How Can I Retrieve the Self?

August 21, 2012 7:31 AM

Where did my "old self" go, and how can I get it back?

FWIW, I'm the anon from this question. Still struggling with the same issues and looking for encouragement/advice/relevant experiences, or any other input.

It's hard to know exactly how to explain what happened, but I'll try here:

I started taking a mood stabilizing med this spring, and while on it, I felt emotionless, so I decreased the dose. I then took a dip in mood, reinstated the original dose, and then struggled with pretty severe sleeping problems. My mood didn't recover, and I also started feeling really slow cognitively and really flat emotionally. I took a "sedating antidepressant" in combination with the mood stabilizer, with the goal of improving sleep and mood, but with no real luck. Throughout June, I slept terribly, and had an especially bad couple of nights of sleep in combination with the two meds, and I woke up one day to feel that my inner landscape of thoughts was *missing*. My pdoc added Prozac in July, but this didn't help-- I continued to feel like my inner self (thoughts, personality, emotions) had been surgically removed, and I was left with a verbal but empty husk of myself.

I gave it a month, and then started weaning off both the Prozac and the mood stabilizer. I finished tapering off a week and a half ago. I noticed a *slight* positive change last week (felt calm and positive for a few days), but my intellectual strength, ambition, emotions, and formerly enthusiastic, happy personality are still missing. My close friends notice that I can't make witty remarks, and I feel like my brain is still wrapped in thick, thick gauze.

My pdoc is flummoxed and thinks I'm suffering from depression. But I don't feel depressed per se. When I look at the neuroscience literature, it seems like my issues are consistent with frontal lobe problems-- but I'm wondering, how did this happen? And if one has a frontal lobe injury, how can it be repaired? Or did med changes or extensive sleep deprivation cause permanent changes? FWIW I'm also taking CoQ10, fish oil, ginseng, and B vitamins. I'm trying craniosacral therapy next week, and I see a therapist every week.

Any input from anyone with special knowledge or who's had a similar experience would be really appreciated. I'm starting to worry that I'm not going to regain the self I've always known, and that I'm going to have to give up my lifelong dreams and be stuck with this slow, ambitionless, emotionless self. I don't want to countenance it, but I fear that my old self is just not coming back. I haven't heard of people completely losing their entire self and not getting it back, but I'm afraid that is what is happening to me. :(

posted by anonymous to health & fitness (18 answers total)

When I weaned off Prozac, it took me a good six weeks after the last pill for the haze to really get gone. I think it is a bit soon to be worrying about permanent brain damage.
posted by Garm at 7:39 AM on August 21, 2012 [1 favorite]

I assume that "pdoc" refers to a psychiatrist. If so, that is the person with whom you should be conferring. If not, you need to see a psychiatrist. Is this the same person as the "therapist"? If so, I do not recommend seeing a psychiatrist and a "therapist" at the same time. Stick with the psychiatrist.

When you say that you increased and decreased the dose of various medications and then "weaned off" them, is this at the instruction of your psychiatrist or something you decided for yourself? Please take your medication as directed by your psychiatrist. If you are constantly fiddling with it, it makes it much harder for him to treat you and adjust your dosage as needed.

Craniosacral therapy is a quack remedy that doesn't do anything. I do not recommend that you engage in such a practice. The supplements won't kill you but frankly don't do much, either. They certainly won't treat your mental health issues.

Based on your past question, it seems that your mental health issues are relatively recent and naturally have a lot of concerns about this new situation. You are still in the stage where the psychiatrist is finding the ideal treatment for you. Give it time and have faith in his abilities.
posted by Tanizaki at 7:50 AM on August 21, 2012

> If so, I do not recommend seeing a psychiatrist and a "therapist" at the same time.

Disagree disagree disagree. This is recommended practice. Psychiatrists deal with medication; their job is not therapy. You may be in a different system but as I understand it this is the case in both the UK (where I am) and the US.

