So how do I tell my psychiatrist?

I am down on my lithium. I have been wanting to try going down for a little bit- I wondered if that was contributing to the numbness. And then I had a reason to go down- I was taking a lot of Naproxen after my dental surgery, and was worried about lithium toxicity. So on the weekend I decided to take 2 pills instead of 3, which is 600mg instead of 900mg. I wasn't sure if this was a temporary measure or if I would stay with it- but so far I have felt okay. In fact, maybe even better. Like a little less paralyzed.

So I think I am staying with the lower dose. Now I just have to figure out how to tell my psychiatrist... I remember when I lowered my Zyprexa on my own he seemed so shocked. And I got the "you are paying me for my advice, so you should probably take it" lecture- said with a smile and humor, but with some seriousness too.

It would be different if I saw him more frequently. But to expect things to stay the same for 3 months at a time- with no changes- that is a long time. And unless things are sufficiently bad I don't want to go more frequently. If I had out of network benefits, it might be different.

I don't think I want to change psychiatrists, though. I do like him, I think he is good- and I have had too many bad psychiatrists to leave a good one just because of insurance. Therapy is different- I have a new therapist who takes my insurance. I have a high deductible plan, but by the time I went to him I had met my deductible- so it is so nice just to pay my 30 percent co-pay. I can afford to go every week.

Med thoughts

I will see my psychiatrist in a couple of weeks. I'm not sure what I want to do med-wise. I think give Lunesta another go- the Ambien is not working, so I am taking klonopin with it, which makes no sense. Maybe I could just take Lunesta. I think it was stronger- although when I took it, I took 3mg, which is no longer recommended by the FDA.

I wish I could take nothing to sleep- but that hasn't been the case since I went on an MAOI. They gave me insomnia, I wound up taking something to sleep, and never broke the habit. Plus, since my crazy mania's, I am scared of insomnia now, in a way that I never used to be. I used to have a lot more tolerance for it. In fact, I used to use sleep deprivation as a way to pull myself out of a really bad mood- of course it wouldn't last, just until I next went to sleep. But it was something.

My other thoughts are switching Seroquel XR for Zyprexa. Or Lamictal for Zonegran. Or just stopping the Zonegran.

I am a little scared not to be taking an anticonvulsant. The one time in my adult life when I wasn't- I was on lithium instead- I had a seizure. They told me that was because of an interaction between two antidepressants and my levels were high. I never had another. But who knows? I take a huge dose of Effexor. I don't know if other drugs I take can lower your seizure threshold. I live somewhere where I have to drive to get anywhere. I don't want to have a seizure driving. But I don't want to take a drug I don't need to take, either. Maybe I need to talk to a neurologist. Because I don't know if I still need the Zonegran now that I am on lithium- or how low I can go if I want to prevent seizures.  Should I even be worried about that.
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If you are in a hole, keep digging

I just spent money I don't have, but I think it was well spent. After spending the weekend eating ice cream, mashed potatoes, and liverwurst (hey a body needs protein), I just ordered a nutra-ninja pro blender from Amazon. It is the cheapest of the alternatives that seems to do what I want to do: make green smoothies so I can get my veggies in without a lot of chewing. And I bet it could turn my frozen garlic steamed cauliflower into some awesome mashed garlic cauliflower.

I had heard of the Vitamix, but it is $400! Mine is under $100. I hope it works out. I read some reviews, it seems to be pretty good. The one thing I can't do is to mill nuts and grains on a dry setting into flour- but I think I can live without that- it is not like I have been doing that up to now!

The other thing I did was to sign up for HBO so that I could watch "Game of Thrones"- I just had to see it. And now I finally can- previously I have only watched it during their free weeks, and then I have binge watched it. And John Oliver's show is on HBO. That is really about it, though. Not much else. I finished watching the end of "Helix," and I wasn't crazy about the second season, but I like the way they left things at the end. I am still in the midst of watching "Dig," but I am caught up. Then there is "Orphan Black" on BBC which is really wild.

I sound like I do nothing but watch TV. Well, normally that is not true, but this weekend it was kind of true.

My mouth is scary looking. It is not just the missing teeth- it is all of the sutures he put in because of the bone grafting. The retainer I wear during the day which also has teeth for the missing ones is not comfortable. This process is going to be really long. But I think I will feel better once the sutures come out.

