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Severe Emotional Situation behind the poll


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I considered whether or not to start a new topic, and decided that some people probably aren't all that interested in polls so this would be the best way for it not to get lost in the shuffle.

This is the post I am referring to. Please answer the poll if that is your wish, prior to reading the rest of this message as to get an un-biased opinion. Thanks.

http://www.crazyboar...-please-answer/

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Ok, so.. yep. Very black and white.

I've always held the belief that you can have some level of depression that is less brain-oriented that will respond pretty well to therapy. Possibly because thinking something in and of itself likely has the power to alter the way the brain works - think stronger neuropathways. I don't know how far this theory can go, but I've seen alot of talk about things in that regard.

I have also believed that, should the problem be of a particular nature or severity (and I have no idea where those boundaries lie - I don't think anyone can right now) - thought alone cannot and will not solve the problem. That's why you can't "think yourself out of depression."

As a backstory - I've been consistently depressed and mostly suicidal since middle school. Severity has fluctuated throughout the course of time between some polls that have gotten lower and lower as the years have gone on. Nothing I've tried has worked. I've tried meds much more extensively than therapy up until this point. I just started DBT therapy recently - so that is now being addressed full on.

I have had one positive response to medication. One of the very first meds I was on was Cymbalta. I've been on it more than once due to a combination of insurance running out and still being young enough and ok enough at the time that I thought I could manage without it. It worked the first time, worked the second time, pooped out during that second time, and has never shown any effect any time I've gone on it since. I've been up to 180mg. When it worked - it was 60mg.

It was like magic. No side effects whatsoever. It went from doing nothing, to working full effect on the first day of the third week from start-up. Same exact day both times. It worked better the first time because I was less depressed, but even then, the depression didn't completely go away. I now believe that it's this state that is the maximum achievement I can expect from medication alone, and that therapy could hopefully fix the rest.

I often forgot to take my medication that first time. Not, a day-to-day thing.. but an, I'm depressed and taking my meds.. I'm distracted by something and don't have the strong negative feelings to remind me that I'm on meds.. so I wouldn't take them for three days straight. On the third day exactly, I'd get really upset for no reason. I would wonder what the hell was wrong with me. Then would come the realization about the Cymbalta, I'd kick myself, and take it immediately. Without fail, I would be back to normal the next day. I can't tell you how many times this happened, but it was always the same. Eventually I got used to the concept of taking meds every day and managed not to miss any.

I went off for a bit to try and manage.. and I did until the depression shifted and got worse. Back on the Cymbalta, this time with additional meds. I didn't forget this time. Things got worse and worse until I lost my insurance and went off of everything. Cymbalta was my last med to go off of. When I did, I felt exactly the same as when it was in my system. No more three day effect. I realized that it hadn't been working at all and that it wasn't just the depression getting worse, but also lack of actual treatment.

To me, this means that my brain chemistry is fucked up. No med has ever really worked since.. and if no med ever had, I may think differently. Can't fix something by manipulation if it isn't broken. But it was fixable for a time in an extremely consistent and replicable manner. I really can't come to any other conclusion.

Now to the poll:

I went to a poc yesterday for an initial appointment. Those statements were what I was told.

That since all the meds I've tried hadn't worked, my brain cannot be fixed. MAOI's are old, outdated, not really prescribed much, and not worth the time. He simply shrugged and didn't comment when I mentioned ECT. He thinks I'm screwed and that the best I can hope for is enough therapy to avoid killing myself. No actual improvement in the depression.

He gave me a script for 30mg Cymbalta and Perphemazine 4mg. Then said that he didn't think it would do anything at all, but I could take it if I wanted. Hmm.. half of a normal Cymbalta dose that has the strongest track record of not working compared to everything I've been on as I've been on it like 5 times without response.. along with an AP that, if it has *any* anti-depressive effects at all, can only perhaps be as good as any AAP - which cause muscle problems for me, even though they are less prone to do so than the AP's. I may be having cognitive difficulties - but I'm not *that* bad.

I've also had two therapists tell me that in order for therapy to really work, a certain base level of functioning is required. Being suicidal does not meet that qualification.

