Posted by Racer on December 1, 2007, at 13:23:22
In reply to Re: Heart Trouble Patient Looking for AD or Simila » Racer, posted by DStupid on December 1, 2007, at 12:44:44
> Long-term therapy would help me, but I don't have mental-health coverage to pay for it.
It's certainly an investment, and it's hard to come up with the money, but there are options for lower cost therapy out there. And if the medications alone are not fixing what ails you, it might be worth it to invest in yourself by getting into therapy despite the cost.
Of course, it's easy to say that, and a lot harder to do it. Believe me -- I was uninsured for a decade, I *know* how hard it is to hear people say, "Just pay out of pocket, it's worth it..." Sure -- it's worth it, but if it's a question between rent/mortgage, electricity, food, telephone, or therapy -- and it often is -- therapy is the one that drops off the list in a hurry. On the other hand, most urban areas will have some lower cost alternatives for therapy, and it's worth looking into them. Many agencies have interns who can be helpful. They won't have the experience of a therapist who's been in practice for a long time, but they still have skills that can be helpful, and they're supervised by someone who does have experience. Many therapists out there will adjust their fees for some clients without coverage. Other therapists will allow you to pay over time, which is the least helpful, but still better than nothing. There are options out there, for many people who don't have coverage.
Also, in some cases insurance companies will pay for things declared "medically necessary," although that would require your doctor to work with you on appealing the exclusion.
> If I don't find something stronger than Zoloft, I'd try it, thank you for suggesting it, yet I need something stronger acting to show my dad and myself that I'm improving. It's very hard for me to see my dad cry because of me.
Two things jumped out at me from this paragraph: the idea that SSRIs are somehow "weaker" than alternatives, and your belief that your father cries and takes medication because of you. I'll take the last one first, because I won't say much about it: You are not responsible for your father's emotions. I mean that in both senses: your father's emotions are not caused by you, and it's not your job to fix them. I obviously don't know the history here, but I do know that whatever the history, he is a grown man with responsibility for his own feelings. Just as you are a grown man with responsibility for your own emotions. I would much prefer to see you say that you want to improve your functioning for your own sake, rather than saying you want to satisfy your father's needs. Trust me -- I get into that with my mother, and it doesn't go anywhere good. Our parents are who they are, and nothing we do is going to change them. The only thing we can do is work towards coming to peace with our relationships with them.
As for the part about the medications, it's misleading to say that some are "stronger" than others. Some have more selective actions, some have broader actions, but all anti-depressants are about equally effective. (This board tends to attract those who have not had an easy time of it with medications, which often gives a skewed picture.) The only question is which one works best FOR YOU. If Zoloft is effective for you, it's as strong as any other drug. Because of the cardiac effects you've experienced in the past, you're probably locked out of both TCAs and MAOIs, as well as Wellbutrin -- that leaves SSRIs and a few other, newer drugs for you to try. Since the SSRIs are the safest and have the fewest side effects, they're a good place to start. Even though all the SSRIs work by inhibiting serotonin reuptake, they are all somewhat different. Whether any given SSRI will be effective for you is a matter of trial and error, but since you said Lexapro was helpful for a year, it's likely another SSRI would also be helpful for you -- it's a question of which one. Paxil might have cardiac effects for you, Celexa is very similar to Lexapro and might be a very good choice, Prozac can trigger agitation, and Luvox is the least selective for serotonin, as well as the most sedating. That leaves Zoloft, although I'm biased on that score: Zoloft was the most tolerable of the SSRIs for me, fewest side effects, least emotional blunting, etc. Then again, I couldn't handle Lexapro -- at 10mg, I just stopped talking. I sat in the corner, and just stared at the wall, crying now and again, but otherwise pretty much immobilized.
Good luck, whatever you choose to do.