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.

7 comments:

  1. I hate depression. I have that tickling sensation on the back of my neck that I'm in for another bout (external factors suggest it) Then my blood sugars appear to be here, there and everywhere. I'll be seeing the specialist about that too.

    What really unnerves me about the depression is I'm having a productive phase - 1000 words a day for a very much pt writer, and I've just got a new agent who is ludicrously enthusiastic. I am feeling so optimistic that I'm convinced something will blindside me.

    Memo to self. No. One day at a time. You are stronger than it is.

    Thanks for leaving a string through the maze.

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  2. I'm definitely empathetic with your feelings here. It's not something one wants to hear, that they need medications more long-term or for life.

    It says a lot about your strength that you're dealing with the feelings so healthily. And walking the dogs by going swimming.

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  3. What a gift you are! I'm always amazed at how you are able to put yourself out there with such heart-felt honesty.

    And thank you for the links.

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  4. Susan, although I haven't been commenting lately (and only because of too many balls in the air to list) I have noticed that you've been sounding pretty good. I remember thinking to myself just the other day that the new meds must be helping. One could even view the you-feel-better-now portion of this as good news. If one were feeling optimistic to begin with, of course.

    Recently I accepted that I need hypertension meds--another chronic condition that requires lifetime medication. I was sad and reluctant too. Now that I've been taking them for a year-ish, I think, I realize I don't miss the nagging worry about whether my pressure is high. I'm so used to low readings I feel fine about strapping on the arm cuff, the way I used to feel about it before hypertension became an issue.

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  5. Jody can totally commiserate on the daily meds front. In November of 2005 she had her thyroid removed and has been on synthroid ever since. We have noticed that her moods are more stable and has more energy etc. Though it took a while for the doctor to come at the right dosage.

    I tell you, waiting at the hospital for Jody to come out of surgery was the most nerve wracking experience of my life.

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  6. Hey, thanks, everybody! I really appreciate these comments.

    Martyn: I hope you can fend off another bout, or get out of it quickly if it hits. Cpongrats on the productive phase and the enthusiastic agent!

    Claire: Yep, hypertension's another of those chronic invisible conditions. I'm glad yours is under control.

    Christian: Yikes, that surgery sounds scary! I'm glad Jody's okay!

    And thanks to Nickie and JSD, too.

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  7. Why do you always do this?

    I come here to read what you've written, and BOOM! Almost like you're here in my head with me! And you have , once again, inspired another post in me...

    I know exactly what you mean! I am actually dealing with tapering down off of my antidepressants right now, because my doc thinks it is worth a try...

    I've made the mistake of "cold-turkey-ing it a couple of times, with poor results... so we are trying the "slooooow taper" method now...

    And now I have to go write another post, darn you!

    John

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