The Medication Merry-Go-Round

I haven’t napped during the day since lowering my current anti-depressant. My mom seemed to think it made me tired, but I never noticed a correlation. I’ve been on it for 2.5 years. I guess she never said anything because it lifted the last suicidal depression and she figured napping 1 – 3 hours a day was better than suicidal ideation. However, if she was right, she could’ve mentioned it and suggested taking it at night. I think the blog helps me not nap. Usually I have something to vent about regarding my day and I do that as soon as I get home. By the time I’m done writing, it is less than an hour until my mom gets home. So it seems pointless to nap. Nonetheless, I’m done with my current medication tomorrow. Then I start Prozac. Unfortunately, that takes at least 2 – 3 weeks to kick in. So, I’m relying on my mood stabilizer and stimulant to pick up the slack.

I’ve been on the mood stabilizer since my last suicide attempt. No one before, or since, the inpatient psychiatrist agreed with his diagnosis of Bipolar Type 2, but it seems to help. I’ve been on my current stimulant since law school. In college I tried a different one and in middle school I was an a non-stimulant ADHD medication. However, after my first suicide attempt, they took me off of it because they blamed my suicide attempt on it.

Although I really want to try an MAOI because they are efficacious for atypical depression, my psychiatrist insists on trying Prozac again. He says, in some people, their brains adjust to the medication and it suddenly stops working. I think the stress from my eating disorder and especially not getting the promotion contributed to the depression relapse. I don’t think it was purely a medication issue. Part of atypical depression is that it is cognitively mediated. In other words, the thoughts in my head about external events contribute to my depression. In normal depression, people’s moods remain sad regardless of what is happening around them. I have mood reactivity,  I can feel happy  if good things occur. Malnutrition also causes depression. Therefore, I believe the eating disorder and work stress combined to cause the relapse. Last week, the Conversation caused me to spiral. I read some interesting articles about atypical depression. Part of how psychologists know it is a distinct illness from melancholic depression is that it responds differently to medication. It is less susceptible to SSRIs and SSNRIs. However, it is more susceptible to MAOIs. In my research, I found various studies that support a specific MAOI’s, Phenelzine, efficacy for Bulimia. Prozac is the only medication FDA approved to treat Bulimia, but I’ve been on Prozac a few times and it doesn’t seem to change my impulse control or bulimic symptoms. Therefore, I’m curious about Phenelzine for bulimia and depression. My psychiatrist is against MAOIs because they have potentially fatal interactions with certain foods. However, recently the FDA said those fears might be overstated. Plus, my uncle, a psychiatrist, says they now have skin patches, which are less likely to cause that problem.

I am somewhat hopeful about the Prozac, even though I’d rather try Phenelzine, Ketamine, or NSI-189 because I’ve been on all current classes of anti-depressants other than MAOIs. I remain somewhat hopeful because Prozac was the first anti-depressant I tried and I distinctly remembering catching myself whistling as I left gym class. Also, despite not remembering any effect on my Bulimia in the past, maybe it will help this time. In addition, my psychiatrist says Prozac is helpful increasing energy.

I was curious about Ketamine and NSI-189 have novel anti-depressant mechanisms of action. That is, they work differently than any FDA approved anti-depressant. They are both experimental. The first study I attempted to join was for NSI-189 and the second was for Ketamine. Wellbutrin is one FDA approved medication with a distinct mechanism of action. However, my psychiatrist will never approve it because it lowers the seizure threshold and I had seizures as a kid. Moreover, Bulimia can cause seizures. In fact, specifically bulimics on Wellbutrin had a higher incidence of seizures.

Other Studies of Phenelzine in Bulimia:

Treatment of bulimia with phenelzine. A double-blind, placebo-controlled study.

A double-blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives.

A double-blind trial of phenelzine in bulimia.

Sadly, much of the MAOI research is old because they fell out of favor once SSRIs and SSNRIs came on the market.

 

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The Boss and the Behavior Analyst

I woke up in an okay mood. In other words, I didn’t feel like crying as soon as I woke up.

Buffy_I don't want to die that is something right

Ginny said some curious things last night. She said she appreciates me. She knows I was  only trying to help when I filled out the data and I care immensely. I already told you, but she also said she still wanted to hear my ideas because my ideas are good.  She said she still wants to know about the discrepancies I notice behavior plan implementation because then she can conspicuously watch and “notice”. Moreover, my boss didn’t want to talk to me because I was the hardest working and most dependable behavior assistant.

The best part was she said, once I start my course, she wants me to help fix the interobserver agreement problems! Interobserver agreement is the degree to which two or more observers report the same data on the same event. Plus, she is aware that I am the only one correctly implementing behavior plans. I asked her how she knew and she said she listens without looking. People tend to do the right thing when they know she is watching, which is frustrating because that means they know what they’re supposed to be doing. Another way she knows is because when she asks about behavior plans, I always have the right answer, even more often than my boss!

This is difficult to believe since the new assistant behavior analyst arrived, but she said she asks my opinions on behavioral interventions vastly more often than she asks anyone else. It got through to me. 🙂 She thinks I have value at work and even though she isn’t directly above me in the hierarchy, she is the head behaviorist and I care most about the behavioral piece of my job. Therefore, her opinion matters the most. Of course, my boss is my boss and her opinion matters too, but Ginny knows the most about behavior interventions.

