Screw you, Strattera.

So a few weeks back...I forget how many...I started Strattera again. Instead of fighting my ADHD, it made me feel disembodied/dissociated. Okay, no big deal, I can handle that. Especially because it goes away or gets less noticeable after a few days of taking Strattera. Then the dosage went up. Bam. Whatever part of my brain thinks about sex was suddenly broken. Truth be told, it's one of my favorite things to think about; I think about it a good deal of the time and enjoy doing so. But on 18 mg of Strattera, it doesn't cross my mind unless somebody mentions it or I force myself to think about it, and either way it isn't as appealing as it was before. I consider that a fundamental change in the structure of my thoughts, and not a pleasant one. It unnerves me that 18 mg of a chemical can take that away from me. But for the sake of waiting it out and getting some stimulants I put up with it. Only three more weeks of this and I'd be off Strattera. Worth it, right? So I waited.

Then the dosage went up again to 25 mg. And what happened? It gave me depression. I took my first raised dose at night before I went to bed. The next day I woke up feeling like I did before they put me on Wellbutrin. Less severe, but unmistakable. I didn't feel like doing anything. I wasn't hungry (had to force myself to eat) or thirsty. I didn't even feel like getting out of bed. Heck, I didn't even really feel like being IN bed. I felt no emotion about the things in my life that tend to make me feel strongly. Towards the end of the day, when it would have been time to take another dose, it started wearing off and I started feeling normal again. I did NOT take the next dose. I'll put up with disembodiment, I'll put up with it screwing with my thoughts, but depression is not something I'll put up with. So I was off Strattera for the next three or four days until my psych appointment. I didn't feel depressed and thinking about sex was the same as it had always been. It was a relief.

And what did my psych do? She put me back on it. Not the 25 mg dose that gave me temporary depression, but the 18 mg dose. She explained that since both the Wellbutrin and the Strattera affect norepinephrine, the raised dosage of Strattera had been enough to more or less edge the Wellbutrin out of the way and take up the receptors. (So I guess we know what would happen if I ever went off my Wellbutrin. Thank God I have it.) And she gave me 28 days' worth of Strattera 18 mg capsules. I went home and later e-mailed her to ask if she still planned to put me on the stimulants if this didn't work. Her response:

"Plan to eval response with 18mg as adjunct with wellbutrin. Plan to do more formal eval for attention/focus at that time. Still doubtful about stimulants because of health, nutrition & mood concerns."

...

You said stimulants were the next course of action...are you going to renege on your word? Part of me wishes I'd just not said anything about it making me depressed and waited it out. As it is, I'm back on it and not only has it made me stop thinking about sex again, it's also more or less screwed up the corresponding physical functions. Remember what I was originally given the Wellbutrin for? The unfortunate side effect of the Zoloft? Well, it's that all over again.

Strattera isn't helping me--it never has. And I seriously doubt it's going to over the next month. I told Laura what it was doing but her response wasn't a very helpful one. I am only putting up with this in the hope that she'll do what she said she would do and use stimulants on me as the next course of action. I see Laura again in early July.

As far as I'm concerned her "mood concerns" are fairly baseless...I think my mood is at a much, much higher risk if she leaves me in this desperate state where I'm angering the people around me and increasingly hating myself for these problems. Yes, okay, whatever, the stimulants aren't some magic cure-all. But they have a very good success rate, and I need SOMETHING to work, and soon.

Her nutrition concerns...are probably fairly sensible. I'm aware that I don't weigh much. Last weighing I was 121 including clothes, cell phone, and iPod, so that probably puts me at about 118 pounds. But dammit, if I have to eat a box of donuts every day for the week before I see her next to bring my weight up, I will do that. I really don't have that much of an appetite and I'm in weight training now so I'm actually using up energy. So I suppose it makes sense that she wants me to eat more. But stress has a tendency to make me eat less. Meh.

