Doctor, please don't tell me how I feel

[monstro]

You diagnose me with OCD, an anxiety disorder. You say this explains everything I've come to see you about. The racing thoughts, the movements I've always assumed were tics, and the more recent gait problems.

The thoughts, you tell me, are obsessions. They are caused by anxiety.
You tell me that my movements, including my walking issues, are voluntary compulsions. My way of "binding up" the anxiety.

I am a very anxious person, you tell me.

But when I tell you that I don't feel anxious, which is a requirement for a OCD diagnosis, you tell me I'm wrong, wrong, wrong. I really need to read about OCD, you tell me. "You stupid little girl", you probably wanted to add.

I leave your office with the Luvox prescription and don't know how I feel. Anger because I get this major diagnosis from you without the merest sign of sympathy or care to help me understand it? Sadness because I've just been told that behaviors I thought were involuntary are indeed voluntary, so I've been wasting money and time for years on something I could just have stopped on my own? Frustration because I don't understand how one can have an anxiety disorder without feeling anxiety? Hopeless because the Luvox is probably going to poop out like all the other drugs I've taken, but it doesn't really matter anyway because if I could just clear myself of all the "bound-up" anxiety, I'd be alright all on my own?

The whole world could collaspe around me and I wouldn't care, due to my strange personality and megadoses of Klonopin that I'm taking for no known reason. And yet I'm supposedly so anxious that I allow myself to freeze in the middle of busy interactions...even though it seems to me that would make a person even more anxious and that they would avoid doing it. I'm so anxious that my thoughts race as I prepare to go to sleep at night...but are strangely peaceful when I'm explaining complicated matters to my boss and co-workers. And I have so many things to be anxious about! So many things that I can't even list them all. In fact, there are so many things that I'm anxious about that I cannot even imagine a single one. The anxiety must be making me dumb.

I know I'm not a psychiatrist. I know I don't know about all the types of OCD out there. And I do know that having repetitive thoughts--including nonsensical words and phrases--is a symptom of OCD. I know this, doctor, because I have read up on OCD, if you had bothered to ask. I've known about it for a long time now. But I've also read up on bipolar disorder, ADHD, and schizophrenia--conditions that I'm more genetically predisposed to than OCD. Guess what? They happen not to have anxiety as a diagnostic criterion. And they, like OCD, can be linked to movement problems that are not voluntary compulsions.

I was your last patient of the day, but it wouldn't have killed you to explain this to me, like I'm an intelligent person worthy of knowing all the weird things that could be going on in my brain. I think my co-pay, at the very least, affords me that level of respect.

Tell me why you are so highly respected? You're laughing and smiling at your witty turns of phrases while I'm asking serious questions...a respectful attempt to understand what causes OCD and what you think my prognosis is. And I'm supposed to think you care when you won't answer me with something substantial? You might have well have told me that my uterus is wandering around in my body and that I will be alright when I have a baby. That's how useless my visit was.

I'll take your Luvox and your Anafranil (which I once thought was a wonder drug, but now just makes my nose bleed, my bladder reluctant, and my appetite gone). I'll be a good patient and do as I'm told. But if Luvox doesn't work, I think I'll take another vacation from psychiatrists and their walls full of diplomas and their smirky faces that don't deign to show compassion. I'll just keep limping along and muttering to myself and not talk about those things anymore. Because apparently wanting to be rid of these crazy symptoms means I'm anxious.

Read about it if you don't understand, you stupid little Doper. :D


:(

[Lynn Bodoni]

Get another doctor. This one's an asshole if he doesn't listen to his patients.

[Freudian Slit]

Is this supposed to be a spoof of that other depression thread?

[Caffeine.addict]

I think that you need another Dr. This one doesn't seem to be working out for you.

[digs]

BEFORE you go too far down a pharmaceutical road you don't need. At least get a second opinion.

[Randy Seltzer]

1) Get another doctor if you can. This one either isn't explaining things very well, or isn't a very good diagnostician.

2) It is my understanding, and I am no expert, that anxiety is not a requirement for anxiety disorders. They have that name because a certain part of the brain is implicated, but no actual feelings of tenseness/nervousness/etc. need be felt. A good friend was diagnosed with dissociative panic disorder, which is in the family of anxiety disorders. He would be totally fine -- no depression, no anxiety, no problems at all. But one of his triggers would hit him, and he'd collapse in a twitching heap. "Anxiety" had absolutely nothing to do with it, but that was the category of his problem. His treatment was one of the traditional anti-anxiety drugs, and it seemed to work for him.

[Cat Whisperer]

I agree with getting a second opinion. Anxiety is a very strange beast, and can manifest in bizarre ways, and some of the things you've described really do sound like an anxiety disorder, but your doctor doesn't sound like he's working very well with you on these issues. Also, if you do have an anxiety disorder, he shouldn't be sending you out with just a prescription; Cognitive Behavioural Therapy (CBT) should be recommended as well, because it treats anxiety disorders so well without never-ending medication.

[Merneith]

But when I tell you that I don't feel anxious, which is a requirement for a OCD diagnosis, you tell me I'm wrong, wrong, wrong. I really need to read about OCD, you tell me. "You stupid little girl", you probably wanted to add.

I'm not going to tell you what you feel or don't feel. And I certainly don't think you're stupid.

The thing about feelings though - each of us has a subjective barometer. For example certain kinds of fear are sometimes perceived as enjoyable. Ghost stories, for example, or rollercoasters. Some people will be afraid and enjoy the adrenaline rush of one experience even though the other experience might be too intense for them. The rollercoaster is the same for everyone but each individual will have a different reaction to that experience.

This can carry-over into other emotions. A person with anxiety disorder can experience a high level of anxiety every day - but from their point of view, that's not an anxious experience. That's just the everyday baseline for them.

I'm not saying this is what's going on with you, monstro. I'm not trying to diagnose you or anything. I'm just saying, feelings are slippery things and discussing them can be imprecise because everyone experiences them differently. (It seems to me that I don't think it's about the feelings at all really, I think it's about how we perceive and respond to them. But that part is just my take on it.)

I would agree that by all mean get a new doctor if you don't feel comfortable with this one. Having a good connection with your doctor makes a world of difference.

[monstro]

I think what sucks is that I've been told by another psychiatrist that I'm alexithymic--which means (if true) I can't put words to feelings. Apparently this means I can feel emotions but can't label them or describe them beyond "bad" or "good." My current doctor knows about this diagnosis, so he might feel he has to tell me what I feel because I don't know any better. But I've never fully bought the alexithymic label. I very rarely get angry, but I know what that feels like enough to say, "I am angry." I don't need to see myself crying to know when I'm sad. And I know what worrying feels like. There was a time in my life, especially in college, when I was a big worry wart. I would worry about test answers and grades and about what would happen if I lost my scholarship. But I don't think I worried that much more than the average college female. I just had nerdier worries than normal, perhaps.

