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so i have my first pdoc appointment on monday and i'm feeling really nervous. i'm not sure why. i've been told i'll be seeing a psychiatric nurse practicioner for med management, so i know what to expect, but i have a lot of fears.

the lamictal seems to be working well - in terms of an antidepressant lift and a feeling of kind of clearing the static in my head - but it makes me really dizzy and i'm waking up at 3-4 am every morning. don't know if that's from the med or if i'm still a little manic. i'm getting about 6 hours of sleep a night, which is far superior to the 3 or 4 i was getting when i was manic, but waking up at 4 am is not good...it gives me way too much time to think about...everything.

i know i'll probably need to titrate up on the lamictal to get the full effect, and i'm worried about side effects making it hard to keep working. i wonder if i need something for sleep, and i'm worried about side effects from that. and my insurance sucks, with my copay for most meds being $30, so i don't know how many more meds i can afford. (not to mention the $25 office visit copay everytime i see a doc.)

i was actually relieved when i got the BP diagnosis, because all of a sudden a lot of things made sense and i thought i can finally get the right treatment, now that i know what i'm dealing with. but i guess as it gets more real, i start worrying about all these things.

i'm sure none of this is new to those of you who've been dealing with this for a while. but any support/advice/encouragement you could offer would be really welcome.

thanks for letting me rant....

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Thoughts that sprung to mind in no particular order:

* Be as honest as you can bear. No one will give you a gold star for pretending that you cope better than you actually do. A pdoc is someone you can trust with the bad stuff.

* Make notes or symptoms, problems with meds, past meds taken, or questions that you want answered. You might forget or freeze up and having something on paper can help.

* Be clear that you want to be involved in decisions, but try to keep an open mind that psychiatry involves a degree of experimentation and you might not initially feel that confident about a med choice or diagnosis, but it might make sense in the near future.

* Ask as much as you need to. Don't go away with a prescription that you don't know how to take, or in what quantity, or that scares you because you know so little about it.

* Trust your instinct, if the pdoc is in any way inappropriate, unethical, dismissive or refuses to work with you, walk.

* Make sure you know how to get an appointment, you have the correct number to reach your pdoc so that if a med gives you a bad reaction or you need another appointment quicker because of crisis, you can.

I hope that it goes okay.

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- When are you taking the Lamictal? Some people find it sedating, others a bit engergizing (me). Try taking it in the morning and see if your sleep improves.

As Karuna says, don't sugar coat anything, and be absolutely honest. Good luck.

a.m.

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i know i'll probably need to titrate up on the lamictal to get the full effect, and i'm worried about side effects making it hard to keep working. i wonder if i need something for sleep, and i'm worried about side effects from that. and my insurance sucks, with my copay for most meds being $30, so i don't know how many more meds i can afford. (not to mention the $25 office visit copay everytime i see a doc.)

Definately let them know that cost is an issue and if you do end up starting a new medication ask if you can start off on samples. Doctors have samples of many [though not all] medications to give to their paients.

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Thanks so much for all the replies. You guys rock. Your suggestions are helping me feel a little calmer and more confident (though I'm sure the real relief will come tomorrow afternoon, after the appointment is finally over!).

I am taking the Lamictal in the morning, around 6 am - when I get up for work - which is why I'm not totally sure if that's what's waking me up so early, or if it's vestiges of mania. Like you, a.m., I definitely find it energizing.

I appreciate Karuna's comment that "no one will give you a gold star for pretending you cope better than you actually do". This is particularly insightful, because I've done a lot of that in my life, and it hasn't been good for me. With the help of my tdoc, I'm working on it - but thanks so much for the important reminder.

And Luna, thanks for the tip about asking for samples - it's something I probably would've been too nervous to think of. (And yes, I'm jotting all this down so I don't go blank when I'm actually in the office.)

Again, thank you so much for the support and encouragement. You have no idea how much it means to me.

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Just FYI, Lamictals a bitch for samples--all they have is starter packs--and we all know how much THAT sucks!

I've played the pricing game too--I gave up my beloved Topamax for lithium because, as good as my insurance is, hey--I had no job, and $10 beats $61 any day.

At any rate I always check my med costs (i.e., $100/month for Abilify??? No way doc!) and make sure my doc knows it. We try to work my meds to fit my budget. And, well, it works out.

Oh yeah, and back to samples--if something comes up with a med, well, I try to point out that I can't afford it for the next month or somesuch (hey, there WAS a point I had no insurance for a few months) and he tends to have samples. (see: Lamictal starter packs, re: they suck ass)

I would like to know how the pdoc--pnurse for med management goes. Me, I just have the pdoc, and it's all good.

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Well, I did get the dreaded Lamictal starter pack - since it jumps from 50 mg to 100 mg, and the pnurse wanted me to try a step up to 75 mg in between (I'm already on 50), I'm supplementing the 50 mg pills with some of the 25s I still have left. Still, beats $30 for a script!

I'm getting better at letting all my docs know what I can and can't afford. I used to feel a little embarrassed about it, but then I realized, well, why should I be embarrassed that I'm poor? It's just the way it is.

Overall the appt went well. The one thing that ticked me off was, before I even filled out any forms, the receptionist took my picture. They explained why (they have so many patients and if someone calls in between appts it refreshes their memories; also, I suppose, if I go AWOL and they're afraid I'm running rampant, they have a picture to show the police, right? ;) ) BUT I thought I should've had a chance to speak to the pnurse first (I mean, what if I hated her and decided never to come back?). I did mention this and suggested they maybe leave the picture-taking until after the initial appointment.

But I liked the pnurse a lot. She took her time getting a family history and a symptom history and confirmed what my PCP thought (yep, looks like bipolar). She seemed to really listen to what I had to say. She thought the early-morning wakening might be a breakthrough sx, thus the Lamictal increase to see if it helps. So we'll see where it goes from here...

Again, thanks for the comments and support.

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I have worked in docs offices--believe me, the picture is a GREAT idea, especially if the doc employs folks like me who are really visual learners and can't remember names worth shit. Be glad they care enough to want to know who you are. And pnurses (nurse-practitioners) seriously ROCK!!! Wish I could find one here--

china, the ever-unemployed

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Hey Zen,

Just saw a new pdoc in a new country today so have lots to add. All good mind you.

As it's after midnight this side of the Atlantic, I'd best be off, but will post you directly tomorrow am with some thoughts. PM me if you like.

You're still my avatar idol!

Cheers and it will be ok.

Roosle

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Hey China, I understand the deal with the picture, was just a little taken aback. It is a good idea, but I'd rather have waited until after the appointment at least.

And Roosle - I'll be interested to hear your thoughts - and so glad you like the avatar! ;)

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The picture thing would have freaked me out a little too. I am glad you liked the pnurse though. Let us know how the increase goes. I always feel better a few weeks after my lamictal increases.

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Thanks Scatty. So far (it's been about ten days) the Lamictal increase does seem to be helping. I'm sleeping better but still waking earlier than I'd like to. The pnurse said to kind of evaluate how I felt at 75 mg, let her know, and decide whether to increase to 100 or stay at 75. At this point, I'm thinking I'm going to try the increase, and if it doesn't make any appreciable difference, I can always taper back down.

So far I do like the Lamictal. Far different, and more effective (for me), than any of the antidepressants. But I guess that's the difference that having the right diagnosis makes...

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