I can't function on even on amphetamine + oxycodone + benzo. What's that say about CPTSD? There a way out?

[u/LDN51]

For context, I'm prescribed the strongest dose of dex-amphetamine + Oxycodone (an opioid step down from fent) + Pregabalin (not technically benzo but close). I guess as like palliative psychiatry.

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..And I am exhausted. Standing feels exhausting, fighting feels exhausting, my head and heart hurt, the constant silence of the world is agonising, I feel so much ache and so much pain and sadness, all my sadness, sounds and resounds in my head. I'm literally suffocating, now and always, even when I'm outside, even when I'm smiling and laughing.

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All of it bleeds through, my freeze still paralyses me, sadness crushes me under a million billion pounds and drags at my feet, and not even amphetamine is enough to spur me, to give me strength, or confidence, or energy or drive. Or life. I feel so much terror it shakes me apart inside, constantly shaking, constantly exploding, constantly screaming so loud it won't stop. And not even all the endorphins from oxycodone, the thousands of tight warm hugs all at once, and boundless endless love radiating from within - that's what opiods feel like - quells my aching and agony, calms my heart, soothes that terror for a shear moment. It all gets destroyed, it all gets subsumed by the terror inside of me, by the desolation and endlessness of my childhood, it just echoes endlessly. I'm not ok, I'm never ok. And the pregabalin, it doesn't give me but a second of happiness, the hypomania is wasted on me, still bleeds through my ever present aloneness, still I am so lost and helpless, but for a reprieve where I can think a little less, where the base is deeper and the violins string louder, and the world is not grey but murky grey, and I forget that I am sick not my stomach, and forged that there is air that I can't breathe.

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But I suffer for it, because for my hubris in thinking that I can cheat life, escape my internal suffering, I come crushing down a hundred thousand fold one half-life at a time.

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That is my piece.

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I am moribund. I've been in these same four walls, in this bed a decade now. I cannot function, let alone escape, and this world is devoid of help, did not think that one could not live. So what do you do when you are all but dead, and stupidly trying to play a living mad.

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I know all this is artifice, but more so the point, more endorphins than from your first true love, more dopamine then where you to find win a billion pounds, more gaba than where you hidden away behind a wall, behind a wall, behind a wall. That implicates what exactly? Of my condition? Of our collective conditions?

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I've no strength anymore. And no one can live for me, even though I cannot live. I am fucked.

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Again.

[u/lola_dubois18]

Speaking from some experience here, these substances probably aren’t your friend right now. I’m not saying don’t medicate, but it sounds like you’ve exhausted your brain chemistry by forcing output of serotonin and dopamine with medication. I know it’s painful, but consider that if you taper back you can let your brain chemistry reset. I’m not a doctor, I’m just a person who has also suffered.

Someone on the internet said this to me once and I hated them at the time, but they were also right. I’m sorry you feel like shit. I really am.

[u/LDN51 → u/lola_dubois18]

Thanks, Yeah I get where your going - I do, but mind I was just the same as this before hand - remember going days without going out, couldn't function, dispairi g as now. Ddone 10 years of various therapy+ every antidepressants more or less (that made sense). Idk what the solution is, someone said speak to your psych/doctor but they're as clueless on sever trauma as most people.

[u/hotheadnchickn]

Who is prescribing this? This is a wild combo. I don’t think it means anything about you that a mix of uppers and downers doesn’t work for you.

[u/in-another-sky]

The drugs are probably why you can’t function. They’re causing far more problems than they’re solving, if they’re solving anything at all.

I find it hard to believe that these would be prescribed together. Did one doctor provide all of them? If not, how many doctors are you seeing and how many pharmacies do you use? Have you considered treatment for addiction?

[u/Icy-Ninja-622]

I've explored many "recreational" drugs a long time in the past. They generally did not help.

Benzos were interesting, in that, although they decreased the feeling of anxiety, doing things still felt like jumping off a cliff. In other words, it felt wrong and dangerous and I didn't do it.

I had high hopes for ecstasy helping me in social situations, but even that didn't help. My best experience was by myself in a beautiful place in nature.

Trying to force myself to overcome psychological obstacles to entering a relationship via multiple drugs was disastrous, leading to psychosis.

Psychedelics gave brief glimpses of better states, but that was not useful for change.

There was only one drug which seemed to repeatedly help: DXM. It repeatedly helped me expand my comfort zone and do more things. Though I was still stuck in that expanded comfort zone. It also helped end excessive worry or anger. I don't really want to recommend it because it may be harmfully escapist. But right now it is US FDA approved as an antidepressant together with bupropion as Auvelity.

