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Feb 23 2009

A Year on Propranolol

The part I remember best is waking up with my head down on my arms. On my desk. With the voices around me, it only took a moment to figure out where I was. Oh, crap. I decided I must have fallen asleep at work. What could be more embarrassing than that?

Then I remembered.

I know the science on propranolol, emotion and memory is all terribly last week, but I’ve never promised or even particularly tried to be a current events blogger. Also, I still owe Juniper a blog post, and while this isn’t that post, it gets at some of the later stages of how my emotional life changed from child to adult.

I still can’t say what switch flipped between my junior and senior years of high school and took me from deeply depressed and anxious to moderately functional. My social circle hadn’t changed much, but the individuals I hung out with within the circle did. It might have been the one newish friend who I knew wanted something from me but who didn’t reject me when it wasn’t something I could give. Come to think of it, I can’t imagine how that lack of rejection could have been anything other than critical.

Whatever happened in high school, time and success and independence were all very good for me. So was Ben, although that is, again, another story. Eventually, depression was brief (still despair-deep, but brief) and tended to be set off by triggered memories.

The anxiety never went away, though, as might be expected. (Ed, I promise. I’ll keep reading you even if you stop posting about my life.) I still haven’t learned to fall asleep properly when anything remotely exciting is happening, much less anything where people are relying on me. For most of my life, the time before sleep has been filled with obsessive deconstruction of the prior day and planning for the next–or fiction. I prefer the fiction.

Waking life was hardly free of anxiety either. As an adult, I’ve been one of the people whom others look at and ask, “Can you do this?” Usually it’s something I haven’t done before, so I’m as curious as they are. I rarely say, “No,” but this tends to leave me with big unknowns in my life, big opportunities to disappoint. I’m not fond of disappointing people.

I was over 30 before I realized it, but I’d been getting migraines on a very regular basis since at least junior high. I didn’t know that’s what they were, because in a way, I was one of the lucky ones. Only a few migraines a year actually hurt. For the rest of them, the debility came from strange visual and somatosensory effects, hypersensitivity and confusion.

I love my doctor. When I walked in with a big list of symptoms that could, even in this day and age, get me labeled “hysterical” and said, “I think I get migraines, although mostly they don’t really hurt,” she pulled out her PDA and started checking off symptoms rather than immediately referring me to a psychologist. We tried a few drugs for treatment of symptoms, including some stunningly bitter pills that dissolved on the tongue. They worked, but they were nothing that insurance was going to cover at the frequency I got migraines, and they did nothing to cut down the frequency.

Then she asked me how I felt about abortion. She already knew I wasn’t planning to have kids, but she wanted to be sure I wouldn’t feel compelled to carry to term if I accidentally became pregnant while on propranolol. If I would have, she’d have prescribed something else. The idea of congenital defects was obviously quite disturbing to her, pregnant as she was.

With a few more checks of my blood pressure against the lowest recommended pressure for the drug (I was borderline), she sent me off with strict instructions to either come in or check my blood pressure with one of the in-store cuffs every few days for the next few weeks and a six-month prescription. Six more months were to follow if it helped and didn’t produce undesirable side effects. After that, with a little luck, I’d be migraine-free.

Believe me, I checked my blood pressure. Getting used to propranolol felt almost as strange as the migraines. I felt so light. It wasn’t lightheadedness, except when I stood up too quickly. (I learned how to get out of bed slowly, in stages.) I was just light.

It took me a while to realize I couldn’t get really upset if I wanted to. I could still recognize things that were wrong, and I still acted to fix them. I just didn’t do it riding on a wave of righteous adrenaline. I could get angry and act angry, but I couldn’t feel the same degree of anger I was used to. Flooding my body with adrenaline no longer produced any noticeable results. My reputation for calm in the face of chaos became more than just me putting on a calm face to keep others from freaking out and getting me going. It was now true.

The same thing happened with anxiety, of course. I didn’t get any less ambitious in what I attempted, but facing failure no longer raised all the ghosts of failure past. I can’t tell you whether I thought about my childhood during that time, thus stripping it of the negative emotions attached to it. I can tell you that the longer I spent without anxiety, the further away those memories got. That anxious kid became less and less someone I knew. I’d already trained myself not to think of my childhood often. The drug removed the emotional triggers that kept me remembering whether I wanted to or not. It let the present run on uninterrupted.

Maybe that could have been a bad thing, an unexamined life and all, except that I’m nothing if not introspective. Not only had I mined my memories for the lessons they could provide, but I had lived in them far longer than they deserved. Distance was a mercy and a pleasure.

The propranolol got rid of the migraines, too. Mostly anyway. I still get them occasionally, just as I haven’t completely trained myself not to respond to non-immediate threats with a burst of adrenaline, particularly around election time. And I still haven’t learned to sleep well.

Still, a year on propranolol was one of the best things I’ve ever done for myself, even considering the waking up at work.