But not now. I'm not a bouncing ball of endles carefree joy, but I no longer worry about things. I don't know what's happened since I've turned 30, but I just don't think about things like I used to. I walk the streets at night, fully aware of the dangers, but feeling safe just the same. I drive my jalopey all over creation even though I know good and well it could break down on any lonesome road--and me not carrying a cell phone to boot. I lost my wallet for an entire weekend once and spent no more than fifteen minutes thinking about it because I just figured it would turn up. I actually go to therapy because I know I should care more about things--from the way I look to what the hell I should be doing with my colorless life. Perhaps my profound feeling of "nothingness" is a sign of anxiety? As ridiculous and sarcastic as that sounds, I really am getting to the point where I've started viewing everything through this anxiety hypothesis. Just because I want this doctor to be right.

I want him to be right because he's the fourth shrink I've seen in a little over two years. According to multiple people, he is the best in town. He wasn't taking new patients until my therapist made a special request on my behalf. The other docs were too cautious to give me a diagnosis and instead prescribed me everything under the sun. So at least I have to give him credit for giving me something besides shoulder shrugs and hand-waving. But if he really is the best like they say, who would I go to for a second opinion? And how much do I really care to seek out another doctor, waiting umpity-ump weeks for an appointment to open up, filling out another bunch of paperwork, answering the same set of questions, etc.

It's never going to end. I care just enough to take the meds I've been prescribed and hope for the best. If they work, I'll regret I ever posted this drek. But if they don't and the neurologist I see in a few weeks disappoints as well, then I will believe that I have tried hard enough and that it's time for me to just go on with my life, damn the crazy "quirks." If it's anxiety and it's all in my head, then I have nothing to worry about. And if it's not and it develops into something worse, then I will take care of it then.

See, the solutions to my problems are so easy to come up with. It's amazing.

[Nava]

You sure seem to explain things well enough here, but maybe I'm read-monstro-thymic or something.

The only time I've been put on anything resembling psychiatric drugs, it was because I'd gotten gastrenteritis due to stress; the doctor gave me both medical leave and an ansiolitic. I explained I wasn't anxious: I was enormously tired (several weeks of 12+hr workdays followed by a visit to the Grandparents from Hell), and being given a week of night shift on one where I'd previously been approved for vacation had sent my body over the edge, but once I could get the rest I'd been expecting I'd be fine. He insisted, I took the pills once with the result of being unable to concentrate for a whole day and then said "fuck these pills with a rusty dildo, I'm not going to go through the whole day in a fog because the doctor thinks I should be anxious".

I hope you can get a doctor who understands that "may have difficulty finding the right label for a feeling more often than most people" does not mean the same as "does not know whether she's eating or shitting", or eventually get this one to understand it.

[The Flying Dutchman]

But not now. I'm not a bouncing ball of endles carefree joy, but I no longer worry about things. I don't know what's happened since I've turned 30, but I just don't think about things like I used to. I walk the streets at night, fully aware of the dangers, but feeling safe just the same. I drive my jalopey all over creation even though I know good and well it could break down on any lonesome road--and me not carrying a cell phone to boot. I lost my wallet for an entire weekend once and spent no more than fifteen minutes thinking about it because I just figured it would turn up. I actually go to therapy because I know I should care more about things--from the way I look to what the hell I should be doing with my colorless life. Perhaps my profound feeling of "nothingness" is a sign of anxiety? As ridiculous and sarcastic as that sounds, I really am getting to the point where I've started viewing everything through this anxiety hypothesis. Just because I want this doctor to be right.



Wow, if I'm reading you right, you are heavily and seriously worried about the fact that that you don't worry much about the little things.

Like you, I walk the streets at night without worry.

Like you I drive a beater and often very low on gas without a charged up cell phone.

Like you, I've lost my glasses or wallet (with a momentary level of anxiety) and expected them to turn up even after a couple of days.

Like you, I've taken prescribed medications without any percieved positive results. In my case it was for depression. A change in circumstances seems far more effective.

I'm asking myself if you really aren't chasing a problem that doesn't really exist or if I need to go see the doctor again.

I've seen your picture once. Its hard to imagine that you haven't got a picture perfect life.

[WhyNot]

Don't get too caught up in the diagnosis. The fact of the matter is that no one can make an accurate mental health diagnosis on the basis of a 20 minute conversation.

The good news is it doesn't matter much. In all honesty, we have no fricking idea why or how most psych meds work. We just know that sometimes they do. And sometimes what works isn't a med developed or traditionally used for your diagnosis anyway. The diagnosis isn't useful for anyone except your insurance company or the doctor trying to get paid for his work.

Have you noticed all the TV ads lately for Seroquel and Abilify, aimed at patients with Depression? Seroquel and Abilify are classified as atypical antipsychotics. Yet people with Depression don't generally have psychoses (delusions, hallucinations, etc.). Somehow, they help anyway (some of the time.) We don't know why. If you're the patient and it works for you, you don't care why!

The other thing I'd add is that there's a possibility you've got some dissociation from your feelings going on. I really did have an anxiety disorder once upon a time, but I'd rarely have described myself as anxious. I wasn't afraid or jittery or ruminating - I was numb. I was so numb and calm it was ridiculous. Yet I was numb in those situations which one would expect an anxious person to be anxious in. My own personal form of anxiety, more often than not, isn't what I was taught anxiety looks or feels like, but is dissociative numbness. That IS anxiety, for me. And what helped most was Prozac, an antidepressant.

[Vinyl Turnip]

megadoses of Klonopin that I'm taking for no known reason.

This doesn't sound good.

[monstro]

I've seen your picture once. Its hard to imagine that you haven't got a picture perfect life.

That's crazy :), but also very sweet. Thank you.

The other thing I'd add is that there's a possibility you've got some dissociation from your feelings going on.

I've spent the morning reading about dissociation, just in case you guys could be on to something. Does dissociation have to be caused by a traumatic experience, or can it be totally idiopathic? Unless I have a big ole mental block going on or it happened when I was an infant, I've never had a traumatic event in my life. I've been stressed out before, yeah, but not traumatized through abuse, abandonment, or physical injury.

But I'll concede it's easily possible I'm cut off from my feelings. I'm not going to make myself out to be totally emotionally put-together when I know this isn't true.

I guess it's just the way the doctor was so cavalier about the whole thing that bothers me the most. OCD is not a trivial disorder, and if I've got movements associated with it, that makes my prognosis piss-poor and actually kind of scary. But I've had to find this out on my own, not through him. Perhaps he's so used to working with kids that he's gotten in the habit of treating all of his patients in a condescending way.

[you with the face]

If you find that your tics, vocalizations, and bizarre movements correlate with certain environmental stimuli--regardless of your perceived emotional responses--perhaps this is why the doctor has reached his conclusions. You may not be consciously aware of this stress while you're in the moment, but it could very well be there.

I'm not an psychiatrist, but consider that the antidepressants you're taking are putting distance between you and certain emotional responses. Things may be going on inside of you that you can't sense the same way you could before.

And the end of the day, it may not matter. If ten different diagnosis with ten different pathophysiologies all just happen to be treated the same way, then practically speaking, there isn't much need to focus on which of the ten different conditions you're dealing with.

