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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by linkadge on November 17, 2019, at 18:14:15
I've just had one of the worse relapses in my life. I am still trying to process exactly what has happened.
I had been sleeping relatively well for the past few months. Within a matter of days, I started waking up within a few hours of falling a sleep with a feeling of horrible dread / panic. I took some old clonazepam which barely touched it. After more clonazepam I was able to fall asleep for perhaps 4 hours. I woke up at 4-5 in the morning with insane physical anxiety (feeling it in the back of my kidneys - adrenaline, cortisol release, who knows).
The next day I experienced intense anxiety throughout the day, mostly physical. Almost like serotonin syndrome or something (but with no change in meds).
This pattern has continued for a few days. I has subsided a bit, but I am left completely shattered. I don't know what brought this on, and why it has been so difficult to treat.
Early morning wakenings are my #1 fear as there seems to be little way to treat it.
I had been feeling some depression / apathy leading up to this event. I'm not sure (if I am bipolar) if this was a switch into mania (or a mixed state).
I have had this pattern in the past (far beyond regular run of the mill anxiety / insomnia). When it happens, the force is so strong, it seems to override heavy medications.
Meds that would normally knock me out barely touch it.
Linkadge
Posted by PeterMartin on November 17, 2019, at 23:42:52
In reply to Horrible anxiety relapse (still reeling), posted by linkadge on November 17, 2019, at 18:14:15
Wow. Sorry you're dealing with this. You said your medicines haven't changed. Have you recently had anything refilled? Maybe they gave you a different manufacturer or a bad batch of something?
Of course it might not be med related at all but I find I've been having more and more issues w/ pharmacies switching generics around lately.
I hope you feel better soon!
Posted by beckett2 on November 17, 2019, at 23:43:47
In reply to Horrible anxiety relapse (still reeling), posted by linkadge on November 17, 2019, at 18:14:15
I'm sorry Link. Zyprexa knocked me out (I was given it in hospital). Have you seen a doctor?
Posted by Lamdage22 on November 18, 2019, at 9:56:15
In reply to Re: Horrible anxiety relapse (still reeling), posted by PeterMartin on November 17, 2019, at 23:42:52
Has nutrition changed?
Posted by Lamdage22 on November 19, 2019, at 1:04:55
In reply to Re: Horrible anxiety relapse (still reeling), posted by Lamdage22 on November 18, 2019, at 9:56:15
Your nutrient levels may have lowered.
Posted by linkadge on November 19, 2019, at 7:46:14
In reply to Re: Horrible anxiety relapse (still reeling), posted by Lamdage22 on November 19, 2019, at 1:04:55
Thanks for all the responses. I haven't really changed my nutrition at all and haven't refilled my meds.
I'm doing a wee bit better. I increased my lithium to 600mg and have continued the clonazepam.
I'm still waking up at 3-4 in the morning with crazy adrenaline release. It's the same feeling I get like I'm about to run a big race (can feel it in in my kidney area).
A working theory is that (perhaps) was in a hypomanic episode (not convinced) that suddenly collapsed into depression. I have been working quite a bit of overtime, and I thought I was handling it well.
I know that cortisol rises in the morning, but its like its happening much earlier and MUCH stronger than usual. When it happens its like NOTHING can override it.
Linkadge
Posted by beckett2 on November 19, 2019, at 19:00:47
In reply to Re: Horrible anxiety relapse (still reeling) » Lamdage22, posted by linkadge on November 19, 2019, at 7:46:14
> Thanks for all the responses. I haven't really changed my nutrition at all and haven't refilled my meds.
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> I'm doing a wee bit better. I increased my lithium to 600mg and have continued the clonazepam.
>
> I'm still waking up at 3-4 in the morning with crazy adrenaline release. It's the same feeling I get like I'm about to run a big race (can feel it in in my kidney area).
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> A working theory is that (perhaps) was in a hypomanic episode (not convinced) that suddenly collapsed into depression. I have been working quite a bit of overtime, and I thought I was handling it well.
>
> I know that cortisol rises in the morning, but its like its happening much earlier and MUCH stronger than usual. When it happens its like NOTHING can override it.
