Curse Your Sudden but Inevitable Betrayal!

5:00 AM: In a cruel twist of irony, I can’t sleep and the very music I listened to yesterday to give myself energy is playing itself on repeat in my head, keeping me awake.

There are other factors, too. I went to bed feeling anxious about the morning, when I’ll have to leave the house earlier than I tend to wake up in order to be on time for my appointment with Wakana. I went to bed before Fox  – who was playing Oblivion – because I was tired and bored and didn’t know what else to do with myself. I felt like somehow being creative, but I couldn’t decide on an outlet so I decided to sleep.

When Fox came to bed he was very nice. I thought he fell asleep, while I had trouble getting comfortable, but he thinks I fell asleep first. I must have fallen asleep for part of the time because I have vague memories of stressful dreams somehow related to the 11th Doctor, Amy, and Rory in a parallel universe or … something. The Doctor is happy to see his friends again, but I think one of them dies and he ends up having to kill the other. Because that’s the kind of thing the Doctor really needs.

On Monday night we listened to relaxing Native American music; that really seemed to help us both fall – and stay – asleep. Last night there was no music and I definitely noticed the difference. Whether we play it while we’re falling asleep or I listen to it right before bed, I need relaxing music to help my head quit spinning. Winding down is at least as important as revving up to ensure I have enough energy.

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Planning A Head

I have had enough. Enough feeling horrible. Enough choosing not to go out because I don’t want anyone to see me. Enough living in clutter because I feel completely unmotivated to do anything about it. On Monday I didn’t even want to eat, that never happens (if anything, I usually overeat).

Saturday night was a lot of fun; Fox and I went out with some friends to a game store, where we could play board and card games to our hearts’ content and socialize with other people. It got a bit loud and overwhelming, but I was able to enjoy the social interaction and have fun playing the games. I even won Ticket to Ride: Europe and a hand of Magic: The Gathering. That felt really good!

A map of Europe with colorful train tracks connecting major cities.

The outcome of a 5-player game of Ticket to Ride: Europe. I played as blue – and won!

Unfortunately, it went a bit on the late side, and when we got home we were too excited to go to bed. We ended up pulling an all-nighter (sorting through Magic cards) and were a mess for two days. Our sleep cycles have been completely thrown off, our diets far from balanced (meals? what are they?), with barely any energy or motivation to do anything useful. We both seem to have some kind of cold or something. Yuck.

(Potential) Psychiatrist C-1 called while I was in my session with Wakana on Friday and I didn’t have a chance to call him back until Monday. No answer. I left a message. No return call. Now it’s late in the day on Tuesday. Nada. It’s been two business days, he might not even be in. But I’m sick of this nonsense. I know it’s unreasonable to blame him and I really don’t but I need to do something. Psychiatrist C-2 hasn’t called at all.

It’s time – past time – to take the matter into my own hands. I’ve had enough – more than enough – of this nonsense. I’ve written about treatment plans before but did I act on them? No. Well, not this time.

I really really hope, not this time!

Wake Up on the Right Side of the Bed

On Monday I made a 25-minute playlist of 5 songs to help me feel energized – or at least less dead – in the morning. I listened to them soon after waking up today (Tuesday) and wow, what a difference they made!

MP3 player next to a quarter.

This tiny little mp3 player is awesome.

The first two songs are from Barefoot and Flying by the Ebony Hillbillies, who play Black string music. They’re fun and active without being overly energetic or hectic, and I’m madly in love with the bass. The vocals are quite enjoyable, too. One song has a violin part that outright tickles me, and I enjoy the unique rhythms and timbres from the washboard and other percussion in both.

Two more songs are from Dance of the Celts: the first starts kind of mellow and picks up speed and energy as it goes along, while the second includes didgeridoo. The low drone and unique timber of the didgeridoo do amazing things for my mood; listening to it (for me) is like eating the most decadent chocolate while having absolutely fantastic sex. If that can’t perk me up in the morning, nothing will.

Finally, I ended the playlist with The Chieftains Reunion, an 11:22 monstrosity with a variety of changing instruments, very fun energetic rhythms, and a unique female solo vocal part around 8:30 that I can’t resist singing and sometimes even dancing to.

By the time I finished listening to the list, I felt calm, alert, ready to face the day, and even happy. I noticed that my mood started worsening pretty soon afterward, though, and the high energy to … well, nothing – because I wasn’t listening to music anymore – seemed to be the key contributing factor. I think adding a mellow, soothing song or two to bring my energy down more gradually would probably help quite a bit.

Break Your Fast

I’m usually pretty good about eating something very soon after I get up, even if it’s just a handful or two of raw nuts. Add some water, and I’m pretty much good to go – or at least less grouchy. My ideal would be to have eggs and whole wheat toast for breakfast every morning; it’s the most satisfying and energizing breakfast I’ve ever had.

