Healthcare Update

The system might be effed up, but there are people in it who can be pretty awesome. Not long after my last (April 11th) post, I received a voicemail about my health insurance application with the state. I’d gotten fed up with the Healthcare.gov website and applied to my state’s program directly; when I finally received coverage under my birth name I didn’t ask any questions.

Anyways, I called the person back hoping he could resolve my name change over the phone. We played phone tag a couple of times, but within about 2 hours he said he had taken care of it. I received a piece of paper a couple of days later saying I, [my married name], do indeed have health insurance through the state. That man saved me a trip I really didn’t want to take. He’s my hero!

And it gets better. My and Fox’s primary care provider (PCP) is a short walk from our home. It’s a small practice shared by a couple of doctors, a nurse practitioner, and a friendly-professional staff. I didn’t get to see the doctor who’s listed as my PCP, but that’s okay because I really like the nurse practitioner. She prescribed an anti-inflammatory for my upper body pain and suggested I have a sleep study done to see if I have sleep apnea; they should call me by Thursday to set up an appointment. I asked to have blood work done; the nurse who drew my blood was courteous, respected me and my knowledge of my own body, and caused me minimal pain. I left feeling quite good about the whole experience.

The one downside is that I’m still not sure if I need a referral to see a psychiatrist; the nurse practitioner didn’t think I should but suggested I call my insurance to be sure. If I need one I just need to call the PCP and the staff will get me a referral, no problem. Well, that’s a relief!

The Healthcare Headache Continues …

I thought I had the answer: I would take a 3-credit course, in part out of interest and in part because it would make me eligible for my school’s “voluntary” part-time student insurance. But today I learned that there are no longer any part-time student plans available – whether that’s because my school dropped them, or the insurance company stopped offering them, I don’t know. I just know that I was very confused and frustrated when one part of the site still said I could opt-in to the voluntary insurance, but when I clicked the link it said no plans were available.

I’ve reluctantly accepted that they’re not offering insurance to part-time students, based on the mail-in forms having last year’s dates. They just didn’t bother to update the whole website. Lazy bums. (Acceptance doesn’t make me any less angry. It just saves me the trouble of trying the same thing over and over again just to be repeatedly disappointed by the results.)

I’m disinclined to trust the $400/month short-term insurance plan offered by an affiliate of my school’s insurance company. The very nice representative I’d talked to called back, reminding me to apply in time for coverage to start on the date I’d requested. She also re-sent the information she’d initially sent me. I’m tempted to call her back and thank her for her help. But the attached PDF clearly stated that prescriptions weren’t covered; when I tried to see if other plans were available, the one she’d recommended disappeared, so there were no plans available at all! I know I can call her back and ask questions, but I don’t want to risk wasting money (that I don’t really have) if the information she gives me turns out to be wrong.

In light of all this, paying nearly $2,000 to take a class purely out of interest became a lot less appealing – especially since a similar one might be offered for free on Coursera. I started listening to the lectures for one of my Coursera courses last night and found them to be positively fascinating. It felt so good to just soak in the information. No deciding what to wear, traveling, finding parking, potentially being late, awkward social situations, and consequences for not doing assignments required. So, I’ve decided to drop the 3-credit course I’d registered for at my school, and go the continuous matriculation route. A relatively small fee means I’m still a graduate student, really!

That still leaves the matter of health insurance.

I’ve decided against going to see a psychiatrist for the time being. The SAM-e (along with other factors) seems to be helping quite a bit, especially on days when I remember to take 2 doses of it (400 mg 2x/day, total 800 mg per day). It’s not perfect, but it’s at least as good as the antidepressants I’ve tried so far, with less adverse side effects (maybe because it doesn’t contain weird, unnatural chemicals?). It’s not exactly cheap, but I think I’m saving money over seeing a psychiatrist and paying for medication, especially if I need brand-name instead of generic. I can buy the SAM-e in 3 clicks and have it shipped to my front door – no phone tag, traveling, disclosing personal information to a stranger, and waiting at the pharmacy required. It might not be the best, but it works better for me right now. I can’t help wishing I’d found out about it years ago.

Health insurance suddenly seems a lot less important if it’s not the only way I can afford to treat my depression. Wakana doesn’t take insurance; I’ve been paying her at a discounted rate out-of-pocket. Insurance wouldn’t cover the SAM-e anyway. Hospitals are required to give life-saving care regardless of whether you have insurance. The only thing left is preventative care, which I’m hoping I can find a clinic for nearby. To my knowledge my state isn’t among the insane ones trying to shut down Planned Parenthood, so I intend to begin my search there.

