Friday, February 28, 2014

Progress, I think

I saw my psychiatrist yesterday. I am now not scheduled to see him for 3 months- previously I have been seeing him more frequently. Obviously if my mood tanks I will call.

It is good but bad is some ways- I feel like I need to see someone more regularly to be able to tell them what is really going on in my life sometimes. It is hard to get it all in during these short sessions- and yet, I can get in enough. Because the problems I am having in my life right now I do not think are medication-related, they are just life-related. Things to be addressed in therapy.

The good news is that Costco is carrying Provigil in its stores, just not mail-order any more. And I have been able to back down on my dose a little bit. And I realize that I have almost hit my out of network deductible- so I might be able to afford biweekly therapy for a little bit longer- until July when my deductible turns over again.

I continue to have anxiety- it builds during the day. Some days it is bad enough that I take a little bit of klonopin to take the edge off of it, and some days it is less, so I just suffer through it. Today I am just suffering through it. I did get a new script for my half milligram of klonopin.

Tomorrow I am joining Costco. I am actually excited to go shopping there! I have no food, I am totally out of everything- I need to stock up. And I need a new microwave. It is about a half hour drive from here, but a drive that I will now be making once a month to go to the pharmacy. Everyone says that Costco is really, really nice.

Wednesday, February 26, 2014

Why do I do it?

I try to take as little klonopin as possible these days. I can sometimes get a little bit of a rebound effect the next day if I take it. I don't want to be fuzzy- although at the doses I take it these days I am usually not. But mostly, I think I have it in my head that if I don't take the klonopin, I will some how get stronger and not feel so anxious, or at least get better at handling the anxiety.

Well, the anxiety has gotten pretty bad this past week, and I think it has to do with equal parts work stress and the days getting longer: more sunlight. I have been very anxious some days. Today I was really tense and anxious- and it just got worse and worse as the day went on- with the result that I practically fled at the end of the day after work instead of staying to do notes as planned, and I have been good for nothing all evening. Finally I broke down and took a little klonopin, and I am feeling much better.

I have to accept this med thing. I need meds to function at the level at which I want to function. Even the meds I don't want to take.

Sunday, February 23, 2014


I'm having a bad day. And I'm remembering an experience that I remember from time to time- usually when things are not going well- now I think because I am considering going back on a stimulant- which was part of what set all of this off.

I was very manic. My psychiatrist put me on 500mg of Seroquel and 10mg of Klonopin. For about a month, I think I just basked in the relief. But I was sleeping 20 hours a day, and couldn't talk in complete sentences when I was awake. I told my doctor this was not acceptable. He decided to put me on dextroamphetamine to counteract the sedation. First a little- then a lot. I complained it was making me agitated- he decided it meant I was still depressed and needed more. He basically told me to stop being a baby and to keep taking it. It turns out he was in the midst of a psychotic break. (He told me at the first appointment that I reminded him of his wife- and it turns out he was in the midst of a nasty divorce).

At times it was so bad I wandered the streets all night, looking for places where I wouldn't be disturbed. I drove my car all night and screamed and cursed and got speeding tickets. I then took my Seroquel and crashed into sleep- only to wake up and have it all start again.. And then I decided, enough is enough, it can't be any worse off of meds.

Within 24 hours of stopping them I had trashed my apartment. The neighbors called the police. The police took me to the hospital. I spent hours in the ED, answering the same questions, trying my best to hold it together and not yell at anyone or throw anything. And then- when I was admitted to the floor and shown my room, I thought I could finally be alone and stop fighting to keep it together. And a nurse walked in and started asking me the same damn questions. I threw a pillow at her.

That is all I did, throw a pillow at a nurse. And not even at her face. But it didn't matter. Security called, four point restrains, and me fighting all the way. Once it started, I was so mad I couldn't help but to fight, even though the outcome was never in doubt. They wound up retraining my too arms too far apart- it injured my shoulder- but I was too mad to say anything. They wheeled me to the quiet room and injected me with ativan. I don't know how long I spent there- but eventually they let me out of the restraints and I spent the rest of the night in the quiet room, hallucinating. It was my 2nd night without Seroquel.