I'm trying to get input on this from my current therapist and her office at school today. I also called the emergency number of one of my initial pdocs and spoke to him directly - he's willing to try to treat me and was very pissed off about what that man told me.

Ultimately.. I don't know what to believe. I made a decision to choose all forms of treatment over suicide. At first, that decision came with another one, that if nothing worked, I would kill myself.. couldn't live like that. Very recently I decided to reconsider that concept. Perhaps I could be miserable for the rest of my life without hope? I figured that I had time to properly re-assess and finalize my position. Now that time just got thrown out the window.

I hope he's wrong. I hope it can be fixed. But, just because the good pdoc is willing to fight for me, doesn't preclude that that ass could in fact be accurate & that the reality is, the good pdoc is just as stubborn and hard-headed as I am with insisting that something *must* be possible.. in spite of all evidence to the contrary.

I don't want my life to be over - but I fear it may be.

(Just to be clear, so you don't worry.. I'm not under any circumstances going to act rashly on this. I think things through and look at options. I'm still in that process. So no hospital talk, ok? I want proof that he is wrong. But - ultimately - I want the best truth that can be arrived at. That is the point of this post. ...well, that and to cry and talk to people who can understand.)

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I too think you pdoc is an irrasponsible (sp?) ass who doesn't sound terribly competent with the script for an AP w/o AD properties, not to mention saying it would help. Why the hell would you prescribe it?

See your other pdoc. MAOIs work for some. ECT works for a lot of people. And, you probably have other meds to work in different combos and retrials, especially since your pdoc sounds like an idiot who may not have gotten it right.

I still think your poll will not get you meaningful info on which to base any decisions or to form your own thoughts upon. It is toooo black and white. Sorry, but I find the idea that it might be used in those ways a bit scary.

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And, you probably have other meds to work in different combos and retrials, especially since your pdoc sounds like an idiot who may not have gotten it right.

Well, to be clear, this was a new guy and his first med decision with me. My prior combos have been though.. um.. 5 pdocs total. All of whom tried and ultimately ran out of ideas. I've entertained odd combos in the past.. but the vast majority I found no fault with. And then threw in anything off-label that had any support at all once all the norms had been tried. But, hell, if someone can look at it and find some sort of gap - I'm all for it. I just think at this point.. it's really not there to be found when dealing with current availabilities.

I still think your poll will not get you meaningful info on which to base any decisions or to form your own thoughts upon. It is toooo black and white. Sorry, but I find the idea that it might be used in those ways a bit scary.

I gotta run out of the house, so I can't give this the thought it deserves.. but,

1. I'm weighting it accordingly

2. I'm open to suggestions for improvement

3. I'd like to hear further elaboration on it's negative aspects

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Your post made me think of my Dad. He was diagnosed with stage 4 melanoma, which means the cancer has metastasized to other tissues and organs. He went to the head of the oncology department, who told my dad nothing could be done, he had max 6 months left to live, and he needed to get his affairs in order. My dad saw another oncologist who believed in my dad's case and came up with a treatment plan. My dad chose to believe the 2nd doctor and to disbelieve the 1st. He followed the treatment plan of the 2nd doctor and after completing that and years of surveillance and scans, he has now been declared cancer-free. If he had believed the 1st doctor, who was the head of oncology at the hospital, my dad would be dead. Sometimes doctors are WAY WRONG.

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I've had one pdoc whom I saw once and that was it because he was an ass. I mean really. He actually started comparing me to Woody Allen movies (which I had not seen) and didn't even give me a prescription for anything. I wasted a lot of money on him for nothing and only to end up feeling worse. While it was painful and shocking at the time, I decided to not pay him any mind and to find a pdoc with whom I could work. So I just want you to know that there are horrible pdocs out there. Also, I've had several pdocs who swear by MAOI's. MAOI's are old, but they do seem to work for some people.

I've been reading over the list of ex-rx meds in your signature. I am just like you in that no meds works well for me. A few years ago, I had success with a combo of carbamazepine, citalopram, mirtazapine, clonazepam and risperidone. I'm now working to get back to that combo in the hopes that it will work for me again. I'm not saying that this combo will work for you, I'm just saying that sometimes it takes a while to find a combo that works because there are many, many more possible combinations than single meds out there.

