Anxiety and Missing Medication Doses. A Missed Effexor Dose.

I woke up from my husband’s alarm this morning. It’s Saturday, and what most people would consider a day to sleep in. But for us almost every week for a different reason, for the past 9 years- there is some reason to get up.

6am today.

The beeping jarred me awake from a very vivid dream that I try to hold onto for a moment or two- trying to make sense of what it meant.

At some point just moments later, I realize that I feel EXHAUSTED. I mean exhausted, in case the uppercase didn’t relay this feeling well enough. Next I notice an almost unbearable throbbing of my head. My nose is stuffed. My mind is racing for no good reason. So badly that my heart and breath (with stuffiness) matches the anxiety.

But there is a reason for anxiety. We are moving and had just spent a week in the new house meeting with contractors, getting quotes, installing ductless air… working for work… working around the house… managing upcoming renters and our mostly adult children. A week of some big changes too. Devin, the youngest of our brood of 4 passed his road test on Thursday. Days of carting kids are just suddenly over.

I went through this week like any other. Feeling like I’m going through the motions to get to the next step. Feeling like I’m barely hanging on and can hardly make it another day at this pace. Telling myself and my husband that we cannot keep going on like this. That the work we are doing has to be for some great reason so in the near future we can finally rest.

Massive changes taking place around me hardly phase me. If I went back to every week in the past 9 years- nearly every one of them would show at least one or two mega great changes and things to celebrate or mourn. It’s constant. This week was really like no other. So why am I anxious today? It’s no secret I struggle with anxiety disorder and PTSD. But it’s felt very under control for about a year now with a few relapses. Why now?

I think back to yesterday when at some point around 2 or 3pm in the afternoon I felt unbelievably restless. Then it turned to feeling trapped. Next I’m frantically texting my husband about how I feel. This alone is an old familiar feeling. I hadn’t done this in about a year either. I’ve had relapses of panic and/or PTSD episodes, but this one is different. It feels a little more uncontrolled.

We’ve had workers in our house since Tuesday around the work day clock. They were supposed to be done Wednesday. Then they said Thursday. Thursday when I arrived home at noon they were still there. 7:30pm and wanting to eat dinner with no where quiet to sit… they are still there. Thursday evening they say they will need to come back for a half day Friday (yesterday). I am ready to go back to our home on Cheshire. We have renters coming today (Saturday) and I haven’t been home in a week. We are also going to Long Island. I’m starting to feel overwhelmed again. Like I have no time for myself. There is so much to do. I’m sick of eating take out, I want to cook but need to shop first. The house in Cheshire is on the market and I can’t even think about what it might look like after my quite messy 22 year old came home for the month of Aug. I can’t bear to look at my broken fingernails with dirt underneath due to the copious amounts of yard work- and there is more to do in Cheshire. My body is sore from what feels like non stop physical labor from cleaning, fixing, working. I have bruises, bug bites and cuts everywhere. I need to unpack my clothes and loads of food in Cheshire only to pack an overnight bag… then unpack again Sunday.

As the hours tick by and the workers are still there- relaying they are ‘almost done’ every 1-2 hours. I become increasingly more agitated. At 4pm they announce they are in fact done and start to clean up.

I drive home in commuter traffic with a car packed to the gills with air conditioners, food, photo albums, clean and dirty clothes, frozen items defrosting rapidly in the nearly 90 degree heat, amongst a myriad of other things. My car is constantly packed with stuff to cart from house to house or to drop off here or there. My anxiety starts to go over the roof.

Somewhere on Route 10 about 20 minutes away from home while moving at a snails pace I start to cry. Really really cry. And it feels good. It’s a release of all the toxicity I feel has been building up that I just pushed away and dealt with.

Long story short I get home and feel fine, but the night is filled with mixed emotions ranging from sadness to anger to despair to PTSD related thoughts. I’m crying, then laughing.

What is wrong with me?

IS there anything wrong with me?

Wouldn’t most others hit a limit of feeling like it’s too much as well?

To add other weird fuel, I have 4 known trigger dates that I’ve identified in my PTSD treatment. Trigger dates are times to rest and realize your body recognizes similarities in the atmosphere (light falling certain ways, temperatures, smells, etc). One should rest because our lower brain only feels these things without rational thought and goes into fight or flight mode in an attempt to protect itself. If we don’t consciously pick up on this with the higher brain, the lower brain shuts the higher one down at a certain point to divert all energy to fight or flight. This used to happen to me a lot. With and without dates, brought on by other known triggers. The only thing is you don’t know when those other triggers will strike. At least with dates there is an ability to prepare and take it easy.