>
> Linkadge
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>I'm glad you're feeling a bit better. I think I understand your description of of a jolt originating from the kidney area :(
Do you have daylight savings in Canada? Maybe you've considered your dark therapy.
My TCM practitioner thought pork strengthened the kidneys. Also, there is a Japanese garment, a harimake. During the winter I wear a camisole for the same effect, esp at night. I imagine they could be made from a tee shirt or old sweater.
(Just an example here) https://www.amazon.com/Binchotan-Haramaki-Warmer-Bico-Charcoal/dp/B01IB0XONU
Posted by ed_uk2010 on November 20, 2019, at 17:16:15
In reply to Re: Horrible anxiety relapse (still reeling) » Lamdage22, posted by linkadge on November 19, 2019, at 7:46:14
Sorry to hear you're not well Link. How are you doing today? Hope the increased lithium and added clonazepam are helpful.
Posted by linkadge on November 24, 2019, at 16:46:52
In reply to Re: Horrible anxiety relapse (still reeling) » linkadge, posted by ed_uk2010 on November 20, 2019, at 17:16:15
I'm doing a bit better. I am sleeping, but still some daytime anxiety and crying spells (hard to admit, but yeah).
I still don't know exactly what happened. I know I had a stressful 2 weeks leading up to this, but I thought I was handling it well. Daytime mood fluctuations are not typical for me.
Linkadge
Posted by undopaminergic on November 29, 2019, at 10:44:39
In reply to Horrible anxiety relapse (still reeling), posted by linkadge on November 17, 2019, at 18:14:15
For (short-term) drug treatment, you might try opioids. In my experience, for anxiety (or fears or nervousness), this class of medications beats the sh*t out of benzos. (The asterisk was added by the system, not me!)
That said, a better way (at least in the long term) to treat anxiety is psychodynamic (as opposed to "pharmacodynamic"). What works for me is to focus on the anxiety, trying to feel it as completely as I can, savour it, and even imagine that it is worse than what you're feeling. As a result of this exercise, the anxiety will subside faster than otherwise. No guarantee it works for you, but it's my best trick. I haven't felt anxiety for months.
How does this trick work? I think it has to do with "gating" mechanisms in the brain. Only one (or a few) thing can find its way through the gate, into your attention/awareness, at any given moment. When you have consciously registered a particular feeling (eg. anxiety or pee-neediness) fully, which you do fastest by noticing it and feeling it as fully as you can, the brain will consider the attentional item to be processed to its satisfaction, and allow some other item to come through the gate, and (for the time being) locking out the processed item (ie. anxiety) from the attentional gate.
Seems to me, that is how self-harming (eg. cutting yourself intentionally) works. When you harm yourself, the sensation of the harm will take over your attention, pushing the anxiety out. Some forms of self-harm will also lead to the production of endorphins -- remember that I recommended opies (synthetic endorphins) for short-term anti-anxiety treatment!
I never intentionally cut myself, but when my apathy has been unbearable, I have sometimes coped by beating myself in the temples with my fists. The more pain this produces, the better it works!
Cheers,
undopaminergic
Posted by linkadge on November 30, 2019, at 7:25:50
In reply to Re: Horrible anxiety relapse (still reeling) » linkadge, posted by undopaminergic on November 29, 2019, at 10:44:39
Hey Undopaminergic,
I have been doing better recently (slowly). Thanks for the tips.
In my profession, I encounter many students who self harm and I've never understood it. What you say makes perfect sense (as a way to distract, and get an endorphin release). However, exercise will give you that endorphin release (with an added endocannabinoid and phenylethylamine boost). I suppose what I am saying is that going for a run puts me in a much better mood than if I punch myself in the temples (much better for the cardiovascular system).
Linkadge
Posted by Lamdage22 on November 30, 2019, at 13:07:04
In reply to Re: Horrible anxiety relapse (still reeling) » undopaminergic, posted by linkadge on November 30, 2019, at 7:25:50
Exercise FTW. It raises self confidence.
Are you a teacher?
