Saturday, October 17, 2015

Saw My Psychiatrist a Couple Days Ago

I saw my psychiatrist a couple days ago.  I called and was able to get in sooner than scheduled, which was fortunate because I'd been feeling pretty bad.

The appointment went all right.  He recommended increasing my Cymbalta.  I'd been on 90 mg and it was my understanding that 90 mg is the highest dose studies have found to be effective.  While  higher doses are safe, studies haven't found them to be beneficial.  So I had though increasing it wouldn't help.  However, what I wasn't thinking of is that sometimes higher doses might be helpful for someone, even if statistically studies haven't found that to be the case usually. 

I was on a very high dose of Effexor for several years, 450 mg, when most people are on 300 mg or less of that.  And it caused me to develop super high blood pressure, but it did help my depression, when a lower dose hadn't.

While I'm not sure a higher dose of Cymbalta will help, it does seem reasonable to try that before switching to a new antidepressant.  Plus it might help my pain, too.  I mean, Cymbalta does help my pain, that's one reason I am hesitant to switch to a different antidepressant.  I just mean maybe the higher dose might help even more.  I was worried that changing to a different med would cause a significant increase in pain.

He also prescribed Trazadone for sleep, which I've been on before.  Trazadone is actually an antidepressant, but for it to help much with depression, you need a big dose.  But it's very sedating, so it's seldom used for that purpose these days.  We have better antidepressants now that have fewer side effects.  But it's often used for sleep in smaller doses because it is so sedating.

Well, when I took it before, it seemed like if I was on a high enough dose to make me sleep, it made me really groggy and hung over the next day, which I did not like.  But at this point I'm willing to try it.  He prescribed 100 mg but I plan to start with 25 mg (I will chop the pill into quarters) and increase it after a few days.  I am desperate enough for some relief that I'm willing to deal with some grogginess in the morning if I have to, but I want to minimize the side effects as much as I can.

My psychiatrist also recommended I find a therapist for CBT, or cognitive behavioral therapy.  I've done CBT before and I know it works for most people but I really did not find it helpful.  If I wanted to do therapy, that's not what I would want to do.  But I don't really want to do therapy.  I reminded him I have not been in therapy for almost three years, not since my horrible experience at the ER and in the psych ward.  I pointed out that I don't trust mental health care providers anymore.

He sort of laughed at that.  I sort of laughed, too.  I was like, "I don't really trust you very much, either."  I trust him enough to see him, but if I didn't have to see him in order to get my meds, I wouldn't.  But my PCP won't prescribe my psych meds.  And I wouldn't feel very comfortable having my PCP adjust my psych meds, either.  I believe my psychiatrist is more knowledgeable and better able to do that safely and well.  But that doesn't mean I trust him a whole lot.

He tried to talk me into CBT.  I don't think he understood what I was saying about it not being helpful for me.

I did think about it afterward.  I did a little DBT, or dialectical behavioral therapy, when I was in the hospital up in Michigan many years ago, the hospital that specializes in treating PTSD and trauma-related disorders.  I'd be willing to consider doing that again, if I could find someone that does it nearby.  It's often done in a group therapy setting and I might feel safer in that setting than one-on-one.  But I have no intention of doing CBT.

* The hospital I was at in Michigan is Forest View Hospital in Grand Rapids.  I highly recommend it for anyone needing inpatient care for PTSD or DID.

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