Mental Health Cycle of changing meds and building tolerance

[ac360]

I have a pretty complex mental health situation. I've had pretty bad issues since I was really young. Diagnosed with ADHD at 11, depression and social anxiety at 13, at 15 it was "unspecified eating disorder" - I never consciously made myself through up but my anxiety got so intense that my throat was closing up, food was getting stuck in my throat which lead to me eating less and then vomiting, long story short I lost 60 lbs in 6 months and went inpatient for 16 days when I was 15. When I was there, my anxiety disorder was changed to generalized anxiety, and along with the unspecified eating disorder I was also diagnosed with a mood disorder. I'm fully aware that it may have been a subconscious way of me starving myself, and my therapist at the time thought it was more likely that but my psychiatrist thought it was purely physical which I think it was. Since then, the diagnoses have remained consistent and so have the symptoms, so currently at age 18 with depression, GAD, non-bipolar mood disorder (looks like bipolar II but 200mg Zoloft and years of ADHD meds never made me manic) and of course ADHD.

I've been on so many medications it's ridiculous. The weird thing is that they all work in really different ways on different things and I always build up tolerance really quickly if they work, and many make no difference at all. My life has changed a lot, living with different family members, different jobs friends etc and now college but I don't stay at a dorm bc I'm absolutely terrified of that. The depression and ADHD symptoms almost go away entirely when the medications are being effective for them but the anxiety symptoms only get to my life being more or less of a living hell. I was in therapy for two years between ages 15 and 17 which I thought was helping me but when looking at it, it made no difference in my mental health whatsoever. Tried again for 6 months when I was 17 with someone else and it didn't do anything again so I'm done paying for it. I know it helps a lot of people including many I know and my mom is a therapist for god's sake but it didn't make me feel better to an even measurable amount - nowhere near the meds.

I started Vyvanse when I was 11 until I was 13. I was too young to even recount if/when it became ineffective. Then taken off and put on Zoloft 50mg and Buspar (idk the dose). After that the Vyvanse was added back on and then removed again because the amount of anxiety it caused. Post hospitalization when I was 15 I was on 200mg Zoloft and .5 xanax 3x a day. Then it was 200mg Zoloft and Vistaril, which did help in retrospect but anything non benzo following xanax will seem ineffective. The zoloft was played around with between 100-200mg range for a while because it wasn't helping once the xanax was removed. Then vistaril was removed and buspar was tested again, which made absolutely no difference for me. After that, we tried 5mg Abilify with the Zoloft which ended up making a difference for a while. That combo for anxiety/depression made me functional for a year and during that time we worked on ADHD. Ritalin made me too hyper and didn't help me focus. Then Ritalin SR did the same thing. Ritalin LA helped me focus immensely for about a week or two then gave me the hyper unfocused thing. Focalin after that which did the same. Then tried Strattera which made no difference in anything whatsoever. Adderall IR after that which didn't even make me hyper just a little less sleepy. Ended up back on Ritalin IR on a higher dose than the first time. The depression was up and down throughout the stimulant changes but the anxiety was on a slow decline. This was about a year after I was first put on abilify and Zoloft and I was on those two w ritalin for 6 more months. I was still going through hell mentally but other changes we made just made me feel even worse so I agreed to settle. Switched psychiatrists and was taken off Ritalin. Switched to Lexapro 20mg, Remeron at a dose I don't remember, and Ativan 1mg 2x daily, abilify left at 5mg. Started to feel better and then a month and a half in I tanked once again. Switched to Prozac and Remeron removed. Only change was being more awake. Then ativan to klonopin which did nothing. Left on that combo for awhile because it being the best we could get and the psychiatrist not wanting to make it even worse again. Two months later I was back to ground zero and I got an appointment with yet another psychiatrist two months later. Put back on ritalin, neurontin added (don't remember the dose, believe it was on the lower end and it was 3x daily) Small improvement so next month abilify was removed and the taper up to 100mg lamictal started. Month after, lamictal hit 100 and neurontin was replaced with .5 xanax 1x daily. This time I saw the biggest change in my mental state ever. Everything got better like it hadn't since 200mg zoloft/.5 xanax 3x. It was amazing. This lasted for a month and a half which resulted in my first doc appt in years where no meds were tweaked with. But two weeks after that everything went on a downward hill. Next appt 150 Wellbutrin XL was added and xanax increased to .5 2x daily. Brought me back to feeling great for two weeks then slipped back again. Next appt after that (3 weeks ago), Lamictal was increased to 150mg and from 20mg Ritalin IR 2x daily to 40mg Vyvanse (at which point I realized Ritalin hadn't been doing shit for months). Was amazing for two weeks once again and now I've declined worse than I did the last two times and back to pre this psychiatrist levels. Current meds are 150 lamictal, 150 wellbutrin xl, 20mg lexapro, .5 xansx 2x, and 40mg vyvanse. I'm feeling like this is going to be my life forever which is terrifying because it's not a functional state, the ADHD and depression have already tanked so I ruined my grades on finals. I'm sleeping all the time again even with Vyvanse. Random crying. The "watching paint dry" depression. Once the anxiety kicks in I can say goodbye to my job because I work in retail and I will be crying in the bathroom within 20 mins. The anxiety also kills my relationships which I've recently rebuilt and naturally the depression gets way worse.

