This is a direct update to the immediately previous post.
Apparently there are two competing hardware systems, but little means to evaluate which is better. We found a provider who uses a less common system which I had not seen in my previous research. It does use stronger magnetic fields, in case that might be a good thing.
Earlier this week I had my second of two "evaluations" with the provider. This one was with the actual MD who owns the practice. It was two hours of intense questioning, more thorough than most psychologists or psychiatrists I have seen. It all felt pretty casual at the time, but afterwards I was exhausted. I still have paperwork to do, and they still have to get my history from other providers and work things out with insurance, but it looks like I will be doing this thing.
Daily treatments five days a week for several weeks. Just showing up to the same place at the same time day after day is going to be difficult for me. That's kind of why I don't have a job.
I am far less concerned about the treatment experience itself, and certainly less concerned than they expect me to be. In both evaluations, I had to interrupt long disclosures of risk and accompanying assurances of safety to assure the provider that I had done my homework already.
That's enough about that for now. Not hopeful of positive results, but glad to get on with it so I can either be surprised, or move on to ECT, Ketamine, or final defeat.
Friday, March 22, 2019
Tuesday, February 19, 2019
This has less worth
A pseudo-random sequence of events led to me re-reading my most recent posts, so I might as well do an update, I guess. To keep it as brief and non-redundant as possible, this makes no attempt to make sense as a stand-alone post, but rather presumes one has read at least the most recent posts, which are themselves largely redundant.
Upon revisiting my psychiatrist and discussing my ever-narrowing treatment options, I acquired a referral to a provider of TMS (Trans-Cranial Magnetic Stimulation). Due to insurance issues and some very non-satisfactory discussions with the staff, this was a dead end. The next logical step was to identify an alternate provider compatible with my insurance and then get a referral to said provider.
It seemed prudent to combine my search for a provider with some additional online research into TMS. I had expected to wade through an evaluation of a broad spectrum of competing hardware and treatment protocols, comparing each to the most solid science I could find on the subject. I was surprised to discover three things:
1. There is essentially only one hardware system from one manufacturer, and only slight variations in treatment protocols, since all providers are directly trained by the manufacturer. Providers are numerous, but there appears to have been a bubble of growth in this industry which is in the early stages of bursting, with a number of bad links already.
2. There is no solid science to support the efficacy or prudence of TMS. There are many articles discussing the difficulty in designing experiments which would provide more definitive results. Ok, this part wasn't really surprising. The most reputable sources were the most skeptical about TMS, not the least of which, the APA (Americal Psychological Association) itself. The only good news is that, effective or not, it is largely benign with very rare incidence of serious negative effects.
3. Seemingly trustworthy and well-known large medical universities have vaguely positive things to say about TMS and claim to be engaged in TMS research. Suspiciously, all photography of experimental apparatus appears to depict the very same equipment sold to the individual practice providers. My wife spent a lot of time following up in detail with OHSU (Oregon Health and Sciences University) about their TMS research. Their story, as it turns out, appears to be typical of the other universities as well. They had some initial enthusiasm and limited experimentation, ran into the same difficulties in designing experiments and producing solid results that everyone else has had, and are not currently actively engaged in any research on the subject.
So... probably another form of electric snake oil, but just enough of a hope/doubt mix to maybe give it a try, with very low expectations.
It appears that my next step will most likely be just that, give it a try so long as it is covered by insurance, but invest no hope.
This ultimately brings me back to my obsession with threes, in this case, three choices:
1. Go ahead and pursue ECT (Electroconvulsive Therapy). A treatment much maligned in popular culture, but which has a fairly good rate of initial efficacy, although a higher than hoped-for rate of relapse and diminishing returns with subsequent re-treatment (a profile it shares with success stories claimed for TMS).
2. Abandon all physical or pharmacological approaches to treatment, and do my best to live out what remain of my days as tolerably as possible, with or without a return to the endlessly disappointing talk therapy. My concern is not as much with what I can tolerate, but more with what is reasonable to expect others to tolerate in terms of my behavior.
3. Ummm... So far, I only have extremely brief moments of psychic discomfort so intense that I contemplate the final solution. These moments have passed and not led to a very loaded word I am loathe to invoke in this context: planning. In calmer times, I have dispassionately gone through the intellectual exercise of finding the inevitably unacceptable consequences or risks of consequences that come with any methodology I can imagine for implementing a final solution. I understand that a person can reach a point where the final solution is coveted as the last and only thing within individual control, but even that sense of control is false as there are too many variables that can lead to unintended results. This is a strongly discouraging situation before moral philosophy is even considered, which tends to cast even more doubt on the prudence of the final solution.
So much for my obsession with threes. There is a fourth, very unlikely, course of action:
4. Engage in experimentation with legal and non-legal pharmaceutical treatments. I have done some online investigation into this and it is not very promising. The best I can hope for is a temporarily altered state of consciousness which occludes one set of mental dysfunctions with another. The most promising substance, MDMA, is far too difficult to synthesize properly and I would trust no amateur manufacturer. It is a substance that has been, in pharmaceutical-grade form, tested by scientists, with some hopeful results for some extreme conditions, but FDA approval seems very far away, if it ever comes, and even then, there is much that is not known about appropriate dosing or long-term efficacy.
Once again, as always, way too much, and no hopeful conclusion. I expect that I will never tire of complaining until the day I die.
