Showing posts with label mirtazapine. Show all posts
Showing posts with label mirtazapine. Show all posts

Wednesday, November 4, 2009

Anxiety, my rude, neurotic room-mate

I have always had an ambient buzz of anxiety sitting in my body. Always. Thanks to Remeron, not anymore! Which is great. But it means that when I DO experience anxiety recently, I REALLY notice it. I think because it's no longer a constant...it's just popping up in appropriate places, instead of being the annoying electrical whine-hum in every scene.

Basically I spent my life with a screaming person (anxiety!) in my house in the next room over. Instead of dealing with it, for 30+ years (my longest relationship ever, by far) I simply kept the door to their room closed. because I had to. You just can't get through life with a screamer like that if you actually acknowledge it all the time. I could still hear the screams and the sound had me on edge, constantly...but the sound was muffled a little bit. Now, I've stopped pacing, flung the door open wide, and have the luxury, at last of the energy to find new ways to deal with this issue. The Mirtazapine, a tetracyclic antidepressant sometimes used to treat anxiety (generic for Remeron), flat out shuts the screamer up much of the time and the silence is GORgeous so it doesn't matter if the door is open or closed. But sometimes the screamer has a legitimate complaint and will start screaming again and in comparison to the silence, that sound is hell (better than a randomly screaming screamer though!). Door's open and I can't ignore the screamer. So I might actually stop in the doorway and ask the screamer what's wrong. And if the screamer can tell me, I can deal with their concern, and maybe get them to stop screaming. A few times, when I was in the middle of a stressful project this weekend, I couldn't figure out what in the hell was wrong with that screamer...but they got tired and stopped screaming after a couple of days anyway. Eventually maybe I'll learn how to understand what the screamer is telling me in those kinds of situations but...ongoing project I guess.

The feeling of all of this is new though so at first I thought oh crap...something bad is happening again with medication. But in this case I'm fairly certain (because I feel SO relaxed most of the rest of the time) that it's just a matter of readjusting. And how cool is this...I used to live with anxiety that I had to expend enormous amounts of energy trying to ignore because it was so constant that over-ride (and giving in to obsessive-compulsive behaviors from time to time) was what I had to do to get through the day. I had to say "that's just anxiety making decisions for me so I have to ignore it" and push through my feelings and just act. It was a matter of survival, not choice. Now...much of the time the anxiety just isn't there and I marvel at how thin that line was between relaxation and the constant, malicious buzz. So that now, when I DO feel it...it is safer for me to check in with myself about why I am feeling that way, and actually consider if that anxiety is giving me good information that I can actually use to make decisions! I can at least use it to try to understand why certain things makes me nervous, and then proceed from there.

When ambient anxiety was my daily reality, I think that my method of coping was just fine...ignoring my feelings and even giving in to some impulses I shouldn't have was what I needed to do, and it was the only thing I COULD do under the circumstances. This process is freeing my feelings and allowing me to trust myself that much more, because the blatantly questionable anxiousness has been eliminated. Revolution and nothing less.

I am not thinking in terms of regret but I can't help thinking about the millions examples of how anxiety was running the show for me. Its tentacles wrapped around and through me and throughout every aspect of my life. And that line was so thin all that time...life without anxiety was available to me all that time. Seriously, it's pointless to regret decisions that I clearly wasn't ready to make earlier in life but it's pretty stunning to ponder.

Another fascinating tweak of understanding anxiety better is that I feel that I understand the line (at least for me) between anxiety and what we presently call ADHD that much better now. Some people experience anxiety as a result of ADHD, and I think that I also have that experience at times. But the weird ways that anxiety would nest in my body and my thoughts...it's just not the same thing. I get a little amped up when I'm worried because I'm feeling disorganized, but it's different from the ball that sat for probably 18 years beneath my left shoulder blade. The constant throat clearing that I couldn't stop myself from when I would just feel wiggy for no reason. The ambient sense of impending action or reaction. The self-consciousness of worry.

A perfect illustration of where the line is, exactly, is this: sitting in a meeting as I was yesterday. I arrived at the meeting and sat in my chair. I was feeling fairly relaxed, though groggy as I usually do in the morning. Doesn't matter what time I go to sleep at night or how much sleep I get, I'm not feeling awesome until about an hour or two after I wake up. I'm sitting in the chair, free of ambient anxiety. But I can't hold my mind still...and I'm watching other people in the meeting...and I start picking my finger nails, and I start jiggling my leg, and I start repositioning my legs under me like a little kid trying to get comfy in a big people chair except I'm in a conference room and I have to remind myself to adopt an adult posture, and then I realize that there's a bank president sitting next to me and what is this person going to think of me if they notice that--oh hey, is there a water cooler in here, nope just coffee, get up to get water, no, don't get up, then they're know you're not paying attention, stifle impulse, watch others, moves legs, wiggle feet in shoes, glad I wore what I did because it's cold in the room, checking out paintings on the far wall (I don't like rooms with nothing on the wall when I have to wait, that's the worst).

This whole time, between bouts of figeting I'm working to appear that I am listening. Occasionally I try taking notes, but realize there's not much to take notes about and of course once I realize that my mind is off an running again and I am spending the meeting working to appear that I'm paying attention instead of actually paying attention and THAT is the problem.

The funny thing about these kinds of situations is that because you're paying attention to everything else going on in the room you start to notice the others who can't pay attention. They're not everywhere but they ARE in places you wouldn't expect sometimes., like in this meeting Some of the most powerful, wealthy players in many circles are the ones that can't pay attention and keep checking their Blackberries, and accidentally interrupt people, but they're charismatic and funny and they get away with it because all of these behaviors are--for those who have ever taken an acting class or studied human behavior--high status behaviors and if you have money and status people expect you to display these kinds of behaviors. If you aren't rich or powerful people label you in a very different way. In the right situations, interrupting, refusing attention, and commanding attention with charisma are signs that someone is of higher status than you, or at least they think they are. They are also signs that an ADHDer was lucky and resourceful enough to quickly get themselves into a position in life where those behaviors will get them promoted instead of fired. I would bet there's a pretty even split between business people having these characteristics consciously or as a result of earned status...and having them because they have ADHD and think out of the box. The right circumstances and maybe even some compulsive ADHD risk-taking put them in the fortunate position of being "the boss" or the shot caller instead of in the unemployment line.

So...what I forgot to mention previously was that I took my Vyvanse not long after I sat down in the meeting. I fidgeted and worked to appear normal for nearly an hour...then the Vyvanse started working and I was able to sit still and contribute to the conversation instead of just skipping through it like a rock on a lake. Suddenly I wasn't even noticing the people around me because...I didn't care, because my brain wasn't flying.

This whole time, I did NOT feel anxious. That feeling I've come to know as anxiety was not even in check, it simply did not exist.

And this seems to be the pattern, the new way of things. The Mirtazapine soothes the anxiety away and the Vyvanse stills my mind.

I just can't believe I lived like that all this time! Gee, I wonder why it was easier to constantly make "new" choices instead of stick around long enough to really challenge my intellect and set some goals. Between my disordered anxiety and ADHD I was already spending so much energy fighting to appear "normal" I could have been...well, exactly where I am now. Finally able to explore the other possibilities, whatever they may prove to be.

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. Overall...it 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 days...so 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 otherwise...in 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...