But I didn't just hallucinate. I also thought I was reading a book I found there- an old philosophy text book on the ambiguity of language. And as a result, the next morning I couldn't talk, because I didn't know what words meant. I did manage to say "I don't know" quite a bit, because I knew that I had to tell these people something- but I knew deep down that I shouldn't even be using these words. I was copping out.

They gave me haldol. I agreed to take it because it was a new experience. But it turns out, not an experience that I liked, so that after two days I refused it. But by then I was talking.

The funny thing is how real the experience of the book is to me still. For a couple of years I found myself wondering, why would they have such a book on a psychiatric unit? People are in such a vulnerable state already, they don't need to read that book. And I wondered if I should write or call the hospital to tell them to get rid of it.

And then one day it hit me- there was no book. I spent the night in the quiet room with nothing- there was no book. It would have been pretty funny if I had sent my letter. But I guess psych units are used  to strange letters from former patients.

How much does the "antipsychiatry" movement apply to me?

I am reading the blog of a woman who used to blog as a bipolar woman, but has developed tardive dyskinesia, gone off of her meds, and now states that she was never even bipolar.

I think that there is a lot of overdiagnosis and overtreatment. I don't know her entire story, and how it is that she wound up diagnosed as bipolar. But if it is true, that she was wrongly diagnosed, then I wonder to what extent her story is relevant to people who actually "have something."

It seems to me that a lot of the people who argue against medication state that they were wrongly diagnosed. And if that is true, that is a huge problem with psychiatry. But not my problem. I had multiple disabling depressions before I ever went on meds (yes, I am old enough that back then they didn't medicate children and teenagers). Sometimes I wonder if the meds caused the bipolar aspect of my mood disorder- but who knows.

It seems to me that there are different camps in the antipsychiatry movement. One is that the medications that we have aren't very good and we aren't very good a identifying who could benefit from them and who doesn't need them- and to this I have some sympathy. But the other is that there is nothing to medicate- that we are pathologizing normal human emotions. The "I was misdiagnosed" argument generalized to everyone else.

I think that there are a lot of people who are misdiagnosed. Who technically meet the criteria, perhaps, but really shouldn't be treated. But serious depression is hell on earth, and not normal (I hope). And of all the drugs I take, I really do not want to stop my antidepressant.

Useless response from the NIMH

I thought that perhaps the NIMH might actually care what someone who really had a mental illness was interested in as a research topic. Or that at least that they would pretend to care.

I e-mailed them last week with a suggestion for a research topic. I stated that I have bipolar disorder and currently take Zyprexa. I will soon be getting to the  age at which I have to decide whether or not to go on hormone replacement therapy. I would really like to know if hormone replacement therapy would increase or decrease my chance of getting tardive dyskinesia, and there doesn't seem to be any published research on this.

So I think that this would be a really good research topic. More and more people are being prescribed antipsychotics. The population is aging. Older women are the most susceptible to tardive dyskinesia. I realize that this probably can't be done as a randomized controlled trial- it would take too long, you can't blind people for 10 years as to whether or not they are taking hormones or not, etc. But it must be possible to do some kind of retrospective study.

I got this long, very legalize type response. First, they cannot give me medical advice- I should talk to my psychiatrist or another health care professional. They cannot discuss the safety of drugs- that is the purview of the FDA. And they cannot influence the topics of mental health research outside of the peer review process- that would be seen as prejudicial. If I want to see my concern addressed by research, I need to contact a researcher who might be interested in doing that sort of research. They did give me a web site that could help me identify researchers.

Well, I did find 2 researchesr whom it might be worth contacting- but I am not holding up great hopes. I e-mailed one of them yesterday. He is not really looking at tardive dyskinesia, but rather the effects of atypical antipsychotics on older adults, primarily metabolic effects. The other researcher- the only one I could find who is actually working on tardive dyskinesia- doesn't seem to be studying it in human beings.

