New Drug, New Adventures

I had been treated for Anxiety, PTSD, and Panic Disorder with a healthy dose of Xanax throughout the day.  I am also treated  for depression with Wellbrutin. I also participated in a Transcranial Magnetic Stimulation program for depression several weeks ago. I had hoped that TMS would help anxiety too.

Post TMS (you can read my previous posts) I felt a boost in mood but no benefit to anxiety. Then one day, like the switching off of a light, that mood boost was gone.  The cause is unknown to me and my doctors; but they have told me I didn’t respond as well as they would have liked or as much as the average patient to TMS treatments.  My mood decline also coincided with the anniversary of the death of my former partner from suicide and his birthday, so multiple issues are involved.

For three weeks my anxiety increased and my world began to shrink again.  My mood also dipped; I was reliving trauma and grieving.  Neither was near my worst ever experiences.  However, I did feel as though each day I regressed further and further downward.  When you make progress it is a wonderful feeling, when you regress it simply adds to the anxiety and negative feelings.

At the same time I began to suspect Xanax wasn’t quite working as well as it had been for the many years I have been taking it. I’ve always kept myself at minimum dosage, only increasing (PRN with doctor’s permission)  during times of extreme panic or stress and I dosed throughout the day to maintain a minimum steady state level.  Suddenly it seemed, more and more I began to feel the ups and downs of the drugs short acting character.  My anxiety levels were high and I began having more frequent panic attacks.  Strangely, upon taking a dose of Xanax instead of feeling its quick calming effects, which I still somewhat felt,  I was instead acutely feeling its cognitive side effects.  Dizziness, and mind fog being the most prevalent.  Those two effects exacerbated my already high anxiety, temporarily negating the calming effects of the drug.  It wasn’t until those side effects subsided that I was able to feel the calming effects of the drug.  Then the drug acted as it is designed to; but being short acting the effects dissipated and the pattern repeated.

Although still somewhat effective, I began to feel that it was letting me down and creating too much of a constant state of rebound flux.  I don’t know how long this was truly happening since when my anxiety was lower these rebound states may have been less noticeable and easier to handle.

At my next doctors visit I discussed this matter and my desire to try something else.  I was interested in trying Xanax Extended Release.  I was once encouraged to try Klonopin so I was also open to considering that too.  My doctor recommended Klonopin over Xanax XR because he felt it would put me on a more even keel throughout the day.  I agreed to Klonopin 1mg twice a day. (the dose had to be slightly increased to add .25 to .5 midday)

It’s been two weeks now and I am still deliberating.  I have noticed some advantages and some disadvantages with side effects.  Although I was told they were very much the same with Klonoin just being longer acting, I found them to be quite different.  Different is the word I have most often used in my comparison.  At times I can’t even articulate exactly how they are different, they just are.

There is always more at play than just drug interactions.  I also got past the trauma anniversary dates at the same time I began trying Klonopin so what is attributed to what is hard to say.  I can say that I had no adverse reaction switching from one to the other.  No Xanax withdrawal.  I will also credit Klonopin for providing a more longer acting calm throughout the day.  I don’t experience the rebound flux I had been experiencing with Xanax.  Klonopin seems to keep my anxiety just below the surface.  Sometimes it rises and  I use my CBT methods to quench it. I have had only one full blown panic attack during this time.  Those are the good effects I’ve noticed and been able to verbalize so far.

On to the side effects;  of which Klonopin has its own set of unique side effects.  Again,  different from Xanax.  So far it’s the most descriptive way I can say what I am feeling and experiencing.  First and foremost it has sexual side effects I did not anticipate, especially after being told it is in the same class and essentially a longer acting Xanax.  I never had any sexual side effects on Xanax.  I don’t feel as interested in sex and when I do its more difficult to maintain and nearly impossible to, without getting to graphic, reach completion.  This has been extremely difficult for me to manage.  I’m a very sexual person so this is obviously at the top of list of concerns.  I’m hoping it will improve, if not to my previous level of function, then at least to a livable level.  The other side effects are cognitive in nature.  Not as dizzy like Xanax, but more of a lightheadedness. A lack of focus and concentration, and a general spaciness.  Also, transient fatigue, which I find puzzling.  Some days I feel more energy and others less.

Some of these side effects have slightly improved over the two weeks.  Some I feel are more manageable than the constant rebound flux of Xanax. That is why I have not yet made the decision to either remain on Klonopin or request to try the extended release Xanax.  A part of me thinks I owe it to myself to at least try Xanax XR but I really hate changing medications. Therefore I am giving Klonopin more time.  My main concern is the sexual side effects.  Again without getting to graphic or personal, I was able to function twice.  I think both were at a time when one dose was wearing off and it was time for the next dose.  It’s something I am continuing to experiment with and monitor in order to help me make the decision on this medication.

