Any experience or advice on medication for negative rumination?

I tried various …ines for a while (sertraline being the first) but each I quickly became resistant too, leaving me only with massive weight gain (my set point has moved two stone) and other unpleasant side effects like constant jumping limbs especially when trying to sleep. Eventually I came off them but the anxiety has been so intense for two years now that I felt I still needed help, and aware that CBT is less effective on the neurodiverse. 

my proposed solution (and thankfully my GP has agreed) was to be allowed a repeat prescription of diazepam for carefully rationed use. So I take it on the tougher days, about three times a week. That means my system never builds up too much resistance and I also reduce the risk of addiction. It’s a 4 mg dose (2 was barely scratching the surface) at this point, and I’m grateful for the slight cushioning it gives me to help hold ruminating a little more at arm’s length. But I feel I also need my uin-cushioned days too, so that I can properly process worries, get back in touch with my core self and so on. And reassure myself that therapy is still needed, not just the suppressant effects of medication. As ever, balance seems to be key. 

There is a lot of negativity regarding the use of SSRIs on this thread and others. What should be made clear is that they work for ‘most ‘ people when they have depression and associated symptoms.

They will not have an effect on autistic burnout. This is crucial to know, as no one needs to be taking meds for simply being autistic if you know what I’m saying. I myself was offered them a few years ago. I knew I wasn’t depressed, and declined. I didn’t know I was autistic though!

And you are right, Alexithymia plays a part in all of this, and what will help. I couldn’t say that I felt great, and balanced and mentally better (as I stated in my post); I just knew they were working because of what I was able to achieve after they’d kicked in. 

You have only one life and if medication can help improve the quality of your life, give it a go. Antidepressants and antipsychotics have changed a lot, so my advise would be to speak to a psychiatrist who ideally has experience working with autistic patients and try medication. But if that is not possible, do your research, make a decision as to what you want to try and speak to your GP about it. Explain why you want to try A, B or C, take of course their advise into account too and see if this will make you feel better. Keep in mind that you have to try different dosages, different types or even combinations, but if it makes you feel better in the end it's worth wile it. I never wanted to be medicated and also have bad experiences, such as being prescribed the same drug under different brand names, but all in all it really helped me a lot. Personally, I have been taking quetiapine now for a few years, after being on SSRIs and it helped me tremendously.  

Unknown said:

I wish sometimes I could just take my brain out of my head and give myself a rest.

This!

The counselling I did introduced me to the concept of alexithymia - and I do struggle with that and I am becoming more aware that maybe there is some long-term burnout that needs to be addressed as well. 

Thanks for the input - it's appreciated and it helps and there's a lot here that resonates with me.

I now understand a lot of my "generalised anxiety" was probably stress of dealing with every day life as an autistic adult (ie masking) and also autistic traits (difficulty with change, transition, intolerance of uncertainty, perfectionism) which made dealing with the big stuff more difficult on top of the every day stuff.

I started taking SSRI's during a period I now recognise as burnout. I didn't want to take them but didn't have much choice in the end. I felt they didn't make much difference. I dont know if that's because they didnt make much difference or alexithymia came into play. I'm not on them now.  I do meditation which does help. I think changing your environment could help but you said that isn't possible. You seem to be doing what you can yourself (you said being proactive about your sensitivities which is good). Some acceptance of the situation as well (here my brain goes again) and awareness of how autism impacts you (hyperfocus actually can have adverse effects...). And then building in time to do things I enjoy in order to distract a bit. (Engaging in my special interest after work can help but). It's hard. I find the brain loops are a lot more active when I've been around other people. When I'm in my own environment at home, it seems a lot quieter in my head but I ruminate more on existential matters then. I don't think there's a one-size fits all, you just have to find what is best for you. I've found talking therapies and acceptance of myself more effective than medication. I wish there was an off switch. I wish sometimes I could just take my brain out of my head and give myself a rest.

Reading people's lived experiences of this issue - positive and negative - it helps a lot.

Thank you.

I agree 100%

And also: 

Kate Kestrel said:

it gives them ‘breathing space’ to allow them to deal with those things

^^ and this would be my first reason for taking a medication. I had refused when I was younger. Around 35 I had a doctor tell me there was a chance I was headed for a stroke if something didn't change and I realised it was probably time to try something different. I had no idea how debilitating the intensity of my emotions actually were until the first time I took something to calm the anxiety. Working through something with clarity really helped make significant changes. 

