Just Lamotrigine

… yeah. I didn’t take the trazodone Wednesday night, nor Thursday, nor last night. And I’m doing better. I feel like I’ve woken up from a bad dream. And speaking of dreams, I’m back to my usual anxiety dreams – which I KNOW are dreams once I wake up. So much better.

My anxiety is kinda overwhelming tho. I’d almost forgotten what it was like to feel like this. I have a thing I need to be not only present at but act in a professional capacity. I think I can deal with it, but I’d wanted to go to a cultural event at my local library – no pressure there, just show up have fun and leave. But I was kinda freaking out about it – especially the leaving and getting to my later commitment on time part – so I guess I’m not gonna go. It’s just easier that way. There will be other opportunities … right?

*sigh*

I’m kinda doubting whether I’ll ever be able to find and maintain gainful employment.

I don’t want to stay on just lamotrigine, and either way I’ve been thinking for a while that it would be good to increase my dose slightly. I’m debating whether I should ask to go back on fluvoxamine or clonazepam. The former was a rocky start, but I got used to it and I think staying on it might’ve been good for me. The latter … I don’t think I ever had any problems with it – I don’t remember any. It helped with my anxiety. It’s not the safest med in the world but you know what, fuck it. I’d rather be functional while I’m alive than live longer.

Something tells me getting my prescriber to agree to this won’t be easy. I’m writing her a letter in hopes that will prevent me from ‘acting irrationally’ at our next appointment.

Quit Playing Games with My Brain

Disclaimer: Anytime I write about medications, I’m sharing my own thoughts and experiences. This is NOT medical advice.

I had a rough time on the fluvoxamine maleate, at least initially. September was a stressful month anyway, though. So, it’s kinda hard to determine whether the problems I faced were a response to stress, a reaction to my meds, or some combination. All I know is I started occasionally mispronouncing words that normally I’d have no problem pronouncing correctly. I had to stop most of my Green Party activity because I was getting too overwhelmed. And I was suicidal.

I visited with Banji the first weekend in October and felt much, much better by the end of it. But I’d already told my prescriber about being unhappy with the fluvoxamine, and she’d already switched me to a new medication. Almost reluctantly, I weaned myself off fluvoxamine this past weekend and started taking trazodone.

The only things I’m happy about on trazodone are that 1) I’ve stopped mispronouncing words, and more importantly 2) I had the good sense to make sure I wouldn’t be driving for 5 hours on a new med!

Since I started taking trazodone Sunday night, I’ve had weird, vivid, disturbing dreams that it’s taken me a while to realize (once awake) were dreams. I’m having a harder time falling asleep, in part because the occasional involuntary muscle movements are becoming more frequent. I feel like I’m having trouble staying asleep, but that could be because my sleep cycle is shifted later than it should be. I feel groggy and tired. I’m anxious and having trouble concentrating and following conversations. On Monday while driving I couldn’t see the sign for the place we were going until we were practically there. When people gave me directions I heard “right” and thought “left” until the last moment. When I speak I’m too aware of my mouth movements and I feel like I’m listening to someone else.

When I told Ron about this stuff, ze said, “If you feel like your brain is broken, the trazodone is doing its job. It’s a hospital med used to shut down the brain of a patient who is psychotic and make them sleep. As an outpatient, if you are not psychotic, you have no business taking those meds.”

Ze urged me to find a new prescriber. I … I can’t. Not like this. And even if I were 100% on top of everything, I’d probably have to make my first appointment at least a couple months in advance. And that’s assuming the places I called even had mental health prescribers available – most are already overwhelmed with too many clients.

IF I remember our conversation correctly, my prescriber said I could try this med for a few days and stop taking it if I didn’t like it. I’m sure I remember her telling me I don’t have to wait a whole month, and I don’t think she said I should call before stopping. But I’ve been thinking for a while that I’d rather take just the lamotrigine if that’s what it takes. Maybe all I need is another slight increase, I’m on a pretty low dose.

