Ramping

Hi there.

How was everyone's holiday? We went to Southern California to visit my family (6 days. 12 adults. 5 kids. 3 bedrooms. 2 toilets. 1 shower. No matter how you do the math, things don't quite add up. It's a good thing we get along rather extraordinarily well, no?).

Anyway: whatever holiday you celebrate, whether it's over or continuing or hasn't yet begun, whether you've been filled with the spirit, frolicking in sand or snow, or find this a joyous, pleasant, or just mildly tolerable time of year, I hope you and yours are well and your wishes have all come true. 

In the words of Charles Dickens, "God bless us, every one."

_____

I wasn't sure what I was going to write about today, so I went back and read my last post, and now I know.

I talked last time about that raw feeling, that in-the-moment feeling, that wow-I'm-really-doing-this feeling that I seem to get at the top and bottom of my med arc. 

I guess it makes sense for exactly the reason I said: it's the flip-side of the same coin. Feeling is feeling. Feeling bad, feeling good, feeling whatever. Whether I'm getting a tidal wave of chaotic emotion-salad or a clear channel of manageable micro-feels, being able to interpret and experience them in real time is something to treasure.

Well. At least appreciate on its merits. I mean, let's not go CRAZY.

So I try to do that. I do, don't I? You saw me. I do.

The middle part of the arc, though? SUCKS.

I am there right now.

I am not used to this. I've never been on the med circus train before. This ramp-up-ramp-down thing? Um, no thanks.

I feel foggy, exhausted, forgetful, creaky, vacant. I can't remember conversations. I can't remember things I did two days ago. I feel... like I'm on drugs.

The irony is that now that I'm back in the muddle of the ramping again, I realize that I'd actually begun to get to a good place with the Cymbalta.

Granted, there were many things about it that were not good for me. It was causing more problems than it was solving, although the problems it was solving, it was solving really well. I just realize that I'd begun to feel creative, as I said last time, I'd begun to feel motivated, I'd begun to make plans, I'd begun to get excited.

That was fun.

I want to get back there.

I don't feel like that now. I feel... well, I forget. Sigh.

Except.

Here are a few things that have happened since I started the ramp-down-ramp-up. I'll give you an abbreviated list in the order of occurrence, starting with a couple of weeks ago, when I first began. I detect a trajectory. See if you can spot it:

• Tired and muddled. Vacant. Forgetful. Occasional flash of hopeless overwhelm. Remember feeling like that all the time. Hope that isn't going to get worse.
• Tired and muddled. Vacant. Forgetful. Lorazepam not helping much. No more hopeless overwhelm.
• Tired and muddled. Vacant. Forgetful. Lorazepam helping. Need one every day.
• Tired and muddled. Vacant. Forgetful. Lorazepam helping. Prefer but don't need one every day. Occasional flash of creative enthusiasm.

It helped a lot to write that down. That shit is TRUE. I left out a whole lot of "tired, muddled, forgetful, tired, muddled, forgetful, irritable, tired, forgetful, what the fuck, tired, shut up, tired, leave me alone, forgetful, tired, muddled, tired, tired, tired."

But those are the main themes. That last one ALL HAPPENED TODAY.

Okay. Okay. Good. Yay me.

I've got a long way to go with the ramp-up for this Amitriptyline-- it doesn't reach full potency for 6-8 weeks, like most anti-depressants (because if there's one thing we depressives have, it's time to fuck around) (and okay, yeah, I've added depressive back to my resume, reluctantly, but with a lower-case r and in the fine print, because fuck you depression you're not the boss of me, that's why).

Ahem. Anyway, long ramp-up. As is to be expected. But there is more progress to report: 

Today was my second official "Day 3 of no Cymbalta" day, as I shifted from 20mg every other day to 20 mg every 3rd day.

And guess what? Unlike last time, I woke up this morning and I felt... 

Just fine.

I mean. Tired. Muddled. Vacant. Forgetful. 

