Dear P-doc,
I feel like at first you really listened to me and seemed to think outside the box a bit, which is why I really liked you. Now you seem hung up on me just increasing the Zoloft, that it couldn't possibly be contributing to my agitation/anxiety, and still want me to go up on the Lamictal, even though you're saying you don't think I'm experiencing hypomania right now. And are attributing everything to anxiety and depression.

Yet you seem to be talking about regular mania, which I don't have, not hypomania. I hate that instead of trying to think of something else, you're just having me increase those, then saying I could take Benadryl for sleep or anxiety. And melatonin. I hate that you refuse to prescribe me any benzos, even though I've taken them very responsibly and very sparingly in the past (as prescribed by another p-doc in the same practice), because of the fact that I drink alcohol. I wish you could trust me that I wouldn't take them at the same time as drinking.

I tried the propanolol, but as I told you, it helps a little while leaving me feeling kinda sick and shaky, and then gives me a horrible headache the rest of the day. Buspar didn't help much and gave me a continous headache. Benadryl leaves me feeling fuzzy. I think maybe the Zoloft just isn't working anymore. It would be nice if you could either consider that maybe this is bipolar II, that maybe I need to be on something else other than an SSRI (or SNRIs, which were nightmares for me).

I feel really bad saying this, but I feel like I've done worse in the past year since I started seeing you, which may have been due to other stuff, too, but I don't know. I really want to like you--you seem earnest and you clearly care--but I almost want to go back to my previous p-doc, who wasn't so overly concerned with things like my drinking, etc. OK, the person I really want to go back to was before I joined your practice, the one who did things like send me for bloodwork to seem if maybe a deficiency or thyroid issue was causing my symptoms.
But I feel like if I say any of this to you, it will either seem like I'm just drug seeking or that I'm noncompliant or need to be inpatient or in a day program or just can't accept that it's straight up anxiety and depression, and the drugs that say they'll work for that will work for me, even though my body is generally very sensitive to meds.

So...yeah, all that.