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July 29, 2014 7:28 AM   Subscribe

I'm no longer sure what my problem is or what medications to try. blizzard inside for those that enjoy helping others sort their mental health issues....

I have a psychiatrist. This is my 3rd pdoc over the last 8 years. I got new insurance and she's closer than my previous doc and the before that retired.

I also have a therapist. I was in a therapy pretty regulary for a few years but we worked through stuff and reached a plateau so we were both fine with the sessions ending. I am back in therapy with a different therapist now. I see her maybe once a month and that's ok. 36 year old female. Work full time, decent job, no other major stresses. By all appearances life should be good.



My issues... the majority of the time, it feels like everything is such a freaking effort. I go through this cycle where I'll be motivated and I'll cook my meals and eat healthy and maybe even exercise several times a week. Then it just gets harder and harder, so I give myself a break here and there, I've been doing good after all. Then it just becomes monumentally difficult all of a sudden. And then I go exercise, even just a nice walk, and I don't feel better, I feel angry (yes, isn't that weird? what am i even angry about? I don't know - I'm just keyed up and tense and awful feeling.) I can't calm down so I try to clean or have a glass of wine or some ativan but nothing helps and I just end up not sleeping very well, if at all and that's how I know yay I'm back in the slumpy time.

I can't concentrate on work, even breaking down tasks seems like I'm forcing myself against this current and I try and I try. I don't even have a hard job and I can get by doing the bare minimum, which makes me feel awful because I LIKE my job. I walk to work so I don't have a commute anymore and that used to be a huge factor in my general malaise. All I want to do is lay around and read books in bed. I don't do the thing where I sleep 12 hours a day but I find it hard to fall asleep and then hard to wake up. Everything is just overwhelming, people at work talking or laughing, having to find something to listen to on my headphones so I don't hear them, not liking what I find to listen to, just wishing it were quiet and I was at home because then it would be safe and quiet and just fine. (I cannot work from home. Not an option for my dept. Once in a while we can, but not regularly. I do it maybe every other month, claiming a delivery or home repair people coming or other legit reason (which are sometimes legit), but it's not enough to deal.) I will go an entire week at work where I just do nothing but the barest bare minimum and I know people know. I feel in a fog.

I've tried B12 and Vitamin D, I've been on many ADHD medications and depression and anxiety meds. All of them work for a few weeks to a few months until I'm just feeling this way again. I liked having Adderall in the past in small amounts because it makes me able to just get through the goddamn work day and get something done. I didn't take it all the time, just to manage the down times. Welbutrin seemed to help for a bit but I wasn't quite myself on it. My current pdoc doesn't think I have ADHD and neither does my therapist, although every previous psychiatrist and therapist has thought so. The current doc and therapist think I have very bad anxiety. The only thing that seems to work is ativan and I develop a tolerance very quickly and only like to take it in emergencies. Right now it sucks because I can take 2 mg and not even fall asleep. So that's exciting.

It always goes away. I call it my hibernation phase. But it's not conducive to having a grown up life and a relationship when I need to have a week or two to "recover" from living every few months.

I'm on birth control, the same bc for many years now, it has helped. I don't smoke pot. I don't drink excessively. Maybe a glass of wine a few nights a week or some drinks with dinner, but I can go all week or weeks without drinking.

I have an appointment with the pdoc today to try something else. We had been on something called gabapentin in conjunction with the Welbutrin but i developed horrible, horrible tinitus. So we tried to stop one and then the other and the tinitus stuck around with each one on it's own, so I just had to stop both. The gabapentin seemed to work pretty well at first for the anxiety, but then it gave me weird muscle tension, I always cracking my neck and back.

So I have't been on anything for over a month now (the doctor knows, we were trying to get rid of tinitus before trying something new.) I just had one of my "spells" where I needed to "recover" from life. I took some sudafed today so I can try to caught up on things at work.

This is just a horrible way to live and I'm tired of it. I feel like I keep doing the right things but they don't stick. And I don't mean like for a few days, I mean I try for months. I was going to the gym several times a week for 5 months, giving myself the ok to skip a day here and there, and I just ended up having to force myself to go do something I loved and made me feel good previously, but that now that just me feel angry and exhausted.