...and her health concerns, those I can't argue with, and that's what scares me. Yes, my heart rate went up on Zoloft. Yes, I had tachycardia for a while. Yes, my heart is sensitive to some medicines. But I've never been on stimulants (other than caffeine, and that doesn't count), and statistically, very very few people without preexisting heart conditions have a bad cardiac response to these meds (and the clinic VERIFIED that I don't have an actual problem with my heart; it was just the meds that I was taking at the time). Surely the risk is not too great for her to put me on the lowest possible dose for one day and then take me off of it if my heart does something bad. I don't actually know what the risk is, I just know that I'm scared and I really really need something to work.

...sigh.

I'm just see-through, faded, super-jaded, out of my mind

So my psych has got me on Strattera, the norepinephrine reuptake inhibitor, again. For a month. If it doesn't work, she said the next course of action would be stimulants.

This comes as a relief.

That's an understatement.

Anyway, I'm on the Strattera right now--10 mg for the past five days, and tomorrow I go up to 18. Five days later I'll go up to 25, and then five days after that I'll go up to 40 for the remainder of the month. As I did last time I was on Strattera, I'm having a feeling of detachment, dissociation, disembodiment. Even on 10 mg. I feel like my body is...not quite mine. I look at my arms and they look far away. Sometimes everything in the room looks far away. I feel somewhat cut off from my emotions some of the time too. Which is not to say I cease having emotions, but they feel...I don't know, detached from me. I'm at a distance from them.

It's more weird than anything else. It doesn't upset me, thus far (when I went off the Strattera last time, it went away). I don't have a clue what's going to happen when my dose goes up, if even 10 mg can do this to me. Maybe I'll have an out-of-body experience? That would be fascinating.

Whatever the case may be, canoeing is over, so now I have...a week and a day of summer vacation before I go back to class until Thanksgiving break.

Edit: In doing some research, I found this:

"A high variety of factors have been implicated in the emergence of depersonalisation and derealisation episodes, including different drugs. A case abruptly induced by two applications of reboxetine, a selective and specific norepinephrine reuptake inhibitor, is reported occurring in a 50-year-old woman treated for a major depressive episode. The episode rapidly remitted after discontinuation of reboxetine. Previous data having indicated a role of the serotonin system in the pathophysiology of the phenomenon, a noradrenaline induced serotonin liberation of Raphe neurons is suggested as possible underlying mechanism."

(http://www.ncbi.nlm.nih.gov/pubmed/12947529)

So maybe this is something akin to that? I don't know. Depersonalization is reported as an occasional side effect of all of the meds that affect norepinephrine reuptake, as far as I can tell. Is this related? Will it become more related as my dose goes up? Who knows.

Here, have some music.

(You need to be viewing this in an RSS reader, like Google Reader or something, to be able to stream the audio. Sorry, but I don't know any other way to do this in Blogger yet. Or you can just go listen to it on http://hmmcclish.xanga.com.)

So a while back I took some songs that I strongly identified with and stuck them together in Audacity into one song to describe myself. It's been over a year since I did that, so I decided to make a new one. It doesn't quite describe the present--it describes the time period I just went through, namely, clinical depression and the trip to the hospital. Usually it's the lyrics; sometimes it's also the tone. 


These are the songs, in order (and sometimes the rest of the song besides the bit I pulled out has no relevance):


"It's All Your Fault" - Pink
"Bring Me to Life" - Evanescence
"Hospital" - The Used
"Fscene8" - The Medic Droid
"Wind Up Toy" - Alice Cooper
"Hospital" - The Used (again! It just happens to coincide well with this period of my life in more than one section)
"A Perfect Sonnet" - Bright Eyes
"Wave Motion Gun" - Marcy Playground (oh so much.)
"The Bird and the Worm" - The Used (they're just a good band for this kind of mood)
"Soldier Side" - System of a Down

Several of these helped me get through this time in my life...so thank you to the people who gave them to me. Namely...Vivian, Crow, Sarah, Rachel, and Henry. And my own searching.

Will probably get around to making one for my present state eventually.