Being on clonazepam wasn’t perfect, and I know there can be risks – particularly addiction. I feel like my sleep was more satisfying on the fluvoxamine. But I miss the way my brain worked on clonazepam. I rarely felt anxious – that’s probably the most important thing. I might’ve felt depressed, but I was functional. I knew I could do what I needed or wanted, and when I tried I would usually succeed. Now …

New Prescriber, New Meds

I had my second appointment with my new prescriber last week. At our first appointment, she told me she’s not a fan of one of my medications, Clonazepam, and said she wants to start weaning me off it so I can start taking something else. She wanted to put me on a SSRI (selective serotonin reuptake inhibitor) “to help with both depression and anxiety.” I resisted because I’ve had bad experiences with two different ones. There were no changes to my meds last month.

But this month she reiterated the need to get me off Clonazepam and told me to start cutting the pills in half. She also said there are medications that help with hording and prescribed me one, Fluvoxamine Maleate. It’s a SSRI. I’m torn between not wanting to take it because I’m scared of how it might affect my brain and the rest of my body – and wanting to take it because I can use all the help I can get to deal with this hording.

I talked to Wakana about it and she seemed very concerned about the change in meds, especially since I only just started seeing this prescriber. I’ve been taking half doses of Clonazepam since September 1st; so far I’ve already had two days (Monday and today) when I felt ill enough that it affected my functioning, and almost kept me from following through on important plans. I’ve been feeling down, slightly queasy, less sure of myself, tired, anxious, freezing (as in fight, flight, or freeze), and sometimes twitching – in other words, like crap. I suspected on Monday that I was having withdrawal symptoms; Wakana confirmed it today. I have an important meeting tomorrow at noon, and another Friday evening; I don’t have time to malfunction because of changes to my meds.

I’d say “especially changes that are based on the prescriber’s philosophy rather than the medication’s effects on me,” but it’s a little more complicated than that. Clonazepam can be addictive, it has interactions with a lot of things, and I was questioning how much it’s been helping me. I feel like I need more support vs the depressive symptoms than I’ve been getting from Lamotrigine. (There’s no way I’m going off that, though. It keeps my brain from trying to kill me.) To this prescriber, at least, all signs seem to point to SSRIs. I don’t quite get why she’s so obsessed with them.

I’m starting a new bottle of Lamotrigine tomorrow, so I figure it’s a good time to start taking the Fluvoxamine. But I’m really not sure whether it’s the right choice – especially since Wakana pointed out that I’m already addressing the hording without this med, and we agreed that many of the problems I’m facing can only be addressed by getting Fox to take responsibility as well. What will this stuff do to me?

I don’t know, but Wakana suggested tracking my mood and I think it’s a good idea. I’m not sure exactly how I want to do it though – I’ll probably find an app – and I’m annoyed that I don’t have a way to get a baseline. I’d rather not do one retroactively, I’m already having issues because of one change in meds, and I was having issues before that due to interpersonal drama – in short, there are too many variables to determine whether whatever I’m experiencing has anything to do with a particular medication.

I’m just feeling more and more like I want to be done with everything. That’s not a good sign…

Fus Ro Dah!

Since writing my last post and looking at lists of Lamictal/lamotrigine side effects, I’ve done a 180 and no longer feel safe taking my medication. Part of me believes it is a lot easier than confronting the APN about her decision to have me stop taking the medication. Part of me believes that I’ve been experiencing side effects the whole time and either ignoring them, not attributing them to the medication, or acknowledging them and attributing them to the medication but refusing to admit that maybe this isn’t the right medication.

All of me is angry at the APN, psychopharmacology, and the entire “healthcare” system: all doctors, their administrative staff, and especially managed care… I want to say I know it’s irrational, but is it, really? My blood pressure and heart rate are high and that’s set off some alarms regarding the medication… but maybe it’s due to the stress of trying to access medical care!

There isn’t really anywhere for this anger and the accompanying destructive urges to go. The APN’s office is closed for the federal holiday, so the earliest I might be able to talk to her is tomorrow. I have too much other stuff on my plate to waste time trying to get in touch with someone as flaky and dismissive as her! Verbally abusing anyone else would be mean and probably backfire. Physical acts of aggression, homicide, arson, etc. would take way too much effort. I’d rather play Skyrim. Shouting at people in that game is a lot more satisfying, and if it isn’t enough I can set them on fire with my mind.

