Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Saturday, August 22, 2009

One crummy Saturday

I had to go see Dr. Brain today. That's so routine by now it's no big deal; every 4 Saturdays I do this. It's a long trip. I knew they've been doing some weekend construction in one city (where I work) so I left a bit early. This week I had no problem with the construction, so I did an errand and then drove up to my appointment.

I'm feeling better, but I'm still anxious and distracted easily by the anxiety. I was worrying and not paying enough attention and while passing someone sped up a tad. I noticed and started to slow down about 15 seconds before I saw the cops. Two cars pretty well hidden under a bridge, using laser guns. I saw them point at me, and then I was pulled over. To make it all worse, this happened in a place that there has been construction but it is done so there are no physical signs of it except apparently the speed is still posted as lowered to 60. And at the moment I was caught I was at 75. I'd been there only momentarily, but I was there. I knew it when I saw the cop and knew immediately I'd be pulled over. So, I was 15 mph over in a construction zone, which means the fine will be doubled. And since I had an accident in December, this means I'll have enough points on my license to cause my rates to go up. I'm expecting the fine to be around $300, based on what I remember of the fee schedule I was given with the previous ticket after my accident. So, I was late for my appointment (thankfully the doctor was too and was just finishing with her prior appointment when I arrived) and have been stressed and upset all day.

Then I talked to her about my depression. Which is much improved, but I'm stressed about it because I'm on the highest amount of my antidepressant I can possibly tolerate, and I'm now on a big dose of fish oil too, so there is no more increasing easy stuff. She wants me on less AD as soon as possible, but it may not happen for months simply because if I'm not ready to back off in 4 weeks it will probably be spring before I can, thanks to SAD. I have tried one more bump up on the this AD, to the biggest amount she will allow me to take, and I was manic in a few hours. So this is it for imipramine. It is the only AD that has worked this well this long; I think I've taken it for 4 years now. I've been on many, many antidepressants. I don't do well on them, but I'm also one of the occasional bipolar patients who seems to need one. Imipramine has been wonderful, and it was a last ditch effort when it was tried, not likely to do much since nothing else had. (Remeron worked well for me but ultimately contributed to hypertension). The only ones I've not been on are MAOIs, a few other tricylics that aren't much different from what I'm on, Lexapro and Cymbalta. Lexapro is out because it's an SSRI and those have made me manic with a 100% rate. Cymbalta must not be a really good option because we didn't even discuss it. Which leaves me really one option: Emsam. Emsam has been out a few years. It's an antidepressant patch. It's also an MAOI. Those drugs have the distinct disadvantage of interacting with certain foods or meds to cause dangerous hypertension. Emsam at the lowest dose has no restrictions. All other doses have limitations. For me that wouldn't be a ton; the biggest would be soy, which I do eat a decent amount of but could live without. Aged cheese is the only other biggie, and I don't eat a ton of that. I could live with the other options. So why worry, right? One "small" problem. If there were another oral drug I could try I would be able to taper off imipramine while starting the new one. It wouldn't be likely to disrupt my life much. In contrast, all other antidepressants must be out of your body for a week before starting Emsam. That is a very scary prospect. I honestly think I'd ask to be hospitalized for that week. Partly because it keeps me safe during what might be a hard time, partly because it easily excuses me from work to get through it. I need to not worry about something that isn't happening now, but this is hard. The one thing that is hardest for me in this whole illness is the knowledge of how few options there are when things change. I've simply been through most of them. It's a little better knowing that Seroquel worked when there were almost no options for a main medication left, and it wasn't very likely to work. And of course things just aren't that dire now. I just really needed to get that little bit of news when I wasn't totally upset by spending a huge portion of my paycheck on not paying attention to what I was doing.

Then I went out of my way to go to an outlet mall to buy shirts. I need more than 5, which is what I have right now. Total waste of time. I wound up with some underwear and socks and 2 pairs of socks for Christmas gifts. So getting home took about 4 hours longer than it needed to.

I am now tired and grouchy and upset. And even more anxious.


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