Monday, February 8, 2010

Hell Is What You Make It.

Last night, my relationship ended. If time is any indicator of intensity, it was eighteen months to the day. It felt like being ripped in half. This morning I went and saw my psychiatrist as per my appointment. His main concern was my moods over the last few months. We didn't discuss the relationship breakdown for too long, but he did mention that he would withhold treatment for comorbid moderate to severe depression until I re-adjust and finish the grieving process. He did switch me back to instant release Ritalin and helped me come up with a dosing schedule so I could get twelve hours of medication coverage through the day.

We're working on where I want to go in life. He's insistant that I go back to university, and wants me to consider what I enjoy, what I'm good at, and how I can make those activities stimulating and varied enough to do them professionally. He also recommended me a coaching service, and is looking into an appropriate psychologist.

My sleep patterns are OK - but they're still fuelled by temazepam. The treatment he suggested for the depression is a sedating tetracyclic antidepressent called Avanza (also known as mirtazapine), which he believes may tackle both the depression and also eliminate the need for benzodiazepines or hypnotic type sleeping pills. He also says its safe to take with stimulant medication. His assessment was similar to the one I got from the psychiatric nurse - I seem well adjusted, just chemically imbalanced and consequently confused. Initially I was going to see him weekly, but now I'll be seeing him for further assessment every two to three weeks.

My next appointment is on Thursday. I'll likely be out of temazepam by then. I've been coping pretty well generally, but if I start sinking back into the depression I had last week, I'll probably talk to him about antidepressents. It wouldn't be my first time on them - I've tried taking St. Johns Wort for depression  as recent as a few months ago (but it seemed to weaken Ritalin's ability to help me focus), and years ago I was on Sertraline (which was horrible - a teenage boy should not be deprived of his sex drive).

Tonight I'm going to try to get to sleep without temazepam. Doctors keep asking me if I've get enough temazepam to last me until the next appointment. Frankly I'll be happy if this is my last script of the stuff for a while. I've had insomnia since before I was eighteen months old, and sleeping tablets have been the only thing that really consistantly beats it. I tend to just shut my eyes and try to ignore my mind racing, my body will get heavy and I won't be able to move. Eventually I might get up, but if I'm too tired I'll just cop it. Sometimes I kind of fade out at around 4AM, but often the alarm will go off or the phone will ring and I'll just think "Shit, this is going to be a fun day." Falling asleep at around 4 is generally worse than not sleeping at all - being jolted awake in the middle of a cycle brings about the most unpleasant sleep inertia experience. Tonight it'll be chamomile tea and warm milk.

So now its treatment time.

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