I’d been sitting at my desk, having just raised my soda, when someone came around the corner to ask me something. I quickly swallowed–too quickly, setting off one of those pointless but painful esophageal spasms. Pretending I wasn’t about to gasp with pain, I turned to listen to my coworker. When I felt the roaring in my ears, I took a couple of deep breaths to hold back the black, but it was too late.

People look at you differently when they’re afraid you might drop on them at any time. A bottle of prescription drugs and the explanation, “I swallowed funny,” don’t quite cut it. They gather around. They want you to lie down and take things easy and reassure them several times a day for the next several weeks that, really, you feel fine. No, really.

Yes, passing out at work because your blood pressure is low and doesn’t respond well to pain is ever so much more embarrassing than falling asleep.

18 comments

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  1. 1
    gregladen

    My favorite post of the week, because I learned some interesting things. I laughted, I sorta cried.For most of my life, the time before sleep has been filled with obsessive deconstruction of the prior day and planning for the next–or fiction. I prefer the fiction.Aha! You never told me THAT! That’s easy to fix. Oh, and the low blood pressure thing is easy to fix. Jut become a blogger.

  2. 2
    Stephanie Zvan

    This is what happens when you don’t pry and I don’t talk about myself. It’s amazing you know anything about me at all.I’d miss the fiction before bed, which is what I mostly get now, but I’m curious what your solution would be. And as for blogging, stable blood pressure is kind of important too. That’s how this whole thing started.

  3. 3
    gregladen

    I went through a long period of stress induced insomnia. I fixed it.Can’t cover that now though. Class is at 6:00 and I need to prepare!!!

  4. 4
    sunnyskeptic

    I’ve been through that as well. It wasn’t until I started educating myself in regards to behavioral intervention for other individuals that I realized I could intervene with my own behavior… :) lol.

  5. 5
    Stephanie Zvan

    Ahem, class is over. [tap, tap, tap] See, you never told me that, either. I must say, though, I have some concerns about your cures. I suspect most of them aren’t gentle.Crystal, I have to say that I’m glad I figured that one out early. There were a few things that needed fixing.

  6. 6
    Silver Fox

    This is a truly amazing post – you say so much, and say it so well. And it makes me think of so many things…I’ve never considered beta-blockers for migraines. Mine generally go away when I don’t work — I take that back, I first recognized them as true migraines during a long period of not working, lots of stuff involved. They may get worse when my BP goes up.Glad that all worked for you and is mostly, mostly better.

  7. 7
    Greg Laden

    The cure is very simple. It takes some practice.Allow yourself, explicitly, thinking time after you’ve gone to bed. This is time specifically to think about the stuff that keeps you up, to work out some of the issues or define some of the problems, etc. Then, in the latter part of this time, shift modes slightly to develop a simple plan for how to address all these issues first thing in the morning, or at least some time the next day. This second phase requires significant glossing of detaials and perhaps considerable denial, etc. That is the part that takes practice. But all you are doing is coming up with the simplest possible “They woke me up out of bed at 3 AM and I needed to have a solution for everything” level thinking.Then read for a few minutes and go to sleep. This may sound trite or silly, but it can work, and has worked. My stressful days involved a constant reworking and re-evaluating of work loads on multiple projects. Decisions I made determined if people had jobs, every single day. Decisions I made had legal consequences, safety related consequences, and business related consequences. There wee between 12 and 50 people, depending on the season, depending on me. Constant uncertainty, constant change, constant stress.But every night I got to the point of having the basic “if they get me out of bed at 3 AM plan” and could then go to sleep.Of course tonight, I’m having flashbacks…

  8. 8
    Ed Yong

    Stephanie, thank you, both for the beautiful post and the hat-tips. But mainly for the post

  9. 9
    Stephanie Zvan

    Thank you, Silver Fox. I do recommend that if you haven’t talked to a doctor recently about the migraines, you give it a go. If nothing else, those expensive, bitter pills can help a lot of people stave off the pain when taken early. Nothing helps everyone, of course.Greg, I’ll keep that in mind and give it a try if I run into that kind of insomnia again. Right now, I’ve moved on to the new and improved type–the kind where I dream I’m awake.Ed, you’re very welcome. Thanks for the compliments here and on your blog and for the consistently excellent writing.

  10. 10
    Jonna

    Wonderful post, Steph!

  11. 11
    Silver Fox

    Greg, I’m glad you posted your falling-asleep cure. I have had to take calls in the middle of the night, sometimes – fortunately I usually get to tell them that they (drillers) called the wrong person.Steph, I do have the Zomiggy stuff. It helps, has helped in the long run. I don’t take it at work for fear I’ll be too groggy to drive. If they get bad again, I’ll be sure to remember this option.