Don't give up hope.

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That since all the meds I've tried hadn't worked, my brain cannot be fixed. MAOI's are old, outdated, not really prescribed much, and not worth the time. He simply shrugged and didn't comment when I mentioned ECT. He thinks I'm screwed and that the best I can hope for is enough therapy to avoid killing myself. No actual improvement in the depression.

I can't tell you whether your brain can be fixed or not. But I think this new pdoc is really wrong here. MAOIs are old and not prescribed much because they're kind of onerous, but I know of people who improved on them when other meds didn't work. ECT can also be remarkably effective. There's no guarantee they would work, but they are definitely things that are worth trying. He absolutely cannot predict whether you would or would not experience benefits from these treatments.

(There are also other medical treatments that may become an option later on, TMS, deep-brain stimulation etc. Invasive procedures and definitely not for everyone with depression, but potentially worth it for chronic, severe depressions.)

I would not continue seeing this new pdoc. He sounds like an ass. What is the use of paying to see a pdoc who has already decided there's nothing he can do for you?

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Thanks. Yeah, I'm trying.

I definitely will not be going back to that man. I actually didn't end up even paying for it. I went to check out and there was an odd set-up, so I asked where I was supposed to go. She pointed through the middle of the office at a desk in the corner and told me to go there to make an appointment. So I did (extra time to decide what to do and less awkwardness to just call and cancel later).. was told to have a good day and see you next time, so I simply walked out. Screw that. I spent the money on groceries instead.

I went to see a school tdoc yesterday.. as a walk in before class. I actually got the one Jenn sees, so I already knew him. He's a good guy. Really hard to get a read on what he felt about the whole thing other than that I'm doing really well considering, and that I'm making the right decisions. It was nice to talk to him about it.. but it didn't really help. We did have a laugh about having a note in my file from intake that I'd take anyone but him as my tdoc. He said it took him a second to realize the Jenn connection and go from "oh, crap" to "good call." I have my next appointment with my tdoc on Monday.

But I got through my two classes that I had, and I'm off today. I got new patient paperwork for the pdoc appt I'm trying to make done and faxed while at the school's counseling center. Their office gave me a call during class that I have to return today - as they were closed when I got out. They didn't leave any details in their message - so of course I'm freaking out that there's some problem that's come up.. when in reality that's probably not it. But I'm dragging my feet out of fear. I really don't want to hear any bad news.

I'm really at my limit as to what I can handle.

Edit: Update - called and couldn't get in touch with anyone. Left the office a voicemail, but they didn't call back. They just closed, so I left the pdoc himself a message asking to let me know what else I need to do whenever he gets the chance.

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He ended up getting back to me and I made an appointment for Monday afternoon. ...which happens to interfere with my tdoc appointment. Go me. Didn't realize that until I got off the phone with him. I called the tdoc's office and left a message about changing my appointment time.

He said that he didn't know what the phone call was about, but that he assumed it was to schedule something. I have no idea what, if anything, he's going to be able to work out payment-wise. Right now I really don't care if I have to pay the $150. It could be marked as a consult and be free however. I'll just have to see.

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I went to a poc yesterday for an initial appointment. Those statements were what I was told.

That since all the meds I've tried hadn't worked, my brain cannot be fixed. MAOI's are old, outdated, not really prescribed much, and not worth the time. He simply shrugged and didn't comment when I mentioned ECT. He thinks I'm screwed and that the best I can hope for is enough therapy to avoid killing myself. No actual improvement in the depression.

That utter sonofabitch. Not only should you never see him again, you should file a complaint with his supervisor. Nobody gets a free pass for bedside manner that sucks that comprehensively, or for wasting your time and money and making you feel worse than you did before you saw him!

I know several people, my mother included, who take MAOI's. If they work for you, they work for you. I think sometimes doctors don't want to prescribe them because they're a nuisance for the doctors to monitor.

I've also had two therapists tell me that in order for therapy to really work, a certain base level of functioning is required. Being suicidal does not meet that qualification.