I tried not to read too much on the internet because its full of horror stories and I know everyone reacts to drugs differently.  I also know that I have a proven track record of being extra sensitive to medications and can not take most of what is offered to me.  The fact that I can tolerate Klonopin at all is a plus.

I would be interested in hearing from anyone with any experiences with Klonopin or Xanax XR and welcome any questions since I know I’ve had a difficult time putting into words my experiences.

 

 

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Depression and TMS Afterthoughts

Depression has walked with me for so many years that sometimes I forget we spend so much time together. We’ve been together so long I can’t remember the date we first met. It’s been at least 25 years. We became aquatinted gradually and our relationship evolved into quiet acceptance. We always managed well with medications, even if those medications came and went with increasing regularity.

It’s during times of exacerbation that depression creeps up and reminds me that we’ve never really been apart. Over the years life has thrown me many curveballs and the last four years have been the most challenging of my life. During this time I’ve suffered multiple losses, trauma, the resurgence of anxiety, and the diagnoses of PTSD, and panic disorder.

These conditions are not only at the forefront of my impairment but they present symptoms that often overlap and loop together. Like the chicken and the egg story, it is sometimes hard to know what condition causes what symptom or if one precipitates another.

The final blow to whatever nerves, resolve, energy, and strength I had left within me after walking for so long with these demons and dealing with life’s punches,  was the death of my mother last year. Her death affected me profoundly. I somehow held myself together just long enough to see her final wishes fulfilled then I shut down.

Grief turned to depression which included an amplification of anxiety and frequent panic attacks, which I’ve not had in decades. The culmination of all these things left me incapacitated, unable to work, socialize, or leave the house. It’s from this deep pit that I’ve been attempting to climb out for the past 12-15 months. Sometimes I climb up only to fall back down but I keep getting up again.

It’s hard for me to accept that I may never be the same again. I may never be able to handle the stresses of the job I once loved. I continue to work on my self and hope that I can reclaim my life, if not exactly how it used to be, then something acceptably close.

Its been about two weeks since my very last TMS session. I had my doubts when the doctors told me I might feel improvements after the treatments ceased, but I think I have felt some additional improvements. It’s still inconsistent, and maybe it will stay that way, but It’s something to latch on to. On better days I try to make the most of the good feelings and accomplish CBT tasks and take pleasure where I can find it, whether its a walk admiring nature, spending time with my partner, music, or working on this blog.

i suspect I will re-visit my TMS impressions in a later blog. It isn’t easy for me to describe my feelings, emotions, and the nuances of my conditions but I hope I was able to convey something that might be informative or of use to someone considering the treatment.

End of TMS

My perception of the rollercoaster of moods is that it came about suddenly. I don’t know if that is entirely true but I felt the same way with its end. It just seemed as though one day there weren’t any rides anymore. My mood varied from day to day and even within a day but it wasn’t the unexpected or unusual moods of the coaster.

I finished my last full week of treatments and was heading for the home stretch. The next two weeks was a weaning period and the treatments dropped to twice a week. At this point I had many conflicting experiences with TMS, but I refrained from final judgement until it was over. I was determined to finish the course and was still hopeful I’d see improvements in anxiety.

I did feel some improvements; maybe I needed more than the structured course? However, I didn’t feel any anxiety benefit, a continued source of disappointment. Also, I kind of missed going every day. I had fallen into a routine and the staff were familiar and welcoming. It was like going to work and seeing your work friends.

During these last weeks of treatments I began to feel more level. Gone were the days of the rollercoaster ride of moods. I’m still not sure how to describe how I felt and continue to feel. It’s not normal or even “back to my old self” and it’s not depression free. The only way to describe it is as improved, and more level.

I truly did want more sessions. Since everyone is different and reacts differently to treatments of any kind I think perhaps I would benefit from an extended treatment duration. The protocol is strict so it’s not going to happen but patients are monitored afterwards and if necessary “maintenance” treatments are sometimes offered.

My last TMS treatment was a bit of an anomaly. With all the progress I’d made I was expecting a quick visit. A few new things were going on in my life and my anxiety was a little higher but going to my treatments was now familiar territory. I arrived in the building and immediately felt off. Something wasn’t right. I’ve had off days before so I just went into the session knowing I’d get through. Once in the chair I became restless, which wasn’t the usual anymore. Restlessness soon turned into anxious thoughts and a desire to leave. Soon enough I was in a mild panic, with subtle physical symptoms of sweating, palpitations and nausea. I thought I was past this but here it was happening during my last treatment. I wanted to end it but I knew I’d have to answer to my therapist and my partner, so I pushed though employing all my coping mechanisms. I made it and oddly enough my last session ended not too differently from my first. I chalk it up to a few extra stressors that week. This is how life is with anxiety and panic disorder. Every day is different and presents it’s own set of struggles.

