Being Right Feels Awesome

I feel awesome. Because dropping my Effexor dose was the right thing to do and made my crazy symptoms go away. And because I was right to insist that my psychiatrist drop my dose of Effexor. Reminder: I write my experience; I don’t give medical advice. Just in case anyone mistakes this for me endorsing tapering medication without supervision, though, let me clarify! I am still under supervision. The lower dose I’m taking is a small step down, the smallest possible, a careful step, and it was prescribed by the same psychiatrist who has been writing my prescriptions since early 2012.

I explained last week why the amino acid supplements I’m taking probably warranted a smaller dose of Effexor, by just a little bit (so far), and why I was angry at my psychiatrist for being rude about my attempt to use holistic, integrative medicine to improve my anxiety. I have an appointment with her in ten days, and I’m pretty darn excited to be able to go and report that I feel ten times better, now. I also have the name of a psychiatrist who advertises as having had training in integrative medicine to call in case my doctor is condescending again.

I’ve gotten some props for acting quickly and decisively as my own advocate, and I am taking those props. If I had been wrong, I’d have called up the doctor and told her I was going back to the higher dose. And I’d still be proud of myself for actively participating in my own treatment. I went searching for an image that illustrated how I feel about my own ability to clearly articulate my needs and demand that they are met by my health care providers. Enjoy what I found. She’s pretty awesome, too.

rowboat

This is a woman rowing a boat around 1900. There is no copyright on the image, anymore, but I found it on Flickr commons. I love that she is so strong. I love that she’s part of a team. I love her hat, too.

Why Must Psychiatry Fight Holistic Healing?

My introduction to psychiatry was blessed by a doctor who spent half his working life doing neurology research. Why was this a blessing? Because people who do research in neurology know one thing very clearly: it’s damn near impossible to find out what’s happening inside the human brain. He knew better than anyone that his work in psychiatry was guess work–the best work the traditional Western medical community could do for patients in dire need of help, but far from the more precise science of other diagnostic procedures. When I asked him if I could be feeling something because of a medication I was taking, he once said “Well, it’s not on the list of common symptoms, but that doesn’t mean much.”

I’m not sure how my doctor for my first five medicated years would feel about my current work with a functional medicine/holistic medicine practitioner (Brie) and our effort to use amino acid supplements and nutritional changes to heal the damage done to my body and brain by years of trauma and medication. I do know that my heart draws me to this work, and the more I learn, the more my head says YES! THAT! that is what is for me!

Pause for clarification: when I say that damage has been done to my body and brain by my medication, I’m not referring to any weird theory about medication being toxic and “unnatural.” Meds saved my life. Meds keep me functional, today. I am pro-meds, when prescribed and taken by communicative, cooperative doctors and patients. Any doctor will admit that there are downsides to the kinds of medication I take, a benzodiazepine called clonazepam/Klonopin (generic/Brand) and a selective serotonin re-uptake inhibitor (SSRI) called venlafaxine HCL ER/Effexor XR–“benzos” and Effexor are both notorious for causing chemical dependency, which is NOT addiction, but which leads to withdrawal-like symptoms when we try to stop taking them. There are no clinical studies outlining the effects of  SSRI use for long periods of time (10 years or more), but it does seem that SSRIs decrease serotonin made by our bodies and brains. Click that last link for more information about how SSRIs work–particularly if you think that they increase serotonin production, because they don’t cause our bodies and brains to make more “happy” chemicals. They just change the way those chemicals get used.

Now, what exactly is the work that I’m doing? First: a change in diet. This Monday, 13 days into my gluten-free, sugar/sweetener-free, soy-free, cow’s milk-free, low-glycemic diet, I began taking amino acid supplements in large doses. Why am I swallowing stuff you’ve probably only heard about in the context of food and nutrition to help with my brain? Because one way to get to the brain is through the fatty acids that cross the “blood-brain barrier.” This is exactly what amino acids do, among other things. Why such large doses? The Franklin Institute piece I just linked to explains that “The fact is, if amino acids reach your brain at all, it should be considered a success. Not only do brain cells compete with body cells for amino acids (body cells pull amino acids from the bloodstream more easily), amino acids must pass the protective blood-brain barrier.”