My thryroid has been checked, I had a full blood workup done in February. Nothing is wrong or abnormal. At all.

But obviously something is. I realize that everyone has peaks and valleys, that everyone has off days, but I have off WEEKS. It's not related to my period because this has nothing to do with where I am on the pack. It's a cycle where I keep going down slowly over time and then hit a bottom and stay there for a while, then climb back up and feel good and on top of things and then slowly start going down and so on and so on.

The pdoc says we're gonna try SSRI's next and I'm scared because I don't want to gain anymore weight, my clothes and bras barely fit now and I can't afford to just buy a whole goshdarn new wardrobe. I was on Zoloft a few years ago and it made me the most awful I've ever felt, I couldn't even drive. Then it's just been a parade of Adderall, Adderall XR, Dexadrine, Ritalin, Concerta...they all work for a while and seem to help me get the minor lows but then it's like I'm just done again, I need my recovery week or weeks. Then I can start taking them again and I'm fine.

I never took mental meds until I was 26 but this cycle has been going on for as long as I can remember, so it's not brought on by being on the medications.

I just don't know what to do anymore. I feel so much better than I did years ago, I made a TON of personal progress. But I feel like I'm at the end of what I can do in therapy... this doesn't seem to be something helped by therapy anymore, it seems to me to be chemical. I'm just frustrated and don't even know what to do anymore. I know the tricks like put on your gym clothes and then you'll want to go to workout!! yay!! but no. When I am down, this doesn't work. I can put on my gym clothes, but it's like dealing with a petulant 3 year old. And if I do manage to drag myself outside even for a nice stroll, all i want to do is run back home away from the light and noise, even while I can appreciate it's quite lovely outside, and I just want to be inside where it's safe and quiet, lying on my bed with the fan on and my cats there and reading on my kindle and the nice silky comforter.

Yes, I can show this to pdoc. I guess I just want to know what has worked for others medication-wise when everything else doesn't seem to work. CBT does not work for me because it just makes me even more anxious.

(also, i thought about writing this for weeks and weeks now but the prospect was so overwhelming because I'm sure everyone will just look at my post history and tell me to go to therapy and i just want a wand to be waived that will make not feel like eyeore. i only managed to write this today because yay sudafed.)
posted by inmyhead to Health & Fitness (25 answers total) 18 users marked this as a favorite
 
Has Bipolar (I/II/NOS) been an option floated by your doctor? If not, it's something you should bring up at your next session.
posted by feckless fecal fear mongering at 7:45 AM on July 29 [1 favorite]


I wish I had THE answer, because I have the same issues... one thing I am working on is that it is an iron deficiency. Have you have your ferritin levels checked? You can have low ferritin levels without being anemic, and it can cause a lot of these symptoms:


Fatigue
Poor work productivity.
Poor attention and memory.
Sore tongue.
Poor condition of skin, nails or hair, including hair loss.
Pica (there has been debate as to whether pica is the cause or the result of iron and zinc deficiency).[7]
Restless legs syndrome.

I try taking a liquid iron supplement but my motivation levels mean it is difficult to keep remembering to take it - when I do, I think it does help a bit..

Exercise helps me, but not when I put pressure on myself to do it - can you try going for a short walk instead of running?

Anyway, sorry I couldn't help more. Hopefully other people can give more useful input!
posted by Dorothea_in_Rome at 7:49 AM on July 29 [1 favorite]


can bipolar not have the super high mania? i don't ever get super manic.

my doc a long time ago did try to treat for bipolar II, but i think my general anxiety (that was resovled with therapy and life getting better in general) was still so bad that the meds for the bipolar didn't work very well.

i had forgotten about that. i'll bring it up today. thank you. i do kinda feel like i get bipolar-lite, with subtle rather short mood swings, rather than the years depression, months manic, that full on bipolar seems to have.
posted by inmyhead at 7:59 AM on July 29


Bipolar can absolutely exist without serious mania. You might look up "hypermania" and "mixed states", perhaps "rapid cycling," and see if any of that seems to fit you.

Of the two loved ones in my life with bipolar diagnoses, one is primarily depressive with occasional swings into short-lived hypermania or mixed states. He went mis- and un-diagnosed until his mid-30s, where he had his first full-on mania, which finally got him diagnosed properly. The other flits about more evenly between hypermania, mixed states, and depression, but she has never had a full-on manic episode as far as I know.

