So, um, I'm starting in the middle of a very long story, and just trying to provide context where it feels necessary. Please feel free to ask for clarification at any point. So. My moirail, Jake, has had issues with Very Unpleasant Brain Stuff for years. About six months ago, his health insurance status was finally good, and he finally had the cheerleading from his support network, to seek help. He found a psychiatrist in our area, who did an assessment and immediately prescribed him fluoxetine and buspirone. Said psychiatrist did one followup a month later, and then went out of the country for five months. So. During those five months, Jake got a little more energy, and a bit better at some executive function stuff. He did not have any noticeable improvement on depressive symptoms, and his anxiety has honestly gotten a lot worse, culminating to increasingly frequent anxiety attacks, two of which landed him in the hospital since they drove his (genetically prone to be high) blood pressure to dangerous levels. FINALLY psychiatrist gets back in the country. Apologizes. Says "hey here's a new med you'll take - one a day, and half if you have an anxiety attack." (Jake couldn't remember the name off the top of his head when he was texting me tonight.) Didn't change doses or discuss switching either of the meds he's on. Scheduled a followup in a month. Is it just me or is this really, really, REALLY fucked-up care?
That's fucked up care. 1) Blood pressure is a serious issue - I was born with excessively high, meds bring it down to "emergency care needed", and have spent my life being told I would die from it. It is NOT a trifle side effect. Don't fuck with blood pressure - it is not a "minor side effect". Ever. I can give a list of the damage it can cause if you want to get scared, but I doubt that is desired. 2) New med the doc KNOWS is better but hasn't actively tried to change to? Hasn't scheduled transition even though they advocated it? 3) five months is a fucking long time - no interim doc? 4) I know nothing about depression other than a fambly member has it.
1) His general practitioner IS taking the blood pressure super seriously. I'm not really welcome in his psychiatrist appointments, so I only have Jake's impression, but the psych doesn't seem to be taking Jake's opinions or concerns very seriously in general. And I don't need the list of damage, although I appreciate the offer. 2) I think I'm confused syntactically by this point. Jake didn't mention anything about scheduling a transition off of the fluoxetine or buspirone - just this additional stopgap antianxiety med. 3) Absolutely no interim doc. Also, apparently, our immediate geographical location contains absolutely zero psychiatrists available through his insurance who are accepting new patients at anything less than a six month wait list (although since it's Jake's wife and father in law who provided this information I have less than complete confidence in it - convincing Jake of that is another matter). thanks for confirming. Jake just wants to say "I have to trust that he knows what he's doing because he's the only psychiatrist I can get," but I am desperately trying to find any other kind of med management options for him. (So far, his GP has been unwilling to manage his psych meds - they'd prefer having a specialist on it.)
That is definitely fucked-up care, especially since worsened anxiety is a really well-known side effect of fluoxetine.
Update: Jake just went to pick up his new medication - it's trazodone, 50mg. I'm doing some research on my own, but anybody have any experience with this one? It's outside my experience. Just, the reading I'm doing really really isn't comforting.
I'm on it now. It's pretty good, it's what they replaced my seroquel with when I was in the hospital. Makes me very sleepy, take it at night. Doesn't do all that much for anxiety but it's better than nothing and pretty good for depression. I'm having trouble translating to normal person responses because I need absurd doses of anything to have them work (I have a very high chemical tolerance, which is very sad because they keep me alive). I haven't had any side-effects that I know of aside from the drowsiness (which was intentional because insomnia). Also the 150mgs come in the stupidest shape.
Yeahhhh... the sedating effects I was reading about were actually the most concerning to me, bc his nighttime meds already include muscle relaxers for his back injury, so it's the kind of thing they don't recommend mixing at the same time. Also, he's the stay-at-home dad for his month old baby, so being on sedating things in general feels kinda... unwise. Or at least possibly problematic. I don't even know if this asshole is actually considering his medications for his non-brain issues or not. Then, I don't know if I'm just getting irrationally angry and defensive of him at this point.
