DOSE:	50 mg	oral	Pharms - Sertraline
	repeated	oral	Alcohol - Beer/Wine
	2 hits	inhaled	Nitrous Oxide	(gas)

BODY WEIGHT:

225 lb

First, I should mention that I've been very depressed, off and on, for about the last ten years. I've been on and off medications for depression again and again - and every time I think I'm 'better,' whether I've been on meds and doing well for 6 or 8 months, or once, for almost 9 months, whenever I go off them, whether all at once or slowly tapered over a year, the depression always returns, insidiously, slowly, sucking my will to live, making life seem dull, tedious, repetitive, and myself seem utterly worthless and vile.

Not only that, but the last two times I've been depressed, I've also developed incredibly acute anxiety and paralysis of decision-making, which make it impossible for me to do anything without first 'thinking' about it for more time than it actually takes to do the thing I'm thinking of. My mind is unable to accept doing something 'wrong' or making the 'wrong' choice; it's constantly tracing from the present to the distant impossible-to-predict future, trying to find the 'right' life path for me. Of course, this has wasted years of my life, but every time I try to think of what to do next, I have to consider what that means and how it will affect all the other decisions and variables I'm trying to juggle... and after a while, I get tired of worrying and go lie down and try to forget life for a while.

So, it had been about four months since I took my last Prozac (I'd whittled my meds down from 150mg Effexor, 40mg Prozac, and 50mg nortriptyline / day, to only 5mg/day Prozac), and thought I was doing well enough at my new job, biking every day, and getting ready to go back to college, to get off the last little bit. And I was doing OK, then I was getting bored and more anxious at the same time, then I started sleeping in instead of getting up for dinner (I work night shift, another bad thing for depression), then I started feeling awful and wishing I was dead again, then I started being unable to do anything without a little voice in the back of my head telling me what a loser I was, how I wasn't doing anything right, and even discounting every positive thing that happened as either chance (if I didn't directly cause it) or 'just what was expected, nothing more,' if I'd done it myself. Everything negative, of course, was my fault, whether it seemed to just happen to me or not - because I should have anticipated it, I should have figured that out, if only I'd made the right choice, it wouldn't have happened...

Suffice it to say, I've got a lot of mental baggage.

Lately I've started seeing a new psychiatrist again. About three weeks ago, again, I don't know if this has any effect or bearing on what's going on now, I was prescribed Lamictal, on the off chance that I'd actually been bipolar the whole time and just was depressed mostly (since I've had some hypomanic to manic type behavior every time I've been on antidepressants before... and anything that affects serotonin or norepinephrine tends to make me really happy, creative, and active for a short while, and then drop me back into depression, whether in a day or two (pot), a week (DXM), or two weeks to a month or so (mushrooms or acid).

The Lamictal didn't do much for me. On the starting dose of 25mg/day, I was OK for the first few days, then I got a cottony feeling in my head and couldn't concentrate as well, started making stupid mistakes on the computers at work (I draw newspaper graphics using Illustrator.. and even graphics I'd done a hundred times before, I was doing out of order, getting confused by, etc.), and started feeling like I was dreaming while awake, or was disappearing. Then after a fight with my mother one weekend, and a really tense nine-hour shift at work the next night (both my coworkers called off), I couldn't sleep for three days. The first day I was happy but distractible and unable to concentrate, then two days and nights of insomnia and worry. It only ended after I stopped taking the medication and called off work to sleep the day and night.

Anyway, last weekend I started taking Zoloft (sertraline), 50mg, once a day. The doc said 'well, you haven't tried this medication before, and it's good for anxiety, depression, and OCD, all of which you've been diagnosed with, so try it.' I thought for a couple of days before starting it, about whether I wanted to get back on the medication merry-go-round, but Friday morning, after another night of endless worry and rehashing of fights with my mother and gear-grinding thoughts of 'what do I do, what do I do, I want to die, I'm a loser and I'll never fulfilL my dreams, even though I don't even know what I want to do anymore,' I decided enough was enough and on the way home from work that morning, I bought my prescription and resolved to take it that night when getting up, as the doctor said 'in the morning' - for me, night IS morning. Sick, I know.