At this point I don't know what to do, think, or ask. I'm desperate and scared. It's like it doesn't matter what medication, it won't work or will stop working within two months tops. I'm only 18 and don't want to ruin the rest of my life because I'm so messed up mentally right now.

 

[Jabberwocky]

So you're on a mood stabilizer, two antidepressants, a benzo and an amphetamine.

It is pretty bizarre that the wellbutrin and vyvanse make you sleep. Have you fooled around (with your doctors permission) trying the meds at different times of the day? For example, wellbutrin and vyvanse in the morning, xanax as needed, and lexapro + lamictal at night?

Wellbutrin can cause anxiety, as can vyvanse. But then your depression/ADHD would be compromised. I feel like all your medications are counteracting each other. Historically, you are able to function (for short periods of time) on only a couple medications. I wonder if in this case, less is more. An AD for anxiety/depression, and a benzo as needed. And maybe you will need to switch them up every so often, but wouldn't that be better than giving up?

 

[ac360]

As of

So you're on a mood stabilizer, two antidepressants, a benzo and an amphetamine.

It is pretty bizarre that the wellbutrin and vyvanse make you sleep. Have you fooled around (with your doctors permission) trying the meds at different times of the day? For example, wellbutrin and vyvanse in the morning, xanax as needed, and lexapro + lamictal at night?

Wellbutrin can cause anxiety, as can vyvanse. But then your depression/ADHD would be compromised. I feel like all your medications are counteracting each other. Historically, you are able to function (for short periods of time) on only a couple medications. I wonder if in this case, less is more. An AD for anxiety/depression, and a benzo as needed. And maybe you will need to switch them up every so often, but wouldn't that be better than giving up?

As of now, I take everything in the morning except for xanax. I usually take .25 sometime in the morning, .5 midday, and .25 late afternoon. But some days I don't need it and only take .25 to avoid withdrawals and others I'll need .5 three times. The only issue is that during those long periods of two meds I was just barely functional and I was still in a lot of distress and unable to do a lot, I couldn't even drive for a while and then got in a wreck when I gathered the courage. This combo is the absolute best, most functional and "normal" I've ever felt. The 200 zoloft and .5 xanax 3x also relieved my anxiety and depression really well but I was zoned out. The othet weird thing is that ritalin/adderall/vyvanse actually reduce my anxiety and wellbutrin did as well when I started it and it still has, whereas the SSRIs and Abilify initially made it awful, and never reduced it as much as an amphetamine. Also, benadryl, vistaril, gabapentin, and ativan help a lot (not nearly as much as xanax though) but klonopin and buspar may as well have been sugar pills. I'll never give up, I'm just really discourages.