(In case it’s not blatantly obvious, I hate going to see doctors. So, for most things, I wouldn’t bother seeing a doctor. If I’m miserable with a cold or something, I’d rather be miserable at home where I have access to things that help – like tea and soup – instead of at the doctor’s office.)

And in October I should be able to shop for an insurance plan on Healthcare.gov, so hopefully I’ll only lack health insurance until January. Hopefully.

Let’s be honest, I hate making these decisions. But this is the hand I’ve been dealt, and I need to do (or choose not to do) whatever it takes to protect my mental health. I’ve been burned by conventional medicine and the insurance required to make it remotely affordable, so I’m finding alternative ways to take care of myself.

Prescription by Dr. Ziya

WARNING: This is a (potentially risky) decision I have made for myself. It does not take the place of medical advice by a qualified mental health professional.

Today I had a conversation with 2 friends that confirmed a few thoughts I’ve been having:

  1. I will not go back to Psychiatrist B under any circumstances.
  2. I need to stop taking my current medications.
  3. Listening to music daily will improve my mood and possibly also my brain’s functioning.
  4. I need to be honest and talk about my disorder more often.

Psychiatrist B didn’t take my thoughts about harming myself and even committing suicide seriously, despite the fact that the drug he was prescribing me can cause such thoughts. He also needed assurance from me that it was worth gaining weight to have the possibility of recovering from a disabling disorder; that my mental health is more important than my appearance! (He also made the typical assumption that fat = ugly, which I have no desire to perpetuate.) As one of my friends put it, there’s a significant risk that if I keep going to this doctor, his problems will have a negative impact on my well-being. It also certainly doesn’t bode well that the “clinic” hasn’t made any attempts to contact me about rescheduling the follow-up appointment I canceled nearly a month ago.

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long-white-pillsRegarding my medications, the bottom line is: they’re not providing the relief I need. Regardless of whether they’re helping “somewhat,” the fact remains that they are not helping enough. And there’s the possibility that they are causing or contributing to some of my more disturbing symptoms. I haven’t been taking them for the past few days and to be honest it’s been a very rocky road. At this point I’m unsure whether I should hold my ground until they’re completely out of my system – or start taking them again in smaller and smaller doses until it’s safer to stop completely (or I run out). Everyone seems to think it’s better to wean myself off them slowly, but I’m concerned about what might happen if my levels spike again after being so low for the past couple days. It’s also a lot easier to just not take them than to try to figure out what doses would be appropriate and remember to take them regularly.

It’s recently come to my attention that I’ve been doing my readers and the companies that make certain brand-name drugs a disservice. I’ve been taking generic “equivalents” of Zoloft and BuSpar (sertraline HCl and buspirone HCl, respectively); prior to beginning this blog I was taking bupropion in place of Wellbutrin. Anyone reading my blog would think I was taking the brand-name drugs and that they were causing or contributing to the undesirable effects I’ve described. This is most certainly not the case. In Generic Versus Brand: What’s In That Pill? Part 1, Disorderly Chickadee sheds light on how generic formulations of brand-name drugs often are not as effective as the brand-name version; in some cases the difference in functioning one experiences can be “like a brain transplant.”

Most notably, there is a huge difference between Wellbutrin and generic bupropion, enough so that one generic formulation was recalled. It’s not the one I was taking, but it still raises some suspicion that I might have done a lot better if I’d taken actual Wellbutrin instead. I’m also wondering whether brand-name Zoloft and BuSpar would be more effective (and safer!) than the generic sertraline HCl and buspirone HCl I’ve been taking.

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bob marleyI don’t usually listen to music, unless you count the background stuff in Oblivion – which either alerts me to the presence of enemies or puts me to sleep. Yesterday I had the very pleasant experience of listening to some of the more upbeat tracks on a CD of instrumental Celtic music. The bass and percussion were very grounding and calming, helping me to feel safe … while the foregound instruments were lively and played complex melodies in compound meter.

MeterI had a lot of fun listening to the music, felt calmer and happier, and thought it was having a desirable effect on my brain. It required enough of my attention that there was little to no room left for disturbing thoughts, and it seemed to help organize my brain. My hypothesis is that the regular firing of neurons involved in listening to the music (which are located throughout the brain) may have provided the stimulation, serotonin, dopamine, and information pathways my brain needed to function more effectively. I might need to experiment a bit to figure out how many times per day and for how long I should listen to music, as well as what types of music will provide the best effects … but overall I’m optimistic that listening to music regularly will help – a lot!

