Med Report: Month Four

It’s been four months since I started on medication for my PTSD, and I have to say, it was a really good choice for me.

I coped for three years with therapy and herbal supplements alone – but by the end of that time, I was needing four or five times the recommended dose of herbal sedatives to get me under at night, and still not staying asleep, plus I was drinking too much alcohol in an effort to take the edge off. I have a somewhat unusual response to the trauma in that I very rarely feel any subjective sense of anxiety: it’s like my fear is walled off in an abscess somewhere deep inside. I don’t recognize that I feel scared, I just have chest pain, can’t keep still, can’t concentrate, sometimes I can’t speak … all symptoms of fear and adrenaline overload, but subjectively, I have no awareness that I feel scared of anything. This makes it very hard to handle: I have good coping skills for things that scare me, but when I’m just all wound up for no apparent reason, I cannot get myself unwound. I pray, I do guided imagery meditations, I distract myself … but it just isn’t enough. So then I dose myself with all the sedatives I can get my hands on, and I still don’t relax.

Enter Prazosin. Prazosin works by interfering with the function of adrenalin in the brain, and with this stuff in my system … I sleep. I actually sleep. All night. Most nights I don’t even have to get up to use the loo, I just go to sleep and stay asleep. It’s wonderful. Everything is better when you get a decent night’s sleep. I’ve been taking this drug steadily now for the past four months, and the nights are vastly improved, though the daytime mellowness I noticed at first wore off after awhile. A couple of weeks ago, I woke up at 2 am, brain racing, unable to relax, and I realized “oh, I forgot my drugs.” It was very interesting (and validating) to see that when I don’t take them, my troubles come back. It’s not just me being silly, or whining, or thinking I need the drugs when in reality I don’t. I need them. They work. Not taking them means I don’t sleep. Interesting, that.

However, even with the Prazosin in my system, I still have issues. The daytime chest pain is fairly steady, and the brain fog can be overwhelming at times. And then there’s the … full collapses, I guess, for lack of a better description. I had one of those about a month ago. Even in hindsight, I am not at all clear what triggered it … all I know is that I went from totally fine to right off the deep end in very short order. I don’t want to talk about what happened – which should tell you just how bad it was, as I am usually quite open about these things – but it was the darkest place I have ever been in. I was overwhelmed by despair and fear, old ghosts that seemed ever so real. The Reluctant Farmer and The Boy pulled me out of that deep hole … which was, I believe, a form of trauma re-enactment, but it scared the living daylights out of all of us.

I realized then that I really have to take PTSD a lot more seriously. I’ve been working my way closer to embracing the idea that this is a chronic condition, that I’m going to have to make peace with my life the way it is now, to understand and accept that it’s not all going to just go away because I’ve done good work in therapy … PTSD is a big deal, it’s got to be managed, and I have got to treat this with the respect it is due. Because if I don’t, it could do me some serious harm.

So after that full collapse, I talked to my psychiatrist about starting additional medication. I am now on sertraline (Zoloft), 50 mg daily. It definitely comes with some side effects, and the early adjustment was awful. I was so tired I had to go back to bed in the afternoon, could only lie on the couch and read a book, couldn’t think at all, and basically felt like someone who had been in bed with pneumonia for four weeks and was just now able to get up and lie on the couch. I was dizzy all the time – still am, if I’m not careful – and food just seemed unappealing. Now, after three weeks at the higher dose (you start with one week at 25 mg/day, and I had almost no side effects at all then, it didn’t get rough until the dose went up), the dizziness is improving and I have more energy. I’m still not racing around being all productive or anything, but I don’t have to spend the whole day lying down, which is a vast improvement.

The other big benefit is that I’m not needing the daytime Prazosin as much now. Occasionally I still need a bump up dose midafternoon, but as often as not, I feel fine and just take the stuff at bedtime to ensure I sleep. My brain is still pretty foggy, but it seems to be clearing, at least intermittently. I’ve been able to get some things done outside, though I’ve given up on the idea of gardening (even container gardening) this year, as I just haven’t got what it takes. I’m milking Sasha daily, though, working on the new book, and mostly keeping up with other things, though I am definitely not on top of the paperwork or the housework.

I should know how this is working in another couple of weeks, but the fact that I am not feeling as wound up during the day is probably a good sign that this medication is going to be helpful. It comes at a price, certainly, but the fatigue may also be the necessary rest I have been unable to get while my body was so wound up for all these years. The doctor said I’ve been stuck in first gear, that’s true, but the whole time I was still attempting to go 120 km/h so it’s no wonder I feel a bit wrung out. Time to actually slow down, really take the time to recover, and slowly build up a bit more strength.

I’ll probably never have the strength and energy I had before. It wasn’t real energy, anyway, it was life hopped up on adrenalin. Time to find my real strength now.

Hmm. Lots to think about.