I wouldn’t want my psychiatrist’s job.
Therapists have many challenges, as I know, but psychiatrists usually see their patients less often and for less time–and have to figure out what drugs to prescribe, choosing from a huge array of possibilities with an equally huge array of potential risks and benefits. Then they have to worry about whether the patient is going to take them as directed or not…when the stakes can be high indeed.
I saw mine this morning, and the poor fellow had to attempt to grasp in 20 minutes what any reader of mine knows is a rather eclectic picture. So much of my presentation varies with the energy flow of the moment–how to create a general picture and come up with a plan?
My psychiatrist has worked with me since shortly before I entered recovery, so he can see how I have changed and knows the importance of avoiding any inappropriate medications. I make sacrifices to keep seeing him, because a highly experienced and caring provider is hard to find inside the insurance networks (I’ve been assigned to people with whom I didn’t even share a language.) The trade-off is that I try to keep my visits to a minimum; not always a good idea.
But his experience matters; it’s not enough to ask a series of rote questions and consult a diagnostic manual and drug reference. Today he was able to read into not only what I said but how I said it, or what I did not say, or the lines my face fell into when I detached from the thread of the conversation.
And yes, he agrees with the diagnosis I had tentatively made…worsening levels of clinical depression and a need for a change in meds. I have a prescription for something brand new, and I need to figure out whether the insurance will cover it. Then, if all goes well, I need to start taking it–the sooner the better, in his opinion.
Anyone who’s been where I am knows what I am facing now, but for anyone who hasn’t:
Imagine that you’ve been handed a magic potion in an opaque flask. You know you need to drink it, but you have no idea what it’s going to do to you…caught between the misery of the moment and your fear of the unknown, you raise it to your lips. You swallow, and then you wait.
The next day you feel sick. And the day after that, and the day after that. Or you are semiconscious, or your mouth is so dry you can hardly speak, or you can’t have sex any more, or you’re hyperanxious, or you have sudden self-destructive thoughts, or you’re dizzy…but you obediently continue drinking from the flask, because you’ve been told these are normal and will pass soon. But when will I feel better, you plead with the wizard. In six to eight weeks we’ll see, is a common reply.
Yes, boys and girls, though many of the “big guns” of psych meds (such as tranquilizers and antipsychotics) have near-immediate effects, most antidepressants manifest side effects long before any therapeutic effect is felt. The popular misconception of popping a Prozac to lift one’s mood is a pile of crap; antidepressants are not mood-altering in that sense. I feel nothing, just as my bipolar meds don’t alter my state of mind in any short-term way.
After an eternal couple of months, it is at last time to assess whether this one seems to be helping–and perhaps have to start over with something different, beginning the cycle of side effects all over again.
Not everyone suffers this badly with every medication, but those who have ridden the medication merry-go-round have probably experienced this end of the spectrum. In A Bittersweet Pill I wrote about some of my experiences, and my gratitude for my current relatively benign regimen. Now that regimen is to be upset, and I must face the unknown.
A leap of faith, or a leap despite the absence of felt faith, as I wrote a couple of posts ago. A decision to try, knowing it might fail or do worse than fail. Resistance to the judgments of others, who might think I should be overcoming this depression with sheer will. Open-mindedness and willingness to take suggestions. These are what I’m trying to use today; these and the knowledge that I have many brothers and sisters contemplating mysterious flasks of their own.