A field of flax flowers, whose seeds will provide me with Omega-3. image from informedfarmers.com

A field of flax flowers, whose seeds will provide me with Omega-3.
image from informedfarmers.com

The harder thing for me to do is take pills. If I’m going to take them at all, around breakfast is the best time. I’ve decided to resume taking an Omega-3 supplement (1200mg flaxseed oil, which includes Omega-6 and Omega-9 as well but at lower doses) and a complex that has multiple forms of Vitamin B and includes Vitamin C for some reason. I’m thinking I should see if I can find a similar complex by a different manufacturer, though, because the one I currently have includes “inactive” ingredients I expressed concern about in my post, Ingredients.

I ran out of the Vitamin D supplement I’d once been taking, in part because I thought I’d be okay if I didn’t take it in the summer. Unfortunately, I just don’t seem to get enough sun for my body to produce what it needs. So maybe I need a lower dose of the supplement in the summer than I do in the winter, but I still need to supplement whatever my body is able to make naturally. I plan to resume doing so as soon as I’m able.

Finally, I’ve decided to go ahead and self-medicate with SAM-e. It’s a supplement that is supposed to help one’s brain produce the neurotransmitters it needs to run, well, considerably better than mine has been. Unlike Protazen (see previous post) – which explicitly has not been subjected to efficacy research “in order to avoid raising the cost to consumers” (according to their customer service representatives) – SAM-e has multiple empirical studies backing it up. It’s probably not any more – possibly less! – expensive than taking a brand-name drug, even with a prescription (insurance) plan. And I can get it in about 3 clicks, no phone tag required. I took my first dose today.

After shopping around a bit, I’ve decided to buy my SAM-e (and possibly other supplements) from Now Foods. They (say that they) use “natural” ingredients – things you could find in nature or synthetic chemicals that are essentially identical – and explicitly avoid the strange substances I expressed concerns about in my post on inactive ingredients (link). I’m hoping the stuff they use will be a bit nicer to my body and possibly even help (or at least not hinder) the active ingredient.

Spock Helps Those Who Help Themselves

So after I wake up to the sound of music, pop a bunch of pills “natural” supplements, and eat breakfast, I get to focus most of my energy on trying to feel good – or at least less like dying. (That’s not an exaggeration.)

a rat on a girl's shoulder

furry little companions make everything better!

The rats are wonderful. They’re cute and fuzzy and happy to see me – especially in the morning when they’re hungry. It’s really hard to interact with them without a smile breaking out across my face, whether I think I feel like smiling or not. The more I can spend quality time with them, the better.

Hey, you know, Fox is pretty wonderful, too. When he’s not being grumpy pants … and sometimes even when he is. 🙂

Our herb and vegetable garden is doing pretty well, all things considered. Sure, the parsley is a lost cause and the basil has seen better days (literally) and I’m not sure we’re ever going to get cucumbers from the strange prickly vine that’s waiting to ambush us from its pot. But the weed chocolate mint is thriving (seriously, looking for a delicious ground cover? get this stuff and hope your neighbors can appreciate it, too), our peppers are getting fat and starting to turn orange, and on Monday I harvested the first of our beautiful red Roma tomatoes! Just thinking about it makes me very happy. It would do me a lot of good to at least check on the garden every day, even if it doesn’t need weeding, pruning, or watering.

I’m enrolled in several free online courses on Coursera as well. To be honest I haven’t been paying much attention to the one that’s already started, but that’s okay because it won’t affect my GPA, I didn’t pay for it, and I’m taking it entirely out of interest. This gives me something to do and an opportunity to learn about diverse topics I’m interested in, for the fun of it, no need to stress. Win-win.

I’m still seeing Wakana twice a week, though we’ll have some breaks because she’s traveling in August. I stopped being consistent with massages but they’re still on the radar as something to help relieve stress. Aromatherapy can be added to the massage; maybe I’ll even get around to trying it at home, too. For starters, I can use the extra lotion I took home from past aromatherapy-enhanced massages. And I’ve been increasingly tempted to go see a chiropractor as my back, shoulders, and hips become increasingly painful.

Yes, I know, 30 minutes of exercise per day has been shown to help fight depression. It would probably do wonders for my chronic pain, too. I’m just not quite there yet. Nor am I ready to get out, join social groups, try new things, etc. – at least not without a lot of support, poking, and prodding by people I trust enough to share a bed with them. Let me practice on the foothills until I can climb halfway up one without struggling to breathe, before you ask me to climb Mt. Everest.

But speaking of climbing Mt. Everest, I have no idea where the Out of the Darkness Overnight is going to be in 2014. Wherever it is, I want to do it next year; whether I can attend the event or not, I want to start training for it ASAP. The more time I can give myself to get in shape, the better.

book cover: Codependent No More by Melody BeattieFinally, I’ve got some self-help books I’ve been meaning to read and do the exercises in. They have to do with time management, unlearning the lessons of an abusive childhood, and cognitive therapy for depression. One of them isn’t a self-help book per se, but might provide useful information for selecting music based on its potential therapeutic effects. (Just to clarify: that’s not music therapy, because I’m doing it for myself. However, it is one thing music therapists often do as part of their work with clients.)

