doctor, doctor

My previous psychiatrist left his practice with very little warning last December, so I had to find a new one. This week I had my first appointment with the new p-doc, and I think it went very well. After the obligatory paperwork, I was interviewed by an intake nurse who asked me a lot of wide-ranging questions about my symptoms and my life in general. She seemed very organized, and made plenty of notes in the computer.

I was sent back to the waiting room for about 15 minutes, then they brought me in to see the doctor. We talked about my current and past symptoms, and how they have changed over time with the medication. I felt like I had to make a case that I still have bipolar, and he seemed to agree that even though I have been relatively stable with the meds I would be in trouble without them. We also discussed the weight gain with Abilify, and he started me on Topomax, an anti-seizure drug with a major side effect of appetite suppression and weight loss. He said several patients have had success with this combination. Finally, he gave me a little bit of Ativan to take as needed on days when my anxiety is problematic.

I was nervous the entire time, but I think I covered everything I wanted to during the appointment. I had prepared by writing up a list of symptoms, a timeline, a list of meds, etc., which helped me lay things out in an organized manner when responding to questions.

I got the impression from the conversation that he was much more friendly and personable than my previous doc. I also believe he is much more inclined to listen and be interactive, working as a partner in my mental health goals rather than just ordering me to do what he says.

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stable but unwell

My bipolar seems to be in a stable phase lately, however that stability is still not feeling well.

I have had depression phases, but until lately I think they were related to outside events rather than developing on their own. I have had no hypomania phases for at least a year, maybe more. The medication, especially the Abilify, takes the edge off so that I rarely get those highs anymore. I miss the highs a little bit, then I remember that I usually have an agitated mixed state rather than a happy hypomanic state.

This time I seem to be in a real depression. I worry constantly, my OCD is there all the time, I exhibit social anxiety symptoms every day, I try to avoid contact with people, and I have the added stress of maintaining the constant mask that keeps people from seeing how I really feel. Physically I don’t feel well, I am tired all the time despite getting good sleep, and my weight has ballooned. I have no motivation or energy to do anything, and getting the house ready to sell seems like an overwhelming task at this time. When I am overwhelmed, I give up, and that makes me depressed, and the vicious cycle continues.

I don’t know if any changes to my meds are warranted, but I will ask him if I can do anything else. The p-doc says I am maxed out on the Lamictal, and the Abilify is doing nothing for my depression or anxiety. The social anxiety is probably a behavioral issue rather than medical, and changing the meds won’t affect that. There is no magic formula to make me change the kind of person I am, and I don’t believe any amount of therapy can give me confidence or self-esteem, or take away the insecurities I have had since childhood.

I guess the theory behind the medicine is that if they can fix your brain chemistry so that you’re not depressed all the time, you will be able to make changes and make progress necessary to improve your life. Nicole and I were discussing that with respect to her illness, and I was telling her that it seems like she is just stagnating, standing in place, choosing not do to do things to make progress toward independence and rejoining the world of the living. I think I am stagnating as well, but I have the added stress of being forced to play the role of worker and provider and all-around good guy for everyone who needs me.

Fuck bipolar.