thunder

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  1. Nine weeks is a long time. You say you have a job offer, but is it 100% contingent on completing your courses by a certain date? If you have one class that is giving you particular difficulty, would you be able to take an incomplete and finish it while working - I know some people who have had this sort of thing happen, but it depends on the courses and the job. I realize this may be more stressful, and therefore not a good solution if it is even possible. Or if you do withdraw, could you postpone the job offer? Regardless, no degree or job is worth your health. I had to learn that the hard way. It sucks to have to give something up because of your illness, but in the long run, its better to do that than try to stick it out and do irreparable harm. But hopefully it doesn't come to that, and you're able to make it manageable. Good luck!
  2. I'm on 250 mg of lamotrigine and 75 mg sertraline. I'd been on 100-150 mg of sertraline for about 2 years before my new pdoc finally listened to me when I described my cycling and diagnosed me with bipolar. We added the lamotrigine and then dropped the sertraline down to 75 mg (I was super depressed when I started the lamotridge, after crashing off of a hypomanic state). I've been at these doses for about 3 months, after a couple months of tapering and adjusting doses. We decided to leave the sertraline for now since I tend towards depression at it seems to be working well at these doses so far. We're keeping a close eye to make sure I don't start trending towards hypo, in which case we'll drop the sertraline. So I haven't been on the combo for long, but so far, so good.
  3. Since (correct me if I'm wrong) this is your first time in therapy, it can seem a little weird at first, and can be difficult to figure out what you should be talking about.That being said,your therapist should be working with you to determine goals, and help you identify what you need to work on. If you know what you want to discuss - either in general or on a specific day - they should pretty much let you talk about that. And if something doesn't feel right with this therapist, try someone new. It can be okay to take a little bit of time before you spend much time on the big stuff if you need some time to develop rapport with your therapist.When I first started therapy, I had a difficult time naming my feelings and identifying what I needed to talk about, and it can take a bit for a therapist to get a context for you and your life that will enable them to steer the conversation during those silences. But, in that case they generally at least ask substantive questions about my life - what do you do for work, what do you do to relax, what are your hobbies, are you in a relationship, what's your family life like. That way at least they are getting to know you as a person, which can help later on, or it might bring up a starting point for conversation.
  4. I have a similar issue. One thing my therapist recommended was to track not just mood, but other factors like sleep, energy, irritability, anxiety, social activity, concentration etc. The idea is that while I may not always accurately label my mood, we can catch if say, I'm sleeping more, but yet less energetic, that I may be trending towards depression. Or if I'm irritable, not sleeping, and have excess energy I may be hypomanic. I've only been doing it for a month or two, so I can't really say how well it works, but it seems like a good idea. I've been using an app called MoodDiary on my phone (Android). I chose it because you can customize it to add whatever categories you want, but the chart/visual output isn't as clear as ideal, but it works okay.
  5. I don't know of anything that would help significantly long term. Support groups might be of some use, if one is open to those and there are good ones around. I also had found these online meetings http://www.dbsalliance.org/site/PageServer?pagename=peer_Online_Support_Groups when I was working on finding good treatment in a new location. I was always to nervous to actually participate, so I have no idea if they are any good. I also know some people who have gotten short term support from clergy members if that's your thing. Not from, "just accept God and he will solve all your problems" religions, but from pastors in more liberal denominations who will meet with congregants and offer more real-life support and problem solving. It likely will only go so far, but I've known people who this has helped them get through a particularly tough time, or help them fill a gap when for whatever reason they do not have adequate current mental health providers.