I took another look at the chapter on Detachment in Codependent No More by Melody Beattie. I’m not entirely sure I’m done with it, nor whether I want to write another post about it, but I do plan to continue on through the rest of the book from there.

And How Will You Know If All This Stuff Is Working?

The Burns Depression Checklist is a very valuable tool for measuring severity of symptoms and tracking changes in said severity over time. It’s a self-report measure that’s been tested and found to be quite accurate and reliable. It’s used by many mental health professionals. The link above is only one of several that can be found via Google search; I selected it because it includes the scoring scale and will calculate your score for you.

I filled in the checklist Monday evening and my score was 60, indicating severe depression. It’s easier for me to focus in on one day at a time, but the severity of my symptoms can fluctuate pretty drastically from day to day or even over the course of a given day, depending on a multitude of factors. There were times Monday when I felt like I was perfectly fine, and yet also enough shitty moments that my responses earned me a 60. So, I think it’s probably best if I complete the checklist multiple times per week, focusing on a single day each time, and then take the average score for each week. Over time a pattern will emerge, and that pattern will help me see how my depression is doing.

It might also be helpful to make note of anything that might be having a particularly strong impact on my symptoms. “So-in-so visited for a few days and I was very happy to spend time with zir. It was great while ze was here, but a bit of a letdown when ze left.” “I had a very fun high-energy social evening, but didn’t get enough sleep afterward. Sleep deprivation made my symptoms a lot worse until I managed to fix my sleep cycle.” … I think you get the idea. Then instead of throwing up my hands when there are too many variables to have any clue which ones are having an effect, or whether the positive effects of my treatment are just being utterly thwarted by the shit life’s throwing at me, I can actually look at all (well, most?) of the variables and get a better feel for what’s going on.

Holistic Treatments for Depression and Anxiety

angry doctor on the phoneI guess you could say my big accomplishment for the day was finally calling not one but two psychiatrists … and leaving them messages because I semi-intentionally waited until after 10pm. The first, whom I’ll call Psychiatrist C-1, has an office within walking distance of Wakana’s and is reportedly available on the same days I have music therapy. Two of Wakana’s colleagues referred Psychiatrist C-1 to her, so she in turn referred him to me; she even called me earlier today to make sure I’d at least attempted to contact him. (I’ll file that one under “Tough Love.”)

The second, whom I’ll call Psychiatrist C-2, is the one who received 9 5-star reviews on HealthGrades and whom I mentioned in my last post. I’m actually a bit more inclined toward her because I know for sure that she takes my (current) insurance, she got much better reviews on HealthGrades, and I won’t be doubly-screwed if I don’t feel up to making the trek to Wakana’s office on a joint music therapy and psychiatry day. But, I’ve taken the “passive aggressive” approach of leaving messages and waiting to see who returns my call, instead of directly “confronting” each of them with my request to meet face-to-face. So, now all that’s left is to wait … at least until my next music therapy appointment (in less than 12 hours), when I suspect Wakana will “strongly encourage” me to try again.

Wait. What does all this have to do with holistic treatments for depression and anxiety?

Well, I told Mom how I was feeling about calling a psychiatrist – something I’d probably feel less inclined to do if Wakana didn’t insist that it’s an absolute necessity. I’m angry that things haven’t been going well for me on that front, ashamed that I can’t just “snap out of it” and live a productive lifestyle, worried that I’m never going to find the right doctor and treatment … which leads to hopelessness, and feeling like I don’t deserve any better.

Mom said a bunch of things. She thinks the search for the psychiatrist is doing more harm than good and that the medications were doing more harm than good; I seem to be doing better without them. I’m inclined to agree with her – I’m still struggling AND I feel more like myself, more capable, more in control. Tuesday night / Wednesday morning I was able to act on my need and desire for intimacy with Fox for the first time in months – and thoroughly enjoy it! – whereas while I was on the sertraline HCl (and buspirone HCl) I felt … nothing. I also seem to be regaining my ability to tell when I’m not really hungry anymore and stop eating after I’ve had a reasonable portion / before becoming uncomfortably full. The only time I really feel, well, depressed is when I let myself get caught up in my own thoughts, to the exclusion of physical here-and-now interactive interpersonal reality. And when I first wake up. And when obstacles exceed my frustration tolerance, which seems to be lower than normal.

bossy ladyMom also gave me a long list of things I need to be doing to take care of myself, most of which she’d categorize as a “holistic” approach to treating depression. I need to watch what I eat, exercise, get out of the house, clean up and organize all the stuff cluttering my apartment, meditate, do yoga, join social groups, play music, get a job – or at least volunteer – and so on. Any “explanations” I try to provide for why these things are difficult for me – why I’m not already doing them, why I’ve withdrawn from them – are “excuses.” She says I have to “force” myself or “push” myself.

I’m tired of forcing and pushing myself. I need to take a couple moments (months? years?) to love myself. To care for myself. I need a hug.