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meep-and-lolz-cropFinally, it felt really good to be honest about what I’ve been struggling with and have my friends accept my reality. They listened and shared their own related experiences, which helped me feel less alone in my struggles. They offered advice – some of which I found helpful – but more importantly demonstrated that they support me in my efforts to take care of myself. “You know you can call any of us any time you need to talk, right?” Yeah, I do; I just need a reminder that there are people who want me to reach out to them in my times of greatest need, when I feel like I’d be doing everyone a favor if I just ceased to exist.

Second 3-Month Review

Wow, it’s hard to believe this blog is already 6 months old! It’s grown a lot since I created it in mid-December. I’d like to say I’ve grown a lot, too – at least, I’ve gained a better understanding and acceptance of what’s going on in my brain, and turned my focus toward tending to my mental health needs. I don’t always do my best with that, but at least I’m trying; at least it’s my priority.

So far I’ve published 105 posts (this will be #106) and Fox has published 2: “Masculinity, Tools of Violence, and Embracing Femininity” and “From a Supporter’s Point of View”. A Day with Depression has gained over 100 followers and receives over 400 views per month from visitors all around the world! I cannot express how inspired I am by the readers of this blog. Thank you all so much for your support!

A Day with Depression 6-month Stats

The dark blue columns indicate number of viewers per month, while the light blue columns indicate number of views. Click the image to view a larger version.

The dark blue columns indicate number of visitors per month, while the light blue columns indicate number of views. Click the image to view a larger version.

I would like to extend a special thank-you to international readers, who make up about 1/3 of the visitors to this blog. Click the image to view a larger version.

I would like to extend a special thank-you to international readers, who make up at least 1/3 of the visitors to this blog. Click the image to view a larger version.

I posted my First 3-Month Review on March 12th; check that out to read a synthesis of posts from mid-December through mid-March, organized by theme. My current review begins just after that post.

As tempting as it is to focus primarily on my depression, anxiety is a significant factor in my life that affects everything from my ability to get ready and go places in a timely manner, to my ability to sleep, to food choices, to my very career. On March 15th I changed my tagline to reflect this. I also reflected on the primary sources of anxiety at the time: my rats’ health, my own academic performance, and becoming a caretaker for Mom (who was, at the time, preparing to receive double knee replacement surgery). In all these situations I felt like I lacked control, questioned my ability to “perform” well, and expected to have unpleasant experiences. It didn’t help that I felt “violently torn and ripped to shreds” by Mom’s expectation that I would meet her needs arising from a decision she had made, in combination with (what I perceived as) her simultaneous lack of respect for a decision I had made.

I found that taking action seemed to help reduce the anxiety – at least temporarily. “Taking action” included doing my homework and beginning to take anxiety medication (Buspar) in addition to the SSRI (Zoloft); I’m thinking perhaps it should also include regular exercise. The thing about taking action that relieves anxiety is that it gives at least a small amount (or semblance) of control over a stressful situation. For example, I take control over my academic performance by doing my schoolwork, which generally turns out to be high quality. But in life there are a lot of extra factors involved, such as noises waking me up in the middle of the night and the job market and my difficulty finding clothes I like that fit and how expensive everything is and the cruel malicious things people with power and wealth do to make a profit and misogyny and all the messages in mainstream American/Western culture that make me want to turn into the Hulk and destroy everything associated with it.

Click the image to read the blog post: "Being Carrie Marin."

Click the image to read the blog post: “Being Carrie Marin.”

Sometimes I need “taking action” to mean blocking it all out; my default form of doing so is to play a game where my character doesn’t have to deal with all that shit. She can take more direct action to accomplish things I feel I (currently) cannot: earning money, creating things with value to herself and others, dressing sensibly but fashionably, traveling, making friends, and ridding the world of evildoers (and people who piss me off). Best of all, anxiety is never an obstacle for my character; she never has to worry about the sacrifices involved in “desirable” life transitions (as I described in Giving In). If the shit hits the fan, I can reload a recent save and try again!

