Monday, July 25, 2016

Monday Blues

Beginning to wonder if I'm ever going to even get back to the level of awful I was feeling BEFORE starting the medication. I'm seeing the psychiatrist on Thursday and hoping she has some suggestions because this is not sustainable.

Lots of thoughts going through my head that I'm still trying to work out. I feel like we need some change in our lives. But I don't want to make any decisions while I'm in the throes of major neurotransmitter upheaval in my brain---I want to see what I'm still thinking/feeling when the dust settles. (and no, its not about my job). For the past few months I've felt really unsure about what exactly I want my life to look like 5 years, 10 years from now. I envy those that have it all figured out and can make choices consistent with those goals. I used to think I knew, but these days I feel quite apathetic about things I used to be so passionately working towards---both in work & home life.

I'm trying to set my sights VERY LOW for myself. A very short list of what I absolutely want to accomplish each day, either at work or at home.




Thursday, July 21, 2016

Hanging in there

Won't bore you with more of the same...I'm expecting the side effects to continue for another week, so I won't talk about them again until they are gone.

I've been thinking a bit about what my goals are for treatment---what do I expect to happen, and what would I consider a success vs. a failure? Before I started the SSRI, I had anxiety and some depression, and while it was definitely affecting my quality of life, it wasn't debilitating. I had insomnia that was actually very well managed/cured. Now I have pretty debilitating anxiety, worse depression, physical symptoms, and awful insomnia...hopefully as short term side effects of the medication.

Obviously I want all the side effects to go away. But I also just want to feel better. Not "happy" necessarily, but more able to experience the full range of emotions. For a while I felt like my emotions ranged from dread to apathy, rarely crossing over into the positive side. I want more positive emotions. I also would love to feel more calm. More able to deal with the everyday stressors of my life without going into a sympathetic nervous system overdrive.

I don't know if this is achievable, or how long it will take. But I'm hanging in there.

Wednesday, July 20, 2016

Brief Reprieve

Guys, its still pretty bad. I keep waking up at night feeling extremely sad & anxious. The past 2 nights I woke up twice; once around 2:30-3 and then again around 4:30. After the 4:30 wake up, I can't get back to sleep. Yet I felt too weird/shaky to go to the gym or meditate or do anything really besides scroll through my phone.

I feel jittery & nauseous, its hard to eat anything. I'm hungry, but the thought of eating almost anything makes me feel sick, and the smell of most food makes me feel sick. Sort of morning-sickness-like, but no happy secret going on here.

Yesterday I had to take B to an amusement park for a camp field trip. I was dreading it, didn't think I could manage, with the heat and the nausea and the overall awfulness...but I went, and I'm so glad I did. It was really fun, and kept me out of my head and in the moment. We stayed in the water park and the little kid area, where he could go on all the puke-inducing rides by himself while I sat in the shade and waved & smiled. He is so independent, he loved going by himself. He was marvelously well behaved and cheerful. Even the 90 minute bus ride each way was fun---on the way up I chatted with other moms, on the way back, I entertained 4 6-year-old boys by looking up knock-knock jokes on my phone (and they enhanced them by adding "poop" to each punchline)

Of course, today I'm back at work, and nothing is fun and I'm NOT in the moment. I made it through clinic and finished my notes & phone calls and now I just want to go home. My lunch is sitting in my bag and it just doesn't appeal, though my stomach is growling.

Thanks for reading and offering support. It means a lot!

Monday, July 18, 2016

The Valley

So what the doctor did NOT warn me about is that for the first few weeks, SSRIs can really exacerbate anxiety. A LOT. To the point where many psychiatrists also prescribe quick-acting anxiolytics to get you through that hump before the anxiety starts to fade.

I found myself searching "SSRI worse anxiety" on Sunday morning and found out that this adverse effect is very common. Which is good to know, but does nothing to actually help me deal with it. I feel panicky, its hard to eat, I'm having horrific headaches and everything seems overwhelming and awful and I just want to sleep in my air conditioned bedroom all day and not deal with anyone.

Its hard to believe this is actually supposed to HELP me. I've never felt worse! Yet, I'm just supposed to wait it out and theoretically will feel better in a few weeks.

I saw my therapist on Saturday afternoon, before this started. We talked a lot about support systems, and how I don't have a great one. G is just not the support I need for this. He is supportive about the fact that I am treating my anxiety with medication & therapy, and he is giving me the time & space to do so (no small feat---he's taken over more household chores and did a lot of stuff with the kids Saturday). But he doesn't seem very empathetic about it---very matter of fact, like "you do what you need to do, this is important". Like I'm sort of on my own. I'm sure this is partially my fault, as I've been in the past very reluctant to talk openly about what I'm feeling and maybe he's trying to respect that? In any case, I'm not up to the task of "discussing" this with him...not right now. I feel too shaky at baseline, I'm not planning to invite conflict into my life willingly!

