I want to start with some great news. In two days I'm going to be two-months pull free. I decided to start counting on September 14th because I couldn't really remember the exact day I stopped pulling, I know that it was around that date without a few days or so, and it's my step-daughter's birthday so that day will be easy to remember. Two months doesn't sound that long, but as I've mentioned before, it's been a huge improvement for me. Every day has been a small struggle, and I'm really proud of my improvement.
That being said, since doing quite a bit of work and not giving up on psychological/psychiatric treatment (I'm still a bit paranoid about posting those words on here) I'm learning some new developments about myself.
To start off, I've always been somewhat close-minded about taking antidepressants. Not for other people, but for myself. I've seen them do wonders for friends who suffered from depression. But I honestly haven't felt depressed in my life, other than some moody phases in middle school and then one horribly stressful semester when I was in way over my head. And at that time, even the psychiatrist said, "You're not depressed, just way too stressed out."
So, during my recent self-discovery and new journey to stop pulling I was adamant about not taking medication. I believed that I could do it without it. And I did it without it. No drugs, very little therapy due to financial worries. And I'm really proud of that. I realized that by cutting out sugar and employing some Cognitive Behavior Therapy techniques I was able to control my habit on my own.
However, after I reached my first month without pulling, I began to experience debilitating insomnia. No matter how exhausted I was, I simply couldn't fall asleep. During nearly all 4 years of my time at Cornell, I had to use some kind of sleep-aid. My first semester I took NyQuil every single night. After that I switched to a much safer over the counter medicine called Simply Sleep. I was able to ween myself off in Chile, and actually for the first time started sleeping naturally in Chile during 2007 when I lived there for 10 months. There were only a few occasions when I couldn't sleep and those nights I usually popped a Xanax.
Now that I'm in graduate school again and no longer pulling, the insomnia was really getting out of control. My supply of Xanax that I got in 2006 had run out. The only thing that would work for me, and albeit, not always, was to take a Benadryl and 3 mg of Melatonin. The problem with that was I was getting "benadryl" hangovers. And sometimes, after taking it, I would have to take another dose cause just one wasn't working. For some reason, at night, my mind just wouldn't stop racing and I was having trouble hyper-ventilating.
This took me back into the mental health center here at the university. It took me several weeks to get an appointment with a Psychiatrist. I considered canceling my appointment many times because I figured that they would try to get me to take antidepressants. I feel like everyone who goes into the student mental health clinic always comes out with a prescription for Zoloft or Prozac. And I just didn't think it was right for me. I genuinely don't feel depressed.
However, my psychiatric evaluation basically outlined my family mental health history, my childhood, and my current symptoms. Let me tell you, my family is a bit of a mental health "doozie." My great-grandfather committed suicide and my grandfather became an alcoholic. My mother, on the other hand, completely avoided alcohol for many years. While my parents would keep a few beers in the fridge for company, I rarely ever saw them drink when I was younger. My mother, however, suffered a heart attack at the early age of 51. This was a huge surprise to all of us because my mother exercised everyday and was no where close to being overweight. What we did realize was that my mom is generally an anxious person, really wound-up. On top of this we have a history of ADHD on my dad's side, and his father also died of a heart attack at a really young age.
As a kid, no one ever really thought of taking me for an evaluation. I was a worry-wart who had trouble sleeping, but I did really well in school, had a normal social life, and was a bubbly, happy kid. My parents did realize that I "thought way too much" and had pretty ridiculous worries, but they pretty much thought that they were my creative ploys to avoid going to bed. The worries were things like, "What if a tornado is coming?" "What if Dad and I are hiking in the woods and a pack of wolves come?" "What if we are hiking in the woods and I get lost?" "What if we are hiking in the woods and Dad has a heart attack?" (My Dad took me hiking in the mountains a lot as a kid and taught me lots of survival techniques.) "What if our neighbor is a witch?" "Is the door locked?" "Am I sure no one unlocked the door?" "What if someone let the cat out and forgot to lock the door?" They would go round and round in my head and I really couldn't turn them off.
Now that I'm older, I have the same problem, but they are usually focused on more practical things. I worry about school, I worry about what I'm doing with my life. I worry that my stepdaughter misses us too much. I worry about whether or not we should live here or go back to Chile. I worry about leaving the oven on. If someone might be breaking into our car. Lately I worry about the rat in my apartment!
I knew I had anxiety, and I knew I pulled out my hair. I also knew I had trouble sleeping. I also knew that I have trouble with emotional eating. That when I'm worried I reach for the sweets. But I never thought I had full-blown anxiety because I'm not a
socially awkward person. Yes, I feel jitters and I don't like to be in new social situations, but I can do it. I can make friends, I can make conversations.