Anyway, the next night I attended a party at a coworker's house, only about three blocks from my house, but I drove anyway, since I was late already, and had to bring a 12-pack which I didn't care to carry. Lazy, I know, another symptom of depression; everything seems heavier and distances seem farther to walk. It's just harder to move, that's all.

Plus, I was already tense after another 'counseling' session with my mother, which was more me sitting there while she dictated what she thought was wrong with me, then how much more I should be doing for her, and I sat there until I built up a head of steam and let her know right back how sick I am of her. Not fun.

Anyway, at least the party seemed like a good place to wind down. It was a pretty calm environment, there were about 20 people there that I could see, when I got there at about 9pm. There were guys with long dreadlocks and Bob Marley shirts, girls with their nicest clothes on, some stoner-looking guys, some old-school 50ish hippies; a little bit of everything. A sumptuous feast of ribs, sausage and cheese dips, crackers, cookies, brownies, and a few types of soup sat on a table in the dining room, beer coolers overflowed with Cold Ones, and everyone seemed to be smiling and having a good time. I began to relax, but as usual, I was impatient to start 'having fun,' and decided that to make this a real party, I needed a buzz. The Zoloft I'd started taking the night before hadn't done much of anything yet, so I figured I could safely ignore the ubiquitous warnings about mixing alcohol and antidepressants; I'd done it many times before, with much more of both, so I should be fine.

I dropped the 12-pack I'd brought as a party-warmer in the fridge, grabbed a mug of a local microbrew, and mingled with coworkers and strangers alike. I was my usual socially-awkward, very-polite, extra-friendly, always-anxious self for the first hour or so, able to converse on almost any topic, agreeing with everyone, hiding my anxiety and fear of rejection as always.

Then the first beer began to kick in after 20 minutes or so, and I felt warmer, more connected to others, less worried about what they were thinking of me, and happier. But of course, one wasn't enough, this was a PARTY! I grabbed another and sat in the living room listening to some female coworkers joking about taking cellphone shots of their naughty bits, chuckling appreciatively.

Of course, I had no illusions about sleeping with any of them, being as apprehensive of relationships, and even of supposedly no-strings-attached fun, as I am... depression, social anxiety, and OCD make any imperfect momentary pleasure seem not worth pursuing in the light of the unending litany of possible negative outcomes. Of course, that makes life seem more and more unbearable, as one denies oneself more and more enjoyment on the grounds of 'spoiling' oneself, 'cheating' to obtain happiness 'which can only come from within' as the wise say...

In any case, I grabbed another beer, and another... then began to become curious about the few people who kept appearing from the mysterious wooden door in the kitchen which led not outside to the sodium-arc-lit suburban alley with the late-march crickets chirping in the stand of bamboo on the slope of the forested mountain overlooking the bustling campus town in the valley, but to the Den Of Iniquity, the Basement. Ah, basements, the locale of so much sin, depravity, and enjoyment!

I announced my plan to seek entertainment in what others had begun referring to as The Batcave, and took myself down the narrow wooden staircase with a beer in one hand and the banister in my other. The ceiling was low and unfinished, and bare bulbs hung from cords from moorings in the joists of the ceiling. A thin wood-paneled door with a brass knob ahead was closed, but I could hear the sounds of laughter and conversation from within.

I turned the knob and pushed the door open, and the sight that met my eyes was a familiar one from parties past - a roomful of merrymakers, most with a cold one gripped in their fists, some passing a pipe filled with what my nose quickly recognized as the incense-like odor of mid-grade ganja.

Another sight I was less familiar with were the boxes of small rounded metal cylinders - nitrous oxide cartridges, 'for all your whipped cream pleasures,' as stated in a commercial jingle that popped into my head. A brass nitrous cracker was being used to inflate party balloons - the cheap blue latex kind - and several of my colleagues and other partygoers had already sampled the contents, judging by the box of discarded cartridges, their seals broken and their vapors already used to liven the moods of several human brains.

I seated myself against a wall, all the chairs having been taken and the beer cooler too frequently in use to be a valid butt-placement-object. The bong was passed to me, but I declined, on the grounds that the last few times I'd smoked weed, I'd had a very unpleasant panic reaction (strange, since the first few times, back in 2000 or so, I'd enjoyed it immensely. Perhaps it was a different kind of weed, or perhaps I was on different medications which interacted with it differently... but I'd had enough of that after experiencing heart-attack-like chest pains, the feeling of not getting enough oxygen no matter how much I breathed, and the wrenching terror, of course). Marijuana and I no longer mix well.

