Posted by medlib on June 25, 2001, at 0:28:12
In reply to When do you consult your pdoc?, posted by mair on June 23, 2001, at 22:08:03
Hi Mair--
Thanks for your thought-provoking post--it generated all sorts of useful musings for me. At one level, I think the tendency to isolate oneself when depressed is perfectly understandable--after all, it's a survival instinct of all mammals to hide themselves from potential predators at times of greater vulnerability. I know that I "roll in the sidewalks" when feeling down; it takes energy to initiate contact with others and to prepare to defend oneself against potential misunderstandings and hurts--energy I just don't have when depressed. It also seems reasonable to keep a "stiff upper lip" around others you cannot expect to be willing or able to be "on your side."
I've found it useful to examine if and/or how my decisions re mental illness differ or would differ from my decisions on other chronic physical ailments (such as diabetes, arthritis, or heart disease). For example, I take medication for hypertension and hypothyroidism; would I adjust those med dosage levels without prior consultation? My answer is "Yes", I would and have--if there's objective evidence to support a change and I'm confident my doc would concur. It's "No", if I can envision a case for reasonable alternatives, or if I have no data to back up my preferences.
On the other hand, I've had enough severe depressive episodes to realize that my judgment during those times may be impaired. Pain and exhaustion cloud my ability to evaluate objectively, and skewed perception prevents me from being able to see beyond the immediate moment to glimpse a bigger picture or discern repeating patterns of behavior. Rather like learning to take responsibility for recognizing when you're too drunk to drive, I've had to try to become aware when I'm too depressed to decide. Under those conditions, I need to at least share the control.
Some people want not to be ill (physically or mentally) so much that, with the first signs of improvement, they reduce or eliminate medication--often with quite negative long-term consequences. Others wish to remain in control so strongly that they cannot perceive the small signs of an impending mood shift in time to make the minor adjustments which could prevent a crash.
I guess what I'm trying to say, in my typically long-winded ( and possibly redundant) fashion, is that determining when to decide, and when not to, may be as important as the decisions themselves. A good therapist could be a valuable sounding board in evaluating one's judgment, decision-making patterns and biases--but only if s/he can manage to be both objective and supportive. Do you think that yours can?
Re pdoc appointments: IMO, 6-8 weeks between appts. is fine if your med cocktail is reasonably satisfactory and has been stable for awhile. The appointment interval is too long if you are still actively searching for the best fit medically; it's too difficult to maintain momentum and avoid mid-course course corrections under those circumstances.
I had to declare an "emergency" in order to speak with my pdoc in person (during office hours) 3 weeks ago--the first time I'd had to contact him between appointments in the 20 months I've seen him. So, at my most recent appt., I asked him to modify his office SOP for me; I also obtained his email address. (If he hadn't been willing to make those changes, I would have begun seeking help elsewhere.) I see him monthly; if I decide to make a change between appts., I'll email him what I'm doing and why. If he disagrees with my decision, he can let me know at his convenience. Would something like that work for you?
I envy your ability to stay functional while depressed; obviously, you have a great deal of inner strength. It seems to me that all you need is a bit of "tweaking" to enable you to better recognize when that strength is working *for* you, and when it may be working *against* you.
If you're still reading this, you must have great patience, as well. I hope that I haven't said some of this before (some of it sounds distressingly familiar). And please pardon the unsolicited 2 bit analysis; usually, I'm not quite so presumptuous.
Well wishes---medlib
poster:medlib
thread:6723
URL: http://www.dr-bob.org/babble/social/20010622/msgs/6759.html