She asked if I had friends that I could talk to about the "day to day stuff" and I had to say "no". I just don't have local friends I talk to regularly at the moment. I imagine it WOULD help, if I had someone to talk to regularly, to vent & share & commiserate. It would be far better if that person was NOT my husband, not personally involved in any of the stressors of my life. She told me to "work on that". Ha! Like its so easy to just find some friends and become good enough friends that you can talk through the intimate details of your life!

Anyways. I don't have time to wallow, we have a busy week. A childhood friend I hadn't seen in years came last night and is staying until tomorrow morning---I'm going to duck out of work early to hang out with her some, since she has dinner plans with other friends tonight. I have to accompany B on a camp field trip to an amusement park tomorrow (the other option was just to take the day off and stay home with him because there is no regular camp...I'm wishing now that I took that option, honestly). MIL is coming on Saturday.

I just need to make it through. If I'd known about this, I don't think I'd have taken the medication, honestly.

Friday, July 15, 2016

Update...

I did see the doctor yesterday. After 10 minutes of background & some questions about therapy, support systems, habits...I left with a prescription for an SSRI. I don't expect to feel anything for 2-3 weeks (at the earliest). On the way home, I got a call from the psychiatrist office with the therapy group. They indeed hired someone new and they have lots of open slots to fill so I'm in to see her (him? can't tell from the name) in 2 weeks. I know that is too early to make any changes, but I didn't want to miss the opportunity to get onto the schedule of a real live psychiatrist who TAKES MY INSURANCE so I'm going to go establish care.

In response to Deborah's comment on my last post---I don't think its unusual in the least for people to need to try many times to establish habits, even for things they truly believe will be beneficial to them. I've seen countless people make & break goals for things like flossing, exercise, "eating better"---just because its hard, and it doesn't stick after the first (or fourth!) time, doesn't mean its not worth doing. You do have to approach it differently until you find the way that works for you.

After reading a couple of different books, and talking to now TWO different therapists that strongly recommend it, I am pretty convinced that there is something to this meditation thing. It seems to be regarded by the psych community as a good tool for coping with anxiety. And I LIKE doing it! Its really hard not to think about things, and just focus on my breathing for 5-10 minutes, but when I can achieve it, even for a minute or two (which is realistically the most I have been able to achieve given my inconsistent practice), I feel really calm and almost happy for a short while afterwards. Also, when I am regularly doing my formal meditation, I find myself more likely to take the moments of downtime to breathe, look around, not think or distract or pull out my phone. Like going to the park with my kids and just looking at the sky instead of scrolling (again) through facebook.

This time I'm approaching it not as something that "probably would be good for me" but as a legitimate part of my treatment for my anxiety, along with the little orange pill I'll be taking every morning and the therapy sessions.Also, writing all THIS just makes me feel even MORE determined to stick to it and show everyone that I CAN do it...so there's that...

All the other habits I listed, I actually HAVE done successfully, for long stretches of time, so I know I can do them again. I did the shopping ban for a full year. I deliberately stopped it because I needed a few things, but shopping for even one thing means I'll end up needing/wanting many other things...once I give myself permission to look & buy, it opens some sort of floodgate! So instead of one pair of jeans and a couple of work pants and a dress and three shirts, I bought probably double that amount, and now I have way more than enough. I think doing long periods of shopping bans, followed by short periods of shopping when I do need something or want to refresh my clothes, is probably the best overall strategy for me in terms of saving money and keeping a reasonably sized wardrobe.

The benefits of drinking less are obvious, of course, and the majority of the time I am easily able to stick to a reasonable volume---but occasionally it creeps up, and I need to reset. This time, G is also on boards (finally!) which makes it beyond easy. The topic of "do you want a glass of wine?" just doesn't come up and the truth is, I'm totally fine drinking regular or seltzer water or having my new obsession, Yasso yogurt bars for when I feel like an evening treat.

Gotta run. Have a nice weekend. Its crazy hot here and our AC conked out last night...lots of time at the pool?

Wednesday, July 13, 2016

Smorgasbord

I've got quite the mish-mash here today: updates, thank-yous rants, musings & goals

Update: I am seeing another provider at primary office tomorrow. I am going over & over in my head what I'm going to say to convince her to prescribe anxiety meds for someone she has never seen before!

Thank you: for the comments/advice on my last post. This is an area of medicine I know nothing about, in terms of logistics. You were right in that 1) primary care does the initial med prescribing for most run-of-the-mill anxiety/depression drugs with psych for ongoing management & complicated cases  and 2) it is normal to wait a long time & pay out of pocket for psych. For those asking if my therapist could "Get me in"---the answer is no, I did ask. There is one psychiatrist who sees all the patients for 10+ therapists in the group. ALL the patients coming to him "have an in" with a therapist in the practice. There was a psych NP who helped him out who just left---they are hiring someone new, but until the new person is there, he literally cannot fit another patient in.