I definitely feel better than when I started my TMS adventure in May. I can find enjoyment in some of the things I used to. Enjoyment of music returned and for me thats a biggie. I can smile a little more and am even more motivated to participate in my CBT homework. Hell, I even went out to a club for the first time in over a year. Yeah, it was work anxiety wise, but at the end of the night I did enjoy it and I felt a sense of accomplishment, and a certain contentment at having enjoyed something once again.

Enjoy; I enjoyed; those are words and phrases I’ve not uttered in a while and thats how I know with certainty my overall mood has risen. Sure I still have bad days, but I also have decent days, ok days, and sprinkled though some of the decent days are some good moments. I’m hopeful that these good moments will expand into good days.

Are my improvements attributed to TMS alone? I can’t honestly answer that question because there are too many variables, depression has a lot of components, and I have overlapping conditions.

Anxiety keeps me down but the mood improvements I’ve had over the last two months I believe are beginning to help me deal with it better, do my therapy homework, and strive for improvements and a return to normalcy. I continue to battle my anxious, pessimistic mind by trying to be positive and I strive to take one moment at a time, walking with the demonsbymyside.

TMS… Rollercoaster

My TMS treatments continued daily and each day presented its own unique set of struggles, moods, feelings, and emotions. Anxiety reigned supreme virtually 24/7, however; the anxiety about actually going to my daily treatments lessoned as the days passed. Sitting in the chair and undergoing the treatments themselves was still was ridden with anxiety, albeit I did not have an additional panic attack until the very last day, which I will explain later.

My routine became waking up, taking my meds, calming and controlling my anxiety levels (which are always high in mornings) and going to my daily treatments.

Beginning around week three I began to notice some subtle changes and moments of mood improvements. They were usually short and occurred within an hour or so of the sessions. Sometimes it was just the enjoyment of music in the car, other times it was a full sing along. One day I just kept driving and singing along to my favorite tunes for about 30 minutes. Other times it was a less intense feeling and a burst of energy.
In contrast, a few days later I would be in extreme fatigue that would last days at a time. This mystery fatigue continued on and off for about 3 weeks in the mid range of the treatments. There were days where I slept up to 12 hours a day between nighttime and daytime naps. Some days the fatigue was accompanied with a feeling of being down and other days my mood was ok but physically I was weighed down.

By about the end of the third week and into the fifth week I started experiencing inconsistent moods. You could even call them mood swings. Some of my behavior was out of character. I had moments of agitation, irritability, and in one instance, outright anger. This is where the rollercoaster analogy comes in. Up, down, and all around my moods seemed to go, sometimes in the same day. I would feel ok, then out of nowhere i’d snap at someone for a trivial reason. My patience was extremely thin. Though these moods were bothering me they weren’t overly intense or in any way debilitating. They were just different, not what I was expecting, and not what I normally experienced in depression.

I asked more than one of the doctors on staff if these moods were indicative of the treatments and could they represent a persons progression through various components of depression. I’m not sure I ever got a concrete answer but I did get plenty of reassurance that it wasn’t that out of the ordinary and it certainly wasn’t dangerous. Everyone reacts a little differently to the treatments and to the symptoms of depression as a whole. Since every mood I described can be a component of depression it was conceivable that I was experiencing these moods while my overall mood improved; which it was, slightly and slowly.

This period wasn’t easy because sometimes I couldn’t put my finger on exactly how I was feeling at any given moment. I also saw no improvements in my level of anxiety. Many days it was exacerbated by the onslaught of new, different, or just unexpected feelings and moods.

I went into this treatment knowing it was for depression but with the hopes that it would have a positive influence in reducing my level of anxiety. I started getting disappointed that my treatments were nearing their end without any anxiety improvement. The doctors assured me that even once the treatments are over patients report improvement weeks afterwards. Since I was noticing a overall improvement in mood I continued to hope for anxiety benefits and continued to ride the rollercoaster.

Next post…. End of TMS

TMS..The First Weeks

My TMS treatments consisted of 36 treatments. It takes a bit of a commitment because as I said until the final two weeks the treatments are daily. Each visit begins with standard questions to see if there is any change in my medications and if I have had thoughts of hurting myself or others. Then a paper strip is put around my head which is a measurement tool for placement of the coil. The chair is reclines and the coil is put in its pre-determined location just above my head. A test pulse is given to make sure it feels ok to me and to check placement. Then the pulses begin. After each group of pulses there is a twenty something second pause until the next. A tone sounds to let me know the next round of pulses will commence. This continues for just under 40 minutes.

You can listen to music or watch TV to help pass the time. The staff is super nice and very accommodating. Since I wear glasses that have to be removed because of the metal I can not watch TV but I now play my iPod to pass the time.

