Finding Stability
I previously wrote about my journey on how I decided to start taking an SSRI. I shared my experience to ultimately convey my entire journey, including how I leveraged Lexapro to become a stable version of myself, how I decided to titrate off Lexapro, my experience of titrating off Lexapro, and how I am currently working through my anxieties and triggers without medication.
First and foremost, medication is not a magic pill. It took a few months for me to find the right dose and notice how medication helped me or rather, how it did not make me notice my triggers or anxiety as strongly. The feeling was not immediate; for weeks I continued to struggle with extreme overwhelm and endless spirals of rumination. My sleep was disturbed by the inability to stay asleep, waking up every few hours (usually just shy of a full REM cycle) and being extremely awake for 30 minutes to an hour before going back to sleep for a few hours. And in full transparency, my sex drive was pretty low. This lasted for about two months. After two months, I increased my dose, switched the time of day I took my medication, and went through an adjustment period again for about a month. It was a rough three months of anticipation.
Finally, I had reached a bit of lightness. My lightness wasn’t freedom or non-feeling, I had never intended to feel lack of barriers or emotions. The dose I chose and stuck with made me feel much more at ease while still feeling the pricks of my triggers and the pressures of my anxieties. I allowed myself to still feel, I wanted to still feel, I just didn’t want to be paralyzed.
With my newfound ability to go through my days without existential weight, I was able to reintegrate myself into things. I felt more energized by my work, was able to socialize, and became a more attentive and aware partner and friend. Things seemed pretty good — almost too good. And, well, wouldn’t you know it, it sort of was. I was out of touch with myself, stomping all over my dampened barriers without taking stock of what was going on. There was no “a-ha!” moment; slowly, I had come to the realization that cruising over my anxieties wasn’t enough.
Prior to taking Lexapro, I had been extremely mindful in working through my social anxieties. I took notice when things were too much, chose sobriety in social gatherings, and listened to my body when I needed to take personal space. At the beginning of taking Lexapro, I didn’t do any of that. I noticed how it had muted my experiences, but after finding the right dose, I just took a break. I needed that break. But now, I was ready to do the work again.
I once again began to take stock of what things caused me to feel discomfort, what led up to the points where I decided I needed to walk away to take some personal space, and began to work through the whys. The most relieving thing about taking Lexapro for me was the significant decrease in rumination. I was able to observe these feelings without diving into the depths of despair.
Something that really helped me during this time was the discovery and work that I did with a Non-Violent Communication (NVC) coach — or Compassionate Communication, as I prefer to call it. Many things happened in my life and the lives of those around me that led me to work with my NVC “thera-coach,” which I won’t get into here, but I am so glad that I did.
Learning how to hold space, compassion, and empathy for myself and for others really allowed me to sit with my triggers and anxieties in a way that made them manageable. In using this tool, I was able to observe my emotions and how I reacted in situations with compassion instead of just merely noticing my triggers. I will be honest that this type of work did not help me to dive into the whys of my anxieties but rather taught me how to manage myself during situations and to better acknowledge where I am in the present.
I did this work for about a year, slowly working through the NVC guidebook. In full transparency, I didn’t make it through the entire book. There is a part of NVC that does not sit well with me, and I stopped at this point and have not looked back. The first half of NVC was really enlightening for me and gave me new tools on how to diffuse my anxieties and pressure in tense situations, taught me how to show myself grace, and how to better hold space for myself and others.
Tools I built for myself with NVC:
How to Communicate — I know this sounds silly, but I definitely did not know how to communicate my needs and emotions well before. NVC taught me how to frame what and how I am feeling to myself and others. It helped me understand how to break down my feelings into discrete parts and verbalize my needs based on what I had experienced. Seems obvious maybe but this was revolutionary to me.
Perspective — this piggybacks a bit off compassionate communication. In the process of learning how to communicate my needs and experiences, I better understood others’ needs and experiences. Language allowed me to also visualize and internalize what and how experiences and words impact us.
Empathy Bubble — One of my favorite exercises is to practice holding compassion and empathy for oneself before entering a situation that might be triggering. In challenging situations, such as at work or with family, this exercise can be particularly helpful. It requires being aware of one’s needs before interacting with someone or something that may cause friction, or it may require stepping away from a triggering situation.
For example, if you’re about to interact with a family member you don’t get along with, think about your fundamental need that you’re typically missing from that person. Once you have that in mind, recall a time when you experienced that need being met and hold onto that feeling. Then, deeply feel it, breathe into it, and expand that feeling to the rest of your body and beyond, creating a circle that expands to fill whatever size space you need.
I have found this exercise to be effective both before engaging and during a situation. While it may be challenging to step away and take space for oneself, most people don’t really mind or care if you excuse yourself and come back a few minutes later. Ultimately, practicing compassion and empathy for oneself can help manage anxiety and stress in challenging situations.
