Troebia's Diary

[troebia]

I had another crisis involving crying and despair two days ago, very similar to the ones I was having before starting to take vortioxetine. After seeing on forums that many others have had the same experience of initial mood levelling and then only a feeling of emptiness, I will see my GP about this. Problem is, I already tried fluoxetine and escitalopram years ago and seem to be treatment resistant to those as well. There aren't that many alternatives remaining, except maybe some combo that could enhance the effects, or perhaps a bigger dosage.

I sent my therapist an email about how I desperately need a longer, "non-psychological" perspective on things. Fighting demons vs learning to ignore that they exist. More activities to occupy my mind vs stoic acceptance of the tinnitus etc. Hope of a distant cure vs giving up, as one has to accept the loss of a limb. He replied that we will talk about this next time.

[troebia]

I just visited my GP and he has in his notes from about six years back that escitalopram made me so nauseous I had to quit. He recommended I stay on vortioxetine until 12 weeks total (5 weeks more) to evaluate and either lower or increase dosage, or switch. He also said that if I'm constantly under the effect of alprazolam (Xanax), it essentially dampens the "high" I should be getting from an SSRI medication and I should only take it at night or when I feel really bad. It makes sense.

[manuel_moe_g]

Good luck, Troebia, wishing you the very best

[snoringdog]

Hello Troebia

I had another crisis involving crying and despair two days ago,

That is terrible. I'm so sorry to hear it.
Do you think it was simply organic, or were there things leading up to it like stress or hunger or frustration with a specific thing?

How did you see yourself thru?

In the midst of it, could you think of better times, or distance yourself from it a little bit at least?

Not just asking...

(I surprise myself in how easily I can go from "Hey, things are basically OK" to "OMG What's the fucking point of it all")

[Mental Fairy]

Five weeks more!!!! Oh my gosh.

I feel so helpless, I wish there was something we could do. If you come off, do you taper? If so by how much over how long?

Can I ask if you do any exercises physically on a daily basis? Or every few days?
I was just listening to Hubermans recent episode and it made me think of you.

https://podcasts.apple.com/nz/podcast/huberman-lab/id1545953110?i=1000633257776

[troebia]

Do you think it was simply organic, or were there things leading up to it like stress or hunger or frustration with a specific thing?

There is a lot of frustration with my lack of direction in life. Then the T hits me too, and I just want to disappear. Without my wife by my side and our home, I'd probably try something radical like joining an NGO and go to a place where my problems are ridiculously small in comparison, and dedicate myself to helping people in need.

If you come off, do you taper? If so by how much over how long?
Can I ask if you do any exercises physically on a daily basis? Or every few days?

My GP who I really trust says to stick it out for a few weeks. I'm not having serious negative reactions to the vortioxetine. He said if I switch to another SSRI he'll tell me if it's a good idea to taper or not, it depends on the medication.

I do maintain myself active physically with all the things in the grove, for example this week we'll be harvesting the olives. Then there will be a lot of pruning. Also daily dog walks up a steep hill, maybe 3-4 km total.

MF, have you made your first marks in your sketchbook yet? Maybe for starters just doodle some geometric shapes and fill them with color so you get a feel of how the materials react with the paper.

I used to listen to Hüberman but I now find his advice less useful, like he's mainly helping people fine-tune and optimise their already well-adjusted lives. Sh*t, I'm only trying to hang in there at the moment.

[troebia]

Therapy update #5

Somehow, I feel it's going in a positive direction. My therapist says I'm moving from the "ought/must" or irrational mindset towards the "want/desire" or the rational mindset. He explained that some of his methods are based on the works by Albert Ellis. I got charts and new forms for documenting my real life situations with irrational vs rational responses and I'm still trying to get my head around it all.

My wife also has noticed a slight improvement in me. Maybe it could also be due to cutting down a bit on the
alprazolam. The GP told me "you're basically putting the foot on the gas with the SSRI and braking at the same time with the alprazolam". My mood sometimes swings up now, and then down to the low level again. I still need some sedation for sleeping well.

[troebia]

The vortioxetine definitely seems to be kicking in now. I was waiting for and wanting this to happen but it's having strange effects. One moment I get a little rush of restlessness and energy, the other it disappears. I believe it's also affecting my dreams which are now mixing reality with distorted memories, not weird fantasy nightmares as usual. After waking up they sometimes leave me wondering for a moment if it really was a dream.

When I think of words now, sometimes all the languages I know mix themselves up in my head. My general state of mind seems unaffected but yesterday while shaving I noticed a slight smile on my face without feeling especially happy. Or maybe I'm involuntarily letting go of the stone face I have to keep anytime I'm inside the house where my mother-in-law sees me If plans are not thwarted by her with some faked sudden illness, she'll be out of the house soon for a couple of weeks which will give my wife and I a chance to recalibrate.

I hope these "kicks" I'm getting don't get out of control in a bipolar mania kind of way. I want to continue documenting my experience with vortioxetine for anyone who's interested. I also hope to get back in earnest to sketching and post some here because they'll probably be even more telling of the chemical changes in my brain. Mood: wary but hopeful. Expectations: uncertain but looking brighter.

[snoringdog]

Hello Troebia,

I'm moving from the "ought/must" or irrational mindset towards the "want/desire" or the rational mindset.

This seems familiar. Some days I feel like I'm being chased with a stick... Gotta do this....Gotta do that... Daily chores and various living-in-this-world deadlines and such seem like an unending burden. Maybe I have an over-active amygdala or something. Things can seem threatening.
On other days, these things become merely to-do and can even lead to a bit of satisfaction in their accomplishment. Maybe not quite the same as what you're talking about, but...

Is this rational/irrational mindset an Albert Ellis idea?

I also hope to get back in earnest to sketching and post some here because they'll probably be even more telling of the chemical changes in my brain.

That's interesting. I maybe heard somewhere along the line about a posited correlation between artistic style and possible sensory deficits or mental struggles the artist was dealing with.... Do you know?

My painter friend's use of color really ramped up after he had cataract surgery. He went to Times Square (After the upgrade to the super bright and colorful new displays) and almost had a stroke!

I guess he'd become gradually used to the dimming and yellowing of his vision, and thought of it as normal...

[troebia]

.
Is this rational/irrational mindset an Albert Ellis idea?

Yes, he is considered the founder of the REBT model: https://en.m.wikipedia.org/wiki/Rational_emotive_behavior_therapy. It all makes sense to me and I like stoicism in general, but I'm struggling with this A-B-C-D-E-F thing:

A Adversity
B Beliefs about adversity
C Emotional consequences
D Disputations to challenge beliefs about adversity
E Effective new rational beliefs
F New feelings

Very neat and logical, right? BUT there's some mental extremely heavy lifting involved in for example how one would react to being fired from a job: from seeing it as a disaster, as a hit to one's self-esteem and leading to possible financial ruin OR as an reason to celebrate, to finally get out of a situation where one was not appreciated and now with the positive challenge to get a new, better job where one will be more successful and earn more.

My therapist underlined specific answers I wrote in his initial questionnaire about how badly I see and interpret my own situation and told me they are examples of my warped belief system. My task is to challenge my beliefs (D), which is where I'm at right now.