Well, during my psychiatric evaluation, the doctor informed me that I have
Generalized Anxiety Disorder, not Social Anxiety. That they are two different things. And then the puzzle began to fit together.
People who have undiagnosed Generalized Anxiety Disorder suffer from the worries that I've explained above. However, the intensity comes and goes. When it's not intense, they can function perfectly in work and social settings. But when it is, they have problems with the things I've described. And when you're worrying or panic, you stop breathing, you start taking "half-breaths" and that makes your body go into "fight or flight" mode. That fight or flight can be really dangerous if you're in it too often, that's what can make you susceptible to heart attacks, like my mother. People with GAD generally gravitate toward alcohol as a coping mechanism. It's great self-medication... and that why they are so prone to becoming alcoholics. Genetically, my family members at least on my mother's side, probably have a tendency toward the disorder. That's why we have history of suicide, mental illness, heart attacks. I, being particularly careful about alcohol, have probably gravitated toward food as my coping mechanism, and then later, hair-pulling.
The psychiatrist thought that GAD is the underlying culprit for my Trichotillomania. She thought that even if I stop pulling my hair, if I don't treat my anxiety I might still have problems with other things like emotional eating, insomnia, and eventually at a higher risk for a heart attack.
So, that leaves us with a few options, she said. Knowing that I wasn't particularly interested in taking antidepressants, she outlined the following:
The first option was no medication and more therapy. She said some people learn to reverse their anxiety and live with it, but that it would take a lot of work, and it may never correct the genetic and biological causes for the disorder. She could give me a prescription for Trazodone, a drug that knocks you out without feeling so drowsy, to take for sleep when I need it. And I would have to undergo therapy.
The second option was to take another drug called Buspar, which was developed as an alternative to SSRI's (new generation antidepressants). It only works in about 60% of patients, but I could start it to see if it might be beneficial for me. I could combine this with the Trazodone whenever I needed it.
And the last option was a traditional SSRI. To this I scrunched up my nose. I said, "I just really don't want to gain a ton of weight." This sounds vain, but I've recently worked really hard to lose the weight I had gained since moving back from Chile. She gently explained that not all people gain weight on SSRI's, and that they cause less weight gain than the older generation of antidepressants. She said that often, when people gain weight it was because they were originally depressed and not eating very much and as soon as they begin to feel better it "wakes up" their appetites.
There were three factors that convinced me. The first was that she explained that taking certain SSRI's were able to help some of her patients anxiety so much that they were able to start sleeping and expressed that, "The SSRI's have quieted my mind." To me, this sounded like nirvana. Secondly, I realized that perhaps medication may be a way for me to get over graduate school, and that perhaps after doing some effective therapy and being in a less stressful environment I could wean off of them. Lastly, my mother having a heart attack at age 51 was another major motivator. I thought that if I could control my excessive worry and prevent going into "fight or flight" mode all the time I can in turn, reduce my probability of a heart attack.
The other reason was to improve my life with O. We get along amazingly right now, but my fits of worry have become a problem in our relationship. When I ruminate about something, he sees how irrational I'm being and gets frustrated, and I, in turn, get irritated. I would love to stop this pattern. I think it would be great for my marriage.
So, I've started a course of the generic SSRI for Celexa called Citalopram. This week it has made me feel really strange. It takes several weeks for your body to get used to it and it takes up to a month for it to take affect. I'm really excited because in a month my step-daughter will be here, and if this can help me get through the stress of suddenly having a nine year old in my house for 5 whole weeks 24/7, I will bow down and worship the ground my psychiatrist walks on. I am also eager to see how this changes my trip home and getting through the stress of being in my parents' house. And how it helps me to write my final papers. If I can do that without losing so much time agonizing, again, I will be so excited.
I will admit I'm feeling a little bit self-conscious about posting this entry, but like I felt with Trichotillomania, every time I tell more people about my struggles I feel like I get a ton of support. And I'm honestly not writing this to seek attention, and please don't feel pressured to respond or console me, I'm really not that upset about it. :) My guess is some of you who actually know me will probably not be surprised about this diagnosis, might even laugh out loud... (a lot of people I know have identified that I worry too much and have patiently listened anyway, except for my mother who worries just as much as I do and thinks it's normal!) and again, I'm writing as an effort to maybe connect with anyone else who might relate. I do advise anyone against self-diagnosing, especially since these symptoms have to last for more than 6 months for a true diagnosis and not be caused by other problems like hyperthyroidism.
