new meds

[piranha]

finally got myself to make an appointment with the disliked GP. as usual he wasn't caught up on my case, spent most of the time in front of his computer, and then told me the same things the internist had already told me. just before he disappeared out the door i managed to tell him that my biggest problem is really not my heart, but the depression, and would he please try to add an SSRI to the wellbutrin, or i had to stop it because it was gonna end badly otherwise.

and yay, he gave me samples of cipralex (escitalopram) to try. i'm taking 5 mg for now, for the next 4 weeks. i don't want to get my hopes up, but something better work, *sigh*.

as always the most amusing thing are the possible side effects. aside from self harm and suicide risk, i might also suffer from akathisia [1], agitation, heart palpitations (for extra laughs), emotional lability (yeah, like i am not labile now), aggression, hostility, depersonalisation. i might become a real bundle of joy to be around! the doc's biggest concern seemed to be the possible weight gain; *rolls eyes". i rather have a happy life as a really fat person who dies early of heart problems than an unhappy life as a somewhat less fat person who commits suicide, ya know. he is so fucking clueless -- and it's not like he actually even checks my weight; he's not weighed me again after the first time, and he doesn't ask whether i had any weight loss or gain, so WTF.

escitalopram is supposedly more potent than citalopram, which i took before in the form of celexa, but which didn't do anything for me, and i don't know that the GP even remembered the celexa, so i need to do some more reading on that. as usual, it might take 4-6 weeks before i'm supposed to notice any positive change (the side effects i always get within days, but "fairness" does not enter into this, *wry grin*).

and because i don't trust the good doctor to check for interaction with other meds, i did it myself, and a good thing -- the internist is considering putting me on warfarin, and it does not play well with escitalopram. i am not much in favour of the warfarin anyway, because the dosage is so sensitive and requires constant blood tests to assess, i can't deal with even more lab and doctor stuff than i do now, and i don't actually trust the GP to do a good job for me there. the alternative as a blood thinner is dabigatran, which is brandnew, very, very expensive (3.95/75mg capsule, might have to take 2/day), and for which we don't have long-term studies yet. (blood thinners are necessary because the arrythmia can result in blood clots, which can cause a stroke).

i have an appointment for an echo cardiogram on the 11th, have a slew of blood and urine tests still to do at the lab, then i'll see the internist again to talk about blood thinner meds, and what's next.

at least i like the internist, and he's young, so not likely to retire before my next visit like the last one. maybe he'll just move to victoria, *snrk*. i am such an optimist.

[1] about akathisia the GP said that was involuntary body movements (and i don't think he was talking about hard-ons), but when i looked it up, it's more along the line or jitteriness/restlessness affecting the knees, and sitting is apparently difficult.

Comments

re: new meds

[betonica]

If drug blood thinners don't seem to work out for you, you might try ginger. There are a few good studies that show ginger having good blood-thinning (anti-clotting? same thing?) results, though I haven't read them for a while. I'd say two tablespoons of ginger preserves a day, or an equivalent amount of fresh root, cooked into stuff.

Good luck with the escitalopram.

Re: new meds

[piranha]

and hey, i actually LIKE ginger. thanks for the tip. i wonder whether i could try this and have a blood test done to see whether it has an effect. i'll talk with the internist (i wonder how he feels about alternative medical solutions, *snicker*). i'd feel a heck of a lot more comfortable chowing down on ginger than on rat poison.

the two possibilities that seem to be on the table in general are aspirin / clopidogrel and warfarin / dabigatran;the first set works on the platelets, the second on clotting proteins.

[holyschist]

I started on escalitopram and it was pretty effective for my depression and anxiety, but it also made me groggy and lethargic (I was pretty lethargic to start with, because depression). Possibly someone else to keep an eye on.

(Also, it can give you REALLY VIVID dreams. Mine were awesome; I was lucky.)

[piranha]

thanks for the tip -- getting more lethargic is the last thing i need; i am already terribly so. not even gardening this year. dreams would be nice (well, good dreams would be nice). i used to have amazingly vivid dreams, but not for a long time now.

i hope i get at least better enough to look for a doctor with whom i have a positive rapport.

[holyschist]

Yeah, you might not have that side effect, but if you find yourself getting more lethargic, it might be the escalitopram and not the actual depression, is all. It took me a while to notice because I first I was all "OMG I'M NOT DEPRESSED ALL THE TIME! MY BRAIN IS NO LONGER WRAPPED IN COTTON BALLS!" but when that passed I was all "sleeeeeeeeeeeep. sleep alllllll the time."

It was a net positive for me--it got me to the point where I could go to therapy and eventually switch to a prescriber who wasn't a horrible doctor (and then a different drug, which had its own pros and cons)--and I hope it works for you.

i hope i get at least better enough to look for a doctor with whom i have a positive rapport.

I hope you do, too! Positive rapport is huge, and makes it much easier to find effective treatment.

[synecdochic]

Arrrrgh, the meds-go-round sucks bigtime. I hope yours is low key and easily and quickly solved.

[piranha]

it hasn't been solved for the last few years; after paxil originally worked but then stopped, nothing has made a significant difference. but thanks for the good wishes; maybe it'll happen this time.

[green_knight]

I hope you find a combination of meds that works for you.

[piranha]

thanks!

[frith]

Rat poison! good lord. I won't ask you why not aspirin because you probably said why not before and I was probably daydreaming at the time instead of paying attention.

Why I'm here: restless legs! If the cipralex gives you restless legs, my trick is to hold my leg(s) horizontally an inch or two off the ground until the lactic acid build-up in the muscle kills the restless sensation.

[piranha]

re aspirin; i don't think i said before. i have been taking aspirin since the arrythmia started. as i understand it, aspirin works differently from warfarin; it is an anti-platelet instead of an anti-coagulant (which affects the clotting proteins); and the internist said studies show that the latter is better at preventing strokes for people who are more at risk -- which i am, because i had very high blood pressure (it's still above where the doctors would like it), and what might've been a transient ischemic attack.

i am not so sure he's correct, because i've started to look around at studies, and i am finding some contradictory evidence that's relatively recent. but i am having a hard time following it, and it might not take my extra risk factors into account. i'll print out what i'm finding and will talk about it with the internist. the aspirin i am taking right now isn't enough anyway; i'd have to up the aspirin dose considerably.

thanks for the tip about restless legs! i'll tell this to the paramour as well, who has had restless leg syndrome at times; be good if it works.