🧠#102: Xanax & Dr Pepper
This week, I’m trying a new format. I posted each of my sections as individual posts during the week, and my update gathers them. In the update post on my website, I just link to the individual posts, but for those who have been used to reading the whole update in your inbox, I included the full text of each post in this email. Hope you enjoy!
In this update, I try out a new format and share about a rescue med that works, ups and downs, and leveraging caffeine.
These weekly updates share life with OCD as part of my Mental Work Health project to reduce stigma around mental health, especially at work.
Something hard
A rescue med that works
The last little while has been rough with my OCD. I mentioned some about that last week in update #101: Tapering off everything.
When I met with my therapist, I told her I was afraid to go off all medication. I was in that situation at the beginning of 2022, and it was a dark time. As we talked, she reminded me that I wasn’t off everything—I still had my rescue meds.
Getting a rescue med that works for me was a difficult journey through all four of my psychiatrists. With each one, I would tell them about having panic attacks that could last for days, and they would listen and prescribe something. Invariably, the different drugs we tried either did nothing to quell the panic, or just put me to sleep.
With psychiatrist #3, I asked her a few times to just prescribe me Xanax. “Well, I really don’t like to give that one out because it can be addictive, so I want to try these others first.” Repeated a few times.
When I met with my current psychiatrist for the first time, we talked about where I was at and what I needed. As I described my struggle to find a rescue med that actually worked, he said, “We just prescribe Xanax. You are perfect candidate. If you really take it like you say, then I give you ten pills and they will last you six months.”
The first time I took a full Xanax, it was a revelation. I remember marveling that I could be curled in my armchair in the morning, and then working normally the rest of the day. It felt like a miracle. I’m used to being stuck in that chair for hours, or across days when things get rough.
As my therapist reminded me that I was not without options, we also remembered a story that illustrates how careful I have to be with medication. Essentially, we know I’m an addict.
Soon after I got married, I had surgery for my knee. My recovery was slow, but I didn’t take much of my pain medication. I don’t like the feeling of being out of control of my body.
A few months later, my wife told me that she had found the expired medication and thrown it out. I was so upset. “What if I need that? How could you throw it out?”
We worked through it and a couple months later, she brought up that incident as a joke. “Remember when I threw out your medication and you were so upset?”
I couldn’t remember us talking about it at all, but I got upset all over again. “Wait, you threw out my medication!? How could you do that?”
A few months later, she brought up how crazy that was. “Remember that time you got so mad when you forgot we had talked about me throwing out your medicine?”
For a third time, I got super upset that she had thrown out the medicine. I had no memory of the previous two conversations about the very same topic.
We didn’t really know what it meant at the time, but now realize that I have tendencies that could be dangerous.
So I’ve been careful with taking the Xanax. I don’t want to become dependent on it. That probably leads me to be under medicated at times and not get the relief that I could have.
It’s a hard line.
Something good
Ups and downs
In the midst of a rough patch with my OCD, it has been helpful to remember that emotions are always going to come and go.
At one point last week, I journaled a bit in my free writing notebook.
Today I feel so much better. This is an interesting phenomenon. It’s not enough data to go on or make any decisions. But it is a good reminder of why we ride the wave. It doesn’t last forever. Now, I don’t expect this means that my problems are over. But I do know that I can make it through. Whatever else happens today, I don’t want to die right now, and that is a great feeling.
A few days later, I came back to my notebook to write some more, and saw where I had left off.
I am laughing a little reading that above. It was from Thursday morning. I took my daughter to the dentist and then had a chat with a client that day. So I was able to do some things. But it was still a rough day. I watched the rest of Ted Lasso and read a full book. I think I went home and just went to bed. Good reminder that days are going to have ups and downs as well as weeks and months and years.
I told my therapist on Friday that my relationship to sleep varies greatly. At times, I just hate that I need it. I don’t want to stop, and I resent the fact that sleep is required. At other times, sleep is like candy, and I constantly crave it and try snatch little bits of it whenever I can.
Lately, sleep feels like a legal drug. While I am sleeping, I don’t want to die, and my back is not in pain. On Friday night, I remember thinking to myself as soon as I got the littles down, “Now I can indulge in socially acceptable, sanctioned oblivion.”
When I am so low like I have been, I find myself trying to make it through each day and just do whatever I can to get the time to pass. That will be punctuated by bursts of actually getting some work done, and then back to simultaneously dreading and craving the passage of time.
Like I wrote in my notebook, this is a good reminder that even when things are rough, there will still be respites.
Something else
Leveraging caffeine
Part of the journey to figuring out a good rescue med has been understanding all of the options I have to deal with my OCD and its accompanying symptoms.
My therapist is of the opinion that just like depression and anxiety, ADHD can be a manifestation or symptom of OCD. That doesn’t mean that everyone who has ADHD also has OCD, but rather that having OCD typically includes having ADHD.
It’s a classic logic equation: if A then B does not mean if B then A.
P⇒Q ≠Q⇒P
This makes a lot a sense when you think about what these diagnoses are. In an effort to create an understandable shorthand, we take a group of symptoms and call them a disorder. In this case, OCD is something of a superset of the symptoms of ADHD. Poor impulse control? Constant need for stimulation? Tendency to hyperfixate? Check, check, check.
OCD ⊇ ADHD
I bring all that up because one of the unofficial tests for ADHD is the effect of caffeine. If you can drink a caffeinated soda and it settles you down instead of ramping you up, even to where you can immediately go to sleep, that is an indicator that you might have ADHD.
A few weeks ago, I took my three oldest kids to Disneyland, as I wrote about in update #99: Can’t get in.
One of the days we were there, I started feeling my agitation and anxiety levels rise. I realized that even though I had found a good rescue med that works, I had forgotten to bring them to the park with me.
I remembered something my therapist had told me that works for her and ordered a Coke. I sent her a message a little while after I finished it.
Just experienced what you described with a Coke. Was feeling super agitated and had one for lunch and am now relaxed.
It was a great little moment for me to remember and reinforce that I am not powerless when my body and mind stop cooperating. I have options.
I shared last week how I have been changing medications and I was telling my therapist how afraid I was to have nothing: Tapering off everything.
My therapist reminded me that going to have nothing. Having a good rescue med makes a huge difference. And remembering my experience with the Coke, I joked that I would also have Dr Pepper (which everyone knows is far superior to Coke).
I love that. Xanax and Dr Pepper. Sounds like a great plan.
The second part of that plan is important because I need to be careful to not take Xanax too often. So I’m trying to ride the line of using it for emergencies and letting Dr Pepper fill in the gaps. It’s an imprecise science, to be sure.
Wrap up
Last week was one of the roughest I’ve had in a long time. I’m hoping that things are heading back up. And I hope things are going well for you. Here’s to a better week for both of us.