I understand that I need to take some responsibility for my own well-being. The depression isn’t going to cure itself while I’m playing Oblivion and complaining about my lack of energy, motivation, confidence … But, can someone – anyone! – try to meet me halfway? If I could just do all the stuff Mom says I need to do, then we couldn’t be having this conversation. Clearly I need some kind of help to be able to do those things; when she says I should be doing them the message I get is that I’m a bad person for not doing them. A disgrace. A failure. An embarrassment.

I want to do these things for myself, I really do. I just need some kind of emotional support. Someone to not only tell me to do them, but to do them with me. Is that really so much to ask?

I looked up holistic treatments online and found a lot of the same things across websites:

  • healthy/balanced diet, including specific nutrients
    • SAM-e
    • Omega-3 fatty acids
    • folic acid
    • B-vitamins
    • kava
    • valerian
    • reducing caffeine and sugar intake
  • exercise (at least 20 minutes 3 times per week)
  • acupuncture
  • SOCIAL SUPPORT
  • routines, goals, taking on or maintaining responsibilities
  • sleep

The websites in question are MedicineNet, WebMD, and Taking Charge. That last website, Taking Charge, includes a list of medications used to treat depression – some of which (dual-action) were new to me. This might be something to talk to my psychiatrist about, assuming I ever find one.

an orange butterfly and a medication bottle

protazen.com

Of course, the very first website that caught my eye is a giant multi-page advertisement for a supplement called Protazen. It includes a variety of nutrients – including some of those listed above – some of which the brain uses to create essential neurotransmitters such as dopamine, norepinephrine, epinephrine, and serotonin (according to the website). The idea of using natural supplements to support healthy brain chemistry is very appealing, especially if it’s possible to do so “without harmful side effects!”

To be honest the whole thing sounds too good to be true … except that they do clearly state that the supplement is not intended to treat clinical psychiatric disorders, and that results may vary. It’s intended to help people experiencing difficult emotional states, not serious medical issues. Consult your doctor first if you are taking antidepressants or other medications.

In other words, I do not recommend or endorse this product. I repeat, I do NOT endorse this product.

In fact, I’d really appreciate it if you’d take a look at the website and comment on this post to let me know whether you think the supplement is worth trying, whether there are likely to be health benefits. Is trying it worth the potential risks (financial, medical, mental, emotional, etc.)? What experiences have you had taking supplements?

But what if it can help, even if just a little bit? More energy, more motivation, an easier time concentrating, less fluctuations in mood, etc. I could buy it right now – 1 non-recurring 30-day supply for $40 – no phone calls, appointments, uncomfortable questions, stuck-up psychiatrists, battles with insurance companies, etc. required. It will be delivered straight to my door, likely within a week. If I don’t like it I can return whatever I don’t use within 30 days for a 50% refund. No psychiatrist or pharmaceutical has ever offered me that!

Beyond tempting.

Stop having Cancer so you can Find a Doctor who MIGHT be able (and willing) to Treat your Cancer

It’s been over a year since I conceded that I need medication if I’m ever going to recover from depression. “Recover” seems so far away, is it even possible? How can I “recover” from how I’ve been my whole life? Maybe “manage” is more appropriate. I need medication to manage the symptoms so I can live.

Attempt 1: A Depression Study

image from rodale.com

image from rodale.com

A year ago I learned of a study in my area that seemed like a good opportunity to receive medication, earn a small amount of income, and possibly even help others with depression through my contribution to research. I answered countless uncomfortable and redundant questions on the phone while feeling incredibly emotionally vulnerable. I let them take my blood (I hate needles). I submitted to other medical tests. I was honest, maybe too honest: I admitted to feeling suicidal.

The study psychiatrist seemed concerned when we sat down to talk about my participation. He said they would have to put me on a medication and just keep giving it to me for the duration of the study, whether it was working or not. In my case, he thought that wouldn’t be safe; that I should receive more personalized and flexible care – care designed to treat my depression, not gather research data. I appreciated his honesty.

Attempt 2: Psychiatrist A

brand Wellbutrin XL 300mg

I can’t help wondering if this could have worked for me.

Wakana referred me to Psychiatrist A. He prescribed Wellbutrin and gave me 2 weeks worth of the actual brand-name drug. For the first week I took 150 mg/day and thought it was helping. In the second week I (following his instructions) started taking 300 mg/day and found it to be too much. He prescribed 200 mg/day, split over 2 doses. I received generic bupropion HCl when I filled the prescription.

I felt like it wasn’t working and wanted to increase to 250 mg/day. Instead, he added Lexapro. Due to a miscommunication, I ended up taking 200mg of bupropion HCl in one dose, followed hours later by the Lexapro escitalopram (generic). I had symptoms of serotonin poisoning and became very upset when Psychiatrist A said they were due to “anxiety” but I could stop taking the Lexapro escitalopram if I wanted to. I did so and, under his advisement, cut the 200 mg bupropion tablets in half so I could take 100 mg twice per day. I became incredibly irritable and was almost always angry with Fox, through no real fault of his own. Wakana and Psychiatrist A both urged me to stop taking the bupropion, so I did.

