Thanks! This is a draft of a letter I am thinking of faxing to the p-doc (who is very young, hence the style of the draft) tomorrow:

"Dear Doctor!

You rock! You are one smart cookie! A round of applause for you! A standing ovation!

The very first thing that you came up with when I told you about my inability to reach orgasm on Geodon was to try a lower dose. I said that I had had this problem on any dose. Well, you were RIGHT: at 80 mg a day, I AM able to orgasm. It is a dose-dependent side effect after all. Looking back, I was on 80 mg very briefly, and right after Risperdal which was even worse for orgasms. And I was shaken by a then recent separation from my now ex husband and depressed - it is possible that I just didn't try it in that brief period of taking 80 mg a day, and it is equally possible that orgasms were not within reach because of Risperdal. At any rate, now I can have them and a lot of them (think about 50 in the course of an hour).

What does it mean to us in terms of the decision to take Abilify? I want you to make the call. The orgasms are not spectacular (not yet, should I say), not momentuous or earth-shattering, but they are orgasms. Masturbation only gets one so far; possibly once I get into partner sex, they will improve. Possibly, as I continue to take this lower dose, they will improve even with masturbation. So maybe I should wait with Abilify and see where things are with 80 mg of Geodon. I feel great in terms of mood, by the way. I am very functional. Staying with Geodon would give me the peace of mind as I will be on a tried and true medication, whereas Abilify is cat in the sack. At the same time, perhaps the orgasms would be better without any Geodon and Abilify is a good modern medication. Please decide for me.

If you decide that I should stick with Geodon and wait and see for now, please prescribe Topomax right away, without waiting another month. My experimentation with THC has resulted in success: I have found a very low dose that, in conjunction with a low dose of Amitriptyline helps me sleep without any side effects and without any psychodelic effects whatsoever (no hallucinations, no tactile sensations, no nothing, just good sleep and an improved, even, positive mood the next day). So I will be continuing with this very low dose unless I develop anxiety that you warned me about.

Why do I want Topomax now? For two reasons. First, Amitriptyline already helps to prevent migraines. With Topomax, I hope to be fully covered. Second, I want to see if I can lose some weight on Topomax. I am now on the border between high overweight and low obese. My diet is excellent: I eat fish several times a week, plus lots of fruits and vegatables, limited complex carbs, very limited simple carbs, lots of water and only occasional juice, lots of leafy greens and plenty of legumes. The only thing that can be improved in the diet is just eating less overall, and perhaps eating less fruit as fruit has sugar. For that, I would like pharmacological help. I am not going to restrict using will power; I want an agent that will take care of eating a bit less without will power. With exercise, I walk a lot and plan on biking to work soon, which will mean a whole hour of biking on each workday. That qualifies as moderate exercise, doesn't it? But I do not want to be relegated to "diet+exercise" when part of the reason I am fat is pharmacological - my having taken Zyprexa and Depakote in the past. I am not taking the offending drugs any more, but the weight does not come off, even with Metformin, diet and exercise. So I want the same thing - psychiatric medication - that landed me in my current state of affairs to get me out of it. Topomax, Wellbutrin, both of them together - please decide. Inability to reach orgasm was my biggest problem. Now that it is at least partially resolved, weight is the next biggest concern.

Thank you!"