I signed up for the first course I need to become a Board Certified Behavior Analyst (that is Ginny’s job). I’m afraid of going back to school. I think taking that official step increased my depression. I originally started blogging as a coping mechanism in law school. This blog is new (as of July) because I didn’t remember the password to my old blog. Eventually I figured it out, but I already had followers here. So, I just imported the old content from that blog to this one. Anyway, I relapsed into suicidal depression, even worse than now, in law school. I took a medical leave of absence and never went back. It left a back taste in my mouth. I’m afraid the pressure of school will be too much. Ginny bets I could pass the boards now. Lol, too bad they require the courses and official observation hours, even though I bet I meet the hours already. Unfortunately, they only start counting hours after you begin the first course.

I showed another friend my blog. She said I need inpatient treatment and sent me a link to a treatment program.

My mom will be out tonight. That usually leads to behaviors because I can “get away” with it. I can binge/ purge without worrying she’ll get home while I’m purging. Been there. Done that. I can cut without worrying she’ll walk in before I clean up.

Clearly, it isn't Monday

dean supernatural laughs then gets serious

Oops. As usual…failure on my part.

I’m actually feeling up to writing a little bit, yay! There are some long stories involved, but for now, I’m just going to run down the litany of changes in my life over the past 2-ish months.

1. Took a medical leave from law school because passing was impossible with how far behind I was and I really don’t know what I want to do…

2. Looking for a full-time psychology job to try to determine if that is what I want to pursue. Since I only have a Bachelor’s degree, my job options are limited to Mental Health Technician (glorified baby-sitter) or entry level research tech. I’ve applied for about 10 of those positions around town. I’ve had 2 interviews, but no job offers.

3. I broke up with the Doc. Honestly, of all the people I’ve dated or even had a crush on, I liked him the best. I clicked with him on a different level. I’m not sure how to describe it. I broke it off because he couldn’t accept my limits. For example, he didn’t want to use safe words.

4. I’ve had lots of suicidal ideation and I’m still struggling with basic things on most days, but despite threats, no hospital yet.

5. My family is disappointed and angry because I’m ruining my life, I want to fail, I can do so much better, I’m just a personality-disordered mess, etc.

6. I’m still giving dating a shot. Since breaking it off with the Doc, I’ve had 2 dates. I skipped one (with a plausible lie because I was freaking out too much). They were with different men. The one I didn’t skip was fine. (Given #4, I find even 1 date is miraculous)

7. I’m making a concerted effort to rekindle friendships and familial relationships that I’ve damaged through isolating

8. I told my mom about IT and… her reaction was surprising and I wish I hadn’t told her. She wasn’t angry and she didn’t blame me, but she won’t let it go.

 

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Awful Morning

I’m not really sure what is wrong, but my self-talk is atrocious. “I hate you” “You suck” “You’re evil” “You’re pathetic” “You deserve to die” “You should quit law school because you’re hopeless.” “You’re worthless” “You’re stupid” “You’re lazy” “No one will ever love you.” “No one likes you”

Supernatural_Dean_i am crap

That is my usual self-talk, but it is more frequent or louder. I have that heavy anxiety feeling in my chest and I feel sad. I have plenty of academic stuff due before spring break, but it isn’t impossible. I have an email summary due Friday (it’s like a mini draft), an oral argument tomorrow, and an assignment I never turned in.

I was cold called yesterday and I didn’t know the answer. I was cold called in the same course last class. I had a bad afternoon yesterday because of that, but I thought I got over it.

I started having minor suicidal thoughts this morning and they’re getting worse. The only thing stopping me (as usual) is the tremendous hurt I know it would cause. I feel like I’m about to cry.

I know part of the problem is I keep focusing on all my shortcomings and failures, instead of focusing on how to fix the problem.

Also, I’m seriously considering having sex and I think that makes me feel guilty. Ah, so much fear and shame.

It probably didn’t help that my mom keeps praising me for things I’m lying about (working diligently, eating well, etc.). I don’t take praise and compliments well in general. So, compliments about things I’m doing right, which I’m really failing at, but lying to appease her makes me feel guilty.

*Correction: Now I am crying

Today Everyone Hates School as Much as I Do!

Yesterday everyone panicked, which was nice because I felt better about my sorry state. This morning, my section’s first class was Legal Research and Writing. It was hilarious. Our professor enters the room and says, “I’m really looking forward to reading your papers!” Everyone laughs, then she says, “Well, that doesn’t sound good…”

Later she said not to worry about our 2nd brief until next week. We should get some sleep, catch up on the other classes we’ve been ignoring, and do something nice for ourselves. It was funny because it is true! No one has slept or read for other classes. In fact, in Contracts on Tuesday, the professor tried to cold call people, but they kept passing! Everyone was dead tired this morning and not really paying attention. Of course, she noticed and laughed, “You guys are thinking you don’t pay me enough for this.” HAHA, THAT IS RIGHT, WE PAY YOU!

As we left a boy said, “Yeah, we won’t be working on LRW. I think we all have some soul-searching to do!” I felt more comradery with them than I usually feel. Felicia Day_it is easy to bond over hating something together

She is my favorite professor. She said she won’t be with us at internships, so we need to be confident. Then she said, she’ll respond to emails or frantic calls over the summer, but she won’t necessarily be able to help because of the area of law. I thought that was incredibly sweet! I’ve never had a professor say they can help after the class is over!

Plus, she ended with good news. She said our writing program is more rigorous than most law school’s LRW. In fact, she hears from employers saying graduates from our school are exceptionally good at writing briefs and motions, even students who got Cs in LRW. 🙂

Papers, Always Papers

I have a paper due tomorrow at 11:59 pm. For once, I began before the day it is due! However, I’m not nearly as far as I should be. I’m trying to focus; I didn’t even go on tumblr until an hour ago, but my mind is starting to do that paralyzing anxiety thing already.

Healthy thoughts: focus

Unhelpful Self-Talk: ahahahaha no focus for you