My trust in Psychiatrist A had been shattered, so I refused to go back to him. Part of my justification was that Fox’s sister – a registered nurse – had talked to him and expressed anger at how he responded to her. In other words, it wasn’t just me! But now, in hindsight, I’m wondering if there were factors none of us could see; maybe I was too quick to judge and too harsh in my judgment. I was seeing him through the same lens that makes me feel worthless, makes me overly judgmental of Fox, makes every obstacle feel completely insurmountable. I’m trying to look back at the situation through a different lens; who’s to say my perception now is any more accurate?

I had terrifying experiences while under Psychiatrist A’s care, and – whatever his intentions were – he failed to help me feel supported and cared for. Lens or no lens, I can’t risk that happening again.

Attempt 3: Psychiatrist B

Zoloft blob, sad, in cave

a good depiction of how I’ve been feeling, both on and off sertraline HCl

I switched to Psychiatrist B just before starting this blog in December. At first I was hopeful that he would help me – if nothing else, he seemed very confident when he prescribed Zoloft. I, of course, received the generic, sertraline HCl, from my pharmacy. It made me very sleepy but seemed to help calm some of the chaos in my brain – the racing thoughts and raging emotions – without intolerable side effects. When I told him about anxiety-related symptoms I was having, he added Buspar; I received buspirione HCl.

At the very least, those medications haven’t been enough to help me through the difficulties I’ve been having this year: moving, the death of my uncle, having to drop my graduate courses, Mom’s surgery, Fox moving in with me, my rats’ health issues. It’s hard to say whether they’ve been hurting – via side effects such as increased sensitivity to clanging sounds, suicidal ideation, and temptation to self-harm.

Whatever was going on with the medications – I’ve been off them for about 2 weeks now, so they should be completely out of my system – the bottom line is Psychiatrist B didn’t take my symptoms seriously either. He interrupted me in the middle of telling him about my suicidal and self-harm thoughts. He wouldn’t talk to Wakana about my case. He didn’t seem to care at all.

Okay, maybe it’s not really a psychiatrist’s job to support his patients emotionally. It’s his job to evaluate their symptoms and prescribe medication. Psychiatrist B failed to do his job. He interfered with my ability to report on my symptoms. He did not seriously consider the connection between my reported symptoms (suicidal ideation) and known side effects of the medication he was prescribing (also suicidal ideation)! Whether I am inclined to act on the thoughts or not, they are extremely disturbing – and quite the opposite of what successful treatment of depression should entail.

Attempt 4: The Ongoing Search for Psychiatrist C

frustrated woman holding cell phone to ear

why me?

I’ve been procrastinating, but Wakana has been urging me to actively search for Psychiatrist C. On Tuesday, July 9th, she supervised while I searched my health insurance company’s website for potential psychiatrists in my area and called one.

The psychiatrist’s receptionist called back on Wednesday; I returned her call on Thursday. She asked a few questions (What are you coming in for? What medications have you taken previously? Any substance abuse?) and said that the doctor would contact me to make an appointment if she thought she could help me.

Excuse me? I felt like I was applying for a job – when, really, it should be the other way around! I couldn’t even make an appointment because I felt the need for one, sit and talk face-to-face with the Almighty Doctor before she made a decision about me! (I should be the one evaluating and making a decision about whether she’s worthy to treat me!) What is this?

I expressed my anger to Wakana and she agreed that that is no way to treat a potential client. It’s been a week, by the way, and I have yet to hear back from the psychiatrist. To be honest I didn’t really expect her to call me, and I’m not holding my breath until she does.

Riding the wave of my swelling anger – that is, energy – I went to HealthGrades to try and find a psychiatrist in my area who is recommended by patients. I have contact information for one who received 5-star reviews from all 9 of the people who reviewed her. She has 2 offices, both of which are within 15 miles of my home. And I was also able to find her on my health insurance company’s website.

All I need to do is pick up the phone … but that’s where the wave crashes into the shore and I’m left lying there, soaked in sand and struggling to breathe, feeling like any moment the undertow will pull me back out into the ocean. I don’t want to experience any of these disappointments again: the unreturned phone call, the discomfort reporting my symptoms, the lack of being taken seriously, the unhelpful and potentially harmful meds. So it’s been a whole week and I’ve “done nothing” to secure the health care I need; how can I expect anyone to take that need seriously?

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I’m trapped behind a lens through which every obstacle seems insurmountable, every effort doomed to failure, nobody cares, and I don’t really deserve the help I need, anyway. Somewhere there’s the tiny part of me who knows that none of this is true, that hopes that if I just keep trying I’ll be successful, eventually … but right now its voice is very soft and, through the lens, it looks quite naive. Asking me to call another psychiatrist is like if someone had told my mother she had to climb Mount Everest unassisted in order to get her knee replacement surgery. (No one climes Mount Everest unassisted, even if they’re in “perfect” shape.) The reason why she needed the surgery is because her knees were hurting her so much she could barely climb the stairs.

Healthcare Headache

My health insurance finally paid their share of the bill for my first visit with Psychiatrist B, which occurred 7 months ago to the day.

