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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by firstname on May 24, 2008, at 13:38:46
i'm posting for two reasons: first to provide my own cautionary tale. I have benefited SO much from reading other people's experience over the past few months. Second, I am hoping any of y'all might be kind enough to offer any thoughts/theories/advice re: my communicative disorder and possible causes/fixes....
Theoretically, I am a writer, but I can no longer write a simple sentence. The words & thoughts get hopelessly muddled & mangled somewhere between my brain and the screen. I frequently have trouble recalling, spelling and typing words.
Problems started -- but were MUCH more mild -- soon after I was diagnosed with depression and ADHD about 6 years ago. I was put on adderall & and a series of SSRIs that seemed not to do much, which were eventually replaced by effexor XR in 2005.
It was a HORRIBLE two years -- that culminated in what felt like near-psychotic break last spring. At that point, my reg. daily regimen included:
* 450 mg Effexor ER
* 200 mg Provigil
* 30 mg Adderall XR
* Lunesta and/or Ambien every night
Because i am naturally pretty flaky and strongly ambivalent about being on medicine, I would often forget/skip effexor & provigil, esp on weekends, so i was basically going through ever-intensifying Effexor withdrawl for over a year: sleeping 2 hours a night during the week and 48 hours straight through the weekends. Intense brain zaps, epic nightmares, and dizziness eventually made it difficult for me to feel difference between wake and sleep. It is one thing to think you are awake when you are really dreaming, but it is VERY weird to feel like you are still sleeping and you are actually awake.I was a mess -- emotionally, mentally & physically.
Clearly this all made work very challenging & I was so frantic & preoccupied, i barely managed to get to pharm to pick up medication, let alone research side-effects. And while i repeatedly confessed to "doctor" i was often missing doses, she never seemed to suspect withdrawl. She just kept increasing dosage and added two new medications: Focalin for 1 month, followed by 6 weeks of lamictal, which was proverbial psycho-tropic straw.
Since starting the effexor i had also gained quite a bit of weight, but two weeks into lamictil, new bulk appeared so suddenly, I actually decided to google Lamictal,then effexor, etc.
It was beginning of horrifying epiphany that chemical cocktails had essentially been melting my brain for 2-4 years.
I gave notice & went off everything except adderall & ambien pretty much as cold turkey as i could manage without puking on my desk or the car. As i 'm sure many of you with any experience with effexor know, it was a hell of a few months.
But i newfound resolve to do a total brain cleanse, hoping an unadulterated baseline state would help determine what if anything was truly wrong with me versus were simply side effects of meds. I gradually weened myself off sleeping pills and adderall.
No longer working, just focusing on detox & mental recovery & writing paralysis.
Soon after i started on effexor, what had already become a painstakingly slow & labored writing process -- gradually ground to complete halt. i was no longer rearranging sentences and sharpening paragraphs, but really struggling to arrange words in coherent and complete sentences. I began to "write out" whole passages in my head and transcribed thoughts, but soon was unable to remember sentences in my head long enough to transcribe them. Every sentence had to pieced together from mess of fragments and re-read over and over to ensure essential grammatical components are present/ in correct order.
I did some research and found out there is no such thing as late on-set acute dyslexia. But writing paralysis was so pronounced, I began to suspect that drugs/anxiety had altered neural pathways or something and consulted with three separate ADHD specialists.Each administered litany of multi-choice questionnaires & performed battery of neuro-testing, but inattention to biographical details and reliance on pre-fab medical diagnostics did not inspire much confidence. None were particularly interested in communicative impariment -- chalking it up to anxiety - and i left with exact same diagnoses & prescriptions I had been skeptical about since day 1 -- adhd, depression, anxiety; adderall, ambien & anti-depressant.
After the effexor psychosis, i will NEVER take another anti-depressant again. I also happily kicked ambien habit & even adderall for a while. But when i started searching for job a couple months ago, started adderall again and now taking 30 mg xl a day.
It has been 13 months now since that fateful google search for effexor. My memory of the past three years in spotty and impressionistic at best, but generally i feel MUCH MUCH better -- mind, body & spirit -- I am back to regular weight, verbal alacrity feel practical almost normal, thinking is fairly clear and coherent - but my biggest problem & fear remains: i still can not write. there are momentary breaks in thick fog, but producing clear declarative sentences requires obscene amount of time and effort.Sentence as simple as: "I went to the book store yesterday" for instance will come out naturally like: "Book store yesterday, i was there yesterday."
I can't recall even the most basic words -- such as "steep" or "ally" when i finally think of approximate alternatives, i can't spell them; when i can manage to settle on correct collection of letters, i can't type them in order.
As you can imagine - this mysterious & mental impairment is not only quite distressing emotionally but also pracitcally a big hurdle for writer seeking employment....
Wondering if anyone has any insights as to whether this problem sounds like:
1.late on-set brain damage or disability
2. calcified anxiety that somehow infected pre-conscious basic linguistic cognition, or
3. side effect/damage of psychotropic drugs.