Quick-and-dirty comment but I wanted to get this in straight away.
posted by lokta at 8:27 AM on August 21, 2012 [5 favorites]

What, if anything, has your pdoc recommended/tried other than lithium, prozac, and the two tricyclics you trialed earlier? Because it does sound (at least in part) like depression is still lurking in the wings. Effectively treating the depressive state of bipolar can be a tricky thing. A lot of the newer treatments (lamictal, seroquel, and zyprexa, for starters) for bipolar are considered "mood elevating" and may be something to try if lithium + antidepressant isn't working out with your brain chemistry.
posted by drlith at 8:43 AM on August 21, 2012

I don't know how much co-q-10 you are taking but you should probably up it. I took 400 to 600 units (I think mg, but not sure right now) daily for many months -- like a few years -- while recovering my brain from what prescription medication did to it. Other things that were also involved in healing my brain function: Sea salt; high cholesterol foods like eggs, bacon and butter; glyconutrients (aloe vera is a cheap partial substitute); and plenty of b vitamins.

If you have any grey hairs, look specifically for PABA which is a b vitamin which often is not included in b complex formulas. It typically has to be bought separately. I took that and adreanal support because I had gone fairly grey at an early age due to my health crisis. Informed sources advised me grey hair indicated deficencies in those things, so I treated my deficencies symptomatically.

There may be other things I did that helped but that is the stuff I know was specifically relevant for this particular issue.

Best of luck.
posted by Michele in California at 9:04 AM on August 21, 2012 [2 favorites]

If your pdoc (psychiatrist) isn't sure what's going on, you might consider seeing a tdoc (therapist) if you're not already seeing one. You may not feel depressed, but we're not always aware of these things. I know I went through several depressions I wasn't aware of until my mood improved.

Also, you might look at physical reasons why you're in a fog. Get a check-up, check your thyroid, iron levels, stuff like that. I found out that my thyroid is wonky and that's one of the reasons why I've been walking around in a fog for a while. It might have nothing to do with the meds at all.
posted by patheral at 3:14 PM on August 21, 2012 [1 favorite]

My pdoc is flummoxed and thinks I'm suffering from depression. But I don't feel depressed per se

There is also something called dysthymia - which is low grade but persistent depression.
Signs and symptoms according to the wiki: "Dysthymia has a number of typical characteristics: low drive, low self-esteem, and a low capacity for pleasure in everyday life. Mild degrees of dysthymia may result in people withdrawing from stress and avoiding opportunities for failure. In more severe cases of dysthymia people may even withdraw from daily activities.[4] They will usually find little pleasure in usual activities and pastimes. Diagnosis of dysthymia can be difficult because of the subtle nature of the symptoms and patients often can hide them in social situations making it challenging for others to detect symptoms. Additionally, dysthymia often occurs at the same time as other psychological disorders, which adds a level of complexity in determining the presence of dysthymia, particularly because there is often an overlap in the symptoms of disorders"

I'm also seconding ruling out physical causes first. After that consider getting a therapist to help you get to the bottom of this as opposed to just a psychiatrist. As Lokta mentioned, psychiatrists' job deals with medicine, not therapy.

If what you're going through is indeed depression (from what I see and from your previous post, it seems very likely) bear in mind that you might feel this way for now but there is light at the end of the tunnel. You will get over this and be stronger because of it. The best of luck.
posted by 7life at 3:36 PM on August 21, 2012 [1 favorite]

Oh, and as for supplements not doing much- they do enough that they can have drug interactions. They do enough that doctors sometimes need to know if you're taking specific supplements for your own safety. Some supplements do enough that they induce labour. They definitely can have a huge effect on your physical and mental wellbeing; enough so that I strongly recommend that you get imput from someone qualified when you're deciding what supplements to take and how much.
posted by windykites at 3:53 PM on August 21, 2012

[Do not start a craniosacral debate here, answer the OPs question.]
posted by jessamyn at 4:25 PM on August 21, 2012

Since you had a manic episode, is it possible that at least some of what you remember as your "happy, enthusiastic, witty self" might be low level mania that was going on for some time beforehand? In which case, maybe the mood stabiliser was working, and you are actually back to your old self, but your internal calibration of what's normal has changed? In that case, time should help you recalibrate.
posted by lollusc at 5:06 PM on August 21, 2012

I feel that craniosacral therapy has potential to be a useful modality for you, but that you should contact a primary care physician and obtain a diagnoses prior to or in conjunction with any complimentary or alternative therapies that you might want to indulge in. It's important that you determine if there's any specific conditions causing this problem when making treatment decisions.