Upon revisiting my psychiatrist and discussing my ever-narrowing treatment options, I acquired a referral to a provider of TMS (Trans-Cranial Magnetic Stimulation). Due to insurance issues and some very non-satisfactory discussions with the staff, this was a dead end. The next logical step was to identify an alternate provider compatible with my insurance and then get a referral to said provider.
It seemed prudent to combine my search for a provider with some additional online research into TMS. I had expected to wade through an evaluation of a broad spectrum of competing hardware and treatment protocols, comparing each to the most solid science I could find on the subject. I was surprised to discover three things:
1. There is essentially only one hardware system from one manufacturer, and only slight variations in treatment protocols, since all providers are directly trained by the manufacturer. Providers are numerous, but there appears to have been a bubble of growth in this industry which is in the early stages of bursting, with a number of bad links already.
2. There is no solid science to support the efficacy or prudence of TMS. There are many articles discussing the difficulty in designing experiments which would provide more definitive results. Ok, this part wasn't really surprising. The most reputable sources were the most skeptical about TMS, not the least of which, the APA (Americal Psychological Association) itself. The only good news is that, effective or not, it is largely benign with very rare incidence of serious negative effects.
3. Seemingly trustworthy and well-known large medical universities have vaguely positive things to say about TMS and claim to be engaged in TMS research. Suspiciously, all photography of experimental apparatus appears to depict the very same equipment sold to the individual practice providers. My wife spent a lot of time following up in detail with OHSU (Oregon Health and Sciences University) about their TMS research. Their story, as it turns out, appears to be typical of the other universities as well. They had some initial enthusiasm and limited experimentation, ran into the same difficulties in designing experiments and producing solid results that everyone else has had, and are not currently actively engaged in any research on the subject.
So... probably another form of electric snake oil, but just enough of a hope/doubt mix to maybe give it a try, with very low expectations.
It appears that my next step will most likely be just that, give it a try so long as it is covered by insurance, but invest no hope.
This ultimately brings me back to my obsession with threes, in this case, three choices:
1. Go ahead and pursue ECT (Electroconvulsive Therapy). A treatment much maligned in popular culture, but which has a fairly good rate of initial efficacy, although a higher than hoped-for rate of relapse and diminishing returns with subsequent re-treatment (a profile it shares with success stories claimed for TMS).
2. Abandon all physical or pharmacological approaches to treatment, and do my best to live out what remain of my days as tolerably as possible, with or without a return to the endlessly disappointing talk therapy. My concern is not as much with what I can tolerate, but more with what is reasonable to expect others to tolerate in terms of my behavior.
3. Ummm... So far, I only have extremely brief moments of psychic discomfort so intense that I contemplate the final solution. These moments have passed and not led to a very loaded word I am loathe to invoke in this context: planning. In calmer times, I have dispassionately gone through the intellectual exercise of finding the inevitably unacceptable consequences or risks of consequences that come with any methodology I can imagine for implementing a final solution. I understand that a person can reach a point where the final solution is coveted as the last and only thing within individual control, but even that sense of control is false as there are too many variables that can lead to unintended results. This is a strongly discouraging situation before moral philosophy is even considered, which tends to cast even more doubt on the prudence of the final solution.
So much for my obsession with threes. There is a fourth, very unlikely, course of action:
4. Engage in experimentation with legal and non-legal pharmaceutical treatments. I have done some online investigation into this and it is not very promising. The best I can hope for is a temporarily altered state of consciousness which occludes one set of mental dysfunctions with another. The most promising substance, MDMA, is far too difficult to synthesize properly and I would trust no amateur manufacturer. It is a substance that has been, in pharmaceutical-grade form, tested by scientists, with some hopeful results for some extreme conditions, but FDA approval seems very far away, if it ever comes, and even then, there is much that is not known about appropriate dosing or long-term efficacy.
Once again, as always, way too much, and no hopeful conclusion. I expect that I will never tire of complaining until the day I die.
Friday, November 30, 2018
For what it may be worth...
A quick update, now that I am more certain about being clean of SSRI meds.
I feel, in bulk, remarkably similar to how I felt when I was on my maximum dosage, which is what I expected, and why I decided to taper off and cease using the drug.
There are a few differences:
I can cry again, in situations which seem appropriate.
I need to apply more conscious effort to avoiding reacting to stimuli in a negative manner.
Um... that's really it.
Things for which I had hoped, but which have not happened:
My urge to sing, while enjoying a slight resurgence during the dosage decrease, has not returned
My libido remains dead, with all of the negatives and positives that come with that
Despite remaining on my anti-anxiety medication, I have had an increase in anxiety-related symptoms
Social Inertia remains solidly the same
I guess that is enough information for now.
Well, there is this strangeness: my dreams have changed.
While on the SSRI meds, and historically previous to even starting them, my dreams tended to be generally abstract and escapist. Most occurred in alternate realities which are not easily described while in the waking world of this reality. No fear or other anxiety occurred in these dreams, no matter how strange they may have seemed upon awakening. If a dream was ever ever slightly relatable to my perceived real world, I would consistently be inhabiting a much younger version of myself within the dream.
Now, my dreams are both mundane and horrible, like an amplified version of my perceived waking reality. Every dream is about being inadequate and actively unloved by others. I am more often than not self-perceived as a person of my own age and physical limitations, or an exaggeration of the same. Sleep is no longer an escape, and possibly due to this, my sleep patterns have become increasingly fragmented.
I guess that is too much information for now.
I feel, in bulk, remarkably similar to how I felt when I was on my maximum dosage, which is what I expected, and why I decided to taper off and cease using the drug.