I say all that very matter of fact but in reality it was much more difficult for me. As I said before I don’t like medical procedures and my anxiety is at such a high level that just getting and staying there was an achievement. A part of my anxiety is a fear of being alone away from home so my partner accompanied me to the treatments.

Initially each time they put me in that chair I wanted to jump up and leave. I would sit motionless lost in my anxious mind, using every technique I have learned to remain calm and hold back the panic. Many days that first week I wanted to give up and just go home. Having my partner with me and utilizing all my tools helped me stay in the chair and complete each session. Working through anxiety is exhausting and I’d go home and rest afterwards.

I felt no effects during those first sessions. It’s been reported that some people can start experiencing noticeable improvements as early as the first week. For me it was all about enduring, getting there, staying in the chair, and finishing each treatment. I was fatigued the entire week from the added stress and anxiety.

Towards the middle to end of the second week of treatments I began to notice some changes. Subtle and what I call moments. Sometimes after the treatments for an hour or so my mood would improve. One of the first things I noticed was that I was listening to my favorite music in the car again.

I have always loved music and it is a big part of my life, but for about a year I hadn’t really listened to my old favorites or anything pop current, I couldn’t handle a pounding beat, and I didn’t feel any enjoyment from it. Instead I would listen to calming, spiritual, meditative music, or mindfulness podcasts.

That my enjoyment of music was slowly returning was a sign that something positive was happening. It was very inconsistent and some days it wasn’t there at all, other days it could vary from fifteen minutes to an hour or better. It was still an improvement and I reveled in actually enjoying something I haven’t been able to enjoy in over a year.

Next post…..Rollercoaster

TMS (Transcranial magnetic stimulation) & Me

“Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective.” – Mayo Clinic. For more details visit Mayo Clinic

TMS therapy is offered at the University where my psychiatrist is located. TMS is currently only approved for depression using a specific protocol. (number of treatments, the length of each treatment, and the strength of the pulses)

I found TMS treatments intriguing since it’s an approach to depression without the trial and error of medications. My doctor thought it would benefit me. I researched it on the internet and was especially interested in any effects it might have in reducing anxiety. I read some anecdotal evidence that it may help alleviate anxiety symptoms. Depression and anxiety sometimes being comorbid, my doctor’s opinion is that those whose conditions are closely linked benefit (from anxiety relief) the most.  Still, I was hopeful that it would help with anxiety since that is presently my primary debilitating condition.

I’m not convinced that my anxiety and depression are as tightly linked as my doctor thinks they are but I was willing to try something since my conditions are debilitating and keeping me from work, social activities, and living life fully.   Cognitive Behavior Therapy and meds (Wellbutrin XL & Xanex) are my standard treatments and I have been making slow and steady progress, but this seemed like it could be a literal “jump start”.

During the initial consultation TMS therapy was explained to me and I was asked to complete questionnaires and rating scales to determine my beginning level of mood, depression, and anxiety. (Hamilton Scales?) These scores served as my baseline. Every week the forms are completed and the data compiled. In addition to my self evaluation, the provider also asks similar questions and completes their own set of forms for scoring.

The first session is to “map” your brain to determine the measurements for the placement of the coils.  The TMS machine is something like a mini MRI and it makes loud tapping noises (earplugs are worn by everyone in the room). The coil never actually touches your head but you can feel a repetitive tapping on your scalp akin to having a woodpecker going to town on your head. The physical discomfort for me was minimal. The other part of the initial session is what, looking back,  I call finding your twitch.  They have to find out where the pulse will cause your fingers or face to twitch, which, if I am explaining it correctly, determines the final placement of the coils for treatment.  The aim is to get the coils in the correct area of the brain without producing the twitches during treatment.  After the first session TMS treatments are given daily (Monday to Friday) for about 6 weeks. The last two weeks are for weaning off and the treatments drop to twice a week. Each treatment lasts approximately 40 minutes.

Of course my anxiety rears its ugly head at the beginning of this process and I almost didn’t go through with the therapy after my initial session.  You see, I don’t like hospitals or medical procedures,  and simply sitting in a chair at the doctor’s office for 40 minutes was a challenge I had to constantly fight to overcome.

I nearly called the whole thing off once my face started twitching.  I panic at the slightest physical abnormality and having my face and fingers move uncontrollably set me off; I had a panic attack in the chair during the initial session but managed to calm myself and made it through. Desperate for any potential for relief I put every tool I have to work to keep me in that chair.

That was the beginning of my TMS adventure. I have linked information on TMS at the top of the page because I’m not always the best at explaining the details and technical information. If your interested in the therapy I would encourage you to read up on it. Also, I welcome any questions.

Upcoming posts will be about the experiences of my on-going treatments and their results.