.

Thanks Daniel. Correct as always ;-) Need to really start working on focusing on the right things now and not the wrong ones, making it worse for myself.

---------- Post added July 12th, 2010 at 09:33 AM ---------- Previous post was July 11th, 2010 at 11:59 PM ----------

Woke up with a bad stomach this morning, which, well, I don't want to say is 'unsurprising' but it's true. Not that I was planning on having a bad stomach of course, and even after our posts here last night, I wasn't feeling particularly anxious or going crazy about the realizations about the OCD thing etc.

Did myself a little 'exposure therapy' and rather than getting up and quickly taking a pill, or visiting the bathroom, I laid and dozed on and off for 1 1/2 hours in between doing the breathing technique that the previous psychologist had taught me. I was managing to control it and calm it down and noticed that when I was dozing off again, the bad feelings went off completely (gas, wind and nauseous feelings), but then maybe 10 minutes later or so I woke up again with it really bad, so then again did the deep breathing and kept doing that again and again. Anyway, I didn't manage to take it away completely in the end and I did end up visiting the bathroom after the 1 1/2 hours and then (how it always works) after I feel OK. Not sure if this is something that I will be able to totally control in the future as it seems that if I wake up with a bad stomach, there is only one way for it to 'end'!! Now I see the links also with when (whether I realize it or not) I am feeling more anxious at bed time or at least in my thoughts whilst I am sleeping, and hence, this depends on whether I will have the back stomach in the morning. So gotta get rid of those thoughts.... Then hopefully no bad stomach!

---------- Post added at 11:21 AM ---------- Previous post was at 09:33 AM ----------

Another thing I realize now... The days I have a bad stomach are where I don't have an appetite to eat.

I had a few days since late last week with no bad stomach in the morning and my appetite was a LOT better... Now today I have the bad stomach, no appetite at all and can't eat.

So... Higher anxiety = no appetite to eat & bad stomach in the morning.

Not a good day for my family to come over to my apartment for a visit and for everyone to want to eat lunch here where I can not even stand the thought of smelling food, let alone eating it! Oh la la.

 

[AmZ]

Little update from me.

Went to the psychiatrist this morning and got my 'long/er term' medication. Told him about the OCD thing of course, so he has taken that in to account with the medication he's given me.

I'm staying on the Alprazolam (1-1.5mg) a day for now. I said about it wearing off quickly but he was still adamant that even though Clonazepam would solve this problem, on the other hand, it will make me too drowsy. He said that because I work in computers also so a job sitting in front of a screen for 8 hours, even more so the Clonazepam is a bad idea. So fine, I will go with this and just split the dosage of Alprazolam up during the day.

Tonight I'm starting on half a tablet (10mg) of Paroxetine (Seroxat, Paxil) with my evening meal. After 4 days, I will move my dosage up to 20mg once a day. I need to do this for 2 weeks and then call the psychiatrist to tell him how I'm doing on it and see when I can then come off of the Alprazolam. He said in the meantime to still keep the max 3 tablets a day of Alprazolam but of course be aware over the next couple of weeks to not take it if I feel that I don't need it.

How does that sound like a plan?
Any advice or anything I should know on top of this?

Much appreciated.