When I learned of this, I decided to (finally) look into options so I’ll have health insurance after my current plan – which is dependent on my being a full-time student – expires. There is an option through my current company. When I called for a quote, the person I spoke to was very nice! She asked a few questions and suggested a plan that costs – wait for it … – $400 per month! This is marketed to students who are between leaving school and receiving health care coverage from their employer, mind.

I took a look at the information she sent me and became quite concerned. One of the criteria that prompted her to suggest this plan instead of a less-expensive option was my need for prescription coverage. When she told me the benefits, I thought they included prescription coverage. But when I looked at the explanation of what the plan covers, it explicitly excluded all prescription drugs – even generic! It also explicitly excludes mental/behavioral health care.

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I thought, there has got to be something better out there! I searched for “affordable health insurance” and found ehealthinsurance.com. Through that site I was able to find a plan with a different company that costs $320 per month. Their prescription coverage includes a $15 copay for generics and coverage of 50% of the cost of brand-name drugs up to a certain limit. They also cover 70% of mental/behavioral health care, up to a certain limit. Sounds pretty good.

Except that, according to their brochure, I might not be able to switch companies and I might have to wait to enroll within a specific range of dates and I might have to go several months without coverage. I have no idea whether I’ll be able to find a psychiatrist who is in-network for both companies. “Long-term care” is on the list of services they don’t cover – I have no idea whether that applies to me or not or even what it means in terms of practical considerations.

Worst, I read a customer review by someone who said coverage was denied for treatment of a “pre-existing condition,” and ze had to fight for what coverage ze did receive! WTF?! I wouldn’t care so much about health insurance if I didn’t have a “pre-existing condition” that (likely) requires inhumanely expensive medication to treat! And there’s the nagging voice in the back of my head asking, am I really saving any money if my health insurance costs over $300 per month? That’s before the copay for the doctor’s visit, the copay for (or half the cost of) the prescription medication, and 30% the cost of any additional (limited to a certain number of visits) mental/behavioral health care I receive.

But then, I’m reminded of the first time I used my school’s insurance to help pay for a prescription. Long story short, I literally saved $100 on that month’s supply of the generic drug. Add the doctor’s visit that finally got paid for ($250, minus the $25 copay) and I’ve already saved $5. Never mind if I do need to go to the hospital, etc. And preventative health care … I have yet to compare insurance coverage vs. going to a low-cost clinic (e.g. Planned Parenthood), but there’s a decent chance I’d be saving money there, too – especially since companies are increasingly required to cover preventative care at no cost to the patient.

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Oh, I just took a look on Planned Parenthood’s website, which has a link to HealthCare.gov. Starting October 1st, I’ll be able to search for low-cost insurance options there, with coverage to begin in January. Yay, Affordable Care Act!!! Why, oh why couldn’t you be fully implemented immediately?! (I’ll refrain from soapboxing about what healthcare should look like in the US – and still won’t, come 2014 – … at least for now.)

Anyways, I still haven’t decided what I’m going to do about health insurance from mid-August (when my current plan expires) to January (when coverage begins for any low-cost plan I manage to find on Healthcare.gov). But at least I have hope that paying through the nose for whatever plan I do find (or going without insurance, as millions of Americans do) will be a short-term solution.

What’s your experience with health insurance, particularly trying to find an affordable plan? Any suggestions? International readers, how does access to affordable health insurance in your country compare to what I’ve described here?

Ingredients

I looked up the inactive ingredients in the generic “equivalents” I had been taking and compared them to the brand name drugs I was prescribed. In the table below, I organized the inactive ingredients list to clearly show which ingredients are shared by the different medications (Zoloft, the generic sertraline HCl I was taking, BuSpar, and the generic buspirone HCl I was taking).

I suspect that ingredients in italics are essentially the same chemical, but with slightly different names. There may be differences between them, but I’m inclined to think that any differences in their biological effects are relatively insignificant.

The ingredient in bold is only present in one medication; interestingly, the medication in question is the generic buspirone HCl. The only explanation I can come up with for why they’d randomly add sodium lauryl sulfate is because they need it in order to get the anhydrous (condensed) lactose to behave similarly to non-modified lactose during production. I find the presence of sodium lauryl sulfate in my medication disturbing, but haven’t found any information to suggest that it might’ve been interfering with the effectiveness of the medication or having noticeable adverse effects.

Ergo it seems likely that if inactive ingredients were limiting the effectiveness of my medications, switching from generic to brand wouldn’t help me much … unless differences in amounts or proportions are significant. I have no idea whether the amounts of the ingredients are the same across the included medications, but each medication had them listed in a different order.

Wakana sat me down at her computer, worked with me step-by-step to find a psychiatrist within reasonable driving distance who takes my insurance, and insisted that I call to make an appointment. I had to leave a message – to which I have yet to receive a reply – but at least I did something. I felt like a huge weight was lifted from my shoulders. And maybe finding out information about other organizations / programs that could help me will be similarly painless … especially if I can do a lot of it online.