What I find disturbing is that there isn't research being done (at least that is funded by the NIMH) on preventing tardive dyskinesia in human beings. I would think that this would be a big priority. But I am just a mental patient.

Saturday, February 22, 2014

Beauty on ice

I watched the Ice Dancing competition- later, after it officially aired on TV so I already knew who had won. It didn't matter. It was so beautiful! And I realized that I have lost touch with my sense of beauty in the world. It isn't as big a part of my life- or as big a source of joy- as it used to be. And I need to fix that.

I actually liked the Russian's dance the most, who took bronze. It was the most ballet-like, and I love ballet. But all of the top three were so good. How to choose? The judges did.

Today the weather is almost spring-like. I did a short walk and had a massage and did some banking. I actually cooked a chicken breast and had a healthy dinner of a salad with chicken. I did my meds and supplements for the week- no small feat. I take quite a lot of meds, and just as many supplements.

Last night I tried to cut down on the quarter of a milligram of klonopin I take at night along with my Ambien- I thought maybe I could just cut it in half (and maybe this would lead to needed less Provigil...) But I didn't sleep, I got up and took even more klonopin that I would have normally just to get to sleep.

I can't wait to see my psychiatrist on Thursday to talk about this and to try to appeal this. I need to be able to make plans. There is an 8-week mindfulness workshop that I want to take- but it is $500. I won't if I need the money for Provigil. I have someplace I want to go on vacation- but I can't afford it if I am paying for Provigil. I just need to know.

I was thinking that maybe there was something natural that I could take that could take the place of Provigil. But then I realized, if anything natural was anything near as good as Provigil, it wouldn't be legal.

Anyway, I'd rather think about ice dancing. And the wonderful massage that I had today. What will be will be. Today was a good day.

Wednesday, February 19, 2014

China and curling?

I was watching the winter Olympics on CNBC, and there was a curling match between Canada and China. Evidently the men's team from China is pretty good (although the Canadian's beat them). I have not idea what is going on in the women's competition. But I can't help finding it strange to think about China as a curling powerhouse.

I watched the finals of men's Skeleton though on-demand. Of all the sled sports, Skeleton is the only one that really interests me. Going down head first- on the most minimal of sleds- you have to hold your head and legs up- that takes guts. The bob sled- that doesn't interest me so much.

I have to watch the ice dancing, I have missed that. It seems like every time I turn on the TV and try to find the olympics during a non-prime time hour they have curling on! It is a pretty funny sport. I haven't figured out the rules, though. But I haven't really tried. I just find it amusing to watch them play.

Better to watch curling than the news, which is what I usually do when I get home.

I have to stop this

At my higher Zyprexa dose, I blamed everything on being on too much Zyprexa. Now that I am down to 5mg again, I have a shift in mood and I think I have to go back up. I even did over the weekend because I got so obsessed over my Provigil situation- but then I regretted going up. Now I am back down, and feeling good.

I have to tolerate the blips, as long as they are not another depression or a serious hypomania coming on. I have to remember that the studies that show going off of antipsychotics improves outcomes do not show that it helps in the short term. Only in the long term. In the short term I may feel terrible at times. I don't know if I will actually totally get off of it- but I need to hold the line somewhere, and for now that will be 5mg. And I think I need to turn to klonopin before more Zyprexa, if need be. I only take a quarter of a milligram at a time, generally, which isn't too terrible. To think there was a time when I took (and was prescribed) 10mg of klonopin a day. I was very manic at the time.

Work is better on less Zyprexa, it really is. I think that antipsychotics take something from you- a little bit of  your edge, your initiative, something. But it can be very subtle. Everything becomes harder. You have to try that much harder to function. Of course depression does the same thing- so pick your poison.