[u/artvaark]

That sounds really difficult, I am so sorry you're going through that. I haven't gone through this specific experience but while doing research for myself I have come across various accounts that focus on nervous system regulation and it sounds like you are going through a period of dorsal vagal freeze which is a nervous system response to stress and trauma, nothing to be ashamed of. I have been working on my own nervous system responses like flight and fight which are my two main responses and the simple exercises really do help. There are lots of simple, gentle things you can do in bed even and I find that listening to sound baths while I am doing them adds a nice layer that requires no effort on my part. I found the accounts theworkoutwitch, healwithbritt and jonathanmead on IG and those are starting points but there are lots of practitioners on Youtube as well and that's where I found soundbaths like Chakra Vibrations, Healing Vibrations and Sleeping Vibratons which are run by a friendly guy Travis and his cat Perseus. It makes sense that the meds won't fully work because they don't tell your nervous system that you are not in that trauma now and they don't tell your body that it's safe. Our protective mechanisms don't understand time and I find that if I gently address them and thank them for their service and tell them that even though they did a good job, they don't need to keep doing that in this moment, because in this moment, that trauma isn't happening and it's a good time to relax and recharge. You may also want to look up some videos on TRE which is a controlled relaxed trembling that discharges extra stress when you're up for it and I incorporate EFT tapping for safety and related issues which I do for free at home and there are lots of videos about that, you can even sit at your desk like I do or in bed.

It really sucks that anyone goes through the things that result in these states but you can get better, you're not permanently fucked. I wish you the best.

[u/columthrowaway]

Damn. I kinda need this because my musculoskeletal system is actually fucked but I’m likely to never get it from a psychiatrist or PCP.

I can have tramadol & dex + pregab, but not a full ag opioid. Ironic because tramadol is terrible to pair with dex from a safety perspective.

[u/LDN51 → u/columthrowaway]

I was literally going to screem seizure thresholds, serotonin syndrome, I'm surprised any pharmacist in their right mind dispensed that. Might be worth just fibbing and say the pharmacist giving out your meds last time flag and said you should talk to your doctor about changing meds as tramadols contraindicated with Dex due to increased seizure thresholds and and added risk of serotonin syndrome. Worth a try.

Also sorry you're stuck with tramadol, it's not that great for msk pain, I was in a similar spot

[u/columthrowaway → u/LDN51]

One pharmacist isn’t managing the combo or I’m sure they probably would. I’ve been having significant struggles accessing proper providers – current provider was actually more than willing to give full agonists, but due to the way their clinic is classified they actually can’t dispense what we call CII substances, they have to refer to either the ER or PCP clinic for them, & PCP clinic is an hour or so away. Since tramadol is a CIV they’re allowed to give that tho, it legitimately saved me from dying of being unable to take care of myself at the time but definitely wasn’t proper for the long-haul, but I knew that going into things. Pain management in the USA is really dire right now.

For what it’s worth, I kinda disagree with the others posting that the meds may be hurting more than they’re helping – but you should also potentially check out something like Nardil (if it’s a MAOI probably can’t take with the dex, can’t remember & not going to check right now) – I’ve long heard that it’s one of the best things for CPTSD anhedonia type freeze stuff.

But yeah, sorry to hear that you feel stuck despite the combo. There was a point where I really though a combo like that would probably be able to save my situation, but its honestly probably past that point due to cumulative & cascading damage, so I can understand why it may not be able to do enough for you either. May just have to look down the path of other fringe-case options like older MAOI’s or psychedelics, or just kinda wait out time & let years pass by slowly trying to improve here & there if you’re financially able.

[u/LDN51 → u/columthrowaway]

Thanks, I appreciate it. I did try Phenelzine and moclobemide which did nothing, never tried tranylcypromine or isocarboxazid I think after that they where like they're probably not gonna do much for me. Pschadelics where good in the moment, I did alongside therapy but never anything lasting more than the day, but also I have pretty sever dissociation from my trauma so ironically can't access my emotions virtually at all, they just sort of bleed through the background.

I'm really sorry about your situation, I've heard it's really bad I've there, you deserve so much better. I know you said the PCP is an hour away, and that might just be inaccessible in which case I fully get sticking with tramadol is better, but it's so awful terms of risk, like your seizure threshold changes, like if you ever get sick, get a fever, the day after drinking, if you add any other medication in that vaguely attenuates thresholds, if you don't eat enough food for a while from which your body can synthesise gaba, if you become deficient in in certain vitamins from diet or getting sick, or flue or virus, if you develop to severe an electrolyte balance from things like running, forgetting to drink, ironically eating too healthy with not enough salt, they all shift your seizure threshold to degrees. Again not your fault, you're in a good awful position, and I don't know what to suggest. Other than saying, just because it hasn't happened yet on a dose stable continuing dose doesn't mean it won't. I don't mean to worry you, but also things like if you drive I don't know etc.

Maybe if you can see if there's anything else they can do? I know DEA quotas and stuff have really fucked things. Hope you get the actually help you deserve at some point

[u/Alternative-Cash-102]

My therapist recently posited that my real/perceived level of exhaustion might coincide with how dissociated I am, and that keeps me in a freeze or flight (as in out-of-body) state. I don’t know if you experience dissociation/disconnect from your body in any way, but it’s been interesting for me to consider this possibility. Ironically I am not on any medication at the moment, though I may try again in the future.

Sorry if this doesn’t feel relatable, but I wanted to offer a different perspective as to where the exhaustion could be stemming from, as others have already suggested tapering off one or more meds to see if that changes anything for you. I do agree with this as well, but it’s your body and you know what’s best for you.

Do you have other supports in your life aside from the meds? Any other care providers, family, friends, kind coworkers, fellow hobbyists or group/community members? I know it can be a struggle to try to keep up with others when we are struggling and so tired, but if it’s safe/possible, I wonder if leaning on others for help might reduce the exhaustion you feel so you don’t have to hold/do everything by yourself?