New Psychiatrist

I went to see a new psychiatrist, as my "old" psychiatrist is too far away since I have moved. And also, because I want another perspective. It is still going to be a medication perspective, I am not going alternative- but I want suggestions that go beyond adding something else to augment what I am on. I think I am on enough drugs. 

But I am depressed enough that I feel like I do need to do something with meds. At least in the short term. Yes, I can pull myself out of it for a couple of hours, which is kind of strange, but then I fall back into the abyss. The worst part is the fatigue. I feel so tired, so weak, it is like I can't move. I don't think my legs will hold me up. 

I think I like the new guy. Of course there was the diagnosis part. Am I "really" bipolar, or is it all med-induced? Do I really have a seizure disorder, or was it just the medication? I am not really into labels- but I do identify with being "depressed." And by this, I don't necessarily mean major depression, clinical depression, or anything technical- I am not even thinking in those terms. I am just depressed. Severely depressed. Way too much of the time, and it keeps coming back. 

One hour is not enough time to tell the story of your life. It is not enough time to tell why you think you are this depressed right now, at this point in your life. There would be too much to explain. And a whole adult lifetime in the psychiatric system to explain as well. This was all reduced to an excel spreadsheet I had of all the meds I had been on, with dosages, effects, and side effects.

I think I came off as less depressed than I am. I had my couple of good hours when I pull myself together. But still, he did have two suggestions. One is to raise the Wellbutrin to 200mg, as 300mg is making me too anxious. And the other is to switch the Effexor to something like Lexapro. 

I like these suggestions. They don't involve more medication. In fact, I had been thinking about switching the Effexor to Lexapro myself. I'm just very scared about doing it. I'm afraid I can't do it while working. I asked him how easy it would be to change antidepressants. He made a joke, he said it would be very easy, he would just write the prescription. I didn't laugh. But then he said he would cross taper. But first, we are trying the Wellbutrin, which is likely to be less disruptive.

I also like the fact that he actually bothered to tell me the side effects of Zyprexa, and did a screen for movement disorders- he is the first doctor to ever test me for this. 

What he didn't ask me: what is my diet like (terrible at the moment), am I exercising (no energy), how is my therapy going, how is my life going. Maybe he felt he didn't have to ask- it's all terrible. I'm depressed.

That is the trap of depression. I eat badly when depressed, because I get too overwhelmed going into a grocery store. I feel too exhausted to move, let alone exercise. I isolate. I cancel therapy appointments because, it is hard enough to get myself to work, to get myself to therapy after a day of work is just too much. How do you break the cycle?

I try to do little things. Get a few extra steps in. Do a few stretches. Grab a salad at the drive thru if I am going to get fast food. But mostly, try to keep going, and hope that things will eventually get better. 

No to Effexor, Yes to Wellbutrin

Effexor is just not good for my blood pressure, so it is down to 300mg again. Since going down from 450 to 300mg, I have slowing been getting more and more depressed. And I don't want another pill to be the answer. Damn it, this feels like it is about something!

 I remember the first time I felt an antidepressant clearly "kick in," after a couple of months of severe, life-altering depression. While a part of me was grateful, a part of me was mad. Wasn't this about something? Didn't this mean anything? Was is all about some chemical glitch in the system, and all I needed was this tiny pill?

 And that is what I have been telling myself this time- this isn't just some biochemical glitch. This depression is about something. It is about the plateau that my life has been at the past couple of years. It is about the fact that while I managed to get off of disability, 7 years later life isn't getting any easier. There is no longer a feeling of progression. And it is about the fact that I am questioning the very medication that I have for so many years believed in, and now am facing head on what I always knew the Zyprexa (especially) is doing to my health and my brain. And yet, I seem to have to keep taking it. 

