Squeak: Prozac, Ativan, Nerve Pain - Gabapentin - Enough!

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Currently taking 40 mg Prozac (fluoxetine), approx 1.5 mg Ativan, and 600 mg Gabapentin for nerve pain. The gabapentin is new (2-3 mos) after a year of awful nerve pain in feet. I am convinced it is related to 12+ years of Klonopin/Ativan (either intra-dose withdrawal or just exhausted receptors, because it would subside with extra Ativan).


Basically always low and tired, with intermittent awful anxiety and despair. Can will myself to do things but get exhausted. Foot pain flares up occasionally. Need Ativan to sleep and have weird spacey dreamy sleep. Also being treated for adrenal exhaustion: basically, no cortisol at all. Low serotonin, GABA, dopamine, very high epinephrine.




I was first prescribed Klonopin in 2001 for anxiety and IBS symptoms, which were causing me to lose weight. I also needed it for sleep in unfamiliar or stressful situations. I didn't take it regularly until around 2004 (0.5 mg and never increased), and twice switched to Ativan, back and forth. I disliked the nightmares I often got from Klonopin, but found the same issue with Ativan.


I was diagnosed with major depression in 2011, and given different AD's like Pristiq, Abilify, Wellbutrin, and Prozac. The Prozac is the one I tolerated best so I have stayed on it except for about a year in 2015 when I tapered off it because I didn't feel any better. Wanted to use acupuncture and diet for mood swings. But I felt worse without it and was weepy and overwhelmed.


Back on Prozac in 2016, doc went straight to 40 mg. She wanted to try other things for sleep but I didn't want to add something new when I knew I couldn't stop Ativan. Foot nerve pain finally diagnosed and treated with gabapentin, no one mentioned that this is even more GABA receptor confusion. I'm exhausted and don't know how to make changes without major symptoms and crises.

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Welcome Squeak,

I'm glad you found us and posted an introduction. I'm sorry you are not feeling well.


Are you wanting to come off your medication? If so, we can help you with that, but first, can I ask you to fill in your signature with your drug and tapering history. Instructions for how to do that are here:


Please put your withdrawal history in your signature


How did you taper off Prozac in 2015?


Benzos are known to cause depression, perhaps that's what caused yours, then you were given another drug to treat that.


Something to understand about psychiatric 'medications' is that they don't cure anything, often don't help, beyond having a placebo effect and can cause harmful side effects. Long term, they can worsen health, increasing the risk of other illnesses. But if you stop taking them, there is often a withdrawal effect and you end up feeling worse than ever. Most doctors then call it a relapse of your previous illness, or diagnose a new one, and prescribe more drugs, and the cycle continues causing our health and quality of life to deteriorate over time.


But with careful tapering, its possible to come off your medications safely with little or no withdrawal effects and that's what we can help you with, if that's what you choose to do.


There are safer, more natural ways to manage anxiety, difficult emotions, and problems in life. Physical symptoms need to be properly diagnosed and treated or cured medically, not suppressed with harmful, brain changing substances. Unfortunately, this is what happens these days in the name of medicine.


I'm curious about why you think you have low serotonin, GABA, dopamine, very high epinephrine. As far as I was aware, there's no way yet of testing these levels in a living human brain. Blood and urine levels are unrelated to brain levels.


When you have your signature done, we understand your history and know what we can help you with, we will be able to offer some suggestions. But for now, here are some relevant links for you to read through:


Why taper by 10% of my dosage?


Taking multiple psych drugs? Which drug to taper first?


Tips for tapering off Prozac (fluoxetine)


You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want. Its a good idea to bookmark it or follow it, so its easy to find again.



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Thank you, Petunia. I added my signature info to fill in my history. The dates of benzodiazepine use are a bit fuzzy. I know I started them way back in 2001 but I don't know when they became regular and then every day. My best guess is 2012.


