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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by mair on January 7, 2005, at 6:37:15
About 2 and a half years ago I started augmenting my usual ADs with a drug (a tricyclic) which made a difference but which also had some side effects I hated. (weight gain, bloating, constipation, heartburn) Because of those side effects i never took as much of it as my pdoc wanted me to and at the beginning of last summer, I cut my dose by 2/3ds to see how I would do, particularly during a time (summer) when I tend to feel better. My T's observation was that reducing the drug had led to poor control of a particular depressive symptom - mainly a tendency to get locked up in ruminative patterns of thinking. So when I went back to see my pdoc this fall, I told her all this but I also told her I didn't think I could increase the drug I hated so much. Her recommendation was that I try another drug of the same family in the hopes that my side effects might not be the same.
Well the new drug was worse that way. I felt physically awful for a couple of weeks. I think there were other causes as well for feeling so ill, but I think the drug contributed mightily and I was at the lowest possible dose. So I emailed my pdoc, told her I was dropping this new drug and that I wanted to clear it out of my system before we talked about any of the alternatives she's raised in the past. I'm supposed to meet with her on Monday.
Now I'm in this quandry because the ruminative thinking that my T thought was addressed so well with the drug I dropped earlier is back in full force. I feel pretty depressed and vulnerable and I'm also not sleeping well but physically I feel better than I have in a while. For the first time in 3 years I've actually lost some weight and I just feel less sluggish and look, to myself, less repulsive. I just don't think I'm willing any more to tolerate the side effects of the tricyclics. I've checked out the side effect profile of other possible augmentation drugs (mostly of a different family), and they look awful too. I don't feel up to going through the agony (and it is agony for me) of trying a new drug and suffering through the initial side effects while I figure out whether the side effects will go away and whether the drug will work. So while I think I'm still going to keep my appointment on Monday, I also think I'm going to tell my pdoc that I don't want to try anything else now.
My alter ego is telling me that I have a lousy attitude about meds and am a real slacker. Maybe I don't really care about getting better if I'm not willing to tolerate a little discomfort and that it's totally shallow to care more about my weight than i do about my poor mental state. I'm particularly worried that my pdoc and T will think these things about me also. It's a particularly touchy subject for me for 2 reasons. First, when I started with this pdoc about 3+ years ago, the letter she got from my last pdoc summarizing my drug history I thought implied as much. I thought the inference was there that pdoc#1 was never able to get as good a handle on my depression as he thought he could because of my refusal to stick with certain drugs or to limit my doses of other drugs. I've been through a lot of drug trials, but his implied criticism really stung - then and now when I think back. Reason #2 is that my T is going through a divorce now and i know that one of their irreconcilable differences was her hurt/anger over her husband's decision to take himself off ADs without telling her and his refusal to go back on them. While I'd like to think this doesn't make a difference, I think it does. She sees me often so she's the one who seems to be in the best position to tie my use/lack of use of the tricyclics to obsessive thinking patterns. Even though she tells me that she totally understands that I wouldn't want to take drugs whose side effects seem intolerable to me and even though she tells me she supports my decision, I can't get past this feeling that in her mind I'm making our job so much more difficult.
It's not like we haven't talked about these issues before and when I raised it at towards the end of the last session, she suggested that I might want to postpone my pdoc appointment so we can talk about it some more. I haven't talked about tying this in to her divorce situation. Although it may not sound this way, self disclosures she's made about personal matters have been entirely appropriate and even necessary in the context in which they were made. I don't want her to feel bad about that.
Any thoughts?
Mair
Posted by Emily Elizabeth on January 7, 2005, at 9:57:03
In reply to Feeling Like a Slacker (long), posted by mair on January 7, 2005, at 6:37:15
I like your T's suggestion to postpone the pdoc appt. It sounds like it is a complex situation that requires a lot of thinking through. Also, does your T ever talk to your pdoc? I'm wondering if that would be helpful.
Good luck. I can certainly empathize with your frustration.
EE
Posted by Joslynn on January 7, 2005, at 10:42:46
In reply to Feeling Like a Slacker (long), posted by mair on January 7, 2005, at 6:37:15
Hmm, I don't have any concrete advice, but I do the ruminating thing too.
Posted by mair on January 7, 2005, at 12:22:40
In reply to Re: Feeling Like a Slacker (long), posted by Emily Elizabeth on January 7, 2005, at 9:57:03
I think they talk - just not about me. They have other common patients. I'm sure they'd confer if I asked them to. I think my pdoc customarily leaves a voice mail message for my T after each of my pdoc meetings - just giving my T her observations; these are usually positive because I always seem to put on a bright front for my pdoc or maybe it just happens coincidentally that I see her on my good days.
I doubt I'll cancel if for no other reason than that the ruminative cycle of thinking I'm mired in at the moment renders it too difficult for me to make any sort of firm decision. I'm vacillating all over the place. Also my appointment is 8 am Monday morning so it's awfully short notice to cancel right now. There's probably some value even in just letting my pdoc know where my thinking is.
Thanks
Mair
Posted by mair on January 7, 2005, at 12:24:15
In reply to Re: Feeling Like a Slacker (long), posted by Joslynn on January 7, 2005, at 10:42:46
> Hmm, I don't have any concrete advice, but I do the ruminating thing too.
I find it exhausting and debilitating. How about you?
Mair
Posted by Joslynn on January 7, 2005, at 12:48:22
In reply to Re: Feeling Like a Slacker (long) » Joslynn, posted by mair on January 7, 2005, at 12:24:15
It is much better now than it was several years ago. I am on antideps and that may have helped, also, I am trying to make myself stop as soon as it starts.
I think I will always ruminate too much though, even though it's better than before. The worst part is that it takes up mental space I could be using for other things. I particularly obsess about dating stuff and relationships, more than the norm.
It helps me to read complicated fiction books or to exercise. , It also helps to write in my journal LESS often. I know that journal writing is therapeutic for many people, but I would use it as a rumination tool. I would ruminate in my journal, turning over every nuance of a conversation, then I would reread the entries, re-ruminating about what I wrote the first time! Not good.
I still keep a journal, but more of a prayer journal, where I record gratitude and prayers. I don't write down every word of every conversation I may have with a date or coworker.
It is better but still a struggle.
Posted by Emily Elizabeth on January 7, 2005, at 15:12:05
In reply to Re: Feeling Like a Slacker (long) » mair, posted by Joslynn on January 7, 2005, at 12:48:22
yeah, on secod thought, you are right about it being too late to cancel. Maybe it would be helpful to schedule your next pdoc appt sooner than you usually do? A week or two? I'm just saying what comes to my mind in case it is helpful.
Best,
EE
Posted by Dinah on January 7, 2005, at 19:54:57
In reply to Feeling Like a Slacker (long), posted by mair on January 7, 2005, at 6:37:15
I don't think not wanting to take meds means anything other than that the meds make you feel worse than not taking the meds. As my pdoc says, there are side effects to every medication, and side effects to not taking medication at all, and it's up to me to choose my side effects.
That being said, I'm pretty resentful right now at being bulldozed into taking Luvox when I know it's going to be horrendous to get off it.
This is the end of the thread.
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