So I have my pdoc appointment today. My moods have been fluctuationg pretty wildly lately. It's obvious that my medication is not helping.

So now what?

I don't know. I feel somewhat trapped. I have tried about 16 medications. I'm on Trileptal now, but when he added the Cymbalta it made me really sick and I couldn't go to my internship. And the Trileptal is obviously not stabilizing my moods. I don't have the time to play around with meds and side effects.

But what's the alternative?

Feel like this, I guess.



I don't know....

[Gracey]

I can sense your frustration, but I am sure you know that it's all about hitting on the right combination and not giving up until you do. You're a student Pink. . .what would you say to a client who was rady to give up hope on the meds?

I'm not familiar with Trileptal, but Cymbalta is for depression/anxiety, right? I've had friends who've had icky responses to Cymbalta as well. They key here is sticking with it until you find what works for you. You know as well as I do that it often takes up to six weeks to see the effects, and with some meds it takes a while to GET OVER the side effects and develop a desensitization to them.

Keep at it. You can do this.

Besides, what would we do without you?

Thank you so much Gracey. At least there is no couch with pdoc, so I don't have to worry about that I often shut down when I see him. T helps me and relays a lot of the information to my pdoc for me. I forgot to tell him that I'm seeing my pdoc today, and even though they work in the same place, I'm not sure if he knows. I am somewhat curious to find out what he will come up with this time. How many appropriate meds could be left? lol... Not sure what to do if he gives me new meds... both my supervisor at work and my internship supervisor know that I deal with depression-- that's all I have told them. Do I let them know that I am starting a new med and might have to call in sick? I don't know.. I have to leave to go there now.

[Gracey]

Well, here's what I suggest. You and I work in very similar fields, and my experience has been that folks are patient up to a point. We get nervous when we senese that point approaching. I would advise letting your IMMEDIATE supervisor know IF you find yourself needing to switch meds and having issues. I wouldn't say anything at all, until you sense some sort of a problem. When I switched meds, what I did was start them on a Thursday night. That gave me all night to have any sort of reaction, and IF I needed to call out the next day, I not only had Friday, but Sat and Sun as well to get myself straightened out.

I will tell you this sweetheart. What I've learned in the last ten years, compiling my education and experience alongside my life experience is that there is no magic formula to cure depression. YES, it is a chemical issue. . .to a point. You can adjust chemicals all day long, but without appropriate stimulation (therapy) they are just chemicals. Counseling is such an important part of treating depression. When we gain insight about our illness and what caused it, and that works together with balancing chemicals, and we begin moving forward in life, THEN and only then are we able to lift that fog that seems to perpetually surround us. Life is not about managing depressing or controlling it. Life is about living, loving, and always, always walking it out.

Let us know how it went.

[sunrise]

Maybe schedule starting a major new med with your vacation or time off. When there are intense side effects, it is often the first week or so that is worst. Sometimes if you push on through that first week, there is a better experience on the other side. When I started the relatively benign Buspar, I almost didn't make it through the first 3 days. Very intense and I had to decided to give it up by day 4 if I wasn't improved, but by day 4, it was less intense and I was able to persist.

Also, there are non-drug approaches to dealing with mood instability, depression, etc. Your T can help you with those--maybe you are already working on your depression in therapy and outside of therapy using non-drug approaches. (Pdocs are usually focused on the drug approach.)

Meds don't necessarily work for everyone. I also read a really interesting article recently on the use of very low doses of narcotics to treat depression. According to this article, this approach can help some whose depression has not been helped by SSRIs, tricyclics, MAOIs, etc. This approach, however, is also very controversial because of the phobia our society has about narcotics. (I can send you the reference if you want.)

Also, maybe you will never have a completely even mood. Maybe that is OK! Maybe that is who you are. I think there is room for some people to grow into an acceptance of their own personal biochemistry. Maybe, for example, a person will always have shifts in mood to some extent and could learn to control their responses better when that happens through what they learn in therapy and approaches such as meditation, etc. I know that may sound lame, but I have come to greater acceptance of how my brain is and that has helped me. I am never going to be one of those up up up extrovert people, I just am not and I am OK with that. I have beat my depression without meds through psychotherapy. Doesn't work for everyone, I know, but psychotherapy is an important tool to fight depression. It feels so great to not be depressed after years of feeling that way!

Good luck, pinksoil.

Ok, so it didn't go very well today.

Before I tell you guys what happened, I will let you know that I have anger problems, in the sense that if my anger reaches a certain level, I will blast the %#@&#! off. I hope you all don't decide, after reading this, that I am completely out of my mind and have no business being in the field.

(You can see where this is going).

I %#@&#! exploded after the appointment today.