Another pause for another clarification: as the super helpful site I just quoted goes on to explain, “Food is your best source of amino acids. Be cautious about trying to manipulate your intake with individual amino acid supplements.” Please, do NOT read this blog post and go out and buy a lot of amino acid supplements from a drugstore and start popping them. I’m about to go into just how intense this gets, and trust me–you do not want to do this by yourself. If you’re curious about it, start by eating better. More protein, the right kind of protein, balanced with the right carbohydrates, etc. Again, all on this site, here, which my practitioner agrees is a great recourse: http://www.fi.edu/learn/brain/proteins.html. No, I will not post the details of the diet I’m following, because I really needed help feeling ok while making such big changes so quickly. High anxiety and increasingly bad migraine headaches warranted the kind of action I’m taking, in my opinion. But I’m paying an expert to help me, and she’s worth twice what she’s getting.

Now, 730 words in, the story that relates to my title! Sorry about burying the lead, as they said when people still read newspapers, but I’m not feeling so hot. I’m not in a super-high-energy place with anything, let alone editing.

I began taking the supplement course specifically designed for me on Monday. The plan is to send a urine sample for specific testing to see how it’s all going exactly 14 days after taking my first dose. It’s very specific. Two weeks. Not a lot of time. I was surprised, then, but not shocked, when I felt a sudden shift in my overall wellbeing. For the worse. The very much worse. I had been warned, though, that I might feel really badly as my body and brain adjusted, and that this could mean a bad reaction to the supplements, a need for more of the supplements, or that I needed less of my medication. It’s maddening, though, that all three of these things feel pretty much the same way, so trial and error is the only way to find out how to fix it. I did just what I was supposed to do: I left a message for my psychiatrist, who can take a long time to call back, then I called Brie, then my therapist, Linda. Brie was, as she has always been, incredibly smart, clear and helpful. I was going to try this, and if this didn’t work, then that. I called my therapist to keep her in the loop and for comfort (Downton Abbey fans–the woman has the voice, accent and demeanor of Mrs. Hughes). My usually rather warm and always helpful psychiatrist shocked me with her cold tone, short sentences, and distance.

Why? Well, despite the fact that during our last session together, she smiled, nodded and expressed a lot of curiosity about amino acid therapy to help with chemical dependency on medication, my doctor had not done any of the things she had told me she would do. She had not returned Brie’s phone call. She had not done any research into this holistic therapy. Most importantly, she was not supportive of trying a decrease in my medication dosage to see how that reacted. In short, she didn’t believe in any of this. The contempt in her voice shocked me.

This doctor is good at her job. When I was pregnant, she was calm, steady, communicative with my midwives, and always ready to schedule and extra session if I felt nervous. I wish that kind of vigilance were the standard of care for pregnant women with a history of mental health issues. What I’m doing now, however, is far outside her purview. She’s not comfortable, and that’s fine. But she didn’t tell me that when I first explained what I would be doing, when I directly asked her if I could call her, list symptoms and get her opinion as to whether I was feeling too much Effexor or too much Klonopin. Perhaps she didn’t believe that it would do anything, this “kind of thing.” Perhaps she has such strong convictions about the medications she prescribes, that she believe they should be the last change I make. Whatever is going on with her, she handled this badly. I cried a lot. I talked to my therapist for the third time in one day. I ranted and raged about communication and meeting me halfway.

This morning, I woke up newly determined to stay the course with this holistic treatment and very carefully try a lower Effexor dose, before changing my supplement course. This dose of supplements is only supposed to last two weeks, so I wanted to try a tiny step down in the meds before messing with such a short-term program. I felt confident about this because I am very good at communicating with my doctors (yes, even when they suck at communicating with me). I am always honest with myself about my mental health. I feel no hesitation about the idea of going right back up to my previous dose at the first sign of trouble. While my psychiatrist remains uncooperative, she did finally speak to Brie and she is willing (if not happy) to write me prescriptions for lower doses, provided they are within a reasonable range. I’m not interested in huge changes. This afternoon, after a lot of communication with I dropped from 200mg to 175mg. I’ve been paying very close attention to the nutritional aspect of all this, too, so I’m being extra careful to eat more often (an empty stomach exacerbates everything, I find, and makes it really hard to figure out what to do next). I’m sleeping more.

The larger issue here is that I have very few options, when it comes to working to decrease my dosage of psychiatric medications;  when I was so ill that the only way out of that darkest of all places was via medication, psychiatry worked exactly the way that it should. I worked with my doctors. I made informed choices. I was never handed a sample or a prescription without a proper explanation of the short- and long-term side effects and consequences. I was never shamed by a doctor and always felt like an active participant in my own care. In the last 24 hours, I felt as though that had disappeared.