But you're absolutely right. If I hadn't done a good deal of work to begin to understand principles of living and laws of nature and realign my values and core being, find synchronicity, learn to ID abuse vs boundaries and so on, taking a pill wouldn't be a moment of space to collect clarity and assert a new discipline, which changes the neurowiring sending those reward / panic signals.

Kevin m said:

Autism is an Amygdala issue

I'm not sure where you found this information.

You may be interested in this chap, though, if you like neurology https://channelmcgilchrist.com/master-and-his-emissary/

Since there's a lot of misinformation about Autism to begin with, and that misinformation leads to autistic children being abused, tortured and given lobotomies, I think it's safer for us all, if (for instance) I don't have a PhD (or even if I do), to help others understand where the information came from, if I spent 30 years on the research or if it's a possible connexion I've made from medical studies I've recently found. 

Sometimes it's easy enough to reframe how you transmit information found with phrases which help open up a dialogue like, "I've read autism [might be] an Amygdala issue" followed by a link to the research. Adding in 'might be' is helpful in case a parent on this site reads what you've written and suddenly decides to give a 5 year old something that could be poisonous which claims to fix the Amygdala. Being responsible with information is really crucial :)

Yes - I’d say my experience of taking anti-depressants was the second most distressing and scary experience of my life (and I’ve had a lot of scary and distressing experiences!). 
live been reading recently about hypersensitive interoception and I think this has a role to play in why I find side effects so hard to cope with. 
I also think that autistic people can have very complex psychological histories - plus the complexity of what we all experience as human beings anyway - and because of that there is rarely any ONE answer to our problems. Certainly no one medication that will solve our complex issues. But I know it can have a role and can help some - and harm others. 
I feel strongly that what autistic people need is an autism centred mental health services  - but that’s not available to most of us sadly. So we end up going on our on journeys - trying to work these things out for ourselves through various routes. That’s why this community is so helpful - because so many of us are trying to help ourselves and so so hopefully provide support to others who are on similar journeys. 
Trying meditation, CBT etc though is a lot less risky than medication. Medication can be a bit of a shock to the system (it certainly was to mine) - and if you’re already feeling fragile it can be hard to cope with a shock to the system. So take care when trying a new medication, and make sure you have support in case it does not suit you. 
The doctors prescribing these medications don’t even know how they work - there are still many unknowns in medicine. There are gentler ways to find peace - but they take effort and time. Personally I realise now that I needed to work out why I felt so bad - and make changes. No tablet could ever have addressed the underlying causes for my distress.  Medication doesn’t solve the unhelpful thinking patterns we have, it doesn’t remove past trauma, it doesn’t make the society kinder or more easy to live in. It doesn’t provide profound and lasting answers to anything. However I have heard people say it gives them ‘breathing space’ to allow them to deal with those things - and I have to respect and trust that that is the experience some people have - and I’m happy for them. 
None of these decisions are easy. I also had the prescription for a long time before actually working up the courage to take them. All I can say is that in my experience they made me feel much much worse - which bearing in mind that I was already in a very bad way was the very last thing I needed. 

You misunderstand. Anti depressants affects the cortex. Autistic people have nothing wrong with thier cortex. So why would you take a cortex drug? Thats why they are a very bad idea. They just sedate you. Its like having a heart problem. Finding no heart doctors exist. So you see a lung doctor instead. Close enough isnt it? No its not! Autistic people need to see amygdala doctors for amygdala issues. Yes! Surely you agree. But no Amygdala doctors exist.so they give you cortex sedation drugs and hope you are sedated enough so the doctors can ignore you abd your amygdala issues 

Your reply has nothing to do with this post.

Please have some respect for the discussions that people are having here.

Autism is an Amygdala issue. The Amygdala controls how you socially interact with others. This interaction overrides any cortex involvement. So the only solution is to control the Amygdala. Have you ever been told that all meditation is only about either your sipne or your Amygdala? 

Thanks for replying to this - it's appreciated.

I was concerned about becoming some chemically-numbed zombie or losing my 'spark' and thankfully I have a couple of people close to me with relevant experience on the medical side and the consensus seems to be that while that was definitely a problem in the 80s/90s it's much less of an issue now where SSRIs/SNRIs have improved so much, doses are much more carefully controlled and GPs and patients are much better educated about the risk/reward balance. 

