Oh god @TwoBrokenMirrors I do the same thing. The exact same thing. Only add my back on there cuz I pick and scratch at my back when possible.
@Void Annoying, isn't it? I'll pick and pop things on my back but only when I remember to put a hand round there to check it. xP
That sounds like mild dissociation to me. Dissociation usually develops after a traumatic experience, though it can just kind of happen by itself. I can't really guess at why this would happen without a little more context. A whole lot of things can trigger mild dissociation (or are at least associated with it, cause and effect is never clearcut in psychology). Off the top of my head: mood disorders like depression and anxiety, borderline personality disorder, some psychotic disorders, even migraines for some people... There's also alexithymia, a personality trait involving having trouble naming or describing one's own emotions. In general, alexithymic people also have trouble identifying emotions in other people as well. It's pretty common in autistics and can show up with a lot of other disorders as well. However, usually people with alexithymia can tell that they're feeling something, and can say whether it's a positive or negative feeling, they just can't necessarily go into further detail. What I'm reading is that you have no idea you're feeling anything until your body reacts physically to an emotion, which is why I don't think that's what's going on with you. I'm sorry this took me awhile and I hope I didn't miss anything, I've been pretty sick this weekend.
Today, since I have some free time, let's talk about SSRIs, because they are a great object lesson in why psych meds are a crapshoot. SSRI stands for Selective Serotonin Reuptake Inhibitor. To understand what that actually means, you have to know a little bit about how the brain works. One of the ways that the brain sends messages from place to place is by producing chemicals we call neurotransmitters and... well, essentially, letting them float around the brain until they run into a place that can accept that particular neurotransmitter. After receiving the "message," the neuron usually pulls it into itself to save it for later: reuptake. But not every neurotransmitter gets absorbed like this--even under normal circumstances, some will escape and drift back out into the brain. A reuptake inhibitor is a drug that reduces the proportion of neurotransmitter that the neuron absorbs, leaving more to drift around the brain, sending the message further and keeping it in circulation longer. The "selective" part means that the reuptake inhibitor only affects the specified neurotransmitter, which in this case is serotonin. So far so good, right? But: First, while taking SSRIs can improve cases of depression, we don't really know what causes depression. It's likely that there are several different brain things that all cause depressive symptoms that we can't really distinguish between right now. You're probably not touching the root cause of depression when you take an SSRI. It's like taking an ibuprofen when you have a headache: the ibuprofen will probably reduce the amount of pain that you're in, but if you have a headache because you have a cold or bumped your head, the ibuprofen isn't going to fix that. It's just suppressing the pain reaction. There's nothing wrong with not wanting to experience shitty symptoms! But it would be better if we could figure out why you're experiencing shitty symptoms and fix that instead. Second, it really doesn't make sense that SSRIs take three months to reach full effect. People will often tell you that it's taking time to build up in your bloodstream, but that's wrong: the half-life of an SSRI just doesn't last long enough for that. The SSRI is having the same effect on your brain's serotonin concentration on day 50 that it is on day 1. So why does it take so long for them to work? No one knows for sure. Third, serotonin does a whole lot of stuff. Most neurotransmitters do. That's why SSRIs have so many potential side effects. Scroll through the serotonin page on Wikipedia and look at all of that shit. Your brain uses serotonin to send a whole range of different messages. An SSRI will send more of every message transmitted by serotonin, whether it's one you actually wanted to amplify or not. Weight gain is a really common side effect with SSRIs because serotonin is used to regulate appetite, for example. Then you get to the part where there's a truckload of different SSRIs, which all theoretically do the same thing, but one of them might work for someone and another might not and we can only guess at why. Some SSRIs have vague amounts of evidence that they can kind of sort of help more with one symptom or another in some people, so your psych might see that you have particular trouble with one aspect of your depression (oversleeping, for example) and choose an SSRI that that one study claimed helped more than the others with oversleeping. In the end, if your psych prescribes you an SSRI, they're guessing. They're guessing that increasing serotonin levels in your brain will make your depression better and they're guessing that this particular SSRI will work with your brain. It's really the best that we can do right now. I guess if there's a moral to this story, it's that if you've been through five psych meds and none of them fucking work, it's probably not that your mental illness is untreatable, it's just that we don't know enough about mental illness or the brain to make actual good decisions and the dart hasn't hit the correct region of the dartboard yet. And that we should be funding more psychological research.
