save your sanity for later.

So I've been off my antidepressants (hereafter referred to as ADs) for about 3 weeks. It wasn't planned; I had an appointment with my psychiatrist at a time which would've allowed me to refill my meds, but then my grandmother got sick and I had to cancel.

Sure, I could've called the clinic and gotten a refill. That probably would've been the best option, but the weird thing is that basically nothing's changed. My mood hasn't gone appreciably downhill, and I feel a little more irritated with the world, that's about it.

(I didn't get any withdrawal symptoms, either. I might as well have been taking sugar pills.)

Anyway, so ... ADs. Bust. I've taken some SSRIs (made it worse), all the SNRIs (sugar pills), and even Wellbutrin (NDRI) didn't make a dent.

I have a psychiatrist appointment on Monday and I'll bring up Lamictal (a mood stabilizer with antidepressant qualities) then. Maybe that'll do something.

I kind of doubt it, but I'm running out of options.

It's four o'clock in the morning. Again. And I am awake, again. Fuck life.

I'm also angry at a guy who, I have realized, used me. I feel violated. I also feel very conflicted about cutting off contact with this person vs. confronting them vs. letting it go. (Note: no one who could conceivably be reading this is the guy in question, so worry not.)

Erika—not so good with the boundaries. Probably something I should be working on in therapy. (Mental note.)

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Speaking of mental health: For therapy, the state downgraded us to 2x monthly, which is also really annoying the shit out of me. My SCL worker is still coming once a week, and I'm seeing my psychiatrist once a monthish. I plan to call my lawyers later today to see what's up with my appeal, and I think that about covers that.

( Here's my current med rundown, for those who are interested )

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!