I have never been entirely comfortable with antidepressants or benzodiazepines but I am basically anxious, self-critical and highly sensitive. I was frustrated with my doctor just plopping me on fluoxetine and leaving me there even when results were mediocre. The Adderall experiment really turned me off. It did give me a kick in the pants but it's an amphetamine and I just didn't want to go down that road. I preferred natural methods like exercise, nutrition, drumming, connecting with people. Unfortunately, my anxiety and bleak outlook along with isolation often keeps me from any motivation to choose healthier options. I am also very dependent on lorazepam for sleep and have anxiety attacks without it.


The nerve pain in my feet prompted a visit to naturopath when it wasn't recognized by any physician and my own research led me to learn about B12 deficiency. A B12 injection calmed the agony that had been getting worse for one year. B12 deficiency is also linked to depression and brain function. Diagnosis was "Phase 3 Adrenal Exhaustion."


Saliva testing showed the low low levels of cortisol and prompted her to prescribe supplements for bio-available B complex, C, D, Adrenal Cortex support, iron, and 5-HTP (which psych nurse practitioner nixed due to my use of fluoxetine). Urine testing showed low neurotransmitters except for epinephrine. Poor methylation is said to be the culprit systemically for this constellation of symptoms. I don't know if this kind of testing is to be trusted but it fit with my sense of low mood and general low functioning. (Blood tests of course showed normal B12.) Of course, whatever practitioner you consult finds that their treatment will be the solution. Acupuncture and Chinese herbs didn't seem to help me so I have given it up.


I am trying to follow my intuition and my sense of what my body needs. I feel that the nerve pain is related to all of these medications and the complex balancing act of brain, body, spirit, outlook, nutrition, community, and purpose. The last ten years have been a sea of disappointment, confusion, failure, and sadness. I can't help but feel that clearing some of the clouds of medications that have built up in me would allow me to feel freer and at least hopeful that I can heal.

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*My taper off Prozac in 2015 was done with assistance from psychiatrist at the time, but I was losing trust in him anyway. I did two-week interval decreases of 10 mg, so went from 40 to 30, then he said 40 every other day was equivalent to 20, then 10, then 10 every other day, then zero. I remember calculating the half-life after last dose to wait until I was clear so I could take a Chinese herbal mixture called Shine.


I didn't have any major withdrawal symptoms during the taper. I noticed the weepiness and depression returning about 2-3 months later. By the end of 2015 I was in horrible shape and was desperately looking for new doctor or nurse to reinstate some kind of medication. The nerve pain in my feet was a big factor as well, and I believe this started after the fluoxetine taper as well.


Even now, I sometimes forget or miss a day (e.g. Last week I had the flu and was in bed and just skipped my supplements and fluoxetine), and don't notice any symptoms better or worse. I guess I feel like it is an extra large placebo, maybe lifting my serotonin which isn't much anyway, and certainly I don't feel lighter or happier with it. But I don't know the best way to get off without depression returning.

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Welcome, Squeak.


How did you feel after taking bio-available B complex, C, D, Adrenal Cortex support, iron? 


Good to hear you did better with a B12 shot. Did you continue with sublingual methylcobalamin B12?


MTHFR variations are very common. You can resolve "poor methylation" or a low folate state by eating lots of fresh leafy green veg. 


I would take the saliva tests results with a grain of salt. The vast majority of serotonin in the body is in the gut. Also see Invalid: Urine testing for neurotransmitters in the brain


Low mood is a common side effect of benzos. It also sounds like you are dependent on the benzo. Very frequently, people whose nervous systems are acclimated to a benzo will get rebound anxiety symptoms as a dose wears off. 


What is your drug schedule? It's very possible, as you suspect, that you are experiencing adverse effects of the drugs. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. This will help determine what's causing what.


You might consider adding these supplements 


King of supplements: Omega-3 fatty acids (fish oil)

Magnesium, nature's calcium channel blocker

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Thank you for this insight. It fits with my experience of this testing and the naturopath's sort of smug, condescending attitude. It is always hard when some kind of selling of supplements is at the root of their practice. Everyone's motives are different which makes it very confusing to know whom to trust.