One thing I’ll definitely be looking for as I conduct my search for a new psychiatrist will be strong knowledge of how inactive ingredients affect one’s response to a drug, particularly when that may cause significant differences between brand and generic. I need a psychiatrist who will take this concern seriously and be willing to fight to gain me access to the brand drug ze’s prescribing (instead of a generic “equivalent”) if necessary.

UPDATE: I’ve color-coded the inactive ingredients list to indicate possible concerns raised by Disorderly Chickadee in Generic Versus Brand: What’s In That Pill? Part Two. Many thanks once again to DeeDee for compiling the information. Trying to do so myself has been very difficult and frustrating.

Coding scheme:

  • allergen
  • carcinogen
  • toxin, irritant, or other health risk
  • animal product
  • restricted by some religions

Zoloft (50mg)

Sertraline HCl (50mg) Camber Pharm.

BuSpar (15mg)

Buspirone HCl (15mg) Mylan Pharm.

Dibasic calcium phosphate dihydrate Dibasic calcium phosphate dihydrate
FD&C Blue #2 aluminum lake FD&C Blue #2 / Indigo Carmine aluminum lake
Hydroxypropyl cellulose Hydroxypropyl cellulose
Hydroxylpropyl methylcellulose Hypromellose 3cP & Hypromellose 6cP
Magnesium stearate Magnesium stearate Magnesium stearate Magnesium stearate
Microcrystalline cellulose Microcrystalline cellulose Microcrystalline cellulose Microcrystalline cellulose
Polyethylene glycol Macrogol / Peg 400
Polysorbate 80 Polysorbate 80
Sodium starch glycolate Sodium starch glycolate Sodium starch glycolate Sodium starch glycolate
Titanium dioxide Titanium dioxide
  Colloidal silicon dioxide Silicon dioxide
  Lactose Anhydrous lactose
    Sodium lauryl sulfate

Invasion

Two of Fox’s friends came over Wednesday evening. I enjoyed spending time with them, particularly connecting with one whom I’ll call “T”. The thing is, “connecting with” ended up meaning “listening to,” largely in the supportive role I seem to enter automatically, regardless of whether that’s healthy for me at the time. I know some mutual support in conversations is good and expected, the problem is that I have trouble setting and enforcing the boundaries I need to keep the support mutual. Sometimes I feel like everyone just wants me to be their shrink … and I’ll admit that feeling came up several times Wed. & Thurs.

Fox’s other friend, “D”, was on call for work. D got calls after midnight. He got calls from people who didn’t leave a message or didn’t call back. He got calls from people who wanted him to wake a coworker up in the middle of the night for emergency service. He missed the fireworks on Thursday because he was dealing with a customer who blamed his company for serious damage to their house. He was understandably stressed out, and so was I. I find it very hard not to get caught up in someone else’s anger and feel like, somehow, it’s my responsibility. That’s the last thing I need right now.

Other friends (whom I know through Fox) came over Thursday and for the most part we had a very good time. Good food and good conversation; I even learned a few things.

But they made me act as navigator in search of an open supermarket at the last minute on a national holiday “because you’re the only one who knows this area.” And I had to hear their frustration with businesses closing at a sane-for-a-holiday time because where they’re from you can always find someplace that’s open, within walking distance, no matter what day and time it is. WE HAD FOOD COMING OUT OUR COLLECTIVE EARS. There was really no need to get additional stuff to put in the salad. I think the lettuce I’d picked up (at a sane time to be in the supermarket on a national holiday – Fox and D needed to pick up a few things and had let me know of their plans in advance) would have been enough for everyone to have a small, simple salad. The extra stuff they insisted on getting is now sitting in my refrigerator – along with other leftovers. I resent being dragged out against my will to get things other people claimed were important to them and then didn’t even eat.

The fireworks were spectacular. We were able to sit on my front lawn and see 3 different shows, for free. There were times when they were a bit too bright and/or too loud, but for the most part I had no problem enjoying them. No funky sensory stuff provoking anxiety reactions like when we went to see Into Darkness.

I was able to be completely in the moment, joy exploding with each burst of light and washing over me in a rain of changing colors. The booms and crackles and fuzzy visual texture of some of the fireworks practically tickled me, causing additional happiness as I laughed.

I knew it wouldn’t last. But for those precious moments I was free, and I cherished every one of them. Even through the negative commentary from the peanut gallery that made part of me want to fly into a murderous rage – or at least tell everyone to shut up or leave – I had my fireworks. My own internal demons were silent. No worries, no guilt, no second-guessing, just fireworks. Big bold loud gorgeous colorful fireworks. All I had to do was sit there and watch them.

And Fox got to see me happy.

By the time everyone left we were both completely exhausted. We dedicated Friday to being bums; I spent most of it playing Oblivion and you know what that’s okay.

