They laid off almost everyone at my old job on a few Monday’s back. I was already trying to get off pot and booze because they were frankly killing me. I had started Wellbutrin but it was still the 2 week period where that stuff kicks in. When I got told that I was going to be let go I had a really bad mental breakdown. I have PTSD from having an utter shit childhood and really bad episodic MDD. I could not focus and was crying in public which has not happened in a while. I also might have been hearing voices but they are not there anymore. I ended up in a partial hospitalization program under recommendation of my therapist and while it sounded scary it has turned my life around in only 3 days of going.
Next step is they are going to be putting me on Abilify to even out the spikes I have been having. While the Wellbutrin is handling some of my ADHD I want to see if I can change it to 300mg to see if it squashes it along with my MDD episodes that its handling now. The psychologist says I should not be scared of the Abilify even tho I kind of am. She says it will even out the spikes and dips I have been having. Those are what are causing me to cry. I read on the internet too it should be helpful with my autism spectrum issues.
I have been white knuckling it alone for so long that seeing some light on the horizon makes me want to cry with joy. I just hope some of the bridges I have burned can be built back up again because I have left a trail of fire behind me. I am really hoping to figure out this whole vegan thing that I have been so hardcore in hating now that I am not consumed by thoughts of death.
Lastly, I dont know if any of you have had some experiences with Abilifiy if you do I would like to hear about them bad or good. Thank you for reading this my friends, and if you think there is no hope out there remember that other humans have beat what you have and you dont have to go at it alone.
Wow! I love this infodump so much. Another one of my meds is a BP med because all this stuff drives me into hypertension stage 2 and a few times when I got it taken where they were surprised I was not hypertesive shock.
I will talk about this Norepinephrine you speak of because it might take out two birds with one stone. I see my psychiatrist today so I will speak with em. Thanks for the offer to connect me with someone that could explain it too if my psychiatrist needs it. I will let you know if I need it
Thanks again!
Oh cool! Well, not cool but clonidine and guanfacine are both second-line/non-stimulant treatments for ADHD and they are also hypotensive agents so there might be room to use them to assist with ADHD traits and to address your hypertension at the same time.
Guanfacine tends to be better for ADHD, especially with regards to being able to focus. Not so useful for motivation though. I would expect it to work pretty well for rejection sensitive dysphoria and potentially for depressive-like symptoms that come from RSD which may be going unrecognised if it’s just your baseline and you have a tendency to internalise things (more common in combined-type or inattentive type ADHD, in auDHD, late-diagnosis, trauma survivors [esp. childhood trauma] and people socialised as women). No promises though so don’t get your hopes too high, and from anecdotal reports it seems that it either works for people or they hate it.
With regards to guanfacine, if you tolerate it well, you might not notice much but if you’re dealing with a lot (and tbh it sounds like you are - which is a compliment because it means you must be a resilient person) then it might be a subtle thing that others around you notice more than you do yourself or you might find that it takes a bit of the edge off of things and brings the lows up enough that recovery is easier over a longer time frame.
Clonidine is going to have less positive cognitive effects, although it will still work well for RSD and if you’re scatterbrained or depressed due to the impacts of RSD or constantly trying to rein in your impulsivity you might find it has a secondary benefit for your cognitive ability because it will just free up some resources. Same goes for PTSD symptoms too, if you find yourself regularly experiencing trauma triggers. Clonidine works well for sleep as well so if insomnia is a big issue in your life (and insomnia is just terrible for making mental illness worse but it seems to effect ADHDers particularly badly) then it could be useful here.
I’ve been on clonidine and guanfacine at the same time, which is pretty unusual, and tbh I couldn’t identify any real effects of the guanfacine so I discontinued it. You’d have to prise the clonidine from my cold, dead hands though. If your prescribing doctor feels comfortable with it, this might be something that could be used to manage your hypertension and some ADHD traits. Clonidine is particularly nice because it kicks in quickly and, within reason, you can take an extra 50 or 100mcg if you’re particularly anxious or something has just triggered you (e.g. someone yelling and being aggressive on public transport where it hits your PTSD just right and it really rattles your nervous system). Obviously I’m not a doctor and I’m not supervising you or monitoring your conditions so you’d need to get actual medical advice and approval to do this yourself. Also careful with increasing hypotensive agents at any point beyond your daily dose because you don’t want to drop your blood pressure low enough that you go fainting or anything like that.
For adults, I’ve heard a couple of reports that very high doses of guanfacine really work well for ADHD traits - in the vicinity of 8mg a day - but this is off the beaten path for treating ADHD so you’d need a prescribing doctor who is comfortable working outside the standard recommendations.