This is, again, half true. After two years of therapy with my tdoc, he mentioned casually to me one day that he thought I was now stable enough for real therapy to begin. I was pretty surprised, because I thought we'd been doing therapy all along. Certainly I had been deriving benefit from our time together, and I had been suicidal for most of it. We had a talk about it years later. I sent him a card thanking him for "spending all that time talking to the part of me that was willing to live." And it really rocked his world, because it made him understand that while we might not have been engaging it classic DBT or schema therapy or whatnot, he had been an undeniable part of why I was still alive. I learned enough just from gauging his reactions to things I told him and from asking him questions to lay the groundwork for what he thought of as "real" therapy, and also to start changing my behaviors and how I looked at the world. It also helped just to have somewhere to go where I didn't have to pretend not to be feeling what I was feeling.

I am so pissed off on your behalf right now that I feel like I'm being incoherent.

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The supervisor will find out. I was referred to that office by an old pdoc who was very good and I respected. He no longer takes Medicare. I made an appointment based on that recommendation and of course, that ended up resulting in the the visit you heard about. Afterwards, I called the original pdoc, and he was upset about the situation. I didn't have the name for him during the call - it's an odd name. But I will be giving it to him when I see him - as he offered an appointment to me. Even though I didn't end up seeing the recommended person, the pdoc I did see consulted with one who was recommended prior to offering his recommendation. I really don't care much about getting the ass in trouble..he'll actually probably be supported by his supervisor, but, I know my old pdoc will want to know the name.. and I'm going to tell him. I don't feel like protecting him any more than I feel like punishing him.

I really don't think anything will come of it.. and I just want to be helped.

However. I appreciate your feelings and anger. I don't really do the anger thing - it's an issue of mine. I'm glad that I'm not overreacting in having a problem with what happened. It does make me feel that perhaps, I was taken advantage of a little in a situation where I desperately needed help and found only despair.

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Cetkat, I'm sorry you're going through all this, and glad you're going to see a different pdoc.

I too was originally dx'ed with MDD and dysthymia, and riding the med-go-round for 10 years with some relief from Wellbutrin, but a couple of depressive episodes during that time that nearly killed me. My current pdoc (I move a lot for work so change every few years) concluded that I actually probably have BP II, and started me on Lamictal. The Lamictal / Wellbutrin combo has made an incredible difference in my life. I feel like I've gotten my old good me back.

SSRIs were terrible for me and turned me into a complete zombie. I'm not saying the Lamictal / Wellbutrin combo will work for you, but if you haven't tried it yet, it may be worth it. Good luck to you.

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Cetkat, I'm sorry for you, and for me, that I do understand.

I put some of my thoughts as an answer to the poll post.

Here, I'll say your approach to a nasty and intractable situation seems perfectly sane and reasonable, and also that the doctor who considered you a "write-off" sounds completely ridiculous from my experience (appreciable) of doctors in this field.

I'm hanging this on my approach, which as its most basic is "Is there anything we haven't tried?"

After suicide you don't get to try anything else so it has, for me, to be a very real but very last option.

MOAI's aren't outdated in the sense that they are no longer effective, like antibiotics that bacteria are now resistant to.

They simply come with more restrictions and potential side effects and restrictions...

That they are old-fashioned is irrelevant.

Hell, if leeches worked (and they do for a few things, but not depression AFAIK) I'd get some of them.

And there is still ECT. Works for some...

And I'd say talking therapy is not necessarily impossible, either.. It's not as though you were utterly withdrawn and uncommunicative, beyond any sort of engagement.

A good chunk of scepticism and even cynicism, quite possibly...

But if we were nice, happy well-adjusted bouncy fluffy bunnies, therapists would be out of work.

What do they expect they will be working with? An unending successions of Tiggers just needing their bounce marginally re-directed? <<snort>>

Are you getting enough hugs? (assuming you like hugs: not a universal)

It's a shame those aren't available on prescription.

They can have an anti-depressant effect.

Chris.

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That doctor is an ass, and professionally incompetent if he says MAOIs don't work. They require a lot of food restrictions, but they work! The reason pdocs moved away from them was because other ADs were easier for the patients, because there isn't the food restriction issue, so people tended to be more compliant.

Seriously, he is a bad pdoc.