It's very common for people with bipolar to go under- or mis-diagnosed for years or decades, and sometimes for the meds they take for these misdiagnoses to make things worse, not better. Depression and ADHD are common mis-diagnoses in this situation - my partner went through both of those diagnoses over the years.

I can't tell from what you've written if this diagnosis would apply to you, but I don't see anything that rules it out. It's worth exploring.
posted by Stacey at 8:05 AM on July 29 [1 favorite]


There's even a name for "bipolar lite": cyclothymia. You may find it interesting to note that the symptoms of hypomanic episodes can be mistaken for ADHD.
posted by drlith at 8:08 AM on July 29 [2 favorites]


Are you scared of being angry? Anxiety often pops up when we're scared of feeling negative emotions, and unexpressed or unproductive anger often turns into depression. Your throwaway mention of anger makes me think it could be profitable to talk to a therapist who could help you find your anger, and dig into what's hiding in there. That would need to be weekly rather than monthly sessions, probably not CBT. Trauma-informed or trauma-focused therapy would probably be helpful.
posted by jaguar at 8:10 AM on July 29


Hit "post" too soon: it may also be clinically significant that you had a miserable time on Zoloft. I would definitely bring that up with your new pdoc, along with the fact that you were previously treated for bipolar. I note that in a post from 4 years ago you describe yourself as having manic episodes and mention trialing Abilify. Just because Abilify didn't help, or didn't help enough, doesn't mean that what you were experiencing wasn't manic episodes or that one of the many treatment alternatives out therefor bipolar won't ultimately be of use.
posted by drlith at 8:17 AM on July 29


not to threadsit, just an update...i left that relationship from the post you mention 4 years ago and i no longer get the wild swings like that anymore. just the normal-for-me ups and downs that are still more severe than other people's normal ups and downs.
posted by inmyhead at 8:22 AM on July 29


can bipolar not have the super high mania? i don't ever get super manic.

Yes, absolutely. Bipolar just refers to the cycling, not necessarily to the degree/depth of the actual cycles themselves.

You might look up "hypermania"

Cough, sorry, you mean hypomania. Hypermania would be extreme manic behaviour; hypomania is a lesser form of mania.

Bipolar comes in three flavours actually named bipolar (I, II, and Not Otherwise Specified if it doesn't quite fit in those categories), as well as what drlith said about cyclothymia.

The Bipolar Disorder article at Wikipedia is surprisingly well-written and may help you.
posted by feckless fecal fear mongering at 8:23 AM on July 29


You sound a lot like me and I've been through a lot of the same medications. I'm not on any medications right now and maintaining reasonably well, but the last set of meds I was on were Lithium with a super low dose of Celexa (no side effects even!). They got me to the point where I didn't need medication and I'm doing pretty well (for me at least).
posted by disaster77 at 8:49 AM on July 29


I don't even have a hard job and I can get by doing the bare minimum, which makes me feel awful because I LIKE my job.

You like your job and other aspects of your life, but do you really feel challenged by any of them? To be honest, I've had periods of depression when things were working perfectly well and I then let things fall apart sometimes or procrastinate to fake being challenged. Could your "hibernation phase" just be an effect of you disliking the balance you've found?
posted by mikeh at 9:02 AM on July 29 [3 favorites]


i have not been on celexa but i think i may have been on lithium? can't remember.

and mikeh - that's a good comment. i'm currently trying to get the skills to get a more challenging position, but this thing i got with having off weeks is holding me back.

the link for cyclothymia sent me to a page for dysthymia which i've heard of but hadn't read about. that seems much more like me. i printed out both articles to take with me to the pdoc.

and thanks everyone for making me a bit more hopeful that something will work. this is such a sisyphean struggle but maybe i'll get the rock up the whole way one day.
posted by inmyhead at 9:53 AM on July 29


And then I go exercise, even just a nice walk, and I don't feel better, I feel angry (yes, isn't that weird? what am i even angry about? I don't know - I'm just keyed up and tense and awful feeling.)

this doesn't seem to be something helped by therapy anymore, it seems to me to be chemical.

