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    living better through chemistry

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  1. Adderall and caffeine

    I find that with a stimulant my caffeine cravings drop dramatically. It was also easier to taper down the caffeine.
  2. I find it hard to get as "close" to a tdoc who takes notes during session. It's like the clipboard or whatever inserts some distance and prevents deep connection/trust. Like the tdoc is engaged with the notes, not with me. I also tend to worry about what s/he's writing and who might see it. My current tdoc does not take notes during session (after initial evaluation/get to know you), but I have had some that did. My pdoc (who does some therapy with me) takes notes, but mostly they're quick scribbles not longer notes. I still feel like I have to pause, though, to allow her to write and catch up with where I'm at. I think things get lost or missed there because she's not looking at me to see all of my reactions and body language, and doesn't see how the pauses in the process halt my flow in a negative way.
  3. I agree with the others that it’s okay to be in therapy as long as you’re benefiting from it. Life continues and your needs and goals will evolve over time, but that’s not a bad thing. Proponents of “evidence based” therapies view therapy as a place to learn highly measurable skills like exposure therapy, CBT/DBT, etc. Very structured short term therapy tends to be all about learning and practicing coping skills. More general psychotherapy allows you to process wounds (new and old) in the presence and under the guidance of a trained therapist on a more long term basis. The therapist may teach you coping skills in addition to being a support (and most do), but the goals and process of the therapy are different.
  4. It’s not a contest. Your illness is no better or worse than mine. My point was that people misuse the words “depression” and “anxiety” to the point where they don’t even understand what they don’t understand about the diagnoses. Their empathy is meaningless. With MDD, it is not uncommon to be told “oh, just” do xyz thing. Exercise, eat, sleep more/less, stop being sad, pull yourself up by your bootstraps, just want to be happy and you will be. As if that’s all it takes. People who express their pain through music or clothing choices are “emo”. People who cope with the pain through food, drugs, alcohol and/or self harm are seen as having made the wrong choices in life. People who die by suicide are called selfish, the grief of their loved ones superceeding their constant inner pain. Do you know what it’s like to plan your own death? Research methods, write a note, gather tools, start saying your goodbyes (in a cryptic way, of course)? Have you spent months or years making the deliberate and conscious decision to live each day? Any idea how exhausting that decision alone is? I don’t see or hear things that aren’t there, and I don’t become manic and high. I have spent more than 15 years in a deep dark hole, trying one thing after another that promises to get me out... and they don’t. Society says that’s my personal failing. I just don’t want it enough. MDD is as severe, as serious as other mental illnesses. That you disagree tells me you misunderstand too, if only because your depression is “intermittent”.
  5. Sorry, I meant there are other medications I could try (off-label, but still).
  6. Yeah, I just ran into this issue too. My pdoc wants me to try Belsomra to help with sleep. I tried to fill it and they told me it's not covered - similar price point as your allergy med too. Shouldn't my doctor be the one deciding what meds are right for me, not the insurance company?? I have some understanding/patience for a pre-authorization. Fine, expensive med, prove it's worth trying... I can do that (as can you, I'm sure!). But no, they just won't cover it at all. Sucks. Good luck with the appeal. I'm not going that route yet myself. I have some other options to try first.
  7. Is it possible to go to an urgent care clinic instead of the ER for self-harm wounds? Or will they just have me sent to an ER? Urgent care clinic is much cheaper with my insurance. It's also generally a calmer place than the ER. In general I don't hesitate to go to urgent care over the ER for wound care or whatever, but I wonder if they'll freak at the psych aspect. I'm not suicidal. Any wounds would very obviously be self harm due to location and old scars in the surrounding area.
  8. Hmm, I was mis-remembering. I thought Imipramine was a "tetracyclic" but it's not. The other hard thing, frankly, about taking a TCA is my pdoc wouldn't give me more than a week of Imipramine at a time. I have chronic suicidal thoughts and while she mostly trusts me... she didn't with that. Thanks for the tip about Marplan. My insurance just changed, so I don't even have access to their formulary yet, but I'll look into it once I do.
  9. I took Parnate for 2 years and yes - stimulating. I did need Trazodone for sleep to happen at all. It helped for a while but I guess pooped out and I ended up coming off it shortly after starting ECT. A couple months ago pdoc brought up Nardil and I talked her out of it. I didn't want the hassle, and I'm very wary of weight gain. Might be worth reconsidering though. sigh. Genetic testing says I won't metabolize tricyclics including nortriptyline very well. I took Imipramine for a while (I know, it's not really a tricyclic). It didn't do a thing for my mood but it sure made it easy to sleep.