So I’m just fed up with the whole thing and the thought of swallowing their b.s. in the form lamotrigine dispersal tablets makes me sick! I checked, online sources state that stopping lamotrigine without slowly reducing the dose first is safe for people who are being treated for bipolar, but not epilepsy. (do NOT take this as medical advice! Always talk to your doctor before stopping a medication.) Given the alternatives, I’d rather say “fuck you!” to medication and harness the energy from my anger to be awesome at my classes than keep taking something that may be making me sick.

There is a quiet voice in the back of my head saying that maybe it’s the therapeutic effects of the medication that have helped me get to this point. But my symptoms haven’t been much better than before I started taking it, and I’m inclined to attribute the ups and downs to the circumstances of my life. I can’t tell if it’s making a difference, so maybe it’s not. “There’s no point in taking it just to take it.” Right?

I’ve been wasting too much time and energy on this. There are about a million better things I could be doing!

Dismissed

I had another appointment with the APN on Friday. She took my blood pressure – which was a bit high, both for me and based on the health guidelines I’m aware of – and said it was “fine.”

Then she asked how I’ve been. I told her about being tired and unmotivated to do anything; sometimes I don’t even feel motivated to play Skyrim. I tried to put it in the context of everything that’s been going on: the stress of the holidays and then everything just stopping. I told her when I’m very depressed there’s less anxiety because I don’t want to do anything so there’s nothing to be anxious about, but when I’m less depressed and starting to want to do things I feel anxious about them. (To be honest I’m not sure that’s entirely true. I experience different kinds of anxiety. But I didn’t express this to her.) I also told her about the ominous voice twisting all the imagery in the guided meditation into things I found threatening. I told her I’m both excited and anxious about my classes starting next week: excited because I’ll have some structure in my life and anxious because of the responsibilities. (Not to mention my social anxiety.)

As I was talking about this stuff, she was making notes on the computer (facing away from me). Then she looked back through her notes from past appointments and the information I’d provided in the intake paperwork before our first meeting. She weighed me and told me I’m a candidate for sleep apnea. She told me to go get blood work done so she could see if there is a problem with my thyroid or something (past blood work has ruled that out, but I haven’t been able to show her the printout to prove it). She also called a sleep center for me and handed me the phone, basically forcing me to make an appointment for a sleep study.

Okay, I’ve been dragging my heels, I can kind of understand her being a bit heavy handed. But the next thing she did utterly terrified me.

She told me to stop taking the Lamictal/lamotrigine. She said I’m “sensitive” to it and it doesn’t seem to be helping. “There’s no point in taking medication just to take it.”

That’s it. No plan for slowly reducing my dose over time to minimize withdrawal symptoms. No concern over what effects suddenly stopping Lamictal might have on me. Granted, I’m only taking 75 mg, but we’ve worked our way up to that dose very slowly. If I’m “sensitive” to it, doesn’t that increase my chances of being “sensitive” to suddenly not taking it?

I honestly don’t know if it’s helping. Maybe it isn’t. Maybe it’s wreaking havoc on my central nervous system and I should stop taking it immediately. She didn’t explain why she thinks I’m sensitive to it, and gave a very simplistic explanation of why I should stop (which suggested she views me as medication-seeking). Her tone sounded dismissive to me, so I didn’t feel comfortable asking questions. I couldn’t think quickly enough to formulate them and felt like she wouldn’t listen anyway.

Maybe it is helping and my depression would be a lot worse without it. I feel like she’s not taking my life circumstances into account. I was doing great up to the wedding, then suddenly all my loved ones had gone back to their own lives, nothing meaningful had changed, and I no longer had something important to work on. I couldn’t sleep for a week or so while Mom was having work done on the roof. Then the holidays were a blur of excitement, socializing, not getting enough sleep, and thinking my godmother was going to die. Then, once more, everyone left and everything stopped – except worrying about my godmother. The floor dropped out from under me – and my pending courses for the Spring semester are looming over me.

The courses are the thing that has me the most concerned about stopping my medication. I’d like to have a bit of stability going into such a big lifestyle change; the last thing I need is unpredictable changes in my body chemistry and mood at the same time I’m going into a frightening and challenging situation. The last time I took these courses I had to drop them because they were triggering self harm and suicidal urges. I don’t feel safe trying to take them again without some kind of safety net. (I should probably talk to my instructors about this.) At least taking medication is something I’ve been able to do with some consistency; I feel like I’m doing something to help myself!

