Psychological Reactions to Medications/Substances - Part 1

[Kizzie]

Here's to hoping it turns the tide and ACEs, childhood trauma, and chronic stress and their relation to chronic health conditions are put on more peoples' and doctors' (!) radar so people don't feel the need to blame themselves for what they're feeling and experiencing.

 

If you're ever interested in writing an article for our blog on this topic Dolly, plse PM me as I'm always looking for survivors' perspectives and issues of concern.   

[dollyvee]

Thanks Kizzie maybe once things get settled I'll try to put it down and figure out a way to tame my run on sentences 

[Kizzie]

 

[Kizzie]

Happy to report I am not having anxiety attacks like I was so it confirms for me and my GP that it was the particular SSRI I was on.

I do wish psychiatrists were more available to help sort out meds. Where I live you can only get one appointment through health services and that's it, they don't track you or anything after that. Instead of me going to the psychiatrist my GP connected with him instead. My GP is awesome but she doesn't have the deeper knowledge that the psychiatrist she consulted with does. He knew right away what was happening and was able to help her and I make the appropriate change.

Lovely to be feeling better and thankful my GP goes the extra mile 

[dollyvee]

Hi Kizzie,

That's great  I'm kind of in awe that psychiatrists will just prescribe a medication and then leave a GP to sort it out (if there is one) while you deal with the effects. To me, that's literally their job and points to maybe something wrong with the system as a whole. Glad your GP was there for you. 

Now if more would look into the connection between MTHFR mutations and major depressive disorders and adequate methyl donors, my rant.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898281/

dolly 

[Kizzie]

That articles so confirms for me the need for medical (and ideally mental health professionals) to be knowledgeable about how medications/ supplements can exacerbate psychological symptoms.

I know when I was looking into corticosteroids and read about the two people who used eyedrops and developed very bad anxiety I was shocked. One of the people had reported this to her doctor and they had made a plan for her to see a therapist and also start an SSRI.  She thought she was the problem.  How many others is this type of thing happening to?

( Just an aside - When I read the article I kept reading  MTHFR as "motherf*****" lol which about sums up the mutation  )

[dollyvee]

I think that's true and that these things don't operate in a vacuum from each other and to start an SSRI because of a reaction to a medication is almost unbelievable. It just seems like such a failure for doctors to do what they're supposed to actually do. It's also in line with what sweetsixty was talking about with pharmacogentics (?) and that not everybody is going to respond the same to different medications because of genetic variations. That's probably not taken into account enough.

A lot of people read it that way  From reading other peoples' experiences on different forums, it does sound like some doctors do test for MTHFR and will prescribe Deplin, which is high dose methylfolate, if they're found to be homozygous for the mutation (C677T), but I don't think that's the majority. I know from my own experiences and learning about how these things actually work, is that folate needs to be properly metabolized (and there needs to be enough of it) in order to have adequate neurotransmitter production. It seems so fundamental but isn't addressed at the GP.

[Kizzie]

Just a bit of an update. I've further lowered my dose of the new SSRI I'm taking (Lexapro) and weaned off the benzo I was on for a few weeks (clonazepam) and still no return of that horrible anxiety.  So for whatever reason (I'm personally thinking aging) after being on it for about 6 years I became quite sensitive to it.  We were upping the dose which seems a natural response to my anxiety when we should have been lowering it.  A bit counterintuitive but it worked thankfully.

Whatever, I'm just glad to be on the other side of them.  It was similar to being flattened by depression, couldn't get out of bed, didn't eat, insomnia.... but it was anxiety.  I've had some bad bouts of depression where all of that happened but never   anxiety that caused me to become non-functional basically.

Oddly enough after what I just went through and as I mentioned elsewhere on the forum, I have decided to ask my GP if she will refer me to a clinic here to do a trial micro dose of Ketamine to see if I am okay to go ahead with ketamine assisted psychotherapy. I was reading about what it can do for people with treatment resistant depression, anxiety, PTSD and chronic pain and it has some legs (research re its efficacy).   

I have definitely made progress since finding out I have CPTSD but want to see if I can build resilience and maybe even find the joy, peace and enjoyment that often eludes me. 

Anyway, I'll post as I go.   

[Kizzie]

So I spoke too soon.  Two days after stopping the benzo back came the anxiety and on a holiday here (Jul 1st is Canada Day) no less so had to ride it out.  I went into my pharmacy on Sat and because they know me they gave me enough of the benzo to get me to my appt on the 5th.   

So quite the discussion with my GP.  We lowered the SSRI dose again and she's now going to refer me to a psychiatrist who hopefully will see me long enough to figure out what is going on. Typically you don't get much time with them and there are fairly long wait times to see one.  They have the knowledge and experience to sort odd/complex cases like mine out though. 

It was a No to the Ketamine as well, too much going on to try it at the moment.

I am so discouraged. 

[Blueberry]

 

[Kizzie]

Tk you BB, I definitely needed that.    back at you.

My anxiety has been way up despite the benzo so it's a rough ride again or still.  I hate this. 

One clinic of psychiatrists my GP referred me to declined me apparently. Maybe not serious enough for them?   They aren't taking anyone until October anyway. 

