This Thanksgiving, I'm thankful that the medication seems to be helping

G is 8-years-old, and I have to remind myself, when he is being a pain-in-the-tail, teasing, annoying, talking about poop every 29.5 seconds kid, that medication will not change that.  Sometimes it is hard to tell how much of a kid's weirdness is actual, potentially diagnosable problematic weirdness and how much is just being a kid.

I sat with a class of 8-year-olds at a theater performance today.  It was a nice reminder that all second graders, and not just my kid, 1. can't sit still for long, 2. talk very loudly about all manner of random sh*t, and 3. look like ragamuffins.

We are at 2 weeks of Celexa use for G's actual, diagnosable weirdness.  So far, so good.

What I noticed almost immediately after beginning it is that he started falling asleep without his verbal repetitive loop of worry, even when he doesn't take melatonin.  He began the medication on a Monday.  On the following Friday and Saturday nights, he fell straight to sleep and didn't wake during either night.  He has stopped freaking out over every single thing.  If something gets moved, he expresses his displeasure, but he just says it.  He doesn't scream it or cry or otherwise throw a tantrum.

I have noticed that he is saying, "I love you" more to me than he has in a very long time, which makes me wonder if he was just so busy trying to contain worry that he couldn't bother with affection and communication.  That makes me sad.  And it also makes me very glad we took the steps we did.

I wish I could say that I am without worry over him, but I can't.  He has had a runny nose, so my mind immediately went to, "He is allergic to the medication," although nasal drippage is not a side effect I can find anywhere in the literature.

He threw a gigantic fit the first night we gave him the medication, which had me convinced that he would end up homeless, schizophrenic and suicidal, and that worst-case scenario remains at the back of my mind.  I think he thought he would take the medicine and wake up a different person. He kept asking, "Will I still be me?"  He and I are now taking our "brain" medication together every morning, which I think helps him, as did the realization the next morning that he was the same.    

He got a haircut today and didn't cry afterwards, which had started happening with great regularity and led me to start whacking at his hair myself to avoid an actual salon.  He would have preferred to leave it longer, in his eyes and untouched by the stylist, but he was ok.

I don't want perfect or spectacular or amazing.  I'm thankful that my kid, for right now, is doing ok.

Getting older and medication tweaking

Because I'm not in the throes of despair and have come to terms with taking medication, I sometimes forget that I have mood issues.  Eventually, though, I will have a brief relapse that reminds me that I am not cured, only in remission and continual recovery.

I suspect I am starting to experience peri-menopause because my PMS mood symptoms, which have always been unpleasant for me and others, have worsened considerably over the past year.  The frustrations of dealing with young children and their constant badgering day in and day out also contributes to my angry blow-ups.  I have a very, very hard time recovering my tenuous mood stability when every single morning I have G or M (and often both) subject me to an argument or crying fit.  Though I might try mightily to remain calm, the boys' tantrum stamina is too much for me.  By the time lunch rolls around, when they are becoming tired and cranky, I have only just recovered from the morning.

At my last psychiatrist visit, I explained the situation and am now free to take an extra half-dose of my antidepressant during my PMS time.  It helps, but it also brings back a little of that feeling of, "Why can't I deal with this on my own...without meds?"

This PMS/age-related stuff, in addition to bumming my knee a bit during a workout last year and trying unsuccessfully today to fit into my wedding dress (what WAS I thinking attempting that???) has got me really stewing over turning 39 later this summer.  Since I'm not a procrastinator, I like to get my freaking out over turning 40 over and done with the year prior.

When I think of myself now, compared to who I was at 21 or 24, I like myself so much more.  Maybe it is the life experiences...the blessings of time and a small nugget of wisdom I may have picked up along the way.  But I dislike how my body tends to just do what it likes without my input.....my brain, my chemicals, my hormones, my overly-stretched abdominal wall.

Does this mean I'm gonna die soon?

Today has been a day of all sorts of good news.  

This morning I learned that next Friday G will be having his last speech therapy session followed by his exit evaluation/meeting.  In less than a year, he has gone from a slobbery mush-mouth to an age-appropriate pretty articulate little kid.  

In N's folder was a note from her art teacher stating that N's artwork is being entered into a local (and pretty prominent) museum's art contest.  She was one of 5 students selected from all the second graders at her school.  

Wow!  Superb news!  Exciting!

To prove that OCD and generalized anxiety cannot be eliminated, only relieved, by antidepressants, I did have the thought, "Surely all this good news means I am gonna die soon because things cannot possibly be going so well without something horrible happening."  Old catastrophic thinking habits die hard.  I was able to swish it away with my great Jedi-Lexapro force, but the fact that it still reared its head is always a little disappointing.  I may feel cured, but I ain't and never will be.  

Of course the something horrible could just be the weather, which is freakishly warm for January and surely a sign of humanity's doom.  Most people enjoy the days of 65 degree temps in winter, but they set me into short panic spasms.  

Dammit, it's January.  We need some snow if for no other reason than to lull me into a false sense of security that global warming may not really be real (despite endless scientific studies showing it is).   

