Suicidal ideation

With some full disclosure to my doctor, I got a new label of something I have: Suicidal ideation.

Sounds scary or kind of cool or maybe like an awesome name for a band, huh?

Well, if you look up the definition, it can definitely slip over into Scary Land:

Suicidal ideation is a medical term for thoughts about or an unusual preoccupation with suicide. The range of suicidal ideation varies greatly from fleeting to detailed planning, role playing, and unsuccessful attempts, which may be deliberately constructed to fail or be discovered, or may be fully intended to result in death. Although most people who undergo suicidal ideation do not go on to make suicide attempts, a significant proportion do. Suicidal ideation is generally associated with depression; however, it seems to have associations with many other psychiatric disorders, life events, and family events, all of which may increase the risk of suicidal ideation. Currently, there are a number of different treatment options for those experiencing suicidal ideation.

That one comes from Wikipedia.

From About.com we get:

Strictly speaking, suicidal ideation means wanting to take one's own life or thinking about suicide without actually making plans to commit suicide. However, the term suicidal ideation is often used more generally to refer to having the intent to commit suicide, including planning how it will be done. Suicidal ideation is one of the symptoms of both major depression and bipolar depression.

Ah ha!  That's me if you just reference the strictly speaking part...especially the area I set in bold and underlined for extra impact. 

There are days I wish I was dead.  There are moments when I cannot help but think that it is the only way to be done with this.  I sometimes think that my family would be better off without me and my issues.

But...

I do not have a plan.  I have no intention of harming myself or others.  I am not going to kill myself.

Why?

Because I don't really want to die.  I love my life.  I love my family and my friends.  I love the activities I do and the things I accomplish.

My husband knows and understands this.  Often when I tell him that I wish I was dead he will calmly ask me if I have a plan.  When I tell him no, he just gives me a hug.  I also have friends who know and understand.  They know the right questions to ask just to check that I haven't slipped over into the Scary Land version of suicidal ideation. 

So, I have suicidal ideation.  For me, it's not necessarily bad or scary or something that requires intervention.  It's a thought and nothing more.

So...

I haven't done a personal post in a while.  It's mostly because there is nothing to say about me or my life...at least nothing that relates to my mental illness issues.  Since this blog is dedicated to that, I don't want to ramble on and on about my friends or pets or family.

I had a checkup with my doctor on September 20.  It was one of those med review things.  I'm at a difficult point in my "recovery/fight/struggle".  My meds work.  I don't feel bad and have more good days than bad days.  Life in my head is starting to even out some and is less chaotic and I generally know what to expect.  But, I still have bad days.  And I still struggle.  And there are still times that my depression stops me from doing things.

This is a difficult point because I am topped out dosage-wise on my Zoloft.  It cannot be increased anymore.  According to the dr. the med he would usually add on would be Wellbutrin but that doesn't work for me, in fact, it makes things worse.  With Zoloft he doesn't really like the other combos.  So, we would be looking into trying a new med and dropping the Zoloft.

That scares me.  In a way, my Zoloft is a security blanket.  I know what it does for me and how it affects me.  I know which side effects I usually see.  We know each other and are friends.  A new med is starting over.  A new med is potential success or failure.

Because I have been dealing with this for 17 years and have been treating it with medication for 14 years, there are several drugs I have tried that didn't work for me.  Most of those are now offered in generic form.  I still do not have health insurance or a job so we have to budget.  And generic drugs are generally affordable.  If we bump up into the non-generic drugs, things get pricey.  Yes, there are programs available that can offer some help.  And, yes, there is the potential that I can get free samples from the doctor.  But...

I do know that I'm going to do what is best for me.  Even if that means the expensive meds.  Me getting better and leading the best life I can, despite my depression and anxiety, is the priority.

So the dr. and I talked.  He asked me what I wanted to do.  I told him I would like to stay on my current meds.  I want to do this because I feel like I'm finally even and predictable/stable and want to see if that is the kind of existence that I can enjoy.  I need to figure out how to "do me" in my current situation and see if it enough. 

