Emotional Umbrella

For some reason every time I cut or paste anything into Word recently, it adds “A FAIR AND EQUITABLE DISABILITY TAX CREDIT” to the top of whatever I’ve inserted.  Just like that, in all-caps.  I can’t recall ever adding that phrase to my clipboard, but it is apparently something my computer feels strongly about.

More power to you, computer.  More power to you.

…Just not too much at once.  That’s what the surge protection power bar is for.

So my psychiatrist is still an asswipe.  I was not as firm in my conviction after the previous appointment as you all were.  I make a lot of excuses and allowances for other people, and do a lot of analyzing over any potential biases or misperceptions on my part.  Nope.  Definitely an asswipe.

Perhaps a well-intentioned asswipe, but an asswipe nonetheless.

Beyond the priceless “Meh, just continue to take the disruptive and ineffective medication forever” comment from last time, I’ve added a whole new level of wrong from the most recent appointment.  Like, seriously, unbelievably, kick-in-the-teeth wrong.  A wrong so sparkling clear that even I can’t justify it away.  …Which is probably a good thing, since it’s given me the certainty to ramp up the timeline on looking for a replacement.

I went into my last appointment with a pretty good idea of the direction I was hoping to take with things.  The way I figured, if I do manage to successfully finish getting clear of the Luvox, I am never, ever, ever going to want to go near another SSRI again.  …Which is probably okay all things considered, since even ignoring the side effects most of them seemed to make me much worse rather than any better.  Still, though, if I was going to give anything along those lines a shot, this would be the time to do it.

The only time that I’ve noted a significant improvement while on medications was over a year ago, when for a brief period I was taking Cipralex and Wellbutrin.  I was also meditating and taking good care of myself, and in quality therapy, so it’s hard to say what was the defining factor in the improvement, but if it’s possible medication has helped me, that would be the time.  The Wellbutrin by itself this time around has been…different.  I think it’s making at least a small positive difference, but it hasn’t been nearly the dramatic experience of those few weeks last time.  So if the medication was responsible for the improvement, it was either a difference in my reaction to the particular generic brand I was taking that time (which the doctors seem to think is impossible, but I have heard from others has been their experience too.  I had way different and harsher side effects last time too, which I find odd if there is apparently no difference in how the body reacts to them), or it was the combination of Wellbutrin and Cipralex together (the Cipralex by itself gave me nothing but side effects).  This seems possible.  One of the major random changes at that time was that I didn’t give a crap what anybody else thought of me, and Cipralex is often prescribed for social anxiety too.  So if I was going to give something a try, it seemed to make sense to try out that combination again now that I’m on a version of Wellbutrin that doesn’t give me hives.  …Right?

I’ve also now amassed an unfortunate quantity of evidence that “average” doses of these medications are WAY too much for my particular chemistry.  I’ve also come across a number of cases in my research in which too high of a dose of antidepressants has had a huge negative effect on a patient’s mood, while a lower dose actually helps them quite a bit.  So I’m thinking, since we’ve reached the stage of “throw random pills at it in case something happens” anyway, why not try a smaller-than-conventional dosage of an SSRI?  And since I’m on the Wellbutrin anyway now, and the Cipralex might have been helpful in combination, why not try that?  Add a little dose of Cipralex.  If it works, great.  If it doesn’t, I haven’t lost much, and I can just wean off that one instead.

…Except this is how the appointment went down.

-First thing, P-doc asks how things are going as he usually does, and I mention noticing abnormal and dramatic anxiety (almost certainly a side effect of the corresponding doubling of my Wellbutrin dosage). He asks for details and examples.  I explain my barbeque meltdown.  He proceeds to spend ten minutes or so telling me why my reaction to that situation was illogical (and not in a “change your thinking about the event or reframing” kind of way, but in a “that’s dumb.  You make no sense” kind of way).  I tell him that, yes, I recognize that.  That’s why I’m calling it “abnormal” and “dramatic” and am thinking that it needs to be fixed.  He continues to tell me why it’s silly that it upset me at the time.  I grit my teeth and try again to tell him that I realize that.  If I was anxious because there was a bear in my house, I would not have mentioned it as a problem.  He again tells me why my reaction makes no sense.

