Meds Log: Cy(m balTa cont’d

Day 4 back on the Cy(m balTa 60mg without the 500 chOline.

Really helps with the depressed affect during the day, also the focus and working memory are better through late afternoon, then after supper it regresses to its wandering and forgetting from second to second (that is maddening when trying to get something done).

The hyper side is tolerable and no sign of the bizarre stuff I was experiencing last week, though dreams continue to be dynamic, often grandiose, even epic in theme and action, at least the violence has almost gone both in daytime random thoughts and in dreams. As of today I can live with the hyper and fidgety side-effects because the improvement in depression and reducing the other ‘crazy’ stuff definitely outweigh the hyper stuff.

“Life is like a beanstalk, isn’t it?” Feb1st Revisited

I just went back and read what I had in my journal on Feb 1st . Wow, that was pretty embarrassing now that I read it with a much less depressed affect etc. In fact, I was going to delete it as it’s such a cringingly humbling bit of weak prose — but now, I should keep it here to remind me of how those biochemical shifts affect my total perception along with affect, and to revisit if I’m full of myself or something.

Well, some of the points were worthwhile, such as the importance of the filter of perception which one’s brain chemistry changes bring…but enough already.

The title is from a 60’s song, Procol Harum…anybody know the song?(In HeldT’was I)

Pick yer poison…

Meds log, feb 21,2008 ante meridian (for you non-Latin students, that’s a.m. <wink>:

Re-started today:60mg Cy*mb*(lta, 1200mg of flaxseed oil (Omega-3-6-9), Re d Ye ast Ric e (for cholesterol), & B Complex(includes some choline);Took the Cy*mb*(lta at 9am, after about 9 days of not taking it. I know it was still in my system but by 11am felt my affect greatly improve, my energy level up and my concentration way better( know this by how my working memory is: example — 1. go to computer, decide to do task A. 2. Click folder where A task is located 3. Begin task A by clicking on A. Without the Cy*mb*(lta I get to 2 and wonder what I’m doing there, all in a matter of under 2 seconds. With Cym***ta, zoom through like I used to…when I was younger.

We’ll see, if the trade-off of sleep disturbance & weird ideations for focus and non-depressed affect during the day is acceptable. Shall see…and keep open the option of taking the Cym**lta every other day (per prescribing MD).

Cym*b*lta log continues…What’s Love Got to Do with It revisited

Feb20,2008:

Today is about a week since I stopped the Cym*b*lta. The hyper stuff and wild dreams & nightmares continued but seem to be slightly less dramatic each night; the tension & manic stuff seems to have quieted down,and a lot of the more bizarre violent images have pretty much (but not completely) faded. BUT…my neuropathy & even the scar tissue area pain returned with a vengeance today. So…not sure which is worse, but I think that the really crazy stuff came because I was taking 500mg of choline, plus the Tryptophan, both of which impact the neurotransmitters (in a way I’m too fuzzy & tired to articulate now). Anyway…I’ll resume the Cym*b*lta (60mg) tomorrow (Thurs 2/21/08) only won’t take the other stuff. Just will have to keep tabs on it – but man, that violent and weird stuff (suicidal images etc popping into the mind’s eye out of nowhere) were pretty scarey. I’ll try it without the extra choline and see.

..Also, looking back at my ratiocination around my relationship with my SO…wow, I totally don’t see it that way now…so what chemical filter was at work there I wonder? Yes, there are still the issues, but I can see in re-reading it even a couple weeks later just how whacked I was at the time. This is an example of the benefits of journaling — it can be very helpful to revisit other states of mind and being and see what was going on and how it was perceived on different meds etc. anyway… aside from the pain level pushing 7 (I’d been cruising at under 5,rare for me) doing ok. Had the disability interview at Social Security. Might reflect on that when I h ave more energy, but it seemed to go well. Getting great tips from the folks in the HealingWell.com forums(Chronic Pain & Depression) on the whole process of applying for Social Security Disability….

Stopping SNRI antidepressant(Cy*m^balta), log

Commentary:

Given the potential for problems, thought I’d log here any details or observations about my state before, and since, stopping the Cy*m^balta.

