So, I went for the Mannitol challenge test a few weeks back after having cut out my medications as specified. I did the baseline test (like a practice run) and it was incredibly hard work! So much so that for when it came time to do the placebo, my result varied so significantly that they would not continue with the test. Two days later, I was back seeing the consultant at the difficult asthma clinic and he reckons that I had a reaction to the placebo. How can someone have a reaction to nothing?! I don't understand! I thought I had just tried so hard on the practice run that I had worn myself out and couldn't give the same result for the placebo?
So he's not sure whether it's even asthma or not. Then he looks at my file to see what meds I'm taking and sees that I am on antidepressants. He asks if my 'asthma' gets worse if I am stressed or upset and I tell him that if I get very emotional (stressed or upset), I do seem to get more wheezy/cough more. He reckons it would be a good idea to reduce the amount of pred that I take, but when I ask if he would increase it again if my lungs flared he said he would probably think about sending me back to the person I saw at the counselling place years ago. Why don't people understand that having depression (or having had it in the past), doesn't necessarily define you as a person!
Yes, I was depressed before, and yes I still take medication for it, but the main reason I still take it is because I couldn't cope with the withdrawal effects when I tried to reduce it in the past. Now I'm terrified he thinks I'm making the entire asthma thing up?! I went to that appointment to get the answers to what type of asthma I had and how they were going to treat it, and now I'm left feeling like a fraud.
On another note, I went to see the GP today who agrees that we should lower the pred dose and informs me that the consultant is reporting I have ""modest adrenal suppression"" - what is modest? Does that mean that I only have a slight suppression or should I be more concerned?
Sometimes I get the feeling I should just stop taking the entire lot and see what happens then...
Sorry to hear that you have had a rubbish time at your appt.
I know you feel like you might as well give up your meds if your consultant is questioning everthing but PLEASE, DO NOT DO THIS!
I'm sure you won't as you know its not a good idea as your body and lungs are used to having the meds everyday so even if you wanted to try and stop them you have to do it slowly.
Sorry I can't help on the depression side as I have no experience of this but I'm sure someone will be along soon that can help you through.
Take care x
awwww! That sounds like such a frustrating appointment. I am going to start with the thing you know: dont stop meds without discussing it, i'm SURE that's not what your consultant intended (if you're anything like me, you'll know not to do this though! I decide basically every week to stop all of them, i never actually do - but i just get so frustrated to be taking so much and feeling ill still!)
I also don't think your cons will believe you are making it up, i hope not at any rate, i'd say at most he is suggesting that it is a different thing causing some of your problems - that doesnt make it made up! However, that also doesnt mean he's right, anxiety is a common diagnosis in people who are difficult to treat, and it is worth considering to what extent your conditions are caused by anxiety and how much is caused by asthma/other physiological breathing condition.
I believe most non-psych consultants believe than anxiety:
a)excludes all other conditions, you cannot have anxiety and something else
b)is a permanent diagnosis, so once you have it you will always have it
c)that no treatments for anxiety are effective, you can be on all the anxiety meds in the world, if you are still experiencing physical symptoms then the meds aren't working
d)and that you do not need to feel anxious to have crippling anxiety (for example to the extent that you can't breathe)
interestingly i have never met a psych consultant that believes any of them!
a)not only does anxiety not exclude other conditions, anxiety both causes and is caused by other conditions. If you are in a stressful situation (your life is on hold coz you cant breathe) it is completely rational to be anxious or stressed by this! And there are many severe stress related conditions, which need to be treated holistically, both the stress and the disease caused by it!
b)many many people go through periods of anxiety or stress, it does not define the rest of your life, some people, yes, will have anxiety-symptoms their whole life, but that is in no way a guarantee for everyone!
c)anxiety medication is very effective for most people, and there are many treatments such as CBT that give long term coping strategies meaning that individuals dont get into a downward spiral anxiety-wise.
d)just silly, i think that if a condition produces *purely* physical symptoms then you really can't justify an anxiety diagnosis, there must be some perception of stress or anxiety. Unless the consultant thinks you are lying which i think they should be able to justify, and if people did lie it would surely only be because of the previous points!