Ooh, question about alexithymia. When I got my ASD diagnosis, one of the tests was an emotion recognition test, and I realised how absolutely terrible I am at recognising emotions in others, and how bad I am at actually naming what I'm feeling. Like I know I am feeling things, and I can kind of describe what I'm feeling, like I feel "bleh" or "????" or "Like that dog over there that's lying in a patch of sun" or "Like I want to throw myself into a cactus" but none of those things are actually the names of emotions. I can recognise happiness, sadness, love, anxiety, anger, concern, guilt, but anything more complex than that is just ???? (also is love actually an emotion???) I feel things, and I can recognise basic emotions in others and I can name basic emotions in myself, but I am shit at complex emotions. I've started trying to read the emotions of people I see and I have no freaking idea most of the time. Does all this sound like alexithymia?
Sounds like it to me. Alexithymia is probably exactly what the test was looking for. IIRC it's classed as a personality trait rather than as a symptom of anything--being worse-than-average at identifying feelings doesn't mean there's anything wrong with you. It makes sense to me that they would test you for it, though, because it's shared by most people on the autism spectrum. (It's not unique to autistics or anything like that, but if you're not alexithymic, it's a reason to suspect you might not be autistic.)
Huh, never knew that. I've always had trouble identifying my own emotions accurately while I'm having them; I need to analyze, to swim in it a bit, to experiment.
Symptom question: Do you know of things that could cause a slow onset of increased hallucinations and increasingly severe dissociation? (Possibly apart from schizophrenia, but if people have words about that that isn't just 'you'll be a monster and a burden on your family', that would be nice too.)
The whole alexithymia thing is a bit confusing to me. I did a bit of reading and I have a lot of the traits (hello no dreams/imagination + down for low maintenance/close to zero emotional support friendships), but at the same time when it comes to identifying emotions in myself I... kind of feel like I can, it's just that 95% of the time I don't feel like I'm feeling anything? Like if you asked me how I feel right now my answer would probably be 'eh'. Also the few dreams I do have aren't boring, when I actually remember having one they tend to involve shit like clown serial killers hiding decapitated heads under school desks or something like that (I tend to dream like once every 3-4 years or so, used to dream a lot more as a kid). So when going through online tests (which are obviously 100% accurate for diagnosis) I see questions like "When asked which emotion I'm feeling, I frequently don't know the answer." And the accurate answer would be strongly agree, but at the same time it's also... not? Because if I'm having a fight with someone for example, I can pretty easily go 'I'm pissed off because of X' or whatever, it's just that I don't feel like I feel anything most of the time. I'm guessing that sort of thing makes it less likely that alexithymia is a thing for me and points more towards anhedonia? Maybe? I am also completely incapable of describing people (including myself) outside of their interests, so I don't know. Maybe it's just a 'I am deeply intimidated by emotional intimacy with anyone so my brain can't even begin to describe their positive traits' thing. Also I am vaguely curious about what (if any) conditions are associated with... not exactly memory loss, but basically an inability to remember most things unless reminded about them? For example, I had a conversation with a friend a few days ago where she suggested I had been really distant since we had a fight, and I had to ask what fight she was talking about because I genuinely couldn't remember it until she told me what the fight had involved. I struggle to remember what I had for lunch most days, whether I've done my insulin only a few hours before, etc. I think ADD might be one? Is this normal? Edit: I should prob mention that the fight in question was almost friendship ending and happened a few days beforehand, so it was pretty serious. Also here is my test result in case anyone was curious. Aro/ace with no experience beyond shitfaced makeouts, so the sex questions were stupidly difficult to answer.