There are a few differences:
I can cry again, in situations which seem appropriate.
I need to apply more conscious effort to avoiding reacting to stimuli in a negative manner.
Um... that's really it.
Things for which I had hoped, but which have not happened:
My urge to sing, while enjoying a slight resurgence during the dosage decrease, has not returned
My libido remains dead, with all of the negatives and positives that come with that
Despite remaining on my anti-anxiety medication, I have had an increase in anxiety-related symptoms
Social Inertia remains solidly the same
I guess that is enough information for now.
Well, there is this strangeness: my dreams have changed.
While on the SSRI meds, and historically previous to even starting them, my dreams tended to be generally abstract and escapist. Most occurred in alternate realities which are not easily described while in the waking world of this reality. No fear or other anxiety occurred in these dreams, no matter how strange they may have seemed upon awakening. If a dream was ever ever slightly relatable to my perceived real world, I would consistently be inhabiting a much younger version of myself within the dream.
Now, my dreams are both mundane and horrible, like an amplified version of my perceived waking reality. Every dream is about being inadequate and actively unloved by others. I am more often than not self-perceived as a person of my own age and physical limitations, or an exaggeration of the same. Sleep is no longer an escape, and possibly due to this, my sleep patterns have become increasingly fragmented.
I guess that is too much information for now.
Wednesday, October 31, 2018
So. There is this. This thing here. Whatever.
The bad idea is to give a slightly detailed update regarding my medical/mental/existential shit on the absurd presumption that it might be of some interest or service to do so. I am not entirely sure what brings such a presumption into being in my mind, and speculation is error-prone. I'd best just get on with it. (The first typo I caught while writing this was kind of funny. I wrote "one" instead of "on" in the sentence previous to this parenthetical note.)
The sweeping and misleading statement I am likely to use when sharing a link to this is "I'm off my meds!" More accurately, over the past month or so I have been gradually reducing the dosage of one of my psych meds, Sertraline (generic for Zoloft, broadly classified as an SSRI), and as of this writing I have been on dosage of zero for one week. The general "rule of thumb" (stupid, to me, sounding euphemism, of which I do not know the etymology, yet I am using it) my psychiatrist gave me was that with each reduction in dosage, I should know what that feels like after a week. I have decided to err my expectations more cautiously, so I don't expect to know for another week. Similarly, each increment of dosage reduction along the way to zero was at two-week intervals.
How do I actually feel? Similar to my own expectations, I feel not very different from how I felt when on my highest dosage (150mg/day). There seem to be differences, but I am cautious about trusting and reporting such perceptions and life is subjectively a chaotic bombardment of unpredictable variables that can skew my perceptions. Life might be solidly deterministic, but since I don't believe that it is possible for me to know this with certainty, the subjective experience of chaos and choices is all I have. How I may feel differently is better prefaced by an explanation of why I did this.
Why did I do this? I am not confident that anyone fully knows the mechanisms of the brain, not the mechanisms by which introducing specific chemical compounds may effect change. There are some fairly simple-sounding explanations of how and SSRI works and what it does, but I am among many who find that the subjective experience does not match the expectations implied by such explanations. There is a remarkable consistency between my experience, and those anecdotally reported by many others being treated by this, and similar, drugs.
I should avoid undue drama in my report of SSRI use, mostly because the primary effect I seem to notice is a distinct lack of drama. The drug that is intended to make me feel less bad, maybe even more good, made me feel less everything. In many ways, this was a tremendous relief. There are many emotions of which I was content to be free. Anger, irritability, rage. These I do not need or want, and the bargain of losing everything else seemed fair enough, for awhile. Even the complete loss of libido was freeing. People do some of the most silly, dangerous and hurtful things when enslaved to the drive to procreate. From the outside, the whole thing looks like a tragic/comic opera of foolishness.
Over time, while on the higher dosages, two things happened. First, I began to notice that I had less love, the hard-to-define unselfish non-sexual kind of love, the existence of which is subject to debate, but in which I personally believe. Perhaps a better word would be "kindness". Oddly, in my dull way, I also began to miss sadness. Things happened that would once have made me cry only elicited an intellectual acknowledgement that something sad had happened. Worst of all, for me, the urge to sing was gone. I did not sing along with songs, nor sing extemporaneously as I once often had. My interest in music was still strong, but I found myself gravitating towards music more intellectual than emotional, appreciating the cleverness of the construction and the precision of the performance. I have always had that kind of appreciation of that kind of music, but to me, there seems to have been something more that was no longer accessible to me. Also, hopelessness was as present as ever, it just felt more normal, like a simple acknowledgement of the true nature of existence. No delusions remained to dissuade me from grim resignation, yet it also had no edge, it did not hurt. It was like I was already essentially dead, just running out the clock, and was scarcely concerned about it.
The other thing that happened was that all of the above gradually happened less, but in a peculiar way I found to be uncomfortable. I regained some access to some emotions, but only some of the ones I least wanted, such as irritability or any number of other imperfect near-synonyms to that word. Hopelessness regained some of it's ability to inflict pain and panic. The strangely comfortable peace of disassociation degraded into a dull yet pervasive and persistent sadness. But my voice did not come back, not even tears came back, just an increasing desire to be done with it all.
A simplistic way of putting it would be to say that it felt like the drug was no longer working. It never worked as one might have hoped, but having found acceptance of the way it did change me, I was now gradually losing even that, and gaining nothing I held of value.