But I've gone all day without a Lorazepam with no problem. And I've been feeling some genuine flashes of creative excitement about clearing out the room that is going to be my office and designing the DIY desk/storage system that is going to wrap around two walls in there and allow me to set up space for writing AND space for sewing projects in one room without having to set up and tear down every time I want to do anything.

Also:

I spent some time on the long drive from Southern California the other day thinking about paint colors for said office.

And get this:

While I was down south I met with the friend I mentioned a few posts back-- the one who asked me to collaborate with him on the screenplay project-- and he very kindly and generously (not to mention handsomely and intelligently and hilariously) lent me his time and talent and did a photoshoot with me so I could have some real, live, grown-up head-shots for author bios, ahem, should the occasion arise.

Because I thought of it during my Cymbalta high-point (see? SEE?!) and immediately asked him and my uber-talented hair-and-make-up-magician sister, the newly-married Liz, if they'd be interested in helping me out, before I had a chance to second-guess myself or otherwise self-destruct.

I've learned to undermine my own efforts to undermine my own efforts. This ain't my first rodeo, people.

Whoa. You see that? That's two and a half goddamn years' worth of therapy co-pay well-spent. Damn. That's worth the price of admission, right there.

Holy shit. It's a Christmas miracle.

In the words of Charles Dickens, God bless us, every one!

Like a Woman Scorned

So, Cymbalta was not ready to break up and went all psycho on me.

BITCH!

Yeah, apparently, this is a thing that Cymbalta does. Did you know this? I did not know this. Apparently, neither of the doctors I was working with this past week knew this either.

Cymbalta, she does not give up so easily. She gets mad when you let her go. She takes her revenge.

But I get ahead of myself.

Let's back up a little.

Remember last week, that great week I had?

Well, this week was fine, too. Until. I tapered my Cymbalta as directed.60 mg to 40, 40, 40, 40, to 20, 20, 20, 20, and then none, none. I'd only been on it for about 2 1/2 months, so no big deal, right?

Enter day 3 of "none."

Before I go any further with that, I'll tell you that I met with the psychopharmacologist (or the "psychopharm," I'd insist upon being called if I were her), who gave me some DSM evaluations and determined that I should still be on antidepressants, even if anxiety disorder is my main diagnosis, which is fine (as long as I'm on something that is making me feel better and not making me endure side effects for no tangible benefit, I'm down. And as long as I have a doctor willing to manage and supervise my pharmaceutical "experimentation" so I don't have to figure this shit out myself by clueless trial and error, I'm even more down). 

So day 3 of no Cymbalta coincided with day 1 of amitriptyline, my new antidepressant, which also helps with chronic pain, insomnia, and is a migraine prophylaxis!

They're, like, bundling my services, now. Comcast, is that you?!

Ah, but I digress.

Anyway, I woke up yesterday, day three after Cymbalta and I bid our final farewell. I thought we were cool. I thought it had been an amicable split. I still had three 20mg capsules left, and I'd been planning to continue the taper by taking them every other day until they were gone, but Psychopharm (see?! I mean, really) said not to worry about it and just go ahead and stop.

And thusly I came to day 3, and thusly I awoke to a racing, raging attack of anxiety. Right out of the gate.

Not a good start to the day.

My husband was out of town. I got up, discovered that a colony of ants had found their way into the girls' bedroom overnight to escape the rainstorm, had a moment of panicked horror, had several minutes of homicidal ant rage, got breakfast for the girls, deposited them in front of a movie, and climbed back into bed to get some space and calm myself and figure out what the hell was going on.

I fell back asleep, hard, for another hour and a half.

When I woke again, my anxiety was still incredibly high. I kept crying. My skin felt raw. I was restless, uncomfortable, irritable. I kept snapping at the girls. My head was spinning. Completely out of character.

Also, the ants were back, and boy, did they regret it.

I took a lorazepam. A whole one. First thing in the morning. It did nothing.

I didn't take another. Didn't want to go down that road.

