Question: It has been a while since I've talked to you about my ongoing condition and treatment. The good news is that I'm sleeping well, getting by with less Trazodone (sometimes less than 50 mg), and I'm not suiffering from bad spells of anxiety. But the bad news is that I definitely have a problem with crashing after exposure to stress and activity. The more prolonged and more severe the exposure, the worse the crash is and the longer it takes me to recover. Sometimes it can take me all afternoon into the evening before I feel normal again.

It just feels like my mind is not what it used to be, it feels like my "battery" has drained completely and I find it hard to get up and function. I feel best after I've had a night's sleep, and I feel good again after I've had a evening's "chill", i..e, just resting and doing things I can easily handle. The worst time of the day in the middle, after I've had to do some stressful things taking me some hours.

Having a drink is useless and generally makes things even worse. Having a drink had its value when I was having moments of anxiety, but that is not my problem now. My problem is that my mind is not working like it once did, even as recently as one year ago.

What is causing this? If this is not dementia, what is it? What would be the signs of dementia?

Right now I'm still trying to adjust my Lexapro dosage, to see which way will improve things. The main difference between now and last year is that I'm taking Lexapro and Trazodone. As I have said, I am already tapering down on the Trazodone, and hope to be off it by end of the year or so. I recall how I used to be earlier this year when I had bad and prolonged anxiety attacks, but that does not seem to be the big problem now. So, where do I go from here? I don't know.

You say that a cardinal sign of dementia is profound memory lapses. Well, thankfully, I am not experiencing that. In fact, I'm constantly having to fill in others for their memory lapses. I can still solve difficult math problems for that Brilliant website. If that's sufficient reason for not having a diagnosis of any kind of dementia, I'll be overjoyed. But I just do not know.

The best way I can describe how I feel is how one feels when he is inebriated, after having a few drinks. He still has his mental faculties, so that he can function, as an "high functioning alcoholic", but the thinking is not entirely clear and steady and confident. I know how I used to be a year ago, and all the years prior, and right now it's different. The strongest predictor of how and when that happens is the length and degree of stress that I'm exposed to, after which my "battery" feels totally drained. I've been tired and exhausted many times before, but this time it's not the same.

As for weekly therapy, I still have the same online therapist working with me, but she, as well as my prescribing pyschiatrist, are not offering any concrete steps for me to deal with this problem. They simply do not know what is going on.

Now, but here's the thing...once I get extremely engaged in something, I do actually feel more alive and myself again, and for a while I feel okay. I can sustain it for a while and I'm thinking, "hey, I'll be fine!" Then after that stops, my mind then starts shutting down, and I start feeling like a high functioning drunk just sitting in my chair, waiting for the bad feeling to pass over. Which can take hours.

What's going on? Maybe it's just the sensation of "feeling tired and sleepy", but it SURE feels totally foreign to me now. Maybe that is the whole problem. I just do not know. I thought "always feeling mentally tired and sleepy" is one of the early signs of dementia?

Considering that my age is 68, it seems like dementia is statistically unlikely for me.

I watch what I take very closely, I observe my symptoms throughout the day, and every evening I talk with a friend who's known me for most of my life. I agree it's unlikely it's dementia for 2 reasons, 1) it's statistically unlikely for me to have it at my age, and 2) I can still do work that others find difficult to do. I also know that I'm still steadily improving, having come a long way from how I used to be earlier this year. I am now taking less than half as much Trazodone for sleep, I'm getting back into my regular sleep habits without resorting to medications, which is always a good thing. I do not use any of the "herbals" and "supplements" for anxiety, and I rarely ever drink, and if I do, it's just a half shot. I drink far less now than I used to before all this, and I aim to stop entirely. I'm increasingly getting more active, resuming things I used to regularly do before. Eventually, if I can, I plan on gettting off Lexapro as well, if I'm able to return to the kind of life I had before without it.

The point is, I spend far more time paying attention to and thinking about what I am doing than any of the doctors or therapists that I am meeting with.

Dr Cho is still my prescribing psychiatrist and I continue to confer with her about my condition and medications. But she does not fully understand what is going on with me, and for sure a therapist does not. What makes different from most medical condtions is that it involves both the mind and the brain, which are distinct, even as they are intertwined. The mind has to do with your thinking, your emotions, your memories, while the brain is an organ subject to physical changes. How and why you feel as you do is from the two combined, but a therapist is only qualifed to speak of the mind only. We all know how an alcoholic suffers from "anxiety" after quitting, but he is not suffering anxiety because he is WORRIED or UPSET about anything. He is suffering from anxiety because of profound changes that have occured in his brain. A typical therapist does not address that---or at least none of those that I've arleady talked to. To a typical therapist, if you are suffering from anxiety, "It means something is bothering you, so let's talk about what's bothering you and I'll show you that there is no basis for it! You'll soon get better!" That's nearly the entire philosophy of treatment for anxiety, encapsulated, among therapists.

I have already been talking to my online therapist since April, and so far I have no reason to believe that a face-to-face therapist would be any better, given the reality that a face-to-face therapist will spend far less time getting to know me. I already do have a face-to-face therapist, and that's Dr Cho, whom I will be seeing again in her office pretty soon. Like you, she has the more realistic recommendation that I simply expose myself to greater levels of stress, and improve my condition through densensitization. I agree with that. It's looking at the problem as both a mind and brain condition.

Okay, maybe there wasn't a question in my last message, so I'll ask a brief question, kind of a summary. Here's what I plan to do:

1) Keep tapering down Trazodone to nothing in a matter of months
2) Work with Dr Cho regarding Lexapro dosage, with the aim of getting off it completely someday
3) Avoid all alcohol, anti-anxiety herbals and supplements, CBD, etc., as well as medication alternatives to Lexapro
4) Sleep well, eat healthy, be active both mentally and physically
5) Continue with online therapist
6) Steadily increase my exposure to stress, work to resume "life as before"

The only thing I don't plan on doing is finding a therapist for in-office talks.

Is that a reasonable plan of action?

The only way I see how an in-person therapist would have value is if he/she could also address the medical issues involved, such as symptoms from either increases or decreases in medication, or other organic changes that could be responsible. Unfortunately, it is very difficult and time-consuming to go therapist-shopping.

I'll just one more question and then close this out. Should I be concerned about withdrawal symptoms as I taper down both Trazodone and Lexapro? That is, is it unsusual to have to endure such for a while before things finally get better?