I am currently taking a "bio-available" form of B complex which includes B12. My best guess is that this helps minimally with my nerve pain. The gabapentin helps the most, as did the direct injections of B12, which I no longer get. I have no idea what the adrenal cortex supplement is doing, I haven't noticed a difference in mood or energy, although I started so many things at once (AD, vitamins, etc) it is impossible to know.


I will try to journal and keep better track of nutrition, sleep, stress, exercise, and supplements. I have an appointment today with my psych NP and wanted to discuss tapering. My feeling was that the Ativan is causing w/d symptoms in between doses, but after reading, I wonder if I should try to get off the fluoxetine first? I did taper off in 2015 as I stated, and have been back on it since July 2016.

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Also frustrated with my inconsistent use of benzos. Should I try to stabilize my dosage of lorazepam at 2 mg per day before tapering off fluoxetine? The gabapentin is just another layer of confusion. I'm really in a pickle.

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Thank you Scallywag! I am from Mississauga originally (go leafs go) (lol)


I had a "preliminary" kind of discussion with my psych nurse practitioner. She was a bit dismissive of some of my issues, e.g. she thinks my gabapentin has nothing to do with any other prescription or effects I might have. I asked about tapering off fluoxetine before lorazepam and she basically said I "need" to be on the fluoxetine.


I said I was willing to keep a closer record of my experience for the next month. I want to stabilize my lorazepam at 0.5 mg 3x day. She suggested that since I have used it a bit sporadically I probably wasn't prone to any withdrawal symptoms and could reduce to 0.25 twice a day and add Mirtazepine at night. Her feeling is that the mirtazepine will be easier to withdraw after I get the lorazepam down and eventually eliminated.


Again, I am left with adding something new (although I did take the mirtazepine previously when she prescribed it for about a week and seemed okay with it, just uneasy) and I hesitate to adopt this strategy.


I could try reducing the lorazepam to 0.25 3x a day but even that is (what feels like) a reduction pretty quickly. My inclination (and after reading about KIS) is to journal more carefully and possibly taper the lorazepam and then stay at that dose and start tapering the fluoxetine. I will need to get her okay to do that and it doesn't seem very likely right now.


I will stay on the gabapentin obviously since it is helping my nerve pain. Not sure what the long-term outlook is with that drug.

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What is your current benzo schedule?


Since you did so well with B12 shots, you may wish to take sublingual methylcobalamin B12, maybe 500mcg a day. It is effectively absorbed in the mouth.


Why did you start taking benzos way back when?

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I am currently on 0.5 mg of Ativan 3x a day and "as needed." I use them inconsistently which I didn't realize was the worst thing to do.


In 2001, I had a bad episode of what seemed like food poisoning (I believe it was a reaction to alfalfa sprouts which I have read can cause an e-coli type infection) (just my strong gut feeling). I then found it very hard to eat anything for months and was losing weight, down to 107 lbs at 5' 7". My doctor suggested Klonopin for the anxiety I developed with this condition and the hyper vigilance I naturally tended toward.


It did help at the time,and eventually after all kinds of testing they just chalked it up to "IBS" and left me on Klonopin. I had bad nightmares when taking it at night so my doctor switched me to Ativan.


I definitely had some depression in the early 2000's, and tried Paxil, Effexor, Lexapro, and other drugs but didn't like the feeling I got from them and just pushed through my low mood and energy. Still taking Ativan most nights for sleep and periodically for anxiety. After two years at a very stressful job, in 2012 I was diagnosed with major depression and took Pristiq (also,Abilify) for about a year, then switched to Prozac when I wasn't getting better.


I became very frustrated with the lack of progress, and when my doctor kept adding things like trazodone and adderall, I resisted, and tried acupuncture and Chinese herbs. In 2015 I tapered myself off of the Prozac, and thought I was okay, but kept using the Ativan throughout. About three months after taper, I was in a weepy and empty state. And I developed awful nerve pain in my feet which is ongoing.