I was offered a balloon, however. I shrugged and said 'why not? It's a party, after all, and I've tried it once before, and it didn't do much, so who cares?'. I took it carefully, trying not to let any escape, sat down, and inhaled half of it, letting a little air into my mouth afterward to mix it, to try a threshhold dose before I got into the real thing. After a few seconds, the room seemed to get quieter, and my thoughts stopped racing so quickly; I said 'feels like it tones everything down a bit.' I then took the last bit of the gas from the balloon, and held it a while longer; it was a bit like when I stand up too fast and my blood pressure drops; consciousness faded slowly and I felt lightheaded and giddy, but unlike a blackout, I felt like my body was much more sensitive, and I could feel every bit of my skin clearly. I breathed out and chuckled, put the balloon down and headed to the door where my friend, let's call him Dave, had entered.

The rest of the night, I remember I had another three beers, making my total six or seven, and had a good time laughing it up and chatting with Dave and the rest of the Batcave denizens. I remember that I was talking loudly, completely uninhibited, and even mentioned to Dave about the new antidepressant I was on and that I'd decided that I didn't have to be completely 'straight-edge' to feel good, in fact, I thought medications, drugs, and 'natural' techniques like meditation and hypnosis could co-exist.

After a couple of hours, around 2am, the party began to disperse. I and Dave, still a bit tipsy (but nowhere near a dangerous amount for driving three blocks), bade everyone goodnight, and wandered out the front door, deciding to relieve ourselves in the stand of bamboo, which made a fine privacy screen and was a good deal closer than my own bathroom. When you have to go, you have to go NOW, after all.

When we got back to my place, we sat on my bed and watched some video entertainment; I believe I remember watching 'Morel Orel' and some British show called '15 Stories High.' Of course, still being a bit drunk and nitrous-affected, what we watched wasn't as important; it was funny whatever it was.

We passed out about 4 or so, still feeling happy and dizzy. But here's where it gets negative.

About 5am, I woke up to feel an intense feeling of something not being 'right'. I was very anxious, and felt like my body was entirely covered in the feeling of tension and needing to move, no matter what - 'akathisia' is the technical term. I got out of bed and began pacing the main room of the basement apartment slowly, counting my steps to try to calm down. It helped temporarily, but my anxiety grew and grew. I went upstairs to get a bite to eat and to watch something on the computer upstairs so as not to wake Dave. I watched some web cartoons, and though they were funny and I usually enjoy them (though feeling anxious makes them much less so), this time they gave me no solace.

I just could NOT stop worrying, about everything and nothing all at once. My future was a morass of half-made decisions and uncertainty, everything doomed to fail. My past was a pile of discarded dreams and dead-end jobs, failed romances, academic failure, and reprehensible deeds.

More than simply the mental set, though, my body was panicking. My heart rate was at least 120, my muscles were trembling, especially my thighs and my calves, and I felt the cold feeling of fear and dread in the pit of my stomach. All my muscles and nerves seemed to be filled with negative emotional energy. It was as anxious as I'd ever been, almost as bad as the panic attacks I'd had on marijuana a couple of years ago... but it didn't subside. It just got worse and worse over the next few hours. I drove Dave home about 8am, and went upstairs for breakfast. I told my father and stepmother that I wasn't feeling so well, that I was experiencing a lot of anxiety and that it was probably a side effect of the medication.

At 10am, I drove to a local gym to meet a couple of friends of mine who were thinking of signing up. As I drove, I still felt the anxiety and panic in my body, but a little less so. While talking to my friends and showing them around the gym, which I'd been to a few times before, I felt a bit calmer, with something to distract me from my worries and the awful panicky feeling. But I was unable to concentrate very well on what I was talking to them about and a few times just trailed off in my sentences and stared for a while, trying to calm my thoughts, but I don't know if they noticed. Of course, this made me more anxious - was I making a bad impression on them? Even though these are friends I've known for years, one of them 9 years, one of them 8... still, I'm not totally comfortable around them, or even around my own family, not even my father, who's become my new confidante since I stopped being able to stand my mother. I'm just always afraid of what people REALLY think of me, or of revealing the wrong thing I've done in the past or the wrong opinion, or saying the wrong thing about them or making a bad joke.

