Please bear with me for not reading through FAQ’s and forums before posting. In crisis. Starting new meds tonight and have concerns. Sorry for long post. Skip to Today at the end if beginning is TMI for you.

Background
Adult child of drug addicts (both parents)
Brother recovering/relapsing alcoholic
Sister recovering bulimic/anorexic
Hospitalization 20 years ago with breakdown, suicidal.
Long periods of remission with SSRI‘s and counseling
Developed anxiety attacks – form of throwing up in public, while driving etc. – 10 yrs ago.
Long periods of remission with benzo’s and change to SNRI, Effexor.

2003
Effexor dose doubled after post-surgical and situational depression. 1 mo later developed symptoms: tachycardia and spiking BP. Diagnosed with pulmonary hypertension (terminal) and enlarged heart. Plied with atypicals, antipsychotics, super doses of benzos??? They couldn’t make up their minds whether I had an organic heart problem or anxiety. Anxiety attacks were in remission at the time even with the diagnosis of a terminal disease! Could not get them to reason that increased benzos were not effecting heart rate or spiking BP at all. Took a year of visits to 2 major university research centers, risky heart caths, etc. to determine earlier diagnoses inaccurate, but diagnosed Idiopathic Tachycardia Syndrome (read: your heart has been racing for a year, but we don’t know why) Wanted me to undergo ablation. Of course they had my med lists all this time. I fired all of them including local doctors who made original diagnosis. Found godsend, family medicine practitioner: “you’re doctors haven’t been listening to you.” Helped me taper off all psychotropics,exception: put me on Celexa (good) and kept me on large dose benzos (bad.) Conclusion: Effexor was the culprit all along. It raises heart rate 4 beats/min on average. I am an outlier, sensitive to norepinephrine effects.

Current Meds and Recent Patterns
Meds managed by new nurse practitioner seen since Jan 2009.
40 mg/day Citalopram (Celexa) for depression (same for years) - upped to 60 mg/day 4 months ago because anxiety attacks and depression back – trigger: multi-faceted, extremely stressful, situational events.
2mg/day Clonazepam (Klonapin) for anxiety attacks again out of remission for 4 mos. Made my way down from 6mg/day over course of last two years.
New NP noticed rapid speech, tangential thinking and speaking. I’ve reported perfectionistic, multi-tasking, mind-racing mode and anxiety attacks coming out of remission esp. during last 4 mos.

Suggested in last couple years by NP and also my therapist, may be bipolar. I can see possibility because of the ways SSRI’s made me more outgoing, talkative, mind racing. Pattern, last couple of years: I have bursts of creativity (writer, poet, painter, software engineer) which end in burnout then I abuse alcohol and cigarettes to cope. This works for a few days then I get sick so I abstain for a few days and then my mind starts racing again. I have reported episodic alcohol abuse to therapist, but not to NP (stupid, but I don’t want to lose my 2mg klonapin.)

Today
Close to another breakdown, suicidal – trying to avoid hospitalization
2 Weeks ago caught alcoholic narcissistic BF/SO, of 7 years, cheating. Left. Trying to cut off all ties except talks about getting my things from our condo. He has started a new relationship with this woman which makes me crazy. Mind racing about BF and his new GF. Spinning on these tracks and can’t stop it. Can’t eat or sleep even though taking my meds (Citalopram, and Clonazepam) plus my long-term regimen for sleep - diphenhydramine 50mg, melatonin 5 mg. Have lost 14 lbs in 2 weeks. Some nights I don’t sleep at all. In attempt to put my life on new course, 12 days ago, had my last cigarette and alcohol.

Finally went to NP (Nurse Practitioner) today.
Put me on Lithium 300mg to start tonight and trazedone ¼ - 1 100 mg for sleep.

Concerns about Lithium: 1) Cannot gain weight. Gained 50 lbs on Remeron during 2003 debacle and have never lost it except now 14 lbs. NP told me some people lose weight on lithium gave me choice of Abilify or Lithium, pushed for lithium said would start working faster and risk of weight gain less – some lose weight on lithium??? Friend gained tremendous amount of weight on Abilify.

2) Loss of creativity – never heard that one before, I know

I’m okay with some side-effects in the short-term, just to get over betrayal and to start sleeping and eating again. Know I can't go on like this much longer. Worried about long term effects.

Concerns about Trazedone – concerned about not getting REM sleep, although I’m not getting any now, anyway. Again, okay in short term, but am vivid dreamer and journaler – don’t want to lose that.

Would kill myself if thought it would solve my problems but, unfortunately for me, I believe in karmic ramifications in the next life. Also I know that it is difficult to succeed.