I found a pretty sympathetic nurse practitioner in summer 2016 who promptly put me back on 40 mg Prozac. I really don't know if it does anything for me and I feel like the benzo use for so long must be playing a role in my mood swings and lack of energy and motivation. I was prescribed gabapentin separately by a neurologist and it definitely helps my nerve pain.


So I'm really confused about which med to taper and how to get back some mental focus, motivation, and hope. I'm 52 and feel like the last 15 years of my life have been an emotional muddle and I am drained and disappointed.

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Hi Squeak 

Im sorry to hear about your suffering. Im looking to get my cortisol levels tested and I fear adrenal exhaustion. Two questions for you.  One, are you feeling any better with supplements for adrenal exhaustion ? Two, forgive me if it bothers you , have you felt any sort of sexual dysfunction ?

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I did the adrenal testing through naturopath- urine and saliva. My cortisol was 4.0 in the am and dipped to 1, and to 0.5 at night. Normal range is 18-35 in am, 6-12 daytime and 2-6 at night. It fits with what my energy has been like but now I'm reading that these tests are not reliable. However, I'm still sticking with my intuition which tells me something is off.


Honestly, I haven't noticed a big difference with the supplements. Maybe 10% improvement. Could be it takes more time, I'm supposed to stay on them for six months. The other supplements (vitamins, basically) can't hurt, right?


And as for,sexual dysfunction, I can only say n/a. Not a factor for me or part of my life right now ! Can't help you there.

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Hey Squeak - 


I have been on a different cocktail to you - but - I've found that the longer you use these drugs, the more they "suck up" your endocrine system and "feed it to" your mood and functioning.


You may wish to read here:  http://survivingantidepressants.org/index.php?/topic/1591-withdrawal-syndrome-vs-adrenal-fatigue/ where you will see that none of us really agree - some experience high cortisol in withdrawal, some of us are flat on the floor with no cortisol.  And then there's that "cortisol spike" thing, which feels a lot like anxiety, but once you recognize it, you realize it's a biochemical reaction - a cycle in your own body - that's gone haywire.  http://survivingantidepressants.org/index.php?/topic/33-waking-with-panic-or-anxiety-managing-cortisol-spikes/


I've had surgeries, so my case is different to yours.  But I can say that very few of us have gotten good results from naturopaths, naturopathic doctors, chiropractors, herbalists, etc.  Acupuncture seems to be of help (but the Chinese Medicine concoctions are complex and difficult to isolate if you have a reaction to them).  The naturopath wanted to put you on 5HTP, which, as your psych nurse practitioner pointed out - is contraindicated if you are taking Prozac.  So - maybe the naturopath isn't so clue-y after all?


I was watching a video about Vitamin D3, and this doctor (who was working on sleep and headaches), said that a high percentage of her patients were D3 deficient (the most common nutrient deficiency in the USA), and that some of these patients were also B12 deficient.  She said that not all the D3 deficients were B12 deficient, but that ALL of the B12 deficient were D3 deficient.  Just something to think about.  I don't recommend D3 to anyone without proper testing.  


I'll keep an eye out in my reading about "nerve pain" (all pain is nerve pain, really, this category was created by Pfizer for "awareness raising" and to sell their 2 drugs in this newly created class) to see if I can find anything new that might help.  I swear by my Magnesium baths, either Epsom Salts, or Magnesium Chloride - 1-2 cups in the bath, with 1/2 cup baking soda and a splash of ACV - and it really helps my pain.  Since you have foot pain (like I do) you might enjoy The Red Bucket.  I fill the bucket with my salts and water, and just leave it.  On a bad day, I might dip my feet in the bucket 6x a day.  5 minutes is all it takes - the bucket cools to room temperature, and that is soothing, too.  Sometimes I grab a book, and sit with my feet in the bucket for 20 minutes.  And I take 3 full soaking 20-30 minute baths a week.