A different drug was suggested, based upon some enthusiastic anecdotal reportage from exactly one patient. Both my psychiatrist and I were dubious of the prospect of the long and difficult transition to this other, also much more expensive, treatment.
Ultimately, however, I decided that whatever alternate treatment may or may not follow, there was little to be lost in the experiment of slowly separating myself from my then-current SSRI.
So now I have done that thing. What have I gained? So far, just a few tears and some occasional singing, but only when alone. A lot of the symptoms of "Major Depressive Disorder" have returned, and require constant, exhausting effort to manage. Oddly, I am largely unable to stay asleep or awake continuously for more than two or three hours at a time, so the long hibernations of depression have not returned, but I sure could use some more sleep. Empathy and kindness, I think, have improved. I still have unpredictable bouts of irritability, but not intense or frequent enough to be very alarming, just unfortunate for anyone subjected to it.
What is next? My current state does not seem sustainable for any reasonable amount of time. I am even more averse to pharmacological options that I had been in the years I had resisted before surrendering some years ago. I have a lot of experience with, and doubts about the efficacy of, talk therapy. None of them ever seemed particularly interested in their profession, much less their patients, and I was a particularly discomfiting patient, referred repeatedly from one to another like a barrel of toxic waste. I am open to just about anything else, even ECT or TMS. Both of those are expensive and lengthy processes, difficult to get covered by insurance if at all. ECT offers both a longer clinical history and more certain unpleasant side-effects, while TMS is newer and it's science is less proven, it has thus far been nearly free of negative side-effects. Then there are the largely unproven fringe science electric snake oils of tDCS, tPCS and tRNS. In this particular alphabet soup the "t" is for "trans" or "trans-cranial", and they are all low-current forms of purported brain stimulation applied through electrodes on the head, usually at home with a purchased or home-built device. The simplest and most dubious of these is tDCS, which is essentially plugging a 9-volt battery into your head. All of the others use some form of low-voltage alternating current, in a myriad of special frequencies and wave-forms with a Tower of Babel of claims of efficacy exclusive of one-another. Oh yeah, and there's also currently-experimental and terrifying DBS (electrodes surgically implanted in the brain) and the very unpleasant-sounding VNS (Vagus Nerve Stimulation).
I am likely to try something stupid but relatively harmless such as tPCS/tRNS next. I already burned my temples and gave myself a headache, over a year ago, with a tDCS device I bought through eBay from some former Soviet-Bloc country.
As a bonus anecdote, and speaking of the Vagus Nerve. One week ago my wife suddenly passed out in the middle of dinner at a restaurant, and was pretty out of it for an hour or two after. This resulted in endless hours in the ER and then 24 hours in the peculiar lesser nightmare called the CDU (Clinical Decisions Unit), and many tests resulting in a pseudo-diagnosis of some sort of spontaneous action of the Vagus Nerve, which conveniently cannot be proven or dis-proven by any test, but which also does not very neatly fit the full symptomology presented. Further testing is pending.
One more thing, just to round this out. I am in fact still using another psychoactive prescriptive, known as clonazepam, generic for klonoptin, and just one of many drugs in the class of benzodiazapine tranquilizers. This, as has been repeated in previous blog posts, is an anti-convulsive prescribed off-label for acute anxiety. I continue to take the legal limit of 4mg a day in a series of four equally-spaced, on a good day, doses of 1mg. Halfway through my reduction of my SSRI, I got cocky and tried tapering off of the clonazepam, with absolutely terrible results. This stuff is kind of like Heroin, in that there is no easy and safe way off. Besides, I don't think it has much if any bearing on the issues related to SSRI usage.
Now aren't you glad you skipped to the last line instead of reading all of that shit?
The sweeping and misleading statement I am likely to use when sharing a link to this is "I'm off my meds!" More accurately, over the past month or so I have been gradually reducing the dosage of one of my psych meds, Sertraline (generic for Zoloft, broadly classified as an SSRI), and as of this writing I have been on dosage of zero for one week. The general "rule of thumb" (stupid, to me, sounding euphemism, of which I do not know the etymology, yet I am using it) my psychiatrist gave me was that with each reduction in dosage, I should know what that feels like after a week. I have decided to err my expectations more cautiously, so I don't expect to know for another week. Similarly, each increment of dosage reduction along the way to zero was at two-week intervals.
How do I actually feel? Similar to my own expectations, I feel not very different from how I felt when on my highest dosage (150mg/day). There seem to be differences, but I am cautious about trusting and reporting such perceptions and life is subjectively a chaotic bombardment of unpredictable variables that can skew my perceptions. Life might be solidly deterministic, but since I don't believe that it is possible for me to know this with certainty, the subjective experience of chaos and choices is all I have. How I may feel differently is better prefaced by an explanation of why I did this.
Why did I do this? I am not confident that anyone fully knows the mechanisms of the brain, not the mechanisms by which introducing specific chemical compounds may effect change. There are some fairly simple-sounding explanations of how and SSRI works and what it does, but I am among many who find that the subjective experience does not match the expectations implied by such explanations. There is a remarkable consistency between my experience, and those anecdotally reported by many others being treated by this, and similar, drugs.
I should avoid undue drama in my report of SSRI use, mostly because the primary effect I seem to notice is a distinct lack of drama. The drug that is intended to make me feel less bad, maybe even more good, made me feel less everything. In many ways, this was a tremendous relief. There are many emotions of which I was content to be free. Anger, irritability, rage. These I do not need or want, and the bargain of losing everything else seemed fair enough, for awhile. Even the complete loss of libido was freeing. People do some of the most silly, dangerous and hurtful things when enslaved to the drive to procreate. From the outside, the whole thing looks like a tragic/comic opera of foolishness.