It also needs to be understood that anxiety is as *real* as any other condition, there is so much stigma attached to it that people should ""just try harder"", and in the same way i'm sure that theoretically if we all had super-human muscle strength then we would be able to cope much further into an asthma attack by ""just working harder"" however, that is a ridiculous suggestion, we can be given breathing exercises that can try to prevent things that make attacks work, (and we can be given coping strategies to deal with the anxiety) but ultimately its not a case of trying/not trying, it's an illness!!
ok....rant over, hope i haven't offended anyone, it's a point i feel very strongly about, but have tried to be sensitive
On a more practical note for you. Do you feel the anxiety medication treats your anxiety symptoms? (so do you feel mentally able to cope, given the difficult circumstances?) i assume yes given that you have tried to stop and failed due to withdrawal. If no, then perhaps stronger doses, or councelling might help you, anxiety is as real a trigger as an allergen, and so it is important to stop exposue to all triggers oif possible. If yes, do you feel able to stop the meds? So, if the *only* issue previously has been withdrawal, is it possible to reduce slowly (personally i used to take Venlafaxine which is horrific to stop, i managed to cope with the effects by spending a couple of weeks at half my usual dose and stopping from there - still had a few days in bed but nothing to what it had been) you might even be able to take the lowest does, every other day for a few weeks. Obviously this all depends on whether you still need the meds (and how much) i am more anxious than i was on anti-depressants, however it is a level of anxiety i can cope with, whereas i felt it was safer to be off them because of the issues dealing with A&E staff, i had members of staff treat me purely as panic attack until shift change when suddenly i was in resus and very very ill (unless i massivly deteriorated in ten mins without noticing) and i was also facing regular lectures about making sure i was taking anxiety medication and seeing a councellor, something that was completely inappropriate for me as when on a low dose of Venlafaxine I am completely well and experience very few anxiety sympotms at all. This was obviously a personal choice - don't get yourself ill by stopping the anti-d's just to prove a point, but worth considering and maybe discussing with your GP.
If you feel controlled on your current dose, but not able to lower it, then is it worth asking to discuss this with a psych consultant? This is what i did when they were trying to increase my anti-d's, i spoke to this lovely doc and she was amazing, really listened to me, and was sooo supportive. She then wrote a letter saying that I have sufficiently low levels of anxiety that she can't believe i'm on medication that i dont want to be on for it (the venlafaxine - i'd been asking to stop for ages) and that she highly reccomended they stopped the treatment, slowly, for me. And said to me (although i doubt she worte this) that she didnt go around prescribing me inhalers so why were they prescribing me anti depressants! LOL! She is the only psych cons i have had experience with, so i don't know if i just got lucky, but it might be an option for you - just to get someone to support your decision about your mental well-being.
With regards to the adrenal supression, i am certainly no expert - but my understanding would be that with modest adrenal supression they would expect it to pick up again as long as the pred is tapered slowly! Did you have any tests (like short synacthin) which might have pointed to/away from adrenal supression? i *believe* that if adrenal glands are very supressed they put you on hydrocortisone (this is what i take, and then if lungs need it i take pred as well - i know this rule varies from place to place though) so i would read it as a good sign that that hasn't happened. What dose of pred are you on (if you dont mind) i think anything over 10mg can supress adrenal glands, to some extent, most people pick up again naturally, it may be that they monitor you while you reduce your dose and possibly refer you to endo if they dont 'pick up'. If you are concerned, NHS direct has a good page on Adrenal Insufficiency (i suspect that if you had full adrenal insufficiency they wouldn't have said modest) however things like headaches, dizziness, nausea whilst reducing pred might be a good signal to go speak to your GP (other symptoms listed on NHS direct - as i say, not to be used for self-diagnosis - obvs - but might give you an idea of what is worth speaking to your GP about). As I said, this is just my take on what it means, i wouldn't worry too much, when my results came back (and others i know) i got a very worried phone call within a few hours checking i was ok and sorting out meds, so i am sure that if there was anything to worry about you'd have been told!
