Trial and error for meds sucks.

June 18, 2011 7:49 AM

MentalhealthFilter: dealing with the trial and error of meds, wondering if it's just me or if it's really a brain issue.

I've been listening to Pema Chodron's Getting Unstuck and it really helped for about a month. I listened to it whenever I was in my car and I tried meditating and being mindful, and I've found some help with some of the techniques. But it still feels like I'm just barely keeping a beast at bay.

I really hated my job and then I got laid off late last year (yay! seriously, my job was making me very stressed on top of my mental issues). i got a nice severance package, my unemployment is pretty decent and my SO makes enough that I don't need to worry, so I'm back in school for web design and development. I really like it. I have an internship and also really enjoy it in a way I have never enjoyed any other job I've ever had (I'm 32, been working since I was 14.) I feel genuine satisfaction that I can do it, I am good at it, and I can figure out how to do something if I don't know how already. So it can't be work/school that's making me sad.

I've tried so many medications while under two different psychiatrists over the past 4 years. I have been in talk therapy also for several years, two different counselors. I have symptoms of ADHD inattentive, GAD, Bipolar II. But meds don't work, at least not for long. my psychiatrist has me officially diagnosed as ADHD, but is baffled by (non)reaction to medications for all of the above disorders. both psychiatrists i've seen definitely think i have a mood disorder.

Adderall will work for a few days or weeks and then it's like I'm taking nothing, even at increased doses (up to 60mg per day), even in the XR versions. Staterra and Vyvanase made me feel very strange and not in a good way.

Zoloft made me feel awful, like I was a zombie. Buspar, Wellbutrin, Lexapro, Lithium and Lamictal didn't really do much except make me spacey and/or sleepy. Ativan of course works great but that's only a once in a while thing. I've been on several types of sleep aids, none of them work. They either knock me out and I wake up four hours later, or they put me into some sort of fuzzy coma and then I'm just groggy all day. For all the medications, I've always taken them for the 4-6 weeks that the psychiatrist says is the trial period.

I feel like my whole life has been spent trying to just be able to LIVE. I've never been suicidal, but I've felt since I was a teenager that something just wasn't right. I have incredible self confidence issues that I think most people don't notice because I put up such a good front.

I'll go through these phases of feeling despairingly overwhelmed and then back to completely competent (hypomania?) while being involved with the same group of projects. (eg, taking classes at school and working or whatever).

There's not much middle ground. And the middle ground I do find feels so tentative, so fleeting. I'll have a great day where i feel free, like i can actually do that 'letting go' thing and 'be present' , i feel truly lighthearted. but it's just a day or a few hours, and then i'm back to foggy brained introspective barely keeping the beast at bay.

I feel like I'm constantly trying something new to get myself on track - changing my diet (at various times over the last 10 years - raw/whole foods, vegetarian, cutting out processed carbs, cutting out sugar, eating whatever i want, etc.), exercising or not exercising, this medication or that medication - it's your sleep, it's ADHD, it's depression, it's a mood disorder, it's perfectionism. Try CBT, try Feeling Good, try MoodGym, try keeping track of your moods (yeah that really doesn't work.) Everything is fine for a week or two or three, then I just can't keep it up. Keeping track of my moods is something i have never, ever been able to do with any consistency. i don't know how to answer the question or put it on a scale. i have tried keeping diaries and spreadsheets and like everything else, it just goes by the wayside.

Trying to get past more than a few weeks with anything, if I can make it that long is an epic willpower battle. Even something simple, like "I only have to exercise for 20 minutes 3xweek" ends up being just SUCH a struggle in my little brain. I think that at some point, something should have just STUCK. I mean, I'm better than I was several years ago, definitely, I've tackled a lot of difficult emotional things and yet still I feel this way. I graduated from college, I stopped biting my nails years ago, I stopped many self-destructive behaviors (drinking, smoking), i've gone through a lot of very hard therapy - but something as simple as exercising three times a week? I LIKE exercising, but it just seems like a such hassle sometimes. I don't understand. other weeks, i'll exercise for an hour a day, feel great and love it. but then other times, i push myself thru 20 minutes, and feel like it was an hour.

