I had my appointment this morning. It went well. I really don’t know how I feel now, because I didn’t cry during the appointment, and I didn’t cry on the way to work, so does that mean I feel better? Or not? In a way I am going to be pissed if I feel better – I feel I’d promised myself that I wouldn’t go through this again, and I was at the perfect intersection of mood and energy back in December, but didn’t do it because I wanted to give my family a good Christmas. And that’s fine and dandy but all I can think about is that there hasn’t been much that’s happened in the last 3 years to make life worth living, so will I be looking back from the future with regret that I stayed?
I apologized to the psychiatrist for being pissy before Christmas and he said it was okay, and that he’d been worried about me.
He asked if I’d been able to continue taking the lithium and I said I’d stopped two days ago because of the meth-head skin breakout, the shaky hands and the nausea and he said “Okay. So you weren’t tolerating it. Let’s discontinue that then.” I was relieved – I feared he might argue about how I should’ve kept taking it until I saw him, or that I should stay on it to see if the side effects subside. He is easy to talk to and reasonable, so I am going to try not to freak out as much before appointments. It just seems like such high stakes – 20 minutes to guide the next few days or weeks of my life.
He said he thought MAOI’s might be a good choice for me, but I would have to stop taking my existing antidepressant for two weeks. He gives a complete rundown of his logic, like he explained how his patients have responded to it, what the tyramine restrictions were, etc. I said that two weeks of nothing seemed like a terrible idea, as I thought the imipramine was keeping me going enough to stop me from crying in bed all day every day. He said possibly we could do the ketamine during the initial 2 withdrawal weeks but I would have to be an inpatient. He explained that there just wasn’t a protocol in place to do the ketamine on an outpatient basis, although they sometimes got around that by giving generous “passes.” Also the ketamine maintenance can be done as an outpatient – 45 minutes for an infusion.
Anyway, he wants to try me on a different stimulant – modafinil – that has great reviews on drugs.com as an antidepressant helper, and I’ve an appointment for a week from now. He said I should feel the effects of the stimulant right away, like he same day, as it doesn’t take weeks to build up levels in the blood or amything, and I feel good about that. I think he gets that I am running out of patience and couldn’t handle a wait of weeks. I will definitely know if it is working by next week, too, and then I think I am coming around to the idea of ketamine. Now would be a good time to take the time off work, and then maybe all I’d need were the MAOI’s… and if not I’d be set already for ketamine maintenance. I just want to get it under control one way or another!
After only 3 hours of work today I left early as I was fried and getting a migraine, so I didn’t fill the prescription, I will have to do that tomorrow morning.