Fight or Flight Therapy
 

Has anyone heard of this? Have personal experience or any information? I'm desperate. I don't know why I'm thinking this therapy is even feasible as I probably can't afford it. But, I've been in contact with the MD that does this and he seems to want to help. His name is Dr. Tessler and he is in Colorado which is many states away from me.

When I had my accident I didn't have health insurance and racked up the cost of two ER visits. Ouch. However, I can't continue on like this. I feel like this has been going on for two months and now my brain "thinks" this constant anxiety state is normal. I don't ever have a clear mind and think about PCS and it's effects constantly. I'm fearful of going crazy. How do I stop the repetitive thoughts?

The Zoloft is horrible and I hate it. I haven't tried another drug because my MD thought this one is best. My family is supportive but are adamant that I need to stay on the medications. I know there are many that have dealt with the mental state change that comes along with some PCS sufferers.

Thank you.

I know you don't like medications and that's a good thing. But have they tried Xanax just until you heal more and don't need it. Zoloft, in studies, have helped tbi patients, but it takes at least a few weeks to a month to kick in. Good luck to you. I would be interested in Mark in Idaho's opinion on the fight or flight therapy and hope he sees this thread.

RAllen - I haven't heard of that treatment, but I hope it works for you if you pursue it.

I am so sorry to hear about your suffering. I have also struggled with anxiety - the feeling of being on edge and very far away from peace for no discernible reason other than having a brain injury, and I know how miserable it is.

I'm six months post injury, and while I still have bad days and nights, the anxiety has gotten a lot better for me. I've found the book Brainlash very comforting in this regard. The author describes the feeling of agitation as a stage of recovery. You won't have to stay this way for ever. It will pass.

While everyone is different, and I hope you end up getting great results from Zoloft, I will say that I tried it twice under the supervision of two different doctors, both a Neurologist and a Psychiatrist, post concussion and both times it made me feel horrible - rapid weight loss, days in bed, tinnitus louder than usual etc.

The third doctor I saw, a physiatrist at the rehab hospital who specializes in brain injury, took me off zoloft and put me on Amantadine. It's hard me to say whether this or just time has helped, but I know the Zoloft wasn't helping. I've learned after giving something a fair shot, to trust my body and speak up to doctors about what's working or not working for me. I did so just this week when melatonin was making me whoozy in the evenings, and the doctor cut my dose in half. They should be helping you suffer less, not more.

To relax myself outside of medication, I listen to Tara Brach's relaxation meditations and I find they genuinely help. There is even a part where she talks about smiling as a way to turn off your body's fight/flight response.

I also do acupuncture once a week and have found that this helps me to relax. I also got one cranio sacral massage, during which my stomach started rumbling and the practitioner mentioned that digestion was a sign that my body was moving from fight/flight to digestion and relaxation.

Yoga and light cardio (eliptical machine at 120 - 130 heart rate) also help.

Knowing that everyone and every concussion is different, I just wanted to share with you what has worked for me in dealing with the horrible symptom.

Hang in there. It will get better!

Thank you, Capital, for the helpful response. It makes me feel hopeful that this will one day pass. The feeling of being fearful and anxious at every corner is making my life a living hell. I try very hard to work on relaxation techniques. But I'm having a horrible time with my thoughts. They are controlling me.

I'm going to look into the med you mentioned and other techniques. I feel myself at a stagnant place so maybe the answer is pushing myself to do thing I would have done in my "normal" life.

Thank you again for sharing. I'm so happy you are doing well. It gives me hope.

This Fight or Flight therapy sounds interesting. It would be good if there was a clinical study available. The military should be using this if it has a valid use.

How much does it cost ?

I agree than a benzo anti-anxiety med for the short term may be better than the Zoloft but they should not be used for more than a month or two.

btw, Dr Tessler is not an MD. He is an optometrist, O.D.

