9 replies to this topic

[InBetween]

Hey,
I would like to ask you guys for help. Long term stress, vivid imagination and emotional abuse left me in current state:
Almost chronic derealisation/depersonalisation(?) esp. in school. Thoughts about death.. crippling. Thinking about stupid shit like protons and things.. no emotions. My memory is off, to a point where I feel like only present. Had to smoke weed couple of times just to get through school day..

I feel like my psyche has been broken.. I am not me for a long time.

[InBetween]

Edit: also being a dumbass, managed to post the samé topic twice. I can't delete them as I am on my phone, so I apologize and it would be great if mods could delete one of them.

[jadamgo]

Sounds like you've had some emotionally traumatic experiences together with stress that's gone on for a long time, and the negative effects of those things on your brain have really made you unhappy.

The depression side of things can be somewhat improved with nootropics and/or antidepressants, but your response to treatment would be far better if you also looked into some psychotherapy. Also, the post-traumatic-stress side of the equation is really only treated by psychotherapy today. There are drugs that can prevent PTSD and similar problems if you take them right after a traumatic event happens, but there aren't any medicines that work as well as exposure-based talk therapies.

The reason a person feels empty inside after long-term stress and trauma is that there's too much suffering to keep facing every day, and so dissociation in the face of trauma is a form of self-protection. I'll let other people give advice on what nootropics or antidepressants could help manage the symptoms for now, but please understand that the actual cure to permanently solve these problems will be in working with a good therapist.

[Tom_]

I agree with jadamgo, psychotherapy is important. I disagree that medication doesn't really have a place in treatment of ptsd but fortunately first line therapies for both ptsd and depression are the same.

I'd also be hesitant to suggest you have ptsd (you haven't reported flashbacks, hypervigilance, nightmares).

Can you describe these feelings of depersonalization in more depth?

What exactly do you feel or not feel?
Are you aware of where you are?
Can you function at least to a semi-reasonable level during the episodes?
How do you feel about other people during the episodes?
What are your senses like during the episodes (sight in paticualar).
Anything else you have to add about the episodes?

How is your sleep and apetite?
Do you feel guilty?
These thoughts of suicide: how often do they last, do you make plans?
has your functioning at school, in social relationships and other activities deteriorated? can you give examples of before and now?
how is you anxiety levels? Are you having panic attacks? Does something trigger or worsen anxiety?
do you feel better or worse at different points in the day?
Have you had any hallucinations?
If you are able can you give us a brief description of the abuse you have suffered.

I know jadamgo will agree (someone who is very knoweldgeable) when I say this - you can make a full recovery and its quite reasonable that you can make a substantial improvements within only 1-3 months.

[InBetween]

I am bit more stable now, using tradozone 50mg, piracetame 4,8g. Some psychotic episodes occured, but they passed by.. momentally feeling like a 5 years behind, with urge to sprint forward.

PTSD symptoms confirmed in the past - flashbacks, hypervigilance, with some flashbacks occuring now, but they're more guiding than scary.

Depersonalisation mainly when an depressive/psychotic episode present. Body is only reacting to thoughts (not connected), higher pain tolerance, cold tolerance, recklessness, little fear, sometimes anxiety, tendency to overthink.

Currently functioning on path to recovery.
Sight is changing, sometimes 2D, sometimes bright, when the depressions started, sight was nearly perfect - fluidity, vivid colors. I have been on piracetame, choline and pyridinol then.

Sleep ranging from mediocre to bad, usually too much. Dreams just pass me by, not vivid or live.
Guilty.. sometimes. Usually at the end of a episode.
Thoughts of suicide are gone, they might have been caused by SARI antidepressants (tradozone), but I am not sure.
Functioning in school deteoriated (went from A- student to D-), people described me as "empty, just passing by, depressed". Currently trying to reverse the degradation of grades. (No pun intended )
Panic attacks occured alot, felt heaviness of chest, heart aches, aches in pinkies. They're gone now.
Mood fluctuate alot in the day.
No hallucinations.

