Mental Health Working out the drug use pattern

[TeeCee]

Hi,
I was diagnosed with depression and social anxiety at age 19. Was put on Aropax (Paxil), and it really helped. I was out being social again within a week. But looking back I can see I stopped caring about myself as much I used to, I became scattered and disinterested in going to uni, and generally apathetic. I started going out and partying and taking a lot of party drugs, having lots of sex with random people (not always safely). A psychiatrist eventually diagnosed me with bipolar 2 disorder, put me on lithium, and took me off the Aropax.

A few years later I was feeling depressed, and took some Aropax. Basically the same thing happened, and I ended up in a psych ward this time. Ended up on Epilim as well as lithium this time.

Came off the Aropax again.

Got depressed again. This time I asked my new psychiatrist if I could go on Lamictal instead of Epilim. Did that, and for about 3 years I had no depression, was able to hold down a good job etc, cared a lot more about myself.

When I nosedived my psych decided I should go on Effexor this time.

My depression went, but started using heroin this time. Ended up on the Suboxone program for 5 years. Was also put on Mirtazapine as well as Effexor.

For most of the time on Suboxone life was kind of going pretty good. I started a web design business, and it's developed over the last 2-3 years into something good. I could focus on my work and was motivated to do it.

But during this time I think the Suboxone was keeping the Effexor in check, or balancing it out somehow.

I came off the Suboxone 5 months ago, and since then I'm back to not giving a care about my life. I've seriously struggled trying to do any work. I haven't been interested in my business really at all. I've wondered whether this is just PAWS. But I've noticed that since dexoxing off Suboxone other physical Effexor side effects have intensified too. This is worrying to me. I starting smoking pot about 5 days ago, and it's had me contemplating the patterns I've experienced. Again, it's like the pot balances out the Effexor, because I've suddenly started caring about my life again, and have been getting all sorts of things done, and I'm suddenly interested in my work again!

So, really I'm thinking I just need to get off and stay away from these SSRIs/SNRIs. For me, they are just trouble. Also, I have questions around whether I actually have bipolar, or whether it's SSRI/SNRI induced indifference that has made me appear like I have bipolar? Or is it just SSRI/SNRI induced hypomania?

I'd ideally like to not be on any meds/drugs at all, but it's like trying to find a way out of a maze.

Does this make sense to anyone else?

 

[AlphaMethylPhenyl]

Hey TeeCee,

Well it sure makes sense to me!

A lot of the time, people with bipolar become manic/hypomanic when given SSRIs. Lamictal is a mood-stabilizer that's generally thought to work against depression more so than against mania. I'm assuming you mean by nosedived that it stopped working? Did they keep you on a mood-stabilizer after prescribing you effexor? I know from personal experience that when I get hypomanic I get pretty bad cravings for recreational drugs.

Kudos for getting opiate replacement therapy. Things get kind of complicated and hard to follow when people are on multiple medications. Not to say in any sense that people who need multiple medications shouldn't take them, but that it can be hard to pull out what does what. I think the main thing that makes medications not work, if I had to pick one factor, would be using drugs in a recreational fashion while on meds. I wouldn't presume this, just putting it out there.

I mean, I know that the multiple medications I take sort of "check" the effect of others. For instance, the tranquilizer I take helps even out the stimulating effect of another of my medications. Balance is key!

It sounds to me that it may have done you better to continue suboxone treatment. Pot can definitely help some people, but it makes things more chaotic for most. It tends to stop people from thinking clearly. And I would assume what you really need now is to think clearly so that you can isolate and deal with your strife. There are a lot of other medications for depression that aren't SSRIs. I think that's definitely a legitimate question. But the most direct way to figure that out is to ask a professional in the field. I think most people don't really want to be on medication. Despite the stigma, there's absolutely nothing wrong with it, though.

 

[TeeCee]

Hey Ho-Chi-Minh, thanks for getting back to me.