I didn't know you could be on two SSRI's at the same time, in your case mirtazapine and sertraline? I think if after say three weeks on an SSRI you feel it's not having a beneficial effect then I would see about coming off it or trying another, there's a few to choose from. I was offered AD's but turned them down because I'd never taken prescription meds before, I think they could have helped me at the time but was stubborn and chicken, I also wanted to see if I could effect change with diet and exercise, jurys out on that one lol.

I think my real bad anxiety lasted around two months then came down a fair bit from three to four months, at six is all but gone (fingers crossed!) so it will get better, just hang in there.

I'm not sure of the cost. I am waiting to hear back from him. I just happened to stumble across his website when I was searching for methods to kick the body out of fight or flight mode. I will post when I hear something from him.

I didn't think Mirtazapine was an SSRI but I could be wrong. That is my problem, I don't know if these thoughts and feelings are mine or side effects of the meds. The MD says its me because my doses are so low that there is no way they are therapeutic. I don't want them bumped up because they make me scared, anxious , nervous and jittery. It's awful. I've never taken meds before this and have always been pretty sensitive to them.

Thanks for the encouragement.

I'm also wondering why you are on both Zoloft and Mirtazapine.
Mirtazapine is a tetracyclic antidepressant.

There are some Drug Interactions Checkers in the Sticky posts at the top of the forum here.
http://www.drugs.com/drug-interactio...2057-1348.html

[never stop a medication without asking for doctor advice]

Mirtazapine is not an SSRI or SNRI. It is a NaSSA. It works differently than the others.

If the doses are so low as to be non-therapeutic, you should be able to stop them and see how you do. I think you are still getting 'shot in the dark' med care since nobody seems interested in giving your meds a serious look.

Being free of them with an occasional minimal dose benzo for emergency situations may be worth considering.

They put me on the Mirtazapine to aid with sleep. And it works. The Zoloft is for the anxiety issue. I checked the drug interaction- at high doses serotonin syndrome is a risk.

Thanks for the info Mark. I am hoping to come off this Zoloft first and just continue with the night med as I do believe I need it for sleep.

Just wish this nightmare could end. I can't believe I have to wake up to this every morning. My thoughts have gotten so out of control. Thanks you guys for always being helpful.

Good to hear you're on low doses.
I was concerned in case they were high.

There are other things to try for anxiety that are natural.
Some people find them helpful but it varies for the individual.

I was prescribed Zoloft for years and years when I was younger (pre concussion) and it didn't help my anxiety at all. I found it very awful coming off it but I was on a high dose.

So I received my reply from Dr. Tessler and he would rather me fly to Colorado where he is which is not feasible at all. He said he does do a long distance treatment that is $895. I know it may seem inexpensive for some, but I don't know how we would pay for that. We are maxed out paying for the $15,000 in outstanding bills since my fall.

Surely there has to be someone else out there that does this treatment or something that its based off. I guess I shouldn't have entertained the idea. I'm just desperate and feel my poorly controlled anxiety is taking a devastating toll on my mental health.

I have become extremely socially withdrawn and am developing very irrational fears and phobias. Anyone have an idea of what type of MD to see? The state run mental health clinic, psychiatrist and prescribed Zoloft just isn't doing anything for me.

Thank you all.

I still think a benzo for a few months until you feel better is a cheap and reliable choice. but that's just me.

RAllen,

I assume that much of your bills are for ER and other medical expanses. Have you been offered a discounted payment structure ? ER visits may bill at high amounts but the hospitals often will take a small portion in settlement. We have seen up to 80% reductions in billings.

Mark,
That is correct- from two ER visits and an inpatient stay at a "treatment" facility after the accident. They both gave me a 35% discount for no insurance, but it still left the balances pretty high. I have arranged payment plans for what is left.

I wish we had a chunk of change that I could settle with, but I'm afraid with me not working and having two small children we don't have it right now to spend.

I'm hoping I can get into a better MD to help regulate my meds or give me some guidance and direction. My family and I are going about this alone pretty much and unfortunately the current situation just isn't working.

