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#anyway the pcp referred me to a psych
fates-theysband · 2 months
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turns out doctor visits are less fraught when you’re not desperately depending on said doctor to believe you in order to keep your home
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lucysweatslove · 1 year
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So after my other assessment about a month ago I called a psych NP to medically address the ADHD… I wanted to see somebody outside of my hospital group because 1) I didn’t want to have to go through my PCP (who, for the last three years, has refused to even consider I might be ADHD, let alone the potential autism) and 2) I might have rotations at the hospital and I wanted to keep my own medical stuff independent from the people who are required to assess me and give me grades.
Anyway she didn’t call me back for like 3 weeks, but she DID call me last week and I met with her this Tuesday. Yay, right?
And while she is operating under the belief that I likely DO have ADHD, she wants formal neuropsych testing (you know, like the computer based TOVA thing, I think, and other assessment tools). I was referred out AGAIN, and I think Thursday THAT provider called me back. I set up an appointment for this upcoming Friday, and now I can’t remember when I see the psych NP again, but we are actually going somewhere.
And I’m a little scared?
Like what if the testing doesn’t show enough impairment and thus they don’t think I have ADHD? I did the CAARS scale already online to prep for it, and since I don’t really have strong emotional lability and pretty much no anger, and I’m very much inattention and no hyperactivity, which may be not enough. Like I’m just not inattentive ENOUGH. If I was just a little hyperactive or had just a little more anger it would be enough, but it’s not enough now. And if it’s not enough will they try to give some other BS reason why I do what my husband calls “squirreling?” (which is when I start a project or a task, get distracted, get distracted from my distraction, get distracted from THAT distraction, and eventually I have done maybe 5% of 50 different tasks that I haven’t finished and I’m so tired and burnt out I need a nap).
The rational mind says “it’s so classic inattentive ADHD; of course testing will show it,” but the fearful part of me just says nope, the problem is you, you don’t try hard enough, you don’t have grit, that’s why everything is harder, and they will tell you that and leave you on your merry way to tell your husband it turns out you just suck and if he wants to have a happier home divorce may be required because why stay with somebody who can’t just choose to be a normal functioning adult. (Yes this is catastrophizing).
This doesn’t even touch the autism part. Which since I don’t think that needs any treatment, I wasn’t seeking anything about that with psych NP and she didn’t include it on the referral. It’s not that I hide it, I disclose it to my medical team, I just am not coming into the appointments with anything autism-related as my “chief complaint.”
But I’m also a little concerned that the neuropsychologist is going to blame EVERYTHING on the autism, and then say there isn’t anything I can do to treat it, so now it’s at least not my fault but I don’t have much hope of being successful because I just have to live with it and work within my means which at this point in time maybe I can do med school or maybe I’ll struggle with focus so much alongside the, you know, stress of being autistic and having my cohort know something is “off” about me but it’s not SO obvious that they’re nice because they know it’s autism and instead they just avoid me because I’m weird (and yes I’m catastrophizing again)
Also also my car still has its snow tires on, so my husband tried to get an appointment to swap them out, but they are booked for over a month… so instead he is dropping it off Monday and they will do it whenever they get around to it which could take all week. Not that I’m ungrateful to them always being able to work my car in for tire changes, but our other car is a manual, which I can’t drive, so I’ll be stuck at home. I also didn’t get a say in this so it was just thrust on me like “oh btw starting Monday morning you can’t go anywhere for an indefinite amount of time that you have no control over.”
Which is also an issues because Thurs and Fri I was too distracted with assessment intake paperwork and disorganized to get myself into the gym so I was really hoping to go on my normal days next week, but alas.
It’ll probably all be fine. I’ll get my car back on Wednesday or maybe Thursday morning and just miss another couple days. The neuropsych assessment will be fine because I AM disorganized and distractible with attentional control issues. And even if the NP requires I start with Strattera (nobody in my family with ADHD has had success with it), I’ll still be one step closer to medical management to actually help me function better.