I just need more money

I think my computer is going. Maybe it is something simple- I should take it in to Staples and see if they can fix it. I hope so. But it is starting to shut off suddenly, for no reason. For a while it wasn't doing it too often, but now it is starting to do it very often. I am afraid that one day it won't start up. It is less than two years old, too young for this.

I don't want to have to buy I new computer. I still have to pay for my teeth. I just paid for a new car engine. I am hoping to replace my iphone 4 one of these days as it has no battery life anymore. I just need more money.

I can't believe that I was thinking of going away on vacation next month. I don't have the money. If I go anywhere it will be backpacking. I have the gear. That is probably what I will do.

I have to remember not to lean on my chin. It really hurts when I do because of the surgery. I keep forgetting. But otherwise I am just chilling- and giving myself permission to do just that. And that feels good. Maybe it is what I need. It is too bad that I have to get teeth pulled to have that.

I guess I don't have to worry about getting addicted to opioids

I had my dental surgery yesterday and it was miserable. I have fewer teeth, bone grafts for future implants, and lots of sutures. I came home with a prescription for antibiotics and a narcotic- I think oxycodone plus ibuprofen.

I am sure I have taken narcotics in the past- I must have. Maybe after getting my appendix out. I just can't remember. I was a little hesitant to take this one because I didn't know if it would mess up my moods (although they were pretty messed up already). But then as the anesthetic wore off the pain got bad and I took it. And waited to see what it would do.

Very good for pain, but no euphoria. It just made me want to go to sleep. And I didn't want to sleep because I wanted to stay upright for a while to reduce swelling and to keep using the ice pack. Really, I was a little disappointed. I thought I'd get some kind of mood boost. But it is just as well. I'd rather not know if there is a drug out there that could make me feel better than anything I take and that I can't have.

Today the pain is much better- the dentist was right, yesterday was the worst day. I have been able to manage with just Aleve today.

I have to go back to get my sutures out in two weeks. I take out sutures as an OT- but never from anyone's mouth before! So I think I will let him do it.

That is actually one of the reasons I can't go too high on the lithium. I can't afford to have a tremor when I am taking out sutures or doing wound care. Not even a tiny one.

Why do I do it?

I still read a couple of antipsychiatry websites. I have my doubts about meds- I know they don't work as well as advertised- but I have decided that I will use them, probably for the rest of my life. It is too late to stop- not unless I want to do something drastic and take a year or two off of work. And even then there are no guarantees.

So reading all this antipsychiatry stuff does nothing but make me more miserable- which indirectly leads me to take more meds, so it really isn't helpful.

One thing that bothers me about what I read is the implication that we would all be fine if we just got off of our meds. I wasn't fine before I went on meds, going off of my meds wouldn't make things all better. I think you can argue about whether meds make things better or worse in different types of people- but people who don't take meds can be really messed up. I have several family members who haven't gone the psychiatry route and I don't want their lives. Would they have better lives is they had gotten therapy and meds? I have no idea. But you can have really dysfunctional and miserable lives without these.

I have no idea how medications work, especially antidepressants. It makes no sense that a TCA, SSRI, and Wellbutrin could all be antidepressants. Although they could have some common downstream effect. But I wonder if we are wrong in thinking of this at the biological level. Depression is an intolerable mental state. These antidepressants change your mental state- subtly, and perhaps it is through different mechanisms, but perhaps that is enough over time.

All the same, I'd prefer less meds. But as long as I am taking meds- I don't want to take less than it optimal- otherwise why take them at all if I am going to be miserable despite taking them.

It isn't over until the paperwork is done

I'd like to say TGIF, but I will be going in this weekend for a lot of hours to do notes. I have so many papers on my desk and so many charts to finish and so many discharges that they don't even fit into my drawer anymore. I can't believe how many people I have discharged recently.

Still, the weather is supposed to be wonderful tomorrow, so hopefully a short hike in the morning will be possible. And I am optimistic that I will make it into work. My mood continues to be better, but not great. I predictably crash in the middle of the day and I am trying to figure out how to fix that. Yesterday I tried having an iced coffee- but it just gave me a killer headache, and I crashed anyway. I think it must be some medication going out of my system.

I am grumpy and whiney and I hate that. But at least I am not suicidal. I am on the higher dose of Zyprexa- which isn't making me as sleepy as it did last time I tried this, except in the mornings. It is impossible to get out of bed on time. 

