Hope this is OK to post here

I have been honest lately with p-doc, especially because I wanted to make sure she didn't prescribe something that would be dangerous mixed with alcohol. Or that she'd tell me if it was. (I was on Cymbalta for a few months and repeatedly confirmed with p-doc that it was OK to drink some on it, despite warnings about the liver.) She does say that I need to cut way back on alcohol, which is true. But I'm not sure why she didn't suggest that as part of my treatment now.

I've also generally been honest with T about alcohol use--she's definitely been the least judgmental of the three about it, which makes me feel better being honest with her. I think she understands it's a coping mechanism--not a healthy one, of course, but that's what it is.

H and I were honest with MC--well, really, many of our stories of what we did on the weekend involved being at places with "Pub" or "alehouse" in their name or things like beer festivals. I'm not sure if we said how much we consumed. But at some point last year, MC kind of confronted us about it, asking if we thought we could have an alcohol problem. My H was like, "Oh, definitely not! Yeah we drink a lot, but it's fine!" But I was more hesitant in my answer. Since I do worry about it at times. He ended up focusing on the fact that we do some many things revolving around alcohol and also that we kept going to the same places--like our routines involved drinking. So he suggested trying to do other stuff. It came up briefly one or two more times, but it seems he's just either accepted it or given up.

Thanks for clarifying that! I clearly had that impression that it was just for, I guess, "recovering alcoholics." I was afraid they'd be judging or something. And you can just go to a meeting and not say much the first time, right? Like just to feel if it seems like the right one for you? (I'm in a major metropolitan area, so I assume I have plenty of options.) I guess this is probably something I could ask about in the addictions forum on here...

You don't have to say anything at all ever in AA unless you want to. They'll probably want to know your name, so they can invite you to speak, but accepting is totally up to you.

It's like therapy...you're in charge!

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I felt extreme alcohol cravings on Paxil. Once I stopped it and started Prozac, I hardly ever drink. I don't know about Cymbalta (is that an SNRI or SSRI?) but it combined with the Wellbutrin could definitely effect your mood. Some people do not find relief on either wnd sometimes feel worse, so Id definitely press your pdoc about the meds. AA might be a good thing to try if you think a group would help. You don't have to talk, just show up. They can be very welcoming!

I'm actually on Zoloft/Wellbutrin now, but tapering off the Wellbutrin because both I and my T think it's contributing to my anxiety. I was on Paxil before starting the string of different drugs in maybe Feb. due to being hit by a major depressive episode. I definitely felt alcohol cravings on Paxil, so it's good to hear I'm not the only one who had that experience. I'm feeling it a bit on Zoloft, but hard to say if it's that or how I'm feeling mentally.

Incidentally, that string of drugs was:
Prozac, which helped depression, but greatly increased anxiety.

Then Effexor, which gave me my first thoughts of self-harm in like 18 years, which freaked me out, so I got off that.

Then Cymbalta, which was OK at first, but when the dose increased I had myoclonic jerks in legs and arms.

So we decreased the dose of Cymbalta and added Wellbutrin--I think it was while on that combo that I actually engaged in self-harm for the first time in 18 years (though that may have been while just on Cymbalta, not sure).

Still having some of the jerks on Cymbalta, so switched to Zoloft (which I'd been on in the past) and kept the Wellbutrin. While on that combo was when I had the late-night text to MC, extreme panic in the car, then self-harm and a late-night call to T on Thursday.

I feel like all of the self-harm urges only came after being on meds that worked on neuroepinephrine (Effexor, Cymbalta, and Wellbutrin), so I'm wondering if that could be a thing for me? I'd never been on any of that type before, just SSRIs (and Buspar, whatever that is). P-doc is now having me take a lower dose of Wellbutrin for 5 days, then stop and just stay on the Zoloft to see if that helps. She seemed a bit reluctant to do that, but I kind of pushed it. To me, makes sense to at least give it a shot, especially since increased anxiety is a common side effect of Wellbutrin.

I'm thinking the rollercoaster of meds may have contributed to my issues, but it's hard to know for sure. I just know on my second day of being on a lower dose (100 mg instead of 150 mg) of Wellbutrin, I feel considerably less anxious. So we'll see...

And thanks for the info on AA meetings from you and a couple other posters--I feel much more comfortable about the idea of going to one now if I feel the need.

i agree that it could be the med roller coaster. Right now I take Prozac, Wellbutrin and And don't know how I feel about it yet. Interestingly, Wellbutrin makes me tired so but that's not very common.

However, a few years ago I had a similar experience as you except with me the med was Parnate. It helped with depression and energy, but along with it I had the first urges to self harm in 20 years. My bulimia resurfaced too. I didn't stop taking it for these reasons though, and honestly didn't make the connection until very recently. Anyway, if this is similar to your experience maybe another discussion with your pdoc where you firmly explain this connection. This can happen with some people on ADs and doctors shouldn't dismiss patients when they have such complaints.