And I feel trapped. I want my life to change, I just don't know how to do that. I have been trying for so many years, but is seems to take up every bit of effort just do do what I manage to do. I know that I jumped on the anti-medication story because I wanted an excuse. I wanted a reason that I haven't lived the awesome life that I wanted to live. And I wanted something I could fix. If my meds are holding me back- just take less meds, and I will be able to do more. But it isn't that simple. And I'm trying to find a scapegoat for what are really my failings, my shortcomings. I know a lot of it is my learning disabilities- it makes work so hard for me, as well as managing every day affairs. And combine that with my moods, and it is a wonder I do anything at all. Getting off meds won't change this. Figuring out how to work with my brain, and how to pick my battles- I can't do everything, but maybe a few more things- is what I have to do. Plus there is plenty right about what about the questioning of medication. I am sure meds made me worse for several years of my life. I'm sure they made me bipolar. I know Zyprexa is cutting years off of my life with all of the weight gain, and isn't so great for my brain either. But there were years I never expected to live this long. I was sure I would have killed myself by now. So maybe I am living on borrowed time anyway. Wanting to live a long, healthy life is a very recent wish for me. I used to try to bargain with god, please just give me a few good years without depression! Then you can kill me.

 But I can't ignore the fact that my depression has started to get out of hand again since I cut down on my Effexor. But I have been feeling too stubborn to admit that (especially since it was my decision to do it), and to do anything about it. This is real. This is something I have to figure out. This is something I don't want to medicate away. I have to decide for myself if life is worth living or not. Granted, I was already heavily medicated, but I didn't want to add to the mixture! By the end of week I was trying to decide between taking a leave of absence from work- or from life. I just didn't want to go on, didn't feel like I could go on. I felt so depressed I felt like I would collapse while standing or walking, I was holding on to things. And then- an interesting patient, a conversation with a surgeon. And I perk up. Suddenly I want to be around the next day for work. I'm still deeply depressed, but I realize that I don't need to give up on life. I want to live. I want to work. And if work is the only thing I am capable of doing at the moment, well damn it, that is at least something, and something I care about.

 But if I want to keep my job, I had better get this depression under control very quickly. So I go home, and up my Wellbutrin. If I need a little pharmacological help, so be it. I will use meds. That is what I have decided. I'm not going to give up my job, my life, just so that I can be able to say that I am med-free. My work gives me sanity, and my meds let me go to work. I had to figure this out for myself. I'm actually glad that I didn't just decide I couldn't take it anymore earlier in the process, and just decide to pop a pill to get over it- and never have reached any sense of closure with this, or the deep realization that I really am invested in this life. I do have something to live for. I also have a niece and family. And I have my dream of hiking the Appalachian Trail. Meds and all. Perhaps my trail name will be "Medicine Woman." To seal the deal with myself, I bought myself a new backpack- it was on sale, deeply discounted, last year's model. I am excited. And it is black, which is perfect for this city girl at heart. Now all I want is a 300 dollar sleeping bag... Well, maybe next year.For now, I will suffer under the extra weight of my synthetic bag.

 Today a delicious day at home, as I really ramped up the Wellbutrin. Not too much food in the house, as I have been unable to go grocery shopping, but enough that I didn't starve: coffee, canned milk, a protein bar, peanut butter out of the jar, and brown rice mixed with a can of tuna and some cheese. Wellbutrin has always worked very quickly with me- always within a couple of days I feel much better. And I do feel much better. But I also know that I am better because of what is going on in my mind. But tomorrow I need to go in to work to do a marathon day of paperwork, if I want to keep my job. And I do- I really do. And not just because of the paycheck. I love what I do. Except for the paperwork.

 Next week I have an appointment with a new psychiatrist. I'm looking for someone more local, as I still have my Manhattan psychiatrist even though I have moved away. I hope this guy is okay with my meds. I hope he is okay with me "adjusting" my own meds. I hope he can respect the fact that, after 26 years on meds, over half of my life, I am my own best expert.

Feeling good this morning

I chanced going back up on the Effexor last night again, afraid I'd get all agitated again. Instead, I woke up early, feeling so clearly not-depressed for the first time in a long time.

I know that a lot of people will say that an antidepressant can't work that quickly. But we have no idea how antidepressants work. And maybe at this dose it is activating enough that is simply working in that capacity.

I feel good this morning. Even though I know work is going to be rough. By the time I got there last evening, the building was locked. So I couldn't get paperwork done. So I will have to face up to that.

