Sunday, August 31, 2008

The Good, The Bad & The Ugly

I've been more depressed lately and have taken to weeping on my husband around bedtime, so I thought it was a good idea to pay my internist a visit and see if she thought we should tweak my antidepressants.

I've been on Cymbalta almost a year now. Sometime early last fall, when it sank in that this mystery illness wasn't going away quickly, I requested antidepressants because the illness was making me depressed and anxious. I had mixed feelings about going on antidepressants because it seemed to me it was normal to be depressed and anxious when faced with a mystery illness and having your life turned upside down by it. But I figured my being so upset about it all was making Scott & Ellie's lives harder so it was only fair to them I try to do something about my moodiness.

Over the past year, we've upped my dosage twice and now I'm on the maximum dosage of 120 mg per day, and have been for about two months.

So my internist said if it continues, she'll have to refer me to a psychiatrist who would be able to add other meds to the mix to help my mood. But she also agreed that my current mood seems to be caused by feeling like I'm on the sidelines of Ellie's life. She and Scott have done so much this week that I wasn't well enough to participate in -- her first rollercoaster ride, her first ballet lesson, her first trip to an aquarium and her second trip to the beach. And so much more.

I saw the internist on Thursday, and she had finally gotten her hands on some Provigil, the stimulant that my insurance refuses to pay for because I don't fit their criteria for it. Apparently, every time the Provigil drug rep comes into the office, the samples s/he drops off disappear instantly. But my internist managed to grab some this last time and put them in a locked cabinet until my visit.

I took my first dose on Friday. And it was just .... amazing. I was afraid it would make me jittery like I'd overdosed on caffeine, but no. I still had pain, but it was the first time in 15 months that I felt like me again. It was incredible. I still had to take some pain meds, but less than my current normal daily doses.

We left the house around 11 a.m. and had a picnic, then went to New Seasons to pick up a rotisserie chicken and side dishes to bring to my friend Heidi, who recently had her second baby. We stayed at her house for two hours, supervising Ellie playing with Heidi's daughter, Francesca, who's about a month older than Ellie.

Now normally, even that would have been too much for me. But when we left Heidi's house, we decided to use our one-time pass to the Nike Employee Store because it would expire today and we'd been warned that weekend hours would be jammed with people. And wow -- the place was huge (and crowded, even at 3 p.m. on a workday) but we had our list of items we wanted to buy for family members and for ourselves (Scott got three pairs of sneakers!) and we ended up spending like 90 minutes there.

Yes, I was melting away at the end of the shopping experience. But the fact that i was on the go from 11 a.m. to 5 p.m. was just incredible. Unbelievable. And I was just so joyous about having a normal, typical day without feeling like a zombie.

But of course, it all came crashing down. By the time we had dinner, I could barely sit up at the table. And Saturday? In bed the whole day except for 30 minutes in the morning when I came down for breakfast (at 11 a.m.!) and thought I'd be able to watch Ellie so Scott could mow the lawn.

Didn't happen.

I lasted as long as I could, but within 30 minutes of going downstairs, I was back in bed feeling like I imagine it feels to run a marathon without doing any training for it.

I'm doing a bit better today, but if it weren't for the fact that we have circus tickets for a 1 p.m. show, I would still be in my jammies. (As it is, I'm typing from bed, waiting until the last possible moment to go downstairs. I probably shouldn't even be using my limited energy to type right now ... )

I did take another Provigil this morning. (I didn't on Saturday. I started with 21 pills and since I don't know when I'll be able to get more, I want to use them only when I need them.) (G-d, I feel like such a drug addict when I write/say/think that.)

And the Provigil is helping already, although I was starting from such an enormous deficit of energy today that the improvement doesn't feel as good as it did on Friday.

Now the downside? I took a shower today after taking the Provigil (which is how you know it is helping, even today, because I wouldn't have been able to shower without it) and discovered a rash on my hip. It's probably nothing, and not related to the Provigil, but a rash is one of the side effects that the insert warns to "stop taking drug immediately and call your doctor."

"Rare cases of serious or life threatening rash, including SJS, Toxic Epidermal Necrolyis and Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) have been reported. ... Although benign rashes also occur with modafinil, it is not possible to reliably predict which rashes will be serious. Accordingly, modafinil should ordinarily be discontinued at the first sign of rash. ... Discontinuation of treatment may not prevent a rash from becoming life-threatening or permanently disabling or disfiguring."


It's a relatively small rash so far, and isolated. So we'll see what happens, and I guess I won't be taking any more Provigil without discussing it seriously with my doctor.

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