Just posting here again to get my thoughts out (pretty sure my T and MC wouldn't want to hear from me again this week!) I was trying to figure out why I was so freaked out by the idea of the day program. Like I had this immediate, visceral reaction to it before p-doc even explained what it was. And then an intense reaction, with sobbing and shaking, once she did explain it. It's weird--I usually don't/can't cry during a panic attack, but this was like a panic attack plus sobbing.

I think my initial reaction was: Wait, am I really in such bad shape that I need something like that? You really think I need this? Oh God...

Then when hearing about the 4 hours/day thing, it was like, "So, I have to spend that much time talking to people I've just met about what's going in my life and my head? People with whom I've had no time to build trust?"

Then I was like, "Well, I don't want to leave the people here (T and MC)," hoping p-doc would say I could still see them during this time. But she was like, "Well, you'd do the day program for a month, then you could come back here. So you wouldn't be leaving them." But all I could here was the "You can't see them for a month" (and presumably not talk to them). Which I think is really what led to the sobbing part of my reaction. It's no secret on here that I'm extremely attached to MC. But I realized during this that I'm also very attached to my T. Because the thought of not being able to see/talk to her was also very upsetting. In a way it doesn't make sense--I'm going through this rough time, so I'm not allowed to talk to the people I really trust with my feelings? It almost feels like punishment or something. Yes, I know they'd be looking out for my best interests and my safety, but it still doesn't feel that way.

So really, it tapped into my fear of abandonment. Yes, it would have likely only been a month, but it feels like a long time when I can't see them for a week or two. (And then what if for some reason they decided it was best I didn't go back to them?) But it just seemed to tap into childhood stuff, which kinda makes sense because I have definite paternal transference for MC and a bit of maternal transference for T. My parents didn't seem to want to deal with the part of me that had mental illness, so maybe this felt like my T/MC/p-doc also didn't want to deal with me now.

I'm thinking this reaction is stuff I need to discuss next week in therapy. Like why it hit me so hard and made me so upset. Like to the point where I was practically begging p-doc to let me do something else or have a week to see how I do first.

I'm so thankful that T agreed to try the care and safety plan instead...

Thanks for your response. It helps to know you had similar self-destructive urges that came about after starting a med. My p-doc seems more willing to disregard less common side effects, since they aren't as proven (as, say, sleepiness). Like I also had frequent twitching in my left eyelid that started when I was on the Effexor and stopped when I went off it. So that seems like a pretty direct connection. But she seemed doubtful. She did agree to switch me off the Effexor once the self-harm thoughts surfaced.

I think because of her medical background, she's more inclined to want proof that a side effect is connected to a drug. While my T, if I mention something to her, she'll often say she's had another patient experience that. Like when I was on Paxil, my pharmacy (Target) kept changing the manufacturer of the generic. When it went to a certain one, I started feeling depressed. After a second month on that brand and still feeling bad, I mentioned it to my T. She said she's had patients have such negative reactions to a different generic that they've ended up in the hospital. But when I mentioned it to p-doc (it was just after I started seeing her), she doubted that was the cause, just thought the Paxil wasn't working for me (I'd initially taken it for anxiety). So she switched me to something else.

All that being said, I love my current p-doc. She really listens to me and takes my wishes into account when changing or choosing meds. My previous one just seemed to brush off things I thought were major side effects (like insomnia) and didn't seem to listen to me. However, I wonder if the attempt to find just the right med for me and switching so often has led to my more unstable mental state...

yes my pdoc has told me that if you switch too much it becomes impossible to tell what works and what doesn't. I think so long as you are gradually weaned off your meds you'll be stable, however. I just think it might be hard to pinpointt what is causing the side effects. I have heard that Wellbutrin can cause agitation and even aggression in some people (I think it is listed as a side effect) so I don't think it that odd that you may be feeling an increase in self destructive behavior. Doesn't it work on norepinephrine like Effexor does? Maybe it wasn't a good combo? I have also heard and experienced a difference in the side effects of generic Wellbutrin versus the brand name. I took the it prescribed to me under the name Zyban (Wellbutrin but marketed for smoking cessation). Insurance only covered it in full for a few months though, so I had to switch back to the generic. my insurance would never fully cover it as Wellbutrin, even though it's the same medication, just a different brand name.

We had our first marriage counseling session today since all the stuff last week. When we first sat down, MC said he was so sorry to do this, but he would have to leave in 20 minutes for an emergency--well, really an "urgency," since he found out about it before our appointment. He apologized profusely, said he wouldn't charge us, said he debated whether to just cancel or to just have a brief conversation. I said he chose the right thing in not cancelling because after the stuff last week I just wanted to be able to talk for a few minutes.

