Posted by Hombre on December 13, 2010, at 3:22:31
I am very lucky to have had a great psychiatrist this past year. She is not the first one I went to for treatment for my most recent depressive episode, but she is the one that helped me to get out of it, and to feel better than I've felt in years.
I had to fire the first pdoc because I felt he wasn't looking out for my best interest. I came in with severe anxiety, insomnia, negative thinking, depressed mood, little appetite, no energy. I was desperate.
We started out with Luvox (generic), which didn't seem to help, and after one dose increase that did nothing we switched to Prozac. I developed severe diarrhea, which is a known effect of increased serotonin levels, and he wanted to switch to escitalopram. I felt that I needed to get off the SSRI train. I had also been taking lorazepam and zopiclone on a daily basis to deal with anxiety, racing thoughts, and insomnia.
Due to my objections to trying yet another SSRI, he prescribed Remeron, and just let me go with that for 5 weeks. I felt hesitant about this before I even left his office, since we were meeting on a 2 week basis, which is good if you are having acute symptoms.
Remeron started off quite good but faded just as quickly. I went in to see another doctor at the same office, since my doc was on holiday, and tried raising the dose. Nothing. Although anxiety was better, I was still having trouble sleeping, even with the zopiclone. This other doctor didn't like the benzos and the zopiclone, and tried to make me feel bad about taking them.
I've noticed that there are 2 camps on this issue. Either the doc sees no problem with low doses of these, or he has a huge problem.
I finally had enough of this nonsense, since I was still in a constant state of anxiety, housebound and paralyzed from the inner tension. So I switched to a different hospital. This was a really tough decision for me, since I didn't want to be presumptuous, but in my mind the doctor was not being aggressive enough.
I had a tense first meeting with my current pdoc, where I felt I needed to make my case for possible bipolar II. She was hesitant to start me on bipolar therapy, but I wouldn't take no for an answer. I left with a script for lithium. She also wanted to see me weekly. I'm lucky that the country I'm in can offer care for people with no insurance at a relatively affordable rate, ~$40-$50 a visit. Meds are still expensive if they are brand name.
Lithium turned out to be a bust, and later lamotrogine made me break out, but eventually we added Effexor XR which seemed to complement the Remeron. I'd had partial success with effexor in the past, but I relied on benzos and ambien to stay calm and sleep. I'd still get wound up at times. My first pdoc, the one I fired, never even considered adding effexor for some reason. At the time, I was so weak and anxious that I just went with whatever he said, at first.
While my current pdoc was away for a short holiday, she arranged for me to see her colleague. He was in the "no benzos, no zoplicone" camp, which made sense since I found out from the internet that he'd authored some papers on the dangers of zopiclone. He prescribed Seroquel with no hesitation. That turned out to be a good call, and it simplified my regimen so that I could take meds in the morning and in the evening on a regular schedule.
Lorazepam/Ativan works well for me in tiny doses, but instead of taking them on a schedule, which would be unnecessary, I'd wait until I felt agitated or anxious and then took one. That's stressful, and I felt I needed to carry a few little pills on me at all times. Seroquel still knocks me out at night and keeps me pretty mellow.
Back to my pdoc, once we got dosing issues under control, I asked her to write me out a 3 month script for all my meds so I could order them from Canada. She had no problem doing this for me. We also decided that I'd only come in once every three months, since money was tight and I felt stable.
On several occasions I had to have my script modified to meet the minimum order requirements of the Canadian pharmacies. They can be pretty strict about this, and your script will need to be exact, e.g. 12 weeks does not equal 90 days, and 3 months does not equal 100 days.
All I had to do was call in, and then I'd stop by the next day to pick up the modified script. No questions, no suspicion. That also saved me the cost of what would be only be a 5 minute visit. I follow her instructions to the T, I was always open about everything, so she trusts me.
This pdoc also had me fill out a mood questionnaire before each visit. This allowed her to keep track of my progress, being able to quantify my symptoms and track positive or negative trends. This is the first pdoc to do this, but I feel it should be required until you achieve stability.
I will be relocating to a new country in a week, so I met up with my pdoc for the last time this morning. I told her all about the drama that was prompting my move, and as usual she was supportive, knowing it was probably going to help me in the end. I asked her for a letter that I could give to my new pdoc, so my treatment could continue without a hitch. She wrote this up while we chatted.
She actually wrote me another script for 3 months, which I didn't ask for, thinking I'd have time to get a new script in the place where I was moving to before the previous script ran out. But since money and language might be a factor, this turns out to simplify things a lot and was a good call on her part.
I also told her that even though I knew I would be able to manage in the new country, I might experience some anxiety due to the major change in my circumstances: language issues, needing to find work, etc. I asked her if it'd be OK if she prescribed me a little lorazepam to ease the transition. She totally agreed with this, and gave me a once a day, small dose, for a month. I will only take them if I really do start to feel overwhelmed, but I feel much more confident knowing I have them *just in case*.
I don't have a history of abusing any of my medications, and I always tell my doc everything I'm taking, including vitamins and herbs. She has always supported my taking anything that helped with my mood and energy. She supports my exercise routines, and wasn't judgmental when I told her I was smoking on and off.
You may think she just gives me whatever I want, but that isn't the case. I only ask for what I think is best, and it's not like she is careless. In fact, anytime I had to call her outside of normal visits, she always called me back the same day. She was always cautious with med changes, and she took my anxiety and insomnia seriously, making sure I had something to ease the suffering.
I wanted to write this homage to her because I feel that she was a true blessing that helped me to overcome a serious chronic depression--one that has stunted my life for years. I felt responsible for my own recovery, and I only relied on medication to the extent that my own efforts were limited without their help. This is the same attitude that my pdoc has. I feel that she truly cares about my situation, both short term and long term, and she has been my humble ally in what has been one of the toughest years I've ever had to face, oftentimes completely alone in my suffering.
If you aren't happy with your pdoc, and it is possible to switch--even if it means short term inconvenience--it's totally worth it if you can find someone that will work with you. You need to find a recovery strategy that works with your strengths and shores up your weaknesses, be they financial, psychological, or physical. There is also some luck involved, but as they say, you can maximize your chances for luck to work in your favor.
Depression is an emergency; your doctor should see it this way and be as aggressive as possible. You should never feel ashamed about your illness and you should never feel that your doctor isn't listening to you. You should have some say in which medications you put in your body, and you should be able to make the call if a medication is causing intolerable effects on your body or your mind. You should feel supported and empathized with, even if you aren't getting psychotherapy from your psychiatrist.
poster:Hombre
thread:973386
URL: http://www.dr-bob.org/babble/20101203/msgs/973386.html