Thanks so much!ps (this description came out MUCH/ easier than normal for some reason, but still took hours and quite a bit of cutting and pasting)
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Posted by g_g_g_unit on May 26, 2008, at 7:49:51
In reply to can adderall+effexor+provigil, etc = neuro damage, posted by firstname on May 24, 2008, at 13:38:46
hi i just wanted to say that as a writer i understand how incredibly frustrating it can be dealing w/ meds in terms of sfx etc.; personally, i would happily spend everyday of the rest of my life on benzos if it weren't for the fact that such a demanding professional life closes off a lot of treatment options. what's even more frustrating is the disjunct between idealized formulations and real-life application, and hearing your story is an unpleasant reminder that those barriers exist. if it's any help, i have gone through periods where i was absolutely convinced that my ability had been stripped from me, but if you can manage to salvage any pleasure from writing at all, no matter how arduous the process, i'd recommend trying to hold onto it. i hope someone can offer you more sound neurological advice but i just wanted to extend my sympathies.
take care,
g
Posted by firstname on May 30, 2008, at 0:31:39
In reply to Re: can adderall+effexor+provigil, etc = neuro dam, posted by g_g_g_unit on May 26, 2008, at 7:49:51
thanks, g
i DO really your sympathies, not to mention your valiant effort to slog through long post. it feels better to know that what i tried to describe feels vaguely familiar to another human being. shrinks say it is anxiety, writing friends say it is writers block - and i am sure both have played a part at some point along the line. but neither feels like real root of underlying communicative log jam that makes every sentence feel like technical climb up some treacherous himilayan peak... was there anything in particular that you did/do to help dissipate or avoid the bouts of basic debilitation/incompetence?
:)
Posted by firstname on May 30, 2008, at 0:32:18
In reply to Re: can adderall+effexor+provigil, etc = neuro dam, posted by g_g_g_unit on May 26, 2008, at 7:49:51
thanks, g
i DO really your sympathies, not to mention your valiant effort to slog through long post. it feels better to know that what i tried to describe feels vaguely familiar to another human being. shrinks say it is anxiety, writing friends say it is writers block - and i am sure both have played a part at some point along the line. but neither feels like real root of underlying communicative log jam that makes every sentence feel like technical climb up some treacherous himilayan peak... was there anything in particular that you did/do to help dissipate or avoid the bouts of basic debilitation/incompetence?
:)
Posted by undopaminergic on June 3, 2008, at 4:45:14
In reply to can adderall+effexor+provigil, etc = neuro damage, posted by firstname on May 24, 2008, at 13:38:46
I don't think you've necessarily suffered brain damage from the medications. Functional dysregulation or maladaption of the brain in response to drugs can have symptoms that are similar in many ways.
I suspect working memory is a major area of dysfunction. Some medications I would suggest experimenting with are guanfacine, methylphenidate, sulpiride, amisulpride, modafinil, adrafinil, memantine, dextromethorphan, piracetam, aniracetam, galantamine, huperzine A, buprenorhpine, naltrexone, pramipexole, and probably many more.
Posted by GoodSanta on December 31, 2008, at 0:47:29
In reply to can adderall+effexor+provigil, etc = neuro damage, posted by firstname on May 24, 2008, at 13:38:46
You aren't crazy. I'm a tough guy's guy and these drugs did the same thing to me.
I was diagnosed with panic disorder in 2003 (at 17, you know, when young adults are having stress) and put on Lexapro and Effexor. Both put me into a paranoid state of mind that bordered on psychosis. I kept it a secret because I thought my parents would hurt me. I finally stopped taking the Effexor and voila, all of my paranoid and psychotic thoughts stopped. It took a couple weeks but I felt different in a thousand ways.
I have been off Effexor now for a while and my thinking is clear. My parents were worried that I was manic or schizophrenic. Both work in psych, so they know the symptoms. They still think that it is a great drug for some people but that some of us have TERRIBLE reactions. I also had a much more pronounced psychotic break (the kind you couldn't hide) after taking a single dose of Prozac.
No history of abnormal behavior, paranoia, or psychosis when off drugs. My parents say that they have their son back after five years on SSRIs.
The language stuff is very real. It is the red flag of cognition. I scored a 5 on both of the Advanced Placement English tests (highest score) and tested out of all writing classes in a writing-intensive major. I have won all kinds of essay contests. Then I went on Lexapro and I couldn't write a compound sentence to save my life. College was rough for two main reasons 1) I thought people were out to get me 2) My language skills deteriorated. I scored lower and lower on Word Attack, Spelling, and Sentence Elements tests than I did a few years earlier. Tests showed signs of functional regression. I started saying/writing "nonsense" and had zero concentration. I had won several public speaking awards but suddenly started saying "My name is car and I like you here for thanks" when introducing a college speaker. People laughed but I had no idea what was funny. I had said everything right in my head.
Any tremors? A neurologist diagnosed me as having Parkinsonian tremors and MS-type tics. My speech began to resemble that of a stroke survivor. These went away after I switched from Lexapro to Effexor.
So, yeah, go easy on these drugs. I got five years of my life messed up and got the old "anxiety" yarn. That didn't pan out. I got better when I got off my meds. I wasn't "anxious." I was made paranoid by everyone Forest and Wyeth's wonder drugs.
Again, they work for some, but be very careful to look for ANY behavioral changes like manic or psychotic symptoms. Mine were subtle at first but soon spiraled out of control when no one was looking.
If your spending or talking changes even a bit, I urge you to call your doctor. He or she won't kill you, even if that's what the drug is making you think. They're really wanting to help. You just have to fight the nonsense paranoia and let the doc into your thoughts. I know what it's like to suffer alone for five years. As a "guy's guy" it was even harder. Football players aren't supposed to be scared of the mailman. Don't let it happen to you!
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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