Posted by Noa on April 29, 2000, at 13:13:04
Hi, all.
Today is the second of two days feeling a lot better. I have been on vacation for two weeks (just stay at home, no travelling) and that has certainly helped a lot. Not every day has been great--some days, I have been lazing around the house and feeling unmotivated and bored and somewhat depressed, but nothing like the despondent, overwhelmed moods I was in a couple of weeks ago.
Besides the R&R, here's the med situation that *might* be helping: 1)I have been on this dose of cytomel and synthroid for 6 weeks now, and the hypothryoid symptoms of the depression have abated significantly--energy, stamina, "brain fog", etc. And, 2)about a week ago, I decided to see what would happen if I lowered my Effexor XR from 375 to 300, and simultaneously raise my Serzone from 225 to 300. The reason for this is I was having terrible restless legs--both delaying sleep onset, and I was waking up with my feet doing a flutter kick at ultra rapid speed. Also, I am curious as to whether my bladder control problem will be better with a lower dose of Effexor. I also wanted to see if this would help my anxiety, which is always there when the depression isn't dominating all the airtime.
I am happy to be off the lithium. I know it is a good drug, and it even helped my mood initially, but the thirst and urination problems, along with the hypothyroid thing just made it not such a good one for me.
Yesterday I saw an endocrinologist. Omigod. Get this: A doctor's office that is actually NOT chaotic. Where the staff are helpful and seem to be good at their jobs. Where the doctor himself greets you in the waiting room, takes a careful and unrushed history in his office, then does the exam all himself, rather than having someone else do the vitals, etc. Where the doc then brings you back into the office and has an unrushed, attentive discussion with you about his recommendations, taking the time to explain things and answer questions!!!!!!! What more can I say? (But I will, of course) This was so refreshing, as both my internist and my pdoc are part of huge managed care practices.
Endocrine upshot: The doc ok'd my current thryoid doses, and ok'd being at a very low TSH, which I know will not make my internist happy. He gave me guidelines for tweaking the dose if needed, such as splitting the cytomel dose in two, as it has a short half-life, which is totally new info to me. He offered to speak to my internist, gynocologist, and pdoc as needed. He also told me he suspects I might have another endocrine disorder beside the thyroid problem, and wants me worked up for insulin resistance syndrome, Cushings, and congenital adrenal hyperplasia. He also wants to review my workup results from 7 years ago for polycystic ovary syndrome.
PDoc update: I have decided to stick with the guy I have been seeing because, well I don't know, I guess I do feel very comfortable with him, he does know his stuff, we have a good rapport in terms of the back and forth discussions about strategies. As for the accessibility problem, I did confront him about this last time (two weeks ago) and he told me the best times to page him, and said he would allow me to make longer appointments if I want, even though the insurance guidelines call for a 15 min. med maintenance session. And he is humble: today he said the job of the psychopharmocologist is one for masochists, because you have to deal with being wrong so much, because each patient is so different.
Plan: stick with my current cocktail for another few weeks and see how it goes: 300 effexor xr, am; 300 serzone, pm; 20 mg ritalin sr, 2x/day; cytomel 12.5 mcg 2x/day; 50 mcg synthroid, am. Next possible steps: a trial of adderall instead of the ritalin (thanks to JohnL and others!), or adding a morning dose of 75-150 serzone, possibly lowering the effexor more if need be.
Finally, about my mood: Yesterday I felt more ok than I had in a long time. I had coffee with a friend who is at home part time with her infant. I had that good doc appointment in the afternoon. And I had a great time last night, just going to dinner and a movie with a good friend. I laughed and talked more than I have in a long time. I was getting a bit self-conscious about whether I was talking too much or too fast, or being too bubbly or having too many flights of ideas, as conversations tend to have with pals. But I asked my friend and she said she didn't see that at all. She did see me seeming to feel good, and she said she would describe it as euthymic. See, I don't know what normal is. The possible bipolar III (bp depression) dx has me so vigilant for anything that might smack of hypomania, that simply having a good time makes me worried. I did feel more reassured by my friend's words, though. I cried, though, out of sadness for myself and joy, for realizing how sweet and wonderful it is to have one good day, finally, just one good day, and to laugh and be silly, and engage in that energetic girltalk that can be silly and can flit from tangent to tangent, and doesn't have to be a red flag for more pathology.
So far, today has been good, too. On Monday, I go back to work, which I am dreading. We'll see if my mood can hold up under pressure. I was a basket case right before the vacation, as some of you might remember from my post about my meltdown at work. One other benefit of this vacation is that I have had time to reflect about my job, and I realize that I don't like it. I like many things about it, but I don't think it is the right job for me. I even clipped out some job ads, which is amazing, just that there were things I was interested in (interest, how we take it for granted!!). I don't have a lot of confidence now about my competence in general or my ability to conduct a job search. I might not actually make the applications just yet, but I think the exploration is useful in itself. At the moment, I am thinking maybe I will stay at this job for another school year, but begin looking around more seriously at what I want to do next. I might even go see a career counselor, who knows.
poster:Noa
thread:31682
URL: http://www.dr-bob.org/babble/20000429/msgs/31682.html