I go back in 6 months and we go from there. 

Doctor knows best, right?

Well, I'm not overly happy with our next move.  By "our" I mean me and Dr. S.  But doctor knows best, right?  Today was the three month med check since I started on Wellbutrin. 

We chatted and I told him that I wasn't feeling any different at all in the three months since I've been taking the Wellbutrin.  I informed him that I'm taking Ativan more than I did the last time I was on meds.  He presented me with two options.  One option was to increase my Zoloft from 100 mg to 150 mg daily and leave the Wellbutrin at the same dosage of 150 mg.  Option two was to increase my Wellbutrin to 300 mg a day and leave my Zoloft at 100 mg.  He also mentioned that we could go up to 300 mg on the Zoloft and up to 450 mg on the Wellbutrin.

Out of the two options, he felt that option two was the best choice for our first step.  The problem is that Wellbutrin isn't like Zoloft in that it does nothing for the anxiety part of my illness.  In some people, it can even increase the anxiety.  I could be one of those people.  If that is the case, we will go back to 150 mg of Wellbutrin and then try upping the Zoloft.

Since the medicine is already in my system, I should notice any change within two weeks.  I'm to call Dr. S in two weeks to let him know how it is going.  If I see adverse effects from the increased dosage, I am to call as soon as I can.  If the Wellbutrin increase isn't the answer, he will then decrease the Wellbutrin back to 150 mg and increase the Zoloft to 150 mg.

I'm not happy because I really do not feel as though the Wellbutrin is working for me so I don't understand the dosage increase.  Yes, I understand that I might need a higher dosage to see a change.  But if it is doing nothing for me and then the increase either does nothing or increases the anxiety, why have me stay on it?

Dr. S said he selected this option because Wellbutrin doesn't have as many adverse side effects as Zoloft.  In fact, it can help combat the potential Zoloft side effects of sexual problems and weight gain.  However, I'm not experiencing those problems.  My sex life is fine and has improved since I started back on my meds.  And I've actually lost weight since September when I first went back to the doctor. 

If the Wellbutrin increase doesn't work and we then reduce it and increase the Zoloft, I'm back to giving it a try and then calling him two weeks after we start with that med change. (I'm mostly adding that part so I remember.)

Once we get the meds adjusted to a place that works for me, Dr. S said we could wait three to six months before my next office visit.  Just another turn and loop on my roller coaster life. 

My nerves are getting the better of me

Today, I go to the doctor today for my three month med check.  I'm utterly and completely nervous, bordering on terrified.  It's not the actual visit that has me worried.  It is the fact that once I report that the Wellbutrin isn't working, it is what will be our next course of action.

Will he try a different add-on med to supplement my Zoloft?  And if so, how much will it cost?

Will he up the dosage of the Wellbutrin?  How much will that increase the price?

Maybe he'll up the dosage on my Zoloft and drop the Wellbutrin.  Or maybe he'll up the dosage on my Zoloft and keep me on the Wellbutrin.  Or maybe he'll increase the dosage of both.

What if he wants to scrap all the meds I'm on and start me on something completely new and different?  Then there's a potential cost increase.  Never mind the waiting period to see if this med is going to work or not.

And like I said, things aren't necessarily bad with how the meds were working before the addition of the Wellbutrin or even after it was added.  Life was okay.  I was doing okay.  My depression and anxiety was somewhat okay.

But I didn't want to be just okay.

And I still don't want to be just okay.

Because really, I'm not.