Before: Increasing states of agitation, tension, chattering teeth, high irritability and in last few weeks growing instances where suicidal and homicidal images entered my mind. I hasten to add that these were images, out of nowhere, not plans or inner dialogues, just bizarre images rushing into my mind. Dreams were of the same ilk. As all of this is totally unlike anything I’d ever had in my life (in dreaming, daydreaming etc) it got me to revisiting info on OD or bad reaction to Cy*m^balta — well, all of that crazy stuff happens when the person reacts negatively to it.

So…talked to the VA pscyh who did a full initial consult (just moved to this particular hospital for my primary care). Definitely should talk to prescribing MD…so I did. Turns out that I had thought I was taking 120mg(and told the VA that amt) when it was only 60mg — so while my prescribing MD said cut back to 60 — I decided to stop entirely.I’ll put some observations here as I’m a tad scared of what’s been going on…

Log:

• Last 60mg Cy*m^bata on February 12th, AM.
• Stopped all other supplements (even the b complex & fishoil) except Trypto phane at night on February 14th.
• Feb 12-13 — continued hyperness, sleepproblems/nighmares
• Feb 14-15 — still nightmares but fewer of the weird violent or suicidal images
• Feb 15 in a.m. — sadness & flat affect settling in. we’ll see how it goes tonight; stopping work on computer at 9:50PM.

C*ym*balTa…sigh, bad news for this guy

Well, it worked great for a couple months but in the last few weeks I thought that my brain had been invaded or something. Started having really wierd dreams and daydreams as well as randomly during the day. They were creepy, violent and then became suicidal(very graphic and not at all of the kind I ever had in my life) . It was different from the routine fugue state that chronic pain raises from time to time (Thinking to yourself I wish I was dead so I wouldn’t have to deal with this pain…during a particularly bad stretch); you have no desire nor intention to develop a plan to carry it out, you just want to escape it (thus’fugue state/fantasy’ as the specialists call it).

Anyway, I also was having some distressing physical symptoms, sleep behavioors etc. So…looked up the indicators of bad reaction or OD to C y m b_*lta — hey, I got an A plus for having most of them. So…while I loved being less depressed more often, and having better neuropathy symptoms, I have to stop it now and wait till I see the psych in a couple weeks.

I was taking 60mg a day so stopped taking them 2 days ago — still feeling hyped though, and a bit of the crazy stuff intruding into my psychic cave — but better. If I can’t sleep tonight and keep with the suicidal ideation I’ll run into the VA and have them make sure I’m not at risk of anything drastic. So it’s back to the drawing board with the depression.

Coping: Use of various relaxation methods

Put this onto the Healingwell.com chronic pain forum in response to someone. Thought it might be helpful to have it here as well.

Wow I know where you’re at…just moved (after having house on the market forever,3+yrs) so know what a stress that whole thing is. My sympathies…Have you ever done any Yoga, progressive relaxation? Mantra?Sitting Zen etc?

I think the other response talked about focusing on a part of your body. That’s a good one. This type of focus I learned when studying zen a long ago when I lived in Japan. But, being a slothful one, I have not made it a key part of my lifestyle (this IS relevant, pls bear with me). But when my world collapsed and I entered the wonderful world of CP in 1984 I dug it out of the inner tool sack and found it a life-saver.

There’s tons written on it, under various monikers: meditation, progressive relaxation, behavioral medicine, mind-body awareness, cybernetics self-induction, self-hypnosis, trance state induction, etc etc. The part that I think you can find helpful at times like this is the breathing part. if you can find some good step-by-step instructions about how to do progressive relaxation, you can get yourself into a state of deep relaxation in fairly short order once you try it a few times. Where your mind goes once in that state if of course where the long-term challenge becomes and I won’t address that. (Later I’ll add the method I use if you’re interested).

I just want to say that the relaxation stuff is sort of like building a ‘base’ for running; if someone runs say 1.5miles a day, say 5x a week, and works their way up to 3.5miles 4x a week and 7 on weekends, their base resting pulse tends to lower,and their ability to physically relax should be correspondingly lower as well. The pertinence to our CP situation is IMHO this: if one regularly gets the body-mind to that very relaxed state, and builds up a ‘base’, then, when that major BS stressor comes along, the coping tends to improve slightly. PLUS…since you’re accustomed to ordering your body (in so many words) to knock it off, to slow down, settle down and just relax — because of that new body awareness, chances are that you’ll still have worse pain on stress days, but lose some of that helpless feeling; and, depending on the organicity of the pain (ie, structural vs just nerve damage) you may surprise yourself that your pain tolerance threshold actually improves. (ex: formerly, a major stress event took you to 9, after your ‘conditioning’ of yourself you may be able to get yourself back to baseline pain level (whatever that may be).

