trying to sort things out

This might end up long and jumbled, so don't feel obligated to read it if you don't want to. I just have a lot of stuff in my head and I need to get it out and I can say things here that I can't say to my t. I've been thinking for awhile that these meds aren't right, but I REALLY like the side effect (severe appetite suppression and weight loss), so I haven't said anything to my pdoc. I went Thursday and told him I wasn't feeling great, which is true, but also that I have a ton of outside stress right now, which is also true. I did lie a tiny but when I said I hadn't had any manic symptoms. They've been really mild, but still there. For the most part, it's been debilitating depression and anxiety. I got him to increase the dose though. I also finally got back on something for the anxiety. Ok.

Problem #1: I don't have health insurance. In order to afford my meds, I have to go through a mail order pharmacy and it takes FOREVER. I went to my pdoc on Thursday and the anxiety meds haven't even shipped yet. I was able to start the increased dose of the topirimate right away since I already had it, but I still feel terrible. I'll be up to the full new dose on Friday, but even today I was noticing some rapid cycling type stuff so I'm a little worried.

Problem #2: I really like my t and I've been sharing with her quite a bit, although not as much as I'd like to since I have to stay out of the hospital. But I think she's getting ready to drop me. Which really sucks since she happens to be both free AND good. She's too nice to actually do it on her own, but the last few times, she's kind of been hinting about me finding alternative solutions. Every week she asks if I want to come back. Maybe this Tuesday I'll just tell her no and make it easy for her. I don't have health insurance (see problem #1) so getting a replacement is going to be difficult if not impossible.

Problem #3 (TRIGGER): All the crap I want to share with my t and can't. I have no other real friends to share with either. The topirimate got me started losing weight and now I'm obsessed with it. I was (and truthfully still am) grossly overweight for my height, but I can't stop obsessing about losing more. It might be getting dangerous. It's the only thing keeping me from going off the med altogether. I feel like crap but I still need to lose weight. If I go off the meds, I'll gain it all back. Since Sunday night, all I've had to eat is a tortilla. It's now the wee hours of Thursday morning. I'm losing 4-5 pounds a week. I'm also having really strange and graphic images in my head of my own death and I'm obsessed with my own funeral. I keep wondering who would even bother to show up and who would be sad and who would only be there out of obligation. Nothing I'm currently feeling the need to act on, but that wasn't the case a few weeks ago. But several times a day, these images will still end up in my head. I still think about SI a lot even though I haven't done it in a little over 2 years. My t does know that part of it. We talked about past sui plans, but I made very sure to make it all sound past. I want to tell my t about the images and the food but I'm afraid it will sound like I need to be in the hospital and I don't think I really do. I'm not a danger to myself and definitely not to anyone else. Plus, hospitals are expensive (problem #1) and they'd take the topirimate for sure.

Sorry this was so long. I just needed to try to sort everything out. If you actually read this, thanks!

I understand your desire to lose weight, and yet I feel that your mental stability is much more important. Please consider being more honest with your medical team, and sharing some of the critical concerns that you've laid out here. It's possible that there are drugs out there that will help stabilize you without causing weight gain, i.e. you'll be able to keep off (at least most) of the weight that you've lost.

Furthermore, you really need a balanced diet (to whatever extent is possible on your budget) in order to stay healthy. That's so critical to this illness, as I constantly find out. Often I lose my appetite, and yet I force myself to eat small and frequent meals (I nibble) because I know that my body needs nutrition. It's really, really worrying to me that all you've eaten since Sunday night is a tortilla.

Good luck, and keep us posted.

If you don't have any immediate inclination, impulse or strong desire to endanger yourself, then its highly unlikely that you will be hospitalized.

I've always been very open about suicidal ideation, and intrusive thoughts (something I've dealt with since I was 14) but because there was no intent behind them, they weren't "hospital grade"... Though I do admit that when the OCD kicks in, then there's some level of intent, but so far I've been able to keep myself safe.

The not eating is something your T may be able to help you with, I encourage talking about this as it is bad for you, albeit in a very passive way. Our bodies need nutrients to survive and in the end weightloss is no good if you damage your body in the process.

