Brain chemistry in the age of anxiety

I’ve had plenty of opportunities over the last 12 days to observe how my body and mind respond to stress, and I’ve learned something really interesting.  Specifically, my “mental illness anxiety” is quite different from my “fear/rage/stress anxiety.”  This is a useful thing for me to know personally, but it also relates to the way society has trouble understanding that mental illness is an illness and not just a bad day.

The mental illness is irrational.  It can be triggered by anything or nothing.  I’ve written before about what this anxiety feels like.  It is paralysis.  It is wanting to make my brain just stop it, accompanied by a frantic search for what is bothering me so I can make it go away.  Except there isn’t any particular thing causing it, and so my brain just keeps searching and panicking and pulling up every possible thing that could be a problem and making them seem worse and awful.

The fear-anxiety is rational, and so it manifests in my brain in a very different way.  Sometimes it’s overwhelming, and I cry in grief and terror and collapse for a while.  Often, though, it’s motivating.  Instead of freezing up and freaking out, my fight-or-flight mechanism actually kicks in correctly and I make plans to fight or flee.

Oddly, my physical reactions to these two anxieties are distinct, too.  In my post about anxiety, I wrote that it’s “a tightness in your chest, your arms, your jaw.”  If it’s really bad, it almost feels hard to breathe.  This is the reaction to the irrational malfunctionings of my brain.  The rational fear?  It leaves my chest alone but knots my stomach to the point where I cannot eat.  It twists my guts in knots—the same kind of knots that show up before the starting gun of a race.

In one case, my brain is reacting the way it has evolved to do.  It senses a threat, and it responds.  This is normal.  This is correct.

In the other, my neurochemicals are just totally out of control.  This is the illness.

They are different.

My psychiatrist doesn’t know what to do with me

“Have you considered seeing a naturopath?”

“No, I’m not going to go to a naturopath.”

“They’re highly trained individuals—”

“I’m not going to go to a naturopath.”

So went the conversation with my psychiatrist this morning.  The topic under discussion was my ongoing fatigue, which comes up at these appointments because I’m pretty sure it’s at least partly a side effect of my medication.  SSRIs (selective serotonin reuptake inhibitors) put me to sleep.

I reached this point with a physical therapist once.  When her prescribed exercises failed to fix my hip, she started recommending meditation and some odd relaxation exercises that seemed to imply the pain was in my head.  (I’m not knocking meditation—it’s just that that’s when I knew she was out of ideas.)

By this point, my psychiatrist has suggested quite a lot of ideas for my depression and related lack of energy, including acupuncture and something called “somatic experiencing” (which might be a perfectly valid sort of therapy, but my insurance doesn’t cover it, so nope).  We tried megadoses of vitamin B12.  We tried regular talk therapy, which might be worth trying again sometime, but is an awful lot of time and effort when it doesn’t work out.

Now, apparently, we’re at naturopathy.

I get the impression that psychiatry maybe doesn’t know how to handle people like me, who have to manage depression in the very-long-term.  (To be honest, I think our medical system isn’t very good at handling chronic anything.)  It was obvious that starting me on an antidepressant was the right thing to do when I was falling apart after Little Boy’s birth.  The meds worked.  They still work, but they don’t work perfectly, and the side effects are becoming increasingly annoying.

At this point, you might be thinking that the obvious answer is to find another psychiatrist with some fresh ideas.  That’s easier said than done, but as it turns out, I have to do exactly that, because my psychiatrist will no longer be seeing anyone on an outpatient basis after next month.  She’s given me some leads on other people who take my insurance.

We’re also trying something new and fancy and trademarked, a test by GeneSight that will supposedly tell me which antidepressants will work best for my brain.  I’m a little skeptical—it almost sounds too good to be true—but hopefully it will offer some guidance on finding a medication that works better / makes me less sleepy.

So that’s my crazy report.  How’re you doing?