Thursday Conversations With My Psychiatrist | New Pills & A Car Wreck

I’ve changed psychiatrists since I wrote the last one of these. My last psychiatrist — the one who saved my life, retired… or something, he told me my regular Doctor could treat me. So I went without a psychiatrist and talk therapy for the first time in almost fifteen years, but that turned out to be a mistake.

Also, I didn’t trust my Family Doctor to have any idea what meds I should be taking, or the dosage, and I told him that at our first meeting. So he referred me back to the Centre for Addiction and Mental Health, and they called me to ask their standard LOCUS (Level of Care Utilization System) questions. I waited a few months, and then I had access to a new psychiatrist, Dr. LH.

And she’s been awesome. She asks questions pertinent to my life, I don’t have to recap our previous appointment, and she’s engaging. I’ve learned a lot from her over the past two years… unfortunately, she’s also planning on retiring soon. Sigh.

Here’s what we discussed at our latest appointment…

I had an accident with the car the morning of my appointment. I was taking the kids to school, I was tired, and wasn’t paying attention. I backed out of the driveway, and turned right into my neighbour’s parked car. She had parked in the street because she was having major work done on her back steps. It’s my first accident as a driver. There was no damage to her car, but mine is not a little fucked. Big dent in the back right side, and one of the quarter panels has been pushed in.

Surprisingly my first reaction wasn’t to jump head first into a depression. I did get angry at myself, but I was also surprisingly calm. I think some of that had to do with the kids being in the car at the time.

I think I was still in shock when I told Dr. LH.

We didn’t linger too much on the accident. She made sure I was okay, and that if I did fall into a depression that I was to call her.

The mechanic says he can fix most of it, but I’m a little skeptical. It looks like a basketball-sized hole was dug out of my car. The car is fifteen-years old, and I just put $600 into a new fuel pump and I need new winter tires. That’ll be another $400. This is not good.

After a pause of a few seconds, I finally brought up the not-showering thing. I told her I hadn’t showered in a couple of weeks, and that it wasn’t unusual for me to do that… and the only reason I had showered on that particular day was because I had an appointment with my Foot Nurse.

…I explained to Dr. LH that as a diabetic I’m able to get free foot care from the local Family Health Centre, which means I have someone cut my nails and take care of the hyperkeratosis (it’s relatively mild) on my feet. Basically I get a free pedicure every six to eight weeks, because doing it myself, or having someone untrained do it, might mean bleeding and an infection, and goodbye foot. This also means I have to shower for the appointment, because it makes my feet soft and easier to groom.

It comes down to a form of mental inertia… when I do force myself to shower, or I’m forced to because of an appointment or a function, I wonder what all the fuss had been about when I finish. I tell myself that it’s just too easy — turn on the water, get undressed, get in, wash, rinse, get out and get dressed. What’s the big freaking deal?

But, three days later it is a big deal again: I’ll do it later, I’m too late for something so I have no time, I’m too tired, there’s no reason to do it right away, just fuck off about it already, I’ll do it later.

It’s ridiculous but there it is… it’s now been two weeks since my appointment for my feet, and I haven’t showered since. I did get my hair cut a few days ago, so the hairdresser washed my hair, and I did shave my beard down to a respectable length tonight… so there’s that.

She told me that the feeling of Everything being a step too far was not unusual with people suffering from chronic depression. We didn’t talk about it very long, but basically it comes down to ‘the supply chain’ is broken — ie: it takes a million little steps to make a car. Right now the supply chain is broken so the car can’t be built, or it gets really expensive to build it, so it never gets bought. So… regarding the showering, the two dozen steps it takes to get one done are just too much for me to get through.

This is my own analogy, so bear with me. You don’t ‘just’ shower. You have to buy the soap. That means getting to a store. That means driving or getting a ride. That means organization. That means having the money. Once you have the soap, you have to get the time. That means planning, and more organizing, plus you need to have the desire, or the need to get it done. It’s a mental inertia… my supply chain is busted.

I think that makes sense… she liked my analogy anyway.