Over time, while on the higher dosages, two things happened. First, I began to notice that I had less love, the hard-to-define unselfish non-sexual kind of love, the existence of which is subject to debate, but in which I personally believe. Perhaps a better word would be "kindness". Oddly, in my dull way, I also began to miss sadness. Things happened that would once have made me cry only elicited an intellectual acknowledgement that something sad had happened. Worst of all, for me, the urge to sing was gone. I did not sing along with songs, nor sing extemporaneously as I once often had. My interest in music was still strong, but I found myself gravitating towards music more intellectual than emotional, appreciating the cleverness of the construction and the precision of the performance. I have always had that kind of appreciation of that kind of music, but to me, there seems to have been something more that was no longer accessible to me. Also, hopelessness was as present as ever, it just felt more normal, like a simple acknowledgement of the true nature of existence. No delusions remained to dissuade me from grim resignation, yet it also had no edge, it did not hurt. It was like I was already essentially dead, just running out the clock, and was scarcely concerned about it.
The other thing that happened was that all of the above gradually happened less, but in a peculiar way I found to be uncomfortable. I regained some access to some emotions, but only some of the ones I least wanted, such as irritability or any number of other imperfect near-synonyms to that word. Hopelessness regained some of it's ability to inflict pain and panic. The strangely comfortable peace of disassociation degraded into a dull yet pervasive and persistent sadness. But my voice did not come back, not even tears came back, just an increasing desire to be done with it all.
A simplistic way of putting it would be to say that it felt like the drug was no longer working. It never worked as one might have hoped, but having found acceptance of the way it did change me, I was now gradually losing even that, and gaining nothing I held of value.
A different drug was suggested, based upon some enthusiastic anecdotal reportage from exactly one patient. Both my psychiatrist and I were dubious of the prospect of the long and difficult transition to this other, also much more expensive, treatment.
Ultimately, however, I decided that whatever alternate treatment may or may not follow, there was little to be lost in the experiment of slowly separating myself from my then-current SSRI.
So now I have done that thing. What have I gained? So far, just a few tears and some occasional singing, but only when alone. A lot of the symptoms of "Major Depressive Disorder" have returned, and require constant, exhausting effort to manage. Oddly, I am largely unable to stay asleep or awake continuously for more than two or three hours at a time, so the long hibernations of depression have not returned, but I sure could use some more sleep. Empathy and kindness, I think, have improved. I still have unpredictable bouts of irritability, but not intense or frequent enough to be very alarming, just unfortunate for anyone subjected to it.
What is next? My current state does not seem sustainable for any reasonable amount of time. I am even more averse to pharmacological options that I had been in the years I had resisted before surrendering some years ago. I have a lot of experience with, and doubts about the efficacy of, talk therapy. None of them ever seemed particularly interested in their profession, much less their patients, and I was a particularly discomfiting patient, referred repeatedly from one to another like a barrel of toxic waste. I am open to just about anything else, even ECT or TMS. Both of those are expensive and lengthy processes, difficult to get covered by insurance if at all. ECT offers both a longer clinical history and more certain unpleasant side-effects, while TMS is newer and it's science is less proven, it has thus far been nearly free of negative side-effects. Then there are the largely unproven fringe science electric snake oils of tDCS, tPCS and tRNS. In this particular alphabet soup the "t" is for "trans" or "trans-cranial", and they are all low-current forms of purported brain stimulation applied through electrodes on the head, usually at home with a purchased or home-built device. The simplest and most dubious of these is tDCS, which is essentially plugging a 9-volt battery into your head. All of the others use some form of low-voltage alternating current, in a myriad of special frequencies and wave-forms with a Tower of Babel of claims of efficacy exclusive of one-another. Oh yeah, and there's also currently-experimental and terrifying DBS (electrodes surgically implanted in the brain) and the very unpleasant-sounding VNS (Vagus Nerve Stimulation).
I am likely to try something stupid but relatively harmless such as tPCS/tRNS next. I already burned my temples and gave myself a headache, over a year ago, with a tDCS device I bought through eBay from some former Soviet-Bloc country.
As a bonus anecdote, and speaking of the Vagus Nerve. One week ago my wife suddenly passed out in the middle of dinner at a restaurant, and was pretty out of it for an hour or two after. This resulted in endless hours in the ER and then 24 hours in the peculiar lesser nightmare called the CDU (Clinical Decisions Unit), and many tests resulting in a pseudo-diagnosis of some sort of spontaneous action of the Vagus Nerve, which conveniently cannot be proven or dis-proven by any test, but which also does not very neatly fit the full symptomology presented. Further testing is pending.
One more thing, just to round this out. I am in fact still using another psychoactive prescriptive, known as clonazepam, generic for klonoptin, and just one of many drugs in the class of benzodiazapine tranquilizers. This, as has been repeated in previous blog posts, is an anti-convulsive prescribed off-label for acute anxiety. I continue to take the legal limit of 4mg a day in a series of four equally-spaced, on a good day, doses of 1mg. Halfway through my reduction of my SSRI, I got cocky and tried tapering off of the clonazepam, with absolutely terrible results. This stuff is kind of like Heroin, in that there is no easy and safe way off. Besides, I don't think it has much if any bearing on the issues related to SSRI usage.