With regards to clonidine and adjusting the dose upwards, you’ll know that you’ve hit too high a dose when you feel really kinda zapped. Not in the sense that you’re completely exhausted but more like all of your motivation is just completely non-existent. That would be your brain struggling under the lack of norepinephrine. There’s no risk of anything big from this by itself, except if there’s like a house fire and you take a few minutes before the urgency to do something kicks in I guess? (Lol, just kidding but it really can feel like it’d require a house fire to get out of bed when you’ve taken too much clonidine.)
Whatever happens, I’d be very interested in hearing how things pan out for you if you feel comfortable with sharing so don’t be afraid to update me. I think there’s a lot of good options available to you.
I feel like when things have been stabilised and you’re doing better overall it might be worth considering modafinil as an alternative to the typical stimulants that would probably be too risky due to the hypertension - modafinil doesn’t really have those same effects but it can help with motivation and focus etc. especially in ADHD but yeah, that’s one for down the track and with approval from the right doctors before it would be a candidate for consideration. But just because Adderall and Ritalin are off the menu doesn’t mean that there aren’t other options available, so stay positive!
Just getting around to reading this after an eventful day at the PHP building yesterday. Thanks for giving me so much information. I think I might have miscommunicated something in my last comment. I think my BP is so high because of my anxiety and stress. But I will talk about that in a another part. I am going to talk about this Guanfacine to my psychiatrist and see what they say. It sounds like it fits my profile. Let me tell you about yesterday because it was kind of a breakthrough for me.
I ended up having a PTSD episode in front of staff because of a confrontation I had with someone between groups. I got agitated by some comments someone made and communicated it to the person who did it, and they reacted badly back to me even tho it was a reasonable request. I really could not handle his response which would require me to escalating things and instead I grabbed my bag and walked out. A therapist that saw me in the hallway took me outside and that is when I just started crying. I never really have been able to figure out what is happening to cause me to go all emotional during events like this because normally I am a rational person. I have always been called a highly sensitive person by my parents and that never made sense. I am glad I had another person to talk to so I could tell them what I was feeling. What I was describing was basic ass dissociation where I could not feel things around me and I was detached from reality, but I was still cogent while I was crying and talked about the events rationally.
I never really thought of PTSD affecting normal people like me because its all about the troops and shit when people talk about it. I have been in denial with what was happening to me when people would relate their experiences of it in group about it. That is why I never really looked into it seriously before and did not internalized it when they told me before about it when I started the program. They did not tell me directly at the start of the program a week ago they just asked me if I knew what it was. Then told me to look out for symptoms of it just in case. I think it was painfully obvious to those around me what was happening and I just did not have the words for it. I just assumed I was bipolar but my episodes are not psychotic in nature. The things happening to me are reactions to real events, and the emotions are rooted in my past, and my body shows it to people who can see these things in people I think. I am not really reliving the moments as much as I just get raw emotions that override anything I am feeling. I need to map my triggers now which is gonna take time because I have no idea what is doing it when I think back on situations like this. I need to be able to make it though a 60 min therapy session without using 30 of it to cry that is for sure. The meds they say will help stabilize me for that. I am just glad I was around people who could spot PTSD episodes and know how to deal with them.
I have a new thing for my list too and that is my silly ruminations I do on the type of events that happened at the PHP building. I will be up for 2-3 hours just ruminating on events and cant really stop unless I totally shut down the thing in me that wants to rehash shit. Like flat out saying out loud we are not going to talk about this. I hate it because it will toss things at me like comments from a peanut gallery. It stops me from sleeping and if I wake up getting back to sleep is impossible. I think the Abilify is gonna help with that because I took my first dose last night and it knocked me the fuck out instead of depriving me of sleep. I hear it can do ether one to a person. Sadly my head is still spinning a little bit and they said that will happen for like the first week or so. They bumped my Wellbutrin up to 300mg and I am on 5mg of the Abilify.
One thing I have noticed is how much my body reacts to these episodes. Like I said I have hypertension stage 2 right now and I have been taking readings once in the morning and once at night. I also take two readings separated by 10 minutes when doing my readings. I have been tracking it using an app and everything. I also have some other symptoms that are really allergy like that intensify after episodes. I get a sore throat where I can also feel some swelling that might be my uvula, I sweat a lot, I get itchy, and my nose goes all runny. Its like my body is attacking itself when episodes like this happen.
I really want to get off this Abilify at one point but I think that might be years away. I live on my own and really do not have anyone that looks after me physically and so my place is a hoarders hell. Once I clean up my life I was thinking about getting one those psychiatric service dogs. I have a friend who is a DID system and they have one that helps them with their problems. They do tasks for them so they can remain independent which is what I want to be. I don’t want to move back in with my sisters family so they can take care of me better like she keeps on insisting. I know the dogs take years to train but I also have years to train myself on how my body actually deals with things.