If this is a depressive issue, there are a number of modalities that could be helpful for you. A visit to a nutrotionist could be a good approach for you. You might also find other types of bodywork besides cranio-sacral like massage, shiatsu, yoga etc. to be especially helpful because bodywork tends to be very integrative.

Free-writing might help you to feel more connected to yourself or at least allow you to access some of what's going on internally. You might find meditation to be useful.

When I feel especially disconnected, I find it helpful to deliberately focus on what's happening with me; what am I feeling, what am I thinking, what is happening with my body? What persona am I projecting? I try not to dwell on this to avoid getting lost in my head, but doing it briefly can help me to tune in.

You might, with your doctor's assent, want to just give your body more time to adjust to the lack of medication.

You've said that you don't believe you're depressed, but your doctor does. I'm not going to say thst the doctor's right and you're wrong. But I will say that it can be hard to see things about ourselves that ate very easy for a trained professional to see. Not all instances of depression are heart-rending agony. Sometimes
depression is stumbling through a fog. That's what my worst depressions are like. Like there's a huge amount of distance between me and the outside world, and it's almost impossible to react to anything.

Oh, and it sounds trite, but you would be amazed at what a clean home, good sleep hygine, regular excercise and lots of water can do.
posted by windykites at 5:39 PM on August 21, 2012

IANAD, but I am a patient. I want to encourage you to keep trying different medications and supplements. Because we had to try more than 20 different drugs in all sorts of combinations to find something that worked for me (original dx of bipolar 2, now depression/anxiety and adhd). Sometimes the drugs that don't work can help find the right diagnosis. Therapy didn't do a damn thing, except help prove that my problem is chemical. But not giving up was most important. If your pdoc isn't willing to try something else, find someone who will work with you, but do find someone and stick. A doc who has been with you the whole way is better than having to drag out the whole story over and over, and new ones may want you to try the old stuff again because they don't really believe how bad the side effects were.

Also, if they haven't yet, get your vitamin D levels tested. It isn't a quick fix, but vit D, magnesium, and acetyl l-carnitine with alpha lipoic acid have helped me with the brain fog. Which helps with the depression. Feel free to memail me if you want to know more.
posted by monopas at 6:50 PM on August 21, 2012

Meds can definitely take a long time after (months) to stop feeling effects. Very troubling & hard to deal with, but definitely can have after effects for quite some time. No harm checking with your general practitioner if you think something else is going on, or some permanent condition has occurred.
posted by readygo at 7:01 PM on August 21, 2012

The previous question you linked listed your former mood stabilizer as Lithium. I've never been on Lithium, but I have frequently heard of just what you're describing as a common side-effect. And I can certainly say that when I tapered off from Lexapro, I didn't recover for about a month. It well may still be that.

It doesn't sound like Lithium is right for you. But it's not the only mood-stabilizer out there. I'm not bipolar, but I'm diagnosed depressed and cyclothymic, and my psychiatrist put me on Lamictal (lamotrigine). It's an anti-epileptic, but it's prescribed off-label for bipolar not infrequently, and it works much better for me than anything else I've ever tried. (I did have a mixed state once, And How, so technically by DSM standards I would be considered bipolar. I've never been anything other than depressed apart from that, though, so I don't think of it that way.) I don't think it has the brain-fog side effects in general, and I don't have any. Not a single one. Magical! Something to consider. I love the stuff.

I got horrible brain-fog going off of Lexapro, worse than what I had when I was on it. And brain-zaps and sleep problems and all sorts of other things. Give the Lithium a little more time to get out of your system before you worry too much about whether you'll ever get your self back.

And I agree that you should get tested for a Vitamin D deficiency. In some places it's extremely common. I had one, and have fixed it, and it helps. B is good too, so, you know, keep that up. I never used to take vitamins. Oh, but I do now.
posted by Because at 8:37 PM on August 21, 2012

IANAD, but I am a neuroscientist. A few points:

- If you have frontal lobe damage, there is currently no treatment or diagnosis, so it's not worth thinking about. Nothing is in the pipeline or on the horizon medically. Treatments may or may not be available in 10-15 years time.

- What you describe in this post and the last sounds like it is absolutely a direct consequence of Lithium. Lithium can stay in the tissues for a long time; you might be half a year away from it fully clearing, even if you stop taking it, and six weeks or so to being back to being a semblance of your old self.

