Since I went back on medication in December 2016, I’ve seen a rotating cast of psychiatrists and advanced-practice psychiatric nurses in a clinic setting. Because I’ve had years of experience with depression, at first, I wasn’t concerned about interacting with different providers during my every-other month, 15-minute medication consults. With medication-only psychiatric treatment, after the initial 60- to 90-minute session, the periodic check ups tend to be short. You go in and meet with your provider to evaluate the efficacy of the medication, make any necessary tweaks, and update or renew your prescription.
My work schedule, with its unpredictable hours and frequent, last-minute travel, led me to choose a large practice with multiple locations around town. Thanks to electronic record keeping, whoever I was seeing had access to my full history. These types of clinic setups can work well for people whose conditions are relatively stable. In my case, because I did not have continuity with one provider, even with my complete file, it wasn’t possible for any one individual involved in my care to truly see the whole picture. In addition, because increasing medication has always been a solution to my major depressive episodes, I never questioned the plan, and neither did the person across the desk.
This past November, when I could no longer keep my depression at bay, I talked with the provider assigned to me at that time about developing a plan for me to take a leave of absence from my job and rigorously address my recovery. Everything seemed fine. When I returned to the clinic three weeks later to confirm and get the sign off from the doctor, I was told that my previous provider had left the group. Next, they ushered me into a different office than the one I normally went to and I met a new doctor for the first time. She had access to my history, but knew nothing about me. When I brought up the plan I had discussed previously, along with my leave, she told me that we only had 15 minutes and she felt uncomfortable making any changes to my very high doses of medication. In the time I had, I told her about my side effects, but she dismissed them. She told me to see a neurologist for my tremors and memory loss, and gave me a look of utter contempt when I said that I did not want to start taking more medication to control the side effects of my current medications. In that case, she said, she wanted to switch out one of my three drugs with another, an antipsychotic. The antipsychotic would absolutely require me to take more drugs to deal with its side effects. I felt my world closing in on me.
One aspect of my depression that has always been tough for me to articulate is the way in which the medication narrows my span of emotions. Unmedicated during a depressive episode, my emotions run wild. Although I have not experienced mania as a symptom, I oscillate between feeling quite well and suicidal. The best analogy I have is that of bumpers at a bowling alley. Bumpers shrink the width of the lane and prevent the ball from ending up in the gutter. For me, increasing medication is like expanding the bumpers past the gutter. The amount of space for the ball to roll from side to side is decreased until it goes down the lane in, essentially, a straight line. In my brain, that means that the range of emotions that I feel gets narrower and narrower. The benefit is that, without the dramatic swings or the ability to roll into a metaphorical gutter, I remain relatively stable. The downside is that my experience of feeling disconnected, apathetic, and hollow is magnified. I end up in this weird place where I feel nothing.
That’s where I am right now. My sister sent me the most thoughtful and loving card in the mail. Reading it, I was deeply touched. I knew that it should bring tears to my eyes. It didn’t. I have to actively think about the emotional reaction I should be having and, even then, I can’t always convince myself to reproduce that feeling. On account of having acted my way through so much of my adult life, I can mimic the appropriate emotional responses when required, but it isn’t real. I haven’t cried in almost a year. I’ve gotten teary from time to time, but I haven’t had a good cry. Despite how it makes my nose run and my eyes puffy, I have always found crying to be cathartic. Not being able to do that has further contributed to my feelings of isolation and hopelessness about my condition. I want to cry, but, physically, I can’t.
As a result, I’ve chosen to stop being treated at the clinic. After gathering recommendations from people I trust, I have a new therapist who, in turn, has referred me to a new psychiatrist. I had my second appointment with the therapist yesterday and I’ll see the new psychiatrist for the first time next week. I really like my new therapist and I’m optimistic about the doctor to whom I have been referred.
My thoughts about this series of changes are jumbled. First, I am anxious about whether or not these new provider relationships will work out. It can be challenging to find doctors with whom you are comfortable personally and whose treatment philosophies align with yours. Although I am optimistic, it’s still change, and change is hard. Jerk brain has also reared it’s ugly head and is endlessly repeating a talk track that tells me that I’ve already failed at my recovery, because my previous care provider didn’t work out. Somehow, according to my brain, it is my fault and a reflection of my brokenness. In addition to this twisted sense of personal failure, I’m also grappling with the idea that I have a timetable to recover that aligns with returning to my job at a fixed point. That last bit is the one that scares me the most. What if I don’t get better on time? Is making this change going to throw off my schedule? Generally speaking, I am a highly organized and structured person. My current situation is the exact opposite. I’m worried that I won’t be able to do exactly what I’ve said I’d do—get well, and get back to what I perceive is the way my life is supposed to be, by a certain date.
Intellectually, I know that I am on the right path to recovery. My mind gets it, but, once again, my brain is being a total jerk. Although none of these fears are rational, they are, nonetheless, very real.