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a-woman-apart · 5 years
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Effexor Withdrawal (My Experience)
A/N: As I previously stated, this post contains information about medicine, medicine dosages, and side effects. Discuss all your concerns with your primary care physician or psych doctor before you make any changes. Do not discontinue any medication without first consulting with your health care provider.
Trigger warning: Briefly mentioned vomiting
Oh, so you thought the story was over?
It wasn’t.
In one of my previous posts, Advocating for Myself as a Patient, I briefly detailed that abdominal cramping and gastrointestinal symptoms, along with a “tingling” in my head and other parts of my body had accompanied some of my medication changes. I thought that a little rest and taking the probiotics might solve the problem. I also had nausea, and psychiatrist #3 had said that the Hydroxyzine would help with the nausea.
It did, mildly, but my symptoms continued to get worse and be overwhelming. After doing a little digging, I discovered that my cornucopia of symptoms (nausea, diarrhea/loose stools, abdominal pain, sweating, chills, shaking, nervousness, dizziness, weakness, confusion, and paresthesia/tingling) could be attributed to the discontinuation of Effexor/Venlafaxine.
I was on Venlafaxine ER (Extended release) and was still on the starting dose of 37.5 mg. When I asked psychiatrist #3 if it was okay to eliminate that without tapering, she hand-waved it. “Oh yes, it’s just a small dose.” To be fair, though, there is no smaller dose of Venlafaxine ER to help patients with tapering, and you better believe that patients have complained to the drug companies who make it.
Anyway, I continued to be violently sick. It may sound strange, but the paresthesia, and “brain zaps” were one of the most distressing symptoms, and what sought me to do online research in the first place. Sufferers have begun referring to the tingling sensation in the head and parts of the body as “brain zaps” because it can be described as feeling like a small electric jolt or shock. It is disconcerting, because it can coincide with dizziness, weakness, and lack of coordination. Sometimes I would have to lean against other objects for support when a “brain zap” hit me.
I learned that I was not alone. I found out that most people who try to discontinue Effexor—even under doctor supervision— experience even worse side effects than I did. I discovered that like me, most patients are not warned about how powerful this drug is. I was never told that trying to come off even such a small dose would cause such a terrible case of discontinuation syndrome. Discontinuation syndrome is a process of withdrawal that can occur when patients try to come off SSRIs (Serotonin Reuptake Inhibitors) or SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors). You can read this Harvard Health Article for more information. More importantly, scroll down and read the comments, where patients detail how antidepressant withdrawal ruined their health and their lives.
I must stress that it is important that this does not mean that you should not take an antidepressant. If your doctor prescribes something, they are usually taking into account that the benefits outweigh the risks. However, some antidepressants like Zoloft and Effexor have a very short half-life, which means they stay in your system for a shorter time than other drugs (such as Paxil). This quick elimination of the drug from your body upon stopping the drug can cause withdrawal. It certainly does not happen to everyone, but it is a risk that patients deserve to be informed about.
To make a long story short, I ended up in the ER for 6 hours on the day that I was supposed to return to work. This was after rushing to urgent care, where I was told that urgent care was not equipped to treat my symptoms. At the emergency room, they did an EKG and took blood samples, including a lithium level (this was just in case the increase in lithium was causing my symptoms). My heart, thyroid, and kidneys turned out to be fine, and the lithium level was perfect. The doctor prescribed two different medications: Bentyl for abdominal cramps and another drug for nausea.
When I go to fill out the prescription, I see that neither drug was covered by my insurance. The Bentyl was $46, but the nausea drug was going to be $85 for 12 pills. Haha, no. So even though I’ve already spent over a hundred dollars on medicine and medicine co-pays this month, I am desperate, so I pay $46 for the Bentyl.
So, in the meanwhile, I can’t go to work the next day either (got a doctor’s note) and I’m taking the Bentyl with meals as prescribed. At this point, I’ve developed food aversions. I can’t drink milk, I can’t eat anything with too much sugar, and I can’t eat certain raw fruits, vegetables, and proteins. I’m weak all day, and so I spend the day trying to relax. I binged the entire Aggretsuko on Netflix. I am worried that the Bentyl is making my nausea worse, so I wish I had that other drug now but, alas. I ended up throwing up after taking all my night meds. My stomach felt better at that point, but I was also worried that I threw up all the good stuff I needed to help with my mood.