Gosh! This turned into a ridiculously long post, hope some of it's helpful, even if just in a ""you really aren't the only one"" kind of way! let me know if anything doesn't make sense
Two days later, I was back seeing the consultant at the difficult asthma clinic and he reckons that I had a reaction to the placebo. How can someone have a reaction to nothing?!
I don' t know much at all about the challenge test, but maybe the placibo isn't ""nothing"" - it is just something that most people don't react to, even asthmatics. Hopefully, someone who knows more will come along.
I know that when my lungs are crap, even using my nebulizer irritates my lungs a bit, so maybe it was something like that?
So he's not sure whether it's even asthma or not. Then he looks at my file to see what meds I'm taking and sees that I am on antidepressants. He asks if my 'asthma' gets worse if I am stressed or upset and I tell him that if I get very emotional (stressed or upset), I do seem to get more wheezy/cough more. He reckons it would be a good idea to reduce the amount of pred that I take, but when I ask if he would increase it again if my lungs flared he said he would probably think about sending me back to the person I saw at the counselling place years ago. Why don't people understand that having depression (or having had it in the past), doesn't necessarily define you as a person! ....Now I'm terrified he thinks I'm making the entire asthma thing up?! I went to that appointment to get the answers to what type of asthma I had and how they were going to treat it, and now I'm left feeling like a fraud.
I completely understand the feeling like a fraud bit. That's how I reacted when my GP got upset about two bad flares I had a month ago and ""offered"" me an SSRI.
I spent a lot of time working through how upset I was about it and came to several conclusions (a) that I needed to trust my instincts. I knew I wasn't a fraud (b) my real upset was not me thinking i was a fraud, but my fear that my GP wouldn't provide good care because he was barking up a tree with no cat. So once I worked that through I made an appointment with my GP and we had a long chat, which seems to have turned things around.
I didn't mind him considering an emtoional component - I would have thought a lot less of him, if he didn't explore the possibility, BUT I was very upset about the way he did it - he didn't even ask me about my feelings or asthma/stress pattterns. He just launched into the topic in a confrontive way, as in ""I don't believe you have some odd disease....I think you have garden variety asthma and this is anxiety"". Even if anxiety were behind my asthma, that really was *not* the way to approach it.
It sounds like your cons at least took the time to ask how you felt and saw the connection between asthma symptoms and stress, but I guess it wasn't pleasant for you either.
As for the labelling you as a person:...if it is any comfort, my GP raised the issue of my asthma being emotionally driven, even though I have *no* history of developing depression or anxiety disorders despite having survived tremendously stressful circumstances and life events. He even knew I tend to be calm and pragmatic during flares, rather than upset. And he had a hard time letting go of the idea (hope) that there was an emotional cause, even when I pointed out that my asthma was actually on the mend and improved whilst I was testifying and attending the trial of the person accused of kidnapping, raping, and attempting to murder me 18 years ago. (I did say I have had stressful life events, did I not?)
I think physicians ask the queestion because (a) they want to cover the bases (b) the asthma meds aren't doing as much as they would hope (c) they do want to help, even if they do it in a tactless, clue-less way.
I'm personally impressed with your insight into the connection between your asthma and stress. I don't think it makes you ""a fraud"" at all. It makes you honest.
Even though I do not find an emotional correlation, I still regularly ask check in with myself and keep my eyes open for psychological factors that might make asthma or its impact on my life worse than necessary. Over the years, i've also learned a lot of behavioral-cogniive ""tricks"" to relax/calm myself when I'm upset or down. As for asthma, I don't usually get anxious when I'm struggling, but it does happen sometimes. The asthma is more than enough to deal with. I don't need anxiety making it worse, so I'm very glad to have ways to make it less of a factor..
I think health requires both emotional and physical self-care. It isn't either/or. They are both two parts of a whole. So, even without the cons, if you feel you see a connection, it might well be worth taking the time to explore, either on your own or with a counsellor.
Thank you all for the amazingly supportive comments (as always!).