I cannot objectively describe my past now, I am trying to get out of the hole that I am in, leaving the past for the future.
Currently attaining psychotherapy, changing surroundings that I find myself most in, getting diet together. I couldn't exercise for a month because of eye surgery, I think that will change things alot.

[Tom_]

I'm glad to here you are getting so much better.

The best psychotherapy options are CBT, EMDR, IPT, CAT or hypnotherapy (without any of that damn NLP crap :L). Group therapy in the context of IPT, CBT or CAT would likely be the best options. EMDR doesn't seem to be entirely nessary now and may make you a lot worse before you get better.

Hypnotherapy can be done short term and seems to be very effective for anxiety, it might be worth a short trial.

Looking into grounding techniques & mindfulness practice will help you make some significant improvements reasonably quickly.

You are using Trazadone at a very low dose - its regarded as only effective for insomnia at 50mg. A minimum of 150mg is likely to be more effective. You may also consider adjuncts. Adjuncts shouldn't be used until you have been on trazadone for at least a month.

SSRIs are good options as Trazadone even in high doses doesn't have particularly potent SSRI properties. Fluoxetine may be the best SSRI option as it has potent SSRI activity and combineds 5ht2a and 5ht2c antagonism. You could try it with fluoxetine and trazadone at 50-150mg or with higher dose trazadone.

Another option is Venlafaxine or Duloxetine, which typically has more side effects but in ptsd has a lower drop out rate than the SSRIs. This combo is similar to californian rocket fuel (which is one of the most potent combos about). It wouldn't require an increase in dose of trazadone (although its still a perfectly good option in conjunction) but would mean using Venlafaxine in a dose of at 150mg. Milnacipran is another slightly more novel option that is likely to be the most stimulating (reducing sleep time) and not requiring a high dose.

Moclobemide is a fairly new drug and is a potent antidepressant. It can be used with trazadone should be started at a low dose first. It is likely to be quite stimulating and help with your concentration.

Modafinil is an option. There is no research support for it but it will certain have you awake and concentrating better. Furthermore it may be paticually effective in treating depersonalization and is recommened by some psychopharmacologists for dissociative disorders in conjunction with an SSRI.

Lamotragine is off licence as a mood stabilizer has is somewhat effective for depressive episodes. Its also one of the few drugs that may have some use in treating depersonalization.

Pregabalin (NOT gabapentin) may have mood stabilizing properties but most importantly reduces anxiety. Has minimal effect on sleep structure but may make you more tired.

My recommendation would be to up the trazadone to 150mg, wait two weeks and then decide to increase, decrease or use an adjunct.

I don't like piracetam for mood and anxiety disorders, it has a poor research base. I have read of as many people getting worse on it as getting better (I was one of them). However if you have recently added it and found that it has provided improvement then you may as well keep it. I'm glad to see you are using a proper dose of the Piracetam - many don't.

[InBetween]

Thanks for the reply, really apreciated.

I will talk to my psychiatrist about the Moclobemide.
Currently attaining psychodynamic psychotherapy.. doubts of it's effectivity are swinging in my head from time to time.

[Tom_]

Can you give me more information on the psychodynamic therapy? If its a short-medium term IPT or CAT like therapy it may be a very good choice. An intergrative therapy may be better in that it will teach you skills but all of these skills you can learn by yourself. Most practicing psychotherapists would teach these skills regardless anyway.

[InBetween]

It is a kind of a long term therapy based on psychoanalysis. You talk more then the therapist, he gives you some feedback, you're to find the answers by yourself.

Currently on 100 mg trazodone, increasing to 150 mg ASAP, 1 week aprox. My psychiatrist didn't approve any other changes for now.

[Tom_]

I think he/she should have jumped you straight to 150mg but this is still very positive news. Once you reach 150mg you should wait an absolute minimum of 5 days before you decide on a next move.

You have two options after 5 days. Do nothing (if you feel you've had significant improvement then this is for you), increase dose by 50mg (which is what I recommend about once weekly until you reach a dose of between 250 and 300-350).

The long term psychoanalysis is a load of shit. If you can get hold of some real therapy go for it, if not then either quiting or continuing is your choice. If you feel its making you feel worse I'd quit without a second thought.