Monday, March 24, 2008

Clinical Confession

I think the objectification of the self as a patient under treatment qualifies as "outside," though the narrator may be biased.

Since I was begun on a new antidepressant last Wednesday I haven't cried, and have felt better in general--until this afternoon, when I began to feel fragile. This makes me suspect I should increase the dose of the antidepressant now lest I lose the effect, as I have so many times.... Oh, and I just remembered I forgot one medication this morning--Abilify!

That's not good, as one test of my sanity is remembering all the medications I am supposed to pour down my gullet. It's no secret and no shame, here: Lithium, Effexor, Prozac, Wellbutrin, Abilify, Adderall, Enalapril, Aspirin, Celebrex (and M.S. Contin on bad back days). Klonopin at bedtime.

Of course I am transitioning from Prozac and Wellbutrin to Effexor, the new antidepressant, why I am on three at present. I'll stop the Prozac and Wellbutrin on Wednesday.

I used to say to my patients that if they took no more than one pill per decade they could be considered healthy. By that criteria I can't be healthy, as I take two pills per decade. Still, an increase in medications also reflects a doctor's inability to properly treat a disease; doctors always add more in pursuit of the desired effect, whether it's to control seizures or blood pressure. But what is "mood?" And what are its normal variations? And are some destined to be lifelong melancholics like Eeyor?

Flowers for begin to come out of a depression and "smell the roses" when inexplicably, the normal mood retreats and you're left alone again in the shoddy outhouse of your mind. This is what I fear will happen to my Effexor response.

What must it be like for a person who's never seen a psychiatrist to read my blog? Monsanto coined the term, "Better living through chemistry." I can see a suspicion that people like myself just can't handle a little pain in their lives, and thus go running to the doctor for every little anxiety and mood shift. But it's not like that.

I didn't see a psychiatrist until I was 29, though I had suffered severe depressions since the age of 13. I had decided it was simply normal to be suicidal for six months at a time, that everyone must go through it.

I don't expect psychiatry to help me with grief over my daughter's death, or to give me the courage to take my former landlord to small claims court (which I'm doing). I just want to be normal, with normal sadness and anger and fear, the kind we all have. What makes me abnormal is my brain's ability to generate a persistent mood, whether the pit of depression or the peak of mania, for an extended time, a time long enough to damage my life and relationships. For a mood disorder to be worth treating, it must interfere with basic functioning. It must harm one's life.

How I do go on! So much for today's confessional. I'll end with a poem on depression, another objectification:

On the Left Brain

Sometimes I think my left hemisphere
swollen like some great infected testicle,
necrotic, convoluted and gray.
Its vein walls are thinner than the membranes
lizards use to shield their eyes
and inside blood flows so slowly
I consider it a miracle
that a single rational thought escapes.

The great vein of Galen sits
at the bottom of both hemispheres
like a distensible sewer line that eventually empties
through the superior vena cava
into the heart’s right chamber
where its effluent mixes with blood
from the bowels and extremities,
pools in the lungs, and, re-oxygenated,
races from the left ventricle
back to everywhere else.

I tell you this because
the dream engine that pulls the body
has no conception of itself,
and though dependent on blood
is blind as an infected testicle,
as my metaphors bear witness
and your brain understands

Not rated,



  1. Aspirin? Your drugs all sound so exotic, then ... Aspirin. I guess it really is the miracle drug.

    Hoping for better days soon ahead for you.

  2. "Still, an increase in medications also reflects a doctor's inability to properly treat a disease; doctors always add more in pursuit of the desired effect, whether it's to control seizures or blood pressure. But what is "mood?" And what are its normal variations"?

    So often, I fear, all those medications affect what many of us consider normal variations in mood.

    Like Richard, I am hoping for better days for you, for us all soon.

    By the way, considering all those meds on board, you write amazingly well.


  3. That's eleven different drugs on that list, mister.

    You're taking eleven different drugs daily?

    Is it safe to be taking eleven different drugs daily?

    I'm not asking this lightly. I seriously want to know.

    I'm sure you've done your homework regarding possible side effects and drug interactions. Still. That's one hell of a lot of medication you're putting in your body.

    Celebrex raised my eyebrows. Have you been on it long? Are you supposed to be taking aspirin with it? What I mean is, I was under the impression that you shouldn't be taking aspirin or any other OTC pain relievers with Celebrex.

    Is there a job in which a person could nothing all day except listen to and discuss a patient's symptoms and the therapies and/or drugs that patient is partaking of? I need that job. I love, truly, talking to people about their medical conditions, listening to them, then questioning them about their symptoms and what sort of treatment they are or are not seeking. Is there a job that fits that description? I need to be doing that job.

    Seriously, CE---is it safe to be taking all of those drugs?

  4. Is it safe? "Who cares?" is the short answer for one depressed. ;-) But the interaction of drugs is much overrated; except for obvious caveats like avoiding vitamin K with coumadin, most doctors simply keep prescribing until the patient has a complaint--then they go back and try to tease out which addition caused what. But the human liver is amazingly adept at processing all these medications. For the most part, I don't even notice them.

    To do the job you wish you would likely need an R.N. to become a medication nurse--and psychiatric medications are the sexiest, so maybe a psychiatric medication nurse.

    Pat and Richard--we are going to make first Friday in April, right? Is it a date? Thanks for all your support.

    And for those who don't know, Pat is the truly talented one around here. You should see her artwork; she writes poetry as well. I hope she posts her website here again for the edification of all.


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