What Brought You Here?

Friday, November 8, 2002

1:22 am
Today I Saw My Psychiatrist
It seems like the Effexor is starting to work, maybe. Well, it's working on my bulimia, anyway. When this last major depressive episode started, I was on 100mgs of Zoloft. When I started forgetting things and lost all ability to concentrate, and the entirety of my alimentary activity for days on end consisted of nothing but bingeing and purging (i.e. "sudden loss of appetite") my doc decided that, since I freak out at higher doses of SSRI's it would be best to change the type of pharmaceutical dick I'm sucking altogether. So he started me off on a wee lil bit of effexor and cut my Zoloft down to 50mg, which is a big fucking leap. Into a black hole. See, even though the Zoloft didn't prevent me from entering an episode, it did mask the one thing that most people associate with depression: the hapless crying all the time over everything and nothing at all.

He should have known better. I'm very sensitive to the SSRI's1; once he tried to increase me from 100 and I agreed to try 112.5 but got all flaky and manicky and made him let me keep it at 100. He really should have known that, if I show a change in effect with an alteration of 12.5 mg, then 50 was going to put me over the edge. Then again, I should have known better, too. But I am not the fucking doctor. Being totally ineffective at even wanting to fend for myself is one of the symptoms of my illness. Luckily when I leave a sobbing message ending with the word "fuck" on his voicemail, he gets back to me the next day and tells me to bring the Zoloft back up.

Unfortunately the combination of 75 mg of Effexor and 75 of Zoloft have made sex virtually impossible. I have complained to him about this before. But this time I was not going to let him discount me with one of those "weighing the benefits and debits" bullshit. You put me on drugs that make me unable to have sex, you'd better give me a drug that will make me able to have sex He first suggested bupropion, at which point I reminded him that I have an eating disorder.2 (Aside from which, I really think being on 3 different anti-depressants at once would really cramp my style) Then he suggested some anti-impotency drug which is of course not recommended to be prescribed to women because our sexual dysfunction, of course, is not an issue upon which the order of life on Earth revolves. Baseball players do commercials for Viagra, but who the hell cares if 20 million depressed women are feeling even worse because they can't have sex? Nothing helps alleviate those feelings of guilt and worthlessness better than being a cold fish, right?

At any rate, I took the prescription and had to have it filled at a non-uni pharmacy because they don't carry it and my shitty insurance doesn't cover it. I actually got rather pissed off there, and said to the pharmbot "So you guys have the drug that makes me UNable to have sex but don't have the one would make it possible?"3 Ummm, yeah. Impulse-control issues.

I always find it interesting to compare the DSM code he writes on my billing slip each time. Today, I apparently managed to "upgrade" myself from 296.32 to 296.33, i.e. reccurent major depression moderate to recurrent majot depression sever without psychotic features. I wonder if this is some sort of an omen. I will have to pay close attention during the next week as I increase my effexor to see if I can win a "with psychotic features" DX next week.

I haven't been bingeing and purging very much. In fact, I think I may have actually gone a couple of days without doing so at all. Not really eating much otherwise, though, and my weight has dropped to just a few pounds from the "danger zone." So I deliberately binged and purged tonight. I can't even begin to justify the logic behind that action. Both my father and my piece of ass called while I was bingeing. I told my father I'd call him back, I told my POA the truth and how long he should wait before coming over.

The anti-impotency drug worked, by the way. I don't even want to consider the fact that it might be the placebo effect. I want to believe. I have gone on medical leave for the remainder of the term in order that my psychiatrist might play chemistry set with my brain as he pleases. I feel very guilty for this. I am in possession of a relatively large amount of triazolam, considering that I am a mental patient known to be a both a drug abuser and very self-destructive. It actually surprises even me that I have not abused my triazolam.

I guess I do have some shred of a self-preservation instinct remaining.

1. Haha. Welcome to the human race.
2. Fortunately for the disproportionately large percentage of nicotine-addicted cold fish with eating disorders, not many (widely read) doctors seem to care about this anymore.
3. Pharmaceutical yohimbine.

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