is there such thing as physical side effects from therapy?
December 1, 2016 9:56 AM   Subscribe

Whenever I have a breakthrough in therapy, it seems like it causes weird side effects and I'm not sure if they're serious or not. Please help!

I've been going to therapy for about 8 months , the first 7 or so I was seeing a therapist that seemed to focus a lot on the psychodynamic perspective (talk therapy where you just talk and talk and talk. . etc) and I recently in the past month have joined a CBT group session for social anxiety.

Over this time ( and including right now), whenever I encounter a sort of breakthrough in my thinking, it seems like I get very weird side effects that I can't really understand. these can include:

-- Feeling physically exhausted and needing to lie in bed crying, not out of a feeling of sadness but just because of being overwhelmed with emotions
-- Lack of concentration - unable to focus on reading a book
-- Inability to quiet my mind-- my brain feels like a TV that never stops talking, which leads to
-- insomnia and panic attacks in the night
-- A feeling of dissociation where I dont feel grounded or present in my body. for example I went jogging on the treadmill last night for half an hour, and usually it's a struggle to keep going but this time I barely noticed that I was exerting myself
-- decreased appetite
-- Basically a sense that my reality is shifting beneath my feet and that my body doesn't know how to adapt to it
-- Sometimes these uncomfortable side effects are accompanied by an increase in creativity (like writing a song or doing arts and crafts)

Are these normal side effects of making breakthroughs in therapy or are they symptoms of something more serious? If they are just side effects, are there any ways to minimize them? I've tried exercise, drinking coffee, taking a bit of Ativan (makes me super groggy). I think yoga would be ideal but the lack of concentration makes it hard for me to find enough executive function to make myself do a yoga session at home and I can't afford to go to a studio

Another aspect is that I started taking Effexor in August (75 mg per day). At first it affected my appetite and made me not able to eat much but that tapered off. I have noticed that it makes me unable to wake up in the morning until about 9am. also it decreased my desire for exercise since I usually use exercise to combat anxiety. I've only recently started exercising again after about 3 months during which time I didn't do any cardio but just went for 30 minute walks. I've also noticed that my heart rate goes super high while I'm jogging (like 180+) but last time I got my heart and blood pressure tested it was fine (that was about 20 months ago). I've also noticed that I get really fucked up dreams since starting the med.

A third aspect is that on a few occasions over the years, I think Ive had similar symptoms during PMS or during my period (both when I was on the pill, and off it). Sometimes it's accompanied by a sense of being connected to myself in a deeper way or feeling an increased sense of compassion for others. But sometimes it just feels like I'm disconnected with reality.
posted by winterportage to Health & Fitness (14 answers total) 4 users marked this as a favorite
Sometimes a therapy session can leave me feeling a little weepy or out of it for a few hours, but most of what you're describing (insomnia, panic attacks, decreased appetite) are not only unusual, but undesirable "side effects" and they are an indication that something in your treatment is not going well.
The med change is a huge flag for me here - I would be sharing this information with your provider ASAP to at least explore whether that might be a contributing factor. The only other thing I can think of is that if you are addressing or working through traumatic content in your therapy sessions, you may be experiencing some re-traumatization (dissociation, insomnia, panic attacks, etc.) and this is something you should bring up with your individual therapist immediately. Trauma work requires really healthy boundaries and your therapist should be helping you "pack up" your emotions at the end of each session so that they are not leaking into your life like this. I'm sorry you're going through this.
posted by sleepingwithcats at 10:18 AM on December 1, 2016 [5 favorites]

-- Feeling physically exhausted and needing to lie in bed crying, not out of a feeling of sadness but just because of being overwhelmed with emotions
-- Lack of concentration - unable to focus on reading a book

This is 100000% me. Therapy can be WORK and can be extremely emotionally and psychologically exhausting and straight up overwhelming. Definitely a side effect that I wasn't expecting, but the exhaustion is real. And I have ADHD so when I am exhausted and drained like that my ability to manage my ADHD goes down the tubes.

the others? Yeah, I got nothing. I'd def. mention them to your doctor.
posted by PuppetMcSockerson at 10:23 AM on December 1, 2016 [1 favorite]

The racing heart and bizarro dreams are a Thing with Effexor. I think I was on Pristiq (almost the same drug) for several months before the worst of the exercise stuff passed (I was also seeing stars frequently and had wild orthostatic hypotension), and the dreams persisted the whole time I was on it (years).
posted by dorque at 10:30 AM on December 1, 2016