Posted by undopaminergic on December 2, 2019, at 7:43:18
In reply to Re: Horrible anxiety relapse (still reeling) » undopaminergic, posted by linkadge on November 30, 2019, at 7:25:50
> However, exercise will give you that endorphin release (with an added endocannabinoid and phenylethylamine boost). I suppose what I am saying is that going for a run puts me in a much better mood than if I punch myself in the temples (much better for the cardiovascular system).
>Note that I am not suggesting beating yourself in the head produces endorphin release. It is probably more of a distraction, or a third mechanism that I am not sure what to call it; perhaps it is that I feel I've "done something" about the problem (subjectively) and I feel a degree of satisfaction that I have accomplished something.
I'm sorry I have never noticed the "runner's high". But everyone (who says anything at all about the topic) says exercise helps, not only for depression, but all sorts of things. The greatest problem is that when you have apathy, you need an almost tremendous amount of will power (determination) to push yourself to exercise adequately.
I enjoy going for a walk, but this kind of exercise is probably not intense enough to reap the benefits of exercise. It is more recreation for me, and just to kill time.
-undopaminergic
Posted by Lamdage22 on December 2, 2019, at 9:21:55
In reply to Re: Horrible anxiety relapse (still reeling) » linkadge, posted by undopaminergic on December 2, 2019, at 7:43:18
That's true. But once you are doing it you feel like a champ. With severe apathy, it's not really realistic. But if you feel you can do it, you should do it to reap the benefits.
I get better in waves. Hmm. Trazodone helped me into the gym for a few months before partial poop-out and then the addition of blueberries and supplements. It may sound stupid but it's true. I feel like the improvement from supplements (i count blueberries as a supplement, too) do not poop out as Trazodone did to some degree.
I don't think meds get you in the gym, they just create a baseline where you have enough energy to even consider it.
I still have apathy at times.
> But everyone (who says anything at all about the topic) says exercise helps, not only for depression, but all sorts of things. The greatest problem is that when you have apathy, you need an almost tremendous amount of will power (determination) to push yourself to exercise adequately.
Posted by linkadge on December 2, 2019, at 16:11:42
In reply to Re: Horrible anxiety relapse (still reeling) » linkadge, posted by undopaminergic on December 2, 2019, at 7:43:18
I agree with what you are saying, but if one is willing to subject oneself to pain (i.e. via self injury) then one (in theory) would be willing to exercise (also inducing pain - if not in shape). Again, not to disparage others (as I don't understand their situation) but I think there are many more productive ways to get an endorphin release besides cutting or other self injury.
The runners high for me only starts after about 30 min of running. I wouldn't even call it a high as more as it is anxiety relief and a sense of wellbeing.
The high is intensified by taking an MAOI, which does lead itself to the theory of PEA release.
Linkadge
Posted by linkadge on December 2, 2019, at 16:15:47
In reply to Re: Horrible anxiety relapse (still reeling), posted by Lamdage22 on December 2, 2019, at 9:21:55
Just to add, sometimes I don't have the energy to exercise (but I know I really need it). When really depressed (no energy to exercise), I mix fo-ti (MAO-B inhibitor) and PEA in a bottle of water.
Then I start to run and slowly sip it (as needed) to give me the energy to keep going (at least 30 min). I only take small sips as it can increase energy levels fast!
Again, I'm not recommending this, but more that sometimes I use meds (judiciously) to get the energy to exercise, because I know that when I do get going my mood will improve (and can sometimes stay better for a day or two afterwards).
Linkadge
Posted by Lamdage22 on December 2, 2019, at 19:20:21
In reply to Re: Horrible anxiety relapse (still reeling), posted by linkadge on December 2, 2019, at 16:15:47
I agree that MAOI intensify it. Well, if your heart is ok with that strategy... No palpitations?
Posted by undopaminergic on December 4, 2019, at 8:39:06
In reply to Re: Horrible anxiety relapse (still reeling), posted by Lamdage22 on December 2, 2019, at 19:20:21
> I agree that MAOI intensify it. Well, if your heart is ok with that strategy... No palpitations?
>I don't know about palpitations, but MAOIs (at least non-selective ones) lower blood pressure.
-undopaminergic
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