It's not so much a sedative as it makes you really sleepy. I've been able to wake up while on it and it didn't stop my sleep interruption issues. But I can see the concern; if it's too much then he should let his psych know. And you might be! But it's still good things to think about beforehand. Just try not to let it take too much control or give you too much anxiety. If something's really not working then he should call as soon as it happens and if it's got straight-up BAD side-effects he should stop. I don't suggest sudden stops for minor side-effects that you don't want because stopping your meds suddenly can mess you up but trazodone doesn't trigger 'discontinuation effects' like others do.
I'm mostly just so angry and upset because Jake lives with his wife, who is a social worker, and regularly consults on these things with his father-in-law, who is a social worker, and neither of them seem concerned or like they care at all about this entire situation with this really shitty psychiatrist. He's basically surrounded by people he's trusting because they have degrees, but these people aren't taking care of him AT ALL. And, yet again, I end up sounding like the crazy voice from the wilderness. I just want to curl up in a ball and cry. This is the last thing I needed to deal with today.
I've read up on Trazodone a bit, and I am currently doing a psych rotation. To be honest, the sedating effects of the medication are not noticeably different to me than of other psych meds. Most of them sort of have that side effect. To make sure he's not excessively sleepy during the day he could take them at night, though then indeed, you have to take care with muscle relaxants. He might want to check with either his primary care physician or his pharmacist to see if something can be done about it. Also, and that might be difficult: he should not be driving on this medication for at least the first week, until it's clear what the effects of the Trazodone on his system are. He's starting on a really low dose at least, so that should help some with the symptoms (it's generally recommended to start with 150 mg and go 50 mg higher ever 3-4 days until you're at sort of 400 mg). Hope this helps! :)
That helps a TON, thank you. And yeah, I already asked him to call in and ask about any interactions with his muscle relaxer (flexoril) and the trazodone. Not driving could be hard, but is somewhat manageable - his wife and live-in girlfriend both can probably drive for him if need be, and I can be on call for rides too.
Update: pharmacist said muscle relaxant and trazodone is ok. So that's one thing off my plate. ...at least it's only a month until his followup this time? Maybe the psychiatrist has plans to taper him to different things instead of just adding more meds to fix problems caused at least in part by the first meds?
(He knows never to co-sleep if hes taking any kind of sedative anything right? I dont know if thats even a thing but it could be dangerous.)
I'm on Trazodone primarily for sleep but for depression/anxiety as well (in addition to a SSRI). Trazodone's actually a pretty damn safe drug and really hard to overdose on; you'd need to take about 200+ pills to have any risk whatsoever. I'm given 500mg pills I think but most nights I only take half, only more when I'm having trouble.
Co sleeping was definitely not a thing they were doing regardless, but I appreciate the warning :-) Morven, thanks for sharing. I just feel better on a gut-instinct level hearing anecdata about brain meds.
What is definitely worth keeping in mind with Trazodone is that especially when you're new on it, you will be very dopey and unsteady on your feet on it for about 8 hours or so. It's advisable to be very careful when e.g. getting up to visit the bathroom. Also, if you've not had about 8 hrs sleep on it, it's very hard to wake up and get going.
Update: After his first night taking the Trazodone, Jake actually feels like it's already helping (possibly psychosomatic, but he did say it was the 'instant release' variety). His wife threw a fit when she had to get up in the middle of the night to take care of the baby because he was too drugged. Fix one problem, cause another. *sigh*
I'm glad it's helping. For the record, though, re: "I have to trust that he knows what he's doing because he's the only psychiatrist I can get" - he may be the only psychiatrist available, but that doesn't mean Jake can't advocate for himself. Even without explicitly saying "I have a problem with the way you're treating me", you can go very far with "Can you explain why you ____?" or "Could I see you between ___ and ___?" In the case of the psychiatrist going away, it's totally acceptable to ask the psych directly, "What should I do if I have concerns or difficulties with the medication during that time?" Here are some other scripts in my psychiatry-bank: "Out of curiosity..." This is good to apply if you're worried they might take your question as a criticism. "Could you...?" Another way of softening requests that really ought to be demands. "Why do you think [med in question] is appropriate?" May be best when combined with 'out of curiosity'. "I'm concerned about ___. Could you tell me more?/What do you think?" I'll add more later, as I've become distracted; sorry.