Thanks for listening to me again. It helps me a lot.
Oh my bad, I misinterpreted what you said and thought you were dealing with hypertension as a separate health condition.
Given this clarification, personally I’d be scrambling to get my hands on guanfacine (or clonidine) if I were in your situation because it has a lot of potential to help.
Sorry to hear that you’re having a stressful time. It sounds like you’re managing it well though.
So I’m going to reiterate that I don’t hold a qualification or anything but there are a few things that I can recommend looking into or considering with regards to this:
When you’re overstimulated, especially if you’ve had to deal with a lot of “bad” stimuli, it’s very common to have a meltdown or a shutdown. You can also experience the same thing by being emotionally overwhelmed too. So if you’re having a big outburst of emotion it can be that your nervous system is just overwhelmed, either in an acute episode or a more chronic build-up that occurs over the course of a day or longer.
In this situation it can be helpful to tune into how you’re managing your sensory input and to adjust so you have more of the positive sensory input and less of the negative. Stimming can really help with regulating your nervous system too.
Another thing that is helpful in this situation is to try to take little sensory breaks if possible. Even 5 or 10 mins with sunglasses on, headphones in, and disconnecting from the outside world to make yourself comfy can help you manage when you do re-engage with the world.
Autistic people often face significant difficulty in identifying their emotional state. I know for me my interoception isn’t great so I often feel like I’m working downstream, like my awareness works on a delay and I’m always trying to catch up - when things are good and I’m taking care of my needs that delay can be very short and maybe only a few seconds but if I’m overwhelmed and I’m not attending to my internal experience then that delay can be hours or even days, meaning I won’t realise that something irritated or upset me until much later on.
There’s a lot out there on autism and interoception so if this feels like it might apply to you then I’d recommend watching a few videos about it and stuff like that to better understand it.
This is my own opinion but I think that masking dovetails into interoception issues because masking requires you to put a lot of energy out into the world and to really attune yourself to the emotional state of others and to work hard to do things like modulating your tone and carefully selecting your words to avoid unintended implication and doing eye contact “right” and displaying the “correct” body language and facial expressions etc. etc.
All of that is pretty damn exhausting but moreover if you’re doing all of that then it’s really hard to be connected to what’s going on internally for you.
There is tons out there about autistic masking and I guess in short if this feels like it might be applicable then the next step would be to work on becoming a bit more conscious and purposeful in how you mask and to what extent you mask, as well as giving yourself permission or setting your intention to reduce your masking somewhat. Also taking regular breaks so that you can catch your breath, drop the mask, and check in on yourself is very useful too.
ADHDers, especially ones who aren’t appropriately medicated (this varies between individuals and it’s not a value judgement - appropriately medicated might look like being unmedicated for one person and it might look like multiple medications for another person), tend to be much more emotionally reactive because that’s just what comes with the territory.
When you throw in PTSD and a proper trauma trigger then you have a sort of perfect storm where it gets amplified but there’s this thing where ADHDers tend not to have that half second or longer where their emotional state begins to shift and they can choose to deploy strategies to manage this emotional shift in the way that their neurotypical peers do.
For ADHDers who have PTSD the emotional response can be like a hair trigger and it dials up to 11 seemingly instantaneously and you’re left trying to manage the fallout. It was a bit of an eye-opener for me taking stimulants, to a lesser extent, and definitely with clonidine because I found that I suddenly had more ability to direct where my emotional state was heading; if I were to put it metaphorically, it used to feel like these big emotional shifts were a stampede and I was caught under it but with the right meds for me it felt more like I was riding a horse - sure the horse has a mind of its own and it will respond to situations but being on top of it means that I can direct where it goes and I have a lot more influence over it. Or maybe it’s like the difference between being caught as a wave crashes down on your head vs surfing that wave - you can’t control the tide but you can adjust how you navigate the wave you happen to be riding at that moment.
Anyway I’m rambling again. I guess one thing that’s tricky is knowing that it can be a combination of some or all of these things so yeah. My best advice is to do a bit of research, try adjusting things, and see if it makes any positive impact.
Honestly the worst case scenario is pretty much this: you take more breaks, you put in more effort to make yourself feel comfortable, and you put less energy into masking or appeasing others and you redirect that energy into connecting with your own emotional state. Seems like even if this doesn’t address the underlying cause you’re still going to benefit from it anyway.
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Yeah, that’s understandable. I don’t know your story but one thing that has been useful for me with framing this sort of experience is recognising that because it’s something that has always been there in my life, or it’s something that feels that way, then it can be really hard to identify it because that’s just your baseline.