What have I learned? I'm not going to touch my meds for a very long time. Actually, the only thing I am taking that I haven't tried to get off of recently is my Wellbutrin, but I'm not going to try it. For now... Part of me says to go off of it now to "save" it for when I get depressed again, as I am sure that I eventually will. But I will discuss that with my psychiatrist.

I want to believe. I want to believe that I don't need meds. And maybe there was another path, in which I didn't have to go on meds. But I passed that fork in the road a long time ago, and there is no turning back.

I want to believe that the meds made me bipolar (I started out just depressed)- and they probably did- but now I am, so deal with it. And yes, I got very crazy on some of my meds. But the doctors who put me on them were really trying to help me. They just didn't know any better, or were going through their own personal crises.

This has been my year to question meds- something I really never did before. I questioned particular meds, but not the idea of meds. I clung to them too desperately, even when they seemed to be making me worse, as I didn't know how else to make myself better- as the worse I felt, the less I felt capable of doing anything else to help myself beyond taking a pill.

I did succeed in going down on my ambien, which has made a huge difference in morning sedation. So that is a good thing. Other than that, my meds are where they were at the start of this year of questioning. I'm not sure if I still need the Wellbutrin- which did pull me out of a depression recently- but I'm not going off of it for now.

For the first time in months, I am at peace with my meds.

It doesn't matter

At some point, it doesn't matter how your feel. There are a minimum number of things that need to get done if you don't want to be in an institution. And I have to go in to work, no matter how badly I feel, if I don't want to lose my job. I have to do paperwork.

As I get more and more depressed, more and more things get dropped. But some things can't be. And when I am very depressed, it is pretty much only the "have to's" that are getting done, not anything else. Not many of the things that would make my life better. I don't have the energy for that anymore. I have too many have-to's.

When I was on disability, my therapist (who I generally loved- the one good one), told me that she thought that I could work eventually, but she didn't know if I would ever be able to work full time. And I thought that was overly pessimistic. But more and more, as I work full-time and continue to struggle- I am thinking that she just might be right.

I have to think about this.

But first, I have to get dressed and go to work.

I am never going to feel like going in on a weekend to do paperwork, so there is no point in waiting until the mood strikes- it won't! Just go. Because it needs doing. Regardless of how I feel.

Anxious Morning

I woke up not so much depressed as anxious, I'm sure a reaction to the various things I've been doing with meds the past couple of days. So I took klonopin. First I took a quarter of a milligram, but that isn't quite doing it, so now I have taken a second quarter. I don't like taking it- but at least I console myself with the thought that these are tiny dosages. One doctor (a very bad doctor) had me on 10mg a day! But I was kind of manic at the time.

I have to go in to work to do paperwork today. A lot of it. And I have to do laundry. And grocery shopping. And I have to go for a walk or to the gym. I really need to exercise, I have been backsliding on that. Ever since I hurt my back with my personal trainer a couple of weeks ago, I haven't exercised. But it is much better, so I have to get back to exercising- but I'm not going back to a personal trainer for a while.

I'm not as depressed as yesterday. This does not mean that things are good, only not so bad. And maybe I can hang on for a little while longer.

I have a vacation coming up in May. I can't wait. I'm going to go backpacking for a few days. And I want to go to visit my brother and my niece for a couple of days. There is nothing more life-affirming than a baby!

And yet, the idea of motherhood is one of the things that this illness took from me. How could I, this crazy person on all of these meds, have a baby? I never even thought it was an option. This didn't bother me until I started doing "better," and I started thinking what if... What if I had gotten my act together 10 years sooner. What if I had been giver fewer meds. What if.

But 45 is too old to have a baby, at least for me! And I wouldn't do it without a husband, given all the "issues" that I do have, and no husband- so no baby. Oh, well, I worry about overpopulation anyway. This is doing my part.

I've been here before...

Depression. I just feel like my life is going in circles. The same issues keep coming up, things aren't getting better. My life is at a stand still. And, as always, I don't know what is meds and what is not.

I'm trying to find a local psychiatrist, as mine is very far away since I have moved, but that too is difficult when depressed.