In early April, “taking action” meant making the very difficult decision to drop the two graduate-level courses I need to complete my degree and enter my chosen career. I had already waited 2 years to take them and will have to wait 2 more years. But my anxiety and self-criticism attached to those courses were posing a significant threat to my health, possibly even my life. It was the first time I made such a huge sacrifice in my academic life to tend to my mental health.
What I Need + Withdrawn + Taking Off the Mask + Grace

Around the same time I started using poetry as a means of expressing what I found difficult to say in prose. Themes included: my need for space to rest and work through the depression (Wish & Taking Off the Mask), my guilt about spending so much time playing The Sims 3 instead of with Dog (Groundhog Day), what I was trying to block out (Re: Groundhog Day), anxiety (Nightmare), and why I was avoiding my mother (Silence).

ambivalenceThen, the shit hit the fan. Fox learned he had to move out of his apartment after the end of the semester and requested to move in with me. I addressed my thoughts and feelings regarding the matter in Living Together, but the issue went on the back burner until fairly recently. We’ve both been stressed out of our minds about the whole moving process: his need for me to drive him there and back, sorting through and packing his possessions, and finding space for everything in my home. I’ve been procrastinating going through and reorganizing my own stuff because I’d find that stressful in the best of times, and right now I’m terrified of merging with him. A huge part of why I tend to get up in the middle of the night is because it’s the only time I can truly be alone, focused 100% on whatever I choose.

warning-signs-of-caregiver-stressWhile Fox moving in was on the back burner, Mom had her double knee replacement surgery. I was overwhelmed by anxiety for her, frustration about not really being able to do anything for her, my own fear and hatred of hospitals & medical professionals (stemming in part from bad past experiences when loved ones – e.g. my father – were terminally ill), my inability to manage other responsibilities such as schoolwork and chores, and my resentment toward her for being able to receive the treatment and support she needed – including from me – while I felt left largely on my own to try and survive with severe depression and anxiety. I was eventually able to talk to her about some of this stuff and found her to be more compassionate, concerned, and supportive than I’d expected. She’s actually been quite independent (and willing to call on other people for help), doing all she can to lessen the pressure on me – especially as she gains mobility. She also shows a lot of appreciation for my efforts to help her.
PANIC!!! + Don’t Hurt My Mommy! + How to Visit Mom in the Hospital + (Barely) Holding It Together + Sculpture + Communication + Awesome

An unexpected self-portrait.

An unexpected self-portrait.

As if all this weren’t enough, I’ve been struggling with my own symptoms and lack of much-needed treatment. I was off my meds for five days (ending a week before Mom’s surgery) because I couldn’t juggle refilling the prescription in a timely manner with everything else that was going on. I kept seeing disturbing images of knives cutting various parts of my body. I was hurt and angered by Psychiatrist B when he interrupted me in the middle of talking about suicidal and self-harm ideation to take a phone call. A later conversation with Wakana (who had hoped to coordinate treatment with him) confirmed that I need to find a new psychiatrist. I haven’t gotten around to doing that yet because I’m frustrated with the whole process and have been distracted by everyday shit such as the end of the semester, followed immediately by Fox’s move. I’ve been hypersensitive to loud clangy sounds, to the point where I had a severe anxiety response to an action movie. Wakana had to cancel a few of our sessions due to health and family issues, and I had to request phone sessions because I lacked the energy, motivation and/or time management skills to get to her office. I’ve been so physically and mentally exhausted and obsessed with Elder Scrolls IV: Oblivion that I haven’t been able to focus enough to express my thoughts and emotions through writing or other creative means (on most days).

That said, I have made some efforts to express and care for myself. The Bloody Arms Project was an attempt to channel the self-harm ideation (which mostly involved an urge to cut my arms) and the painful emotions behind it into artwork. Not long afterward I discovered the joy and catharsis of Sculpture, which enabled me to channel my anguish into art I took pride in and perceived as beautiful.

CaptureMay“Sculpture” also became a metaphor for taking control over my own life and depression treatment, including asserting my needs in conversations with Mom. I learned about the potential benefits of aromatherapy and had the opportunity to try it out, with good results. Although I have yet to really act on taking a full day once per week to focus exclusively on my own health (Ziya’s Day), it was after I asserted this need that Mom really started being more independent and turning to other people (instead of just me) for help.

Finally, Writer’s Block, In Search of Truth, and this untitled post were my recent attempts to express myself visually when I didn’t have the words to write. For now I feel it’s best to let them speak for themselves.

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!

Finding the Right Medication – Part Three

(Part One | Part Two)

I have been feeling much, much better since I stopped taking the Wellbutrin. I feel calmer, infinitely less angry. I even feel happy at times for no reason! Part of it is that I was able to do something extremely simple to alleviate my symptoms – all I had to do was not do something I had found difficult, anyway! Part of it is that, while the initial energy boost from the Wellbutrin felt good, the medication was making me irritable.