Then yesterday happened. I’d made plans to go out with Banji, who’s in the area for the holiday weekend, and her parents. I couldn’t get ready to leave in time to get to her parents’ house by the time they wanted to head out, so I cancelled. She invited and encouraged me to join them later in the day, but I couldn’t deal with my own emotions. Thoughts about harming, maybe even killing myself. Crushing guilt because I cancelled on my best friend who’d said she really wanted to see me, and whom I’d really wanted to see. Guilt for staying in and repeating the same pattern I could any day instead of getting out, seizing the moment, doing the thing that’s special and new and different with someone I love. Fear that I’ll never get out of this mess. Hopelessness. Sorrow. Bone-melting grief.

And underneath it all, a simmering anger. If she wanted to see me so badly and knew I was having trouble, why couldn’t she come to me? Why should I have to go out?

More guilt for feeling that way, thinking those forbidden thoughts. Mom’s “advice” echos in my head: “You need to force yourself.” But what if I can’t? Am I so horrible? Incompetent?

I ran into Oblivion to escape all these thoughts and feelings. There I could focus on completing a task; I organized my decisions around training certain skills and earning money so I could buy furnishings for my character’s house. I felt tense or even angry while fighting enemies, but there was an outlet for the emotion and I could be sure it would pass. I could even murder an entire room full of guards (one of whom had insulted me), somehow survive to tell the tale … and then load a recent save to escape the game-breaking consequences of my actions. That was the most fun I had all day. Fox seemed annoyed with me for doing it.

I’ll admit I felt guilty about playing Oblivion – instead of, say, spending time with Banji – but I thought it was the most adaptive thing I could handle at the time. While I was focused on the game I was not having self-harm and suicidal thoughts. I was making decisions, focusing my energy into something other than actively destroying myself. (Whether I’ve been passively destroying myself is up for debate.) I was even – though admittedly to a lesser extent than I would like – having fun. Imagine that! Is it allowed? For Ziya to have fun? Oh no, this is an offense that cannot be forgiven. Let the flogging commence.

And Fox. Poor Fox. I don’t know how he can tolerate living with me. I’ve been such a horrible fiancee. It really doesn’t help that the TV is so big and commands such a presence in the room and doesn’t have a headphone jack, so if he’s in the living room he kind of has no choice but to be at least minimally involved in me playing Oblivion – even if I could somehow manage not to make comments, whether directed at him or not, he’d still have to hear the inane “dialogue.” (Seriously, Bethesda, hire some writers – or anyone who’s ever witnessed a real-life conversation. Please!) I don’t envy him at all for having to put up with me, nor do I blame him for trying to have some control over what he’s forced to witness – whether on screen or sitting next to him. Never mind that he could go to another room or leave the house. This is where he’s comfortable, where his stuff is, and where there’s a chance that I’ll pause the game for a moment to make eye contact with him.

But he’s driving me nuts. I want to play the game – whether that means fixing up “my” house just so, running around jumping off rocks like an idiot, seeing how many guards I can kill before I run out of health potions, carefully choosing the ingredients for a potion based on their effects, sneaking everywhere, or going on a mission that seems interesting. He keeps giving me advice on how to “optimize” my character. Don’t do that quest yet because the reward for it gets better the higher level you are, so you’ll benefit more from it if you wait to do it later. You need to raise Endurance so you’ll gain more health points each level; the most efficient way to do that is to raise your Heavy Armor skill (which is ridiculously low in comparison to my other skills, so it will go up more quickly than the skills I’ve been using regularly). You have no interest whatsoever in doing anything with heavy armor, so why not get a set of it, put it on, go out to a cave, and let enemies beat on you? The Heavy Armor skill will rise quickly, and your Endurance will go up, and you’ll gain more health points each level. And be bored to tears while “playing” a game.

I’m playing that game because I want an escape from reality and I want to be in control. I want to try random crazy things knowing that the consequences 1) don’t have any effect on real life and 2) are avoidable if I have a recent save to load. I want to practice making decisions and exercising agency. I want to forget that I’m a generic human living in the 21st-century United States and become immersed in the fantasy world of the game, where I’m spell-casting combat-capable stealthy problem-solving money-earning humanoid lizard who can breathe underwater and isn’t afraid of anything doesn’t suffer from guilt, indecisiveness, and social anxiety is confident in her ability to make a positive difference in the world and motivated enough to get out of the house and do things.

I’ll admit that I do ask for advice – or at least information – about what to do next, particularly along the lines of “will I get a truly useful reward if I do this quest now, or should I wait on it?” Maybe it would be better if I stopped asking Fox for his input and just looked up the information I need to make the decision myself. Or maybe I should be clearer about what I want/need from him. Yes, please do answer this specific question as accurately and honestly as you are able (or decline and I’ll look up the info I need to make my decision myself). Yes, please do point out if you think I missed something important. No, please do not tell me the solution to this puzzle. I suppose it’s reasonable to remind me to save before acting on a decision you disagree with, but please don’t try to get me to change my mind. I’m the one playing my game.

That’s what it comes down to in real life. I’m not even sure what “my game” is, but I wish everyone would take a step back and let me decide how – or whether – I want to play it. And by “everyone” I largely mean the voices inside my own head, who amplify their interpretations of messages from loved ones and society, until there’s no room left for Ziya.