I did try increasing my Effexor. What made me think I could do that on a weekday? The agitation was unbearable. Now I don't know what to do. I want there to be something to do other than meds. I don't know what that thing is. Well, I'm sure it would have been a good thing if I had made it to yoga this morning.

I don't want more meds. I don't want the lithium that my current doctor is advocating.I had too many side effects on it when I was on it before. I don't want to increase my Wellbutrin, the other "sensible" thing to do- because the last time I tried that I crashed my car (in my parking lot, nobody hurt). Going up on the Effexor made me agitated, and I don't want to do that again.

I don't want to be more drugged, more impaired. I go on new drugs, and I am never taken off of things- I only come off of things if I do it myself. No one ever suggests it to me.

Which leaves me between a rock and a hard place. If not drugs, then what? I haven't figured out that one yet. Maybe if I could take a few weeks off to backpack...

If I had money. I don't think they will let you take a medical leave to go backpacking. It is much more socially acceptable to spend a medical leave in a psych hospital, although probably not as effective.

A miserable day

The past couple of days my mood has been all over the place, much more variable than normal over the course of a day, but often bad. I do not attribute this to bipolarity or cycling or anything- I attribute this to less medication. The megadoses of Effexor and the increased Zyprexa are not there anymore to prop up my mood, as I have gone down on them recently. And while this did not immediately plunge me into depression, it has left me increasingly more vulnerable to my dark thoughts and the general bad things in my life. I think if things were going better in my life, I might be okay. But they are not, or at least not enough- so I am getting pulled deeper and deeper down.

Or, maybe I just need more drugs. I broke down and took a quarter milligram of klonopin this evening, and I feel so much better than I have in days.

The easy think is to say, fix your life. Or at least, fix your thoughts about your life. But it is easier said than done- I had decided to stop at the park and go walking after work. But by the end of the day at work I was so depressed, and my depression was so physical, it was all I could do to walk to my car- I felt like I would collapse. Yes, I wimped out, I gave in. I didn't do it.

I don't know what it is that causes that feeling of weakness, like my legs won't even support me. Sometimes I have gone to Walmart to walk when I feel like this, because I can lean on the shopping cart, and I don't have to worry that I will fall down. But then, being in Walmart when depressed is pretty hard too.

I was so frustrated today because I couldn't concentrate, and I wanted to. I wanted to function, wanted to be present, wanted to feel alive and well. I just couldn't be. I didn't know how to make it happen. And so it was a miserable day at work, and I'm a little more behind. And it was noticed that I was quiet. But, I did make it through the whole day.

Sometimes I feel like that is what life is, just making it through the day. And if I make it through enough of them, it will finally be done. I have moments when I can't wait for it to be done.

I'm having a pity party for myself today. I thought that life would get easier someday. I didn't realize that 8 years after getting off of disability, life would still be such a struggle.

I can hear my step mother's voice in my head- just raise your damn effexor already! And I would, if not for my blood pressure, and 450mg of Effexor was not doing good things to my blood pressure. So depression or a stroke, take your pick!

I think I need to get a life

I have been so focused on meds the past few months. I hate that. And, after all that, I think I have concluded that I am staying on almost everything- but I have lowered my Effexor (which helped my blood pressure), and I have lowered my ambien (which helped my morning sedation). Everything else seems to be staying. I can't go below 5mg of the Zyprexa without paying a price- and I seem to have even worse cognition on lower doses- so I am not going to try anymore for the time. I need to get a life for a while.

Recovery has to be on my terms- even if I am not sure if it is really recovery if I am still taking meds. And if I can't be one of those people who gets off of meds and thrives, so be it. Maybe I have been on meds for too long.

I want to go back to taking my meds, and not really thinking about it most of the time. Sort of like taking my vitamins. And then just getting on with my life. When things are bad, maybe that will be the time to try to go off of them again. But I'm not going to make myself bad going off of them when things are relatively good. I'm just not going to do that.

So, issue resolved! At least for now. You know how my mind works, we'll see if this lasts.