The doctor sounds like he has poor bedside manner, though. I would hate to be talked down to like that.

[Maastricht]

I've spent the morning reading about dissociation, just in case you guys could be on to something. Does dissociation have to be caused by a traumatic experience, or can it be totally idiopathic? Unless I have a big ole mental block going on or it happened when I was an infant, I've never had a traumatic event in my life. I've been stressed out before, yeah, but not traumatized through abuse, abandonment, or physical injury. From what I gathered from this book (http://www.amazon.com/Myth-Sanity-Divided-Consciousness-Awareness/dp/0142000558/ref=sr_1_1?ie=UTF8&s=books&qid=1293827419&sr=8-1), no, you don't have to have had one or a few distinct traumatizing events. A longer period of time (months, years) where you felt so bad that taking a mental leave was kind of neccesary, might also ingrain the habit of dissociation.

[Cat Whisperer]

On the other hand, I think one of the basic criteria for if something is disordered is how it's affecting your life - for example, lots of people are afraid of spiders, but it doesn't really affect their lives, so it's not a big deal. If you start having a phobia of leaving your house and your quality of life deteriorates, that's probably a problem. If you have a tic that doesn't really affect anything, is it really a problem?

[The Flying Dutchman]

Have you ever lost an important loved one ?

One of my sisters recently reported that a new doctor has reversed her bipolar diagnosis and identified her condition as Borderline Personality Disorder. To listen to her, it has openned up her life after many years. She described the symptoms and for the most part she was describing me as well. She claims that the rest of our 6 brothers and sisters have it as well. To varying degrees of course. I certainly believe I have it and the cause was the death of my mother at the age of 14.

Earlier I touched on several diagnostic symptoms that I had that agreed with yours.

I checked out Dissociation to find out it can be a significant part of BPD.

Has BPD ever been brought up with your doctors ?

[monstro]

On the other hand, I think one of the basic criteria for if something is disordered is how it's affecting your life - for example, lots of people are afraid of spiders, but it doesn't really affect their lives, so it's not a big deal. If you start having a phobia of leaving your house and your quality of life deteriorates, that's probably a problem. If you have a tic that doesn't really affect anything, is it really a problem?

I'm less bothered by the tics than the racing thoughts, which don't really "hurt" until that time of the month. The content is bizarre but it's really the pressure of them that I find bothersome more than anyrhing. Sometimes I can't speak without vocalizing some of the thoughts outloud, because they're that jam-packed into my head. That's just obnoxious.

I really don't like the gait issues. The tics, I can kind of play off. Even the vocalizations aren't too bad. But when my feet suddenly feel like their entrapped in 30 lb cement blocks, and I'm walking to work and still have a long way to go, then I can't help but feel like it's a problem. I can convince myself that maybe it's not that big of a deal since no one has hit me with their car yet, but I know it's not normal. And I can't play it off--people have asked what's going on. I'd like to be able to say something besides, "I don't know."

[monstro]

Have you ever lost an important loved one ?

One of my sisters recently reported that a new doctor has reversed her bipolar diagnosis and identified her condition as Borderline Personality Disorder. To listen to her, it has openned up her life after many years. She described the symptoms and for the most part she was describing me as well. She claims that the rest of our 6 brothers and sisters have it as well. To varying degrees of course. I certainly believe I have it and the cause was the death of my mother at the age of 14.

Earlier I touched on several diagnostic symptoms that I had that agreed with yours.

I checked out Dissociation to find out it can be a significant part of BPD.

Has BPD ever been brought up with your doctors ?

The doctor I'm seeing now mentioned it as possibility along with a stream of other disorders during my first visit with him. I've already been diagnosed with a pathological personality--schizoid PD, which I have found to be a reasonable diagnosis (though I don't try to think about it too much). Like BPD, it too has been linked to dissociation (or derealization). But I've never thought I had that particular feature.

Maybe I zone out a little when I go for my long walks, but doesn't everyone do that? How would one know the difference between normal and abnormal degrees of dissociation?

Thanks for sharing your experiences, by the way. I know people with BPD don't get much sympathy around here, so that was a brave thing for you to do.

If you find that your tics, vocalizations, and bizarre movements correlate with certain environmental stimuli--regardless of your perceived emotional responses--perhaps this is why the doctor has reached his conclusions. You may not be consciously aware of this stress while you're in the moment, but it could very well be there.

I'm not an psychiatrist, but consider that the antidepressants you're taking are putting distance between you and certain emotional responses. Things may be going on inside of you that you can't sense the same way you could before.

That's true. I don't think the drugs I have deadened me, but if it's happened gradually, how would I really know? Well, I don't think they've cramped my creativity or my sense of humor :), so at least I've got that going for me. But I do know that you have to be careful with these chemicals. They can do a number on you without your awareness. That's why I'm taking my new prescript so relunctantly.

When the doc said he wanted to add another drug to the ones I'm already on, I asked him (dumbly, admittedly), "So I'll be on four drugs now?"

"Congratulations!" he said as he wrote the prescription. What was that? Some kind of whooshy type of sarcasm? Did he not hear the concern in my voice? Perhaps he's used to popping multiple pills, mulitiple times a day and trying to keep track of which ones to take when (bedtime or morning? with or without food?), which ones make you sleepy, which ones depress your appetite and turn you into a skeleton, which ones make your nose bleed, which ones you can't take with grapefruit juice, which ones make you wet the bed, which ones freeze your bladder, which ones turn your stools into toilet-clogging bricks, which ones make you stutter, which ones make your armpits stink--*catching my breath*--but I am NOT used to this! Even after a year and a half of this pharmacutical ride, I'm not used to it. A little compassion and understanding would have been nice. Not a fucking "CONGRATULATIONS!" (You'd think a psychiatrist would be a little bit more aware of how careful he should be with his humor. I let that shit slide 'cuz I'm easy like Sunday morning, but he doesn't know me. I might have been carrying. ;))

They should just create vending machines for psychiatric drugs. You just enter your symptoms into a console and the machine spits out the appropriate bottle of pills. It would be an impersonal process, but at least I wouldn't have to deal with Dr. Congratulations.

[John Mace]

Absolutely get a second, and maybe a third opinion.

Is the current doctor you're talking about a medical doctor or a psychiatrists? Seems like you need to see a medical doctor.

[monstro]

Absolutely get a second, and maybe a third opinion.

Is the current doctor you're talking about a medical doctor or a psychiatrists? Seems like you need to see a medical doctor.

He's a psychiatrist, but they are considered medical doctors, correct? If I go to a primary care doc, they're just going to refer me to a psychiatrist.

