save your sanity for later.

So I had a psychiatrist appointment today.*

(*For those of you who are still impatiently waiting for the entry I said I would write like a week ago about my sex life, I'm going to try to compile it from chatlogs later today. If you wanted a real entry, that MIGHT take another month, if it got written at all and I didn't just decide to pretend I'd forgotten about it, so you'll take what you can get and LIKE IT. [Or dislike it. But either way, yeah.]

For those of you who don't care, I'm going to end this parathentical now.)

For whatever reason, I decided my mood this morning (homicidal, as detailed in my last entry [dw/lj if you have short term memory loss, no judgment, only love]) needed to be annoyed out of submission by pretending to be in a good humor and, most importantly, joking incessantly with anyone I had to interact with.

Unfortunately, as panda would line up to tell anyone repeatedly if she could, my sense of humor can, at best, be described as "morbid" and at worst, be described as "fucking awful."

(At one point in time, I suggested tagging any entries I made that I found particularly funny as "shit no one else is going to like at all because I fully believe this is hilarious." She supported me in this decision, because she is awesome like that. Sadly, that's way too long for any tagging system. So many lives lost due to this tragedy.)

For those of you who do actually find me funny, I'm sorry, this is obviously Stockholm Syndrome. Medical help has been dispatched, but they have no idea where you are, so if you can leave a comment by just lightly rolling your head around on the keyboard (*friend alert system, patent pending by me, instituted due to the profuse drunkenness often found in my IM windows)——they will get to you as soon as you manage to hit 'tab' and 'enter' or somehow post your comment in some other way.

No one at my psychiatrist's office finds me funny. Or if they do, they hide it very very well, behind a level of "I have to work with crazy people all day, but you are maybe the worst——we think the people who don't bathe at all ever may just edge you out, but we don't know, poll results aren't in yet, we'll get back to you."

The problem with that approach is that my brain apparently thinks "no response" means try harder. Brain, I am not a stand-up comedian, I don't get paid for this shit, and what Body actually wants is to go home and go back to bed, so stfu.

My psychiatrist cleverly headed today's stupidity off at the pass by going off on a long tangent about the neuro-physiology of addiction because I happened to mention that I may theoretically be thinking about quitting smoking sometime in the foreseeable future. Maybe.

However, if anyone in reality asks, I am definitely trying to quit by cutting down right the fuck now, and um, if you can say this with a straight face and my psychiatrist is asking, I am now down to smoking 3 cigarettes a day. SO I DIVIDED BY 5. SO WHAT.

In between me pretending to care by asking such insightful questions as "but if dopamine is the neurotransmitter behind addiction, why do people like depressants which are GABA inhibitors" (note: question as displayed in rear view monitor may actually appear to be insightful, this is a TRICK) and actually getting him to admit he had no real idea how that worked——we agreed to cut down my Cymbalta to 20mgs.

I think the logic there was that we would pretend like that might have any effect on the fact that Cymbalta turns my anxiety up to 11 and rocks out to the beat, and in return, he would continue to write a prescription for me for the same amount of benzodiazepines as I got before which doesn't actually do anything to help, since I haven't gotten a full night's sleep since I started taking this shit. (And probably when that doesn't work he'll start prescribing me Adderall again because stims are awesome cut down my anxiety. Weirdest reason for meth use ever, y/y?)

The true secret behind any psychiatry dealing with me appears to be "throwing things at the wall of crazy and seeing what sticks" is what I'm trying to say. I did not tell this to my psychiatrist, displaying my once daily attempt at having good judgment. There is always a possibility he might actually find a capacity to be offended (not evidenced in the previous 6 1/2 years) if I say that when I'm not depressed.

Although! I did notice a new-to-me piece of art, which was awesome, because it got him off addiction and onto rambling about how his wife something Mexico something I stopped paying attention 20 minutes ago, dude, I know you are nearly as bad a rambler as me, but there is a reason that your appointments always run late if people actually show up.

To be fair to him, though, the clinic I go to is the only one in town that accepts the free insurance offered by the state for the seriously mentally ill, so there are a lot of no-shows because as a rule everyone there is dealing with a lot of shit. Appointments are therefore generally on time, because it seems like every other person cannot find the fucks necessary to give in order to make it to the clinic.

(I'm tempted to redefine spoon theory as "Give A Fuck theory" right now. Is it just me? It's usually just me.)