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Well, Lamictal and Abilify were most effective after the Cymbalta. I actually got the best result from a Cymbalta/Lithium combo.. but once the Cymbalta stopped working, the Lithium lost its effect as well. Wellbutrin was the first med I was ever on. I took that as a teen before the depression really got bad and I started treatment in earnest. I remember feeling more rested for awhile, but that wore off. I never noticed any changes in mood. I just got off of a maxed out combo of Lamictal and Abilify plus alot of other things that were added to try and boost those two (and things overall). In all honestly, it never even came close to really working. It did help - but not enough. Still had suicidal ideations bad enough that I finally got the message that it was time to move on.

I've never mixed Lamictal and Wellbutrin, but now that I'm on Strattera.. Wellbutrin isn't a good idea. It's a bad mix. I was having some strange blackout-type issues that seemed to be due to a lack of concentration. When I added Strattera, those stopped entirely. I wouldn't want to go off of that med even with an MAOI.

I know that MAOI's can be more effective than the rest. They tend to work rather well usually, and that pdoc's reasoning was idiotic. But I've always had serious doubts that their effectiveness would be *so* much greater as to actually produce a response. It was being told that that reasoning was probably right (along with that there are no other alternatives) that really got to me. The anti-MAOI talk just sounds like a bias, whereas the later makes sense. I mean.. it's worth the try. I just can't shake the thoughts of what to do when/if it doesn't.

As for hugs.. I'm the odd one out here in that I actually like them. *shrug*

But to answer your question, no.. I'm not. Actually I'm feeling pretty isolated and alone right now. There's not a whole lot of support.

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i can only repeat that this doc is an ASS.

I've also had two therapists tell me that in order for therapy to really work, a certain base level of functioning is required. Being suicidal does not meet that qualification.

this is so very true.

i have been where you are, and sorta still am, and i'm sorry you're in this position. there is so much hope for you, even if this doc is too stupid to see it. i don't know what else to say that would make this easier or make you feel better, except that you have some really good insight and you deserve a doctor who appreciates that.

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[MAOI's] I mean.. it's worth the try. I just can't shake the thoughts of what to do when/if it doesn't.

As for hugs.. I'm the odd one out here in that I actually like them. *shrug*

But to answer your question, no.. I'm not. Actually I'm feeling pretty isolated and alone right now. There's not a whole lot of support.

On the first, again, I regret that I fully understand you.

I do visual thinking to a fair degree, and borrow imagery and ideas from all over the place.

In this case I twisted and idea from the original Star Trek, with Kirk admitting that the human race are killers...

"We can admit that we're killers ... but we're not going to kill today. "

Yes, I'm suicidal, but I'm not going to commit suicide today.

I can always commit suicide... tomorrow.

Meanwhile I have things to try, to struggle with...

No, it's not a light suddenly switching on, or even a mental magic pill.

But, for me, admitting that I keep suicide as an option took some of the pressure off worrying about having it as an option,

I didn't have to guard against it or wrestle with it every moment.

(But that it worked for me does not mean I hold it to be good for all. We vary.)

And as for hugs, if I had the funds I'd fly the Atlantic to hug you.

Just on the basis of "someone who needs hugs"... no need to panic.

No-one acceptable, closer, who understands "just a hug"?

(Admittedly I don't have either, currently.)

Chris.

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Yes, I'm suicidal, but I'm not going to commit suicide today.

I can always commit suicide... tomorrow.

Meanwhile I have things to try, to struggle with...

But, for me, admitting that I keep suicide as an option took some of the pressure off worrying about having it as an option,

I didn't have to guard against it or wrestle with it every moment.

Yeah, I get putting it off. For me, it's always been an option.. just one I didn't want to end up at.

I don't know.. I suppose I just like rules. Deciding "when" it can be an option does in fact make it "not" an option elsewhere, and as such, it's a non-issue. The rule has been, when treatment options run out.. up until recently, that was pretty set.

Then all of this stuff happens.

Not only do I feel like I need to sort out if I'm still applying that rule, but if the rule now applies.

That's alot to figure out.. and I'm struggling with it.