Lamictal did stop working for me. It was great while it did work. Those 3 years were some of the best years of my life so far. My doc kept me on the Lamictal for a few years after going on the Effexor. But I was also on lithium, only I've been on a low dose of that for awhile due to side effects. It was really only a few months after going on the Effexor that I turned to heroin, and life got pretty bad after that for awhile. Maybe I was hypomanic at the time? I know what the signs are, and I don't remember being hypomanic unless it was really subtle. I remember not giving a damn, and thinking oh lets go and try heroin - something I thought I would never do really. In the earlier years, after taking Aropax, my hypomania was more pronounced. I'd get euphoric, get irritable, more talkative than normal, behaviour was a little crazy according to others. Before getting on heroin there wasn't really any of that. Of course, I still have to take responsibility for the decisions I've made. I guess I've just been looking at the context under which I've used drugs.

Anyway, I've pulled up on the pot use today. I spoke to my counsellor and told her everything that has been going on. Her partner is my GP (they both make an excellent team), so she urged me to go and talk to him about it tomorrow, and take it from there. She's thinking maybe getting a second opinion about all of this from another psychiatrist.

I have had thoughts about going back on Suboxone. Maybe it might make things easier? But I'd prefer not to. It was quite a bit of effort getting off it, and I'd rather avoid those side effects again. But yeah coming off it has thrown the balance out. I'm someone who likes to get things done, and have a purpose to each day. Haven't had that a whole lot since coming off the Suboxone.

Whatever happens, I'm going to be on Effexor for awhile. I'm on 300mg, so I would need to come off it very slowly. It's something my current psychiatrist has actually been wanting to do, but I'm thinking she might have second thoughts now that I've had a little relapse! I'll have to see. Regardless of all of this, I'm just going to have to accept where I am, and try to get on with my life the best that I can, and see what my options are with meds. I would definitely consider other types of antidepressants if I needed to.

 

[AlphaMethylPhenyl]

Hey,

Yeah, effexor can definitely cause hypomania. And hypomanic people tend to engage in more risky behavior, be it risky sex, compulsive gambling, or drug abuse. Sometimes it can be hard for someone undergoing it to spot, I always thought I was just happy when I was in fact hypomanic. Again, people who are manic usually under-weigh the risks of rewarding behaviors and/or simply don't care about the future repercussions of an action of the present.

Opiate withdrawal can do some funky things.

I'm so glad you talked to a therapist! I think what you need is the care of a psychiatrist, versus a GP.

I don't know for sure, but it sounds like to me that you got off of suboxone early. I don't think it's unreasonable to bring that up with your prescribing physician. If you can't function well, that may be indicative of a medication issue. Furthermore, you don't want to wake up one morning and have the overpowering urge to use again. Suboxone isn't risk-free, but then again no medication is. I would think of getting off it again when that time comes, if it's decided to be the case. I think what you need right now is an objective, prudent evaluation so you don't fall back more.

Your attitude sounds really positive to me.

 

[TeeCee]

Hey,

Yeah the hypomanic behaviour your describing is pretty much what I've gone through. And I've certainly make some pretty crazy decisions at those times!

I did go to see my GP. He brought up the idea of going on Valdoxan. He didn't want to change any meds himself as he knows I have a psychiatrist.

I saw my psychiatrist the next day and mentioned Valdoxan. As quick as I said it she shook her head and said she'd tried it on many a patient and it only worked for a very small number of them.

She agreed though to get me off Effexor, but put me back on Mirtazapine to cover me while I do it. At the end of all that she said she'd consider a different anti-depressant all together for me. I trust her judgment, and think she's very good at what she does. She also said if I find it really difficult at any stage to call her and she will admit me to the psych clinic if needed.

I also saw my Suboxone doc today, and he was fairly concerned about me sliding backwards, so he's put me on Naltrexone tablets. He said for at least six months. He doesn't want to put me back on Suboxone unless I relapsed on opiates. And that's a fairly good deterrent for me!

I actually don't feel too bad, and I feel like I have tonnes of support with the doctors I have, and a counsellor. My counsellor also runs a Mindfulness Based Cognitive Therapy program for depression, and I've been going to that each week too.

Can I ask what meds are you are on?

 

[herbavore]

Hey, TeeCee, I just wanted to let you know that Ho-Chi is taking a short break so you would not think he just was not responding.