  10. I think the first step is to raise your concerns directly with her - perhaps start with the stuff in your edit? I find it easiest to bring stuff like that in on paper and have my tdoc read it (while I fidget anxiously, stare at her shoes, and so on ). Based on how she responds you’ll know, I think. I would expect her to ask questions about what you want to get from therapy, but hopefully she’ll also want to make changes or help you see how you’ve been progressing and stuff. Basically, you want her to be the opposite of defensive Sometimes my sessions feel like we don’t do anything- no deep work, no tears, and I feel worse or no better for them... but those are about strengthening the relationship. Can’t do it all the time though.
  11. Thanks guys. I hesitate to call them trauma related because I struggle with using that term for my experiences, which don’t seem to be “bad enough”. But yes, nightmares about or relating to bad things that happened to me, from which I wake up anxious, in a cold sweat and can’t get back to sleep. I’ll ask my pdoc about prazosin when I see her tomorrow. I just recently argued against an MAOI and am now on Prozac, but maybe I’ll reconsider. Long washout with Prozac though.
  12. Is there anything that I can talk to my pdoc about taking that would prevent dreaming? I need to be fully functional during the day, but at night I want zero dreams.
  13. I'm sorry you're in such a rough spot, it really sucks to be considering IP. I don't have BP, but I can comment on psych wards in the US. Pluses: it truly is a break from life. You can't do much about anything outside while you're in. sometimes that can be enough to help start a reset. you don't have to think about what to do, when to do it, etc. meals are provided, schedules posted and if you don't want to attend their groups (and aren't trying to get out), you can totally stay in bed all day You asked if they really take away your clothes, phones and so on. Short answer: mostly yes. For patient privacy, you won't have access to your phone. They'll give you time to copy numbers out of it and you can use the patient phones (usually only between certain hours and when there are no groups running). If you bring a notebook, make sure it is glue-bound. They likely won't let you keep one that is wirebound or stapled, for fear that you would pull it apart and use the metal to hurt yourself. The 3 places I've been to provide crayons, markers and golf pencils (the little short ones). You won't be allowed a pen or to bring your own pencil. You can bring photos, decks of cards and little things like that though. I have a friend who would bring an Uno deck to play during visiting hours (which are limited). As far as clothing, Cheese is right. Pack light - usually no more than 3 changes of clothes. I wouldn't bother with socks, they'll make you wear the hospital kind. There will be laundry facilities and soap there for you to use. Washing your clothes is an option, not a requirement, but is viewed favourably as showing willingness to do ADLs (activities of daily living), along with showering, making your bed, and attending groups. Bring comfortable clothing, but be prepared - they'll cut the strings out of sweats, you won't be allowed a belt, or shoes with laces etc. For women wearing bras, choose bras with no metal clasps or underwires. Most places make you wear disposable scrubs for at least the first 12-24hrs. Some places will make you "earn" back your clothes (though you will be provided with clean/new scrubs upon request), others just wait to make sure you're not in such a crisis you can't be trusted with clothing. On admission to the unit there will likely also be a "skin check" where 2 nurses will have you strip (usually only partially, but don't get me wrong, all of your body will have been exposed by the end) so they can document any injuries, tattoos and potential sources of infection (e.g. bruises, cuts, rashes, cysts). You'll see a pdoc and an internist at least on weekdays (weekends/holidays are iffy), but the encounters will be short. I expect you will be frustrated at their approach which can be... blunt. You'll primarily be cared for by nurses and techs. Nurses dispense medication and will talk with you if you need it but don't expect much one-on-one with any staff. I've been to 3 different psych wards. I had the best experience at the local teaching hospital. The doctors there were less burned out and more willing to talk to me like I had a brain and include me in their treatment planning. Mostly... it's boring. You won't learn anything new from the groups, which are fairly basic CBT type stuff usually, designed for people in crisis. I found that I do not fit the typical demographic (partly because I'm smart) and that throws everyone off. Just remember, if that happens to you, it doesn't mean you don't need to be there, but it does mean they may not be able to help you best.
  14. In my case, my substitute tdoc already knew me from an IOP a while back. My tdoc contacted her ahead of time to ask her to step in, and I gave permission for tdoc to give recent background info. I was glad to have somebody to talk to. Obviously that setup is not possible for you now. I found the substitute tdoc was good for supportive listening, and basic skills work. We didn’t do much if any deep work, but it sounds like you’d be okay with that. I think it’s worth giving them a call.
  15. I'll second what @Rabbit37 said. Neither my tdoc nor my pdoc (both whom I see weekly) accept the insurance I had at my last job. Tdoc allows me to pay the amount that insurance would pay her, if she were in network ($69 vs $120 billed rate). Pdoc lets me pay the co-pay I would to see her if she were in network ($75 specialist copay, vs $150 billed rate). I had a 3 year relationship with pdoc while at a previous job with insurance she accepted. We negotiated the change when my insurance changed. When I started seeing tdoc she was accepting my insurance, but after about a year she came off their panels. I pay more than I did (copay would be $30 if she were in network), but it's worth it to me to keep seeing her.