During my first visit with him a couple of months ago, he referred me to a neurologist, who I am going to see in three weeks. I know the drill. He'll give me the routine test (yay, let's test my tandem gait down the hallway, in my stocking feet, for the whole world to see!). He'll write a brief report noting "soft signs" and a recommendation for an MRI. I know this because I went to a neurologist last year. And another one two years before that. Both wrote similar reports and recommended that I get MRIs. Nothing showed up in both instances. Both times I concluded I must be making a mountain out of a molehill. But then the symptoms would make me seek help again. When will I ever learn?:smack:

But this particular shrink thinks I could have PANDAS (strep bacteria-induced OCD, found mostly in kids), because my strep titer came out to be slightly higher than average when I got a blood test. But I did my research (hey, I'm not a scientist for nuttin'). My strep titer is well within one standard deviation of the norm, and furthermore the progression of my symptoms does not follow the typical course of PANDAS. I don't want to say the guy doesn't have a clue, but if he's expecting to find little bacteria munching on my basal ganglion in the MRI scan, he's gonna be wasting the tax-payers dime big-time.

[WhyNot]

I've spent the morning reading about dissociation, just in case you guys could be on to something. Does dissociation have to be caused by a traumatic experience, or can it be totally idiopathic?

From what I gathered from this book (http://www.amazon.com/Myth-Sanity-Divided-Consciousness-Awareness/dp/0142000558/ref=sr_1_1?ie=UTF8&s=books&qid=1293827419&sr=8-1), no, you don't have to have had one or a few distinct traumatizing events. A longer period of time (months, years) where you felt so bad that taking a mental leave was kind of neccesary, might also ingrain the habit of dissociation.
In my case, it was trained into me by my parents, very very uptight people when it comes to dealing with stress or conflict. Just to give you an idea: My parents were married for 14 years and divorced due to infidelity and had exactly one fight in all that time (Not just "one in front of their kid", but one, total. And that one I caused because I lied to Mom about Dad's activities. That'll give ya some baggage, it will.) They're very much "stuff those negative feelings down so deep you don't feel them anymore" kinds of folks. My dad's the only person I know who is not schizophrenic yet mental health professionals describe as having a flat affect. Seriously, he'd make a killing a poker if he wanted to. It actually made it very hard for me to recognize "flat affect" during my Psych rotation - the patients with "flat affect" just reminded me of my dad.

Anyhow, my dissociation was learned, and the anxiety disorder triggered it, but it wasn't from trauma.

[you with the face]

When the doc said he wanted to add another drug to the ones I'm already on, I asked him (dumbly, admittedly), "So I'll be on four drugs now?"

"Congratulations!" he said as he wrote the prescription.

Speaking of disassociation, it sounds like he is completely disassociated from compassion and empathy. With a mouth like his, he should watch that he doesn't a trigger pyschotic episode from a sicker patient.

I wouldn't necessarily worry about getting a second opinion until after you see how this new drug works. But definitely tell your therapist about how his insensitivity and dismissal of your feelings makes you feel.

[Cat Whisperer]

On the other hand, I think one of the basic criteria for if something is disordered is how it's affecting your life - for example, lots of people are afraid of spiders, but it doesn't really affect their lives, so it's not a big deal. If you start having a phobia of leaving your house and your quality of life deteriorates, that's probably a problem. If you have a tic that doesn't really affect anything, is it really a problem?
I should say, this was intended to make you feel better, not belittle your symptoms. If your symptoms are negatively affecting your life, definitely keep on working on figuring out what is going on. I just wanted to give you another perspective, that not everything that isn't strictly "normal" is pathological. :)

[x-ray vision]

He's a psychiatrist, but they are considered medical doctors, correct?
Almost all psychiatrists in the U.S are MDs. The exception are those that are DOs, but they all have medical degrees which is required to prescribe the class of drugs that they do.

[madrabbitwoman]

He's a psychiatrist, but they are considered medical doctors, correct? If I go to a primary care doc, they're just going to refer me to a psychiatrist.

During my first visit with him a couple of months ago, he referred me to a neurologist, who I am going to see in three weeks. I know the drill. He'll give me the routine test (yay, let's test my tandem gait down the hallway, in my stocking feet, for the whole world to see!). He'll write a brief report noting "soft signs" and a recommendation for an MRI. I know this because I went to a neurologist last year. And another one two years before that. Both wrote similar reports and recommended that I get MRIs. Nothing showed up in both instances. Both times I concluded I must be making a mountain out of a molehill. But then the symptoms would make me seek help again. When will I ever learn?:smack:



A bit of my story:
I first became unwell with psychotic symptoms in 1995 - over the next 15 years I was diagnosed with PTSD, various personality disorders and severe depression. Eventually I was diagnosed as bi-polar and put on appropriate medication (3 years ago). My life has significantly improved since then (I have a job, am studying and am preparing my life to fit in some foster kids). When my doctor found out that I fell over a lot (4 times a day sometimes) and had a look at may gait I was sent to a neurologist who checked me out for anything pathological (nothing going on) and then sent me to physio. My gait improved and my balance improved. I still fall over more than most people but I'm a lot better.
As for racing and intrusive thoughts the only drug that has ever helped was lithium - CBT had has more effect on those symptom than anything else but it has taken a long time (I have been doing some form of CBT since 2001).

So knowing what I know now if I were in your position (which at present I am not but there are some similarities to me in the past) I would probably try the medication (even if they have yucky side effects and realising they can take up to 2 months to start working, and sometimes the side effects get better after a while and sometimes they don't) There are a lot of meds out there and everyone reacts differentlt to the so don't worry too much about being ob the medication merry go round (hey it took them 15 years to put me on lithium). Try an get some professional CBT and practice some DIY CBT everyday (get a workbook, write a journal and try to analyse your feelings and motives, join www.moodgym.com.au or www.ecouch.com.au) Try finding some sort of support group (irl or online - with people who have similar issues) it is (for me at least) good to be able to bitch about my illness with people who really know what it is like.

Anyway YMMV and feel free to pick through my blah blah blah for anything you wish to take or leave.

On a last note to let you know where I am at with my illness - I don't look at it as the most horrible and disastrous life destroying thing that ever happened to me (trust me I used to and my life revolved around it). I would not be who I am now without it, It has increased my compassion for those wo are down and out, i no longer take everything at face value and I realise I am not the centre of the universe. Perhaps the fact that I have gone through some horrible experiences can help me help others to avoide similar things or just help them to deal when they do anyway. If i can help in any tiny way then the period of my life when i was in hell was not a 100% negative experience (even though it felt like it at the time) I have chosen to believe this

OK carry on folks.

[Alan Smithee]

I know exactly how you feel, monstro! ;)

I strongly advise against getting a second opinion, because, as you've already figured out, it won't do any good. You've had--what?--four different opinions so far? Which resulted in an equal number of diagnoses? I don't see how one more will help. And as you also no doubt know, the big problem with psychiatry is that there are no objectively correct diagnoses. There are lots of descriptions of different sets of problems, and it's like a parlor game trying to decide which list describes you the best.

When I lived in Washington, DC, I used to rent a car and drive to Philadelphia once a week, because someone told me that the best psychiatrist he knew of was there. I'm not convinced he was all that great, and I imagine I felt much the same way you do. I wanted him to be right, because he felt like my last, best hope, but I was extremely skeptical. He diagnosed me with Bipolar II disorder, which no one I saw before or since has agreed with. In the end, moving to Colorado (by hitchhiking across the country!) did more to help my mood than anything else I've ever done.