Mini-rants about work: I rarely talk about my clinical work but this morning! UGH!
  • I had THREE no-shows. Do people not use calendars (I know the answer, but WHY NOT!?) I am a specialist with a long wait-time for new AND follow-up appointments. Ms No-show is likely the same one who will complain about wait-times or call and BEG me to fit them in. When I make an appointment I put it directly on my calendar (currently using Google calendar, but I used to have a physical one)
  • Medicine would be so much more efficient if we could find a way to bill for phone consultations. I spent 25 minutes on the phone today, going over (abnormal but not life-threatening or urgent) labs, potential treatment options, risks/benefits of each, follow-up plan for each, send prescriptions and then documenting the whole thing. A follow up visit for me is 20 minutes. I could've billed a level 4-5 follow up in that time period if the patient was physically in my office. I know lots of docs make you come back in to discuss labs but I get that it is hard for people to miss work, etc... and I know they are worried, and our office has a policy that we address phone calls within 48 hours so I can't just NOT CALL and once they get me on the phone it is literally impossible to get off the phone. I wouldn't mind it so much if it "counted" for my productivity and clinical effort.
Musings: When I write things here, it keeps me accountable. When I was talking to the therapist Saturday I almost didn't say anything about medication. It would be easy to just let the time run out, telling her my problems, and getting non-medication coping strategies. But I told you guys I was going to, and I can't just come back and hem and haw about putting it off AGAIN. So on that note...for more accountability

Goals: 1) No alcohol on weeknights. My wine/cocktail consumption crept up alarmingly again, and I need to reset. I'm on week 2 and its totally fine (of course it is! I don't NEED it, it just became habitual). Seltzer is refreshing in the heat!
2) Meditation. Oh man, I am tired of coming here month after month to tell you how I failed at sticking to it.  I keep seeing books/articles/science about the benefits of it, and my new therapist is mindfulness as the best tool for managing anxiety. I need to treat it like medication and JFDI. I can't say "it doesn't work" if I don't try it consistently. I missed yesterday but I'm going to do it today. I AM!!!
3) Shopping ban. I don't need any more clothes so I'm not going to buy any. At least until 2017 but maybe a full year again.
4) Journal. Another habit I keep falling out of---writing down my "3 good things" at the end of each day. It ended the day on a high note, nothing except laziness keeping me from spending 60 seconds on this activity.

Monday, July 11, 2016

LIterally keeping me sane?

So I went to the therapist on Saturday and it felt SO GOOD to get everything out there. She told me I definitely had a lot on my plate---it would stress anyone out---but having all that in addition to some underlying generalized anxiety is a bad combination. We discussed how medication may/may not be useful. Either a long acting something (SSRI) or something to take short term when I feel overwhelmed/panicky/can't breathe (benzo) while I continue with therapy, mindfulness, exercise, journaling, etc... She gave me the number of the intake for the psychiatrist with the group, and if that wait was too long, too call my primary for an rx or referral. I felt good. I had a plan. 

We had a pretty good, low-key weekend. The weather was nice. I went to the gym and barre class and took the dog on long walks. I took the kids swimming both days. I cooked a TON of CSA veggies (sitting in my lunch bag is a container with riced cauliflower, baked tofu, sweet potatoes, carrots, swiss chard, zucchini and onions in a red curry sauce as well as a side of cole slaw...G made the slaw).

I woke up early today and did my meditation app for 10 minutes. I drank coffee while I read more of "the Art of Happiness" and got some Dalai Lama wisdom. I showered, straightened my hair, got dressed and came down in great spirits to take over the kids' breakfast & getting ready. I walked B to camp---it was cool and breezy and sunny and he is so excited for another week of playing & swimming.

Then I got to work and decided to try to make that psych appointment. I called the # for the psychiatrist. "not accepting new patients at this time". I messaged my primary "out of the office for 10 days". I called to leave a message for the covering doctor and I'll hear back in 2-3 business days (this is just to see IF they prescribe anxiety meds and if so, I need to make an appointment). I called the behavioral health center of my university. they don't take my insurance. Only residents are taking new patients. I could self-pay and get an appointment with a resident in 8 weeks. The employee assistance program offers THERAPY but not medication management. I went to my insurance website. I went down the list for the psychiatrists in my city (it was a surprisingly short list) and called every number (there were a few groups that had 5-10 providers): "not taking new patients" "no longer take that insurance" "first available in December".

What the actual fuck? How hard does this have to be? And I'm actually doing well enough to have the motivation and organizational skills to make all these calls! And I have one of the two major insurances for this area---how does nobody take it? The freaking company headquarters are here! How can my university practice not take one of the insurance options they give to their own faculty? I am willing to self-pay and still have to wait several months just to see a resident (who probably started in last week)? And the people on the phone were just so matter-of-fact and RUDE. Obviously if you are calling a psychiatrist's office for an appointment, you are feeling pretty shitty. Maybe an "I'm sorry" could be worked into your rejection? I'm not going to get political, but there is definitely a supply/demand mismatch in mental health services.

I feel really discouraged. I have no plan. I have no idea what more I can possibly do. I don't know any psychiatrists personally. I can't prescribe myself psychoactive drugs, nor would I want to. Aaargh.