Now aren't you glad you skipped to the last line instead of reading all of that shit?
Saturday, June 16, 2018
Obligatory Update
[Edit: 2018.10.30. There are some horrific mistakes in what is written below. The worst are inexplicable use of incorrect homonyms of the intended words. I am not fixing them. I don't care to do any more than make this note, just so any imaginary reader knows that I know how stupid I am. For some reason that is important to me, or something.]
Obligated to who or what? I guess a little bit of OCD in me that thinks that I've been blogging all my health bullshit, I might as well make sure I keep it up-to-date. Apparently I lost the little bit of OCD that gave a shit about style or grammar.
This is what old people do. We talk about our gross boring health bullshit, and bad writing, while you anxiously wait for us to die.
I almost did, maybe. Yeah, probably.
If I had written this months ago, it would be peppered with amusing anecdotes demonstrating how profoundly I distrust all medical professionals.. But now I have either forgotten or lack the will to try to remember.
So, just the basic facts:
I almost died of acute congestive heart failure.
It took medical professionals an unacceptably long time to figure this out.
As a result of their aggressive treatment for congestive heart failure, I was released from the hospital while in acute renal failure.
So now in addition to calories and carbohydrates, I have to severely limit my sodium intake and closely monitor and limit my intake of water, or anything that is composed in part of water.
Watching sodium is a good idea anyway, and I was already giving that some attention, but this is a whole new color of threat level.
Limiting fluid intake is counter-intuitive, after a lifetime of doctors and everyone else hammering away about the importance of adequate hydration.
It's even better that all that. If I over-due the fluid intake limiting thing, I go back into renal failure, and get horrible leg cramps when I try to sleep.
So life is now insert apt metaphor or simile here.
Oh yeah, I also have an enlarged heart because I have basically been living in a constant state of congestive heart failure for decades. It just took a minor sickness, over-treated by chicken soup and electrolyte-laden beverages to push me into a sufficiently acute state to be diagnosed.
So the good news... yes, I am capable of perceiving the presence of and dutifully reporting good news about myself... When I have the balance just right and I am not leaning hard towards acute this or that, especially the heart failure thing, I can actually walk at a brisk pace for several blocks, even uphill, without collapsing in a wheezing pile of oxygen starvation and a heart like a hulk fist trying to beat it's way out through my sternum.
One more thing: when they did a CT of my chest before they had any idea what was wrong with me, whoever wrote up the interpretation of my imaging noted a large number of various sizes of something he called "nodes" in one of my lungs. Not one doctor read this. I did, and I pointed it out to my Primary Care Physician. The follow-up CT to see if they're still there and if they have grown is in the next month or two.
If God exists, he hates me.
If the universe has intent, it wants me dead.
If everything happens for a reason, the reason is so I will die.
I have far outlived any purpose I may have had.
My possibilities for satisfying any selfish personal goals have narrowed to nothing.
My psychiatric medications have robbed me of my vital powers of self-delusion.
I'm just running the clock out.
But how in Hell am I supposed to plan a decent suicide if I am constantly being forced to fight for my worthless piece of shit life?
Ok, time for grandpa to take his pills and go to bed.
Obligated to who or what? I guess a little bit of OCD in me that thinks that I've been blogging all my health bullshit, I might as well make sure I keep it up-to-date. Apparently I lost the little bit of OCD that gave a shit about style or grammar.
This is what old people do. We talk about our gross boring health bullshit, and bad writing, while you anxiously wait for us to die.
I almost did, maybe. Yeah, probably.
If I had written this months ago, it would be peppered with amusing anecdotes demonstrating how profoundly I distrust all medical professionals.. But now I have either forgotten or lack the will to try to remember.
So, just the basic facts:
I almost died of acute congestive heart failure.
It took medical professionals an unacceptably long time to figure this out.
As a result of their aggressive treatment for congestive heart failure, I was released from the hospital while in acute renal failure.
So now in addition to calories and carbohydrates, I have to severely limit my sodium intake and closely monitor and limit my intake of water, or anything that is composed in part of water.
Watching sodium is a good idea anyway, and I was already giving that some attention, but this is a whole new color of threat level.
Limiting fluid intake is counter-intuitive, after a lifetime of doctors and everyone else hammering away about the importance of adequate hydration.
It's even better that all that. If I over-due the fluid intake limiting thing, I go back into renal failure, and get horrible leg cramps when I try to sleep.
So life is now insert apt metaphor or simile here.
Oh yeah, I also have an enlarged heart because I have basically been living in a constant state of congestive heart failure for decades. It just took a minor sickness, over-treated by chicken soup and electrolyte-laden beverages to push me into a sufficiently acute state to be diagnosed.
So the good news... yes, I am capable of perceiving the presence of and dutifully reporting good news about myself... When I have the balance just right and I am not leaning hard towards acute this or that, especially the heart failure thing, I can actually walk at a brisk pace for several blocks, even uphill, without collapsing in a wheezing pile of oxygen starvation and a heart like a hulk fist trying to beat it's way out through my sternum.
One more thing: when they did a CT of my chest before they had any idea what was wrong with me, whoever wrote up the interpretation of my imaging noted a large number of various sizes of something he called "nodes" in one of my lungs. Not one doctor read this. I did, and I pointed it out to my Primary Care Physician. The follow-up CT to see if they're still there and if they have grown is in the next month or two.
If God exists, he hates me.