The worst part for me, besides the futility of trying getting a decent diagnosis, is the utter impossibility of evaluating my treatment. My depression (or whatever the hell it is, some doctors have even suggested it's more personality-related than axis-I) comes and goes dramatically and unpredictably. When it comes, we (I and whichever mental health care provider I end up with at the time) decide that whatever I was doing prior to the episode wasn't working, so we try a bunch of new medications and therapies until I start to feel better, at which point we decide that whatever I was doing when I got better must be what works for me now, and I keep taking it for weeks or months or years until it happens again.

When I was seeing the doctor in Philly, he prescribed lithium. I'd never taken a mood stabilizer before. The effect was dramatic. Within a day or two of starting it, my mood went from close to the blackest it has ever been to perfectly normal. My mother (a medical doctor, herself) was as astounded as I was. I had never responded to a medication like that before. I kept telling myself it almost had to be some sort of a placebo effect, that there was no way that it could have effected me so quickly and completely, but the placebo effect seemed even more unbelievable. Until a week or two later, when I saw the shrink again, and he mentioned that the effect I reported happened much more quickly than was actually possible with lithium, that the drug took time to build up in the system. And sure enough, over the next month or so, my depression returned, and after a few more months, the doc took me off the lithium (at my request, I think, but I don't remember.)

Obviously, I don't really know if the move to Colorado did any good either, although the result was just as dramatic and sudden and has lasted for almost five years now. I'm still taking the antidepressant I was on when it happened, too, because--well, I really don't know why I got better, but I don't want to make any big changes that might make me worse again. In any event, you aren't likely to see any major papers on moving across the country as a treatment for depression.

Even for things like medications, you can make judgments at the population level, that, say, 80% of people who doctors labelled with diagnosis X got better in six months compared to 30% of patients taking a placebo, but there is absolutely no way to know if I got better when I was taking it because of the medication or not. Even when I don't get better, who's to say the drug didn't stop me from getting worse, or that when I had a suicidal episode after taking an antidepressant for two years that I wouldn't have had three other episodes in that time if I'd not been taking it. Or maybe I would have gone ten years if the medication hadn't had an adverse effect. I have absolutely no way of knowing, and neither does anyone else.

[monstro]

madrabbitwoman and Alan, your posts have been very educational and comforting. I'm glad I'm not the only one who's had their head shrunken a million times, with no discernable results.

I'm vacilating on what I should do about the Luvox. I guess I should stop reading so much, but I've been reading some pure horror stories from people who've been prescribed this drug. There are many good stories too, but it seems that these are from people with typical forms of OCD and depression. I have neither.

It's almost like what I need to do, before doing anything else, is to jot down all the issues I'm having and weigh them against the potential problems adding yet another of drug to my life would bring. Like, Luvox is apparently very hard to ween off from. Do I really want to be on two highly addictive substances (clonazepam being the other)? I might have to wait months before I see any improvement, all the while dealing with insomnia, daytime drowsiness, exhaustion, weight gain, suicidal thoughts, and the ever-present constipation. Do I really want to be fixed that bad? Cement shoes don't seem so bad when compared against all that!

I don't think I want to risk disrupting the fragile stability I have now, just on the off chance that I will be able to walk better and not have swirly thoughts. But I'm not sure. At first I didn't think I cared enough about this so much (which is why I was just going to pop the damn pills in my mouth like a good little girl), but now I'm wondering. If I don't have OCD and there's something else going on, the Luvox could actually harm me. And I'm already on two anti-depressants? Why do I need three?

I'm fortunate that I get along with my psychologist, but she defers to the shrink on these kinds of matters unless I'm getting suicidal. Plus, I can't bear the thought of starting another drug and trying to cope with the side-effects (particularly the psychological ones) while she's away on a 3-week vacation. I know that makes me sound like a big baby, but if one of the tires in my brain blow out while she's away, I'd be left with Dr. Hotshot, who communicates to his patients through a secretary whenever they call for medical advice. That sounds unethical, right? She shouldn't be privy to all my business. But that's what I get for going to the Best Doctor In Town.

Alan, your mentioning of the placebo effect is making me wonder about the Anafranil I started taking about six or seven weeks ago. About three days into taking it, I thought it had cured me. I was so happy that I told anyone who would listen about its wonderous powers. My psychologist was so pleased for me that she called my shrink and left a gushing thank-you message on his voice mail on my behalf. But after about a two weeks, my symptoms started cropping back up. Now I still have most of the side-effects but none of the good. So now I'm wondering if my "healing" was purely psychological. Also, my problems fluctuate anyway, so it may have been that I started taking the Anafranil during a "good" period. And maybe my psychiatrist took the fleeting improvement as a indicative sign of OCD. Well, in that case, I guess I can't blame him. I guess I'd think the same thing too.

It's too much to think about for right now. I should just enjoy the coming of the new year and be grateful that my car passed annual inspection!

[Cat Whisperer]

The doctor added another SRRI to the serotonin-affecting drugs you're already taking? Not to scare you even more, but is he not aware of serotonin syndrome (http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=554)?

Your mentioning the placebo effect makes me think that CBT would be very good for you - it sounds like you're doing a lot in your own head. The "cement shoes" feet can also be anxiety - there was a member of my anxiety support group who couldn't walk when he was in the midst of an anxiety attack. It is also possible that all the drugs you are on are really flattening your emotions out. And, finally, in my opinion and experience, mindful meditation is the best thing for racing thoughts.

[The Second Stone]

I don't know what medical system you have, but in the US doctors do not get paid to listen to patients anymore. They get paid for seeing as many patients as possible and writing prescriptions. One thing I learned from spending two weeks at UCSF medical school (as a patient) is that listening to the patient is one of the most important things they teach doctors. A thorough history and listening is essential to making the correct diagnosis and instructing the patient and putting the patient at ease.

[BigT]

How long have you been on the Klonopin? It can cause or exasperate gait issues and tics if you are on too high a dose. The loss of motor control is similar to being drunk. And not feeling any anxiety is another symptom of having too much. Like pain and pain medications, the medicine should never make the anxiety go away completely--you need some to function.

And how long have you on the Anafranil? Actual results for OCD takes at least a couple months. From what I remember, you haven't been on it that long, and it can take even longer to work.

I wouldn't have a problem with an anxiety diagnosis if you weren't already on two anti-anxiety drugs. Especially since Luvox works in the same way as Anafanil--by increasing serotonin levels. You're already on a serotonergic drug, and the first hasn't been given long enough to work.

And I've never heard of augmenting a tetracyclic with an SSRI. I've heard of doing it the other way around, but that's with extremely low doses. You are definitely risking serotonin syndrome if you are being told to take both. While the stronger form of the syndrome can be brutal, even the weaker form requires going off all serotonergic drugs, and sudden withdrawal from the high levels can be brutal.