My social anxiety was out in full force, but I managed to make some acceptable conversation, and gloss over the fact that I was totally full of worry and uncertainty.

By the time I got home about 12, I was again much more anxious. Although I was anxious around my friends, being alone makes my anxiety a hundred times worse. With no one else to tell my worries to, they multiply and attack me in a swarm, like the black cloud attacking the Yuyu (look up 'the Yuyu,' it's a great visual demonstration of how my worries and fears attack and chase me wherever I go).

I got an email from my mother, about the counseling appointment and about this trip she expected me to drive her on the next Wednesday - four hours, alone with my mother in the car, it terrified me! - and my heart sank. I became more and more apprehensive about it, and wrote a long angry email about it, how I probably couldn't go because she hadn't asked in time for me to ask off from work, how I'd felt like my side of the story wasn't heard at the counseling appointment, how I was under attack from all sides and couldn't get my head straight about what I wanted to do, only about what my father, mother, and other friends and family expected me to do.

As I wrote, I became more and more anxious and panicky. Finally I just had to stop writing, though I felt like I was ' expressing myself,' it was only making things worse.

I stumbled upstairs and told my father I was panicking. I sat down for a while while he explained what he did to calm his own panic attacks - yes, I get panic attacks and anxiety from my father's side, and depression and OCD from my mother's side. I'm a genetic powerhouse of mental interestingness.

Just talking to someone I trusted made me calm down a bit, but I still felt the physical symptoms more acutely than before. My entire body was full of 'negative energy'... I felt the fight-or-flight response, continuously, though it wasn't directed at any particular object of fear or danger. Many fears and worries flitted through my head, too fast for me to think clearly about whether they were rational or not, much less find a solution to them. I was beginning to feel like I was completely lost, alone, and disconnected in the world. When I closed my eyes, I felt like I wasn't really there, like maybe I was just a speck in the void.

They could see I was really truly confused and unable to think of what to do, so my stepmother, who was baking some breads and Chinese dumplings, gave me a simple task to do: knead the dough. That task helped me immensely. I kneaded the dough intently, trying desperately to keep my mind on my physical body and the task at hand to keep it from veering off into the future and the thousand variables it was trying unsuccessfully to juggle. She tried to show me how to make the dumplings, but I was so distracted by my anxiety that I could hardly even follow a sentence through without suddenly being hit by an image of a negative future, a choice I had to make, or a regret about a lost opportunity from the past. I tried my best to concentrate, and made a few sad-looking dumplings, inexpertly twisted and looking like a six-year-old made them in Home Ec.

Even after the dumplings were done, half an hour later, I felt an intense fear and worry. I decided to try to sleep it off. After lying down, a new sensation began: it felt like my brain was tensing and relaxing in my skull, pressure building and fading behind my forehead. When I placed my fingers to my temples, I could feel my veins pulsing. Clearly my blood pressure was very high. I turned the radio on to NPR and listened to A Prairie Home Companion, which always calms me down, no matter how upset I am. However, this time I could barely even tell what he was saying, and couldn't follow the storyline of the News from Lake Wobegon at all. It was as if the present moment, where I was, what I was hearing, was almost completely gone - it was all negative past, negative future, and desperation to figure things out. My mind, always anxious and worried, had been amped up tenfold, and I was being tortured by it.

Everything ached, too: when I lay with my head on my hand on the pillow, my cheek began to ache after only 2-3 minutes. I had to constantly toss and turn. Finally I slept fitfully after an hour to an hour and a half, but was awakened by the phone at 8:30pm. When I got up that time, the fear and anxiety had even increased since earlier. I staggered upstairs unsteadily, and let my father talk to me to calm me down a bit. I picked up a book on mastering anxiety and panic, and tried to read it, but couldn't get through a sentence or two without getting pulled into worry.

Around 10pm, I lay down again, and was able to sleep maybe 40 minutes, then lay awake trying to fall back asleep till 1:40am Monday, when I had to get up to go to work.