The price of happiness has gone up

Today was my one month med check with Dr. S.  It went really good.  As I've said in a few past posts, I'm feeling mostly good but still just a bit blah and unmotivated.  I'm also still having some brain issues in that my thoughts are jumbled at times and I'm increasingly forgetful.  Dr. S said there were three options to remedy this:

1. Get on a routine that includes at least eight hours of sleep a night.  Exercise daily and live a healthy lifestyle that includes eating properly.  
2. To increase my Zoloft dosage.  Zoloft tops out at 200 mg and I am currently taking 100 mg.
3. Add an additional medication to give me a boost without the side effects of increasing my serotonin like Zoloft would do.  He would put me on 150 mg of Wellbutrin XL. 

The first option is already something I'm working on and it is slowly falling into place.  The sleep schedule is still not right or perfect but that is because of my husband and his current work schedule.  I am trying to eat better and take care of myself physically and spiritually.  It's a process and one that I'm slowly incorporating into my life again.

Option two and three were the ones we discussed.  He wanted to go with option three and I agreed with him.  I'm worried that more Zoloft will make me into a zombie who cannot feel emotions.  It is already messing my my sexual pleasure but that is something I can deal with for now.  Wellbutrin (generic is Bupropion HCL 150 mg XL) will help with the sexual stuff and should give me the boost I need to get motivated and get past the blah feelings.  It will also, hopefully, help with the concentration issues.

Although I have the pills now, I'm not going to take them until Friday.  My Zoloft is almost gone so I might as well start them both at the same time with thirty pills each.  By doing this I also won't be running out of one two days before the other.  It's a little bit OCD of me but that is how I roll.  

So the cost of my happiness has gone up, at least for now, and will if the Wellbutrin works.  Here is my new breakdown for costs of my medications:

• Bupropion HCL (generic form of Wellbutrin) 150 mg XL tablet -- $38.08 for thirty tablets
• Sertraline (generic form of Zoloft) 100 mg tablet --$19.72 for thirty tablets
• Lorazepam (generic form of Ativan) 0.5 mg tablet -- $16.84 for sixty tablets

The Lorazepam is not something I need to refill monthly and, if history is any indication, the sixty tablets should last me around six months.  This makes my monthly medication bill to be just under $60.00.  Not bad, really.  I did find a discount prescription site and my card should arrive in a few weeks.  I'm going to give it a try since it is free.  Heck, it cannot hurt and if I can get my meds for half price or less, it is definitely worth it.  

Dr. S has also pretty much dismissed the thought that I might be bi-polar.  He still wants me to self-monitor for any signs or symptoms.  But he is feeling rather confident that I'm not.  He did mention that it can turn at any time so I'm to report any problems immediately.

Also, I'm to take the Wellbutrin in the morning.  If I find it messes with me being able to sleep, I'm to switch it to something I take before bed.  It's really just a game of chance and figuring out what works best for me.

My next med check will be in three months on Tuesday, January 8, 2013 at 9:30 am. 

Back in the saddle again

Yesterday, I returned to the doctor after being off my anti-depressant and anti-anxiety meds for at least a year.  Overall, it went as I expected but there were some moments that surprised me, in both good and bad ways.

I waited for a long time for my appointment.  I get so frustrated when I have an appointment and it is not kept.  I realize that things happen and that appointments cannot always be kept but I would feel much better, and be much less likely to have the panic attack I had, if someone would at least communicate with me.  Let me know my doctor is swamped or was called away with an emergency.  Just reassure me that I haven't been forgotten.

What do I mean by a long time to wait for my appointment?  My appointment was for 2:30 pm.  I arrived 15-20 minutes early to check in.  At 3:30 pm, I was finally called back from the waiting room.  I was then put in an examination room while a nurse took my information.  To be fair, the clinic is going to a new computerized system so the intake was a bit slower than normal.  After the intake, I sat there for at least 10 minutes before getting moved to a different examination room.  I finally saw my doctor at 4:10 pm.  This means that I waiting for my doctor for an hour and 40 minutes beyond my appointment time.  I call bullshit.

In this post, I wrote about my apprehension for the appointment and what would probably happen.  It is slightly accurate.  One thing I can say for sure is that I now know that my doctor DOES LISTEN to me.  Huge sigh of relief on that.