This famous bit by David Foster Wallace comes to mind.
Yeah this is really typical for what you have described.
It can be easy to think that staying up all night because you’re hyperfocused or the ADHD impulse purchasing is actually a symptom of (hypo)mania and stuff like that.
The emotional swings that come with being ADHD and having PTSD can really come off as bipolar-esque mood swings, especially because you aren’t necessarily able to identify how or why your mood just plummets or why you suddenly feel a surge of overwhelming aggression or whatever else bubbles up to the surface in response to what you experience.
I’m not saying that you aren’t bipolar, or that you are, but when it comes to complex and comorbid conditions like autism, ADHD, and PTSD together then it’s super important to approach this very carefully and to take inventory of all the assumptions and things that you might be taking for granted. Being very diligent and taking a scientific approach of “Observation > Hypothesis > Experiment > Collect Data & Analyse Results” to rule things in/out is extremely important imo.
That does sound a lot like the intersection of Rejection Sensitive Dysphoria and being autistic, where you take hard knocks from the RSD and being autistic you just run into social rejection more often and you have the tendency to experience perseveration. On top of that I think that it’s common for autistic people to sort of decompress and analyse their interactions from the day or the week to scour it for any missed details or faux pas and similar stuff. This can also include determining how certain things made you feel in the moment as well. Part of this is a deeper aspect of masking imo but I think there are other facets to it as well.
If it’s causing you distress then yeah, use those strategies to manage it. But I also think that doing this can be fairly neutral too - I know that sometimes I’m experiencing a difficult emotion and I can’t pinpoint the what or the why but by replaying the events from the day I can glean insight and often things fall into place for me (e.g. upon reflection I suddenly realise that I have been carrying a lot of frustration because earlier in the day someone had misinterpreted what I was saying and so I can deconstruct that by reminding myself that I put a lot of effort into communicating, I was being clear in my communication at that point in time, and that I don’t need to take on the blame for them not listening or seeking clarification from me before jumping to conclusions.)
I think it depends on whether or not it’s “pathological”; is it causing you distress? Does it interfere with your ability to enjoy things? Does it serve a purpose? etc. etc.
This is getting a bit into the weeds but autistic people are more likely to experience auto-immune diseases and similar. It’s pretty well known, although it’s not necessarily established in scientific literature, that chronic stress aggravates this stuff, and we know that autistic people experience really high levels of stress compared to their allistic counterparts.
Experiencing serious trauma, experiencing executive dysfunction, neurodivergent burnout… these things are a recipe for hoarding. And that’s without even mentioning the socioeconomic factors because hoarding is very often a response to poverty or significant experiences of deprivation (e.g. childhood neglect, even if poverty itself wasn’t a factor) and neurodivergent people are so often overrepresented in poverty stats as well as often experiencing deprivation due to stuff like being too burnt out or too overwhelmed to make food so you just don’t end up eating, that sort of thing.
Sounds like it would be a wonderful thing to have!
A service dog can be trained to respond to your emotional state and to alert you to it or to take actions to intervene (e.g. laying their body on your torso to provide deep pressure stimulation to help calm you down). It might be really handy to have a dog who helps you with identifying and managing this stuff rather than trying to do it all by yourself.
Any time! I hope that things improve for you.
(Also apologies for rambling and apologies if I have lectured you about stuff that you’re already aware of - my intention isn’t to make myself out to be some sort of expert who knows better than you do, I just try to resource people and often it’s sorta like dropping PSAs for other people who might be reading this and notice that certain things are resonating with their own experience.)
Hey just to let you know I am just seeing your reply now. Its gonna take me a little bit to process it but I let you know what I think.
No worries, I know it’s a ton of information and I’ve got a tendency to be verbose
a bita lot.Take your time and don’t feel like there’s any obligation to respond.
Oh yeah, another candidate that might be worth considering if Abilify doesn’t work for you is cariprazine - it works as a partial agonist at the dopamine receptors.
It’s kinda tricky to explain exactly how a partial agonist works because I would only expect it’d be useful for ADHD symptoms if the underlying cause is one of the three main mechanisms that affect dopamine in the brain. So it’s definitely not a surefire thing but it’s possible that it might be just what you’re looking for.
Cariprazine is good for a lot of mood-disorder and adjacent conditions while not being sedating like lots of the other antipsychotics.
Brexpiprazole is similar to Abilify but I believe it’s newer and, due to Abilify being prescribed for autism, I believe they’re either doing studies on its effects on autistic symptoms or they’ve recently completed them so that would be another one that might be worth trying, and it’s another one with a particularly long half-life, if Abilify doesn’t work out for you.