I suppose I could possibly enjoy the same effect from continuing to take my supplements (omega-3, vitamin d, and a vitamin b complex with folic acid and vitamin c), but I really don’t want to give up on the Lamictal just yet. Wakana has been urging me to take medication for so long (since before I started this blog), I hate the idea of finding that yet another one doesn’t work. I don’t want to start from scratch again…

During the meeting with the APN, my mood went from 1) low energy, depressed and a bit anxious, to 2) slightly higher energy and a bit irritable, to 3) more depressed, frustrated, and wanting to cut myself. She ended the appointment after telling me to stop taking the Lamictal; she didn’t even ask if I had any questions or concerns or anything else I wanted to talk about. I feel like she thinks I’m not really depressed or only mildly depressed and that I’m being lazy.

(Much of our conversation was her giving me advice: to make healthier food choices, move around more, make a schedule for myself, and give myself a to-do list with simple tasks that help me feel good. Some of these are lifestyle changes I want to make anyway and think would be helpful, but in general it sounds like stuff laypeople say to people with depression because they don’t understand it.)

I left and made sure I have future appointments pre-booked, but thought about not coming back. In an ideal world I would find a better psychiatrist, but with my insurance that would be a nightmare. And I’d have to start the whole medication dance all over again! When I was halfway across the parking lot I thought about going back to ask about reducing my dose slowly, but decided I wanted to consult with someone before trying to advocate for myself. I had just utterly failed at advocating for myself and was in no state to do so successfully.

I talked to someone I know who works with adult psych patients and has bipolar himself, and with his wife who has a good amount of medical knowledge – including potential effects of different drugs and what various symptoms might indicate. Together they helped me decide to continue taking my current dose of the Lamictal until I’m able to talk to the APN again. They encouraged me to talk to Wakana about it and have her talk to the APN as well. My friend with bipolar also made an important point: my insurance might not approve the sleep study right away, or in time for our next appointment, or ever. I can’t wait, untreated, while they bathe in red tape (as I have been for my tooth – brief update: I have an appointment for a periodontal consultation and another to get a root canal).

At the very least, I want a better understanding of her thought process. I want her to sit down and look me in the eye and answer my questions until I feel confident in whatever course of action she prescribes. Is that so much to ask? If I have to go off Lamictal, I feel much safer reducing my dose slowly with a plan we’ve come up with together. If possible, I intend to have Fox there with me. He’ll be there for my future scheduled appointments, at least!

Adventures with Psychiatry pt1

Following in Ziya’s lead, I also recently had a psychiatric appointment. I made it the same date as zir appointment, and it was supposed to be for the day after zir appointment. But of course, things happen, and five days later (the 5th), I had an appointment with the same psychiatrist that Ziya had so many problems with the last time.

My appointment thankfully went much smoother, and since I’ve been doing the Burns depression checklist every night for the past three weeks or so, I had a pretty good sense of what my symptoms really are. This made his choice of medication easy: the generic of Wellbutrin (bupropion). This post (and the next few parts) will consequently track how I’m feeling on the medicine as I ramp up to the full dose and beyond.

So far, I’m a little more than halfway through the ramp up period; I have two more days of just one 150mg pill a day, then I progress onto two. And so far, it seems to be helping with my main symptom: the incredibly low energy (as well as the motivational problems that follow from that). Prior to starting it on Wednesday, my typical score on the Burns was in the 17-26 range; basically, the upper end of mild with the occasional break into low moderate. Since I’ve been taking the bupropion, the highest I’ve gone is a 13, and I’ve seen my second 9 in several weeks. So while I may still hit the low end of mild, I’m seeming to stay more towards normal but unhappy.

I feel significantly more energized and capable of actually getting things done. This is a huge improvement.

But I’m also finding myself more susceptible to distractions (for example, people talking near me or Ziya humming a song or thinking aloud). And those distractions are definitely hurting my ability to focus. I’m also finding that, so far, I’ve been becoming more prone to irritability. Little things that didn’t use to bother me are starting to and with an ease I haven’t felt in awhile. It is possible that the latter issue is (at least in part) due to having the energy to actually feel those emotions again. But I’m not sure if the bupropion is the cause of the former, and I’m hesitant to look at the side-effects; I don’t want my brain to get any ideas. I’m hoping that the former will become easier to deal with; I like this new energy far too much to want to try some other random drug.