And if I do manage to drag myself outside even for a nice stroll, all i want to do is run back home away from the light and noise,


I didn't quote the piece about tinnitus. For some people, tinnitus is helped by magnesium. I did a quick search and there are other people online who have asked "So, are the side effects of Wellbutrin just effects of magnesium deficiency? Because it sounds the same." Since you are still trying to get the tinnitus under control, you might try supplementing magnesium. And, if you need magnesium, you probably need calcium. And to absorb calcium properly, you need vitamin K and vitamin D. Also, some chemical forms are more bio-available than others. Also also, if you have an allergy or something, that may impact what chemical form you can take. (Magnesium glycinate is considered the gold standard for magnesium. The mostly commonly available form of calcium is not very bio-available. Do a little reading and, if you try it and aren't getting good results, consider trying a different chemical form.)

When I get magnesium deficient, I have the same issue you describe above: Oh, god, the light! and The Noise!. When I start acting like everything my sons say is just too friggin loud, we buy me dark chocolate or cashews or some other high magnesium food.

Welbutrin Magnesium?

The other thing I have been reading up on here lately is how the lymphatic system works. Lymph is basically blood fluid with the blood cells removed. It serves as interstitial fluid. It is that clear fluid you get that oozes out of sores sometimes and that kind of thing. It is part of the circulatory system but because of the way it goes out through all the tissues, it is not pumped by the heart. Instead, your skeletal muscles provide the pumping action. Thus, when you go for a walk, you very dramatically increase the rate at which it returns to the heart.

With getting myself healthier, there are a few things I go through that your story resonates with. First, walking has a big positive impact on my health (I no longer drive and rarely take public transit -- I do better if I just walk everywhere). Second, I have repeatedly hit "glass ceilings" where I had to do some serious problem-solving in order to escape the current plateau and stop being stuck there. And it was chemical/biological. Third, trying to get through these glass ceilings typically comes with awful psychological side effects where I get depressed (suicidal, actually) or pissed off because of the chemical stress I am under. It always takes some research and some effort to find a way past that so it doesn't keep me stuck at some improved-but-not-really-right place.

So, for now, the thing I feel pretty confident saying is that you most likely have a magnesium deficiency and there are at least three other nutrients that you need to take to really fix that issue. If it were me, I would start there.

Re the iron deficiency someone else mentioned: I also had low iron for a lot of years. For me, yes, being iron deficient was a pretty sure fire way to make me depressed. And I am not really prone to depression. In the past, if I was depressed for at least three days straight, you could basically bet money I needed iron. (Shorter depressive episodes were often due to exhaustion because of my medical condition, basically.)
posted by Michele in California at 9:57 AM on July 29


You should extremely anxious.

You mentioned SSRIs, have you tried an SNRI? They are a different classification of drugs, but some people respond better to them than SSRIs. The discontinuance symptoms can be much worse, so that's something to keep in mind.

Also you might want to consider that you've reached the end of what you can accomplish with your therapist and may need to find another one.

Everything is just overwhelming, people at work talking or laughing, having to find something to listen to on my headphones so I don't hear them, not liking what I find to listen to, just wishing it were quiet and I was at home because then it would be safe and quiet and just fine.

I know exactly what this is like--having ADHD can make it difficult to tune out background noises and make everything extremely irritating--which can be anxiety producing. Personally, I try to have as many podcasts of soothing public radio on my phone as I possibly can--I can just hit play and don't have to make a decision because when it's finished it goes straight into the next one.

You mention lots about sounds here, so maybe you have a bit of hyperacusis?

Also--how recently did you stop taking your previous medications? Did you taper off of them properly? If you have been going on and off medications that can seriously amplify feelings of anxiety and depression.

Be kind to yourself. Sometimes it's okay to feel like a petulant three year old. If skipping exercise hiding under the covers reading books in a quiet room is what you need sometimes, give yourself permission to do it. Best of luck, I hope you feel better soon.
posted by inertia at 10:29 AM on July 29


Thank you for putting into words almost exactly how I feel most of the time. I was diagnosed with Bipolar II almost 3 years ago. I've questioned that though because my most noticeable swings are toward the depressive side. I've told my therapist that I think my hypomania is like other people's "normal".

