Anxiety

Adventures in Gabapentin

Well that was a complete bust now wasn’t it.

My anxiety levels have been steadily rising as my depression got worse, so I decided with my doctor to start an anti-anxiety medication that is suitable for people with bipolar disorder, such as myself. Of all the medications out there, there are two that fit the bill: seroquel and gabapentin. I’ve tried seroquel in the past. My main concern with seroquel is that it generally makes people gain A LOT of weight. And I just can’t handle that. So there is no way I’m letting a single pill pass my lips. So that left gabapentin.

I took my first dose in the early afternoon, when my anxiety is at its peak. A mere hour or so after I took it, I began to get weird cold-like symptoms. I, naturally, thought these were just a coincidence and that I was getting sick. It steadily got worse, until it looked as if I had a full on flu. At this point, I am still taking my gabapentin. Until my lips started to swell. They puffed and they puffed. They swelled right up. It was actually really scary, I must admit. I googled gabapentin side effects and it popped up basically telling me to go to the hospital – which is advice I didn’t heed… I just did not want to go to the hospital. So instead, I slept for about 17 hours in a row…

I texted my case manager, who then consulted with the doctor – he said to stop taking the gabapentin.

So I’m left here, out of anti-anxiety options. I’m just begging the universe to let my anxiety symptoms subside as my depression eases….

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Anxiety · BPD · Eating disorder

Exposure treatments

The treatment of my mental illnesses has always been complicated, but in recent times my treatment plans have gotten more complex and gained a depth previously unseen in my life.

I have five distinct psychiatric diagnoses, and often these require different types of treatments. It is not a case of “hitting two birds with one stone” – in fact, my treatment is mostly the opposite of this.

The treatment of my adjustment disorder (also known as situational depression) is the simplest of all my treatments. This diagnosis refers to my inability to handle change, and my tendency to be thrust into a triggered depression in reaction to changes that I experience. I simply do not have the mental flexibility or agility to be able to adapt to changing circumstances. This affects all of my treatments, as to heal, one must change, Therefore, healing is made doubly hard for me since, subconsciously, I don’t really want things to change. In short, change, even for the better, is scary. Treating my adjustment disorder is mostly a matter of lifestyle changes and treating the symptoms of depression as they hit me. This means that I try and avoid triggering situations, such as those with extreme changes implicated. When change is inevitable, I try and break the change down into smaller pieces, to be faced individually and in a measured fashion.

The treatment of my anxiety disorder is mostly medication driven. I take an anti-anxiety medication that works very well to combat my chronic anxiety. Medication also assists in the treatment of my bipolar 2, with an anti-psychotic serving to stabilize my moods and maintain stable moods.

Now,¬†exposure therapy is the idea of exposing yourself to triggers in a controlled and risk free environment to acclimatize yourself to these triggers. This is my newest treatment that I have been exploring to deal with my BPD symptoms, and it is by far the most successful and effective. I’ll illustrate this with an example: I get chronic feelings of emptiness, and often feel as if I’m not real or don’t exist if I’m not involved in a task or in the presence of other people. This results in a dread and despair in the prospect of being alone. I am usually unable to handle these feelings and thus seek out refuge in the grounding and validating company of people. However, lately I’ve been in situations that require me to be able to handle my emotions during periods of alone time, ie. when my boyfriend goes to work and I am left on my own. At first this was an unbearable time. But as I continue to push through my emotions, I am finding that I am increasingly able to spend time being content and alone (such as right now!). In this way, exposure therapy is helping to improve my quality of life immensely.

Exposure therapy is not suitable in treating my bulimia. This is because I am still in the midst of its clutches and I have not yet been able to separate myself from the eating disorder as of yet. I am it, and it is me and while I know that isn’t necessarily true all of the time, circumstances arise where I am triggered by the tiniest thing and end up engulfed once again in my eating disorder. Once I have been able to cultivate a little bit of space between myself and my eating disorder, then I shall try exposure treatments again.

 

Anxiety · BPD · Eating disorder · Life

The many formed monster

I participate in many forms of treatment for my mental illnesses. There isn’t a single “cure” for any of them, therefore the treatment must be approached from many different sides. I take a combination of prescription drugs and natural remedies. I see two different therapists, who both have distinctly different approaches and views.

My medication journey is a long and tired road, commencing in September 2015 with a prescription for lithium to treat a misdiagnosis of bipolar one disorder. Ever since then, I’ve been experimenting with a variety of different combinations of psychiatric drugs: lithium, valproate, abilify, olanzapine, venlafaxine, prozac, cipralex, rispiridone, seroquel and ativan. I currently take abilify as a mood stabilizer, venlafaxine as an anti-anxiety and anti-depressant, and prozac as a treatment for bulimia. The first two work well for me, and the third (prozac) is new, so I have no information about its efficiencies. Taking prescription medication can be really hard. My issues stem from the thought that “I’m not good enough on my own”. It feels like a weakness, rather than an illness. I feel guilty for having to take these medications. Here is where one can use the cancer comparison. Say you had cancer. Would you feel guilty for doing chemotherapy? No? Then you, by the same logic, shouldn’t need to feel guilty for having a mental illness and for having to take medication to help your symptoms.