- Being off Lithium a week and a half, and not feeling normal again, does not indicate "permanent problems. You just need to wait longer.

- It sounds like the Lithium isn't working for you. It's an extremely effective mood stabilizer with awful side effects as you've described. If you're not dangerously manic (spending sprees, sex sprees, danger to yourself and/or others), you might want to try other medications and lifestyle changes and keep Lithium as a last resort.

- Some of what Michele in California described (nutritional treatments, etc.) is actually surprisingly effective, statistically speaking, for treatment of certain mood and neuro disorders. Neuroscience is really in its infancy and the small numbers of brain meds available are remarkably nonspecific (compared with the many physical/developmental/genetic factors that may underlie any brain problem). Treatment is a "throw spaghetti at the wall and see what sticks" approach in many cases. There is evidence that nutritional and lifestyle changes can be helpful and sometimes as effective as certain drugs. Craniosacral therapy, though, is supported by very little evidence.

- You should be seeing an MD and not a therapist (only). I couldn't tell whether this is the case from your question.

- You might want to ask your doctor about trying drugs in the anticonvulsant class since you don't respond well to Lithium.

- Stabilization of sleep is also very important for getting back to your old self and controlling your bipolar disorder. There are medicines that can help with that specifically on an as-needed basis.
posted by kellybird at 9:18 PM on August 21, 2012

- You might want to ask your doctor about trying drugs in the anticonvulsant class since you don't respond well to Lithium.

Anecdata... I also reacted badly to Lithium, and the side effects of Lithium took forever to go away, but I do surprisingly well on Topamax. Actually Topamax, which is an anticonvulsant, is the only med that works on my bipolar. I'm so not saying that you should go on Topamax, however, this type of med could be something to bring up with your pdoc (psychiatrist). I know that hopping on the med-go-round sucks, but getting the disorder under control is so worth it.
posted by patheral at 9:30 PM on August 21, 2012

In response to what patheral just wrote... you really need to be seeing an MD who has experience with anticonvulsants (or who is both humble and proactive enough to ask other experts before prescribing) if you want to try this, or in general if you want to keep on the med-go-round. There are ~25 anticonvulsants on the market, all different, and they can be prescribed in combination with other drugs. It takes a LOT of experience to know the right one to start with, or combine, just because the number of options are staggering. You should be working with someone you trust and who has true expertise in terms of number of patients, prescription history of those drugs, success rates, number of years in practice, professional network, etc.

FWIW, I think that prescribing Lithium and adding an SSRI as your doctor has done is pretty much standard treatment, first for bipolar then for the side effects (flat emotions) you described. Your doctor doesn't seem to have done anything wrong so far, except that you said he is "flumoxxed and thinks you are depressed." Nothing seems too flumoxxing at least to me as a research neuroscientist; your response to Lithium is very typical.
posted by kellybird at 9:54 PM on August 21, 2012 [1 favorite]

As far sleep stabilization, that was a big part of why I took co-q-10. It is the co-enzyme for melatonin. Melatonin puts your brain to sleep. Co-q-10 wakes it up. When I was at a point where my brain chemistry was so screwed that I could not sleep, I tried melatonin. I felt half asleep for like three days. I had no ability to counteract the effect and fully wake up again.

Taking melatonin does not increase production of co-q-10 but taking co-q-10 does cause a small melatonin increase about twelve hours later (though for me it seemed to be closer to fourteen hours later). I was able to handle co-q-10 and it helped me sleep better at night and be more awake during the day. When my brain chemistry was less screwed, I was able to add a super low dose of melatonin about thirty minutes before bedtime.

I also did a lot to improve the cleanliness of my bed/bedding/bedroom. My genetic disorder makes me extremely vulnerable to dust, allergens, molds, etc. That turned out to be a big part of why I could not sleep. I thought I was avoiding the bedroom to avoid my husband. My marriage was falling apart and I wanted a divorce. No, it wasn't really him (at least it mostly wasn't him). It was the mold-infested bedroom and contaminated mattress. Throwing the mattress out was a turning point in my battle to get well.

So just keep looking for causes. There have to be reasons. You just have to find them.
posted by Michele in California at 8:17 AM on August 22, 2012 [1 favorite]