Maybe things will shift when I start taking the full dose next Tuesday. Part two will probably go up after a few days on that dose.

Crossroads

I’ve been playing phone tag with Psychiatrist C-1 for over a week now. He said, “I’m unlikely to answer when you call because I’m with clients all the time, so let me know when’s a good time for me to call you.” So, I gave him a few hours today, which I spent within arms reach of the phone. Nada. He couldn’t take 5 minutes between clients to call and make an appointment.

Now I’m at a crossroads. I have a strongly-worded voicemail prepared in my head, which includes the following:

Are you even taking new clients? If not, please let me know. In fact, please find a colleague who is taking new clients and have them call me. If so, call me back with a day and time to meet next week, and I’ll be there.

Yeah, I’m pissed. Dunno how much it comes through in the typed version of the words, but if I spoke them aloud, you could tell that I’m pissed.

I’m glad I’m pissed. The anger gives me energy. So much better than sleeping all day.

The thought occurs that this is a really crummy way to start a new therapeutic relationship. I’m already resistant to going to see a psychiatrist, if I’m angry with him I’m more likely to do stupid things like not show up for appointments, or not take my meds. That would be such a waste. Maybe I should call him and say:

If you couldn’t take 5 minutes between clients to call me today, then clearly you’re too busy to meet my psychiatric needs. Please have a colleague who is accepting new clients call me.

Or maybe now just isn’t the time for me to be dealing with psychiatrists. What do you think?

In other news, I decided to take a course called “feminist theory” at my school. It’s not directly related to my major, but I’m insanely curious about it. Just as if not more importantly, it keeps me matriculated with part-time status, so I can still get health insurance at a remotely-affordable rate from my school. Win!

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?

.

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.

Finding the Right Psychiatrist

I’ve been doing it wrong. I thought I would go see a psychiatrist, and ze would know all about the different medications available and listen to me and figure out what would best help me. I found an organization covered by my insurance and started working with the person they assigned to me. I put random chemicals in my body, who knows what they’ve been doing. It’s so hard to tell whether they’re helping or hurting that I want to rip out my brain!

Wakana’s been ridiculously concerned about me. She asked me to sign a contract saying that if I’m thinking about hurting myself I won’t act on it without talking to her first. She’s basically given me permission to call her any time of day or night. That’s … wow. Frelling huge!

She also expressed an interest in working with Psychiatrist B. I gave her his number (well, the number at the organization that assigned him to me) and when I went to see him on Wednesday I gave him her number. On Friday I asked Wakana if she’d gotten his call.

“We spoke, actually. I thought he was being very arrogant and he wouldn’t talk to me about how you’re doing. He didn’t seem to take your suicidal and self-harm ideation seriously.” (Actually, he interrupted me in the middle of telling him about these sensitive topics to take a phone call from the org.’s billing dept.) “He kept saying it’s a clinic. People just go there for medication. He’s only there two days a week. If anything comes up he tells patients to go to the emergency room.”

Being hit with this reality really hurt. I just want the meds to work their magic and the pain to go away. But my problem isn’t a headache, it’s an extremely complex combination of maladaptive thought and behavioral patterns, disabling physical and emotional symptoms, unbearably stressful situations, and atypical brain chemistry. The medication might be helping the brain chemistry part, or it might not, or it might even be making things worse. I have literally no way of knowing, because how I feel and function on a given day depends on so many other factors that it’s impossible to isolate the effect of the meds (in research-ese: “There are too many confounding variables”). The American Psychiatric Association wasted their time making a new version of the DSM that the National Institute of Mental Health withdrew their support from and has devised no tests that would enable a healthcare provider to objectively observe and measure the effect these psychotropic substances are having on my brain!

That infuriates and terrifies me but now I’m kind of dependent on them. I don’t know. Maybe I could stop taking them and walk away. Maybe whatever effect that had on my brain would end up resulting in my death. I have no idea.