Monday, February 17, 2014

It is too bad I don't drink

It was one of those really stressful days at work- and then I had to stay an extra hour to make a splint (yes there are emergencies in OT). I got out, and I really felt like I wanted a glass of wine to relax. But I hardly ever drink, I didn't have any wine at home- I wasn't going to stop at the liquor store. And, I'm not sure I really should have had that glass of wine. Often it lowers my energy and mood the next day, sometimes just a single glass. So I rarely risk it on a weeknight.
Work has been really stressful recently for a lot of reasons, including trouble with the office staff- which means we have to do more things that they used to do for us. It just bothered me today because I really needed the time to be doing my notes, not tracking down a discharged patient' chart and faxing it out to two doctors. 

So I am in a complaining mood tonight. I didn't even make it to yoga. I forgot my yoga clothes- I couldn't have gone. But even if I had brought them, I couldn't have gone- because I stayed late to make the splint.

Tomorrow more snow. I don't know if it will stop patients from coming or not. My schedule is totally full, I am even doubled at times. But thankfully, no eval's- so a bit of a break paperwork-wise. 

I will see my therapist tomorrow too. It will be a long day,

Sunday, February 16, 2014


I read some anti-psychiatry blogs and sites occasionally, and I don't know why I do. I have decided to use medication for now- and yet. I have my doubts. What if all of this is wrong. What if antidepressants and antipsychotics make you worse in the long term. What if I am just weak- I can't get off my meds. So many doubts. Not enough data.

And then this weekend I was trying to lower meds, of course. But my reason was so that I would need less provigil. I had thought that I had found a "reasonable" price of $450 at Costo- but I think that they are no longer carrying it. And the next lowest price is almost $700. That is just too much, even if I quit therapy. I have to take less. In two weeks when I see my psychiatrist I will try appealing again, but I doubt I will be successful.

If I didn't have this last really big credit card debt to pay off- it would be different. I've paid off my other two, as well as my student loan. I've paid off my car. I hate being in debt. How can I spend that much every month when I am still thousands in debt?

Life gives you choices- but you may not like the choices that it gives you.

I need to stop messing with my meds and stop thinking that there is a way out of this. But I wish that I hadn't seen the $450 price that I can no longer find. I feel like I lost something that I never even had.

Eventually the price will drop more, I just have to remind myself that. And I make a lot of money- I was shocked when I did my taxes today to look at my total income. But between the money they take out for federal and state taxes, medicare and social security, my benefits, my health savings account, my retirement account, and my $10 to the United Way- there is a lot less that actually makes it into my take home pay.

I need to stop messing with my meds for a while. I just need stability. Even at that high price for a little while. Until the price drops some more- which it will.

Tomorrow I have a lot of paperwork to do at work. And then yoga. I haven't been there in a while, with all the snow and all. It should be good.

Tuesday I see my therapist. My 3rd to last session. I decided that I would stop by April- thinking that I had enough Provigil to get me to April. I was off my a month- it is really March- but I have my tax refund coming, so I'll keep going for one more month of every other week.

I know what I need to talk about. How will I know when things have gotten out of hand again, and what do I do. And I don't know if there is a right answer- it is such a find line between when when you push through and try to keep going or call a time out.

Thursday, February 13, 2014

Too much time on my hands

 I know that this Onion article should probably offend me in some way, but I find it very funny instead. Maybe the dog is just too damn cute.

I'm going through things, cleaning a little, and going online and catching up on the Onion and my other websites. I called some family and chatted.

The snow stopped for a bit, and now we are starting with a second round. I have heat, I have power, I have the internet. And I even have food in the fridge. I am in a good mood. It still amazes me to find myself in a good mood, as I am so used to living on the edge of depression. So when I feel good, it is a shocker. A pleasant surprise, but still a surprise.

Another snow day

I really wanted to go in to work today. I had 5 evals yesterday, and I only completed the paperwork for one of them. I needed to go in. I had planned on going in, to be the token OT in case some of our patients decided to come in- I would be there to treat whoever braved the storm.

But my boss really wants us to stay home if there are no patients to treat (which means using our PTO), because our stats look so terrible recently. And all my morning patients cancelled- and it looks like the afternoon will not be any better. So, all patients were cancelled, and I am staying home. And really, that is how it should be given how it looks outside my window, and given that most if not all of the other outpatient hospital facilities have closed for the day.

