of depression, therapy, and insight
I see a psychiatrist for medication management and a therapist (Ph.D.) for psyche management.
I've been on anti-depressants for years. It's a fairly straightforward diagnosis: major depressive disorder, chronic. "Chronic" meaning everytime I ever try to stop taking meds, I crash. No initiative, no affect except irritability and crying, and feeling quite content to do nothing but lay in bed and read all day. For the most part, I feel apathetic. And like a failure. Hence the tears.
Every once in a while (couple of years, maybe) my meds have to be tweaked. Seems whichever SSRI I'm on just isn't as effective anymore. In the past, I had obtained my meds from my general practitioner. I explained to her that it was a maintenance med, gave her the litany of what I've had and what works, and she wrote me a prescription. Good girl. 'Bout a year ago, when it seemed the trazodone wasn't working anymore, she changed me to Wellbutrin. When I told her I didn't think the dose was high enough, she obligingly wrote a new scrip. And when I decided I was ready to quit smoking, I went to her again because Wellbutrin = Zyban. She agreed to go up on the dose again in order to help curtail the nicotine cravings. It worked, I did quit smoking.
Thing is, for the next many, many months, I was an irritable bitch. God, that's such an understatement. I was awful. Irritable. Impatient. Snappy. Quick to find fault and quick to feel that I was being criticized. I saw the negative in everything. I didn't want to do anything. I don't know how people put up with me. I was aware of it, sometimes, but powerless to stop it. I didn't feel depressed per se - no thoughts of driving over a cliff or anything. But just so damned bitchy - all the time.
After a particularly ugly argument at home one night, I made an appointment with my GP. Obviously it was med-tweaking time again. So, I went to see her. This time, however, she didn't complacently write me a new scrip. Instead, she said she did not feel comfortable managing my depression any longer and referred me to a psychiatrist.
Whoa, Nelly. Stop the boat. A shrink? Don't get me wrong here, I don't have any particular biases against psychiatrists. But it was a hassle. And an expense. And it meant that nothing would be changing quickly. "Four to six weeks for therapeutic level" is bad enough without having to wait a month or so just to get the prescription. And it was at least a month. First couple of people I called off of my insurance plan never bothered to call back. Of course, eventually one did and I made an appointment.
I went in, explained my history and current behaviors. His first real question after my lengthy recitation was, "And have you never heard that irritability is an extremely common side effect of Wellbutrin when taken at high dosages?"
I was floored. Usually I educate myself on whatever med I'm taking, but I'd certainly missed that little tidbit re: Wellbutrin. Oh, for the record - the dosage in question was 450mg daily - the extended release type. Needless to say, he started bringing me down from the Wellbutrin immediately. To compensate for the chemical inbalance in my fucked up brain, he started me on Celexa. When that didn't work (um, hello, libido? Anyone?) we changed to Zoloft. Still not so nice to the libido, but better than that damned Celexa. The irritability dropped off almost immediately. I became a much less horrible person with whom to spend time.
Whew. End of story, right? Selph got her meds tweaked and it was all good. Or not.
See, my shrink said something else that really threw me for a loop. Some asinine bs about how the ultimate goal of "treatment" would be to address the "underlying issues" via therapy so that medication could be discontinued.
Did I say I was floored before? This time I damned near had a panic attack. I immediately told him that me without drugs = bad. I told him I had tried several times over the years to discontinue whichever drug I was on, and I always got depressed again. Still, he was persistent. He acknowledged that "a small percentage" of people really do seem to need maintenance medications for life, but he really believed I needed to address whatever my "issues" were.
So I made an appointment with a therapist. And I have to admit, I'm a convert. I'm still absolutely terrified of not being on an antidepressant, but my sessions with my therapist have been extremely revealing. Turns out, I'm a neurotic mess. I care so fucking much about what other people think of me. And I'm so inclined to assume they think the worst. I've spent most of my life "anticipating" others' thoughts and reactions to me, always with a negative context. And my mind is a mess of contradictory desires. I HATE to be the center of attention, yet I crave positive reinforcement. I do want attention, but not "spotlight" attention. I guess it's attention on my terms. I feel like I'm always striving to please or impress, and always failing. Failing others, failing myself. I'm so damned self-critical. I always feel like others are judging me, and I come up short. And it was such a habit, such a familiar state, that I didn't even realize it until I started seeing a therapist. God, it seems so narcissistic. Why the fuck do I think other people think about me at all? But I do. And the frustrating thing is, so far, awareness has not led to change.