It’s important that doctors are cautious about patients who suddenly want to decrease or drop a medication, especially with histories like mine, that include such extreme symptoms and a hospitalization.

It’s also important that patients like me have a chance to try to find a way out of the prescription cycle, if we want to do that. I’ve been taking meds for seven years. At one time, the idea of taking them forever didn’t bother me. But I have this chance, right in front of me, to try something that could help make meds a less significant part of my mental health treatment, and I want to take that chance. No one who knows me well is worried that I will do anything drastic, like flush my meds. No one is even worried that I will fail to report every single feeling and sensation that I have! And yet, I am stuck working with someone who thinks I have been taken in by “so-called ‘science'” because there is almost no one who can write me the new prescriptions I’ll need who believes that anything else works! It’s a cycle that takes enormous strength and delicate self-care to break. I am so angry that my doctor is withholding her expertise while I Google “symptoms of Effexor overdose” and choose all by myself which drug I want her to decrease, all so that she doesn’t have to be afraid that she has made the wrong choice. I get it. Doctors don’t want to experiment. I don’t want doctors to do much experimenting, either.

But there are many people who point to psychiatry and call my doctor’s theories “so-called ‘science'” – we have no way of actually seeing how these medications work. No one has ever SEEN a neurotransmitter in action, in the brain! No one has watched an SSRI travel through a patient’s blood stream, past the blood-brain barrier, and watched it stop the re-uptake of serotonin from happening. It’s good guess work. There is solid evidence. But there is also a lot of money from many drug companies funding the research that provides that evidence. Holistic treatments, for many reasons, don’t get that kind of research. Before now, I didn’t know how to go about caring for my body in a way that would help my brain, even theoretically. I just want to try this very clear, very specific path, to see where it leads.

The truth is that I’m lucky my doctor is willing to even see me, let alone write prescriptions she doesn’t like writing. She is very interested in keeping me safe, even if she would rather I didn’t do this. I have heard so many stories, mostly from readers I’ve never met, about doctors who simply ask a patient to leave and never come back, because she does not agree with the doctor’s assessment. That would be frustrating no matter what, but it’s downright irresponsible when that patient is chemically dependent on a medication and suddenly left with no refills. It’s not safe to simply stop taking this stuff.

I am safe. I am feeling better. I am moving forward in a way that feels true to my heart and mind. I am scared, of course, because this is brand new territory for me. I am hopeful.

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How I Responded When My Toddler Hit Me

My baby is becoming a toddler right before my eyes. He can climb up onto the couch without help or standing on anything! This means that he is HUGE and that we have a big problem, because we put stuff with cords, like laptops, and hot beverages on the sideboard behind our couch specifically to prevent him from reaching them. Obviously, he is therefore motivated not to just get onto the couch, but to climb over the back of it in order to intentionally give his mama a heart attack explore and express his natural curiosity. Well, we were both pretty frustrated after I put him back on the floor for the fifth time in five minutes, and that’s when he hit the back of my hand. His little face was just so full of toddler angst! Jaw set. Eyes blazing.

In that moment, I was really glad that I had been an infant/toddler teacher before he came along, and that I had just read an article called “When Your Toddler Hits You: A New Perspective” over at Hand in Hand Parenting. This part was SUPER HELPFUL–

If it’s your child’s first or second or third hit, take it easy. The thing to do is to gently, calmly move his arm away from the person he’s hitting, so he can’t hit again. You can let him try. Just keep his arm from landing on you or anyone else. Mild words like, “No, that doesn’t feel good,” or, “I can’t let you do that,” might be helpful. You want to give him information, not a blast of reaction.

I held both his hands in mine, exaggerated a displeased facial expression, and said with as much calm as I could manage (he had just hit me! I was a little mad!) “We do not hit. Hands are for gentle. Can you try gentle with Mama?” Walter knows what gentle means, because he learned pretty quickly that this touch was the only way to get the dog to remain within arm’s reach of him. He did not try gentle touch on Mama; he hit the couch cushion. At that point, I remembered something else from this Hand in Hand article–

Not all children hit when they’re scared–it’s not the only instinctive human reaction to the feeling of fear. But it is one of our innate fear responses. So … you can safely assume that if your child is hitting, it’s because he’s feeling scared. … While your child is upset, it helps her greatly when you can be loving and calm. … She can concentrate on letting all that tension tumble out. … She is expelling bad feelings—fear, in particular. She’s using your calm presence as her signal that she’s free to let go of the feelings that have infected her behavior.