Having said that there does still seem to be risks and potentially major side effects and an element of hit/miss uncertainty.

Thanks.

I tried an anti-depressant once and it was an incredibly scary experience. The only description I have is that they seemed to lock me out of most of the brain I use. I wonder if this is not a problem for non-autistic individuals as their brains are wired different. Perhaps this is the part of the brain which is used for problem-solving. 

There were a LOT of things in my life at one time I didn't consider fixable. Most of them were either caused from financial hardship or the wrong perspective. I changed so many perspectives and that actually helped with finances. We all need relationships, but not the wrong ones. And while I do work hard to maintain a better life and am nearing 50 still saving to buy a house, my life is incredibly different than 30 years ago. 

Now anti-anxiety medication, when taken with a bit of discipline and in very small doses as a way to take off some of the pressure so I can actually make sound changes to my life, though slow, has been really helpful.

All this to say, if there's more to the story and specifics perhaps there's some group wisdom here and ideas to try and troubleshoot problems with.

I’m glad to hear this. I will tell you that I was scared to take them, and I had the packet sat her for weeks before I’d dare take one! I always suffer bad side effects with everything, and I’d read too many bad reviews and stories while researching them to death…. 
I felt worse before I felt better, so my advice would be to stick at it. They can take a very long time to work, and it’s wise to say that if one type doesn’t work, there are others to try, should you wish to. They aren’t a miracle cure, but a helping hand. 

Yep, that also troubles me...the fact that they do not deal with the underlying issue. It does make me suspicious that they are only dished out to keep the population functioning without actually having to deal with their needs.

I also wonder whether any those who do say it achieves that objective are NT. Some drugs are known to have paradoxical reactions in some neurodivergent people. For instance caffine. I know a couple of Autistic people who will just go to sleep on too much coffee. For me, I like my morning caffine fix, but it will NOT keep me awake at night if I drink it later - zero effect!

I just surmise our neurologies are different and very individual.

Thank you for this - it's good to hear a positive story and the changes you've listed are relevant to me.

Your point about it creating the space for you to deal with other issues definitely resonates with me and I've heard other people mention that.  

Thanks - much appreciated.

I know someone who had a similar experience - they got him through a tough period and took the edge off enough that they could deal with other things. He then gradually reduced the dose of came off them.

I think it’s varies so much from person to person. 
The problem is that you can’t know in advance how you’ll respond. Because of this my general feeling is try other options (with less risk) first if you can - and if you do try SSRIs make sure you’ve got support in case you really struggle in those first few days. Be prepared, be informed, make sure you’re supported. 

I eventually bit the bullet and took SSRIs because otherwise I’d of done the unthinkable. It was a last resort, and I tried because I had children who needed me. I did not know I was Autistic back then. 
While the side effects were long lasting and somewhat unpleasant, after 10 weeks I noticed a slight change. 
From memory, I recall I started to care less. I wasn’t anxious. I didn’t stress, I didn’t explode nor melt down, and it was very liberating. I felt more capable, thus went back to the GP for other problems I’d previously  off. 
I went to CBT appointments, when in the past I didn’t leave the house, and avoided all things. It felt alien, and I was nervous, but I was able to do it, which was a plus. I felt better about myself, and started to reduce overthinking and doing the negative thoughts.

By no means was I happy and full of beans, or living life to the full, but I was doing the things I would always avoid or put off. I went out. I said yes. I went shopping. I ran errrands. I slept. I cooked.  I pottered in the garden. I started running. I enjoyed trips out with the family, I got a job (I had been self employed at home).

After 2 years I decided I was on top of my life to be able to come off them ( like you are supposed to), so I  tapered off slowly over 4-6 months. I am fully aware of the benefits they can have for those that are struggling. It was well worth surviving the initial side effects. I’m alive. My children have their mum. 

Thanks Kate - I appreciate this input from you.

I am wary of these type of medications. It does really seem hit and miss and even the science is not sure why they do/don't work. 

The negative side effects are definitely a concern for me. Feel like I'm only just getting my head round what it means to be autistic - not sure I'm ready for a whole new set of unknowns.

It is just research for now - trying to be an informed patient - but unfortunately I do need to consider it as an option.

Thanks again - much appreciated.