Why do you think your T wants to drop you?
Maybe she's asking if you'd like to return out of courtesy or maybe she thinks you don't really want to be there? Alternative solutions may be a different approach to therapy, or an addition to therapy, its not neccessarily "seek help somewhere else"...

I would suggest broaching this subject with her, I'm sure you 2 can work it out and continue therapy.

#1

#2: see if she's willing to schedule several sessions at ones. I schedule three sessions ahead. Could her asking if you want to come back just a bad way of trying to let you know your in control? I would really suggest sitting down and looking over the paperwork for what's required for hospitalization and her policies for you. That way you know what is safe to say. If she doesn't see you at your worst then how is ishe suppose to help you figure out ways to prevent it?

#3 I'm going to separate this one:
Topirmite
You need 2-3 liters of liquid a day
Do me the favor and at least eat:

drinking 16 oz of v8 splash a day
3 go-gurts
3 table spoons of peanut butter

Things T should know:

The images that you've had them and when (mood wise, what situations) you have had then before
that you seem to be obsessing about death, food, SI, and things like that

It may have nothing to do with the topimite but more of an anxiety issue.

Feeling isolated can also make depression worse. Is there a way you could get in an outpatient program or something so you're not alone all day?

Thanks for the responses guys. I guess like Trippin and Miguel'smom suggested, I'll have to ask her on Tuesday if she thinks I should be trying to get help somewhere else or what and be honest about how I'm feeling. I'm feeling really isolated right now, so I know I'm extra sensitive to anything that feels like someone who wants to leave.

I think my brain knows I need to be honest with my t, but I'm worried about what will happen if I tell her I'm pretty sure I've traded the SI for an ED. She knows I'm having problems eating, but she has no idea the extent of it. I've told her it's because I'm anxious, which is partly true. I guess if I just make really sure I tell her I'm not in any danger but think she should know what's going on, maybe it'll be ok.

I'd love to get into an outpatient program, but without health insurance, that's not really a possibility right now. There's a behavioral health place by my apartment that does free services provided by interns, but when I called a couple weeks ago at the suggestion of my t, they told me they were "on restriction" (not taking new patients) and I'd have to try again in a few months. I'm only working part time, so even a sliding scale option is more than I can afford for something like outpatient.

Anorexia, anxiety, odd can be caused by over activating 5 ht 1a receptor. How you can fix this and keep the Topiramate: lower the Topiramate, lower your AD or raise your AP.

I actually don't have an AD or an AP at the moment. Just the topiramate and a little bit of a thyroid med I'm weaning off with the doctor's permission since I'd been on it for months and never seen any difference. The thyroid problem had never even been confirmed - he was just guessing. He wanted to do blood work but I had to refuse because I couldn't afford it. I do some vitamins and am trying to get on the Vistaril for anxiety but it still hasn't been shipped yet. I haven't done an AP since high school (about 8 years) and it's probably been at least a year since I was on an AD. Perhaps this is part of the problem?

I would try lowering the topiramate before adding any new meds.

So I went and saw my t yesterday and told her everything, including about my car being stolen (see other post) and the fact that for nine days all I'd eaten was 2 tortillas, a sandwich, a few chips, and a cupcake. I have avoided hospitalization for now, but just barely. She said I looked really pale, but she could've just been trying to scare me. She told me I have to eat at least twice a day every day this week. That was yesterday. So far, I haven't managed to eat anything. I know I really, really need to, but I can't make myself. She told me that what I'm dealing with (high anxiety, problems with my doctor and getting my meds - I STILL don't have them shipped, severe stress, and a potential eating disorder) goes beyond the scope of what she can help me with as an EAP counselor but we're not sure what my other options are without insurance. EAP is employee assistance program, in case anyone was wondering. I get to see her through work, even though I'm only a part timer. She didn't tell me I had to stop coming or anything though. I have another appointment for Tuesday. So basically, I have to get over this eating thing or go to the hospital. Or lie next time I see her. The more I try to force myself to eat, the more I panic about it and can't. I wonder if I can break the tortilla up into two servings and count that as eating twice?