Somebody seems to be winning today's irrationality fight, and it's not the medicated side of my brain.  

The hounds of hell or "What happens to my mood during PMS"

I started my monthly cycle at age 10.  From what I understand, some girls start their periods and may wait months before another one comes around.  This was never my problem.  From the get-go, I had a period every.single.month.  It took pregnancy and breastfeeding to give me a reprieve.

I think I was a pretty normal child prior to menstruating, but I really believe all the hormone fluctuations are what turned on the anxiety, the OCD, the premenstrual insane moodiness that made my mother hate my guts every third week of the month.

Birth control pill usage in my twenties seemed to level me out.  I still had the anxiety and OCD, but not the raging, the outbursts, the feeling that I simply could not control my emotions.

When I became pregnant with M while on birth control pills, D said he'd never trust them again, and I was all too happy not to be in charge of birth control.  Who needs the expense?  Plus, the pill has the ability to turn my normally pathetic libido into a pathetically nonexistent libido.

Yesterday, though, I experienced the "light switch affect," which is when my mood literally feels like someone hit the switch and I went from feeling relatively normal to feeling like a feral cat with rabies.  Sure, the district calling off school AGAIN didn't help.  Sure, it didn't help that G hadn't napped and was more or less a ramped up version of his normal wild thing.  But it is plum scary when I can almost feel the chemical shift inside my head and the fallout from it.

So I am wondering if perhaps I should consider going on the pill for strictly mental health reasons.  Because I really, really don't want my children to remember me as a raving bitch.  Or I may wait and speak to my psychiatrist about this at my next visit since I've heard that taking a slight increase in one's AD during PMS week can also minimize the wild mood swings.  

And the med saga continues-----

When the medical assistant finally returned my call, she told me everything was fine and they had Rx'd Zoloft for me. My jaw nearly hit the floor. This ain't like substituting grape juice for apple juice, people. I had horrendous side effects from taking Zoloft the few short weeks I took it in 2005. So I told her under no circumstances can I take Zoloft. She said she'd have my ob call.

Late this afternoon I got a call from the medical assistant. They were gonna call the pharmacy and ok the Lexapro 20 mg, but asked that I make sure it is ok to take with my new psychiatrist. I told them that the only reason I was even filling it is because my former psychiatrist left me in the lurch. Once I get an Rx from my new psychiatrist later this week, I'll be golden.

Of course, she told me that Dr. H. said the Lexapro is safe to take, which I FUCKING ALREADY KNOW since I have already gone through a pregnancy while taking it. This came off as if I'm the one making a big honking deal about being prescribed Lexapro.

And so I have decided to do the following:

1. Write up and give my ob a brand spanking new informed consent about taking Lexapro during this pregnancy (since I'm going for my 32 week visit tomorrow).

2. File a grievance with the KY Medical Licensure Board on my former psychiatrist. Even if it comes to nothing, it will make me feel better because not informing patients was completely unprofessional and negligent when it leaves patients in a medication lurch, as in my case.

3. Pray that my new psychiatrist doesn't give me a shitload of grief about Lexapro.

What about MY RIGHTS?

I bitched on FB about a dilemma that began in July and clearly isn't going to end until, perhaps, later this week. While I think it will all work out fine in the end, it has provided me a considerable amount of anxiety, something I don't need given the fact that I can create my own anxiety out of nothing.

I have been seeing a psychiatrist since 2005, when it became apparent the 50 mg of Zoloft I was taking was not cutting it. I was very depressed and began having intrusive thoughts about harm coming to N, and by this I mean thoughts of stabbing her or watching her wrap a plastic bag around her head and suffocating. And these weren't just occasional thoughts. My mind was bombarded with these horrendous thoughts constantly. They would not stop.

And so I was diagnosed with OCD and GAD. I was told that people with OCD require much higher doses of antidepressants than other people, like 4 times as much. And so I began taking 20 mg of Lexapro, and have been feeling more or less well ever since.

The last time I saw my psychiatrist was in April. Cut to last month, July, when I called for an August appointment. I was informed that my psychiatrist had left the practice. Unfortunately, none of the other psychiatrists in this practice accept my insurance so I had to scramble for a new psychiatrist. I was able to get an appointment for this Wednesday; my medication runs out this Thursday. I'm sorry, but that is cutting it way too close.... ya know, given my anxiety and all. I need to know I've got a reasonable supply in case something happens, like my car breaks down or the new psychiatrist has to cancel for some reason.

Three weeks ago, when I saw my ob for my 29 week appointment, I told her I had been struggling more with my anxiety, due to the class I'm taking, N starting preschool, having been sick, and the whole "left in the lurch by my psychiatrist" thing. Dr. H, clearly seeing how freaked out I was, gave me an Rx for Lexapro 20mg to get me through the remainder of the pregnancy.

This morning, I took this Rx to my local Sam's Club Pharmacy. A few hours later, I get a call from the pharmacist who has to read to me about the "risks associated with taking this medication in the final 3 months of pregnancy." I told him I was aware of the risks, and accepted the risks, and had given my ob an informed consent regarding taking this medication. He said he still had to wait to get approval from my ob....even though my ob was the one who prescribed the Lexapro. I'm sorry but if that is not the most stupid thing I have ever heard of I don't know what is.