Three out of four of my most prominent annual trigger dates take place on & around July 9th through on & around August 9th.

I’m not taking it easy or treating this time of year with any special care. In fact I’m feeling busier than usual and barreling ahead like someone is chasing me.

As I move around in bed my body hurts in every single which way. Mind, belly, headache, muscle pain, sinuses, heart, third eye.

I mentally go through the morning and imagine going downstairs for coffee and to take my daily dose of Effexor. That is when I horrifically realize that I never did take my medicine yesterday morning. Pieces of the puzzle start to fall into place. My emotional breakdown and complete instability last night. The way I feel today. The feeling of being trapped yesterday. It makes sense.

More often than not if I forget my pills by 10am I have a dizzying headache and feel crazy nausea. I take them as soon as I remember and I’m fine within a few hours. No head ache yesterday. No head ache = no physical reminder something was amiss. Only hours later when my old mood symptoms returned did anything feel off.

So is it the chicken or the egg??? Anxiety from missed dose or missed dose due to anxiety.

Both??

Twice this week when going into work I forgot my pills. One day my husband delivered them and the next I had some in my car. Perhaps I’m anxious, my thoughts are jumbled and I can’t remember?

Is this anxiety or is what we are going through something that would make anyone anxious? 9 years of non stop activity and life momentous life changes taking place back to back (divorce, kids driving & going through all firsts of puberty, graduations, college starts, new jobs, house moves, new schools)

Is it my trigger dates?

Do societal expectations to do it all, hurry faster, give and experience as much as you can cause anxiety? Would my PTSD kick in less if I weren’t so busy and experienced the same levels of increasing anxiety that society in general seems to feel? I know I’m not the only one. Stress and anxiety seem to be a quiet epidemic virally rolling through our nation like a barely detectable tsunami before it strikes.

Does it matter to me where it’s coming from?

This morning I cried some more. I cried because even though I know how sick I get when I miss a dose, I didn’t realize how much the Effexor was keeping the anxiety at bay. Like I said I’ve had relapses. But yesterday’s was something different all together. It was like I never started a single pill and I was right back to where I was before I began dealing with this issue. It feels like a complete and absolute loss of thought and emotional control. The lower brain did take over. It sensed some kind of danger and shut the rest down. It’s terrifying. But I do have to admit the crying jags feel really good! They actually hurt physically in my heart, throat and head- but it is like there is a release of pressure in those areas and it is coming out. Am I not allowing emotion to pass through by taking pills?

The struggle is real. The pills really work. The issues are complex and are both personal and societal.

There is no point to this blog other than to just wonder, chicken or egg? To share with others how missing a dose feels because an hour ago I wanted very badly to read someone else’s experience. To see how long it was before they felt better once they took their dose. To see if anyone else wonders if their life experiences would affect anyone or if there is something truly wrong with the wiring in their brain. 9 years of running around and with delayed onset PTSD creeping in slowly through that time. Would an occasional breakdown be expected?

I used to be so afraid of the thought of having a mental illness. So afraid I didn’t even want to find out. It’s stigmatized.

Once I couldn’t take it any longer and started meds, I was afraid of anyone I know finding out.

Now I just want to shout from the rooftops that it is ok, you will be ok. We all struggle. As soon as we stop pretending we are struggling & that all is hunky dory- it miraculously becomes easier.

Why is that? Because we let the emotions pass rather than holding them down & hiding them? Does the medication prevent real healing then? Or is it a bandaid?

I don’t know. All I do know is that I’m starting to feel a little better about 2.5 hours after my dose this morning. I haven’t left the couch yet so I can’t speak to the level of feeling better other than I’m not suffering through stillness any longer.

Writing about it and seeing my fleeting thoughts in front of me helps.

If it helps anyone else too either now or in the future, then all the more beautiful.

Esterina

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Lexapro Journal (Continued)

I’m writing this blog as an update to the Lexapro 100 day Journal one that I wrote back in 2016.

I don’t blog that often, but when I do check the statistics for the number of readers, I see that between 3 and 15 people each day read this article. It is the only article that picks up any traction after the first few days post publishing. I has received more hits recently, so I’m not sure if it show up higher on search engines; but in any case it’s amounted to a few thousand people who have at least opened it. Doesn’t mean they read it through though!

