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The Flat Effect
A Primer on How Not to Read Me
Flat Affect
I present with Flat Affect, especially when properly drugged. Mostly because of the particular combination of medications I'm on:
This is what I describe as a "meta-stable" combination. It's a finely-tuned imbalance of chaos that needs constant monitoring by the prescribing physician and therapist. It's also very easy to destabilize the end result, resulting in any number of psychoses. Most recently, I entered a major depressive event brought on by a combination of factors. Basically, the brain can process events at a certain rate. But if too many events occur that are too complex, the brain is overwhelmed.
Three of the medications can cause two different kinds of physical dependence with associated discontinuation syndromes: Benzodiazepene Withdrawal Syndrome and SSRI Discontinuation Syndrome. There is also considerable controversy surrounding both of these drugs. And there is a paucity of information on them that is disseminated to medical professionals and patients alike.
Function
I did quite a bit of research before beginning these medications. And after beginning them, my ability to function increased markedly after a nearly 20-year downward spiral. But given the particular of medications, and the various side-effects they have, and the general tendency of the mentally ill to discontinue medications for any number of reasons, ranging from "feeling better" to still only barely being functional, this combination is particularly volatile. And ADHD is insidious. It's much easier for neurotypicals to attempt to interpret intention from behavior in familiar terms. But the mind of anyone with a psychiatric condition to one extent or another is actually incredibly alien to a neurotypical. And if you combine the ADHD with the particular Autism Spectrum Disorder I also seem to exhibit, you have a really fucked up combination.
Initially after beginning drug therapy, I followed every bit of advice from my doctors. After three years of having to regularly increase the doses of drugs, and increase the number of drugs, I realized something incredibly important. I am the odd one out.
Oddities
I don't respond to any of the medications according to the predictions of the textbooks, even for people of various levels of dysfunction on the spectra I exhibit. The only medication I take that directly treats one of the two primary dysfunctions should cause loss of appetite and weight loss even in those afflicted with ADHD. However, in two years, I gained approximately 40 pounds.
The other medications treat ancillary conditions brought on by 35 years of social stress brought on by being so alien as to have either quit or lost every job, client, most friends, loved ones, material possessions, the right to drive, cars, homes, family, and pretty much everything. The benzodiazapenes treat Panic Disorder. Alprazolam is for the acute treatment; I take them when I notice that a panic attic is imminent. The Lorazepam is meant to help control the physical dependence of the Alprazolam. And the Escitalopram is meant to provide longer-term management of the panic disorder. And it's also helping considerably with the depression.
However, the benzodiazepenes are actually not effective at all for me in normal dosages. And so after getting 30 0.5 mg pills of Alprazolam initially, which we expected to last a month, I had burned through them in two weeks. And the panic attacks had abated slightly. But weren't stopping.
Then the doctor prescribed the Escitalopram, which helped, although very subtly. And the Lorazepam also is very subtle, but combined with the Escitalopram managed to bring the panic under control for the most part.