To treat some of my borderline symptoms, such as the feelings of emptiness that I experience, as well as much impulsivity, I use medicinal cannabis. This is a rather stigmatized thing, however, it helps my symptoms immensely. When I use cannabis, I take it orally, and I take only Indica strains. This is a strain that has more of a mellowing effect, and tends to relax rather than excite. I take anywhere from 17.5 mg THC to about 100 mg THC. The amount depends on the severity of my symptoms at the time. I turn to cannabis when I feel extremely impulsive, or when I feel unbearably empty. It can also help to break a bingeing and purging cycle.

My therapy is a double edged sword, with two different therapists playing a role. My private therapist is a DBT (dialectical behavioral therapy) specialist. DBT is the most often recommended treatment for BPD and chronic suicidality. It was developed in the 90’s by Marsha Linehan, who is my personal hero. She suffers from BPD as well, and she created a treatment to help her personal symptoms, and with her treatment of her own symptoms, ¬†she managed to create a whole treatment plan for an entire demographic of BPD sufferers. The therapy itself is of the approach of radical acceptance. This is the idea that it is possible to both be content and happy with something – accepting it – while simultaneously striving to do, or be, better. In this therapy, which I attend once a week, we do tons of behavioral analysis, meaning that my therapist and I deconstruct events in my life to identify triggers, and learn from mistakes made. DBT believes in the powers of both distraction and mindfulness, and thus draws on theories relating to these for treatment plans.There are many skills and strategies that come with DBT, including my self soothe kit (a bag full of things that calm me down or cheer me up), mindfulness strategies and distraction techniques.

My second counselor takes nearly the opposite approach, by trying to fit everything into a bigger picture to make sense of my symptoms. While my DBT therapist is extremely granular, my counselor is very abstract and theoretical. We do a lot of thinking, realizing and epiphanizing during these sessions, which I also attend once a week.

I see my psychiatrist regularly once a month, but more often if I happen to go to the hospital anytime in between.

I try many lifestyle treatments too. By adjusting my creative output and thinking, using mindfulness techniques such as meditation and reducing the stressors in my life, I am able to maintain a semblance of control over my life. I use this blog as a method of reflection, and it allows me to verbalize end express a lot of my emotions in an indirect method of communicating, which I find I am more comfortable with in general.

I also am training my dog Pippa to be (eventually) a PSD (psychiatric service dog). She will be trained to alert me to mood changes and remind me to calm down. She provides an acute anti-anxiety treatment, as an alternative to drugs such as ativan or seroquel.

My treatments are many-pronged, and varied. However, this strengthens the approach that I take towards my mental illnesses. From drugs to cannabis to dog therapy to lifestyle choices; the focus of my life at the moment is working on myself and healing my mental illness.

Anxiety

Anxiety attacks: what to do?

While I do not appear to suffer from panic attacks caused by a panic disorder (a type of anxiety disorder causing severe and usually random panic attacks), I do experience anxiety attacks about once every two weeks on average. The difference that I see between these anxiety attacks and a true panic attack is that mine are usually triggered (side note, when I use the word “triggered”, don’t laugh – I know it’s a joke practically now – I really DO get triggered…) by an external situation.

Combine my already heightened anxiety due to GAD (Generalized Anxiety Disorder) with an extreme sensitivity to external stimulus and an impulsive emotional reactivity: you end up with a Jenna-like anxiety attack.

So what’s a girl to do in this situation? Here are a few things that I always rely on to bring my anxiety levels down:

  1. Time. Anxiety levels cannot stay that elevated for an indefinite period of time – that’s a fact. With enough time, I will always return to my emotional baseline.
  2. Tea. Drinking tea, especially if it’s not too hot, will always serve to calm me down.
  3. Eating mints. Mint flavoring is such a calming thing, that I often eat tic-tacs or mentos periodically throughout the day as a preventative measure, to keep my anxiety levels down.
  4. My “self soothe kit”. This is a therapist suggested “chill out” strategy. It is basically a bag of stuff that is supposed to soothe my senses. To soothe my sense of sight, I have pictures of happy times. To soothe my sense of smell, I have rose essential oil. To soothe my sense of touch, I have soft fabric. To soothe my sense of hearing, I have earplugs. To soothe my sense of taste, I have mints.
  5. Being in the presence of people. Since my anxiety attacks are often triggered by social interactions, and in particular a lack of belonging in a social interaction, the cure for this is genuine socializing.
  6. Being somewhere familiar AND calming. This could be my garden, or my room in particular. These environments are easily controlled and are comforting to me. Mood lighting, such as candles and soft lamps also help.
  7. Thinking with “rational mind”. I will explain more in detail what the terms rational mind, emotional mind and wise mind mean in another post. For now, it will suffice to say that rational mind is where my logic and higher thinking powers live, whereas emotional mind is powered by feelings and impulses. When I am extremely anxious, there is no use of rational mind. To counter this emotional mind takeover, use rational mind. To do this, remind me to “think of the facts”. If this comes up empty handed, I can do math problems, or genetics problems to try and calm me down.
  8. Being with my dog Pippa. ‘Nuff said there. Dogs are obviously some of the most calming things that have ever existed.
  9. Distractions. Things such as gardening, knitting, reading, writing or doing an art project, will all serve to distract me from my feelings.
  10. Eating food. While this is never my first choice of anti-anxiety treatments due to my bulimic tendencies, it is a sure fire way to calm me down.

If absolutely NONE of these work, medication may be necessary (such as Ativan or Seroquel). If I begin to get even a little suicidally minded during an anxiety attack, call a crisis line (VIHA crisis line: 1888-494-3888) and get me to talk on the phone to the people there.