There's just always this underlying dissatisfaction with my life. If that's not a ringing endorsement for depression, I don't know what is. ha. But if it IS depression, then why don't meds work? When I find the right medication, I should feel BETTER right? And I should find that life is not necessarily "easier" but that it doesn't feel like so much of an uphill battle to not be sad, to not feel overwhelmed by everyday things?

I am just so frustrated with the medication trial and error...the weeks of being out of it, the feeling of failure at YET AGAIN some new plan to get better not working. I realize it's not a personal failing if it really is an illness. I mean, I just can't be this lazy and just lacking in life skills - if I was, I wouldn't notice all this and think it was a problem, right? Sometimes it seems like I'm just overthinking things, but other times, it's pretty darn apparent I'm not. maybe i just dont want to be a grownup and have responsibilities, but that doesn't seem true.

I haven't seen my therapist in a few weeks due to an insurance snafu, but I'll be seeing her soon.

Relevant info, since this is anon: I'm 32 years old, female, on birth control (Junel) that I take for 3 months at time before the placebo week, so it can't be PMS because this can all happen during those 3 months. I'm on pretty regular schedule of sleep/wake, I eat decently, I have a grande sugar free latte or frap from Starbucks almost every morning, some days I don't drink it all, some days I do. I've tried the calcium/mag thing and B12 and didn't notice anything the way some other folks here have. My dr is testing my B12 and D. i'll know in a few days. My thyroid has been tested twice in the last 12 months and came back fine. I've felt this way since I was about 12 or so.


tl;dr
- How do I deal with the trial and error of meds when I have to do things like work and school?
- When I find the right med, how will I know? Maybe I'm expecting too much from meds so I'm not recognizing when they do help? The fuzzy should go away, right?
- What on earth do I keep track of and HOW when there are so many variables? Mood, diet, exercise, whatever stresses I had during the day - how on earth do I keep track of the millions of things that could possibly be contributing to knowing whether I'm just handling things poorly (eg, low emotional intelligence) or if it's a brain malfunction or a carb thing or situational or what?

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posted by anonymous to Health & Fitness (11 answers total)

Sounds very frustrating. I'm going to sound like a broken record here but when you go back to the doctor to get your B12 and D tested have him test for Celiac as well. Lots of mood, energy and attention stuff can be connected to gluten intolerance. I have no idea about the non-effect of drugs - do you have a superfast metabolism? Good luck sorting it all out!
posted by leslies at 7:57 AM on June 18, 2011

1. unfortunately, just having to cope with it. I'm in school right now, it's seriously stressful, and I just mixed up my meds, which has made me .. grouchy and have difficulty dealing with people. Try to forgive yourself for this period of transition/trials - you're trying to take care of yourself, it's a hard process, you'll slip up and have problems for a while, but you have a goal with this. working on a lot of CBT/DBT skills for anger/emotional dysregulation/mindfulness has been helpful for this.

2. Finding the right med for me was realizing after a few weeks that I felt pretty okay, the world was alright, and the side effects were liveable. it was more of a gradual realization that everything had been okay for a little while, and I didn't feel terrible. The fuzzy often dissipates, but it's a lot like birth control -- people can react differently to different ones. isn't that the most profound sentence? some people can go through 10 different birth controls before finding the one that works for them.

