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Aug. 25th, 2015 12:46 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
the_rckMy psychiatrist and I decided that it doesn't make sense to start a new medication this close to surgery, not when we don't know if I'll need chemo. We're kind of assuming tamoxifen, but my doctor wants to know for sure because it takes at least one potential medication off the table. Also, several of the potential meds cause constipation, and I don't want anything like that until after I'm off whatever pain killers they give me for the surgery. It's only three days. Ativan will see me through that pretty well, and she says that it doesn't interact with much of anything that they're likely to give me.
We talked about some SSRIs, including some that are new enough that we're certain I never previously tried them. I haven't had great luck with SSRIs, but they sound like the safest things to try right now. My doctor mentioned Remaron as a good candidate from another family of drugs. The main drawback with that is that it's certain to lead to weight gain that my knees and ankles could not endure. The tricyclics are marginally less likely to cause weight gain (though still very likely), and the one time I tried one before, I had to stop it because it lowered my blood pressure too much. I'm willing to deal with that for a few months as long as I don't need to leave the house without another adult with me.
I think we will probably try an SSRI first. None of them are ideal, but they sound like better options, side effect wise, than Remaron or any of the tricyclics. I do need to check with my pharmacy to see if they have records going back fifteen years and can tell me if I actually tried certain medications and what the doses I was taking of Tofranil and Klonopin were. I took both of those for several years. The Klonopin was for non-specific myoclonus, and the Tofranil was off-label for urinary frequency. I stopped both of them some time in 2001 when Scott and I got serious about possibly having a baby and when, because I was no longer leaving the house much, taking them seemed unnecessary.
We took MAOIs off the table because it would be a couple of months before I could even start taking one because I'd have to get off of Wellbutrin completely first. There are also a whole host of complicated hoops to jump through for an MAOI that I'm not convinced I want to deal with. When I took Nardil, twenty plus years ago, I could only eat vegetables if they were cooked to mush, and I pretty much couldn't eat fruit at all*. What with the other restrictions on diet (many of which my doctor says no longer apply), I was mainly able to eat bread and meat. I did lose weight during that time. We're also not sure how much of the improvement I saw then was actually the Nardil and how much was dating and marrying Scott (also, giving up on trying to do grad school while working full time).
We also took all SNRIs off the table because the risk of repeating the Effexor side effects is unacceptable. Those were actually life threatening and not worth risking.
*If I recall correctly, this is the period when I got the IBS diagnosis which I rather think is baloney. These days, I'll have an episode once every two or three or even four months where I need to be near a toilet for two or three hours, usually in the morning. It has never happened when I needed to go somewhere that day or when I was away from home. Maybe I should talk to my PCP at some point about whether or not I actually ought to have that diagnosis. I know it once made a different doctor laugh off my assertion that I had an intestinal bug. He said it was just IBS and stuck with that until Scott and Cordelia also came down with it. Of course, he was an idiot on other occasions and almost never actually listened to me. He was, unfortunately, almost always the doctor working walk in late or on Saturdays.
We talked about some SSRIs, including some that are new enough that we're certain I never previously tried them. I haven't had great luck with SSRIs, but they sound like the safest things to try right now. My doctor mentioned Remaron as a good candidate from another family of drugs. The main drawback with that is that it's certain to lead to weight gain that my knees and ankles could not endure. The tricyclics are marginally less likely to cause weight gain (though still very likely), and the one time I tried one before, I had to stop it because it lowered my blood pressure too much. I'm willing to deal with that for a few months as long as I don't need to leave the house without another adult with me.
I think we will probably try an SSRI first. None of them are ideal, but they sound like better options, side effect wise, than Remaron or any of the tricyclics. I do need to check with my pharmacy to see if they have records going back fifteen years and can tell me if I actually tried certain medications and what the doses I was taking of Tofranil and Klonopin were. I took both of those for several years. The Klonopin was for non-specific myoclonus, and the Tofranil was off-label for urinary frequency. I stopped both of them some time in 2001 when Scott and I got serious about possibly having a baby and when, because I was no longer leaving the house much, taking them seemed unnecessary.
We took MAOIs off the table because it would be a couple of months before I could even start taking one because I'd have to get off of Wellbutrin completely first. There are also a whole host of complicated hoops to jump through for an MAOI that I'm not convinced I want to deal with. When I took Nardil, twenty plus years ago, I could only eat vegetables if they were cooked to mush, and I pretty much couldn't eat fruit at all*. What with the other restrictions on diet (many of which my doctor says no longer apply), I was mainly able to eat bread and meat. I did lose weight during that time. We're also not sure how much of the improvement I saw then was actually the Nardil and how much was dating and marrying Scott (also, giving up on trying to do grad school while working full time).
We also took all SNRIs off the table because the risk of repeating the Effexor side effects is unacceptable. Those were actually life threatening and not worth risking.
*If I recall correctly, this is the period when I got the IBS diagnosis which I rather think is baloney. These days, I'll have an episode once every two or three or even four months where I need to be near a toilet for two or three hours, usually in the morning. It has never happened when I needed to go somewhere that day or when I was away from home. Maybe I should talk to my PCP at some point about whether or not I actually ought to have that diagnosis. I know it once made a different doctor laugh off my assertion that I had an intestinal bug. He said it was just IBS and stuck with that until Scott and Cordelia also came down with it. Of course, he was an idiot on other occasions and almost never actually listened to me. He was, unfortunately, almost always the doctor working walk in late or on Saturdays.