After lunch, we went to the airport and picked up my husband. He'd been in LA for three days because he had a gig at the House of Blues in Hollywood on Friday night.

(For those of you who don't know my husband, I told you he was cool, right? Did you know he was that cool? Well, he is. That cool. Aside from being the best husband ever, he is also, among other things, a bass player. And in his spare time, he does stuff like this.)

Oh, what the hell. Let's have a shameless plug for the man. Ladies and gentlemen, may I present: 

Uniform Standard

That's him, in the hat. My cool boyfriend. Hands off, girls. He's all mine!

_____

Okay, so anyway, I picked him up and as soon as he was there, things started to get better. He told me to call the doctor, which was one of those great ideas that never would have occurred to me.

While I was doing that, we started talking about whether the cause could be the introduction of the amitriptyline or withdrawal from the Cymbalta. Both seemed a bit extreme, considering, but he got online while I was on hold and started looking things up, and sure enough, Cymbalta is a notorious withdrawal monster.

Like, SERIOUSLY so.

When I finally reached the doctor on call (not my NP, to whom I will be speaking this week), he said to go back on 20 mgs and taper more slowly. 20 mgs for a few more days, then every other day, then off. Even that, at this point, seems suspect to me after what I've read, but then again my experience yesterday seems relatively mild and manageable compared to some of the ones I've seen in the forums.

Some people actually do something called "bean counting" with Cymbalta, where they take apart the capsules and count out the grains inside and transfer them to smaller capsules and gradually cut the potency by hand.

Of course, these are people who have been on it for years and taper off over 18 months or something-- I won't need to do anything like that. But it certainly gives one pause.

And it also gives me a new research variant to consider before greenlighting any new medication: what's it like to quit?

Because if the answer is "Worse than the reason you're taking the fucking drug in the first place," perhaps I will reconsider that particular option. As should you.

Down with Cymbalta!

_____

Here's something else that occurred to me yesterday for the first time, though: that hyper-emotional feeling, which I hate so much, has a flip side.

In the past few months, I've had moments of genuine excitement about things. Engagement with creative projects and partnerships with creative people, and getting my creative house in order, mostly. I've felt passionate about those things in a way I haven't felt in many, many, many years. And that is coming from the fact that I've torn so many of those emotional defenses down in therapy.

On the other hand, now that those defenses are down, when stuff like this Cymbalta thing comes up, it's harder to get through, more grueling and frightening, because I can't protect myself from it the way I used to. My lockdown box is broken. I can't just make it disappear anymore.

I think yesterday was the first time I experienced both sides of the coin in the same day, saw them for what they were, realized it was a tradeoff, and thought....

Yep. Totally worth it. I can do this.

Like I told the doctor on the phone, if this is a known thing, a finite thing, a period that just needs to be endured and gotten through, I can do that, no problem. If you can tell me I'm doing the right things to manage myself correctly during this transition, that's enough for me. I will handle it.

I'm just not afraid of that kind of thing anymore. I get it. It's going to suck and then it's not. Fine. It's happening because the drug is doing it, but also, I am experiencing it the way I am because I have worked hard to be able to feel this horrible shit when it happens, and despite how it sounds, that's actually a victory.

To feel crazy and anxious and terrible sucks, don't get me wrong.

But to feel crazy and anxious and terrible right now, while it's happening, and have actual, authentic, real-time reactions to those feelings?

Don't underestimate that pleasure, friends. I bet it's something that every one of you takes for granted every day, and you shouldn't. You shouldn't.

Not all of us get to live in our actual minds and actual bodies all the actual time. 

Realizing I'm doing it feels a little like the moment you're riding your first two wheeler down the sidewalk and you notice your dad let go two houses back and you are suddenly slammed with the knowledge that all the balance you've had for the past few blissful seconds has been yours and yours alone.

Does that knowledge make you freeze up with the burden of the responsibility and spill over on to the ground, or does it set you free, now that you're no longer held back and can go forward as fast as your feet will take you?

You have one, blinding second to decide.

NOW!