Soph - I am taking venlafaxine 150mg. When I tried to stop it in the past I experienced what I imagine something like heroin withdrawal to be like - vomiting (not being able to keep even fluids down), shaking, insomnia etc etc. I spoke to the gp about stopping the anti-ds this morning but she is not keen and was concerned that I was trying to change too much too soon. Plus I think I was a little emotional about it and she probably thought I wasn't really ready to stop them. As for the pred, I am on a maintenance dose of 15mg but usually have to take more due to flare-ups. I feel it's incredibly unfair that people like the staff in A&E see a diagnosis of depression (or in my case that plus the old self-harm scars at the tops of my arms) and think that everything is obviously stress/anxiety-related. Or if I have had an accident, then I have obviously hurt myself intentionally. I AM NOT THAT PERSON ANYMORE!!!
In terms of the adrenal suppression, I haven't had any definitive tests for it - the cons had done a battery of blood tests and has gotten the result from one of those. I just wasn't sure what exactly ""modest"" was supposed to mean. They really should think of wording things better like saying ""moderate"" or the like. In fact, the same cons has described my condition as ""precariously stable"" - is that even possible??? Anyway, thanks again for the very detailed and supportive reply
Beth - oh my goodness you have had stressful life events!!! I cannot imagine having to cope with something like that. As for the cons, I don't mind them having to try and clutch at straws or hope that there is something anxiety-based just so that they have something to diagnose and treat, but they need to be a little more sensitive and logical about it. I understand that yes, I was very depressed to the extent that I attempted to take my own life on two separate occasions, but that was a few years back and I am not the same person. I do find though, that when I go through appts like that one and I come out feeling like I did, I still get the ""what's the point"" feeling - but that does not mean that I am going to try anything or even need to speak to someone about it - surely other non-depressed people experience the same feelings?!
On a last note - I don't intend on stopping all meds, it was just a spur of the moment feeling!
its always tough when you get emotional in a conversation about not being stressed or anxious lol! Stupid brains making everything harder. Just for if you try it in the future when i stopped venlafaxing i spent time at 70mg, then at 37.5mg on the way, not sure how you did it last time, but im sure i more gradual approach could help! I have done venlafaxine withdrawal when the hospital was unable to get hold of it for 3 days, and i was on a surgical ward and they were saying that no ifs no buts you have to walk to the toilet (i wasnt even a surgical patient - and on resp wards they are much more cautios) i got to the point where i actually stopped drinking i was too dizzy to even sit up in bed and retched when i moved, getting up and walking all the way to the loo was not even almost an option, so i just stopped eating and drinking for 24hrs, it was ridiculously poor, i even explained that is what i felt i had to do, or just wet the bed (and that wasnt high up on my list of options) and they acted like i was making up and ""you cant be withdrawing this quickly!?!) grrr!
I would suspect that they aren't too concerned about you adrenal glands if they arent doing more specific tests, its one of those things thats worth bearing in mind though (especially if you were involved in a car accident or something dramatic), and if you find that on a very low dose of pred (lower than 7.5mg) you start feeling really awful then i'd go back to your GP and discuss whether it might b causing problems (i *believe* that 7.5mg is about what we make on a normal day under normal circumstances, so at a lower dose you are more likely to experience issues)
i can see your GPs point about stopping things one at a time, esp as pred can mess with mood - but i really would consider having someone you can discuss the fact that you feel you are psychologically coping at the moment (if you are) and to put a note on your file expressing this, worth a thought at any rate!
with the mannitol test - i have heard of peoples airways being so hypersensitive that they react to saline - and it *can* just be an asthmatic response, so dont worry too much about it, it may well just be a strong indicator of how cross your lungs are at the moment!
Beth - do you find that telling docs about your past experiences makes them focus more on the emotional side of things. I think my 'stressful life events' just show that i am able to cope with the extremes of emotional pressure without (in this case) having severe asthma, so the fact that in a comparatively benign situation it seems irrational to assume that anxiety is going to play such a significant role?!?
Hope you are feeling a bit better now Chukkin - helps to just ""get it out"" sometime si think
I'm not sure I can add a great I'm afraid, but just wondered if venlafaxine is hard to withdraw from, if its possible to switch to a different SSRI? I am asking this purely from a layman's point, its just I was on paroxetine for about a year, and found coming off these easier when I did it fast, rather than slowly as I first tried and failed. Just a thought.
I hope future consultations are more constructive, and hope that you feel better having got it off your chest so to speak.