We also have something called Access Mental Health here.  My GP referred me in March so I could see a psychiatrist to manage my meds - still nothing from them.  I phoned, she phoned and you have to leave a message and they will get back to you in 2-3 business days.  Mental health is just not a priority funding wise obviously.

[Armee]

  Kizzie.

It's so complicated and frustrating so much of the time.

[Kizzie]

Tks Armee, It's bad enough trying to find a therapist who knows about CPTSD but a doctor/psychiatrist, good luck.  It's still PTSD, not Complex PTSD.

We so need for medicine to know about and be able to treat us for the injuries exposure to traumatic stress causes, not just psychologically but physically. There is very little I've come across about psychopharmacology in everything I've read.  One recent book about treating complex trauma had one paragraph and yet so many of us are on one kind or another (SSRI's benzodiazepines, etc).  My GP still refers to me as having PTSD but at least she is willing to admit my case is complex and she needs a hand from a psychiatrist to help get me the right med(s).

[Kizzie]

I came across this webinar in an email from ISSTD today so am going to take it into my GP the next time I go (21st).  You never know, she may take the time to attend.  It's only three hours and the cost is quite low.

"There's a Med for That! Trauma Psychiatrists Discuss How to Think About Medications for Complex Trauma and Dissociative Disorder Patients" - Webinar presented by the International Society for the Study of Trauma and Dissociation and The Centre for Advanced Studies in Trauma and Dissociation October 28, 2022.  Cost is $79 for non-members and $59 for members (US)

Link - https://cfas.isst-d.org/content/theres-med-trauma-psychiatrists-discuss-how-think-about-medications-complex-trauma-and#group-tabs-node-course-default2

Presenter: Benjamin Israel, MD
Dr. Benjamin Israel is delighted to be participating in the ISSTD's online education series. Dr. Israel is a Clinical Assistant Professor at the University of Maryland School of Medicine, Department of Psychiatry. He works at a variety of clinical sites focused on consultation-liaison and emergency psychiatry. In July 2022, Dr. Israel opened a trauma-focused outpatient community psychiatry clinic within the University's Division of Addictions Research and Treatment. Dr. Israel is the lead author of a forthcoming publication exploring trauma-responsive addictions treatment and clinic management. Dr. Israel teaches and supervises psychiatry and psychotherapy trainees at all levels. He also sees private psychotherapy patients, most of whom suffer with complex posttraumatic and dissociative syndromes. Dr. Israel has presented to professional audiences locally, nationally, and internationally on the diagnosis and treatment of complex posttraumatic syndromes. He has developed and led workshops on trauma tailored for medical providers who are not mental health or trauma specialists. Previously, Dr. Israel worked at the Trauma Disorders Program at Sheppard Pratt Hospital, where he functioned as a psychiatrist, psychotherapist, clinical supervisor, and Service Chief. Dr. Israel graduated from the University of Pittsburgh School of Medicine and completed residency training at the University of Maryland / Sheppard Pratt combined residency program in Baltimore. He is board certified in adult psychiatry. He lives in Baltimore, Maryland, with his wife and their two sons.

Presenter: Rich Loewenstein
Richard J. Loewenstein MD is Clinical Professor of Psychiatry at the University of Maryland School of Medicine, Baltimore, MD. He is the founder of, and from 1987-2020 was the Medical Director of, The Trauma Disorders Program at Sheppard Pratt, Baltimore, MD. He is rated by U.S. News and World Report as among America's top 1 % of psychiatrists. Dr. Loewenstein did a research fellowship at the National Institute of Mental Health in Bethesda, MD. In the past he was a faculty member of the Departments of Psychiatry at Yale University, New Haven, CT; George Washington University, Washington, DC; and University of California, Los Angeles, CA. He is the author of approximately 100 papers and book chapters on dissociation, dissociative disorders, and trauma disorders, among others. He is the Section Editor, Dissociative Disorders, of the American Psychiatric Association (APA), DSM-5 Text Revision (DSM-5TR), to be published in Spring, 2022. He is co-editor of the 4th Revision (in preparation) of the International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for Treatment of Dissociative Identity Disorder in Adults. Since 2000, he has been an author of the Dissociative Disorders chapter in Kaplan & Sadock's Comprehensive Textbook of Psychiatry. He is leading the revision of the Dissociative Disorders chapter for the upcoming (11th) edition of this textbook. He is distinguished life fellow of the APA and, among other awards, has received the Lifetime Achievement Award of the ISSTD.

[Kizzie]

So I decided to go to a private psychiatrist which is horrifically expensive but I need to see one.  It's $1400 for an assessment and $365/session, all out of pocket so it may dig very deep into our savings depending on how long it takes.  What else can I do though?  I need someone who knows more about meds than my GP (and she agrees I need a psychiatrist), ) and the wait list for psychiatrists paid for by our provincial health is months long. It's absolutely appalling.

I just finished filling out the intake forms - 30 of them if you can imagine.  There was only one form about trauma and it was to screen for PTSD.  The mental health sector is very slow to change.

My GP did switch me to a new SSRI and I do feel somewhat less anxious so fingers crossed this will be the one.