A whole lot of mental disorders can trigger psychosis in various forms, enough that I'm not even sure where to start. I mean, yes, there's schizophrenia spectrum stuff, but you'll also get psychotic features with bipolar disorder, PTSD, severe depression, OCD... Enough things that I'm not even sure how to guess with what you've given me, to be honest. If I absolutely have to make a guess, I'd use the dissociation as the clue and suspect PTSD or a dissociative disorder with psychotic features. But I really don't know. As far as schizophrenia goes: the cases shown in the media are pretty much always deeply exaggerated. Even if untreated, people usually have psychotic episodes lasting a couple months to a year with periods of more-or-less normal function in between rather than being completely psychotic all day every day forever. And antipsychotics are way more effective and generally more likely to work than a lot of psych meds--usually the choice of antipsychotic is down to avoiding side effects instead of just having things not work. Schizophrenia is not pleasant (no mental illness is) but it's not the life sentence that people think that it is. (Also I have met several people with schizophrenia, and some others with psychotic illnesses, and they've been some of the nicest and most understanding people I have ever met, no joke. Definitely not monsters. Quite the opposite.) In the event that you do have schizophrenia, you have something going for you already, which is that you know something is wrong. That's a very powerful indicator of good treatment outcomes. Edit: I'm going on a trip this weekend. I've been busy getting ready and I might not be able to answer questions at all Friday-Monday. Don't let that stop you from asking questions; I'll just take a bit to get to them.
I have a housemate with schizophrenia. He has it pretty bad but medication keeps it in check, though he still gets audible hallucinations ("voices") all the time, he just knows they're not real. Unfortunately a heavy-guilt Catholic upbringing means all of his are demons from Hell taunting him all the time.
I remember reading once that part of the reason there's suicide warnings on antidepressants is because they can kick your brain into gear to Do A Thing without thinking about the fact that the thing your brain wants to do is a suicide. Like, somehow your brain's been too lazy/apathetic to do a suicide before and suddenly because antidepressant it can Do A Thing? Is this even real or is this some pop psychology bullshit I accidentally devoured?
No that is real. I was told this by my therapist and psych. Sometimes your brain hasn't caught up on the "don't want suicide" but the meds gave you MOTIVATION!!! So you are like "OK!!! I HAVE ENERGY TO JUST DO THAT THING LEMME JUST DIE" It is a weird and big problem, not a common reaction from what I remember being told, but they have to warn people just in case.
Okay, good, I was doubting myself if it was just some LRH/Scientology "psychology is bad, you'll die if you do any" bull. Because it makes total sense I guess? More of "meds are a crapshoot." A more general question, not sure if anyone ever in the universe has ever had an answer, but: How do atypical antidepressants even work. Like how even.
Okay, so @Aya , have you noticed an issue with diagnosing ADHD when the person also has depression? Spoiler: because long here is why i think i'm adhd Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level: Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. this is one of the big reasons i'm bad at math. there's always one little mistake that throws off the whole thing. I miss stuff in instructions, too, and these days I focus better, but I have to know instructions are coming so I can switch my brain into instruction mode - or, even better, write it down. Often has trouble holding attention on tasks or play activities. It's just boring. I mean, when I'm in creative mode, I've accidentally pulled all-nighters. but with everything else, I have to come up with a decent, short-term reason for why I care that this thing gets done. Often does not seem to listen when spoken to directly. This was the one thing I didn't think I had a problem with, but I was talking to a few of my friends about the symptom list, and they were like "dude, everytime I start talking to you that we aren't already in a conversation, I have to wait a few seconds for you to switch tracks. it's real weird" Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). if something is a little difficult, then something else will come up that is more interesting. If I make myself actively worry about it, then I can make myself do it, but otherwise...if it's boring, it's either not going to get done, or I'll do it as quickly and shoddily as possible. Often has trouble organizing tasks and activities. Lists are my life. I have a calendar on my phone, and every few weeks I write up a multi-page list for things I need to get done. Also kintsugi is a godsend, because this way I'm accountable to you guys, too. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). I know objectively that doing the thing is important, but...it's boring, and harder than I'd thought it would be, and I'm not interested, so I'm not gonna. Multiple draft papers were horrible in college. Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). This one is not very bad. It helps that I have giant pockets in everything. But when I'm stressed, I will lose all things. Once I lost my phone like 8 times within 6 hours. Is often easily distracted Yuh. If someone interrupts me mid-task, I'm never going back to it. Phones help, because when someone texts me, it somehow doesn't count as an interruption - or at least, not in the same way that someone talking to me would be. Music helps keep me on task a lot, though. Is often forgetful in daily activities. I write so much stuff down these days for this exact reason. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level: Often fidgets with or taps hands or feet, or squirms in seat. This is the only one I count for on this list. I tap fingers, play imaginary piano, drum on tables, leg tap...yeah. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often "on the go" acting as if "driven by a motor". Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting his/her turn. Often interrupts or intrudes on others (e.g., butts into conversations or games) I went in to my college's psych services center to get officially tested, and they told me I'm not. Like, we did the computer test thing too, where you have to focus on the boxes on the screen. So they told me that none of the cognitive issues they'd expect to see from ADHD were there, but that my test score/whatever marked me as a "very creative individual", and that I had issues staying interested in things that aren't interesting to me. (Like, yes, how would I be interested in uninteresting things) Apparently they're sending me the final results in the mail, because they didn't have time (in the 3 weeks before my last appt and when I moved out) to give them to me there, so maybe there is more official language on that. Partially I am grumpy about this because I hate being wrong, and I thought I had a pretty good case for being ADHD. I'm also grumpy about this because, okay, I have issues staying interested in things? Yes! That's why I suck at school! If it was ADHD, then I could have been, "oh, so meds, official therapy for time management, I have a reason, instead of what feels like a really new-age version of that 'all kids are unique' thing." But I was wondering if you've ever noticed stress (like upcoming finals)/depression screwing up ADHD diagnoses (oh right, also I am female shaped and have done pretty well in school, but this is because I do ok under pressure and am a very fast reader/writer.)? Or if I should give up on this whole ADHD thing and just live with my new status as a "highly creative subset of the population".
@Aya thank you! I realise it's very wide, but that at least gives me ways to narrow it down. @pixels yeah, that is absolutely a thing with antidepressants. If they give you slightly more ability to do shit, but the shit you still want to do is kill yourself (or they prompt you to want to kill yourself, because psych meds are a crapshoot sometimes) (a friend described it as 'throwing darts in a dark room and hoping that there is a dartboard'), then, well, you have more ability to do that.
A lot of the traits overlap, but I would say that if you can identify emotions but don't feel that you are fully experiencing them, that is probably not alexithymia. I kinda just put that there for the sake of completeness. (Also some of the questions they ask about are not, strictly speaking, alexithymic traits at all. Dissociation can result in memory weird. It could also be caused by, well, whatever is the cause of the dissociation. It's not really something I feel confident about guessing. I do know that humans are wired such that we remember events with more emotional content more vividly, and if you are dissociating on an emotional level as you have mentioned, you wouldn't have that to aid you.
A lot of researchers believe that's the case, though it's hard to be sure because no one understands antidepressants. Depression, especially if it's severe and/or chronic (ie, the kind of depression where you would think about suicide), can have cognitive symptoms beyond just depressed mood. Executive function (the planning system), memory, concentration, and a bunch of other stuff can end up affected. For a lot of people, cognitive symptoms respond faster to medication than mood, so they're able to do more things earlier than they feel better.
Well, atypical antidepressants aren't really a united class (unlike for example the atypical antipsychotics, which all do more or less the same thing). Each one is a Special Snowflake drug that works on different brain chemicals. And of course we have no idea why any antidepressant works anyway. But on a broad scale, atypical antidepressants work similarly to the more usual set in that they affect (usually increase) the quantities of various neurotransmitters (generally serotonin, dopamine, and/or norepinephrine) circulating around in the brain. Of course, that may not actually be why they work (see my rant about antidepressants earlier in the thread). But it's at least a thing that we know that they do! Atypical antidepressants are usually tried third or fourth if other antidepressants haven't worked, unless there's some other known effect that makes that pill valuable. For example, wellbutrin reduces nicotine cravings in many people and tends not to wreck sex drive the way that SSRIs do. And trazodone is sometimes used as a sleep aid.