If I were you, I would stabilise on a reasonable dose of Ativan (don't make it too hard on yourself!), and then - s-l-o-w-l-y try to sneak out from under the Prozac.  I might get the Prozac down to 20 mg, and then try to reduce the Ativan again.  Only one drug at a time, and no more than 10% tapers, and at least a month in between tapers.  After getting the Ativan down to 50% of current dose (whatever dose that is you choose), I'd go back and get totally off the Prozac, saving the last little bit of Ativan for last.  


There may be some times when you are depressed, moody, and suffer waves of withdrawal, during this process.  We go slowly, so that we can choose the "downtimes," and as we learn our symptoms, we can control our descent better.  I guess I'm just saying - it won't be a cake walk.  Tapering slowly reduces symptoms, and it does get better, but it's also hard work!  And some of that work is on the inside, where nobody can see it.


For your pain, have you tried Omega-3 fish oil?   Some of us with pain have gotten good results from tart cherry extract, as well.


 Wouldn't it be marvellous, once you got off your drugs, if this pain in your legs went away?  After you've been off Ativan for a year, you may find that you want to taper the gabapentin, too.  It will need to be tapered, as - they didn't tell you - it's a psych drug, too.  Any drug which acts on the neurotransmitters of the brain - needs to be tapered.


How much exercise can you do?  Can you walk?  Even 10 minutes a day will help.  I found great relief for pain in Yin/Restorative yoga, as well.


It will get better!  You are bravely embarking on a path which will improve your overall health.  


I hope you see the sun today!

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Thank you JC for taking the time to respond so thoroughly. All of your suggestions are wonderful. I appreciate the research on adrenal fatigue and cortisol. I am reconsidering the cortex supplements, since they haven't done much for me. I want to focus on nutrition, and I will take your suggestions about epsom salt baths.

The "nerve pain" is definitely something different than any other pain/soreness/injury I have ever had. It feels like an electric shock or sunburn around the bottom of both feet. It ebbs and flows daily, and is eased by the gabapentin for certain. So it's a mystery to me but has been the most document-able symptom because it's easy to know when it is terrible.

Today I woke up completely fuzzy due to trying my NP's suggestion of using Mirtazapine for sleep instead of Ativan. Awful dreams and dizziness, in addition to knocking me out swiftly while watching Hulu on iPad. I didn't even have time to close the case! Woke up unsure of where I was and what day it was. Terrible. But good to find out it is a NO for me. I will stick to my slightly lower dose of Ativan as you suggested and stay there until I feel stable. Which I don't today...my mood took a dip after I (forced myself) got up and tried to focus on anything. Hungry and grumpy and just all over the place. Finally gave in and returned to bed. I'm going to give myself a break rather than continue to feel upset. I am disappointed because I thought I was making a little progress just in making the decision to be more proactive. ☹️

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Hey Squeak (I have a special affection for your name - my best cat ever was named Squeak, she picked the name herself) - 


The "nerve pain" is definitely something different than any other pain/soreness/injury I have ever had. It feels like an electric shock or sunburn around the bottom of both feet. It ebbs and flows daily, and is eased by the gabapentin for certain. So it's a mystery to me but has been the most document-able symptom because it's easy to know when it is terrible.


But you guessed earlier that this might be a drug reaction.  If you look on Dr. Joseph Glenmullen's Most Common symptoms of Withdrawal list you will see burning (especialy in extremities) listed there. It's not uncommon in withdrawal and side effects, especially after long term use.   I suspect a huge portion of "restless legs" is a drug reaction, as well.  Whether it's ativan or Prozac, both are good candidates - as is the synergy of taking both of them!


Please add your mirtazapine dose & date to your signature so we can track whether it makes you feel better or worse.  Have you quit the Ativan entirely?  Or just reduced it?

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The nerve pain in my feet is so troublesome every day. I am confused if it could have started after tapering off Prozac, why it has stuck around after I started taking Prozac again? And why it seemed to be relieved by Ativan? Is this just confused receptors acting up? I have been back on Prozac for 8 months. Now it seems as though the gabapentin is the only thing that eases this pain and it is frustrating to have to add another drug after w/d and reinstatement of Prozac. :(

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Some withdrawal symptoms take more than a few weeks to ease and disappear. A few may continue as unwanted companions traveling with you for your entire taper. Expectations can be detrimental at the best of times; during withdrawal they're often our worst enemy.