The more I know about the condition of psychiatric medicine, the more I am not impressed. We seem to act like we are much further along than we are. The point where we are right now is closer to the 19th century for other types of medicine. We barely have a working theory for how a lot of these pills work. We know what their immediate effects are, but have no clue why that causes symptom reduction. or what actual physio-chemical problem is being corrected. I mean, we're still finding studies where drugs that were previously declared effective are having their effects questioned.

Heck, I can do what they do: you found that a sedating drug with an antihistamine action (Anafranil) helped you temporarily and are having racing thoughts. Well, Seroquel is often used for racing thoughts, and has one of the strongest antihistamine actions around. So, since we can't do any tests, let's try you on a low dose of that.

Obviously, I'm not a doctor. But that seems to be the way it works. Just keep trying and trying medication, based on whatever random thing you notice in the description, and see if it helps. And if it does, then use the drug to make the diagnosis.

[monstro]

Obviously, I'm not a doctor. But that seems to be the way it works. Just keep trying and trying medication, based on whatever random thing you notice in the description, and see if it helps. And if it does, then use the drug to make the diagnosis.

That's essentially it, BigT. My psychologist said that doctors do this all the time, and that while it sounds strange, it's not that big of a deal. But I'm like, what?! How is not a big deal? It's like throwing everything and the kitchen sink into a hole in the wall, and then pronouncing that the last thing you threw into it before it sealed shut can be used to trace the source of the problem. It's a screw driver, so a busted screw must have been what caused the hole in the wall. Here's your prescription for a screw driver.

NEXT PATIENT!

I started off with a low-dose of Anafranil...the lowest dose possible. That alone should have told the doc (and me as well) that miraculous recovery within a week of taking the medication should be viewed with skepticism. But it's too late now. He's convinced it's OCD, so now I'm on the OCD drug review. Before it was the schizophrenia drug review (Geodon, Lexapro, Abilify, Saphris), with some poppers to deal with anhedonia and depressive symptoms (Wellbutrin). Let's jigger with the dopamine levels for a while. That's the ticket! Klonopin, I was told, was for the tics...which to be honest, were a lot worse before I started on it. I actually had forgotten about that. I forget how that class of drugs work, but it's doing something. But I'll probably have to be on it forever.

So now we're jiggering with my serotinin. Tweaking a different area of my brain until it stops the swirly thoughts and the movements that Klonopin can't seem to touch. And may be making worse, which I have considered. Catatonia is a side-effect of clonazepam. And whaddayaknow? My movement problems seem pretty damn close to catatonia! Is it wise for me to be taking a drug with side-effects that mimic the very problem I'm trying to fix? I don't think it is. But if I should bring this question to my doctor, I will be dismissed with advice to go read up on something. Because no patients come to the doctor's office already knowing some stuff, apparently.

Sorry for the rambling. I just don't know what to do now. All I want to do is stay in bed and sleep, which is the opposite of what I usually do on sunny Saturday mornings. :(

Happy New Year, ya'll.

[Cat Whisperer]

I agree with BigT - my experience with doctors and drugs left me with what I am fairly sure was a mild form of serotonin sickness (they added Effexor to the Wellbutrin I was already taking) - I have never felt as sick in my LIFE, and every time I went back to the doctors, all they did was tell me it takes a while for the side effects to calm down, and give me a prescription for more drugs (usually a tranquilizer). When they decided to give me another drug to combat the nausea and inability to eat that the first batch of drugs were causing, I decided the original anxiety which had prompted all this felt better than all the drugs, and with my doctor's support, I withdrew from all the drugs. I've been drug-free for seven years now.

I am truly sympathetic to what you're going through, monstro. The days when I was taking all kinds of drugs for anxiety were a very painful, confusing time in my life. The doctors were supposed to know what to do - why weren't they actually helping me? Why was I getting better information from books and the internet?

[monstro]

I agree with BigT - my experience with doctors and drugs left me with what I am fairly sure was a mild form of serotonin sickness (they added Effexor to the Wellbutrin I was already taking) - I have never felt as sick in my LIFE, and every time I went back to the doctors, all they did was tell me it takes a while for the side effects to calm down, and give me a prescription for more drugs (usually a tranquilizer). When they decided to give me another drug to combat the nausea and inability to eat that the first batch of drugs were causing, I decided the original anxiety which had prompted all this felt better than all the drugs, and with my doctor's support, I withdrew from all the drugs. I've been drug-free for seven years now.

I am truly sympathetic to what you're going through, monstro. The days when I was taking all kinds of drugs for anxiety were a very painful, confusing time in my life. The doctors were supposed to know what to do - why weren't they actually helping me? Why was I getting better information from books and the internet?

Thanks so much for sharing your experience, Cat Whisperer. I did not know that it's not good to add an SSRI to Wellbutrin, which I'm currently taking and appreciating. Yet another reason to hold the phone on Luvox.

I am seeing a therapist who specializes in CBT, which I haven't really mentioned yet. She's taught me relaxation techniques, and when I remember to use them, they can make things not so bad. It's just remembering to use them that's the problem! When the brain is full of whirly-gigs, all I can seem to do is moan and cower in pain. But I was just thinking...exercising really helps me keep the thoughts in check. I'm thinking (don't laugh now) about getting a mini-trampoline, or actually two of them. One for the office and one for home. When the thoughts get bad, I can just jump until I shake them into "place." I know that sounds crazy, but walking is effective in managing them this way. Why wouldn't jumping?

[BigT]

Do you think you could go to a psychologist who specializes in testing? That was how I found out that I only had OCD, and not ADHD nor a PDD. Taking me off the ADHD medicine really, really helped. I may be a bit absent minded, but I'm a lot happier.

And you didn't mention how long you've been on the Klonopin: while it's anti-anxiety effects usually last for a pretty long time, (forever for some people) its other effects often diminish over time. Since you say you took it for the tics, the fact that they are coming back could mean that it is losing its effectiveness.

I'm surprised they didn't start you on an SSRI first for you tics. Those are much safer, even if they take longer to work. Tics and OCD are very closely related: some people think the compulsions in OCD are just tics in a different part of the brain.

Oh, and Klonopin is a benzodiazepine, and works on the, well, benzodiazepine receptors, which are part of the GABA[sub]A[sub] receptors. Those are the ones that work as neural inhibitors, which work not only to stop seizures, but also to stop anxiety and relax muscles. In fact, it should help with racing thoughts.

[Cat Whisperer]

<snip>
I am seeing a therapist who specializes in CBT, which I haven't really mentioned yet. She's taught me relaxation techniques, and when I remember to use them, they can make things not so bad. It's just remembering to use them that's the problem! When the brain is full of whirly-gigs, all I can seem to do is moan and cower in pain. But I was just thinking...exercising really helps me keep the thoughts in check. I'm thinking (don't laugh now) about getting a mini-trampoline, or actually two of them. One for the office and one for home. When the thoughts get bad, I can just jump until I shake them into "place." I know that sounds crazy, but walking is effective in managing them this way. Why wouldn't jumping?If it works, it works. People use any number of visualizations to get unruly brains under better control - I know a lot of people use a visualization of a "STOP" sign when they start going down the garden path of obsessive/racing thoughts. As I mentioned before, mindful meditation really worked for me - I just focus on my breathing instead of the never-ending narration in my head.

