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  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. @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.
  6. 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.
  7. 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."
  8. 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.
  9. 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?
  10. Could you say something really general like, "My schedule has changed and I can only work 3 days a week." They might ask why or if there are days you can no longer work, but you could again give something general like family obligations, or just say that any 3 days are fine. Since you are currently working part time already, they may already assume that you are doing something else like a 2nd job, or going to school, or serving as a caregiver for family members, and that something has changed with these. You may just be able to play into this assumption without actually saying that.
  11. Gotcha. I guess I was trying to figure out how you were separating dysphoria from depression, since as I apply to to myself, I tend to think dissatisfaction and distress is a symptom of depression, and unease either indicates anxiety or irritability. But I think I get what your saying. It doesn't really sound to me like what I think of as a mixed episode. There aren't really any of the features of (hypo)mania in what you describe (elevated mood, decreased need for sleep, pressured speech, flight of ideas, distractibility, goal orientated behavior, agitation, or risk taking behavior. It sounds more like variations in the intensity of depression, since there is no "up/activated" component. When I had what was labeled at the time as "agitated depression", which now that I have a BPII diagnosis, retrospectively may be better characterized as mixed episodes, I would have low mood, suicidal thoughts, insomnia, agitation/restlessness, and anger/irritability. However, I tend to think of sporadic episodes of suicidal, crying and general inability to cope just to be an element of sever depression. Depression does not have to be 100%, all the time, at exactly the same level. But YMMV, and it is probably good to bring this up directly and see what your pdoc has to say about it.
  12. It seems that the answer to this depends on who you ask. Since we don't have much understanding scientifically of what happens in the brain to cause any sort of mental illness or episode within an illness, all diagnoses are based on a mixture or grouping similar symptoms, conjecture, and aggregated clinical experience of various psychiatrists. Therefore, there is a lot of room for interpretation of diagnoses by individual doctors. Apparently the current version of the DSM allows for a modifier of "with mixed feature" and with "anxious distress" to both depressed moods and manic/hypomanic moods, depending on what the prevalant mood state is (i.e. whether has more symptoms that meed the criteria for depression or for hypomania/mania). It does also not that depression with mixed features is frequently indicative of bipolar disorder, but does not consider depression with mixed features alone to be sufficient to necessitate a bipolar diagnosis. Anecdotally, as I can recall, I did experience the sort of mixed, agitated, irritably depression in my teens and early 20s before I experiences clear hypomania. Without increased energy/agitation or significant irritability or anger, it doesn't sound like what I consider to be my mixed episodes, but people are different. Although I'm not sure what you mean by intense dysphoria because I associate that with irritability, which you said you don't have to a significant degree. With anxiety as the primary symptom, I'd wonder if its a comorbid anxiety disorder, The important thing is to treat the symptoms, but as I recall, you've had difficulty with finding meds to adequately treat your symptoms, so I understand wanting to find a box to fit your symptoms into in hopes that it will provide a better direction towards finding appropriate meds.
  13. Coping skills take time to develop, and aren't always enough. You shouldn't feel guilty about taking Xanax. You were prescribed it for a reason, presumably because your doctor thinks you will need it. That said, Xanax is the fasted acting benzo, so many doctors prefer to prescribe it only for occasional use, and go with something longer acting for more regular use. I would see if your doctor thinks switching to Ativan might work better, since it seems like you need something that gives longer relief rather than needing something like Xanax that kicks in quickly. I know you said you don't want to take SSRIs because of bad side effects, but did you try multiple different ones? Its not uncommon to react differently to different ones, even though they are chemically similar, and there really is no way to know which ones will work better for any given person. There are also other non-benzo, non-SSRI medications that can help with anxiety. Vistaril is one, although for many people it is sedating so it is often used more for sleep. I hated it, and it didn't really work for me, but some people like it. Buspar is another one, although it can be it or miss. I was going to try it at one point, but we were messing with other meds and then decided that I didn't need it once we finished the other changes. Some people on this board also take anti-psychotics to help with anxiety, and beta-blockers can also help, but I've never taken either of those classes of meds, so I'll let someone else speak up about those.
  14. It does sound like your current meds are not working, but that doesn't mean that being unmedicated is the only other option, nor does it mean its a good option. From what I've read (and experienced) episodes frequently get worse over time if they are not treated or not treated properly, so its possible that the worsening is not actually a result of the meds per say, but just an indicator that your meds are not doing their job. Definitely raise the issue with your doctor, and hopefully they can find something that works better.
  15. The others have given good advice on this. I just wanted to say that I also struggle to know when I should call, and also to actually call when I know I should. Like you said, it feels too hard to figure out what to say on the phone. Asking for an earlier appointment is a good idea, and is usually what I do when I make myself call. I find that even if an appointment is not available, hearing my therapists voice and knowing that they know things are bad is enough to make things more bearable. I also have been known to call for made up reasons, like to confirm the time of my next appointment, just to hear his voice. This wouldn't work if you have a regularly scheduled time, but I had really variable work hours and frequent work travel at one point, so my appointment times changed from week to week around that. Or I'd even call, listen to his voicemail, and then hang up, because just knowing that he was there helped without actually talking to him.