When I tried to go off Lexapro just a little over a year ago, I wrote another blog entitled Lexapro Rollercoaster. I haven’t written anything about it since. I’ve been approached by so many people (some I know well & others hardly at all) who have read my blogs. Folks have asked for advice, inquired how I’m doing, or wanted to share that they or someone they love has experienced the same thing. Because I see that a few thousand strangers have read some of this as well, I wanted to follow-up as Lexapro wasn’t my answer.

I didn’t particularly have a love affair with Lexapro. I started it in March 2016. It seemed at first to be to a miracle drug. After several months the side effects kicked in. Particularly they were the two I was most afraid of – decreased interest in sexual activities and weight gain. Initially I thought it was a fluke and both would pass. But as pounds kept adding on and I felt less and less inclined to indulge in carnal activities, I knew it was the medication.

In January 2017 I didn’t feel like I needed Lexapro any longer. I felt stable emotionally. My primary care provider talked me through tapering off. It was a little difficult because I felt physically sick, but that passed after a few days. A few days later I felt off kilter emotionally again. I went back on Lexapro the same way I went off, but this time I held the dose steady at 5mg to test out how that made me feel. I immediately felt better, as I had the first time I went on. At 5mg I didn’t have the unwanted side effects. Fortunately my BMI had always been on the low side, and even with all the weight gain I was still in a normal range. I didn’t lose any weight, but I didn’t gain more either. The other department I feared was also in check. But my moods weren’t steady. I could get hyped up at anxious about almost nothing, and angry at the drop of a hat. I felt off balance. Nowhere near as badly as I originally did, but not as great as I did at 15mg either.

I believed with some meditation and a deeper yoga practice I could keep taking 5mg, feel better and go off completely. I set a soft goal to go off Lexapro before the start of summer in June. But I didn’t deepen my yoga or meditation practices. I didn’t have time to, I was as busy as ever. Although I cut down my professional hours at work; I taught as much yoga as I could without being picky and I wasn’t even doing my own practice. My husband and I started renting out our second home in Branford and I was managing all the rentals and turnovers. Even though I changed the stressors in my life, I unknowingly added different ones back in.

In May that year I took a 50-hour training in domestic violence and sexual assault in order to teach yoga at safe houses in Connecticut. One evening during a presentation about PTSD, I realized with unbelievable clarity that the slide I was looking at described me perfectly. Until then I have prided myself for rising above being a childhood victim of domestic violence and putting it behind me. It wasn’t until that evening I realized I was indeed affected by my past. The ground slightly shifted beneath me, but I wasn’t sure what to do about it.

My emotions became more tumultuous after that. If I was more aware of myself I may have noticed Lexapro really wasn’t helping anymore. One evening in July I had the worst emotional breakdown I ever had. I knew I needed help in a different way. After a little research I filled out some FMLA paperwork and cleared my calendar so I could spend a month in intensive outpatient mental health treatment.

Under the care of the facility, I started to decrease my 5mg of Lexapro daily to once every other day until I went off completely. I felt great. I had no responsibilities during this month other than to care for myself. I journaled daily after my sessions. For the first time ever, I had the time and was willing to really think about how I feel, where my assumptions and habits formed, and how I got to be where I was mentally, physically and emotionally. I was able to sit and question whether or not I wanted to do those things or if they were just maladaptive habits I had from childhood. I made conscious, well-thought out decisions about what I wanted to do, what I wanted to keep in my life and what I wanted to let go.

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I needed follow-up after the program with some type of regular treatment. I’ve gone to weekly couch talk therapy for years on an off and never found it helpful. With the advice from the program I just completed, I researched local therapists that specialized in the exercises we used that I found most helpful. I messaged a few by reaching out and providing a short background about myself. It was easy to discern who I might have a connection with through upfront written communication. I settled on someone local that I thought might work.

When I finally met my new therapist, before she asked me anything about myself; she explained some practices and tools she uses and why. She described the energy and meridian lines that run through our bodies and explained that most people start to question their lives after they meet their goals toward success (or the second half of life). She didn’t need to go on any further, I was sold. Energy, questioning life and it’s purpose, Pema Chodron quotes on the wall, a jiggle jar on the table, a semi-organized non-dusty dank/dark room… This is the therapist I was looking for and never knew it. Additionally, since I had just finished a month long intensive therapy treatment, I knew exactly what things I needed to work on and where they came from. For the first time I felt like I had clear therapy goals and found someone who spoke my language and could help me.