 

[Jabberwocky]

Good - I had a feeling you wouldn't give up, but just wanted to hear you say it

Have you considered starting therapy again? Drugs can only do so much.

 

[ac360]

Good - I had a feeling you wouldn't give up, but just wanted to hear you say it

Have you considered starting therapy again? Drugs can only do so much.

Yeah I just finally got another job and once my paycheck with my built up hours gets deposited I think I'm going to go back. It was just hard because with both therapists I felt like we got into my problems but I could never resolve or improve them I was more just re traumatized. My first therapist told me that she was consulting with other therapists at a conference and we both established after a while that it was just going to have to be a weekly release because I was never able to improve my emotional state at all. My second therapist was much more open and quite frankly scared the shit out of me. She said she'd never had a client like me and that my anxiety is so intense that I behave as if I've had PTSD since birth, that the "adaptive parent"?, the soothing reassuring voice in my head never developed during childhood. Me and her tried so many techniques and she came to the same conclusion that my previous therapist did very quickly. Told me that when clients are experiencing a lot of anxiety the goal is to get them back to their "safe space" in their mind and grow on that, but I never developed a safe space or felt safe so she was pretty much at a loss. She recommended ECT, Ketamine, and a PARTIAL LOBOTOMY so she just scared the shit out of me

 

[pcbnative]

I have a pretty complex mental health situation. I've had pretty bad issues since I was really young. Diagnosed with ADHD at 11, depression and social anxiety at 13, at 15 it was "unspecified eating disorder" - I never consciously made myself through up but my anxiety got so intense that my throat was closing up, food was getting stuck in my throat which lead to me eating less and then vomiting, long story short I lost 60 lbs in 6 months and went inpatient for 16 days when I was 15. When I was there, my anxiety disorder was changed to generalized anxiety, and along with the unspecified eating disorder I was also diagnosed with a mood disorder. I'm fully aware that it may have been a subconscious way of me starving myself, and my therapist at the time thought it was more likely that but my psychiatrist thought it was purely physical which I think it was. Since then, the diagnoses have remained consistent and so have the symptoms, so currently at age 18 with depression, GAD, non-bipolar mood disorder (looks like bipolar II but 200mg Zoloft and years of ADHD meds never made me manic) and of course ADHD.

I've been on so many medications it's ridiculous. The weird thing is that they all work in really different ways on different things and I always build up tolerance really quickly if they work, and many make no difference at all. My life has changed a lot, living with different family members, different jobs friends etc and now college but I don't stay at a dorm bc I'm absolutely terrified of that. The depression and ADHD symptoms almost go away entirely when the medications are being effective for them but the anxiety symptoms only get to my life being more or less of a living hell. I was in therapy for two years between ages 15 and 17 which I thought was helping me but when looking at it, it made no difference in my mental health whatsoever. Tried again for 6 months when I was 17 with someone else and it didn't do anything again so I'm done paying for it. I know it helps a lot of people including many I know and my mom is a therapist for god's sake but it didn't make me feel better to an even measurable amount - nowhere near the meds.