3. to keep track of things: for a while I've worked on keeping little charts/tables: in the first column I write things like "Caffeine" or "Exercise" or "practiced banjo" or "socialized" -- things that I know affect my mood one way or another. in the top row I put the date, and check off things for the day to try and get some gauge as to what patterns of activity I might be able to correlate with mood stuff. put both good and bad stuff - when i only put positive stuff on there and i don't have any checkmarks for a day, it bums me out a lot more, and isn't helpful to keep track of things.

and finally, the last few things are just the same old same old crap: exercise (I have a baseline goal of the gym once a week), not eating crap/sweets. I'm glad you're getting back into therapy - part of getting that satisfaction back in life was just learning how to prioritize positive things for myself and be nice to myself.
posted by circle_b at 8:04 AM on June 18, 2011

First off, I would suggest enlisting the help of your SO to help you track your moods.Getting the opinion of an outside party can be helpful as far as a more objective assessment of how well you're functioning. The very things that cause us to seek treatment can also cloud our judgment of how we're doing; my son, for example--being a typical teen, of course, he is not fully convinced that the medications he's on are doing anything for him, but *I* can tell when things are working, when he's taking his meds regularly, and when he's getting inconsistent or has simply stopped. He's not magically "fixed", but he can cope much, much better with stresses. Ask your SO to check in with you regularly about how you're feeling--not only will this help you keep track, but it's an emotional boost to feel like your SO is looking out for you and engaged with your well-being.

Also, over the years, with myself I've developed some "benchmarks" that are a bit more objective and help me sort out the odd "crappy day" stuff from a genuine downswing/upswing in moods (for me, those benchmarks are things like: am I having insomnia issues 4 or more days out of the week? (not good), do I find myself thinking about my own death? (even badder), am I treading into suicidal ideation? (really bad)...etc).

Second, the medication trial and error thing can be really frustrating, and at least in the case of my kids and some friends I've known, there may not be any one "magic bullet" that fixes you back to normal, it may not be a common first-line med, or it may require a combination of things. For example, my daughter has a fuzzy diagnosis of "mood disorder", has some bipolarish/ADHDish/anxietyish symptoms and has tried a LOT of different things, some of which she reacted badly to (Zoloft), some of which were neutral (Lamictal), some of which crapped out after awhile (Abilify). She's wound up on a drug (Trileptal) that's fairly far down on the list of things you might try for a person presenting her set of symptoms, and which doesn't address everything she's got going on, quite frankly, but at least keeps her on an even enough keel that she can work on other things (like anxiety) through non-pharmaceutical means.

Or there's the case of my friend, who has basically the same symptoms as I do (ADHD and depression), and who has settled on a cocktail of good ole Ritalin, plus Zoloft, and Wellbutrin. That sounds like a lot of meds, but it's been working for her for more than 15 years now, and she's super functional on it.
posted by SomeTrickPony at 8:29 AM on June 18, 2011 [5 favorites]

I don't have an answer for you. Except from reading your post, I got absolutely exhausted, and can see how you are as well. I get where you are coming from and have dealt with some similar issues (I went the herbal route and am completely happy, btw), and I really hear your frustration. I know this is a problem you want to solve, but maybe take a break from 'constantly trying to resolve' it. A mental vacation might re-energize you. And it really sounds like you need it. Give yourself a month off from trying to fix yourself.
posted by Vaike at 9:49 AM on June 18, 2011 [1 favorite]

Boy do I know that old song and dance. I wish you the best of luck in figuring this all out. Here is what I figured out for myself:

1. I can't take Hormonal BCPs. Ever. Not light doses. Not some new combination. I don't take them. I can't take them. I want to take them. But I can't. It took me years to figure that one out. I had been taking them for over 15 years.
2. Wellbutrin and Ritalin is the pill combo that works best for me.
3. I never eat sugar. I mean NEVER. I almost never eat flour. Not white, not wheat, not rice. Avoiding those things forces me to eat a healthy diet... Once you cut out donuts, cheeseburgers, and pizza, well, there isn't much left.
4. Looking back on it, I used to be in a nearly constant state of dehydration. Now I drink water like a woman lost in the desert.

I've been amazingly stable for the last 4 years. I really hope you find a good combination. Some of us are more sensitive to our body chemistry than others.