Prior to that I was diagnosed with dysthymia and was on SSRIs for about 11 years. Apparently SSRIs make bipolar worse, although I didn't have any significant issues (I just felt pretty much dead inside) until I suddenly had a true hypomanic if not manic episode that resulted in hospitalization.

I currently take Lamictal with a tiny dose of Paxil. I still have swings to the depressive side just like you described. One thing I've found to help with the insomnia (which pretty much impacts everything else) is to absolutely not goof on the internet in the evenings. Once I quit that I immediately started falling asleep easily/sleeping better and was able to get up in the morning without difficulty.

I hope this is helpful in some way.
posted by auntie maim at 10:37 AM on July 29


I am sure this isn't what you want to hear, because the meds for this suck even harder, but don't write off another mood spectrum disorder like bipolar. I have type II, and it's very similar to what you're describing. I don't get mania. I also have pretty powerful anxiety.

Honestly, I've had so much trouble with meds that I haven't used them for several years, but the things that have made the most noticeable difference in my quality of life were switching to a low glycemic index diet (for the most part; nobody's perfect), having an extremely regular daily bed/wake schedule, and getting regular morning exposure to a full-spectrum light therapy light, especially in dark months. I still have swings, I still have a stronger reaction than most people to stress, but the fatigue and the depths of my downswings are much milder.

YMMV. I know people who have gotten a lot out of vitamins, or yoga, or running, or volunteering, or therapy, or meds. I tried those things, and they didn't help, but my light box on my office desk for a little time in the mornings and avoiding blood sugar spikes seem to. At the very least, there's certainly a range of tools for you to choose from, even if you're having crappy luck with meds.
posted by bowtiesarecool at 11:41 AM on July 29


You mentioned you don't want to gain any more weight. Does that mean you're heavier than you've been before? I know from personal experience that carrying around 50kg more than my skeleton is suited for makes me tired and sore and angry and disappointed especially when I try to "do the right thing" with exercise.

Body acceptance is a fine thing, and "fuck you very much" truly is the only appropriate response to those who express disgust at my shape on aesthetic or moral grounds. But that doesn't alter the fact that being way way heavier than I need to be is fucking hard work, makes me chronically tired and sore, and is generally a shitty way to live. I've been fat, and I've been lean. Lean wins.

I have built a practice of regular fasting into my life that I intend to stick with for the rest of it, I'm now losing weight year on year instead of gaining it, and not having to lug so much around is making me feel much better.

I still have days where everything is just too fucking hard and anything that isn't too fucking hard still fucking hurts and all I want to do is pack the kids off to school and call in sick and take the phone off the hook and crawl back under the doona, but they're getting less intense and less frequent.
posted by flabdablet at 12:00 PM on July 29 [1 favorite]


It honestly sounds like there's a huge discrepancy between your internalized expectations around how you SHOULD feel, and how you ACTUALLY feel. It sounds like it's this discrepancy that's causing the problem, and why said problem is so vague and hard to pin down.

Your post makes it seem as though you are looking for a complete solution that will make you stop feeling how you're feeling, full stop.

I think you, and your well-intentioned doctors, are misidentifying the problem.

You write that you know that everyone has ups and downs, but you also seem rather convinced that your particular experience of these ups and downs is way outside the norm (whatever the hell the norm is, mind you), and that drives you to seek more and different solutions.

I would suggest that it's possible that this is who you are. That you are not broken. That you might have anxiety -- in which case, hello, welcome to the club, we have GREAT tote bags! ;) -- and even a skosh of something else. But consider that you are okay. That this is normal for you. That you can stop struggling against yourself and start coming to terms with who you are, to start addressing why you think there is something wrong, and what you think "right" or "normal" might look like, or feel like.

Maybe the next visit to your therapist or psychiatrist can address this possibility, and what it means, and what next steps are. Just to see what happens.
posted by gsh at 12:53 PM on July 29 [5 favorites]


I actually go through something similar to what you describe, though to a milder extent. (But it has affected my work before.) I go through these cycles all the time, but I've never seen a doctor, I don't take meds, and according to everyone I know, I am a highly functional/productive person.

