Monday, October 19, 2009

On the maplessness of medication...

I had someone ask me a few questions offline about meds. Of course, I can only address this question as someone who is currently a guinea pig, not as a medical professional. I'm addressing this in a post because I think others are often wondering the same things about trying meds...I know I do. Know too that I am writing as someone who is still searching for a good combo...I have only been on this road for about 6 months. Anyway, here goes:

Meds can hit everyone differently. Some people try meds and nothing happens. Some people, like me, try meds and EVERYTHING happens/the side effects kick me in the ass, and everything in between can happen too. This fact can make it a little hard to feel like you really know if they are "doing something" or "doing what they're suppposed to do".

When you are a really busy person, it makes it even harder to tell, because you might have so many things coming at you at once that it's hard to know if you're coming or going, nevermind if your meds are "working".

Also consider that if you are taking meds, but not doing therapy, you may be slapping a band-aid on a broken leg. You could be so used to hobbling around on the leg that you don't really see that the band-aid is not changing your relationship with that leg. Once you heal the leg the band-aid might be helpful for more cosmetic issues...which is what it is meant for, but band-aids don't fix broken legs. You can't use something for a purpose that it was not intended for, and them blame "it".

All of that said, in my experience, it seems like the stimulants are pretty straightforward drugs. seems to me that based on my own experience and what I've read of others' experiences, IF you are having an effect from a stimulant medication, you will KNOW it. Either a particular drug will "work" for you or it won't. And for me that means I get an intense and pleasant state of focus where my brain just chills out, and my thoughts slow down a bit, and I can just keep working away without the distraction of "thoughtsplosions". There is nothing subtle about it, it is absolutely obvious that the focus is occurring. The other effect I seem to have with a stimulant (currently, for me, that means Vyvanse) is a very particular feeling of calm. Clear, light calm. It does not make me feel heavy, or speedy, in fact it's like a breeze blowing across my brain, making my energy focus a bit, and allowing me to just "do" whatever it is that I'm doing. It also puts me in a really good, light mood. Sometimes this can make me just a tiny bit oblivious about things going on around me while I'm working, but it does make me more productive so I consider this a good thing, and I can switch to focusing on something new without feeling grumpy. Again...there is nothing unmistakeable about this sensation.

Within these sensations, I still have to choose to make better decisions about how I spend my time, and what I blow all that focus on, and sometimes my choices are better than others. If you are taking a stimulant and truly do not notice any difference, I would go back to your prescriber, give them this information, and see what they say. The good news about stimulants is that there are several of them these you can try others if the first ones you try don't seem to "do" anything.

The only other drugs I have experience with are anti-anxiety/anti-depressant meds. I get the sense from reading other people's experiences that working with these drugs (mostly SSRI's, SNRI's and the like) tends to be a much more subtle experience. Allegedly, it takes a little longer to see a result, during which time some interesting side-effects might pop up. In other words, you're not likely to take one dose of one of these types of drugs and magically feel like a whole new better you. It could be more like 4-6 weeks before you settle on a good dose. If you're like me, that could be a totally different experience...I have been "hit" by these drugs within an hour, and not in a good way, lol, BUT, most people, thankfully, are not that med-sensitive, so I would hardly report my experience as representative.

I have taken Strattera (an SNRI), Citalopram (generic for Celexa, an SSRI) and Mirtazapine (generic for Remeron, a tetracyclic antidepressant). Other than Strattera, they are not really intended for improving focus...I take them for generalized anxiety. Strattera gave me some cool focus, but was a little heavy for me that it actually made my mood feel a little "heavy". The focus was also not very consistent. This was a much wishy-washier experience than the stimulant. It did calm me down, and that, I liked, but overall, I tried it for a looong time, and it just didn't pan out.

Citalopram was another barrel of monkeys entirely...I've already blogged about that, but I will say this...whatever it was doing, for me, was not good for a lot of reasons, and it was REALLY OBVIOUS.

Remeron, now that I'm on a smaller dose, seems to be adjusting to me quickly, and this is giving me hope that I will be able to find a dosage of it in the next couple of week that will give me some real benefit.

When a med isn't working (or is "doing" something lame!) there are a lot of things that could be wrong. Wrong dosage, wrong drug for you, wrong diagnosis. The best way to address it is always by giving a prescriber and a therapist, if you have one, as much honest information about how things are going for you as possible, so they can help you figure it out.

So final summary, in my experience...seems like if a stimulant is "doing" something you will feel it. If you don't, might mean you need more of it, might mean you need to try something different.

Anti-depressants are more subtle and take their time. Again, if you feel no effect after a few weeks, tell your prescriber. If bad things are happening, then tell them that too, and right away so they can help you if there's a problem.

After you try a few, you will start to develop your own "map" in your head about "if" something is happening. And definitely ask your prescriber lots and lots of questions about each drug.

Lastly...if you're like me and your life is way too busy, do yourself a favor and take a few things off your plate so that you don't have a ton of stuff adding to your stress and making it harder for you to be able to "see" if anything is happening. Seriously...I am a terrible role model for that, but I'm trying...I really am, and I swear it's worth it.

Gonna go work on that one right now...

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