psychiatrist visit: new anti-depressant

[redbird]

I saw Dr. Segal this morning, and told her that yes, I want to add a second antidepressant. She couldn't remember, and hadn't written down, which atypical antidepressant she had been thinking of the last time I saw her, so we discussed options starting with what I'm on now (welbutrin). After considering which antidepressants I've tried before, and likeliest side effects of the different drugs we were considering, we settled on mirtazepine, to be taken late in the day because one of the commonest side effects is sedation. ("Side effect" is an interesting term; the pharmacist asked if I was taking it for sleep.)

I asked if I can add that to the evening meds I currently take around 9-9:30 p.m., and she said yes. One dose a day, starting at 7.5 mg (half a pill) to be increased to 15 mg in a week or so if I don't have bad side effects other than sedation. Oddly (not my adjective) it is more sedating at the lower dose, so if the only problem is excess sleepiness, increasing to 15 mg could fix that. Dr. Segal also said that if it's helping, but not enough, the dose can be increased up to 45 mg/day.

Dr. Segal recommended this in part because it may help with my sleep, though I noted that part of why I'm not sleeping well is the tennis elbow, which is still at the point where my wrist hurts every time I wake up, making it harder, and less appealing, to go back to sleep.

I also filled the prescription for the diclofenac (NSAID) gel; twice a day, but I'm waiting until evening for the first dose because I had naproxen this morning.

Comments

[carbonel]

In a recent episode of FBI: Most Wanted, Wellbutrin (under the generic name of bupoprion) figured as a drug of abuse. According to the show, it's often prescribed for PTSD, but the users take too much, then go on the street for additional supplies. It was described as "poor man's heroin."

Since I took Wellbutrin for several months (with limited efficacy), I found this entirely weird. I have no idea how accurate that was.

[redbird]

That's weird; I've never taken heroin, but I have tried other recreational pharmaceuticals, and for me welbutrin doesn't have any effects that I would call recreational. More a return to baseline, where baseline is an unmedicated and functional self.

"Poor man's heroin" also suggests that heroin is a drug of the middle and upper classes, which is true only in the sense that they use it, not that poor people don't.

I was once on a "special narcotics grand jury," during which I learned that (a) there is a street market for Xanax, (b) people were buying it to help them get off narcotics, and (c) the city of New York thought it was a good idea to set up buy-and-bust operations to stop this. All three were surprising; the third was counterintuitive and still makes no sense.