Thursday, December 24, 2015

I'm in a strange place (for me)

I'm doing better enough that I am actually thinking about lowering medications. I actually have already lowered my Effexor from 450mg to 300mg, and after a rough month I think I am in at least as good a mood as I was before. Should I go lower?

It is not that I don't have my down times- but there are things that meds can't help me with- except to get me through the moment. Like last weekend when I was so overwhelmed with everything I had to do I shut down and couldn't stop crying and took Zyprexa and klonopin. But the meds never really got me to be able to multi-task and prioritize and have the executive skills that most people have. They never helped my initiation. I have to work on that in other ways. DBT. Meditation. And when it gets to be too much, I run to my pills maybe- but that is better than taking higher doses all of the time and being too out of it.

I've also lowered my Provigil by half a pill. And the klonopin, which had been creeping up, is back to half a milligram a day most days- except for the days I am too wound up at the end of the day to sleep. Then I might take another quarter milligram.

I know that the key to this is doing it really slowly. I should stay where I am with the Effexor for a while. But the reason I think that maybe I should get off of it is that if I forget to take my morning meds (but I take my Provigil separately, so I usually take that one), I often feel better and have am less tired- until I start feeling withdrawal. I don't know why. Could it be the morning Effexor dose I am missing? The morning Zonegran? My blood pressure medication? I should experiment.

I also feel like I can't go off of the Zonegran unless I go off of the Effexor, or at least to a low dose of it. I once had a seizure- during a brief time when I was not on an anticonvulsant and just on lithium- and they said that it was from high levels of an antidepressant. So I am a little hesitant to take an antidepressant without an anticonvulsant, especially a high dose of one.

It is really nice to have a 3 day weekend with the holiday. Not just this week, but two weeks in a row. Plus we are closing early today, I think my last patient is at 1:30. Not too many people want to come to therapy on Christmas Eve.

Every year at Christmas patients give us food. This year must break the record. We have so much candy, chocolate, cookies, and cakes. It is unbelievable. And very sweet- in both meanings of the word.

Saturday, December 12, 2015

Still moody, but at a higher level

I am doing much better. My lows aren't as low and my highs are higher. I am still moody, and my mood swings can be quite severe. Sometimes it is my fault- like the night I had wine and felt awful the next day, and then yesterday when I let myself run out of synthroid. And sometimes it is just the pressures of life that I am responding too as I am trying to get caught up from being depressed for so long and my mother and various other things. And sometimes I just don't know.

I still have trouble with initiation but it is a little better. And I still have trouble with energy but most days it is better, at least somewhat. I think those are the hardest things that I deal with.

I wish I had more weekend. Tomorrow I am going to a Handel's Messiah sing along, something I have always wanted to do. I am going with my day near where he lives. I sang it in glee club in college- well, some of it. And they will have scores there. I think it will be fun. But I am basically going to be losing the day (other than also making my monthly trip to Costco for my Provigil). I won't make it to church, I have been saying I would start going to church for advent. Last week I was at my dad's for his birthday. And now this. Not enough time.

Today I need a day at home, I really do. I had so much going on this past week- even though some of it good- I am still someone who needs to recharge. If I am really good I'll make it out for a walk. But I have mountains of laundry to do and so much cleaning to do.

My dream is to work fewer hours a week. I work 40 on paper (which is 42.5 including lunch). I have always worked 37.5 in the past, so this job is more for me. Plus I put in a lot of extra time with paperwork- and occasionally stay late to get in an urgent post-op patient in. 36 hours would still be full time, and that is what I really want to work- I think it would make a big difference in my energy and I could still afford to live on it. But it is not an options- they said that it would take hours away from the position and they don't want to do it. And really, that wouldn't mean there are less patients. We are a small department and I am the only full-time therapist at my site.

But things may change. Insurance is getting worse- I had a patient come in the other day with a $100 co-pay. She is not coming back. We may find that we are not getting enough patients to justify my hours. Especially during the slow season. And I could flex up during the winter when it seems to get crazy with all the wrist fractures from all the falls. But we also have a new hand surgeon- and although he is only at our site 1 day a week, that may be enough to keep our numbers up.

I think it takes more energy to create a life than to keep a life going. And I have no life other than work, and it has really been that way for many years. It has been hard enough to keep that going. I thought my next step would be church, but other things are getting in the way. I think that eventually I want to join a chorus- I just found out about two that are possibilities- you don't have to be wonderful singers who can sight read. And I want to take piano lessons again- but I don't think I can afford that plus therapy at the moment. I just started up therapy again with my old therapist who doesn't take insurance after two unsuccessful tries with in-network therapists. Now that I no longer have out-of-network benefits, I was hoping to find someone who took my insurance, but I don't have the patience to keep trying.