[monstro]

And you didn't mention how long you've been on the Klonopin: while it's anti-anxiety effects usually last for a pretty long time, (forever for some people) its other effects often diminish over time. Since you say you took it for the tics, the fact that they are coming back could mean that it is losing its effectiveness.

I've been on it since around May 2009. So almost a year and a half? At 3 mgs. I don't know if that's a real high dose, but it seems that way to me.

I'm surprised they didn't start you on an SSRI first for you tics. Those are much safer, even if they take longer to work. Tics and OCD are very closely related: some people think the compulsions in OCD are just tics in a different part of the brain.

I don't know either, to be honest. It seems like from jump-street I was started on the atypical anti-psychotics. I was prescribed Lexapro, however, but it--along with Geodon--made me an insomniac, suicidal, uber-depressed zombie. So that's another reason why I don't want to take Luvox. I've read that if one SSRI does a number on you, chances are another one is just going to do a repeat performance. I cussed out an old lady while I was Lexapro (or maybe it was Geodon...that whole period of my life was weird). I don't want to do that again.

The doctor told me to take Luvox in the morning. I would take it with 1 mg of clonazepam. Don't know if this is good for my particular system or not. From what I've gathered, many people take it at night and then can't fall asleep. They then spend the next day drooling at their desk, half asleep--which seems very familiar to my experience with the Anafranil! But you cannot take caffeine with it. So maybe a morning dose is better? I don't know.

Oh, and Klonopin is a benzodiazepine, and works on the, well, benzodiazepine receptors, which are part of the GABA[sub]A[sub] receptors. Those are the ones that work as neural inhibitors, which work not only to stop seizures, but also to stop anxiety and relax muscles. In fact, it should help with racing thoughts.

I wonder why it's not. The Abilify didn't touch the thoughts either and it was actually somewhat effective with my movement issues (but I had to stop because I was developing TD, ironically). Out of all my symptoms, the racing thoughts are the most recent development--having begun about two years ago. And really, they are the thing I wish to be gone the most. I hate the cement shoes, don't get me wrong. But there's no pain associated with it, just awkwardness and unwanted pity from on-lookers. However, the thoughts HURT. It's like they exert a physical pressure, and I can feel them pushing up against my eyeballs or something. Fortunately the pain only happens every once in a while, though the thoughts are always in the back of my mind. Swirling around like confetti in the wind.

I was put on Intuniv about a month and a half ago. It's an ADHD drug. But I've never had attention issues. Akathesia, yes. But Intuniv didn't do anything for that. It just made me almost pee on myself a lot. Which is funny because Anafranil does the complete opposite.

I think it's clear I have a basal ganglion disorder. Maybe I've got a little of mania-like agitation and racing thoughts going on, with the kind of tourettism and parkinsonism you'd expect to find with abnormal fluctuation of dopamine activity. Maybe my serotonin needs some tweaking, but I haven't see any clear evidence that it does. I do know that whenever we fool with the dopamine knob, things change. If they could reformulate Abilify so that it didn't make my lips have a life of their own (and it would be great if it also did not turn my stools into bricks), then maybe I could go up in dosage and actually see improvements in my thoughts as well as my movements. But I was stuck at a low dose because of the TD. It did just enough to quell some of my tics, but that was about all I could expect at the dosage I could tolerate.

Maybe I need to talk to the doctor about going back on Abilify. (Shut up, you with the face. I know we've had this conversation before.)

[monstro]

I guess May 2009 would be more than a year and a half.

The drugs. They make monstro do bad math. ;)

[Maastricht]

If jumping does the trick for you, why not get a skipping (http://en.wikipedia.org/wiki/Skipping_rope) rope (http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=skipping+rope&x=0&y=0)? It is easier to take with you and smaller to store. Lots of athletes use it for aerobic excercise.

[Gestalt]

The doctor added another SRRI to the serotonin-affecting drugs you're already taking? Not to scare you even more, but is he not aware of serotonin syndrome (http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=554)?


Cat Whisperer, I think seratonin syndrome is a very valid concern, but I'm 99% certain the doc is aware of it; it's fairly common and something that even non-psychiatrists must constantly be on the lookout for. I'm confident a psychiatrist knows what it is and knows what he's doing when prescribing it.

[DoctorJ]

That's essentially it, BigT. My psychologist said that doctors do this all the time, and that while it sounds strange, it's not that big of a deal. But I'm like, what?! How is not a big deal? It's like throwing everything and the kitchen sink into a hole in the wall, and then pronouncing that the last thing you threw into it before it sealed shut can be used to trace the source of the problem. It's a screw driver, so a busted screw must have been what caused the hole in the wall. Here's your prescription for a screw driver.

NEXT PATIENT!
Here's the thing--not every set of symptoms results in a clear diagnosis. Doctors don't like to admit this, partially because the system is based around diagnoses and partially because patients don't want to hear "I don't know what's wrong with you, and more tests and referrals aren't going to give a clearer answer". But we'd be better off if more doctors would admit that, and indeed I teach my residents to say exactly that.

A lot of people have this attitude that "my doctor could figure out what's wrong if he would just LISTEN TO ME", as if life were the last ten minutes of a House episode. But most of the time he's listening just fine; there just isn't a neat diagnosis or treatment that goes with your set of symptoms. Unfortunately we have a fairly limited set of tools at our disposal.

Accordingly, speculative treatments need to be presented as such. "I don't know what is going on with you, and more tests aren't going to tell me. But your symptoms are clearly bothering you, and I want to give you some options. We have classes of medications that treat broad ranges of conditions. I'm not saying you have one of those conditions, but some of your symptoms are similar and the meds may help. They may not help, and the side effects may be intolerable. But you may be better off on them, so if you'd like to give it a try, we can."

Medicine is not an exact science all of the time. Sometimes it's still an art. Both doctors and patients need to learn to acknowledge the difference.

[Cat Whisperer]

Cat Whisperer, I think seratonin syndrome is a very valid concern, but I'm 99% certain the doc is aware of it; it's fairly common and something that even non-psychiatrists must constantly be on the lookout for. I'm confident a psychiatrist knows what it is and knows what he's doing when prescribing it.
From my linked article - Although serotonin syndrome was described more than 40 years ago,1 most clinicians are unfamiliar with the condition. I would truly love to believe that all doctors prescribing SRRIs have it in mind when someone like monstro shows up with four medications already, but I don't have confidence in that any longer. I think Doctor J is describing it very well; I don't think there's any bad intentions on the part of the doctors, but you don't always get the results you hope for.

monstro, I had a thought this morning - you can talk to your pharmacist about prescriptions and drug interactions. They seem to be an overlooked resource, but they're the experts on drugs.

[Gestalt]

From my linked article - I would truly love to believe that all doctors prescribing SRRIs have it in mind when someone like monstro shows up with four medications already, but I don't have confidence in that any longer.