On Tuesday, December 11th I had my first appointment with a new psychiatrist, Psychiatrist B. He accepts my insurance, so that appointment only cost me $25 – a tenth of what I’d paid Psychiatrist A!

As we talked, I felt like Psychiatrist B was listening to me and really understood why I had decided to change doctors. He said that, from what I was telling him, Wellbutrin might not be the right medication for me. He theorized that, if nothing else, cutting the slow-release pills in half caused too much of the medication to enter my system too quickly, so I kept oscillating between overdose and withdrawal. That is what caused the intense feelings of rage.

Psychiatrist B gave me a prescription to get my thyroid checked. He said it was up to me whether I wanted to try a different antidepressant medication, or wait until I knew whether my thyroid was involved in my symptoms before determining a course of treatment.

Based on the assumption that I am still getting some benefit from the Wellbutrin, even though the side effects have basically ceased, I decided I would rather not risk “sobering up” to find myself with severe depression and no medication in my system to keep me from hitting rock bottom. That could literally be fatal.

So Psychiatrist B wrote me a prescription for Zoloft, a selective serotonin reuptake inhibitor (SSRI) which he called his “favorite.” I probably should have asked him why it was his favorite, but I didn’t. And he gave me very specific instructions: I’m supposed to take half a pill each morning for six days, and then start taking a whole pill once a day, in the morning. If a whole pill is too much I should go back to taking half, but stay with it consistently for at least a month.

You can’t get much clearer than that!

I decided to create this blog late Tuesday night, so I was not able to wake up early enough Wednesday morning to feel comfortable starting with the Zoloft. I’ve spent Wednesday largely focused on setting up the blog, including the About Me and Breaking the Silence pages, as well as this very long, 3-part post. Thursday will be my first time taking the new medication and I’ll admit I’m a bit wary of it. There’s really no way to know what effect it will have on my brain, the rest of my body, and my ability to function in society – until I take it!

Finding the Right Medication – Part Two

(continued from Part One)

I called Psychiatrist A near the end of October intending to increase my dose to 250 mg per day. Instead, he prescribed Lexapro “to give [me] a boost.” He asked what my Wellbutrin dose was so I said 200 mg; he did not ask me whether that was in one or two doses. So, when I picked up my new prescription, I had Lexapro in 10 mg pills and Wellbutrin in 200 mg pills.

I had no idea when to take what, so I looked online and found out that people tend to take Lexapro at night because it makes them feel drowsy. I followed suit that night and, thinking it was what Psychiatrist A intended, took 200 mg of Wellbutrin the next morning. My pupils dilated and I developed a headache and muscle twitches.

By that night I thought I was doing okay, though, so I took a second dose of the Lexapro. When I turned off the light and lay down to sleep I had the most awesome visual hallucinations. There were beautiful designs in vivid colors, some of which were more abstract and some that looked like vines and leaves, in a kind of stained glass style with white outlines. They filled my entire range of vision and moved slowly as one unit like the surface of a lake. I joyfully went to my mom – the hallucinations stopped as soon as I turned on the light – and told her what was happening. She said I was high on LSD and to go back to bed. I followed her advice and happily enjoyed the show until I fell asleep.

The next few days were not nearly as fun. My muscles kept jerking – to the point where a spasm might cause me to sit up in bed! – and my ears were ringing loudly and constantly and I had a horrible headache that would not go away no matter what I did! I felt cold and hot at the same time. I was terrified. I couldn’t get in touch with Psychiatrist A and when he finally called me back he said my symptoms were due to anxiety. He said if I was really so concerned I could stop taking the Lexapro. He instructed me to cut the Wellbutrin pills in half so I could take 100 mg twice a day again. I followed his instructions but was very upset by his attitude because I felt like he wasn’t taking me or my symptoms seriously.

Over time my drug-induced symptoms ceased, though a month and a half later I still have occasional muscle twitches that did not occur before the Lexapro and Wellbutrin overdose. I continued taking the Wellbutrin, 100 mg twice a day, by cutting the 200 mg pills in half. But I found it very hard to take the doses at the same times every day, and I found I often would forget to take the second dose. I was also becoming more and more angry. When I made a mistake I would act on the compulsion to hurt myself – the physical pain helped me calm down. I thought, “I should just kill myself.” I knew I was overreacting to my frustrations and others’ reasonable expressions of annoyance, but that did not reduce the intensity of my emotions at all! Actually, sometimes the knowledge made me feel worse because I beat myself up for being “so immature.”