Over the next couple of days, I found myself almost completely unable to sleep, and at the same time gripped with the intense anxiety and fear, worry about everything and nothing, and inability to concentrate. More worrying even than that, though, was the sense that my identity was disintegrating, that whoever I had thought I was, even through all the depressions and different drugs I've tried, was disappearing, and now I didn't know who I was, where I was going, or when I would get there - and at the same time, that whatever happened would be the Wrong Thing, because I had messed up my life and could never be happy. I was sure I would feel this way forever. I kept thinking of suicide - as I often have in the past year or so; the thoughts always come back after dropping my medication dosage , and I'd been completely off for months now. But they were more intense now, and life seemed a burden I could hardly bear.

Still, I knew it was likely just a medication side effect; the doctor had said SSRIs often caused more anxiety before they began working 'in 6 to 8 weeks max,' he said. But this was much, MUCH worse than it had been every time I'd started meds before. Even back in 2004, when I'd started on 150mg/day Luvox and 50mg/day nortriptyline, from not having been on anything for 6 months, all I had was a bit of anisocoria (uneven pupils and a bit of a headache), after a month or so.

I looked in the mirror, Monday, and found that, sure enough, I had that weird 'serotonin overdrive' headache, and my left pupil was larger, slightly, than my right. (The first time, incidentally, that occurred was back in 2001 when I took 800mg of DXM while I was also on Celexa. I felt incredibly strange, couldn't tell the beginning of a movie from the end, and didn't recognize myself in the mirror - and my pupils were different sizes - but felt great for a week afterward.)

Anyway, the panic reaction continued for the next two days. I felt awfully anxious, at work and at home, Monday, and when I got home from work Tuesday, I felt 'high' for a while, then low again - and COMPLETELY unable to sleep. Every time I lay down, I'd worry for hours, partially doze, almost get to actual sleep, then suddenly when about to pass out, I'd black out for an instant and wake with what felt like an electric shock all through my body, a very powerful 'startle' reaction. This was almost the same effect I'd had in 2003 on DXM and Luvox / Nortriptyline - staying up for days, inability to sleep without waking up with a start, and strangest of all, having moments of 'no-mind' as meditators would call it - any unexpected sound would make my mind 'reset' for an instant, and all I would be experiencing would be the sound, not any other thoughts. Like momentary 'enlightenment', except that my mind reacted to it very negatively, with fear and panic. It doesn't like letting go of its control over me.

In any case, I couldn't sleep till Wednesday when I finally dug up some old Klonopin that I found in my brother's room, I guess one of his 'emergency supply' (he's prescribed them, too); I took 0.5mg and an hour later I was drowsing and two hours later I had the first real sleep in 64 hours. When I saw the psychiatrist that night, he chastised me for having messed with other chemicals when we didn't even know how the one I was starting would affect me; he said 'rebound effects' of depressants like alcohol and nitrous were probably the cause of my anxiety (though I think, personally, it's more like some kind of universal interaction between NMDA antagonists and SSRIs - look at the other reports of DXM and SSRIs or nitrous and SSRIs).

So, that's the last dissociative I do for a long time, since I expect to be on this Zoloft for quite a while. I'm not going to stop it without a good reason this time - a little side effects or the 'pride' of not being on medications aren't good reasons to get depressed again. If my brain can't decide life is worth living without drugs, it'll have to be on drugs - and this time I want to have stable happiness instead of making waves every weekend with different chemicals and temporary bliss .

So, for now, I'm going to stay on just the Zoloft for now, and see what happens in a few weeks. It can't be any worse than the hell I just went through for three days. Mixing SSRIs with dissociatives gives me, in summary:

- the feeling of being about to 'fall out of my body'
- 'snaps' of sensory overload, like startle reactions to sounds and physical contact
- being unable to breathe enough oxygen
- my heart pounding like it's going to explode
- my stomach constantly churning and freezing with fear
- my entire body being full of jittery terror
- a sense of loss of identity, purpose, and meaning in life, a feeling of absolute confusion and disintegration

In short, a 3-day bad trip. Not recommended.

[Reported Dose: '2 hits N20 (approx. 1.5L?), 50mg Sertraline (daily, 2nd day), 6 drinks (over 4 hours)']

Exp Year: 2008	ExpID: 70266
Gender: Male
Age at time of experience: Not Given
Published: Dec 26, 2015	Views: 4,866
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Pharms - Sertraline (88) : Large Party (54), Depression (15), Retrospective / Summary (11), Combinations (3)