I get very triggered when I meet with my pdoc. And it's not just my pdoc, it's any pdoc. So I meet with mine today, tell him how things are going with the mood cycling, the anxiety, etc. I tell him that the medication is not helping. I tell him that I have SI'ed repeatedly over the last week. So he asks, "Are you seeing T tomorrow?" I tell him yes, and he says, "Ok... why don't you talk to him, and we'll just keep things the same for now. Then after you talk to him he can call me and we can decide what do do" What the %#@&#! am I paying him for then? And then the rage started. The anger started to come out in his office... I wasn't going nuts or anything, but it was definitely there. I walked back to my car which was parked a couple of blocks away... and I exploded. I took anything that was in my car and hurled it at the passenger side dashboard. A few CDs and cases, a big hard plastic hairclip, a bottle of lotion. Lots of things are in pieces on the floor of my car right now. Then I picked up the phone and called T and told him... I know I'm gonna see you tomorrow, but I just had a session with the doctor, and right now I cannot control my anger... I have broken things, and I need to tell someone how mad I am so that I can at least get that off my chest. Then I went home cause I had some time before school and I was sort of exhausted so I fell asleep on the couch for an hour. When I got up to leave for school, all the rage was still there. While I was in the car on the way to school, T calls me back. He asked what happened, and I said, "I %#@&#! lost it." He asked if I was in the car at that moment, and I said yes. He said that he didn't want to talk long if I was driving, but mostly he wanted to find out if I was safe. He asked if I still felt enraged. I told him that honestly I felt extremely explosive at that moment. He said that he wanted to make a contract with me at that moment, that I would explode anymore in the car because he wanted me to be safe and be able to come in tomorrow. I told him "I promise." I had taken Klonopin a few minutes before he called and eventually that helped to calm me down.

So.....

yeah.

He probably thinks I'm out of my mind now.

I have had explosive anger right after I started getting sick with depression and anxiety. It would mostly happen at home, like when my mother pissed me off. It would happen with my husband too, when something between us got me very angry. I also tend to have mini-explosions on my own when I get angered about something... they aren't full blown, usually just a hot-temper sort of thing. But this was one of my full-blown rage episodes where I wanted to destroy everything in my path. I honestly ran out of stuff to break in the car so I had to stop. Something this explosive has not happened in a long time.

I don't even know what else to say. I'm tired.

[Lemon]

((pinksoil)) I'm so sorry this happened. It is great that your T was able to call you back and that you have an apt today. I'll be thinking of you.

[pachyderm]

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pinksoil said:

He probably thinks I'm out of my mind now.

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Probably

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I also tend to have mini-explosions on my own when I get angered about something...

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Sounds like me, especially in the past. But not often explosive now. This morning I realized that I was somewhat angry with my therapist, after my session yesterday. I thought he was underestimating the threats I perceive in everyday life (while I overestimate them). That is, I am thinking that he does not see, and does not want to see how some people may want to dominate me. And feeling that maybe he didn't want to see what I see made me angry -- and frightened that maybe he wouldn't be on my side when I needed him. (That sort of thing has in reality happened to me in previous therapy.)

But when I can understand what anger I am feeling, and reason out why, I realize I might be wrong about what he is really doing, and I can also keep my perceptions and increasing understanding within myself, rather than having to go running to him immediately to have him fix my panic. We can talk about it at our next session!

You complain about your medications not working. I hesitate to say this, because it seems very politically incorrect these days, but -- have you ever thought that maybe that is telling you something?

Maybe they don't work.

[purplemoon]

(((( Pinksoil )))) I am sorry you are so upset. Maybe we could meet in the middle - Me "Yes I am very irritated" is my big anger explosion. Maybe send a little over this way. I am glad T called you back. Hope you have a better day. Thinking of you.

[Gracey]

Pink. . .you and I are a lot alike sister.

I blew my lid once with my pdoc too. And I mean BLEW IT BIG. I sort of broke his printer. (Dont ask) So, when it was all over with, and T was asking about it, I told him, "It frustrates the hell out of me to pay someone this kind of money and the advice they give me I could get from a bum off the street. What message do you think that sends me about my value as a human being?" He sort of stopped. . .and said, "You're right." Personally, I get better advice from my hairdresser, you know?

I'd have blown my lid too girl. You do have to figure out another way to deal with your anger, but I'd say your anger was justified. The behavior wasnt' necessarily so, however. But, I think you already know that, huh?

Pdocs are overworked, over scheduled, most are under experienced (little time in practice, scant internships, etc). I liken them to gynecologists who deliver babies. . .most have the minimal amount of experience required to license. And then, it's all on the job training. Kind of sucks for us, you know? I don't talk to my pdoc a whole lot. . .but i'm fortunate b/c he is fantastic, serves in the military like me, and we happen to speak the same language most of the time. But, I reserve "therapuetic" issues for my T and T alone.

Let us know how you're doing, ok? Sending good thoughts your way today.

[sidony]

Hey pinksoil,

Sorry it was such a rough day. I hope you didn't break anything you really wanted to keep! T sounds like he knew how to help on the phone. I hope you have a good session with him today.

I've had anger explosions before though not as intense. I remember in college once breaking my hairbrush because I was pissed that my foot had a cramp in it. I don't know what was up with that -- pretty dumb. But at least sometimes it's a release.

The whole med thing sounds really frustrating. I say concentrate more on therapy and how it can help you deal since the meds don't seem to help enough. And therapy's more interesting anyway.

If it's any comfort to you (and I've always been the misery-loves-company type), my life is s@#t right now. Maybe I'll start another thread where I complain about it some more.

Hope you have a really good session today and take care,
Sidony

[lauren_helene]

Pink, that would totally split me in two. I would certainly feel as if he deferred his job to your therapist.

Is a p-doc not supposed to be asking questions about SIDE AFFECTS of what ever meds you take, weigh that against what you have taken and then decide on the best course of action?