First off, well done getting help and sticking with it when this stuff is tough! Super awesome.
  • Totally agree that your doc should find out that these things are happening -- and also your therapeutic provider(s).
  • I'm reading this book right now and so I'm pretty primed to think in this vein, but yes! Bodies are weird. Whether you believe in the woo-woo-ness of stored up energy (I do, sorta?) or not, there's definitely something to all of this -- and as other folks pointed out, trauma can work out like this sometimes.
Take care and good luck!
posted by hardlikealgebra at 10:31 AM on December 1, 2016

This sounds no fun! I'm sorry you're dealing with it.

I agree you should talk to your prescribing doctor and also your therapist - maybe you would benefit from different meds or a different dose, etc. etc. It took me a long time to find the right med and dose for me.

On the yoga front, have you tried Yoga With Adriene at home? Free on YouTube, variable lengths, and focused on connecting the mind intelligence to the body intelligence, which it seems like might help you right now. I find, on low motivation days, that if I can just muster the energy/willpower to *start* the video, I find it really easy to follow her instructions and keep going, and then I feel way better afterwards.

Her tagline is "Find What Feels Good" which also helps me see it more as self-care and less as must-do-exercise-now.

In particular, you might try Yoga for the Upper Back (my fave!), Bedtime Yoga, and Yoga for Anxiety. Even just doing some Alternate Nostril Breathing in the middle of the night when you feel panic attacky might help. Some of these are aimed more at beginners, but I find it's very nice to have something low pressure where I can focus on alignment and breath and moving mindfully. (She also has sweaty Vinyasa practices if you want one of those, but when I can't muster a lot of energy, I go for the gentle ones.)

Good luck!
posted by bananacabana at 10:43 AM on December 1, 2016 [2 favorites]

What you're describing sounds a lot like various physiological effects of flooding.

I've found it a normal cycle in my therapy. Not a pleasant cycle. But I went in with depressive symptoms where I experienced no emotions. So the first breakthrough was suddenly feeling feelings in an overwhelming way.

The window between when you finally realize you need to abandon a maladaptive coping mechanism and really feel comfortable with your new coping mechanisms is scary and huge.

Definitely bring it up in therapy. I've found that to get through it, I have be really honest about why backsliding feels safe and tempting and that right now I feel really lost and abandoned, and I worry that I can never feel safe again. Having that feeling validated by the person who pushed me into this scary unknown helps reestablish hope that I can eventually feel steady in this new reality.
posted by politikitty at 10:44 AM on December 1, 2016 [4 favorites]

(Also, when I first my first breakthrough, my therapist/psychiatrist recognized that my biggest symptoms had ceased to be a lack of affectation, and more anxious rumination. So we did switch meds. Finding a psychiatrist who does psychotherapy is amazing.)
posted by politikitty at 10:47 AM on December 1, 2016

These really can be normal, and it seems like a lot of therapists aren't very proactive in warning about them. When you are learning/creating competencies in something hard - and this stuff is absolutely hard - you are literally making new connections your brain. It's like learning a new language or new kind of math or how to control a new video game or do a new dance move; there are neurological implications. Exhaustion is common, irritability, difficulty concentrating. Rage, sometimes (raises hand - the summer I spent doing a really intensive French course in summer school was...volatile, to say the least). It can exacerbate depression symptoms too, just because of the energy drain and irritability. Dissociation can come with those things, but you certainly want to eyeball that as a biological issue that needs to be monitored too. It can be very similar to PMS, which is driven by slightly different mechanisms but there's endocrine functions involved in both cases.

While I have known a few people who come out of therapy appointments feeling cheerful and unburdened, most people I know, myself included, come out needing a nap and carbs. I can't go early in the day; nothing else gets done afterwards. It's where the term "emotionally exhausting" comes from.

Effexor can have its own suite of sometimes-intense side effects, and it may be hard to say what's the drug and what's just your body. You should be logging as best you can, and talking to both your therapist and your prescribing doc about them. Obviously if any of these symptoms can be mitigated by more closely examining dosage, timing/spacing of doses, etc, you want to get that taken care of.
posted by Lyn Never at 10:47 AM on December 1, 2016

About six months in to therapy I started getting a lot of the same side effects you mention, especially panic attacks, exhaustion, feeling like my emotions were all jumbled, and lack of concentration. Therapy was something that got worse before it got better, for me, but I guess around the eight month mark things started to settle back down. I kind of think if you're doing it right then you're going to have a lot of tumult and unease during the process, as whatever you're been suppressing or not addressing gets stirred up. (on preview, what politikitty and hardlikealgebra said!)

