The increased Lexapro dose seems to be a win so far. I think I do have more reserves of “I don’t give a damn”. Unfortunately I’m also sweaty and a bit sleepy, but that should be less of a problem in a week or so.

The increased stability is welcome. I still get tipped over into various bad mental states by the usual triggers, but the level of discomfort is about at “mild stomach ache”, rather than “severe nausea”. I’ll take it.

As an example, I’m having my usual Sunday night depressive crash but it’s more of a thump than a crash.

One thing I’ve noticed on the current regimen is that I am more annoying. I’m louder and I talk a lot more, and I write a lot more, and I’m more opinionated and authoritative. Being less depressed and more focused is part of it, and I’m sure that the other effects of the stimulant also contribute. I assume that this is a transitional thing, but maybe I’m headed back towards being the all-knowing blowhard I was at 21 before the Big Crisis. Hmm. Maybe I should become a rock critic again?

Saw the psych doc today. We agreed that things were going better but could be improved. I no longer hit the bottom floor of depression and stay there for days and days; the worst low I’ve had in the last month was 12 hours or so. Anxiety has mostly been tamed, and my concentration is much better.

My main complaint still is that I get “tipped over” by triggering situations and then go straight down to the worst possible place and get stuck there. Any kind of confrontation will do it, as will any situation where I feel socially or personally rejected. The reaction is vastly disproportionate to the severity of the incident. It’s been a lot more frequent (although not nearly as long-lasting) lately, probably because I’m working on that stuff with EMDR and other psychotherapeutic techniques.

So we’re increasing the serotonin drug (Lexapro), which he says may increase my ability to “not give a damn” in his words. Giving it a month’s try anyway.

Another odd brain pattern we discussed was my dissociations. When I’m feeling very bad emotionally, I alternate being flooded in anxiety and despair with a detached, anesthetized state. I have that distant “wrapped in cotton wool” feeling that I get with a fever, my senses are generally reduced, and social interaction is nearly impossible. At my worst I can cycle between these two a few times per hour even, although that’s rare. Again, this has been worse lately because I have to deal with the uglies in psychotherapy. The therapist has noticed these anesthetized moments and sometimes will walk me out of it by having me go through my senses, notice colors of objects in the room, rub my hands, etc.

The doc said that sometimes low doses of neuroleptics (the drugs most often given to people who are having serious psychotic symptoms) can be very helpful, especially over a short difficult period. That was interesting to me, since the very very worst of those horrible/anesthetized cycling times made me wonder if I was “going crazy” at times. I think this was mostly because of the rapid change in mental state, and also coming out of dissociation feels almost like waking from a fugue. I remember at one point, long ago, being afraid to sleep because I thought I would wake up “crazy”.

In any case there isn’t much need for that right now, but it made me realize that I probably had seen over the wall into psychosis a few times. Glad I’m on this side.