I've been on anti-depressants for years. It's a fairly straightforward diagnosis: major depressive disorder, chronic. "Chronic" meaning everytime I ever try to stop taking meds, I crash. No initiative, no affect except irritability and crying, and feeling quite content to do nothing but lay in bed and read all day. For the most part, I feel apathetic. And like a failure. Hence the tears.
Every once in a while (couple of years, maybe) my meds have to be tweaked. Seems whichever SSRI I'm on just isn't as effective anymore. In the past, I had obtained my meds from my general practitioner. I explained to her that it was a maintenance med, gave her the litany of what I've had and what works, and she wrote me a prescription. Good girl. 'Bout a year ago, when it seemed the trazodone wasn't working anymore, she changed me to Wellbutrin. When I told her I didn't think the dose was high enough, she obligingly wrote a new scrip. And when I decided I was ready to quit smoking, I went to her again because Wellbutrin = Zyban. She agreed to go up on the dose again in order to help curtail the nicotine cravings. It worked, I did quit smoking.
Thing is, for the next many, many months, I was an irritable bitch. God, that's such an understatement. I was awful. Irritable. Impatient. Snappy. Quick to find fault and quick to feel that I was being criticized. I saw the negative in everything. I didn't want to do anything. I don't know how people put up with me. I was aware of it, sometimes, but powerless to stop it. I didn't feel depressed per se - no thoughts of driving over a cliff or anything. But just so damned bitchy - all the time.
After a particularly ugly argument at home one night, I made an appointment with my GP. Obviously it was med-tweaking time again. So, I went to see her. This time, however, she didn't complacently write me a new scrip. Instead, she said she did not feel comfortable managing my depression any longer and referred me to a psychiatrist.
Whoa, Nelly. Stop the boat. A shrink? Don't get me wrong here, I don't have any particular biases against psychiatrists. But it was a hassle. And an expense. And it meant that nothing would be changing quickly. "Four to six weeks for therapeutic level" is bad enough without having to wait a month or so just to get the prescription. And it was at least a month. First couple of people I called off of my insurance plan never bothered to call back. Of course, eventually one did and I made an appointment.
I went in, explained my history and current behaviors. His first real question after my lengthy recitation was, "And have you never heard that irritability is an extremely common side effect of Wellbutrin when taken at high dosages?"
I was floored. Usually I educate myself on whatever med I'm taking, but I'd certainly missed that little tidbit re: Wellbutrin. Oh, for the record - the dosage in question was 450mg daily - the extended release type. Needless to say, he started bringing me down from the Wellbutrin immediately. To compensate for the chemical inbalance in my fucked up brain, he started me on Celexa. When that didn't work (um, hello, libido? Anyone?) we changed to Zoloft. Still not so nice to the libido, but better than that damned Celexa. The irritability dropped off almost immediately. I became a much less horrible person with whom to spend time.
Whew. End of story, right? Selph got her meds tweaked and it was all good. Or not.
See, my shrink said something else that really threw me for a loop. Some asinine bs about how the ultimate goal of "treatment" would be to address the "underlying issues" via therapy so that medication could be discontinued.
Did I say I was floored before? This time I damned near had a panic attack. I immediately told him that me without drugs = bad. I told him I had tried several times over the years to discontinue whichever drug I was on, and I always got depressed again. Still, he was persistent. He acknowledged that "a small percentage" of people really do seem to need maintenance medications for life, but he really believed I needed to address whatever my "issues" were.
So I made an appointment with a therapist. And I have to admit, I'm a convert. I'm still absolutely terrified of not being on an antidepressant, but my sessions with my therapist have been extremely revealing. Turns out, I'm a neurotic mess. I care so fucking much about what other people think of me. And I'm so inclined to assume they think the worst. I've spent most of my life "anticipating" others' thoughts and reactions to me, always with a negative context. And my mind is a mess of contradictory desires. I HATE to be the center of attention, yet I crave positive reinforcement. I do want attention, but not "spotlight" attention. I guess it's attention on my terms. I feel like I'm always striving to please or impress, and always failing. Failing others, failing myself. I'm so damned self-critical. I always feel like others are judging me, and I come up short. And it was such a habit, such a familiar state, that I didn't even realize it until I started seeing a therapist. God, it seems so narcissistic. Why the fuck do I think other people think about me at all? But I do. And the frustrating thing is, so far, awareness has not led to change.
posted by psychoselph at 11:00 PM
0 Comments:
Post a Comment
<< Home