Good luck. I know very well the feelings that you're having. I could have written your post.
posted by madred at 9:52 AM on June 18, 2011 [5 favorites]

My problems present a little differently, but generally I am in the same place you are. From the little I've read, you DO have a real mental illness and you are not suffering a failure of character. The reason you suspect you are is because that's the sort of virulent, blind, circular reasoning that depression (and anxiety) create and propagate in our weakened mental state.

It helps me to understand, through reading, the evolutionary explanation of my disease. Anxiety is hyper-vigilance. The animal that is constantly primed for the onset of danger will be quick to react to and avoid it. Unfortunately for me, my God-given skill is no longer necessary and now it is just hindrance.

My type of problem, and others that I haven't read much about, are just anachronisms. I don't know the provenance of your ailment, but I know that learning about mine helps me put it into perspective, for instance:

When I see a pretty girl but feel deep, prohibitive anxiety about talking to her, what I am really is a homo erectus afraid of showing improper or unsatisfactory courting behavior, because that raises the risk of me being excluded from the group, which lowers my risk of survival.

The same as my stage fright---if I perform the sacrificial dance wrong, I risk getting clubbed to death or booted out of the tribe, where I'll surely die for lack of ability to hunt large game on my own.

All these huge horrible feelings are million year old survival mechanisms that don't know they aren't outmoded.

Would you buy a damned iPhone that had a built-in phone jack for dial-up capability?
posted by TheRedArmy at 11:39 AM on June 18, 2011 [1 favorite]

Oh, and cannabis is not a cure but it can help with symptoms. If you're into that sort of thing.
posted by TheRedArmy at 11:43 AM on June 18, 2011

I think it's probably a brain thing.

Ordinarily I'd need a little more of a smoking gun for this answer from your present question or your other posts, but the fact that medication works for a little while then stops, the age of onset, the possible hypomania, the ongoing indefinable sense of something not right, the list of serious side effects of the two medications you can't tolerate (Strattera and Vyvanse), and the one that makes you feel like a zombie (Zoloft), taken together have enough of a whiff of cordite about them to make me think you may have an underlying seizure disorder.

If you don't want to see a neurologist or can't easily get a referral, and since your doctors seem to think you might have a mood disorder, you might consider asking them for one or more of the mood-stabilizers which are also anticonvulsants, such as Keppra and Neurontin.
posted by jamjam at 1:05 PM on June 18, 2011

I am newly diagnosed with bipolar II, and one thing that has helped with the medication trial and error is participating in a partial hospitalization program. The program runs from 9-3 each day and includes group therapy, DBT skills, med management with a psychiatrist, relaxation and meditation etc. I was previously diagnosed as severely depressed w/ADHD inattentive, so it's taken a while for me to get my head around the fact that the times I used to think I was "well" were really hypomanic episodes. Being able to really dig into that plus tinker with my meds daily if needed has really helped. If your insurance pays for a similar program, I would really recommend it.
posted by Biblio at 3:36 PM on June 18, 2011

Try eating more protein. Seriously, it keeps my moods way more stable.
posted by gjc at 7:39 PM on June 18, 2011

You mention your thyroid has been tested twice. Did the doctor/nurse give you a thorough breakdown of the results? Just because your levels fit within the "normal" statistical range doesn't mean that your thyroid isn't involved in your symptoms.
Read this: http://thyroid.about.com/od/gettestedanddiagnosed/a/normaltshlevel.htm
You might want to get a referral to a specialist to reexamine this.

Also, you say you have tried many different diets/behavior mods, but then say you have trouble sticking to things for more than a few weeks. Personally, all behavior mods (mindfulness, gratitude journal, etc.) take me months to be able to feel any effects. Diet changes take 6-8 weeks minimum for me to get noticeable effects, although I know lots of people say they can feel a difference within days. I think you might need to give some of these things more time. Try picking one diet change/behavior mod that you will work on for the next 4 months. You can fall off the wagon as many times as necessary, but don't give it up for something new until 4 months are over.

Feel free to take this with a grain of salt or ignore it - IANAD and I only speak from personal experience here.
posted by anotherkate at 8:20 PM on June 18, 2011