To make matters worse, there's an old billing insurance issue that came up with the old pdoc that I was unaware of, and I haven't been able to see him. I'm trying to sort it out, but I don't know if I can. The thought of having to just keep going through this process of looking and not finding any help is bothering me. Alot. I really don't need any more doctors taking one look at my med list and declaring me hopeless or even just too difficult to treat.

i have been where you are, and sorta still am, and i'm sorry you're in this position. there is so much hope for you, even if this doc is too stupid to see it. i don't know what else to say that would make this easier or make you feel better, except that you have some really good insight and you deserve a doctor who appreciates that.

Thanks. I wish it were easier to find that doctor. I didn't realize that it would be this hard. It's like I'm worse off than I thought.

And as for hugs, if I had the funds I'd fly the Atlantic to hug you.

Just on the basis of "someone who needs hugs"... no need to panic.

No-one acceptable, closer, who understands "just a hug"?

(Admittedly I don't have either, currently.)

Heh, thanks for the sentiment.

Unfortunately all the moving I've done in the past cut alot of ties.. even though it was back and forth. The close friends I do have are either in another city or dealing with their own stuff. I'm pretty much on my own.

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  • 2 weeks later...

Well, update time.

Still haven't gotten to speak to the pdoc I was going to see but found out that I owed money to. I waited for him to call, then when he didn't.. I decided to put it off. Taking a step back from actively working on the situation make things a bit easier and stable. Nothing lasting of course, but purposefully not thinking/feeling your emotions at times can be beneficial.

I decided that I'd be better off focusing on the paper that needed to be written for school. It was a huge part of my grade & I was rightly concerned that continuing to work on the pdoc issue would interfere with getting that done. It was the right decision.

The paper was harder than I expected. The inability to concentrate came back on a pretty severe level. I spent more time *trying* to write the paper and freaking out that I couldn't than I did actually *writing* it. Ultimately, I'm pleasantly surprised how it came out.. and the teacher (having a distant role in my therapy - she's half teacher/half therapist at school) had already said that if I messed it up royally, I may be able to do extra work to compensate because she knows that I've been having difficulties. Also, considering the general knowledge level in the class, I think my poor paper will fare pretty well comparatively. She's not looking for something as advanced as what I wanted to write.. at least I believe that's the general case.

Anyway, I decided to call the pdoc again today after they'd closed. I got the voicemail and left a message that ended up being pretty much exactly what I wanted to say. (I hate voicemail). I got cut off at the end, but I only left out the whole.. thanks, I look forward to hearing from you type of ending. So I just sent it and didn't worry about it. I expect to hear back from him sometime this weekend. I told him that if he decided not to allow me back, then he needed to give me a reference he was pretty sure would actually take me - having a difficult case and all. I even said that he may need to actually call them to confirm that they're up to it. (But I did this in just the right way, so it didn't sound bad.)

I don't know what's going to happen. I do know that if he does say no, my mood is going to tank. Rationally, however, I'm thinking that I'd take another break in that case and focus on the exam I have on Thrus, along with a tdoc appt on Wed. I honestly have no idea how well *that's* going to work.. but considering I have that test this coming week, and another one the week after... simply waiting for all of that to pass isn't a great idea. My mood would probably sink anyway from the frustration and waiting without doing anything about it type of thing.

I also got permission from my gdoc to re-start my Mirapex med. It's a dopamine re-uptake inhibitor. I have no idea if it'll do shit at all.. but I know that it won't hurt, and that I don't have to worry about taking an MAOI right after - there's no waiting period. I could probably even take them together if I wanted to. However that can cause issues if the dopamine level gets too high. No way to know where the level is.. so it's not exactly a good idea to just "find out."

(My old pdoc was at a clinic, and was unable to rx the Mirapex due to it being off-label.. so I did a gdoc workaround. That's how I was able to re-start it without going through a pdoc - just FYI)

So, yeah. Basically I'm in a "hanging in there" state of mind that sinks here and there. Not something I can really sustain.. but temporarily.. I think I can deal. I think.

I guess I'm just forcing myself to just "not go there" in my mind. It can work temporarily.

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I just wanted to say you've got us to talk to Cetkat, we're here for you, so just know you might be physically alone in this, as we all really are, but you've got a lot of people here who care. Just keep on keeping on, that's the best we can do sometimes....

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