If the universe has intent, it wants me dead.
If everything happens for a reason, the reason is so I will die.
I have far outlived any purpose I may have had.
My possibilities for satisfying any selfish personal goals have narrowed to nothing.
My psychiatric medications have robbed me of my vital powers of self-delusion.
I'm just running the clock out.
But how in Hell am I supposed to plan a decent suicide if I am constantly being forced to fight for my worthless piece of shit life?
Ok, time for grandpa to take his pills and go to bed.
Thursday, January 25, 2018
Hey, let's obsess about drugs and mental health some more!
[New Improved Editorial Note, June 14, 2018: Holy Mother of Goats, I am an idiot! As you read, if you read, this post, not that I recommend it, please mentally replace the word "Zoloft" with "Ambien" everywhere it occurs in this post. I am also on Zoloft, but as prescribed by my psychiatrist, not my PC. I don't even have a PC any more. He moved. I meet a new one next month, because this is all information of vital interest to everyone!]
[Editorial Note: I just noticed that this blog entry is virtually identical in content to the immediately previous one. Well, damn it, I put in the time, so it stays, and stands as more evidence that I am, pretty much literally, losing my mind.]
At my annual wellness exam, my primary care physician made it clear that what I have been doing to get myself to sleep for the past few years is dangerous, likely responsible for my recent problems with equilibrium, memory, and general cognition, and a suspected contributor to risk of developing Dementia.
Fine talk from the very doctor who prescribed enough Zoloft for daily use when my chart already showed that I was on high doses of another Benzodiazepine. Yet, it is still my fault that I, against all warnings, added alcohol to the mix.
Clearly, at some level, I knew what I was doing. After all, for awhile my nightcap to accompany Zoloft, Clonazepam, and sometimes Diphenhydramine (Benadryl) was my favorite skull mug filled with a combination of Nyquil, Vodka, Kool-Aid, "Rescue Remedy" and whatever else struck my fancy. I called it "Death Grog" so, yeah, that's on me. Those are years without a lot of memories attached.
Essentially, what I was doing to get to sleep was roughly equivalent to what some people do to try to end their lives.
This led, of course, to stumbling sleepily through mind-fogged days, and a lot of napping. When I was needed to be awake for some task, usually driving, my drug of choice was Monster energy drinks, sometimes two or more a day.
The vicious cycle this creates led to mental health symptoms that somewhat resembled Bipolar Syndrome, and more. Alternately spazzy, irritable, prone to panic, cognitive deficits, and almost catatonic periods of disassociation. That's probably not a complete list.
So, here's the good news. Dropping Zoloft cold turkey seems to have no withdrawal symptoms. I have long since abandoned Nyquil and Benadryl. Eliminating bedtime alcohol and drastic reduction of caffeine intake, have all, one week into the process, proven easy. I no longer have difficulties with maintaining wakefulness, so long as I am allowed to follow my natural sleep patterns (roughly 4AM to Noon), and my moods swings are less extreme.
Not to worry, I am still beset with depression and anxiety. I feel completely worthless and unworthy, and can't handle noisy, bright, crowded situations, or any kind of direct interaction with people that lasts more than a few seconds.
[Editorial Note: I just noticed that this blog entry is virtually identical in content to the immediately previous one. Well, damn it, I put in the time, so it stays, and stands as more evidence that I am, pretty much literally, losing my mind.]
At my annual wellness exam, my primary care physician made it clear that what I have been doing to get myself to sleep for the past few years is dangerous, likely responsible for my recent problems with equilibrium, memory, and general cognition, and a suspected contributor to risk of developing Dementia.
Fine talk from the very doctor who prescribed enough Zoloft for daily use when my chart already showed that I was on high doses of another Benzodiazepine. Yet, it is still my fault that I, against all warnings, added alcohol to the mix.
Clearly, at some level, I knew what I was doing. After all, for awhile my nightcap to accompany Zoloft, Clonazepam, and sometimes Diphenhydramine (Benadryl) was my favorite skull mug filled with a combination of Nyquil, Vodka, Kool-Aid, "Rescue Remedy" and whatever else struck my fancy. I called it "Death Grog" so, yeah, that's on me. Those are years without a lot of memories attached.
Essentially, what I was doing to get to sleep was roughly equivalent to what some people do to try to end their lives.
This led, of course, to stumbling sleepily through mind-fogged days, and a lot of napping. When I was needed to be awake for some task, usually driving, my drug of choice was Monster energy drinks, sometimes two or more a day.
The vicious cycle this creates led to mental health symptoms that somewhat resembled Bipolar Syndrome, and more. Alternately spazzy, irritable, prone to panic, cognitive deficits, and almost catatonic periods of disassociation. That's probably not a complete list.
So, here's the good news. Dropping Zoloft cold turkey seems to have no withdrawal symptoms. I have long since abandoned Nyquil and Benadryl. Eliminating bedtime alcohol and drastic reduction of caffeine intake, have all, one week into the process, proven easy. I no longer have difficulties with maintaining wakefulness, so long as I am allowed to follow my natural sleep patterns (roughly 4AM to Noon), and my moods swings are less extreme.
Not to worry, I am still beset with depression and anxiety. I feel completely worthless and unworthy, and can't handle noisy, bright, crowded situations, or any kind of direct interaction with people that lasts more than a few seconds.
Tuesday, January 16, 2018
The Latest Version of More of the Same
Maybe there is just enough story here to justify a return to telling.