I ate some soup—which I was able to keep down— and went to bed.
It finally becomes Wednesday—and time for another group— but I went to my clinic early so that I can see psychiatrist #3 before group time. When I get in to see her, she is harried (it’s quite busy) and visibly annoyed at me for coming in to see her again so soon. I explained my symptoms and that I felt that I was experiencing withdrawal from the Effexor/Venlafaxine removal. I asked her about a remedy that I had seen online, which was to introduce a single dose of Paxil to help with the withdrawal symptoms. Paxil leaves the body slowly, so introducing that single dose can alleviate symptoms and aid in the tapering off process.
She told me, “Your symptoms are caused by anxiety. You need to take the hydroxyzine, and that will help with the nausea (again I saw scant evidence of that). There’s no smaller dose of Venlafaxine for you to take. The only thing we maybe could’ve done was to have you take the medicine every other day, until you came off from it, but you’ve already been off it for over a week.”
She then cautioned me from getting back on the medication, and I assured her that I had no intentions of getting back on it. Finally, she said, “If your symptoms persist see your PCP.”
I was slightly annoyed that with the risk of discontinuation syndrome associated with this medication, that she wouldn’t have encouraged that slower tapering, just to be safe. I had considered doing that every other day thing for myself, too, but when she hand-waved the side effects I just did what she told me to do. Also, the apparent lack of knowledge about the withdrawal was concerning. From what I saw, about 20% of people experience discontinuation syndrome, but with millions of people suffering with depression, those numbers are significant. Doctors need to be much less careless with this, and if they do not know there should be better education provided. So many people get back on their antidepressants just because the “brain zaps” and other physical symptoms of withdrawal become too devastating.
Withdrawal can last anywhere from 1-3 weeks, but symptoms can persist for months and in rarer cases, even years. This is not a matter to be taken lightly. One of the worst things was just not being informed. I rushed from psychiatrist, to PCP, to ER, and back to my psychiatrist because no one could tell me what was wrong with me or fully help. I have missed hours of work time, lost hours of sleep, and will have spent $100s once this is over. More importantly, because hypochondria/health anxiety is part of my anxiety disorder, I have agonized over what might be wrong with me. The emotional and mental distress—especially because I am coming out of mixed mania that may or may not have been exacerbated by the Venlafaxine—have been almost unbearable. Yesterday, I just kept crying because I was so paranoid that I was going to be met with suspicion or disdain when I returned to the workplace, because I had just missed so much time and I am only a part-timer.
Even today, my symptoms are not fully alleviated. I have not been able to walk in the park in days, laundry is piling up because I didn’t make it out there this week, and I still have to be careful with food. I’ve tried soymilk as an alternative to dairy milk, but I still don’t know whether my stomach likes it or not. I think I threw up because of the Bentyl, but I also did have a lot of soymilk that day (I might have to take my chances because I am fiending for a bowl of cereal).
In summary, dealing with a mental illness can be exhausting and your physical health may also be compromised. Doctors often either cannot—or will not— put themselves in the shoes of their patients. You must advocate for yourself. I cannot stress that enough. It can be difficult and costly, especially when your insurance does not cover everything. Your life is worth it, though, and your health comes first.
Finally, for the love of all things holy and true, do not come off antidepressants like Zoloft and Effexor cold turkey. I’ve read nightmare stories about people coming off dosages as high as 225mg and then just trying to stop. Bad, bad, bad idea. If 37.5mg did this to me, then imagine what a higher dose could do. I have even heard of people experiencing terrible symptoms when it was doctor-sanctioned and their dose was cut in half (like going from 150mg to 75mg).
Please be careful, y’alll.
P.S. I am aware that hydroxyzine is an anti-histimine (like Benadry). It’s off-label use is to treat anxiety.
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