Dr. J.

[vaneramos]

She is an East Indian woman in her 50s with a warm demeanour and just enough of an accent that she could tell me to jump of a cliff and it would sound wise. But really, I liked her very much. Maybe she will fall in the middle between Dr. C., who passively listened and hardly gave a word of advice in five years, and Dr. B., who had no patience and essentially told me to get a life. I'm looking for someone who, besides diagnosing the problem and prescribing drugs, will listen to my concerns and help with behaviour modification.

It's too early to tell. As she said, it will take several appointments for us to get to the bottom of things, then we can work out a plan. But my first impression is good.

She explained the anxiety symptoms and panic attacks are part of the same biological serotonin deficit that causes depression. Remeron has been working well for me in some respects, improving my sleep pattern and preventing depression, so she wants to increase the dosage from 45 to 60 mg to see whether it will alleviate anxiety. However she indicated we will also address social and behavioural aspects later.

At the end she said, "I don't work evenings and weekends." She suggested that having a doctor in Guelph to help with crisis management might be important, but suggested the walk-in clinic as another option. "I want you to understand I have some limitations." She is not on call.

"I'm not worried about that," I replied. "I'm pretty good at surviving, I'm just not good at managing."

However, I should consider her suggestion about having a crisis management plan in place. Things haven't been that bad in a long time, but if I start making changes, life is bound to get harder before it gets easier. And I guess knowing what to do when Something Horrible happens is one of the keys to facing situations that trigger anxiety and panic.

Thanks for all the kind replies to my previous post. It is very reassuring.

Comments

[eloquentwthrage.livejournal.com]

Sounds good. I think I need one of those crisis management thingees. People are really pissing me off these days if they cross me. This morning, it was all I could do to keep from exploding in the doctor's office because I showed up at 10:30 for a 10:50 appointment, and I waited for an hour before I told them I couldn't wait any longer. The assistant was like, "Well, I can reschedule you, but not for a few week." I calmly said, "I think you should try to fit me in next Monday since you inconvenienced me so greatly today." She went and consulted the doctor, and I got an appointment on Monday.

It would have been okay except for two things: 1) I had a therapy appointment for my hand at noon, and 2) I heard one of the assistants tell the others that the radiologist had decided to take her break early, and not tell anyone, and that was the reason I was waiting. I was not happy.

But anyway, keep up the progress...

[vaneramos.livejournal.com]

Wow, it sounds like you handled that problem pretty well. I have the hardest time asserting myself when it feels like the world is passing me by.

The kind of crisis she had in mind was suicidal feelings, because thoughts like that are part of my history. It has been a long time though. I have a lot more hope than I used to.

[eloquentwthrage.livejournal.com]

Paranoid much? ;-)

[vaysha.livejournal.com]

van- what is the difference between remeron and say prozac? Do they both work on seratonin levels?

I have generalized anxiety/a tendency towards ocd as a way to fixate the free floating anxiety and at times depression- I am on prozac but I find that while it works to stop the repetetive thoughts that go round and round it has a tendency to be stimulating ad cause agitation. I am wondering what your thoughts experience on the remeron is.
xo

[vaneramos.livejournal.com]

Remeron (mirtazapine) is a newer drug and based on something different from the SRI function of Prozac, Zoloft and a host of other antidepressants. If I had done my homework, I would know how it works and why, but must admit I haven't done any research.

I took Zoloft for a few months in 1995 and it gave me the same problem you have with Prozac. In hindsight I can see how the agitation exacerbated my anxiety symptoms at the time.

Paxil had the opposite effect. I took it from 1996 to 2001. It made me sluggish and compounded my problems with concentration, memory, organization and following through with plans.

Remeron has not had either of these effects. The most dramatic benefit is that I'm sleeping 7 to 8 hours instead of 5. What used to happen to me is I would have an anxious response to something bad happening, my thoughts would fixate on the problem the way you describe, and I would start sleeping worse and worse, getting more upset until I was so exhausted that I lapsed into depression and an "I don't care" approach. Then I would do nothing but play computer games for a couple weeks while dishes piled up in the kitchen.

Now when anxiety symptoms hit, I might have one bad night when I only sleep three hours, but those anxious thought patterns don't persist and I invariably catch up the following night. In general I have noticed an increase in my energy, but not in an agitated way -- it's just so nice never to feel overtired. And I have been more creative and productive because of it. I'm also gaining confidence in my ability to make and follow through with plans, even handle situations that trigger anxiety.

The one difficult side effect of Remeron is that it increases appetite so I have put on about 15 pounds. This is not a huge problem because I'm only marginally overweight, but I'm trying to eat more fruit when I get hungry, and going to the gym to fire up my metabolism.

I suspect it also depressed my libido slightly, but did not cause impotence the way Paxil did.

[vaysha.livejournal.com]

I couldn't take paxil at all- it made me feel like a zombie. I've been sticking with prozac and simply taking herbs and vitamins that are relaxing and so far it's been ok although along with the agitation I also can get really bad tension in my muscles particularly my jaw from clenching at night time.
=/
I am so so happy you found something helpful for you.

[daisydumont.livejournal.com]

i'm so glad you think you'll work well with dr. j.! having an emergency contact is probably a good idea, though. best wishes as you get to know her better. :)

[vaneramos.livejournal.com]

Several years ago I made an agreement with a friend who lives nearby that we could phone one another at any hour if necessary, but we probably need to reaffirm that from time to time.

[willowing.livejournal.com]

glad you got on with her, it's always good to have a therapist you click with ... I've had a few gems of my own. *more hugs*

[vaneramos.livejournal.com]

Thank you, she may turn out to be a gem!

[ciddyguy.livejournal.com]

This is great Van, I'm glad that initially she seems to be what you need. I'm in agreement that due to her location and her limitations, having a crises management there in Guelph when she's not available is indeed a good idea.

Good luck with all of this.

[vaneramos.livejournal.com]

Hugs back, Craig. I do know, and you're a great listener, too. I always have a ready ear, too. I'll be hitting Toronto on Friday, so hopefully we'll have a chance to connect this weekend.

I got the impression that this new therapist was much more interested in what I had to say, and in how I was feeling. I think that's a good sign.

[grandiva1968.livejournal.com]

Yer not as CURAAAZEEEE as me!

I'm glad things are looking.  Not neccessarily up or down, just less fuzzy.

*HUG*

[vaneramos.livejournal.com]

Niether more nor less. We're all just crazy in our own ways. But yes, things have seemed a little clearer lately.

xoxo

[roosterbear.livejournal.com]

Maybe she will fall in the middle between Dr. C., who passively listened and hardly gave a word of advice in five years, and Dr. B., who had no patience and essentially told me to get a life.

Aaiiieee. Both B and C sound dreadful. There is much much better than that out there.

I hope she works well for you. The first impression of Dr. J does indeed sound hopeful. This is good news.

[vaneramos.livejournal.com]

C was my first psychiatrist, and at the time I was so relieved to have somebody listen to me that it took me several years to figure out we weren't getting anywhere. So I quit therapy for several years. When I decided to go back 18 months ago, Dr B was the first one my GP recommended and referred me to. It has taken be all this time to get to see him, figure out he was a quack, go through other avenues to get another recommendation and ask my GP for a referral. Phew. So I sure hope it works out.