And just to add, i often think of stopping meds too, as i often worry that the gp thinks im making it up when i get the 'clear chest' comment, in reality i never would, nor has the gp ever suggested im making it up, its just how ive intetpreted things wrongly coz ive been stressed and worried.
Take care Chukkin xxx
Thanks again to all who commented. It's so supportive to know that (a) there are others out there in the same or similar positions, and (b) that people don't mind if you need a rant! I would feel so much safer if I were to stay in hospital during withdrawal, especially since last time I did not have the asthma problems that I have now and if I couldn't cope with it then, I don't see myself being able to cope with coming off them now. Plus, I was unable to eat/drink so taking meds for my other problems would be out of the question.
Butterfly - I have tried being on about 5-6 different SSRIs in the past and ended up on venlafaxine as it was the only one which seemed to make a difference to the way I was feeling. I'm not sure if changing to a different one now just to be able to come off them would work. Something to ask the gp about I think... I also get the 'clear chest' comment which is great - but not when I'm feeling like I'm drowning in mucus and quite tight inside.
xxx
Venlafaxine has a half-life of 5 hours which is relatively short and studies looking at selective serotonin re-uptake inhibitor (SSRI) withdrawal demonstrate that individuals who withdraw from an SSRI with a longer half-life are less likely to experience any withdrawal effects.
It is be possible to switch to an SSRI with a long half-life (Fluoxetine) and withdraw from that. The equivalent dose of 75mg Venlafaxine is 20mg Fluoxetine. Fluoxetine is also available in liquid form which makes it easier to reduce the dose by 10%, so you could speak to your doctor about prescribing Fluoxetine liquid. It is advised that you then ’stabilise’ on the liquid Fluoxetine for 2-4 weeks before beginning the dose reductions/withdrawal.""
Not saying whether or not you are mentally well enough to come off Venlafaxine (you have to be the person to decide that!) but if you do decide to, now or in the future, there are things to make it easier
Oooh, thanks for that Soph - food for thought!
. I do find though, that when I go through appts like that one and I come out feeling like I did, I still get the ""what's the point"" feeling - but that does not mean that I am going to try anything or even need to speak to someone about it - surely other non-depressed people experience the same feelings?!
Bit late to this, but I just wanted to say - I completely get where you're coming from with this one! I luckily have not personally had issues with anxiety or depression or been given any medication for it even wrongly, but I have most definitely had that feeling after appts without needing to be 'officially' depressed. I had a really awful one last April (or it felt like it at the time) with a consultant who actually turned out to be pretty good and did become a good listener, but he phrased things in a way that wasn't helpful, telling me to 'try not to think about it and get on with things' (which I couldn't do because it interfered) and I came out feeling as though he'd said it was all in my head, and how screwed up must I be to feel physically lke that if it was. I had to remind myself he was actually listening and trying to do something (he'd prescribed a strong dose of Symbicort which did actually help) but I did feel so down for weeks after that and just like nobody was really listening and I couldn't talk to anyone because they'd just take it as 'proof' that it must be in my head.
I wasn't actually depressed, I don't think (I've had friends with depression - this didn't really come anywhere close) - just down, and fed up, and feeling like what was the point if everybody was going to always come back to things being in my head - and there wasn't even any history there for them to latch onto or any reason to think I was anxious or depressed, except that oddly enough I was fed up with the symptoms and with being told things like 'just try not to think about it'. SOmetimes drs just don't seem to think before speaking, or realise that it\s not as easy as 'try to ignore it' when you're getting daily symptoms, whatever is causing them. I was lucky enough to be able to go on holiday the month after this 'down' period and stay with a friend, and that really helped me to step away from going round in circles and wanting to escape from the whole asthma thing (I know this may well not be an option for lots of people, just saying that it's how I dealt with it and I didn't need to go on medication - it was a fairly natural reaction to something that's tough to deal with, and I don't think that automatically means it's a serious mental health problem even if someone has had problems in the past).
So I guess I'm trying to say that I get what you mean, and I hope it helps for me to say that. Unfortunately not having had any experience with it I can't advise on withdrawing from the medication, but I hope you find a solution to that and to the asthma issues.
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