And so I called my ob and left a message saying that I need my fricking Lexapro otherwise they are gonna have a very mentally ill person on their hands for the next 8 weeks. I doubt it will come to that, but apparently no one besides me realizes the anxiety that goes along with thinking you might go cold-turkey on your meds. While still taking a class. While raising 2 children. While being 32 weeks pregnant. None of these makes a healthy combo.

So here we have, at least in my opinion, one of those delightful "momma's good versus the good of the fetus." And until I get an approval for my Lexapro, the good of the fetus is outweighing my good as a mentally healthy, happy and non-stressed momma. Because it is REALLY healthy for the baby to have a mom who winds up in the hospital due to lack of sleep and failure to eat due to overwhelming anxiety. I have been there before, and I have no doubt that I can end up back there terribly quickly.

Believe me, I will be asking if this is a Sam's Club policy or do they do this for every antidepressant Rx for pregnant women not prescribed by a psychiatrist. I never had this problem while pregnant with G.....but a psychiatrist Rx'd it then.

Somebody is clearly itching for a fight with an almost 160-lb, 8 months pregnant woman. They have no fucking clue who they are dealing with.

Warranties. Guarantees. Certainties

Actually this post should be called, "Why I HATE Obs," but I don't want every rabid ob in the country to make hateful comments on my blog.

Yes, I know they are the most sued medical specialty and have outrageous malpractice insurance. I feel for them. They deal in a field where people have their hopes and dreams focused on that precious cargo, and if something goes wrong, it is far easier to blame a doctor than nature or god or themselves.

But for just once I'd like for an ob to try a little bit not to terrify me to stinking death. Some history:
In May 2006, I saw my ob for an annual exam and asked her about the use of my AD, Lexapro, during pregnancy. In her defense, she said she prefers women to use Zoloft or Prozac. I told her I can't take Zoloft due to serious side effects and that my psychiatrist was ok with me using Lexapro during pregnancy. She seemed ok with that. She didn't tell me I needed to switch.

Fast forward to last week when she tells me I need to get off my Lexapro. Uh doc, you think you could have said this last May long before I started trying to get pregnant? She mentioned things like babies possibly developing ADD or ADHD and possibly having respiratory problems at birth (which I knew about). She said something about fetal demise, and I think that is when I stopped breathing and thinking and went into panic and pissed mode.

Now I know her job is to warn me (and cover her ass), but really, when I tell her straight up I HAVE GAD AND OCD (not 1, but 2 anxiety disorders) and am medicated and under the care of a psychiatrist, DO NOT TELL ME SHIT LIKE THIS!!!!!!

And then she suggests I start taking Prozac in addition to my Lexapro until I can wean off the Lexapro (sure, expose the fetus to 2 ADs, not just 1). When I asked her what would happen if I didn't respond to the Prozac or had serious side effects, she said I would go back on the Lexapro. (I didn't tell her that Prozac tends to make patients more anxious which is specifically why my psychiatrist avoided giving it to me in the first place).

And then she actually looks at Prozac's information and tells me nevermind, Prozac has the exact same warnings as Lexapro.

How many weeks of therapy will it take me to get over all this crap?

I think I was too stunned to process a response to her. And it wouldn't matter anyway because she is ignorant like most of the rest of the world about mood disorders and medication. And her game is "avoid litigation at all costs."

So here is my response to her:

God knows, if I had my preference, I would have no need for antidepressant medication. Under no circumstances do I like the idea of potentially exposing my baby to anything that may harm him/her. However, given the extent of my 2 anxiety disorders and the fact that I have to function for myself and my daughter, it is not in my best interest, my family's best interest or the best interest of the fetus for me to change or stop my medications.

Granted I am not a physician, but I have consulted my psychiatrist and read lots of books and research concerning AD use during pregnancy. I know there are risks, but there are also serious risks if I forego my meds. It is far more risky if I switch meds when the one I use now works at a low dose. It is entirely possible that if I attempted a switch, I would have to go back on the Lexapro at an even higher dose (and I am on the lowest dose now). Plus, if I have to endure the weight loss and insomnia that occur when my anxiety rears its head, that isn't good for anyone.

Pregnancy and birth are a risky business, in general. Always have been. Plenty of children are born who develop ADD or ADHD who's mothers never took ADs. Plenty of babies are born with respiratory difficulties who's mothers never took ADs. I have mood disorders and my mother never took ADs. That is genetics and nature and chance. I accept that.

I know your job is to present information to me so that I am well-informed but the mistake you make is 2-fold: assuming I don't know shit about my own mood disorders and the resulting risks of medication and assuming you can speak to me in the flippant way you do other patients who don't take things to heart as much as I do.

There, I feel better. I told her, "Well, we'll just have to hope that everything works out ok." And isn't that all we ever do anyway in life....pregnancy or no, meds or no.