Current meds:

Zyprexa 5mg
Effexor XR 300mg
Wellbutren XL 150mg
Zonegran 300mg
Provigil 400mg
Ambien 5mg

It's too much, I know, but I've been on much worse.

It wasn't hypomania

I did not sleep much last night. And I didn't feel sleepy today. Instead, I felt very awake. I felt my emotions were very strong, my thoughts were very loud, and a little racy. My anxiety was up, and increased over the course of the day.

Oh great, I thought. I am getting hypomanic. And it isn't a nice one. My doctor is right, I really do need to go on lithium... I even broke down and took a quarter milligram of klonopin.

And then I got home, and saw my bottle of Zyprexa on the table. I had forgot to put my Zyprexa in with my nighttime meds when I "did my meds" for the week. I was off Zyprexa. That was all.

And because I didn't know that's what it was, it brought out all my fears. A part of me even started to think, maybe I haven't seen the last of the inside of a locked hospital ward. Which is really something I wouldn't like- because they would just want to give me antipsychotics, no doubt, and that is what I am trying to get off.

I blame insurance companies and psych hospitals in part for the increased use of antipsychotics for non-schizophrenics. There was a time when they would keep you 3 or 4 weeks for a depressive or manic episode- enough time for an antidepressant or mood stabilizer to have a chance of kicking in. Now they want you out the door as fast as you come in. And the only way to do that, if you are very distressed or agitated, is to put you on an antipsychotic, perhaps in addition to an antidepressant or a mood stabilizer. But as soon as you are calmer- "stablized" is the term they use- they kick you out the door. And then your outpatient doctor is afraid to take you off the meds that got you "stable," especially as an outpatient, so you are now on the antipsychotic, for a very long time if not for life.

And then if they do try to take you off of it- or if you try to go off of it yourself, you might get withdrawal symptoms, which will be interpreted as illness progression, or proof that you need the drug. And so there are studies that show people who stop taking their meds relapse sooner. That doesn't prove they should be on them, or that they improve long-term outcomes. If you take an addict off of cocaine, a good number of them are going to have symptoms of mental illness for a while- it doesn't mean they should take it for life.

I am trying to get off of Zyprexa without relapsing. My therapist- who I think I will continue to see for a while- actually had an interesting suggesting. I was telling her that I don't know how to do this while working as many hours a week as I do, and having to function at a very high level. She suggested taking a medical leave to try to get off of the last bit of it.

It is an interesting idea, and one that deserves consideration. Most people go on leaves to go on meds, not off of them! But if you no longer need a medication, if it is bad for your health, and you can't get off of it... why wouldn't this be appropriate?

But not now. And not without trying to taper down some more.

My psychiatrist had the idea of going on klonopin to get off of Zyprexa, and then tapering off of the klonopin. And I actually found the blog of someone else who did that. But I think I would be too impaired to function at work if I was taking that much klonopin. I'm not worried about getting off of klonopin- I have had to taper down from large dosages twice, and it was never that difficult as long as I did it at my own pace. The last half milligram, that was the only hard part, but I did it.

Someday I will be writing about something other than meds again in the blog!

I don't think my therapist believes me when I tell her that I wasn't like this a year ago. Since I have known her, I have been questioning. I always questioned the Zyprexa, but I didn't even know how bad it was- I thought it was just weight gain and tardive dyskinisia (as if that isn't enough!). But there has been all this new research out about what the antipsychotics do to your brains- and the longer you are on them, the more brain volumn you lose.

Granted, this research wasn't there when I was first put on the antipsychotics. And in fact, I was also told that the risk of TD with the atypicals was minimal. But I wonder if what people are being told today has changed.

And now I am questioning, not just Zyprexa, but meds in general. This is new to me. Sure, when they weren't working, and obviously making me worse, I questioned. I assumed my psychiatrist was just an idiot! But antidepressants have pulled me out of some very, very deep depressions that I thought I could never emerge from, when I didn't even think that something as simple as a pill could ever fix. In fact, sometimes I got mad when a pill made me better. All that suffering! I thought it meant something! And it was just some biochemical hiccup that some pill can fix! I was mad, but grateful too. I kept taking my pills.

