Wednesday, January 31, 2007
Meds for Life
I spent all morning at my mental-health group: first I had an appointment with the psychiatrist to discuss meds, and then my regular weekly appointment with my therapist. My primary-care doc, whom I adore, has been prescribing and monitoring my meds, but when I was having trouble on just the nortriptylene, my therapist got me in to see this shrink, who's evidently excellent (and whom I like very much).
In the meantime, my primary had put me on an additional, very small, dose of Effexor. That combo's been working pretty well, and the shrink says that she sees no need to change it. After taking my history, though, she did tell me that I'll probably need to be on antidepressants for the rest of my life. People who've had three episodes of major depression -- and I've probably had more than that, although I didn't recognize all of them when they were happening -- have a 90% change of recurrence, and the episodes become more severe and happen closer together as the patient gets older.
The psychiatrist who put me on Prozac back in 1994 had told me the same thing; when I went off Prozac in 1998 and stayed off for eight years, I thought I'd proven him wrong. Regular readers of the blog know that I hated going back on meds, and also hated having to start a second med when the nortriptylene wasn't working by itself. I'd really been hoping that the latest bout of depression was just a result of the situational crud that started three years ago, and that I could get off meds in a year or two, so I wasn't happy about today's pronouncement. When I told the doctor that I'd been off the Prozac for eight years, she said gently, "Sure, but then you had to go back on. Maybe you can get off again for a while. You probably won't be able to stay off, though." And then she gave me the speech -- which I know by heart, because I've given it both to myself and to other people -- about how I have to tell myself that I have a chronic medical condition, like diabetes or high blood pressure.
Intellectually, I know all that. But I'm still bummed.
So, anyway, I'm going to switch my meds management from my primary to this shrink, because if things go south again, I want to be an established patient of someone who has more experience. (My primary's very good, and the shrink was impressed by the nortriptylene-Effexor combo, which wasn't one she'd have thought of; still, in this case I think a specialist is better.) I'm seeing her again in a month, and she said that if I feel worse again before then, I should call her and she'll get me in right away. If I were doing worse, she'd either raise my Effexor dose or put me on Cymbalta. I'd probably opt for the Cymbalta; the doctor confirmed that Effexor is one of the drugs that tends to numb creativity. I'm really, really hoping that none of that will be necessary!
After seeing the shrink, I kvetched to my therapist, who was very sympathetic and said, "Look, you can try to go off. It's not a big deal. You might just need to go back on, that's all. You're very aware of your emotional states. You know when you need to be on meds. You'll take care of yourself."
So there you have it. And now I'm going to go swimming, today's version of walking the dog.