So for seventeen years I've had pain depression. It especially feels like it's squeezing my heart. It hasn't historically been *about* anything. I've just chalked it up to biochemistry, heredity. And I've thought about suicide, most days, for at least fifteen years - because pain sucks. Ups-and-downs. Roller-coasters. Probably every person on here has done time at the worst torture theme park in the world.
Two years ago, my cocktail started working. There was some CBT and DBT in the mix too. I decreased my daily Ativan from 3mg to 2mg. Plus 20mg Latuda, 300mg Sertraline, 100mg Topamax. I actually felt happy, for about two years, until this October. Then it stopped working. And I stopped working. I work in a level I trauma center, where I identify cancer, anemia, and the effects of the coronavirus on the human body. I feel like I have a front row seat to human suffering, without being empowered to ameliorate it, and it's another kind of torture.
I am very tired of fighting. If there was a euthanasia travel agency, where I could just walk in, plan my funeral and end-of-life arrangements, plan my ideal death, and just call this thing at 38, that would be a somewhat attractive option (not telling, The Tallest Man on Earth, flaming-Viking-burial-at-sea.) I'm tired of fighting this disease, personally. And I'm tired of coming up against the tsunami of "world suck" (H/T Vlog Brothers) which seems to be hate-fucking itself ad astra.
So the strain theory, which I haven't read much on yet, is that we consider the termination of our lives when under one or more types of strain. I personally find this theory hopeful, as targeting the sources of strain, i.e. "world stuck," could reduce the inducements to terminate one's life. The General Strain Theory, according to one Wik I. Pedia cites loss of positive stimuli, addition of negative stimuli, or the inability to reach a desired goal, as three possible sources of strain. I will follow up on this with my tdoc on Wednesday. I think work is introducing negative stimuli, and I have a shit ton of unreached goals, but am starting to care about goals less and less. Basically, it pisses me off that I've had to dramatically reduce my goals due to my diseases, and it's kind of tempting to just leave the party. Please feel free to weigh in if you have personal and or academic experience with this.
I'm also meeting virtually with my pdoc tomorrow... to tweak the cocktail. Would love recommendations. My current rx mix, dxs and rx, failures are in my signature. Lamictal induces hives and vomiting. Depakote causes dyskinesia. Lithium ruined the thyroid and causes acute renal failure. Medicine. Ha ha. Organ roulette.
So the observation about different species of depression is that while for a decade-and-a-half I experienced what seemed like purely biochemical, chains-around-my-heart, tar-and-shark-filled, basements-beneath-basements depression. This feels more like a rational(?) depression, which has me concerned about whether it will be responsive to biochemical therapy.
I'm trying to figure out how to address my nervous tics lately. They've been persistent this past year and are always changing. From eye blinking, to head shaking, to sticking my elbow in my sides, squeaking, to a eye closed swallow things. I can't remember them all.
I don't always have them. If I've properly slept and aren't stressed/anxious they don't exist at all. As I'm typing this I keep needing to pick up my thumbs and bend them till I hear something crack.
I don't know where to put this though!
This has become the central topic of my latest ruminations...I'm still in my 40's, but I'm worrying a lot about getting older. I'm having some random health issues (aches/pains, chronic fatigue etc) that I never had before.
I don't have any children and get triggered every time I see photos of other people's kids (literally everyone I know my age has kids now). I know that it's not a given that all families are happy or one's kids will take care of you in old age, but it's just the thought of having a family around! My parents are approaching late 70's and they live very far away, cannot travel. I have no other close family (or even close friends) that I can really depend on.
Anyone know how to remedy these anxious thoughts? One of my biggest fears is being alone in old age, with increased health issues, and being totally isolated/alone in despair. I'd rather die young.
Why does Mirtazapine cause Restless Legs Syndrome? Mirtazapine is known to often provoke restless legs syndrome (RLS). Mirtazapine has an approximate 30% chance of inducing it; by comparison, paroxetine, sertraline, and other psychiatric medications only have an approximate 5% chance of causing RLS symptoms.
Why is Mirtazapine prone to causing RLS?
It's very interesting, especially that high percentage. No one seems to know why. They say that it might be due to its strong antihistamine properties. Some experts have proposed that it is due to its 5HT2 antagonist properties. But then other strong antihistamines and 5HT2 antagonists should also be prone to cause RLS, e.g. Amitriptyline, Nortriptyline, Doxepine etc., but they don't seem to cause it as frequently as Mirtazapine. One could argue that it is due to anticholinergic properties, which might have a counterbalancing effect.
Some say that it may be Mirtazapine's pro-noradrenergic properties, but shouldn't we see it with other NRIs and pro-noradrenergic drugs? Many questions, no definitive answers...
So, I was extremely depressed in January after tapering off all my meds on my own (stupid). My doctor put me back on Wellbutrin, and we decided to try Prozac as an SSRI. The Prozac wasn't kicking in and I learned about the GeneSight genetic test for antidepressants. I asked for and had the task done. They never sent me a copy of the results.
After a month on the Prozac and no help, I also asked to go up from 300mg Wellbutrin XL to 450mg, and that seemed to help. I had an appointment mid-April and was mostly feeling better. He decided to keep me where I was at. I forgot to ask about the GeneSight results.
I generally feel good during the week but am miserable on the weekends. I generally lay in bed all day feeling depressed, binge eat, try and sleep as much as possible. I don't know if this is something that can be fixed with medication or if it is purely behavioral. My therapist suggests making plans for the weekend ahead of time and trying to make my weekends structured.
I finally got around to sending the doc a message on the patient portal asking about the GeneSight results. He responded that the report showed all my meds were good for me except Prozac. The test recommends Lexapro or Zoloft instead. He did not say anything about changing the Prozac.
For three days I have been trying to make an appointment to see the doctor. If I call I'm on hold for 10 minutes before leaving a message. I've also tried requesting an appointment with the patient portal. Nothing. So, I'm thinking about just messaging the doc (since I know he responds) and mention the problems I'm having on the weekends as well as concerns I have about staying on Prozac. I want to know if I should switch, or if I should just stay where I'm at since I'm basically doing good except no motivation and very depressed on the weekends.
What do you all think I should do? Ask the doctor online about switching, keep trying to make an appointment, or just try and add structure to the weekends and see if I can get by without a med change?
Current meds (all generic):
Wellburtrin XL: 450mg
hydroxyzine: 25mg 3x daily P.R.N.