This is the year I discovered Robert Whitaker's work, and that there is more to the anti-medication movement than crazy scientologists. There are a lot of research studies out there in peer reviewed journals whose finding have huge implications for mental health treatment, and yet no one is talking about them- well, no one in the main stream media or main steam medical community.

So I need to figure out what to do about these findings, I need to figure out what all this new information means for me. What do I do? I don't trust that my psychiatrist is going to be able to have all the answers for me. But I want to hear his perspective.

Hypomania?

I hate having to wonder that, to analyze myself.

I typically get a little hypomanic in the spring, at least for a few days. It passes, usually without doing to much about it- maybe a couple of days of extra sleep meds or zyprexa. But the past two years, I haven't even had that hypomania.

Sometimes hypomania is pleasant, and sometimes it turns very unpleasant- irritable, etc. So it is hard to say if I miss it. I miss the nice hypomania I guess.

Tonight I slept for 3 hours, and then I woke up. And now I am awake, and I don't even want to get back to sleep. I actually washed a few dishes, went through some papers, but mostly watched the TV news coverage of the primaries. I have to stop doing that.

I ate lunch in my car today, sitting in the sun. Is that enough to set me off? Or maybe it is just one sleepless night. I don't feel too racy. I just don't want to sleep. But I feel like I "should" be sleeping, like if I don't I will pay for it tomorrow. So I will give it another try for a couple of hours. I have to get up soon anyway.

I think I'm quitting therapy

I found myself dreading my therapy session tomorrow. Because I didn't want to admit that I haven't done much studying. Because I didn't want to admit that I went back up to 5mg of Zyprexa, at least for the moment. I just don't want to have to explain myself to anyone, if I don't want to.

And I know what I am doing with meds for the next month or so- nothing! No changes. I have come down some already, I will just try to maintain that. At my next vacation, I will reduce something a little bit more. But this is going to be a very, very long process. And I suspect I won't be able to get off of everything.

And I think I also did in therapy what I have to periodically do- which is to tell my story of my crazy past. OK, so now what? She's not the person to discuss my concerns about meds with. I don't want to do DBT. Now that I have found a support group, even if I do not get myself there every week, just knowing it is there- I feel like I am less in need of just a supportive relationship.

I don't believe in therapy forever, at least not for me. And I have certainly had a lot of therapy. It is time to stop. I know what I need to do to make my life better. Whether I do it or not- it is up to me.

Plus, I won't have to be taking money from my parents for therapy.

Am I wrong about this? It is not often that I find a therapist who I like, and who has been useful. Most of them are really bad. Do I want to give this up before I am sure it isn't going to help anymore, especially when I am getting help paying for it? And maybe this forced weekly social interaction is a good thing?

I don't know.

I feel a ton better- and I almost wish I didn't

Feeling so much better on my 5mg of Zyprexa. If I didn't, the choice would be obvious, get off of the stuff. Now I don't know what I am going to do. Perhaps put my "quitting" efforts on hold until after November, when I take my exam. Which is really what makes the most sense.

Is it possible to get off of Zyprexa after 12 years? Or does it change your brain so much during that time that you need it to function normally? Or, am I one of those few people for whom maintenance use of Zyprexa might actually be a good thing? For whom the benefits might outweigh the harm?

I don't see my psychiatrist until May. And I won't even have the time to discuss these matters with him, as I have something else I need to discuss, and a form I need to get filled out. The idea that we can see a psychiatrist for 15-30 minutes every couple of months- where did that come from? Medication is much too complicated for that. These types of visits encourage the use of maintenance medication- just keep taking what you are taking for the next 3 months until your next appointment, and then, there really isn't time to make major changes. If you stop taking a medication before your next appointment, many doctors will consider you non-compliant. But maybe you didn't have to take it that long.

My psychiatrist would see me as often as I want. But I pay privately out of pocket, and for what I pay him, I'm not going to see him too often. He is a very good psychiatrist- plus, very respectful of patient autonomy. But, he is very much a psychopharmacologist, very pro-drug. He doesn't like using Zyprexa because of the weight gain, but otherwise he is pretty quick to prescribe the antipsychotics.