Thanks for the reply. If it comes down to it, I may just let one of the big ones go into collection. I hate doing that because my husband and I have worked very hard to have high credit scores. But you've got to do what you've got to do sometimes.

How long have you been on zoloft? If its longer than 6 weeks and you're jusr feeling crappier, it may not be the right drug for you. It certainly wasnt for me. Two days of it was a terrifying experience. Lexapro has worked much better for me. Everyone is different but if you think the drug is making it worse you should ask about/insist on an alternative. Hang in there. Keep breathing. You're gonna make it thru this.

Re what kind of MD, psychiatrists are gonna know the most about meds and brains. But i got the zoloft from my obgyn so you could try that route sinxe its cheaper

Thanks underwater. It is a psychiatrist in our county mental health system. He's the only MD available there so my family and I have discussed tonight going to someone new (a private practice psychiatrist) and just paying out of pocket.

I have been on the Zoloft for 6 weeks. I guess I'm trying to satisfy my family's wishes as they are so, so supportive. They are walking along with me blind so when the first psych doc said this medicine is what you need, they insisted I stay with it.

Something has got to give. I think they see this now and we are to the point where we are going to have to go another direction.

I cant believe your psychiatrist didn't give you a benzo short term at least. There is no reason to be suffering. They've been mentioned multiple times on the board. Is there a reason you would not want to take them short term?

What family is telling you to stay on the Zoloft ? Husband or parents ? They are not living in your mind.

Bad credit from medical bills are not nearly as bad on credit records as bad credit for stiffing a credit card or car loan.

Regarding the discount, 35% off is chump change. They routinely discount twice than to an insurance company. As a single income family with no insurance, they can give you a better deal.

Does your state have a Traumatic Brain Injury Trust Fund ?

What was the rationale behind the inpatient stay in the treatment facility ?

markneil- I did have ativan that I used for the first two weeks. It just seemed to make things worse for me. I would just pass out for 2 hours and wake up in a panic. I tried xanax too and it did the same.

mark in idaho- It's my husband, father and sister that want me to stay on meds. My mom is a little more understanding. I think they believe with these meds that I'll return to normal function level, but I'm just not as of right now.

I couldn't believe some of the billing offices wouldn't work with me a little more. Frustrating to say the least as I am probably one of the few without insurance that is actually trying to pay a debt.

I have no idea about the trust fund. Where would I find that information?

The inpatient stay was a "no other option" type of thing. I went 17 days without eating more than 500 calories a day, lost tons of weight and didn't sleep for more than two hours a night. I guess I had a nervous breakdown of sorts and told my family I couldn't go on living anymore like this. It's like my body got stuck in fight or flight mode, hence why I found that fight or flight therapy and it gave me some hope.

I still feel that way now. It subsided for a short spell, but even as I type this I am shaking and a nervous, panic stricken wreck for no reason. I just wake up like this and battle it all day long. The internal struggle of trying to convince myself I'm okay is wearing me so thin.

Thank you for continuing to help. I need all the help I can get.

I'm sorry it's so hard for you still.
It really makes me sad to read how bad you feel.
:hug:

It appears Alabama does not have a brain injury trust fund. They do have an agency that supports people with traumatic brain injury http://www.rehab.alabama.gov/individ...injury-program

I lost 30 pounds in 6 weeks. The Klonopin was the first med to be able to break that cycle. I was also put on Zyprexa. It appeared to make a difference even though it was only for a short time.

As I said, your family has not been inside your head. Please do not let their well meaning but ignorant comments stop you from finding the right meds.

I see you have tried Ativan and Xanax. Klonopin is slower and longer acting and many find it does not cause the jittery feelings the other two may cause. A .25 mg dose may be just enough to take the edge off. A normal dose is up to 1 mg. Worth a try in my opinion and experience.

You could also try taking a GABA supplement. You can also add L-Glutamine. 500 mgs of each two times a day would be a good start. They are over the counter, safe and affordable. A vitamin shop will have them. I know there is a form of GABA that is better but I don't know what it is called. Maybe MrsD knows.