I started Vyvanse when I was 11 until I was 13. I was too young to even recount if/when it became ineffective. Then taken off and put on Zoloft 50mg and Buspar (idk the dose). After that the Vyvanse was added back on and then removed again because the amount of anxiety it caused. Post hospitalization when I was 15 I was on 200mg Zoloft and .5 xanax 3x a day. Then it was 200mg Zoloft and Vistaril, which did help in retrospect but anything non benzo following xanax will seem ineffective. The zoloft was played around with between 100-200mg range for a while because it wasn't helping once the xanax was removed. Then vistaril was removed and buspar was tested again, which made absolutely no difference for me. After that, we tried 5mg Abilify with the Zoloft which ended up making a difference for a while. That combo for anxiety/depression made me functional for a year and during that time we worked on ADHD. Ritalin made me too hyper and didn't help me focus. Then Ritalin SR did the same thing. Ritalin LA helped me focus immensely for about a week or two then gave me the hyper unfocused thing. Focalin after that which did the same. Then tried Strattera which made no difference in anything whatsoever. Adderall IR after that which didn't even make me hyper just a little less sleepy. Ended up back on Ritalin IR on a higher dose than the first time. The depression was up and down throughout the stimulant changes but the anxiety was on a slow decline. This was about a year after I was first put on abilify and Zoloft and I was on those two w ritalin for 6 more months. I was still going through hell mentally but other changes we made just made me feel even worse so I agreed to settle. Switched psychiatrists and was taken off Ritalin. Switched to Lexapro 20mg, Remeron at a dose I don't remember, and Ativan 1mg 2x daily, abilify left at 5mg. Started to feel better and then a month and a half in I tanked once again. Switched to Prozac and Remeron removed. Only change was being more awake. Then ativan to klonopin which did nothing. Left on that combo for awhile because it being the best we could get and the psychiatrist not wanting to make it even worse again. Two months later I was back to ground zero and I got an appointment with yet another psychiatrist two months later. Put back on ritalin, neurontin added (don't remember the dose, believe it was on the lower end and it was 3x daily) Small improvement so next month abilify was removed and the taper up to 100mg lamictal started. Month after, lamictal hit 100 and neurontin was replaced with .5 xanax 1x daily. This time I saw the biggest change in my mental state ever. Everything got better like it hadn't since 200mg zoloft/.5 xanax 3x. It was amazing. This lasted for a month and a half which resulted in my first doc appt in years where no meds were tweaked with. But two weeks after that everything went on a downward hill. Next appt 150 Wellbutrin XL was added and xanax increased to .5 2x daily. Brought me back to feeling great for two weeks then slipped back again. Next appt after that (3 weeks ago), Lamictal was increased to 150mg and from 20mg Ritalin IR 2x daily to 40mg Vyvanse (at which point I realized Ritalin hadn't been doing shit for months). Was amazing for two weeks once again and now I've declined worse than I did the last two times and back to pre this psychiatrist levels. Current meds are 150 lamictal, 150 wellbutrin xl, 20mg lexapro, .5 xansx 2x, and 40mg vyvanse. I'm feeling like this is going to be my life forever which is terrifying because it's not a functional state, the ADHD and depression have already tanked so I ruined my grades on finals. I'm sleeping all the time again even with Vyvanse. Random crying. The "watching paint dry" depression. Once the anxiety kicks in I can say goodbye to my job because I work in retail and I will be crying in the bathroom within 20 mins. The anxiety also kills my relationships which I've recently rebuilt and naturally the depression gets way worse.

At this point I don't know what to do, think, or ask. I'm desperate and scared. It's like it doesn't matter what medication, it won't work or will stop working within two months tops. I'm only 18 and don't want to ruin the rest of my life because I'm so messed up mentally right now.

Just know that you are not alone. Your experience is familiar, though, your regimens include more drugs than mine. My theory is to not give up! I’ve been doing the rounds of finding the right cocktail for only 4 years. It’s very frustrating! I wanted to thank you for sharing! It helps others in the same predicament! Good luck in your journey! My current meds: Vyvanse 70mg, Pristiq 100mg, Abilify 2mg and Adderall XR 30 mg (taken at 2pm), oh and I almost forgot the 100 mg of Trazedone. Diagnosed with ADHD, GAD, depression, and PTSD. I got sober from alcohol and then all of this mess got real. I’ve been in therapy since my last drop of Alcohol, 8/18/2013. I’m 54. Fml?

 

[AlphaMethylPhenyl]

Ketamine is a legitimate option these days. Also will be psychedelic therapy. These substances are part of the new coming generation of psychiatry (along with serious study of all phytocannabinoids). Clinics for psilocybin for treatment-resistant depression/anxiety aren't far off. Similarly but to a lesser extent are DMT and LSD being studied.