  6. My therapy appointments vary from week to week depending on what's happening in my life. My current therapist starts by asking me how my week has been. I like this better than when they ask me "how are you?" since that's so easy to answer with okay, fine, good, or whatever that doesn't really get us anywhere and I still require more prompting to start talking. If we had talked at my last session about something I was going to try to work on, or something that I had coming up that I was anxious about - or just something significant coming up, even if it was something good - my therapist will ask me how whatever it was went. Sometimes we'll then talk about coping skills that I could have used in something that happened in the past week, or feeling that I'm having at the moment and work on trying to understand them and whether there is something I can do to change my current situation. If I'm really depressed and not really doing anything, like you mention, we'll brainstorm on little things I can try to do during the week that will make me feel better, even if it seems to hard to do them. We also have some bigger "goals" although those are pretty vague. I'm working on figuring out what "normal" human emotional reactions are versus something that indicates I'm in a mood episode. This also includes working on being more aware of specifically what I'm feeling, since I've tried to avoid my feelings for a long time, partly as a way to cope with things that were too big and scary to face. We're also working on some mindfulness and relaxation strategies that can help with my anxiety and irritability. I have a hard time with identifying long term goals in therapy, but this mix of day-to-day and larger coping strategy and mood identification/regulation stuff works well for me. It sounds like you want more concrete "goals" to address in therapy. Are you able to identify what these goals are? If not, it is still worth mentioning that you feel like there isn't much continuity and purpose to your sessions. Ideally your therapist would then be able to help you identify and target your therapy towards what you're looking for, even if you can't yet articulate it. Sometimes even discussing what exactly it is you want to work on and trying to identify it can be helpful on its own. Some therapists do tend to be more open ended, "let's just talk" types, so if that's basically what your therapist does, it may be time to look for someone who does more directed therapy, if that's what you want. Edit: You posted while I was typing. It's frustrating because it never seems like its doing anything, but sometimes when I'm waiting for meds to kick in, just having someone consistently "there" for me is helpful. It never feels like enough when it's happening, but in retrospect, I can see that I needed help existing and enduring until I was a little more stable, and that just having the consistency and compassion of therapy helps me to survive. .
  7. If you tell them you think about suicide, they'll generally ask you if your safe, if you have a plan, whether you intend to act on that plan and such. Generally, they'll only consider hospitalizing you if you have a plan along with the means and intent to follow through with the plan. If you can assure than that you're safe then they won't hospitalize you.
  8. I am not in Arizona, so I don't know the specifics of their Medicaid plans, but I do have Medicaid in the state I live in. I had previously been on insurance through my employer, but I had to leave that job, at which point I got Medicaid. Honestly, for me, its such a relief to have Medicaid, to the point that it makes me sad to think that when I go back to working full time (I'm working again, but my income is still low enough that I can keep Medicaid) that I'll have to go back to either employer-based or ACA health insurance. I haven't had issues finding providers who take it, and its so nice not to have to worry about copays and deductibles and all that. I'd take a close look at exactly what having the ACA plan instead of just Medicaid would get you as far as providers. It should cover basically any medical condition that private insurance covers. Medications vary so much by plans, that it's hard to say. My Medicaid plan actually covers one medication that my previous insurance didn't. The size of the provider network is likely to be the biggest drawback of a state Medicaid plan. Do you have any established medical providers? If so, check whether they take the available ACA insurance, Medicaid, or both. If you don't have any, I'd suggest really looking and seeing if you have a couple options for pdocs, therapists and endocrinologists who take Medicaid. I know you said you looked at endocrinologists and couldn't find much, but are there ones on the ACA plan that look significantly better? I've generally found that regardless of how good or well established a doctor may be, most doctors don't really have much internet presence. You may actually find that just having Medicaid is actually less stressful than private insurance, since it means you'll be able to make healthcare decisions based on what helps you the most not what helps you enough for the lowest cost. And remember, if you do have someone you really want to see who's not covered by Medicaid, you can still pay out of pocket. It wouldn't likely make sense to do that for something like a tdoc who you see regularly, but paying $300 twice a year to see an endo who you like is still a lot cheaper than paying $6000 a year in premiums, and then still having to pay the $300 because you haven't hit your deductible.