He asked what we wanted to talk about, H motioned for me to go ahead, and I just looked at MC and broke down sobbing, saying how I was so freaked out about the stuff Friday with p-doc pushing for me to do the day program, and plus the night before that, when I called T at midnight, she had mentioned hospitalization. And I said it all just scared me, triggering fears of abandonment, being judged, and loss of control. MC added "And rejection," and I was like, "Yes, that, too." (He and I had dealt with some of those issues in the past related to my transference for him and whether he was willing to offer me more than the first individual session to process that.)

He told me that he wanted to make clear to me that none of the discussion of increased care came from a place (on the part of him, T, and p-doc) of anger, frustration, or annoyance with me. That it might feel that way to me, but that wasn't it. Instead, it was because he/they care and are concerned about me. He confirmed with H that he'd heard that, because he knew he'd probably end up phrasing something in a way that would make me have doubts, and he wanted H to reassure me of what he'd said and meant.

He also brought up the misunderstanding (or whatever you'd call it) from a few months ago, where he'd said the thing about no longer allowing any individual sessions (I have a thread on that somewhere on here). He said that also came from a place of caring, and he hoped I realized that now, even though I clearly didn't at the time. And I think I do.

I said how I felt like I already had a couple strikes against me and was afraid of what would be the third one (I'd talked about this with H, too, and he said it was also that I didn't know where the strike zone was.) MC said the way I was wording it sounded like the increased care was punishment, when it wasn't (still kind of felt that way).

I noted how it felt like I was maybe a bit blindsided by what p-doc said, and he said it wasn't out of left field, that they all talk amongst themselves (with my permission), and it was a combination of things the past few weeks/months that made him and T think I might need more care. He said if you all were selfish/arrogant, you'd think you could handle everything with me on your own, but you weren't and wanted to make sure I got the care I needed. He compared the situation to a parent keeping their eye on a kid who had certain symptoms--though he clarified that he wasn't saying I was a child. Specifically, he compared it to his needing to keep an eye on a deep cut his son got on his foot over the weekend. That his son didn't want to go to urgent care, but MC said that they had to keep checking on it. And the next day, they ended up going. His son thought he was being punished, but it was needed care.

That analogy made sense to me, and I hadn't thought of it that way. It didn't occur to me until after I left, but I guess it's easy to think of mental health as being more of a judgment call--emphasizing "judgment"--than physical health. Like, "Wow, you're acting kinda crazy (not that a T would use that term of course) or unstable" instead of "Hm, your fever is increasing" or "You hit your head pretty hard, let's get you checked out at the ER." But it's harder to tell if someone is at risk because a T know how honest a patient is being with you. Like MC said the reason T brought up the ER and hospital when I called her at midnight is that it's hard to assess someone's well-being on the phone. And someone placing a call to a T at midnight is already setting off a red flag, so better to err on the side of caution. He said he also likely would have mentioned the ER had I called him and said what I did, just to be safe.

But MC basically just kept reiterating that it was all from a place of caring (on his and T's "and even p-doc's part") and he knew I could understand that intellectually, but wanted to make sure I understood it emotionally/in my gut, too. Which I think is what I needed to hear. Again, I could understand that in theory, but with anxiety and depression, plus the abandonment/rejection fears, it's easy to feel it's something else. Hearing it in his voice and seeing it in his eyes helped me to really believe it.

The 20 minutes was up way too soon, but I was glad I had it. Without him even saying it, just seeing him, I can tell he cares about me. And not like just because I pay him or he's worried about getting sued or something. Like he genuinely cares and doesn't want to get rid of me as a client because I happened to text him at 3 a.m. one night or tell him I love him or have left occasional weepy voice mails on his office phone when there was a misunderstanding. I started crying again when he said he had to go, but thanked him for taking the time instead of just cancelling (I sent him a quick e-mail tonight about that too.)

I'm a little nervous to see my T tomorrow, since we'll be discussing the "self-care plan" and "safety contract," but I feel better about it after having seen him. Like, I assume if she was raising all kinds of alerts about me, he wouldn't have been as reassuring and would have tried to convince me I needed to try the day program or something. So I see T tomorrow, then p-doc Thursday--who I'm really nervous to see...

On a related note: Why do I start crying, like I am now, when I think about someone caring about me? Do I not feel deserving? It's like when I got a surprise birthday package from my friend in January (it was my b-day--so not *that* big of a surprise), and it just made me start crying because it seemed so nice and caring. Pretty sure this is a topic for future therapy....

Lt - good post about the reasoning behind suggesting a day program. You explained it very well.

I had a similar experience to your birthday present. A young woman in my apartment bldg was in the elevator with me - shes a fairly new mother - anyway she said to me, you look stressed. Usually you say, oh no im fine, right? But i WAS stressed, so i admitted it to her. It was the first time really that she took care of me - usually i take care of her with hows the pregnancy, hows the baby etc. Tonight i saw her in the pool, and it was like our friendship had gone to the next level. It was pretty neat.