It sounds like you have very good support and a very well-rounded program and I think everything you are doing is going to strengthen you. The mindfulness training as a way of thinking was pretty life changing for me in terms of my natural propensity to anxiety. It really feels like having a set of mental tools that I can pull out when old thought habits start to overwhelm me.

 

[AlphaMethylPhenyl]

Hello Again!

Yeah your psychiatrist probably knows what's best for you. Mirtazapine has a lot of mechanisms, but I haven't heard of it causing mania. It also, like Effexor, has some downstream effects on opiate receptors, so perhaps works especially for former opiate addicts. If naltrexone works for you well, that's awesome!

I think it's pretty important for all of the people treating you to talk to one another. That way, they become aware of more perspectives, and can better help you recover.

Mindfulness is an invaluable tool for most people having some emotional difficulties. I'm very happy to hear that you have access to it.

I don't really go into detail about that. Hope you understand. Some drugs work extremely well for one person, and horribly for the next, even if they have very similar manifestations of mental illness. You need to find the combination that most fits you, that most makes you feel like your healthy self before all this rubbish started, and frees you to be content, but not manic, in human society.

 

[TeeCee]

Hey, TeeCee, I just wanted to let you know that Ho-Chi is taking a short break so you would not think he just was not responding.

It sounds like you have very good support and a very well-rounded program and I think everything you are doing is going to strengthen you. The mindfulness training as a way of thinking was pretty life changing for me in terms of my natural propensity to anxiety. It really feels like having a set of mental tools that I can pull out when old thought habits start to overwhelm me.

Thanks for letting me know! Yeah mindfulness has been pretty life changing for me too. My counsellor and I were recently talking about the resilience it brings in the long term, ie. how it allows you to bounce back quicker after something upsetting or triggering in your life. I've definitely noticed a change in this area. I'm quicker to bring myself back to the present, instead of endlessly ruminating about something. Glad it's working for you too.

 

[TeeCee]

Hello Again!

Yeah your psychiatrist probably knows what's best for you. Mirtazapine has a lot of mechanisms, but I haven't heard of it causing mania. It also, like Effexor, has some downstream effects on opiate receptors, so perhaps works especially for former opiate addicts. If naltrexone works for you well, that's awesome!

I think it's pretty important for all of the people treating you to talk to one another. That way, they become aware of more perspectives, and can better help you recover.

Mindfulness is an invaluable tool for most people having some emotional difficulties. I'm very happy to hear that you have access to it.

I don't really go into detail about that. Hope you understand. Some drugs work extremely well for one person, and horribly for the next, even if they have very similar manifestations of mental illness. You need to find the combination that most fits you, that most makes you feel like your healthy self before all this rubbish started, and frees you to be content, but not manic, in human society.

Hey Ho Chi Minh,

That's completely fine that you don't talk about your meds. I don't talk about my meds with everyone either. I was asking, not for ideas for myself, but just out of curiosity. I agree that each med can work great for some, and not for others. It is definitely about finding what works for us as individuals.

All of the people treating me do know each other as they're all connected to the psych clinic I've been a patient in a number of times. I will talk to them about communicating with each other, as I think that's a great idea thanks!

From what I've read mirtazapine can cause mania, but not as often as something like Effexor, so it's safer in that regard. I feel much better being on the mirtazapine again. And I've started to very gradually reduce the Effexor.

Yeah the mindfulness is great. I've looking up Buddhist temples/meditation centres to go to, as I like meditating in a group. The MBCT program just finished this week so i want to keep up the group meditation.

 

[AlphaMethylPhenyl]

Sure thing! Yeah, I've found that even when the people treating me are in the same building, they usually don't go out of their way to talk to each other about their impressions of me unless I request it. It's kind of a sad truth the people who tend to get better are those who can most help and advocate for themselves.

Yes, I believe most common antidepressants have the potential to cause mania, discounting some oddballs such as lamictal, which is technically a mood-stabilizer. That said, I haven't heard about it with regard to remeron, but definitely have with effexor, so it sounds like a decent choice, given that your doctor is on-board.

Right on! Group therapy, involving meditation or otherwise, can be really helpful. Also, cultivating an individual, daily meditation practice might help a lot, too. Just starting with a few minutes per day, preferably at the same time of day, and working your way up to a comfortable length of time from there. Go you!