Wow, well, I retract what I said then. I feel like we've already talked about it 1000x (only in second year of med school) so I assumed it was very well known.
Always good for patients to be vigilant, though.

[monstro]

I've decided to take the Luvox (I know. Will I make up my mind already?!) The thoughts are gearing up for some reason and my hands are all dystonic, reminding me why I went to see this guy in the first place. So if Luvox is the magical fix, then I'm going to let it do its mojo on me. And if it's not, I can stop taking it (hopefully without a bunch of hassle).

The doc prescribed a low dose of it anyway (25 mg). Combined with the low dose of Anafranil, I don't think it will kill me.

I just need to have trust that that this guy knows what he's doing. Maye that's why it's taking so long to fix me. I just don't trust people enough.

[DSeid]

Who knows if this is the case for this guy, and it is no excuse for his absolute crappy communication skills, but some psychiatrists are sort of like some expert surgeons who do well despite being poor communicators and, well, assholes ... but instead of having skill with their hands that get people coming even though they hate them they have their ability to be medication gurus and concoct the potion that works.

monstro, through the years I have admired your posts - I am very sorry to hear that you are having such a hard time right now. I have no advice or knowledge to offer (I'm a pediatrician, not a shrink, I hear your symptoms and think Tourettes, which is of no help whatsoever, just another label of no utility); only best wishes for a speedy response to an effective treatment plan.

Btw, the problem with the rope skipping is that it is a bit more difficult to keep up for any extended period of time - it really is an high intensity interval training kind of exercise - the mini-trampoline is more of something you can keep up for as long as you need to emotionally. And bouncing on a trampoline is kind of like Steve Martin's old joke about playing a banjo: you can't play a sad song on a banjo, and its hard to not crack a smile bouncing a trampoline. Oh okay fine, you can play the Blues on a banjo ... but a bouncing on trampoline is still fun. :)

[monstro]

monstro, through the years I have admired your posts - I am very sorry to hear that you are having such a hard time right now. I have no advice or knowledge to offer (I'm a pediatrician, not a shrink, I hear your symptoms and think Tourettes, which is of no help whatsoever, just another label of no utility); only best wishes for a speedy response to an effective treatment plan.

Thanks, DSeid. Your compliment actually means a lot because I've always thought you had a low opinion of me. Don't know why. I just did. :)

I thought Tourette's too, but my symptoms didn't appear until I was 21. I've searched the medical literature about adult-onset TD and have found studies about people who had tics as children that grew worse with adulthood, but nothing about it just springing out nowhere.

It's also just been within the past two years that I've had vocalizations (mostly a kind of echocalia...repeating my thoughts out loud).

Btw, the problem with the rope skipping is that it is a bit more difficult to keep up for any extended period of time - it really is an high intensity interval training kind of exercise

The main problem with it is that I'm just too much of a klutz! I'd be falling all over the place. I'm evidence that not all black girls can jump rope. Or do those complicated hand-clapping games. Or do the stereotypical neck-swirl that generally accompanies the exclamatory "Oh, no he DI'INT!!!!"

But I can swim. A little.

[DSeid]

:)

Again it is of no utility whatsoever, but childhood tics are often not labeled as such - sometimes just eyeblinking that occurs for weeks at a time, blamed on allergies or thinking that maybe the kid needs an eye exam - or vocal tics that are restricted to what sounds like just habit throat clearing, that mainly show up when the kid is tired. So they could have been missed. But so what? Even if the label was accurate it does not change the treatment plan at all or advance understanding much. The bottom line is still finding the right combination of medication and other interventions that provide adequate relief and for now that has meant some trial and unfortunately some error.

I am sorry that somehow I gave off the impression that I thought poorly of you. Really.

And on preview I see that this is three posts with smilies in a row. Bleh. But it stays anyway!

[monstro]

:)

I am sorry that somehow I gave off the impression that I thought poorly of you. Really.

And on preview I see that this is three posts with smilies in a row. Bleh. But it stays anyway!

It's not every day in the Pit that we get three smilies in a row. We should get a prize or something.

And I hope I didn't make you feel bad, either. Sometimes I guess I read more into people's posts than what's warranted.

[Nava]

I have a question, trying to understand this "dissociation" concept.

Sometimes I'm in a situation which other people would find stressful but, because I know how to solve it, I don't find it stressful at all. That's fine. That is serenity.

Other times I'm in a situation where if I could I'd be screaming and running in circles, but I don't do it because there's people who need Someone Strong and I got that lottery ticket. So instead of screaming and crying and running and saying "why me?", I pat backs, keep the house clean, wipe noses, feed everybody... And then people will congratulate me on my serenity and I'll think "if you only knew".

Would "dissociation" be when you do the second thing so often and so deeply that you don't notice you're doing it any more?

[WhyNot]

I have a question, trying to understand this "dissociation" concept.

Sometimes I'm in a situation which other people would find stressful but, because I know how to solve it, I don't find it stressful at all. That's fine. That is serenity.

Other times I'm in a situation where if I could I'd be screaming and running in circles, but I don't do it because there's people who need Someone Strong and I got that lottery ticket. So instead of screaming and crying and running and saying "why me?", I pat backs, keep the house clean, wipe noses, feed everybody... And then people will congratulate me on my serenity and I'll think "if you only knew".

Would "dissociation" be when you do the second thing so often and so deeply that you don't notice you're doing it any more?
Pretty much. More importantly, it's doing the second thing without conscious choice.

Knowing that you have an emotion or negative thought and choosing not to feel/think it right now is called "suppression" or "thought suppression". It can be very useful when dealing with stress, especially stress like the behavior of your coworkers. It's when you chose to push those negative thoughts or emotions down so you can deal with them at a more appropriate, comfortable or safe (physically or emotionally) time. It's healthy defense mechanism.

When it happens to you without you choosing to do it, generally without you being aware of it, it's dissociation, and it's considered not a healthy thing, especially if it's the primary way you deal with stress. You can get away with it occasionally, especially in acute trauma situations, but long term it tends to lead to dysfunction in life and relationships.

[BigT]

I just need to have trust that that this guy knows what he's doing. Maye that's why it's taking so long to fix me. I just don't trust people enough.

I don't think it's actually a good idea to trust a doctor who has not earned your trust. It's one of those things that doctors like to make you feel guilty about.

One doctor I had would love to tell me that you must learn to trust some people. Thing is, if he had actually paid any attention, he would know that, up until him, I had trusted every doctor I'd ever had--because they gave me a reason to do so. He was the first doctor I'd had who pulled the stupid 10 minutes thing and refusing to talk about the issues so I could know he understood them. And he's the one who put me on a benzo for longer than he was supposed to.

I know doctors want to be able to treat as many patients as possible, but that's not so effective when you can't have time to treat them. Treating every patient like they need the same amount of time is foolish.

My suggestion is to actually tell the doctor about these things. If he can explain why it's safe to take three serotonergic drugs to your satisfaction, then try it and see if he can gain your trust. But don't just hand out your trust: I learned the hard way that that's how you wind up worse.

[Nava]

Thank you, one of the reasons I love this place is because it increases my vocabulary.