Aside from taking a three day or week long vacation, which really helps me when I get into a slump, I do something that is probably not healthy. I will drink coffee on Friday, stay up all night reading (in the quiet and the dark), get super tired over the weekend and completely switch up my sleep schedule. And usually by Monday, something in my brain has reset. Basically, the point is to completely throw off the monotony of my routine and to get my brain to recognize normal life as something "challenging" and therefore "engaging."

What I've also done is taken advantage of "up time" when I'm really energetic, engaged, and enthusiastic by working down my todo list of big projects during that time. I plan things out (months in advance) so that I don't have to constantly work at 100% output, and so there is a lot of slack for me to slow down or take a weekend or two to reset.

I don't necessarily recommend this method of dealing with it, but I just wanted to let you know that I also experience this and that I just deal with it. I consider it part of the cycle of life, rather than a problem.
posted by ethidda at 1:09 PM on July 29 [1 favorite]


Like gsh, the difference between how you think you should feel and how you actually feel is coming through very strongly to me, too. I understand you are trying to emphasize that you have a real problem; that it is not in your head; that you are genuinely experiencing something different than what most other people go through. I believe you. I also support efforts to find the right meds or supplements or other physical ways to deal with this. Personally, what has helped me tremendously with my own tendency to see a huge discrepancy between how I should feel and how I actually feel, is ACT.
posted by Bentobox Humperdinck at 1:24 PM on July 29 [3 favorites]


I was you for a lot of years. What finally helped me the most was Remeron. I know you're afraid of weight gain, and Remeron is notorious for that. But for me, it's been worth the 10 extra pounds. I finally feel human again. Trust me, I know how hard it is to try one medication after another, but the main thing is to keep trying. Don't give up on yourself.
posted by storminator7 at 9:17 PM on July 29


Hi all -

Just wanted to post an update.

I brought many of the points you all made, including about the "should" discepancy. I totally get that point, however I feel that this is not a "should" so much as a "I don't want to live my life needing a week or two of "recovery" from general life every few months." I have discussed in therapy those lovely voices of parents etc that contribute to negative self talk and this is not that.

So in short:

- We are trying Prozac. She said that I don't seem to be bipolar, even bipolar II, because my ups are not up in that way but that I have definite lows. She also said Prozac can help those with social anxiety, which I do have, as well as general anxiety.

- She did give Remeron, even tho I didn't see that comment before the visit. That is to help me sleep. She thinks (and I agree) that my trouble sleeping can also be a problem. I tried it last night and it knocked me out at first - I woke up and thought it was 4 in the morning, but it was only 12:30! I had horrible restless leg and couldn't back to sleep fully the rest of the night. I came into work late and don't feel horrible, but also feel like I didn't sleep at all.

So we'll see. She definitely thinks it's more about low-level depression, anxiety, and restful sleep.

Also, I had blood work done in February from my GP. She looked at it and thought that the Free T3 was low (it is at the very minimum end of the range) and has ordered blood work for me for further thyroid testing, as well as B12, D, Folate, and a host of other vitamin type things.

Thanks again everyone.
posted by inmyhead at 8:00 AM on July 30


inmyhead, you might also want to ask your doctor about Trazodone for sleeping. (Unless they're doing a two-pronged antidepressant approach). Non habit forming, well tolerated by pretty much everyone, and lets you slip into a natural restful sleep instead of being knocked on your ass. Also it's a pretty old drug and the generic is cheap.
posted by feckless fecal fear mongering at 9:46 AM on July 30


As a counterpoint, I have never been more exhausted and unable to deal with life than I was about nine months into a Trazodone prescription for insomnia. It felt like I was in an unending first trimester of pregnancy, pretty much unable to get off the sofa. A prescription for a mild case of hypothyroid, iron, D, and B supplements, and lots of O3 (fish oil), as well as gradually increasing exercise helped a *lot*.
posted by instamatic at 10:25 AM on July 30


Trazodone ended up being the miracle drug for my partner, specifically because it not only knocked him out but kept him out. A couple of other things he tried first did exactly what you're describing - knocked him out for like three hours, but then he'd wake up and be unable to go back to sleep.

I wish there were a better answer than "keep trying stuff," but...keep trying stuff. I know the process is so painful and time-consuming and expensive, but fingers crossed there is something out there that will help you.
posted by Stacey at 11:02 AM on July 30


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