The snow is pretty lovely. If I didn't have anywhere to go, it could just be lovely. It is only because of places that I have to be, and schedules that do not follow the rhythms of nature, that it becomes a nuisance.

We have had a lot of snow this month and a lot of cancelled patients. A lot of our patients are older or injured, so they don't go out even when it doesn't seem too bad to us. Maybe they broke their wrist in the last snow storm. I am not impressed by accounting and management in that they don't seem to be able to adjust for the effects of weather on our productivity. The expectations remain the same, no matter how many blizzards we have in a month. Does this make any kind of sense?

Perhaps we need to create some huge artificial intelligence computer system that can lower productivity expectations expectations when the weather is bad. Human managers do not seem capable of doing this wherever I have worked.

But for the moment, I will enjoy my snow day.

Sunday, February 9, 2014

My Sci Fi weekend

I didn't get most of the things done I wanted to get done. But I did have a good time. I was either reading my sci fi book (and yes I finished it), or binge-watching 3 episodes of "Helix" on the Syfi channel thanks to cable on demand. Helix is really good, I can't wait for more episodes so that I can find out what is going on. There are a lot of mysteries that get you hooked.

I just finished "Fall of Hyperion," and it is the type of science fiction that I used to love growing up, but then stopped reading so much after going to college as a physics major. It is the "space opera" genre, with faster than light drive, colonization of space, aliens, etc. Which is all so unbelievable now that I know about relativity. But still so much fun. And the book is so beautifully written, with aspects of poetry, religion, and philosophy, just a wonderful book.

In recent years I have tended towards books about earth's future that do not involve cold fusion, faster than light drive, or other improbables. I think that a part of me is looking for solutions, or at least a glimpse of what our future could actually be. And I don't think it will involve faster than light travel. Physics is cruel. Thermodynamics is pretty depressing if you really think about it. And quantum I never really understood that well- but does anyone?

What I don't understand right now is the fascination with vampires and zombies. I don't find either all that interesting. I am getting so bored of zombies- I tried to watch a few episodes of "The Walking Dead," but there really isn't anything interesting about zombies. Nothing. And the plot was not compelling enough for me to see witness another zombie attack.

The only good vampire movie I have seen is "The Daybreakers." That was an awesome movie.

Saturday, February 8, 2014

Still feeling good

I've been in a much better mood for the most part since I got back from Florida. I got upset a couple of times over things, but that hasn't lasted.

I've also figured out my Zyprexa dose. I'm back to 5mg down from 7.5mg, I went down over vacation. My mind is so much clearer on the lower dose I realize that it really is no contest as to which dose I should be on long term. I think maybe there were some advantages to the higher dose in terms of managing my emotions at times- but I can take a little extra prn or some klonopin if need be. And generally, just having my head feel clearer is making me feel less depressed. I feel more competent, and like more things are possible. Things aren't as hard. Even my paperwork is not as hard.

I also recounted my Provigil and realized that I have less than I thought. I'll be out at the end of the month. I think I'll be buying mine from Costco mail order, it seems to be the best price. Yesterday I was obsessing over it again. I think that I will try one more appeal, though, to my insurance company. The last time we tried I was too depressed to appeal the denial. Plus I was still able to get it from my overseas supplier at the time, so it was not as big an issue.

The amphetamines give me tachycardia recently. I think that is because I take a large dose of Effexor, which is an norepinephrine re-uptake inhibitor. I suspect that if I took a straight SSRI, I could get away with taking an amphetamine again. But that is a huge change to make just to get off of Provigil. Provigil increases dopamine, but not norepinephrine as well like the amphetamines do. I think that it is the double increase of norephinephrine from both the Effexor and the amphetamines that caused the tachycardia. But that is just my theory. I somehow don't think my insurance company will be impressed by it.

Today is a lazy day. Laundry. Cleaning. Grocery shopping. And trying to finish my book! I have to finish it! I can't stop thinking about it. Tomorrow I'll go to church, the gym, and in to work and do paperwork. It is a fact of life that I just have to accept: going in on the weekends to do paperwork.