I have a week's vacation coming up in May, right after a psychiatrist appointment. I am wondering if I should try an experiment- switching to Seroquel XR. Could I do it in a week? Would I know in a week if it was better or not? But I am adding on Benedryl to sleep- I don't want to take more klonopin- maybe the Seroquel would fix the sleep too. Maybe it would be better for the depression.

My insurance company has step therapy for Seroquel XR, and it is really practicing medicine without a license. It is not like they just say that you must have failed with two other atypical antipsychotics, they say it has to be two of the following four: Seroquel, Zyprexa, Geodon, or Latuda. Well, I've taken all but Latuda. The psychiatrist who prescribed Seroquel and Geodon is dead (he was old), so I have no documentation. They would have to take my current psychiatrist's word. 

My other thought is switching Zonegran for Lamictal. And my other thought is getting off the Effexor. Maybe going on an SSRI. 

I know this isn't all meds. I know that meds won't fix my life. But I will take any biological help that I can get. I think recently I usually say, my life is a mess, of course I feel awful, so I don't try to change my meds. But that wasn't working. I wasn't fixing my life. So maybe I need to do things differently. 

A good day, a new therapist

I was visiting my brother and his family this past weekend- and I got to meet my new niece. I had a good time, and yet the depression peeked through a lot as well. But Sunday morning we spent a lot of time outdoors at an Arboretum. It was sunny. I think the company, the walking, the sun and nature did me good. Today I felt better than I have felt in months.

I also started with my new therapist today- and with my good mood found myself wondering if I had jumped the gun going back to therapy. But I like him, and he may have something new to try. Plus, as I have met my deductible for the year- it is the least of my expenses. The main thing I am giving up is time.

I thought I might feel strange with a male therapist- especially since it really hasn't worked out with the few male therapists I have seen in the past (although I don't know to what extent it was because of gender as it hasn't worked out with a lot of female therapists too). But I felt at ease with him.

But tonight I am tired. I am not walking or cleaning or doing anything productive or even fun. I think I will go to bed early and get up early. Then clean and walk before work. At least that is the plan.

I did it

I called a therapist today and made an appointment for Monday. If he had not picked up the phone I don't know if I would have left a message, but fortunately he did. So I have one thing settled.

It was a really bad day. I left work early after my last patient cancelled. I actually thought about the hospital today, something I really haven't thought about in a very long time. But I don't have any faith that they could help me. There is no magic bullet.

And I have been experimenting with how I take my effexor recently. And I realize that I am probably taking too much- it is making me agitated when I take the double dose. I have been taking a lot of Zyprexa, which somehow isn't knocking me out the way it did last time I tried this. I felt like that was the only way I could stay alive and out of the hospital, take Zyprexa. But I did feel fuzzy on it.

I thought about asking my doctor for Abilify to add to my mix. At higher doses it gave me akasthesia, so I stopped it- but a low dose might work. But then I saw that my insurance required pre-authorization, and I just couldn't deal with thinking about that. I'm not going to go to the pharmacy and cry again when I can't fill my prescription. I've been there before.

I couldn't do Easter this year

I never know when to make plans. Do I just give up on planning because I don't want to be unreliable? But then I would have no life. I think there is no right answer.

Anyway, I couldn't get out of the house to go to my Dad's for Easter. And it was my idea to have us all do Easter dinner. I called early to give notice- but that only meant there was more time for them to try to convince me to come.

If I didn't desperately need a shower I might have made it. Or maybe not. But that was the thing that I knew I couldn't do at the moment. The next thing on my "get out of the house" list. Not that I had any idea what I was going to wear- but I hadn't come to that yet.

I felt so bad calling it off. I need the drug that will let me take a shower and get out of the house. I haven't figured out what it is. Something that won't make me too sedated or too anxious. But it there was such a drug then everyone would be taking it.

Last week I had a day so bad I wished I did (illegal) drugs. I wanted a drug that made me feel good- because I couldn't quite remember what feeling good felt like- and I needed to remember that so I could know that there was a reason to keep going with life.

Couldn't sleep

Yesterday I was very anxious- which is unusual for me for a Saturday- it usually isn't until Sunday that I start getting anxious- I think about all the things I didn't get done and about the upcoming week. Saturday I can chill out. But Saturday I was very anxious- and I even took klonopin a couple of times and still had trouble falling asleep. I took my backup, benedryl- which seems to have a shorter half life than anything else I have so it leaves me with less of a hangover the next day then klonopin would. It helped but I still took a while to fall asleep and woke up a couple of times throughout the night.