On Monday December 3rd I was so angry a cold calm clarity was starting to come over me, to the point where I almost felt I could commit horrible violence and not feel bad about it at all. I decided what I wanted more than anything was to have an entire room full of things I could completely and utterly destroy. I wanted to feel my whole body moving through that space, have the satisfaction of watching objects shatter, make the most atrocious mess humanly possible … and when I was done, just walk away. No consequences, not even concerned, frightened, or angry looks from other people. I felt like it was a metaphor for what people have gotten away with doing to me.

On Tuesday December 4th my professor was talking about people with depression and suicidal ideation. I was half tempted to raise my hand and give an insider’s perspective – that’s actually part of what inspired me to create this blog. After class I talked to her and she offered me a lot of encouragement. She got me talking about music and the next thing I knew I was smiling, laughing, and thinking about my future.

On Wednesday December 5th I completely ignored my music therapy session and my music therapist. I shut out the whole world.

I finally returned my music therapist’s calls on Thursday December 6th. My music therapist suggested that the intense rage I was feeling might be a side effect of the Wellbutrin. I had not taken any of the Wellbutrin since my first dose on Wednesday, so I decided to just stop taking it altogether. Sure enough, on Friday, Psychiatrist A confirmed that I should stop taking the Wellbutrin!

(to be continued)

Finding the Right Medication – Part One

It is hard to say how long I have been severely depressed: sad, with very low frustration tolerance, and lethargic most of the time. But by mid-late July 2012, I was frightened enough by my suicidal thoughts and compulsion to hurt myself that I decided it was time to start taking medication for my depression. My music therapist agreed with me and recommended Psychiatrist A.

Psychiatrist A does not accept insurance, so I had to pay him $250 in cash – and that was a discounted rate! Based on our conversation, he suggested that I try Wellbutrin. He gave me a one-week supply of 150 mg extended-release pills and a one-week supply of 300 mg extended-release pills.

During the first week, taking 150 mg of Wellbutrin each day, I felt as though nearly all of my symptoms were significantly improved! At times it almost felt like I had too much energy! – but it was a very welcome change from what I had become accustomed to. After a while, I started to settle down. I still felt much better, but I was no longer bouncing off the walls.

During the second week, I started taking 300 mg of Wellbutrin each day. I had a panic attack on the first day, but attributed it to the fact that I had taken that day’s dose a few hours less than 24 hours after the previous day’s dose, so I probably had too much of the medication in my system. Sure enough, I responded better to the medication in following days when I took the doses about 24 hours apart. I felt more motivated, had the energy to do what I wanted, and was in a better mood.

Except that each night I had horrible chest pains. I tried to keep calm and tell myself I was okay, but I couldn’t sleep. I tried to find information about what it might be online, but the more I read the more convinced I became that there was something wrong with my heart. I was having a heart attack. There was a blood clot in one of my essential arteries. The medication was causing the blood vessels in my chest to constrict and spasm. Whatever! Each night I was taking my life into my hands; I had finally decided not to kill myself but I was convinced I would probably still die.

Finally, after nearly a week of this, I had a night were I could not sleep, so I decided to call my mom. She picked me up and, since it was the middle of the night, took me to the emergency room – despite her conviction that I should wait until morning to go to a regular medical facility. Sure enough, by the time we actually got to the hospital, I was starting to feel better. All the tests they did came out completely normal; I discovered my heart and I are actually in excellent health! So healthy, in fact, that I managed not to have a real heart attack when I received the hospital bill …

I called Psychiatrist A about reducing my dose and we agreed that it would be safest to take me back to 200 mg per day. He told me to take a 100 mg slow-release pill twice each day. Without more specific instructions, I decided to take the pills 12 hours apart – which, due to my sleep cycle, tended to mean taking the second dose at midnight or later. It took about four hours for me to wind down after the second dose, so I basically became nocturnal.

A friend who also takes two doses of Wellbutrin each day told me that he takes them about 6 hours apart, and I should never take the second dose after 8pm. I tried following his advice, but it wasn’t always easy.

Over the next couple of months I often found myself angry, and while my depression wasn’t as bad as it had been I was unsatisfied with the effects of the medication. The depression was still interfering significantly with my ability to enjoy myself and take advantage of career-related opportunities that involved interacting with people. My self-esteem was too low for me to feel comfortable trying to make a good first impression, and my energy level and mood were also too low. I didn’t want a potential employer to see me on the verge of tears!

(to be continued)