Thoughts Before Meeting My New Psychiatrist

I need to pull my thoughts together in preparation for my first appointment with my new psychiatrist today, and I thought I might as well do it here.

Medication refills

The discharge prescription from the hospital was for weekly refills. I want to get more medication than this at a time, and here’s my concern. When I have meds, I take them. When the difficulty of getting them outweighs the resources I have available, I either start rationing them or I stop taking them. That’s been a big issue over the last year.

I get that there’s a concern that I might overdose if I had a larger quantity on hand, but here’s the thing. The meds I’m on wouldn’t kill me; they’d just make me barf a lot. If I wanted meds to overdose on, I’d ask to be switched to a tricyclic antidepressant (TCAs tend to be more effective than many other antidepressants, but they can cause a cardiac arrhythmia). But every time that’s been suggested, including during my recent hospitalization, I’ve said no, that’s not safe for me to have at home, because the chance of me overdosing on it at some point is a risk that’s not worth taking. That’s not the decision-making process of someone who’s intent on stocking up on meds for the purpose of suicide.

Dexedrine

I stopped taking Dexedrine last year because I didn’t have a prescriber. It helps somewhat with my mood and concentration, but mostly it helps with the psychomotor retardation (slowing of movement & thinking). I’ve never felt any effect from it right after taking it, and certainly no “high” of any kind, but I have noticed that after 3-4 days either on it or off it, there’s a change in how slow my movement is. I didn’t ask to restart it in hospital because I see it as being symptom-targeted rather than important for the illness process overall, and I wanted to see how much of a change that ECT made in how slow I was. It helped somewhat, but the psychomotor stuff has gotten worse since I was discharged.

Given that it’s hard to get out and do things like go to the pharmacy when I’m super slow, I’d like to go back on the Dexedrine. The highest dose I’ve been on is 15mg twice a day, and 15mg once a day seems to be the minimum dose where I start to notice a real benefit from it.

Appetite

My appetite has gotten worse since getting out of hospital, which is somewhat concerning, as it’s usually not an issue when I’m well-medicated. I’d like to bump up my mirtazapine from 30 to 45mg a day and see if that helps. I’ve tried taking 45mg in the past, and it disrupted my sleep (at lower doses, the antihistamine effects of the antidepressant mirtazapine make it quite sedating, but at high dose, it has stronger effects on norepinephrine, making it less sedating). However, at that time I was only on 300mg of quetiapine (antipsychotic) rather than the 600mg I’m on now. I’ve been taking 45mg for the last four nights and my sleep has been fine.

I don’t know if the psychiatrist is going to be open to doing anything with my meds on the first visit, but I want to go in conveying that I am the one in charge of my treatment. The psychiatrist may not like that, but it’s my brain and my body, so it’s gotta be me in the driver’s seat. As for increasing the dose of mirtazapine myself, she might as well get used to the fact that I’m very proactive in managing my own med regimen, and if changes need to be made, I’m not going to wait around for a doctor to make them. Wish me luck!