It's PharmaGABA. I got some after reading about it on the forums from mrsD but my daughter ended up using it.

You can do a forum search for PharmaGABA and also Inositol. There is a lot of info. that mrsD has posted as well as others. I've been using the Inositol for anxiety issues, but the PharmaGABA seems to help some people better.

PharmaGABA

Here's info from the iherb encyclopedia on
Inositol
Don't be put off by the dosages mentioned. It's a powder. I use about a gram a day. 1/4 teaspoon = 600mg

Another medication that is helpful for treating anxiety is Propranolol. It's a beta blocker and used for a number of different conditions including migraine. It's prescribed in very, very low dosages for people with anxiety.

Are those supplements listed safe to take with the SSRI or should I wait until I wean off it? I know I will have to stay on the Mirtazapine at night so I will check the drug interaction with it.

They are safe to take while you are taking an SSRI. My doctor (psychiatrist trained at Duke) addressed this issue directly.

St. Johns Wort is one that would not be taken with the Zoloft or the Mirtazapine

I've been asked by a member to look at this thread.

I'll say right up, that I am not an expert on TBI ...but I know about drugs and supplements.

Some people just do not do well on Zoloft. It can be quite agitating, even at the low doses.
The Remeron has this postulated activity in the brain:
from http://www.rxlist.com/remeron-drug/c...armacology.htm
Remeron is often given to help with sleep, because it has sedating qualities/side effects.

The suggestion to use a Benzo like Xanax or Clonazepam would address this anxiety issue. You could do this over the counter with PharmaGaba...more safely and gently however.
Benzos and PharmaGaba work on the inhibitory nervous system, which balances us against the stimulatory system which is activating. The neurotransmitter GABA works here, and neither drug you take affects it. The RX drugs that work on GABA receptors are quite habituating, but the PharmaGaba is not. You can find this at iherb.com or Amazon
Not all GABA supplements work orally, but PharmaGaba does. I've used it myself. 100-200mg a day often works for many people. You can take it before bedtime to calm you for sleep.

Some people just naturally have lots of serotonin, and using SSRIs for these people is just too agitating. You should trust your feelings and resist any dose increase. The mildest SSRI is Celexa, and that is because it is not a pure drug, but a mixture of active and inactive molecules so the SSRI actions are much weaker. (Its cousin Lexapro however is the purified form and much stronger).

Hello RAllen
 

I hope you feel better soon. Please keep this site informed about the fight to flight response. This particular body reaction happens with other medical conditions as well. My fight to flight response is engaged with auto immune problems. AT least that is what Mayo clinic discovered.
This type of therapy would benefit. I hope there are studies on it. ginnie:grouphug:

Mark in Idaho, Lara, Mrs. D, and ginnie-
Thank you very much for taking the time to reply to this thread and the wealth of information given. We have a health and food store in our area that is wonderful and luckily has 10% on their vitamins/ supplements on Sunday! So I will be making a trip there today.

I just wanted to say that without the help of you guys (along with my family, of course) I would probably have given up on this and lost this fight. The support and time that people are willing to take to help someone in need is in one word amazing. So THANK YOU, each and every one of you!

Here's to a better week and I hope everyone enjoys this Sunday. God bless.

You might have to get PharmaGaba online. iherb.com and Amazon have very discounted prices for it.

one other fast-acting anxiety med is hydroxazine. the doc gave that to me when i had a panic attack when i simultaneously cold-turkeyed amatryptaline, started 50mg zoloft and went through a breakup. it's not addictive like benzos.

they described it feeling like a strong anti-histamine and that's what it felt like. not sure it worked really, really well, but it helped me through a few critical days til the meds evened out.

have you considered going back to the state's psychiatrist and asking for an alternative (and thereby saving $500 on a private shrink)? or was he difficult to work with/access?