Wednesday, February 5, 2014

Snow day and good reading

I have been reading a good book. Over last week's vacation I read "Hyperion," and now I am reading "Fall of Hyperion." Really, really good. And also books that make me think about our present situation.

Spoiler Alert: it involves environmental destruction, cultural stagnation, and the attempt to destroy that civilization- or allow it to be destroyed- as remedy.

I often worry about Peak Oil and Global Warming. Perhaps I need to think of it differently. These are both 2 issues which are going to necessitate serious adaptation by human beings- or rather by our society. At least it will stop us from getting too stagnant. The worry is- people can adapt. I don't know how well civilizations can adapt without revolutions or mass casualties.

California is going to have to adapt to less water, more wild fire. The problem is- so much of our food comes from there. Well, I have been predicting for a couple of years that farming is going to be coming back to the Northeast because of the water situation. I hope there is still some farm land left.

It has been a slow week at work thanks due to the weather

Monday I saw all of 2 patients, but got a lot of paperwork done. Yesterday I did see a lot of patients, but then today all of my morning patients have cancelled because of the snow and ice so I stayed home. I'll go in for my afternoon patients.

Our stat's look horrible this winter, and my boss is freaking out. And really, I don't know where the money will come from to pay us. But what can you do about the weather? It is what it is. Ironically, while the weather is keeping the outpatients away, it is driving the inpatient admissions up. Plus, in a few weeks I will be seeing the patients who have slipped and fallen and broken their wrists these past few days as their casts come off, or the man vs. snow blower injuries (I have yet to see a woman vs. snow blower injury).

It is hard to believe that I was at the pool just a few days ago. But I really don't mind the snow too much. It is already starting to be lighter earlier in the morning and later in the evening. It is the darkness that I can't take.

Last night I went to see my therapist, and while it was good to see her, I wasn't sure what I wanted to talk about. I am still feeling better after my vacation, and still trying to keep that good feeling going. I am making plans of things to add to my life- but I don't want to make a commitment to her that I will do things. Because then if I don't I will just feel even more bad on top of feeling bad that I didn't do it. Maybe I really am ready to stop therapy pretty soon. Just in time to start paying for my provigil.

I know what I need to talk about in our remaining visits. How will I know if I get too depressed again to do my job and need to take time off? But she may not be able to give me the answer. Before my hospitalization this past year she was downplaying my statements of how impaired I felt at wok- I think she thought it was the depression talking. And it is a fine line, really. When do you push through, and when do you say, I shouldn't be here?

Sunday, February 2, 2014

Back from sunny Florida- almost had a nervous breakdown at the airport

I had a really good week in Florida. I got a lot of sun. I walked on the beach. I swam in the pool. I went to an Everglades preserve. I went to a Japanese museum and gardens. I did a lot of reading. I spent time with my dad and step mother. I relaxed. The depression lifted.

And then I came back and couldn't find my car in the airport parking lot! Well, it turns out that I had gone to the wrong parking lot. And I had very helpfully left my ticket in my car so that I wouldn't lose it. But I was sure it was in this one lot- and I walked it twice- the second time with tears streaming down my face- wondering if it had been towed or stolen- before I started to wonder if I could be in the wrong lot. I went to the other lot- and of course my car was there.

I think I am finally recovering from this experience. At least I got my exercise today.

Tomorrow it is back to work. Tomorrow it is going to snow! But I am grateful for the small gift of temperatures in the 40's today when I got back from Florida. It wasn't too much of a shock to my system. And I didn't freeze while searching for my car.

What do I take away from my Florida week? The reminder that I need sun shine and nature. The day I really felt my depression break was walking in the Everglades preserve.

It is a strange world, however, the retirement communities of Florida and the larger community that caters to it. But something felt like it was missing. It wasn't complete. But maybe I just say that because I am still to young to move into a place like that. My dad and step mom have become Snow Birds, renting a condo in a retirement community- but I can't see them living there full time for a long time (I hope). It is too small a world.