We talked and we both listened to each other.  He told me that besides my meds, I need to also be leading a healthier lifestyle that includes getting eight hours of sleep each night, incorporating regular exercise and eating healthy and regular meals.  I know that and agree and will do my best to make those healthy habits stick.

One of his new concerns, and one that I've heard before, is that I might be bi-polar.  His thoughts are based on how my moods sometimes cycle rather rapidly.  I do not experience intense mania, but may be quite "okay/normal" one moment and an hour later I can be impatient and in tears.  Dr. S's concern is that if I'm bi-polar, treating me with only anti-depressants will be a bad thing that can actually escalate the mania moments.  Not cool.

If I am bi-polar, I'm okay with that.  Different diagnosis do not scare me any more.  I feel the more I can be labeled with as far as my mental illness(es) go, the better because knowing what I have to battle against allows me to best prepare for that battle (e.g. medication, research, support groups).  If I can name the problem, I can address it.

The fear I do have if I am bi-polar is affording the medication.  It is much more costly than regular/typical anti-depressants.  Dr. S did reassure me that there are a number of programs available to help offset the cost.  There's a lot of paperwork involved and the application/referral process will take upwards of twelve weeks.  I will need to rely on my parents even more should this be the case.

Because Dr. S isn't fully convinced I am bi-polar, we are going to continue to treat my depression and my anxiety.  I'm back on Zoloft, 100 mg once daily and have Ativan, 0.5 mg that I can take up to three times a day as needed.  I am to be hyper-vigilant for any expressions of mania or high moods.  My anti-depressants should start to show in my moods in about two weeks with them reaching their maximum helpfulness in six-eight weeks.  I am going back for a recheck in four weeks on October 16.

I'm back in the saddle again.

Baby steps

I go to the doctor on Monday.  It will be three weeks since I made the appointment.  It will be approximately six weeks since I had the realization that I needed help and asked for it.  It will be almost eighteen months since I have last seen a doctor for my depression.  It will be at least a year since I've been on medication prescribed for my depression and/or anxiety disorder.

I am terrified apprehensive.

If the visit goes as it has it the past, I know exactly what to expect:

• I will arrive, check in, visit with the financial representative, pay my bill and head to a waiting area.
• I will sit in said waiting area for much too long given I have a scheduled appointment.  There will be people coughing and sneezing and sticky children will be running rampant.  I will glance at the magazines available in the waiting room and maybe read one.
• If I read said available magazines, I will later feel germy.
• A nurse will pop out, mispronounce my name and I will follow along like a little duck while trying to be polite and join in the courteous small talk.
• We will stop at the scale.  If life is being good to me, we will stop at the "skinny" scale that always seems to weigh me at a much more favorable and flattering weight.
• I will be deposited into a little room to again wait.  I will fight the urge to search through the drawers and explore.
• Dr. S will arrive and ask me "what's going on?" which is his way of asking me why I am seeing him.
• I will start to explain.  I will cry.  He will appear to be listening and I sincerely hope that he does listen.  I may or may not have to sit on the examination table and go through some ear and throat viewing and stethoscope listening.
• We will talk about medication.  He will probably suggest a lower, starter dosage.  I will ask for higher dosage.  I will remind him I do not have insurance.  He may suggest some blood work to, yet again and for the third time by my count in nine years, check my thyroid.
• He will suggest exercise.  I will nod in agreement but probably not change a thing.
• He will write a prescription for me.  Probably for Zoloft 100 mg (take once daily) and Ativan 0.5 mg (can take up to three times a day, as needed)
• He will suggest seeing me again in either three or six months.  He will, of course, remind me to call if the symptoms get worse.
• I will leave, get to my car and have a mini-meltdown

Once that is done, I will head to the pharmacy to have my prescription(s) filled and get started taking them that day.

Please, oh please, let my medications start working ASAP.