  12. 12
    Stephanie Zvan

    Thanks, Jonna. I’d tell you the same about most of yours, you know, if you had comments enabled. :)Silver Fox, I’m glad you’ve got something that works. I can’t imagine being one of the people for whom nothing does.

  13. 13
    Juniper Shoemaker

    I try to avoid commenting on this blog, because anything I say after any one of your posts will be anticlimactic. Your eloquence provokes both my fervent admiration and my performance anxiety.Maybe that could have been a bad thing, an unexamined life and all, except that I’m nothing if not introspective. Not only had I mined my memories for the lessons they could provide, but I had lived in them far longer than they deserved.Spot on. (Wellbutrin has effects on me similar to the ones you describe.) I’ve also discovered that fits of inspired writing still enable me to “live in the memory” vividly enough to describe it the way (or very close to the way) I want to– without violently upsetting the apple cart. This is enough further examination of these memories for me. So I’d much rather live with the help than without it.

  14. 14
    Stephanie Zvan

    The funny thing is, Juniper, that I feel the same way about your writing. Maybe we should get over that. :)I’ve had it both ways with the writing. This was relatively easy to write about, but I’ve bawled writing one, too. That one wasn’t so much traumatic as sad, though, so I’m not sure it compares. But yes, I’m perfectly happy to have had the help.

  15. 15
    DuWayne Brayton

    Of my first twenty-four hours out of the womb, I managed to sleep for just under ten. It has all gone downhill from there. By the time I was eight, I was sleeping an average of four hours a night. By my teen years, I was sleeping two or three.While I have never managed to get a damned thing to happen for sleep, I am dealing much better with the neurological issues that have come along for the ride. After years of self-medicating with a variety of nasty substances (not all nasty, just a few of them) I am now managing much better with a combination of cognitive therapy (with a rocking fucking therapist who has worked out in spite of a) being a women, b) being an intern and c) being convinced that I’m actually smarter than she is – which may be true, but rocking therapist she is it doesn’t matter) and pharmaceutical therapies, namely Ritalin and Xanax.I can functionally actually sit down and go from one homework task to the next, instead of feeling compelled to do it all at exactly the same time. When I try to clean, I don’t feel the need to do every step at the same time. And when I feel myself slipping into a depressive/manic cycle, I take a Xanax and don’t.I still live with migraines, but they rarely flare up into serious spikes of pain. I still don’t sleep, but the sleep I get has actually steadied into a regular sleep cycle that occurs at roughly the same time each morning. And I still manage to cry when things that I read or experience touch me in a certain way (reading I Don’t Want To Talk About It has been particularly good for this). I also prefer the fiction, much easier than the harsh reality that is life. The problem that arises of deconstructing the events of the day, is that it becomes a cycle of second guessing and ultimately self-loathing. I just don’t believe in self-loathing, so when I descend into it, it becomes a vicious circle – loathing myself for my self-loathing. Hating myself for becoming a whiny little bitch.Much better to take ownership of one’s absolute brilliance and revel in the brilliance of those around oneself.

  16. 16
    Stephanie Zvan

    Okay, DuWayne, I get why inexperienced might be an issue with a therapist. Same with feeling you’re smarter than she is (although that’s not so bad with cognitive therapy, since you’re doing most of the work). Why is her being a woman an issue for you?I completely agree on the problems with dissecting the day. The only downsides I’ve found with fiction are (1) I had to learn not to tell myself stories about real people and (2) I had to learn to trust that I wouldn’t lose something important by letting myself fall asleep in the middle of building a story.

  17. 17
    DuWayne Brayton

    Why is her being a woman an issue for you?Because in the past, the only time I ever experienced success in therapy, was with a male therapist. When I was younger, I was a naturally manipulative little fucker and I was also an avid reader. When I was ten or so, I discovered some women’s studies texts that had pictures of naked women in. I grabbed them for the pictures, but had this compulsive nature about reading books I picked up (I knew about the g-spot and how to manipulate it before I discovered masturbation).It took a very conscious effort on my part to not manipulate women around me – this included the therapists I went through. I was interested in psychology even then and I was charming. All this worked out to a zero sum productivity with female therapists.And part of the issues I’m working through are rather heavily related to my being a guy. So I went into this assuming that this wasn’t going to be terribly productive, but with the understanding that if she didn’t work out, they would help me find a therapist who would.I find that with fiction, I just don’t worry about it. It’s like the songs I used to sing during live shows. I pretty much just made it up as I went along – about half our repertoire was improvisational. Occasionally this resulted in some really fucking awesome songs, songs that even I wanted to remember. I didn’t get upset about it, because I just remembered that the whole reason those lyrics existed in the first place, was because I had forgotten the last lyrics I sang to that theme.

  18. 18
    Stephanie Zvan

    I figured there had to be an interesting reason. Thanks.As for the fiction, my tendency is more toward the obsessively focused, so it’s not too surprising we have very different ways of reacting to the same thing.

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