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Re: Update -- Shelli et al.

Posted by Elizabeth on August 7, 2001, at 15:46:31

In reply to Re: Update Lorainne, Elizabeth, et. al. Lorraine, posted by shelliR on August 7, 2001, at 12:33:18

[re oxycodone]
> No, I do think I need it, at least until parnate hopefully kicks in.

Once you feel the Parnate starting to work (and I do believe it will work at least partially for you), my advise is to try to taper off the oxycodone *very* gradually. You might need to switch to the immediate-release formulation at some point (since the lowest strength OxyContin comes in is 10 mg, IIRC).

> > Shelli, do you have an addictive past?
> No. At one point I got pretty high up on valium (30mg a day) but that was only for one week. And then I got completely off of it.

That's not addiction. I'm going to be unpacking my books later today; I'll post the definition of addiction that's given in DSM-IV. (I'm not a big fan of DSM-IV, but in this case I think they got it right, or at least came close. The definition underscores the fact that tolerance and "physical dependence" do not constitute addiction, although they can be signs of a possible addiction.)

> So, really no other addictions, except I am a true sugar/starch addict.

Heh -- did I ever tell you what I think the 4 food groups really are? (Starch, starch, carbohydrates, and starch.)

> Once I start, I can't stop, unless I am at someone's house or at a restaurant (and embarrassment saves me) and I even throw things out so I won't eat them.

It sounds like there might be something wrong with the mechanism that tells you when you're full (I think the hypothalamus is supposed to be in charge of this sort of thing). I experienced something similar on Nardil, and I do think it gave me a sense of what it's like to be an addict.

> The difference between sugar and say alcohol is that if I don't have sugar, I don't crave it.

Cravings are an essential feature of anything that is truly an "addiction," IMO.

> I made a commitment to her about only taking drugs that my pdoc prescribes (because I was taking vicodin on my own). So then I broke that commitment so I had to deal with how to proceed from there.

This is just my opinion, of course, but I don't see it as appropriate for her to be pressuring you into making "commitments" like that in the first place.

> This is really the only issue she has ever threatened me with, so I'm not all the time thinking is she going to terminate with me or anything. She is totally unflexable on this one because she thinks I'm in danger of becoming an addict.

I wonder why she believes that so strongly? I really do think she's crossing a professional boundary by making threats like that to you, even if it is only around that one issue. It seems to me that she might have personal issues of her own surrounding addiction.

> If my pdoc had said no, I would have supplemented with drugs off the internet and terminated with her.

I'm glad your pdoc is being reasonable, because it's much easier to get into trouble with drugs if they're not being monitored by a physician.

> ...I've worked with her for four years now and know what we can work out and what is just a waste of time and energy to keep pushing.

The rigidity/inflexibility that she's exhibiting really does bother me. It strikes me as something that she needs to work out rather than taking it out on her clients.

> She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor.

See, I think that regardless of whether or not it's necessary to follow your doctor's orders to the letter, that's an issue between you and your doctor, and it's not your therapist's business.

> I think you also do what you have to to survive in life and if it means self-medicating, I don't have a problem with that. But I always tell my pdocs what I have done, always tell them if I am supplementing and if they can't handle working with me, it's their choice. Her complaint is that I tell after, not before.

I think that you *should* try to decide on a plan with your doctor before implementing it, if possible, but if there's a problem and it can't wait, I don't think that there's anything wrong with taking it into your own hands.

> I really want to get the medication thing straight before I make any changes in my life. I have not disclosed some of my shame issues to anyone but her, and several other past therapists. But I have gotten the furthest on shame issues with her. I don't feel a need to share them with anyone else at this point. I am still working, I guess, on sharing them with her.

If I were in your situation, I'd have a hard time even speaking to her about meds. Like I said, it's not really her business. Ideally, I think one should be able to be completely open with a therapist; if a therapist tried to manipulate or threaten me the way yours has, I'd consider it to be interfering not only with the doctor-patient relationship, but also with my trust in her.

I think the important thing is whether you're doing what you believe is right -- not whether you're doing what your therapist believes is right.

> I do a lot of nice things for myself and am pretty forgiving of myself. I have to work really hard on not letting people hurt me--really minor things hook right into my depression , and so far I can only deal with that cognitively, since that is my strongest function.

This struck me in the context of your conflict with your therapist. Do you feel hurt by her threats? I'm actually kind of impressed that you can tolerate the way she's acted; I'm not sure I'd be willing to stay with a therapist under that kind of circustances. (Then again, my priorities regarding talk therapy vs. medication are probably very different from yours.)

> I'm so glad that you are in an upswing; I don't think MAOIs poop out quickly in the same way SSRIs do.

I've heard an awful lot of stories about MAOI and SSRI poop-out, actually. And Nardil definitely pooped out on me, both times I tried it. I hope that Parnate continues working in the long term for both of you.





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