I have a profound feeling of isolation and powerlessness, given that there are things that plague my mind which I cannot share with anyone, not even my marriage partner of over 30 years. Not even with my psychiatrist, with whom I have an appointment "tomorrow" (later today).
I had an appointment with this same psychiatrist some months ago, arriving at least as burdened with needful, for me at least, things to say as I am now, but the very first words out of his mouth were "How is your lovely wife?" You see, he had met her, and like everyone else who meets her, the fact of my existence became part of her, much more interesting, story. She does not make this happen by intent. It is just the natural response everyone has upon meeting her. She is amazing, and putting up with me as a husband is just one more way in which she is amazing. I know it sounds like I am resentful, but I really am not, most of the time, and when I am, I always come to realize that my feelings were wrong, ungrateful, and petty.
She is not the reason I have problems. She is the reason I am still alive. Her, and my granddaughter.
I would not be writing this if I believed that anyone, even my original singular assumed reader, was going to read it. Paradoxically, I am motivated to write largely because I made a link to this blog the sole external link on my Bandcamp page. I am still arguing with myself about why I would do such a thing.
Here's the story:
I have been having disturbing incidents in which it seems that my psychiatric medications do not appear to be working. At the same time, I am noticing, subjectively at least, a decline in my general cognitive function.
I had already made this next appointment with my psychiatrist when I came due for an annual wellness exam with my primary care physician. Much to my surprise and discomfort, they had a whole new questionnaire addressing, quite specifically, mental health. I had been comfortable compartmentalizing my physical and mental health with two different care providers, but I felt an obligation to complete what was put before me, and to do so honestly.
Apparently, my honest answers set off some silent alarms, or the whole intake procedure for a wellness exam had been radically altered. Once I was ushered into an exam room, a nurse orally administered a much more comprehensive psychological evaluation, followed by additional questions from my doctor. The primary focus seemed to be on risks of suicide. Maybe it is a risk management thing. There was more weird shit, but I am getting tired, and my window of available sleep time is narrowing.
Notably, however, I was taken aback by newfound warnings from my GP about the risks of Zolpidem (Ambien), which he had long ago prescribed to me. Suddenly now, after at least two years of daily use, I am warned that this drug can contribute to both short term and long term cognitive deficits, and problems with equilibrium, including an elevated risk of developing full-on dementia. I am now terrified that the damage is already done, while also trying to cease use of Ambien "cold turkey".
Almost as if motivated by learning of my barely controlled anxiety and depression, he also told me that my decision to cease use of a CPAP machine several years ago was probably causing permanent brain damage, and would also increase my risk of developing dementia.
Hooray.
So, a lot to cover with my psychiatrist, if he lets me finish a sentence or two, and very little time left to sleep.
More than enough. Goodbye.
I have a profound feeling of isolation and powerlessness, given that there are things that plague my mind which I cannot share with anyone, not even my marriage partner of over 30 years. Not even with my psychiatrist, with whom I have an appointment "tomorrow" (later today).
I had an appointment with this same psychiatrist some months ago, arriving at least as burdened with needful, for me at least, things to say as I am now, but the very first words out of his mouth were "How is your lovely wife?" You see, he had met her, and like everyone else who meets her, the fact of my existence became part of her, much more interesting, story. She does not make this happen by intent. It is just the natural response everyone has upon meeting her. She is amazing, and putting up with me as a husband is just one more way in which she is amazing. I know it sounds like I am resentful, but I really am not, most of the time, and when I am, I always come to realize that my feelings were wrong, ungrateful, and petty.
She is not the reason I have problems. She is the reason I am still alive. Her, and my granddaughter.
I would not be writing this if I believed that anyone, even my original singular assumed reader, was going to read it. Paradoxically, I am motivated to write largely because I made a link to this blog the sole external link on my Bandcamp page. I am still arguing with myself about why I would do such a thing.
Here's the story:
I have been having disturbing incidents in which it seems that my psychiatric medications do not appear to be working. At the same time, I am noticing, subjectively at least, a decline in my general cognitive function.
I had already made this next appointment with my psychiatrist when I came due for an annual wellness exam with my primary care physician. Much to my surprise and discomfort, they had a whole new questionnaire addressing, quite specifically, mental health. I had been comfortable compartmentalizing my physical and mental health with two different care providers, but I felt an obligation to complete what was put before me, and to do so honestly.
Apparently, my honest answers set off some silent alarms, or the whole intake procedure for a wellness exam had been radically altered. Once I was ushered into an exam room, a nurse orally administered a much more comprehensive psychological evaluation, followed by additional questions from my doctor. The primary focus seemed to be on risks of suicide. Maybe it is a risk management thing. There was more weird shit, but I am getting tired, and my window of available sleep time is narrowing.
Notably, however, I was taken aback by newfound warnings from my GP about the risks of Zolpidem (Ambien), which he had long ago prescribed to me. Suddenly now, after at least two years of daily use, I am warned that this drug can contribute to both short term and long term cognitive deficits, and problems with equilibrium, including an elevated risk of developing full-on dementia. I am now terrified that the damage is already done, while also trying to cease use of Ambien "cold turkey".
Almost as if motivated by learning of my barely controlled anxiety and depression, he also told me that my decision to cease use of a CPAP machine several years ago was probably causing permanent brain damage, and would also increase my risk of developing dementia.
Hooray.
So, a lot to cover with my psychiatrist, if he lets me finish a sentence or two, and very little time left to sleep.
More than enough. Goodbye.
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