In related news, I have lost the ability to tell when I'm being sarcastic. I'm just going to assume I'm being serious all the time now, which makes my offer yesterday of being able to transport a body (my car is black! this will work well if we dump it at night!) kind of scary in retrospect.

If you happen to find a sarcasm-detector, maybe you can leave it somewhere where I'll trip over it. Although on second thought, maybe I should blame all of this on the two physical illnesses (both infections, not another abscess tho, no worries) I currently have and just pretend that I'm not like this when I'm not running a fever.

I mean, it's not true, I'm actually like this all of the time, but it is an extremely convenient explanation, and I feel kinda bad not using it when the excuse is just hanging around, bored. In my experience, there's usually another convenient excuse when this one inevitably reaches its statutory limitations.

(And now having ended up on a kinda downer note, I'mma just leave this here and pretend I didn't see it.)

( Chiller asked me five questions. )

Here's my twist on the meme: If you want five questions from me, you must ask me at least 3 (three) questions.

So. Why I'm so interested in seeing my psychiatrist this week:

On Thursday I had a really bad episode of depression due to Adderall wearing off (as best I can tell).

It wasn't a case of running out of meds, it was a case of the adderall being immediate release instead of extended release, so think of it like a food you eat and then feel hungry again 3 hours later, as opposed to a food you eat that keeps you full all day.

I can't think of a food that you eat that keeps you full all day but oatmeal certainly doesn't make me REALLY HUNGRY 3 hours later, as opposed to a donut, for example.

So think of extended release versions of medication as the equivalent of more fiber. Generally they add time release coatings to some of the medication so that you get a little at any given moment, as opposed to the immediate sugar rush of an immediate release medication.

Because it's IR, my adderall wears off in roughly 4-6 hours, and I can tell it's wearing off because I start getting a little hungry and then about half an hour after I get hungry, I start feeling like complete shit.

Problem is ... I have to let the adderall wear off or I can't fucking SLEEP, because this is basically prescribed speed.

So I have a few options here. One is to try to time the Adderall wearing off with going to bed. Which just—hahahaahahahah no.

Another option is to up my antidepressant so that my default state isn't quite so shitty. The problem is that the antidepressant I'm taking is digital rather than analog. It only really has two modes, on or off. 50mgs is the prescribed dose because they tested it at higher doses and it literally did nothing more. This is VERY rare. Most antidepressants, certainly all I've taken before this one, have more effect at higher doses (and more side effects too, of course); this one does not.

So since managing my adderall use so that it wears off at exactly when I want to go to bed is a little iffy (to put it mildly), and upping my antidepressant won't work because of the digital nature of the AD... we're left with adding something.

Now generally the option one would choose here is to add a mood stabilizer.

However, because of the way my lack of insurance / insured through the state for mental health care works, I fucking can't take lithium which is the best mood stabilizer because I'd need regular blood tests and the state doesn't pay for regular blood tests, even if they're required for the medication you're on.

Why do you need regular blood tests for lithium? Can you take it skipping the blood tests? You could, but you'd be playing with your liver kidneys and your life. Lithium's toxicity dose is extremely close to its effective dose, which means taking it without blood tests is like playing Russian roulette.

Moving on to Lamictal, the second best mood stabilizer for depression. Lamictal has a very rare side effect of causing a rash that, over the course of two weeks, will EAT YOUR SKIN. Fun stuff. It also has the more common side effect of increasing your sensitivity to irritants. Since I already have what is almost an allergy to perfume, I don't want to increase it to the point of an epi-pen allergy.

The rest of the mood stabilizers are really more for mania, so I won't bother going over them since I'm not diagnosed with bipolar disorder. (Depakote... maybe. But I'd take Lamictal over Depakote any day.)

Alright. So can we up the anti-psychotic I'm already taking? We could, but that's not going to help with the crash, in my opinion. It's POSSIBLE that it might, since Abilify is approved to treat rapid mood swings in children with autism, but I'm kind of doubtful.

My preferred idea so far is to add another antidepressant, since obviously the one I'm on right now isn't doing enough, and my preferred choice is Wellbutrin, since I've taken it before and it upped my energy and concentration without doing much bad except some anxiety. But then we have to add Valium to counteract the anxiety from the Wellbutrin. Which I am okay with.

Hope you enjoyed this episode of Med-Go-Round! Stay tuned for Thursday, when we actually find out what Erika's doctor thinks!