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Couple of updates: my feet have continued to be my worst symptom. Just stinging and burning up to a level that is bothersome. Tonight I had an interesting insight although (literally) painful: I soaked them with Epsom salts in warm water for about ten minutes, and owwwwww, afterward felt like when you have a really bad burn. So painful! I am sitting here with stinging all over, even after pitting them on cool water for a short time. Frustrated. Hope it's just a one night effect and have learned something about what not to do.


Also: I was feeling pretty upbeat all weekend, taking part in a sports event, my schedule off, getting up early and having to interact more than usual. Monday I had a terrific day, going on a short trip and having a great experience that I really enjoyed and skipped and danced through. I got very little sleep, and then started wondering if it is possible to develop manic symptoms while tapering or changing dosages. Today I woke up super early again, and felt like my ideas and thoughts were racing. A lot of creative ideas etc. Just unusual for me. I got a little freaked out and took a double dose of Ativan so I could slow down and rest instead of bouncing around a dozen different directions. Anyone have advice about this? Tonight I felt my mood change to irritable with my feet hurting. ☹️


Finally, what is the recommendation for skipping doses of fluoxetine? I had been running low on my prescription and for about a week now I've been skipping a pill or just forgetting to take it since it's not in my little pill keeper. I have done this before and honestly hardly noticed a difference in mood or energy. It's one reason why I am doubtful the fluoxetine does anything for me anyway (or anymore)?


I don't think the skipped doses are related to the manic-type symptoms, although you good folks here might tell me differently. I think they are way more due to events happening and activities I'm doing and running around a lot more the last 4-5 days. It's like my system revs up with the excitement, but I am worried about a crash. What should I do now that I've gone about a week taking my 40 mg dose every other day?

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Have more or less accidentally skipped doses of Prozac for about a week, is this a big problem? Should I go back to my regular daily dose, or have I created withdrawal already somehow? Should I lower the dose to (say) 30 mg instead of 40 now that I've done this?







The above post is from your benzo thread, but I'm placing it here as it concerns your antidepressant withdrawal. 


I'll address two issues brought up in your last couple of posts.


1.  It's best to be consistent with Prozac. According to this thread, "After you take it for a few days, half-life is about 16 days." So while Prozac does stay in your system that long, it's not recommended to alternate doses, as this can destabilize your nervous system.  I would take the amount you've been taking (40 mg) every day and at the same time of the day. Do you have enough to do that or do you need to contact your doctor for a new prescription?


2.  Yes, it's quite possible that alternating days with Prozac has destabilized your nervous system enough to shift you into a manic mood. It's best to keep the Prozac dose consistent every day and avoid situations where you need to take an extra Ativan. 


Please note that antidepressant withdrawal is not a linear experience, so you may not feel the effects of the drug or a change in dose right away. There may be a delay and this is how a lot of people never connect their symptoms to the drug. They may come off an AD and not feel any symptoms for several months and then all of sudden, it's like the carpet was pulled out from under them. And unfortunately, most doctors don't understand this aspect of AD withdrawal, either, and will most likely tell their patient they have a new case of depression and put them right back on the offending AD drug. 


Please keep updating and let us know how you do when you're back on a consistent dose. 

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Thank you. I posted to the benzo forum as well, since both are so intermixed for me right now. The Ativan is the one I'm tapering a tiny bit first, hoping to stabilize at 1 mg/day before tapering Prozac a tiny bit.


It's difficult to "avoid situations" when I need the Ativan, since it's so unpredictable and mostly comes from family and other people's energy affecting me so greatly. I am a HSP and empathic as well, so I absorb so much of what's around me, from noise to sadness, to weekend partiers and helpful advice that doesn't sit well, etc etc etc. I hide away a lot when things get too much, but that also brings on depression.


Anybody else have this problem?

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