Around the same time I stopped practicing NVC, I began considering cycling off my medication. While these two events were unrelated, it took me approximately six months to make the decision to stop taking medication. This period of consideration occurred during the spring and summer seasons, which are typically associated with increased happiness and lighter moods due to the warmer weather and longer days. Throughout those six months, I started to extensively look into alternative treatment options and experimented with several of them.
Alternative options I tried (while taking Lexapro unless otherwise noted):
Meditation — hilarious failure for me, at this point in my life I found meditation to more likely put me into a rumination spiral, even while taking Lexapro! Quite wild. I tried all types of meditations and found guided ones to be a bit more helpful but not really a good fit for me.
Breathwork — this was actually a pretty intense experience that I was just NOT READY FOR. These experiences had me crying and uncertain of myself, the confusion was extra confusion. Lexapro had given me tools to be very aware of myself and NVC had taught me some tools but I was just not ready for the magnitude of what came with breathwork. Breathwork and deep breathing to ground yourself are very different things. I now love breathwork but it was just too much for me at that point in time.
Supplements — I started upping some supplements (thanks to many of the longevity work out there from Andrew Huberman, Peter Attia, and Rhonda Patrick), specifically Omega-3 and Magnesium Threonate. These seemed to help a bit but it was really hard for me to distinguish between increased activity due to weather and supplementation. I additionally started taking N-Acetyl Cysteine (NAC) on the suggestion of a friend for a completely different reason but DID start to notice that there was something more to NAC.
NAC — NAC gets its own section because it feels like more than a supplement to me. NAC is an amino acid that is a precursor for a lot of things in our bodies. It has been studied the most in the treatment for addiction recovery. There is also a growing body of research indicating that NAC may be helpful in PTSD and anxiety, particularly for those that experience rumination (see links below). After reading these studies I decided to try taking larger quantities of NAC daily. I began doing this simultaneously with Lexapro. After a month or so I decided to see what would happen if I didn’t take Lexapro every third day… nothing. I felt fine! Maybe I could just do this! I continued this for a few weeks and then tested out every other day–whoops, big failure, I felt serious mood shifts and swing and it was not comfortable. I went back to taking Lexapro daily.
None of the alternatives I tried seemed to work, but NAC made me realize that maybe it was time to say goodbye to Lexapro. However, I didn’t start the process until about a month later. The final push came during my first visit to Burning Man. I thought I was good to go, feeling stable and well with Lexapro, but the extremes of the festival were too much for me to handle. Being stranded in the middle of nowhere without my usual spaces to retreat to was rough. On the sixth day, I had a complete meltdown and nowhere to hide. I was forced to confront the ugly side of my anxieties in front of friends who were having the time of their lives. It was a moment of shame, embarrassment, and helplessness. That was my tipping point. After leaving Burning Man I decided it was time to (1) find a therapist that I could build tools with and address my whys and (2) titrate off Lexapro.
This piece is part of a larger series of Anxiety. This series is ongoing as I continue my journey.
I suggest reading in this order:
Rumination, Finding Stability, Titration [WIP], Discomfort & Vulnerability [WIP], Understanding [WIP]
Early research on utilization for NAC for anxiety and PTSD. The following research is promising but is not a substitute for a physician.
- Ooi, S.L., Green, R., & Pak, S.C. (2018). N-Acetylcysteine for the Treatment of Psychiatric Disorders: A Review of Current Evidence. Biomed Res Int, 2018, 2469486. doi: 10.1155/2018/2469486. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217900/
- Minarini, A., Ferrari, S., Galletti, M., Giambalvo, N., Perrone, D., Rioli, G., & Galeazzi, G.M. (2017). N-acetylcysteine in the treatment of psychiatric disorders: current status and future prospects. Expert Opin Drug Metab Toxicol, 13(3), 279–292. doi: 10.1080/17425255.2017.1251580. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27766914/
- Bradlow, R.C.J., Berk, M., Kalivas, P.W., et al. (2022). The Potential of N-Acetyl-L-Cysteine (NAC) in the Treatment of Psychiatric Disorders. CNS Drugs, 36(4), 451–482. doi: 10.1007/s40263–022–00907–3. Retrieved from https://link.springer.com/article/10.1007/s40263-022-00907-3
- Back, S.E., McCauley, J.L., Korte, K.J., Gros, D.F., Leavitt, V., Gray, K.M., Hamner, M.B., DeSantis, S.M., Malcolm, R., Brady, K.T., & Kalivas, P.W. (2016). A Double-Blind, Randomized, Controlled Pilot Trial of N-Acetylcysteine in Veterans With Posttraumatic Stress Disorder and Substance Use Disorders. J Clin Psychiatry, 77(11), e1439-e1446. doi: 10.4088/JCP.15m10239. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27736051/