I need to find someone who will take every word I say to zir as seriously as Wakana does, if not even moreso. Someone who knows everything there is to know about every medication and how it interacts with every other. Someone who can juggle what information is available from scientific research with experience treating diverse clients; someone who is willing to try new or atypical approaches and will be responsive to my every symptom and concern throughout the process. I don’t care if you’ve been practicing psychiatry since before Freud was born, this is my body and the only brain I have. I need it to last me a good 70 more years or so. The depression is taking enough of a toll without the meds I’m taking to try and treat the depression fucking things up even more. I’m taking a huge risk; I can’t hit “undo” or “restart.” There is no option to save first, then exit without saving if something goes wrong, reload and try again. There’s just my life. I need whomever I work with to respect that and take it seriously.

Wakana doesn’t seem to think Psychiatrist B is capable of doing that. I was extremely angry with him when he interrupted me in the middle of trying to tell him about the symptoms I couldn’t bring up at our last meeting. It was very hard for me to organize and express my thoughts about what I’ve been experiencing – something that doesn’t lend itself to words to begin with, and that tends to be hindered when I don’t feel emotionally supported by the person I’m trying to share this information with (“lack of rapport”). I don’t know what to make of my body randomly twitching in response to certain sounds, especially if I’m tired or anxious or angry. I never experienced that until the first time I took a SSRI. It’s not like this is an experience people typically talk about; I can’t poll my neighbors or classmates or Facebook friends about “What makes you twitch as though Gimli has his axe embedded in your spine?” Don’t blow me off and tell me “it’s the depression.” If you’re going to say something like that, at least explain what you mean.

I need a psychiatrist who respects that I’m trusting zir with with more than my life. Someone who respects that I’m trusting zir with my Self. My thoughts, emotions, conscious experiences, self-perception, how I interpret and respond to everyone and everything around me. It’s all been affected, and for all I know I’d be a lot better off if I’d never started taking medication.

Finding the Right Medication – Part Five

On Wednesday I met with Psychiatrist B for another 2-month follow-up. I told him about the increased depressive symptoms I’ve been having and the situational factors involved. He gave me relatively useless advice on what to do about my relationship with my mother and told me I have to take responsibility for my schoolwork (instead of, say, smashing the clock). I couldn’t get up the nerve to mention my recent suicidal thoughts or the freezing Wakana had helped me label (Using Words to Say What They Cannot). On a rational level I knew if I was going to talk to anyone about those symptoms it should be my psychiatrist, but on an emotional level I just didn’t feel safe doing so.

Psychiatrist B decided to stay with the Zoloft at my current dose (50mg 1x/day) and add another medication that’s used to treat anxiety. I don’t remember how he pronounced it and I can’t read his handwriting, but I was able to make out the first few letters. When I typed them into the search bar on drugs.com, it recommended BuSpar.

Based on the information on the website, my only concern is the risk of interaction between the two drugs, which can result in the serotonin syndrome I believe I experienced near the end of October (Finding the Right Medication – Part 2). At that point in time, miscommunication resulted in an overdose; this time I have very clear instructions on how much of each medication to take, and when. He’s keeping me on a low dose of the Zoloft and having me start on a low dose of the BuSpar, increasing it gradually over the course of 5 days.

The thing is, I have no idea what’s going to happen. Based on user reviews, the effects of the drug seem to vary pretty widely from person to person. It could work great with minimal side effects, or it could make me so dizzy I can’t read for school. And worse.

I’ve spent an inordinate amount of time playing The Sims 3 over the past couple days. I played until the children from Ending a Life grew up into teenagers, then decided I wanted to have family portraits that included the patriarch and recently-deceased matriarch. So, I created a new game and restarted playing this family from scratch – only to have the game barf on itself when I tried bringing my intended photographer to Egypt so she could learn her craft. (World Adventures expansion: visiting Egypt is the only way to acquire a camera and learn photography.) After several repeated attempt I concluded that the save file was corrupted. I had to restart my game again; this time I sent her to Egypt first and everything went smoothly – in the game, that is.

I, the embodied Ziya, have been eating crap, depriving myself of sleep, neglecting my schoolwork and other responsibilities, ignoring the pain in my wrist and shoulders from sitting in a weird position for hours on end, and allowing my space to become (more) cluttered! I’ve put off filling the prescription for the past two days, denying myself a medication that could (perhaps, if I wiggle my toes the right way) actually be helpful!