17 October 2010

Choosing medication as a treatment option

It's early afternoon on Sunday, and it's quiet here-- yesterday was exactly the opposite, because yesterday was a home football date and my neighborhood on home dates is all about football.  I knew this was the case when I signed my apartment lease, and I honestly like the atmosphere.  Yesterday in particular was absolutely electric around here.  Game day for me is actually a work day, but it is fun, even if my neighborhood is loud at times.  My neighbors are pretty good about settling down once it gets to be later at night, and by the next morning you can't tell there were 80,000 people here.  Today it's just another city neighborhood.

There's another sports event going on this afternoon, that I have a ticket for, but I decided to pass-- I woke up an hour before the event, felt pretty stiff and immobile when I tried to stand up (~15 hours on my feet yesterday), and realized that the quiet of Sunday morning felt kinda nice.  So I'm staying home, drinking a couple of cups of coffee, tending to some household chores, and planning to get some studying going later this afternoon.  I feel better just for making that decision.  Of course I'm keeping track of the score of the game, but now I have some freedom to get things in order before the start of a busy week.

At one point this week in one of my classes, a graded exam was being handed out-- the TA divided the class of about 250 into several subsets based on last name (A-K, etc), and put the piles on a table at the center of the room.  At the same time, the class is actually two classes; one is a 100 class, and the other is a 101 class, but both share the same lecture.  So we also had to hand in the day's lecture activity to get points for attending.  It's the same class I've written about, where we "clap" in response to the professor's questions.

~250 people all at the center of a lecture hall, trying to get into a small space to drop off papers and into another small space to pick up papers.  I sit at the front of that lecture hall, and by the time I had stuffed my gear into my backpack, I was surrounded by people and noise-- I managed to shove my way close enough to literally throw my lecture activity to my TA, and then I shoved my way back out and up the steps, and out of the building.

Not fun.  Not at all.  Confined space, lots of moving people, lots of noise--- not fun.
 In a couple of my classes, the professors are in the habit of pausing during the lecture-- they'll ask a question, possibly write it on the board, and wait for an answer from the class.  It's during those pauses that I have the most trouble, and am the most likely to have to deal with flashbacks.  I've trained myself pretty well as far as being able to take coherent notes, but the pauses and breaks in the timeline mess me up.  I'm being pressed for a response to a question I haven't learned how to solve yet, and when that happens it's a trigger for me.  The pauses take me out of my comfort zone.

It's actually better, for me, if the professor just keeps going, and lets me concentrate on documenting what's going on so I can look at it and make sense of it later when I'm in a quiet environment and I'm not so stressed.  But I'm having trouble being not so stressed when I get to that quiet environment, or I'm having trouble even getting settled down enough to pack up my stuff and get to the library...

This week, I have an appointment at the VA hospital's mental health clinic.  Until now, I've resisted the idea of medication as a PTSD treatment option. 

Some background, to hopefully explain why-- I was on Celexa once, about ten years ago, and I remember that I didn't like it.  That was when I was still married, but during the time that my marriage was entering its end stages.  I was dealing with depression first and foremost, and this was long before I would be diagnosed with PTSD.  The medication ultimately didn't do much for me and I stopped taking it, which was a really, really stupid thing to do because stopping made things worse.  The medication didn't work because it didn't really treat the cause(s) of my problem(s).  I was in fact dealing with PTSD, but at the time is was buried under a lot of other more immediate problems.

Recently, I've been really paying attention to myself; what's having the most negative impacts on my life, my social interactions, my relationships, and my ability to study and work and be productive.  I have an arsenal of tools now; the results of my 12-week CBT therapy program for PTSD at the VA Hospital, the results of a year long group therapy program to deal with social anxiety, and the research I've done on my own.  I'm not a doctor, but I have access to a fantastic library system at school, and I've been making use of it to read the literature concerning PTSD and treatment options.

The conclusion I've reached is that I've taken things about as far as I can on my own.  There is a lot that I can do, consciously, with materials from both therapy programs to reorient my thinking and in general stay on track.  Both therapy programs did wonders for me, and they're the reason I'm here, but school and life are requiring more-- I want to do well in school, I want to have good social relationships, I want stable and fulfilling romantic relationships.  PTSD therapy was a year and a half ago, social anxiety group therapy more than two years ago, and my life has changed a great deal since then. In essence, I'm pushing myself beyond the envelope, asking things of myself that are beyond what I've ever done.

Many things in my life are going in the right direction, but it's when the flashbacks and nightmares happen that I realize things aren't all quite right.  I spend a lot of time in classes seeing images of things that have happened in my life; I'm "traumatized" by them, they're scary images, and I don't want to see them.  I often feel desperate and abandoned when I'm alone.  My brain will take an image of someone I'm attracted to and create an entire movie of an entire relationship (including the end) in a second.  I'll numb and turn everything off for a bad (long or short) relationship, just because it's better than being alone.  I'll walk the street, and see images of a building blowing up, a gunman on the roof, a car hitting me and bouncing me over the hood.  It's frightening, and once I'm back to reality it takes a while to come down from that.  All of those chemicals in the brain and the bloodstream take time to settle back down.

It's in that time to settle down that I have some tools to comfort myself available, but they're not working.  All of the reading I've done suggests that the effects of PTSD may be cumulative if a person is exposed to traumatic events repeatedly over time, which honestly is my life-- broken home, sexual abuse, war, divorce, bankruptcy, being damn near homeless.  I've been a punching bag, taking one shot after another.  But dammit, I need by brain to work on school and relationships and being happy, and I want those synapses back.  There's enough research out there to suggest that medication may be able to calm down all of that excess and unwanted brain imagining that's going on, so I can work on what matters.

I've resisted meds until now because I remembered that when I was on Celexa, I had a lot of difficulty and wasn't very happy-- but my life at the time wasn't very happy, either.  It was in fact falling apart, and most of my life wasn't under my control.  So now, after reading a lot of literature and thinking about it, I've decided that maybe the right medication would be a good thing, in my current situation.  My arguments against meds are based on a situation that happened ten years ago, and I've done so much additional work and healing since then, that this is no longer the same situation.  I need to do what's right, for right now. 

And right now, the writing in journals and making flash cards and working through cognitive therapy worksheets isn't getting it done.  So on Tuesday when I'm at the VA hospital, my doc and I are going to discuss medication as a part of my treatment plan.

There are certain things I'll probably never feel comfortable with-- being crammed into a small space with a jostling crowd is one of them-- but those are only a small percentage of life.  It's the rest of the time, working, studying, being around other people that make up the bulk of my time.   I'm willing to live with having to try to avoid certain situations, and hopefully with the right additional treatment I can make the remainder of the rest of my life a little easier to deal with.

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