Hydroxazine has a half-life of only 3 hours so it has limited use for reducing ongoing anxiety issues as it would need to be taken often. It is an anti-histamine too so it has those side effects.

Slower acting longer half-life benzos would be better for taking the edge off a chronic state of anxiety, at least in my opinion.

I found out you're not supposed to take L-tryptophan or 5-HTP while taking an SSRI. I took 5htp for a couple takes before i learned this and had body tremors kinda like i had while adjusting to the lexapro. I stopped the 5hpt and tremors stopped. I attribute it to too much seratonin or just my body trying to get used to more seratonin

one more thought...i remember you said something about "non-therapeutic" dosage. I'm on the child's dosage of lexapro (5mg), and it's helped a good amount. not entirely--a stressful work call and perhaps PMS has made me more anxious & depressed last few days, but not scarily so, just unpleasantly so. been considering upping my dose of lexapro but gonna see if i feel better in a couple days.

anyway, just b/c a doctor says you can cold turkey b/c you were on a low dose, don't necessarily do that. i followed two docs advice and got screwed coming off of amatryptaline cold turkey. and just b/c you're on a low dose doesn't mean more would make it better--my shrink says some of us metabolize drugs slowly (or quickly? can't remember which), which means lower doses are appropriate.

i've been taking pharmagaba for a few weeks, having really noticed a difference. maybe i'll up my dose

one more resource. http://www.lef.org/magazine/mag2011/...of-Calm_02.htm

nice review of all the natural remedies.

You are not supposed to take 5-HTP but L-Tryptophan is OK while taking an SSRI. 5-HTP bypasses the blood brain barrier and metabolizes into serotonin. L-Tryptophan does not pass the blood brain barrier. My Duke trained MD, biochem degree for Harvard doc said they are OK. L-Tryptophan does not have the bio-availability that 5-HTP has. I used L-Tryptophan as I was weaning off Paxil (both at the same time) and took it for a year while taking Celexa, both while under a doctors care. I increased the L-Tryp while I reduced the Paxil.

I just went off the Celexa and may switch to 5-HPT instead of the L-Tryptophan over time. But, with 5-HTP, you need to establish a disciplined dosing regimen or risk roller coaster serotonin.

underwater,

I can't get your link to work.

I actually have the Hydroxazine and I have taken it in the past. I'm calling Monday for another appt thats not 6 weeks out to try another medicine. Or maybe just wean of the 25mg and suggest the pharmagaba?! I know I need to stay on the Mirtazapine at night.

So do you guys think that plan sounds good? And I know this sounds odd, but when you take a daytime AD that "works" are you supposed to feel like yourself, just a calmer version or do you find yourself feeling like you are "medicated"? I'm just asking because this nervous/ jittery feeling is all I've gotten. I have a friend that takes 10mg of Lexapro and loves it. She says it takes the edge off and evens her out.

Thanks again for all the info.

RAllen,

You are not taking a daytime AD. You are taking an AD at the start of the day. Zoloft has a half-life of 26 hours. It stays with you for days once you have been on it for 2 weeks. It peaks 5 to 8 hours after taking a dose When you take the Mirt at night, the SSRI is still at nearly full strength. You may have a small spike in plasma level at first but once you have been taking it for weeks, that spike has leveled out.

Why do you think you need to stay with the Mirt at night ? Even the Mirt is pretty much at an almost constant level throughout the next day. It has a half-life of 20 to 40 hours. This means there is so much overlap between doses that you should have very stable amounts in your blood if you take it every night.

Go ahead and get the PharmaGABA. You can take it at the same time as the other two. GABA does not interfere with serotonin. It is a separate neurotransmitter. There are three that tend to be out of balance. GABA, norepinephrine and serotonin. SSRI's only effect serotonin. GABA should be at a balanced level with the other two for best function and symptom relief.

You could even get some generic GABA at the store while you wait for the PharmaGABA to arrive. I see GABA on the shelves at many stores that carry supplements. I think Krogers carries it.

My best to you.