One night of bad sleep is okay, especially when it is not on a weekend. I told myself that, and it helped. Don't worry over things that haven't happened yet. I am just worried because I do know that spring time often means a lot of anxiety and trouble sleeping, even if it isn't true mania or hypomania. And really, between the Zyprexa and the lithium and the Zonegran, I don't think I could go into true mania anymore. Which is good since I don't do happy manias. Hypomanias can be happy for a little bit- but if they stick around too long they turn bad. And my true manias have been really bad. That is why, at first, I didn't believe I was manic.

But I had some good insight into my depression this past week based upon the title of a blog post on "Psych Central." The title was something like "Depression vs. Chronic Shame." And the article itself had nothing to do with me- it was about people who had been abused as kids, and needed a certain type of psychotherapy to deal with it.

But I realize that I don't give myself permission to be happy sometimes. I feel too ashamed of myself and my life. Of how far behind I am on my paperwork. Of how fat I am. Of the limited social life/ beyond work life that I have. Of how dirty my apartment is. And so on. And this shame keeps me depressed, which stops me from cleaning, from going in on the weekend to do my paperwork (because I am home in bed), from exercising, from doing activities outside of work. I am too depressed and don't have the energy.

I feel like if I fixed my life, then I could be happy. But not only that- I have to fix my life in order for it to be okay to be happy. Or at least to have some sense of progress- then I could let myself be happy, and I am missing that right now.

I have had it at various times since going back to work as an OT. First, just going back to work. Then, having a couple of boyfriends. A different job- changing to hand therapy. And passing the CHT exam. And now- things seem to be at a stand still. How do I change that?

That is what I have to work on.

A good movie if I suspend disbelief

Isn't that how it is with most movies?

I saw "Interstellar" today, and it was really good. But there were a few times that I decided that either the movie got things wrong or I don't know my relativity. But it really wasn't a movie about science, even though it used science. It was a movie about mankind's fall from greatness, about hope, betrayal, and mostly about relationships. The science was the glue, the medium. But it wasn't the story itself.

Otherwise I would spend too much time wondering how a civilization that could take itself to the stars and set up a functioning ecosystem couldn't manage to survive a "blight" of farm crops. They better make sure they don't take any of the blight to their new world.

It would have been more believable to me if the issue had been out of control climate change- but that probably would have been too political. Still, it was a good movie.

Perhaps California is going to be in the relocation business one of these days. They are calling for mandatory 25% water reductions- that is serious. Even if this drought is not primarily driven by global warming- it is proof that we are rubbing up against nature's limits. Because even before the drought they were draining aquifers and they certainly had no spare capacity for dry times.

This was supposedly one of the hottest winters on record- except for one key area: the American northeast. Which is an unfortunate area to be spared, policy-wise. People tend to be pretty egocentric and Americans are particularly known for this.

I don't have answers. I saw a talk by the head of the IMF. Or maybe it was the world bank. He thinks we can stop using fossil fuels without making lifestyle sacrifices- that we are looking for energy efficiencies rather than giving things up. I think he is wrong- but I am not giving up my car either. He wants us all to be driving Teslas. That is a rich person's solution. Not only are they expensive, they also require a place to plug in. If you are a renter and you park on the street or in a parking lot, an electric car isn't going to be a good option.

 

My moods are out of control

I knew yesterday might be bad after the Effexor fiasco. But even today I had such mood swings. I am starting to wonder if it is my meds going out of my system. I am going to change the way I take my Effexor. I have to look at some other meds too. I have to see if there is any way I can take Nuvigil instead of Provigil- it is smoother. I just can't do this anymore.

It is not that every moment is bad, but enough of them are. And every day I have some excuse for why I am having a bad day. There is always a reason. And so I just accept it and tell myself that maybe tomorrow will be better- and sometimes it is, but often it isn't.

Yes, I admit- I have been feeling sorry for myself today. I hate it when I do that. I am depressed enough to see how my life sucks, but too depressed to take any steps to fix it. It seems like nothing I could do would matter anyway.

Maybe I will go back to therapy. With someone who takes my insurance. I have hit my deductible- it is like hitting the healthcare lottery jackpot. Of course I had to spend $2500 to get here- but now that I am here, I might as well use it.

Enough complaining. I got my car back today, and that is a good thing. It was a lot of money- but less than they quoted me. And they even paid for the rental that I was driving for the past few days. So I am hoping it is good for another 5 or 6 years.