I know there are cynics about all this, but all I can say is that because of my improved awareness (built painfully and very slowly over the years from 1986 to today) that what used to lay me out for 3 days I can now get through without even having to up my meds or hit the horizontal for days. I’m sure that many here can put their own twist on this self-awareness aspect. Sorry if I sound preachy, but I stopped my (SNRI which cannot be named) because I’m totally hyped(manic)….so I’m tending to rant, sorry. Hope it helps.

Chicken or the Egg;Fallen Monk’s Ruminations on Causality

More rapids of consciousness from my journal, Feb.1, 2008:

Don’t really like it over there much, sitting in my sadness. Seems a tad self-indulgent. So, drank a lot of coffee today and took some choline (brain food, said to help with my severe acetylcholine deficiency — & ergo immediate & short-term memory). Am clearer and more focused in the daytime –but edgy — while those neurotransmitters are doing their thing. Ah, but now as evening turns to night, a dampened shadow returns to me, much like the sound of rain and wind outside my window…. Can’t help but think that so much of this is we CP’ers at the mercy of the cocktails of brain chemicals (and whatever other chemicals we put in there to get by); Maybe the CP experience is just us at the mercy of what’s creating and stirring our little bit of biochemical elixir( neurotransmitters) and how they produce – and react to—our own thoughts & behaviors.

The causal loops between pain & depression are hard to discern. Maybe the answer rests in the question, or questions I raise to myself: Does the pain cause the depression, or the depression cause the pain? No… does the pain create perceptions or merely filter them? Is the pain genuinely there (in objective physical reality) and if so, does the awareness of it make the pain worse? Better? gone?

But yet, If I can somehow alter my awareness in-the-moment to acknowledge and accept the very real physical pain at my nerves’ endings(all that damaged tissue & nerve bundles) – can that tweaked perception in ipso(in and of itself) enable the pain to be felt differently? But more questions arise before I can answer …it just seems that the loop of depression to pain, and back to depression again, seems different than the loop between cognition & pain perception: I know that I have learned how to reframe pain and do more now with worse pain than I did 20years ago (the hardwiring and damage now is far worse than then, yet somehow now I can live with it better, do more). As the youngen’s say, “Whassup with that?!”

So…if I can sit inside my damaged organism, looking out through the clouded cockpit of my mind and somehow tweak my perception of this thing called “pain”– so that it stops being “suffering” and is instead, just “tolerable pain” — is the same true of this sadness and dark depression I experience?

Well, so far, not for this Bozo. The difference seems to be that the biochemical elixir at work in my brain when truly depressed may not let me ‘tweak’ the depression experience so that it is no longer ‘suffering’. But…maybe I haven’t tried hard enough…

But still, as I take this twisted syllogism to absurd ends the penseur in me won’t shut up: Of course you idiot, your questions are all wrong, for there is no singular mechanical causation, no clear-cut syllogism nor binary algorithms for the reality you live in, your ‘pain-depression-sadness’ is a seamless reality. You may sometimes manage different aspects of it better than others, but it cannot be dissected, cannot be reduced to a formula or equation. That’s what makes living in CP so very difficult – your perception process is a filter and a valve all at once. So, sometimes the only thing left to do is to get some relief, some respite from the burden of this ‘loop’ by sleeping, preferably a sleep made easier by chemistry, or at least a bunch of L-Tryptophan…. What say you all you right-brainers out there? Has the man finally lost it?

Is he counting angels on the head of a pin? Tossing bones to augur the freezing temperature of maple syrup when all he needs is a thermometer? Probably, but such rambling helps him when he takes it outside of his head. When left inside, it works against him, ever so slowly, but strongly, tugging him down the vortex until his syllogisms become word salad and none of it makes sense to him, or anyone. So…prithee indulge this lapsed monk, for you can take the monk out of the monastery but you can’t take…you know the rest.