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…

I forgot to refill my prescriptions until I ran out – of course on the day I was running late and had to rush out the door. I tried to put in the refill request for the clonazepam first, but was unsuccessful; somehow my prescriptions got de-synchronized so I was out of refills with that Rx number and I didn’t have the new one to put in. I was in crazy anxiety rush mode, so I didn’t try refilling the lamotrigine – even though it had 2 more refills with that Rx number.

I asked Fox to go to the pharmacy for me and he did, because he’s wonderful. He said (they said) they didn’t have anything in the system for me. I was tabling at a pride event and he had to leave for work and it was Sunday, so there wasn’t really any opportunity to follow through on anything.

On Monday I realized I should’ve tried to refill the lamotrigine, better to have one of my meds than neither, right? That was no problem, but I had to speak to a pharmacy representative to deal with the clonazepam. The person I talked to at the pharmacy had an irritating tone to her voice and was too nonchalant, like there was no problem with them not having the information necessary to make sure I have access to a medication that keeps me alive. She didn’t even try to be polite like saying ‘sorry’ – but she did offer to fax my prescriber. And she explained that the clonazepam prescription had expired because it’s a controlled substance, so it has to be filled within 30 days.

I walked to the pharmacy with my inner voices screaming, an irritable mess, barely holding myself together. By the time I got the lamotrigine my ears were ringing and my eyes were so full of static everything was in a darkened haze and I couldn’t think straight and everything felt completely WRONG. That was after missing one dose – and it’s not even that high a dose. I took the dose – better to at least take one of my meds, right? and everything cleared within minutes. The difference was noticeable to Ron over the phone.

I had to play phone tag with my prescriber for a couple days, but I was able to refill the clonazepam today. I didn’t notice as much as an effect when I took it, except that maybe I’m a bit calmer? And I was rather sleepy, I attributed it to waking early from a bad dream, but the medication is known to make people drowsy. Ron seemed surprised I’m able to function at all taking [my dose] of it every day.

To be honest, between what ze’s been telling me about it and what I’ve read online, I’m a bit wary about staying on the clonazepam. Apparently it’s habit forming and it’s better not to take it for extended periods of time. But my prescriber added it for a reason – I think because even with my mood stabilized I was still struggling with anxiety. And I don’t know if I wrote about this yet, but my prescriber is retiring, so I need to find a new one within the next month or two. I’d rather not change my meds until I’ve developed a good rapport with the new prescriber.

So, yay, I’m back on my meds! I anticipate that going a day without lamotrigine and two days without clonazepam will have thrown my levels off; it might take a while for them to get back to normal. And I’m a bit shaken by how profound my (withdrawal?) symptoms were before I took the lamotrigine. I’d come to accept that I’ll probably be taking these medications for the rest of my life, and I’d rather do so consistently than risk going back to how things were before I started taking them. Still, this was a rough reminder of how dependent I am.

Building a Future Together

Fox and I had a productive marriage counseling session today. We talked about how the stuff we’re doing now is working toward the future we want to create together.

It started with me expressing concern that he comes home from work so exhausted – and has such low energy on his days off – that I’m worried he will never “have the energy” to find an internship. (He needs the internship to complete his degree and enter the career that is his calling.) But he explained that right now working full time is important to him because it provides us with some income and financial stability. When the time is right he will cut back on his work hours to make finding and fulfilling an internship more feasible.

This was very helpful to me because I was seeing the situation as either-or: either he’s pouring all his energy into a dead-end job that’s currently paying less than the local, recently-increased minimum wage… or he’s doing nothing until he manages to find an internship, which might take a while. He helped me see that the situation is more complex: right now he’s pouring all his energy into the job, but over time he can put less energy into the job and more into pursuing his long-term career goals. There can be a more gradual transition; it doesn’t have to be an abrupt ending.

Similarly for me: I don’t have to go from living in Skyrim to taking classes and being in various extracurricular groups and applying for internships and trying to find a job. Right now, taking classes again is enough of a leap. I’ve decided to try joining two LGBTQ+ discussion groups that each meet on campus for an hour once a week. They are the definition of low stress: no homework, show up when you can, have a conversation, and leave. One is for LGBTQ+ students and their allies to socialize. The other is specifically for bisexual, pansexual, non-binary trans*, and other gender-queer people to talk about sexuality and identity. Of the groups offered, it’s the one that sounds like it was designed for me.