I didn't really do anything that helped me get through it, but looking back I would probably try exercising to the point of physical exhaustion, limiting caffeine after noon or cutting it out completely, and experimenting with trying something like Whole30. For exercise, maybe lifting weights? That's what worked for me and it might skirt the heart rate issue (which is concerning). I found that my 'natural' anxiety is a lot worse when I'm not watching my sugar/caffeine so that might be something to try. You could also look into taking Magnesium Citrate as a supplement, which seems to regulate my nerves a bit.
posted by stellaluna at 10:47 AM on December 1, 2016

I think it's *much* more likely to do with side effects from the Effexor or another medication (eg bcp) than from talking about stuff.

I mean, I haven't done therapy in a while now, but talking about something upsetting might screw up my mood for the afternoon, or make me a little anxious, thats it.

Appetite loss, brain fog, insomnia, panic attacks at night, dramatic change in mood... see Effexor side effects.
posted by cotton dress sock at 11:19 AM on December 1, 2016

Oh man yes. Definitely look into the Effexor side effects, but more generally (and in line with the book linked upthread, which is excellent), the whole body/mind separate duality thing doesn't hold up so well when dealing with emotional trauma or stress, however big or small. We are our bodies, and the connection goes both ways - physical states or postures can absolutely effect your mental and emotional state. Dealing with only one side of yourself probably isn't going to be completely effective.

I've found this book to be very practical (and while there is some Woo in there, this guy has also written stuff with Kolk, so like with everything...try it and see which parts work for you). Seriously it's what's gotten me through November, and specifically was what got me through election night.

The stuff you're feeling is normal, and I bet you can use it to help yourself along.
posted by schadenfrau at 11:28 AM on December 1, 2016

They can be normal effects of therapy, but your therapist should be informed so that they can help you develop healthy coping techniques for dealing with them and so that they can adapt the therapy sessions a bit if they're too triggering, which is what I would be worried about with the dissociative symptoms you mention. Your healthcare provider should also be informed so that they can rule out any physical causes.
posted by lazuli at 11:44 AM on December 1, 2016 [1 favorite]

Check on those possible Effexor side-effects, but yes, this can absolutely happen.

If you habitually store a lot of tension in your body, especially if dissociation is one of your usual defense mechanisms, relaxing can bring up the emotions you were trying to get away from in the first place, which can lead to more dissociation and tensing up again. Letting down your emotional defenses, because of increased trust in your therapist, can also bring up things you'd been shutting out.

It's important for you to let your therapist know this is happening, so they can help you process these emotions, and so they know that they need to do careful work around wrapping up each session to help you stabilize without carrying your emotions into the rest of your life more than you can handle.

I say more than you can handle because therapy is a process, and you are going to experience that process outside sessions as well as in them. It's not just normal but reasonable to find yourself being more introspective, considering things that happen and old memories in the light of things your therapist said, and dwelling on old pain more than you habitually do. But none of this should be overwhelming. If it's overwhelming, something needs to change with your meds, the way your therapist is ending sessions, or both.
posted by Rush-That-Speaks at 12:37 PM on December 1, 2016 [3 favorites]

Yep. You sound just like me. Particularly when participating in the type of group therapy you're talking about. I have a theory: since a lot of CBT is really about changing thought patterns buy identifying and and challenging them, a lot of your "neural-net" is changing and shifting, which is uncomfortable. A therapist once described it to me this way: You thoughts and thought patterns are like well worn paths that are easy to follow because you've been down them so many times. But they aren't the best paths to follow, just the ones you're used to. CBT is like taking a machete and carving out a new path through dense forest growth. It's exhausting and the ground under your feet isn't all packed down so you're slipping and sliding and finding your footing. I hope that makes sense.

Also, disassociation is something that totally happens to me in therapy. Particularly if I am a being presented with and trying to understand information that is counter to what I have believed previously. For instance, I experienced disassociation when I was first taught about self compassion because it was so opposite to what I was taught growing up.
posted by dchrssyr at 5:34 PM on December 1, 2016 [2 favorites]

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