Monday, February 15, 2010

A little extra help

I saw Dr. R again today and told him about my nearly fatal bout of BPMS.

"I'm just having the worst winter, mood-wise," I said. "Nothing seems to work. I use the light box, I get some exercise, I've got a great boyfriend, and I'm still depressed. The last week of January, I was miserable every minute of every day until I got my period. I thought I was either going to cut my throat or check into a psychiatric hospital.

"It's taking me more than a month to recover from minor gum surgery. Work is excruciatingly difficult. I can't always shower when I should. I need more help," I concluded

"What do you think we should do?" asked Dr. R. I like to think that he asks me questions like that because I'm a mental health professional, not just because I've tried so many medications. Or because he doesn't know what he's doing.

"My friend Joey thinks I should go on the pill," I said. Joey's a psychiatrist; I've mentioned him to Dr. R before. "Joey says that estrogen is the best mood stabilizer for women with bipolar. He has a patient with bipolar who went off the pill to get pregnant, and every month she nearly kills her husband."

"Have you spoken to your gynecologist?" asked Dr. R.

"He refuses to put me on the pill," I said. "He says it's not indicated for women with bipolar disorder."

"Unfortunately, I am not familiar with the different birth control pills, so I cannot prescribe them. What other options do we have?" asked Dr. R.

"Well, Lamictal and Gabitril didn't work for me," I said. "I don't think going back on Depakote would help. Eli Lilly markets a time-limited form of Prozac as Sarafem for Pre-Menstrual Dysphoric Disorder." That's what psychiatrists officially call PMS. "You could write me a prescription for 30 days, and I could take it when I've got PMS. Prozac always worked well for me before, although it did make me manic."

"But you are taking lithium now, so that is less likely," observed Dr. R. He wrote out a script for 20 mg of Prozac. I thought about asking for more, but he's fairly conservative -- starts low and gradually builds.

"I don't know if I'll still need it after the time change," I said. "I might feel better then. This winter just hit me so hard. I'm not functioning well. I can't believe my mouth still hurts -- the surgery was a month ago."

"There was research done during World War II on how long it takes wounds to heal," said Dr. R. "When the army was advancing, wounds would heal faster. When the army was retreating, they healed more slowly."

"Morale," I said. Right now, mine is low, and it shouldn't be. I'm doing well at work, but it's a constant struggle.

I'll be trying the Prozac in about 5 days, and I'll see Dr. R sooner than usual. Fortunately, he accepts the insurance my employer is switching to. I think.
Copyright (c) "Ayelet Survivor"

3 comments:

  1. hi ayelet thanks for having me in your blog
    ive heard abouta pill " lustaral "that it helps ..
    it says that בשורה טובה which means good news will help you feel better.. i would also suggest be comfortable where you live
    think about the day after the deppression and about the many many years to come that forsure you would achieve alot

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  2. thanks for reading, Ari :) I'll look into lustaral, but you're also right that when I'm feeling my worst, I need to remember that it's just temporary

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  3. The lightbox does not actually replace the vitamin D of the sun that also needs to enter your skin, not just your eyes.

    You have to exercise, even if you have to have a friend annoy the crap out of you to do it. The natural endorphins are medication themselves. My preference, kickboxing, wii active is great.

    Keep sugar levels help too. Eg. Switching from wheat based products to more rice, buckwheat, quinoa.

    If you aren't meditating or doing yoga, no time like the present.

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