In our session I said that I’m taking my classes and I’m going to see how they go, then possibly build on that as seems appropriate. Maybe I’ll love and feel so empowered by my experiences, I’ll decide I’m ready to apply for internships. Same possibility with jobs. Maybe something will come to me once I’m out in the world doing things and interacting with people again. Or maybe I’ll just need to focus on my classes, and setting boundaries around them will help me feel like I’m asserting myself and taking control of my own life. I am in the driver’s seat. It’s up to me where, via what route, and how fast I go.

Individually, we are figuring out what works in terms of current occupational focus and future occupational goals. Together, we are supporting each other and making decisions that move us in the direction of our joint goals. For example, my hormones have been throwing increasingly disruptive temper tantrums demanding that I procreate as soon as possible.  Most recently, they convinced me to decide what I’m naming my first child – so now ze has a name; ze is an entity I’m denying entrance into the world.

I don’t know whether Fox’s hormones are also clamoring for babies, but he remains the voice of reason: “not yet.” It empowers my own, internal voice of reason: “we can’t take care of ourselves, yet. Let’s get really good at doing that before bringing a new life into this world.” Having a baby now would be a complete disaster financially, emotionally, for both our careers… it wouldn’t be healthy for anyone involved.

So together we make the decision to wait. Together we do what we can to meet each other’s needs. Together we build the foundation for our future family.

It felt good to have an idea of what the future might look like, for once. Too often it looks dark and empty, nebulous. I’ve been having trouble being creative and my experiences have taught me that nothing is guaranteed; my wanting something to happen has no influence on whether it will happen. So how can I decide what my future will look like? I can’t. It’s just… formless. A waiting void.

But I can put things in that void. They might not happen how I expect – if at all – but I can put them there and work toward them and feel good about knowing we’re building something together. Kind of like improvising: I know what sound I think should come next, but it isn’t always what my fingers end up playing. When I make a “mistake” I incorporate it into the improvisation, so what was unintentional becomes intentional – possibly a central motif! I might build an entire song out of something I never even meant to play. So with life… it’s not about knowing what exactly will be there, just that something will – and it will be something we work together not only to create, but to continuously shape.

After our session, I noticed that I was becoming very irritable. I kind of snapped at Fox for slamming the car door, and again for being indecisive when it was time to order lunch. He caught public transportation to work and I came home; by the time I got here I felt like I was being subjected to nails on a chalkboard. Cardio exercise helped me clear my mind while I was doing it, but didn’t have any lasting effect on my mood. I was very agitated and all the sounds were making it worse.

I suspected I may have been experiencing symptoms of withdrawal from Lamictal, which from what I read can be quite the nightmare. (I had abruptly stopped taking my 75 mg dose, per the APN’s orders, on Monday.) Part of my mind was clamoring for me to take a 25 mg pill to take the edge off. Part of me was thinking that if this is what withdrawal from such a low dose is like, maybe it’s better for me not to be on it at all.

The thing is, I have my classes, and I have all the stuff I just wrote about. Plus, Fox and I have been talking about adopting a new pair or trio of rats; we want to raise them from as young as possible this time. Last night we learned that a nearby rescue has several newborn babies that will need homes within the next six weeks (once they’re weaned); that gives us time to prepare but also a nice kick in the pants to do so. Our past pet rats brought a lot of joy to our lives, so we’re hopeful about adopting again. (I also hope that having pets to care for might get my hormones to quiet down a bit!)

So I can’t be going through withdrawal symptoms right now. I just can’t. I need to be able to focus and direct my energy at what’s important to me and enjoy my time with Fox. Things snowball and become horrible when I’m irritable toward him (which is different from when I’m justifiably angry – then we can talk and come to a new understanding).

I felt guilty about “bothering” the APN’s office again, but I also felt like I was going crazy and needed to do something about it immediately! The only way I was going to get the help I needed was by asserting myself. So I called and said I needed to talk to the APN about my medication.

I actually got to talk to her right away! and it was very helpful. Ironically, I still don’t know which risk factors prompted her to take me off the lamotrigine – just that she had weighed the risks and benefits and thought I’d be better off not taking it. She asked if I had a rash – so maybe that’s it?

Anyways, I told her that I thought it had been helping me at least somewhat, particularly by decreasing my suicidal thoughts. She said, “Oh, I hadn’t realized it was so helpful to you. I’m glad to hear that.” She instructed me to start taking 25 mg again. I considered arguing for 50 mg, but I didn’t want to push it. Maybe I am better off at the lower dose?

I still have enough of the medication to take 25 mg every day until after our next appointment, so I was able to start taking it again right away. I feel much better – in part, I think, from expressing all this stuff, being listened to, and getting my desired result. I’m calmer, less irritable. I can think more clearly. Life is good.