-P-doc asks me what I plan to do from here.  I ask for clarification of the question.  He seems to be talking about work.  I tell him that depends on what kind of a difference there is in things once the depression in under control.  I’ve likely been depressed the whole time I’ve been in my career, so it’s hard to say what difficulties are a result of the job and which are a result of the depression.  I say that obviously I wouldn’t be able to handle it now, but that I hope it might be different once I get into some treatment that’s working for me.  He looks confused and gruffly says “what do I mean I couldn’t work now?”  Um…that I’ve been curled up on my sofa the last several weeks, so nauseous I was afraid to move?  That just before that I was sitting in a parking lot literally for hours, crying so hard that I couldn’t drive myself home?  That until recently I haven’t been able to stay conscious for a consecutive six hours during the work day?  …And that’s if you ignore that whole “depression” thing that they pulled me off of work for in the first place.  You  know, the part where envisioning killing myself was calming?  We’ve talked about this…  He brushes me off.  He asks me why I would want to change my job.  I detail all of the ways that it feeds into my biggest problems and stressors, and how I end up working myself to the bone.  He says clearly I need to change my job.  What did I like about my job?  I detail the thinks I really liked and found fulfilling.  He says I love my job.  I say…um…refer to previous list.  I alternately love and hate my job.  He asks me what I dislike about my job.  I repeat my previous list.  He brushes me off by telling me every job is stressful.  I try to tell him that I thrive on some types of stress and give some examples, but that the particular stresses of my current situation aren’t good for me.  He brushes me off by telling me every job is stressful.

-In addition to the anticonvulsant he has now prescribed for the sleeplessness that was a side effect of the Wellbutrin, p-doc now wants to prescribe an antipsychotic medication as well, because it sometimes has heavy sedative effects and might counter my anxiety.  I tell him that the anxiety was so strong only since the increased dose of Wellbutrin, so since he has agreed to lower the dose back down, I don’t think I need more medications to deal with the side effects of other medications.  He tells me to take the antipsychotic.  I tell him I am not really comfortable adding another medication unless absolutely necessary since my body seems to be so sensitive to side effects.  He tells me to take the antipsychotic.  I tell him I am not sure I want to add another medication to the mix while my dose of Luvox is still not stable, since it’s still having a significant effect on my physical and emotional situation, and I wouldn’t be able to distinguish whether problems or benefits I noticed were related to the changes in Luvox, or to the addition of the new drug.  He tells me to take the antipsychotic.  Then he tells me the effects of the Luvox are all in my head.  I remind him that we did not one, but TWO double blind trials which he had previously agreed determined beyond reasonable doubt that I was sincerely reacting to the Luvox and not imagining things or creating them for myself.  He brushes me off.  He taps his index finger to his temple with a condescending knowing look.

-I explain the reasoning I outlined above, and ask if it would be possible to try a very small dose of Cipralex.  He asks me if I want to try a full dose of Zoloft.  I repeat my reasoning about Cipralex in particular, and smaller doses in general.  He asks me if I want to try a full dose of Zoloft.  I say no, but that if I was going to explore the Cipralex option, I would like to do that before I go to all the work of getting off the Luvox completely, because it has been unpleasant to say the least.  He taps his temple.  All in my head.

And my very, absolute favourite,…

-When I begin to get frustrated that he is not in any way listening to what I am saying, or addressing my clear level of discomfort with the treatment he is suggesting, he tells me in the most patronizing way possible and with a “pat pat” hand gesture that I should take the antipsychotics because they will “calm me down.”  I am in no way hysterical or anything.  I just have some concerns that he has not yet addressed.  I continue to present very rational points that I would like addressed before we proceed.  He gives me the condescending knowing look of “see, you’re agitated” and tells me again in that placating way to “take the antipsychotics.”  I continue to try to ask about concerns.  He cuts me off and tells me to “take the antipsychotics.”  I explain to him that the levels of uncomfortable anxiety I’ve had have come from the Prozac and the Wellbutrin, and are not an intrinsic part of my personality without those drugs in my system.  He cuts me off and tells me to “take the antipsychotics”.  He did this several more times, all with that look on his face that said clearly I was irrationally anxious and not REALLY FUCKING FRUSTRATED because the outcome of all of this is kind of important to me and he was being an insensitive douchebag and would not even HEAR OUT WHAT I WAS SAYING.  I swear that man didn’t register one thing I said the whole hour.  Not that he heard me and disagreed, but just simply didn’t listen.

-Then he tells me that he’s going on vacation for a little over a month.

I am not sure that I have ever been so frustrated.  Not being listened to, especially about something important, is one of the very few things that can get me truly irate.  This is the kind of thing that I have nightmares about.  Nightmares in which I bite off people’s faces.

So in conclusion, I will be asking for a referral to see someone else, and in the meantime am hoping that my family doctor will be willing to support me in making a change and take over my medications for a while.  I’ve also started daily meditation again, which I think was crazy helpful last time.  Ideally I think I’d like to just focus on that for a while and give myself time to get off the Luvox before adding any more craziness to the mix.  I don’t even know what I’m like anymore without side effects.

At any rate, there is stands.  And I would very much like to take the antipsychotics, and shove them somewhere very unpleasant for him.