  9. I suspect it has more to do with the alcohol+Xanax+melatonin, as well as the effect of alcohol alone for someone who very rarely drinks, than it does strictly the Lexapro. Although the Lexapro might have contributed to the effect.
  10. I didn't gain weight on Zoloft. It helped my anxiety some, but I think therapy made a bigger dent. I also didn't gain significant weight on Celexa, but it didn't help my anxiety as much as Zoloft. Oddly, Lexapro sucked more for me (hypomania/mixed episodes that were not diagnosed at the time as such). I eventually ended up cycling on Zoloft, although I did have probably a year or so of good results on it before that.
  11. @saintalto - Sorry if it sounded like I was contradicting you. I really only meant to contrast with your comment about extensive testing to say that I've basically never had a pdoc interested in doing anything other than talking to me about symptoms and behaviors. Very little attention given to potential physical causes beyond basically "do you have a primary physician? okay." The paragraph kind of wandered then into my experience with how pdocs have handled talking and recording diagnoses.
  12. I don't really find Ativan (or Xanax for that matter) to be sedating. My pdoc and I settled on Ativan for an as needed med since it lasts long enough to avoid some of the high/lows of Xanax, but had a quick enough onset to be more useful as a PRN. We discussed trying it and possibly switching to Klonapin if I ended up taking the Ativan fairly often, especially if I was taking it multiple times a day regularly, since then the longer action could provide better coverage. But I only take it maybe a couple times a week, so we stuck with it. I've only take Xanax twice, both times single prescriptions for specific events where the shorter, more powerful effect was desired, so I can't really say much about my experience with it.
  13. Hypomania on SSRIs is generally not considered enough on its own to diagnose bipolar disorder, but it is often considered a possible indication that you might be bipolar. So it likely will lead them to dig a little further to see if you might have had previous hypomanic episodes that were not identified. It also might be something that can lead to a bipolar diagnosis if your on the boarder of what they might otherwise consider to be significant enough symptoms to warrant a bipolar diagnosis. In practice, hypomanic reactions to multiple anti-depressants or a hypomanic reaction that persists after stopping the antidepressant, often lead to a bipolar diagnosis, or at least a decision to consider medication that may be generally used to treat bipolar disorder. In response to saintalto's comment, I just want to say that I have never gone through this sort of extensive testing. They usually ask when my last general physical exam was, and if I have had bloodwork recently, but if there was nothing that came up abnormal on anything on that, they don't generally look any further there. The only bloodwork they have ever been interested in is your basic stuff like red/white blood cell counts, kidney/liver function, cholesterol, blood sugar, and thyroid, with the majority of these being of interest to know and monitor if there is anything that they need to be careful with when prescribing medication that can effect those systems. Never had brain scans or any specific physical tests. And while it is usually considered a work in progress, a diagnosis will generally have to be given for the purpose of insurance billing from the first session on, although this can change at any time. I've rarely had pdocs that specifically name DSM diagnosis, but rather will say things like, "this should help with your anxiety as well as the depression" or "if we're leaning more towards bipolar, lamotrigine would be what I would try next, since it can also be helpful even if you are just on the unipolar side of things."
  14. Some people do still take Valium. If you've taken it before and it worked, I would definitely mention it, since "what has worked before" is usually a good starting point for figuring out meds (and not just psych meds). I don't remember if you've posted this somewhere before, but if you need something on a daily basis, have you tried any non-benzo options, like SSRIs? In my experience doctors prefer to at least try something along those lines if your anxiety is pretty consistent, and stick to benzos for occasional needs - although many people on this board do take benzos on a regular scheduled basis.
  15. IF this was your first time trying to give blood, is it possible that the process of getting ready to donate was ramping up your anxiety? Dealing with getting to wherever the donation site was, filling out the forms and answering questions can be stressful. So is it possible that now that you've gone through that part and know what to expect that you'll be calmer next time if you tried again? And then maybe your blood pressure and pulse wouldn't be so high?