Suboxone has legitimate potential.

What you can do right now involves your part int he recovery process. Diet, exercise, meditation, therapy, sobriety, cleanliness, socialization, and so on...it may seem trite, but these activities are very beneficent.

Just know that you are not alone. Your experience is familiar, though, your regimens include more drugs than mine. My theory is to not give up! I’ve been doing the rounds of finding the right cocktail for only 4 years. It’s very frustrating! I wanted to thank you for sharing! It helps others in the same predicament! Good luck in your journey! My current meds: Vyvanse 70mg, Pristiq 100mg, Abilify 2mg and Adderall XR 30 mg (taken at 2pm), oh and I almost forgot the 100 mg of Trazedone. Diagnosed with ADHD, GAD, depression, and PTSD. I got sober from alcohol and then all of this mess got real. I’ve been in therapy since my last drop of Alcohol, 8/18/2013. I’m 54. Fml?

If you have GAD and PTSD, I'd hesitate to take so much amphetamine, if any at all. You're on about the equivalent of the max recommended dose of adderall. How long have you been on those doses of vyvanse and adderall?

Pristiq is heavily adrenergic, too. That dose of abilify offers little to no anxiolytic effect. It takes a good 10mg+ for it to work well for anxiety, imo.

 

[checktest]

How you live at age 18 may not determine how the rest of your life is - countless people have had drastic shifts and struggles, and formed new approaches to life. They may not even recognize the person they were then given the amount of change. (Also some people die at 18 so it isn't the case for all. I'm just trying to caution about over-projecting into the future based on what has happened.)

I would give some deep consideration into the balance of your thoughts, your actions, and your emotional states- there are a couple of possibilities. Drastic changes both chemically (hormonally) and in overall lifestyle (home, work requirement, school) often happen in teenage years- this stabilizes over time for many. Some might put it in a dichotomous viewpoint - is it that biologically things are changing and driving your life, or are situations changing rapidly and your thoughts around it are shifting? But a more nuanced view may be to place elements of both and the thoughts around it interacting to form your state.

I would really urge trying to find new therapy, though I know having a parent who is a therapist can bring a lot of other stuff to the table. Preferably one who works on building a safe space or some functional goal rather than back analysis. I understand not finding much in therapy but there can be additional options to try.

Is there a seasonal component that you can see? I've known a few bipolar people who switch up drugs around the change of the seasons actually. Lights and other things can happen.

Let's take the example of finals- I've seen this happen with a close friend. Could you unequivocally say that your mood got worse and then you didn't do as well as you hoped, or was there a more complex interaction of thoughts of perceptions of state that may have interacted with mood, and then you didn't do as well? My close friend has bipolar but exacerbated her mood with dysfunctional evaluations and expectations around what she was doing. She'd do well for some time but when it reached a certain level, or when she had a mood dip, she dropped off drastically due to this difficulty of transition and managing stress. She had to learn to balance her anxiety around her mood states (and her anxiety, haha). Eventually she both changed up medicines and finally saw a new therapist, and has settled in recent years. I'm just using this to highlight that going straight for biological or psychological definitions can be limiting in the situation.

For straight up mood instability without precipitating factors, I think a lot of psychs call a duck a duck and go with different mood stabilizers or upping the dose. Atypical antipsychotics still hold a place, but are tricky for a lot of people. Mixed states can resemble or involve intense anxiety, so some go under the radar in terms of defining mood instability. Basically you have done abilify and lower-dose lamotrigine for possible stabilizers, mixed in with various drug combos. They really have been moving away from the amphetamine-benzo combos. For complicated situations, a holistic view including therapy may be beneficial.

Besides what others have mentioned, for drugs I'm still going to toss out memantine. Interesting for anxiety and ADHD, though long-term use is unclear. I've found it beneficial. Whether glutamatergic changes from NMDA antagonism, or 5-HT3, or some of that D2 agonism, sigma receptor, it is an interesting option.

Best of luck!