Around the same time I started therapy, I started a 9 month advanced yoga teacher training. This training wasn’t all that different from the standard 200 hour teacher training, but it was far more in depth. This time, having a new-found goal of self-care and making time for myself, I was actually deepening my own yoga practices. I also started a daily sadhana (spiritual practice).

I was only in the training a few weeks and saw my new therapist a handful of times before taking several weeks off for a trip I had previously planned with my husband. I was off medication and only using some new techniques and my sadhana practice to keep everything in check. It was going very well.

Once we returned from vacation I had to cancel my next therapy appointment. I got busy and fell back into the older routine of not making time for myself. After just a few days of skipping sadhana and not doing the therapy exercises, I was completely off balance. It took a full week of being back on the wagon before I felt like myself again. Two more weeks passed and I again made the decision to skip my practices for a few days because I became busy with the holidays. Again, not shortly after I felt incredibly unstable.

For a myriad of reasons I didn’t have a therapy appointment scheduled for several weeks. One day during work when I felt like I was completely unraveling, I called my PCP for an appointment to discuss anti-anxiety meds again. I received an appointment for me the next morning. I spent the evening online looking up various medications that I might ask about. I didn’t want to use Lexapro again and was fearful about gaining even more weight or losing that loving feeling again.

When my provider asked why I went off Lexapro, she asked me to consider Effexor (Venlafaxine). It’s not for everybody, but most patients don’t report weight gain or sexual side effects. I had nothing to lose.

The first evening I took Effexor I felt incredibly sick and disoriented. My husband said I looked and sounded drugged. The next morning I woke up feeling like I had a really terrible hangover. I was groggy, dizzy and nauseous. Sometime around dinner the next evening I didn’t feel dizzy if I wasn’t moving. I was able to eat. I was almost feeling normal by the time I was ready to take the next pill. The next pill brought the same side effects, but they were about half as bad as the evening before. The following day by lunchtime I felt as good as I did at dinner the previous evening. On the third morning I had some vertigo for just a few short hours. I have since experienced zero effects.

Exactly one week after beginning Effexor, I made a nice dinner for my husband and I. We enjoyed it with some wine. As we were cleaning up and getting ready to watch a movie, I was dancing around doing silly kicks and laughing. My husband said I looked and sounded really happy. To which I replied “You know what? I am!” He said it must be the wine. I laughed it off but thought about how we have wine often but I often don’t feel that way. I considered that it might be the meds. I hadn’t felt that good in a long, long time. Before I started “waking up”, having anxiety, questioning the second half of life, giving myself time to contemplate the trauma that I made myself too busy to think about…. I felt like my old self, minus all the stress.

The next day I realized I felt just as good. I felt good the day after that as well, and so forth for the next several weeks. Sometime in January I became busy again and starting skipping self-care. Like the previous experiences, I wasn’t myself. However, this time it took just two days of practice to feel good again. Then again two weeks later I skipped my self-care and practices three days in a row. Not surprisingly I fell right back into the hands of anxiety and stress. It was then I realized that I need to continue to make self-care a priority.

It’s been approximately 2 straight months since I have felt balanced without excessive anxiety. I continue to take Effexor, go to therapy and do the “work” and self-examination it takes to improve mental stability.

Thanks to the program I spent a month in last summer, yoga, and therapy – I’ve received the reinforced message that it is not only ok, but necessary to take care of yourself. I know some people take that too far, but for me taking it too far was never even close to an option. It was almost a necessary survival tactic to stay so busy that I would never have time to relive some of the trauma I was trying to avoid until my body was ready to process it. Instead of running from it, I’ve learned it’s not going to hurt me and sitting with it is the only way to get through it. Sitting with [dis]-ease has only become easier and helped me in all types of other areas of my life.

I still don’t have a magic answer for anyone looking for help. Lexapro was my start. I have my own personal combined strategy that is feasible and working for the time being. For anyone struggling with anxiety or depression – there is no magic pill. It has taken me two years to find something I can keep up with and works. I had to look to where it was coming from. For me that was a strain of PTSD. I had to figure out what works for my body. And I had to find a therapist that I really feels can understand the issues that I struggle with. I hope to sustain some level of sanity while I heal and deal with old issues that have plagued me. I truly am happy and feel more better and better each day. I trust there is something for everyone and it won’t look anything like what helps me. Like I said, unfortunately there really are no magic pills.

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