I’ll admit, I’m not a huge fan of the phrases “bad feelings” or “infected her behavior” but the overall sentiment is one that makes perfect sense to me. As an infant/toddler teaching assistant, I always saw better outcomes from calm teachers willing to keep an overwhelmed child close. I’ve heard about a “Time In,” instead of a Time Out, where a parent removes the child from the situation where he is exhibiting the behavior that is unacceptable but remains with him, often holding him close on a lap or in her arms.

So, when Walter hit the couch, I picked him up, and I said “Let’s have a Time In.” I held him close, and he cried. I said softly, “I know it’s scary when the big grown ups take away all the interesting things and put them out of reach.” He might not understand those words, but it was as much for me as for him. I want to respond to his big feelings by engaging with him, while he’s still so little. I want to teach him that big feelings can be scary, because they are so big, but that they won’t scare me away, and therefore don’t need to be hidden. It was my first step in forming the good habit of responding to toddler behaviors that can be shocking. Hitting, biting, throwing toys. It happens, but it’s never easy. It is so easy to hold my crying baby and know that I’m sending a message of love and acceptance. It won’t be so easy when he’s arching his back, trying to get away, full-on tantruming, but that’s why I want to start working on my own reaction early!

Hugging his doll, before The Incident.

Hugging his doll, before The Incident.

Healing Anxiety Naturally, Phase One: Food

I’m embarking on a new path, in conjunction with my more traditional talk therapy and psychiatry treatments, that takes a more holistic approach towards anxiety, depression, and trauma. Called Functional Medicine, it’s a unique approach to healing anxiety naturally (also: depression, trauma, chronic pain, hormone imbalance). “Functional medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease” (The Institute for Functional Medicine).

I’m working with a practitioner in California, because a childhood friend referred me. We speak online, in a video conference, and even before our first long visit, it became clear to me that while I had asked for a referral to help with my migraines, I had no idea how to untangle my physical health from my mental health. Anxiety goes up, migraines get worse. Anxiety goes down, migraines respond to medicine, again. So, while she usually begins with a gentler, slower approach and more subtle changes, we decided to jump right in to a full-blown resetting of my mind and body’s systems for dealing with stress, trauma, etc. I’ll talk more about how that works in a future post; the science is pretty incredible.

What I love most about this treatment is that it works with the philosophy most often found in Eastern medicine: our emotional, mental, physiological, and spiritual selves are intertwine. And it also uses Western medicine’s greatest assets: insight into how physiological mechanism work and change, and amazingly precise medical testing.

My first step is to follow a strict diet, for two weeks, that is meant to give my body a break from the stress I put on it from the way I was eating. I’m skipping foods with a high glycemic index (the body responds to them by ramping up blood sugar production) and sticking to eating smaller portions, consumed more often, of foods that will keep my blood sugar even. My anxiety acts as an appetite suppressant, often, so I was going a very long time between any sort of meal or snack. I am also an admitted sugar addict–we ate our feelings, in my dad’s house, usually in the form of ice cream. Between what I was eating and when I was eating it, my blood sugar and energy levels basically were doing major peaks and valleys all day. I knew that. I knew better, too, because the nutritionist I saw while I was trying to go off my medications, before we tried for a baby, told me all about it. As I remember it, it goes like this–

I skipped meals. I craved sweets. The healthiest option I chose might have been a bottled smoothie, full of sweet fruits and soy protein. My blood sugar would skyrocket in response to the two bananas and five kiwis and whatever else I had consumed in about three minutes, in juice form, and then pretty soon, it would begin to fall, taking my energy level down with it. My body would try to make up for my energy nose dive by producing extra adrenaline. Chemically, that’s the same thing as anxiety, by the way. It’s also just not healthy and takes a big toll on the body.

So, for yesterday and today, I have skipped bread/wheat, refused sugar, chosen eggs, avocado, fish as protein. Apple, pear and grapefruit are the closest I’ve come to sugary foods. And I feel like HELL.

I’ve felt this before. It’s withdrawal. My body is freaking out, because I am not feeding it sugar. Sugar addiction is real, people. My headache, stomach ache, shaky hands and sensitivity to light and sound are proving that, to me. But I will do this for 12.5 more days (but who’s counting?) and it will get better. I may slowly add some gluten, sugar, diary, back into my diet. But I will be careful, and see how I feel after having a little of each food, one at a time, and I will avoid becoming addicted to sugar, again.

sugar

Coming up: how amino acid supplements can reset my brain to its original production, delivery and use of chemicals like serotonin, dopamine, and cortisol, to name a few.