I also told her I’ve been getting some great sleep over the past ten days. I’ve been mostly staying awake during the day — working on this blog, reading comments, making comments on Other Blogs, which is making me tired at the right time. She was very happy to hear this for a couple of reasons:

Sleep is vital to recovering from a mental illness. At least getting control over it is. I was an insomniac for the fourteen to eighteen years I was untreated, and it’s just a vicious circle… the disease won’t let you sleep, and the lack of sleep feeds the disease. The only way to stop the cycle is to really hit it with a sledgehammer… for myself that means Seroquel and Abilify at bedtime. Both operate as a sedative, and just turn my brain off long enough to fall to sleep. If things are really bad, I’ll take a Zoplicone. It’s specifically for insomnia, and is non-addictive.

The other reason my psychiatrist is happy is because I actually have an interest in doing something during the day. This blog, along with medications and talk therapy with a psychiatrist, was a vital piece of my Recovery for most of the past 16-years. Writing, for me, has always been an important way of working issues out… I described it to my psychiatrist it’s like a way to massage the knots out of my brain, kind of like EMDR. She liked that.

The last major issue we discussed was adjusting my meds. Specifically the Abilify… I had a possible epiphany a few days ago that maybe, just maybe, the reason I’m tired all day is because I’m on the max dose of the med.

Every mood stabilizer I’ve ever been on — the Lithium, the Epival, and now the Abilify, has been prescribed at or close to the max dose. I think the general idea was that the dosage would come down over time, but I never had any crazy side effects, so the dose remained the same.

I was never tired with the Lithium. I don’t remember being tired all the time on the Epival, but I think some of the responsibility for the tiredness I feel daily comes from the Abilify. So my newish psychiatrist and I have decided to start reducing the prescription a little at the time. So from 20mgs to 18mgs to start.

It was never something I thought too much about until very recently, while I was reading Other Blogs, that maybe there was a connection to my needing five-hour naps everyday and the drug I was taking. It’s just that the dose seemed so small… 20mgs is not a big number considering I was taking 2100mgs of Lithium, and 1600mgs of the Epival.

As the Abilify comes down, I’ll start taking Trintellix — “[t]his medication may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living.”. I’ll begin at 5mg in two weeks, just so I have time to get used to the effects on my sleep at the new Abilify dose. The basic plan is, as the Abilify comes down, the Trintellix will go up.

The thing is I’m normally very wary of changing medications, or even the dose… and now I’ll be doing both at the same time. This will be interesting.

About Gabriel...

...diagnosed with manic depression when I was nineteen, for the next 14-years I lived without treatment or a recovery plan. I've been homeless, one time I graduated college, I've won awards for reporting on Internet privacy issues, and a weekly humour column. In 2002 I finally hit bottom and found help. It's now 2022, and I have an 8-year old son, and a 12-year old son... I’m usually about six feet tall, and I'm pretty sure I screwed up my book deal. I mostly blog at
This entry was posted in Appointment Day, Bipolar Disease, Bipolar Disorder, Blogging, Health, Lithium, Living With Depression, Living With Manic Depression, Manic Depression, Mental Health, Psychiatry, Sleep and tagged , , , . Bookmark the permalink.

6 Responses to Thursday Conversations With My Psychiatrist | New Pills & A Car Wreck

  1. SusanR says:

    I’m so glad you found another psychiatrist that you like and have confidence in. It takes time to build a relationship like that and losing it is a huge loss. Hope the Trintellix lives up to the hype. Certainly sounds promising.

    • Gabriel... says:

      …I have high hopes for the Trintellix. I’m thinking that by reducing the Abilify at night, I’ll be more awake during the day, and with the Trintellix in the morning I’ll also get a little boost for the day. Then, I’ll be totally UNSTOPPABLE… or something. So far the lower dose of the Abilify has made it hard to stay asleep… so last night I had to take a Zopiclone so I could sleep. This could be difficult.

      I was really lucky with the psychiatrist they assigned me, I’m also very lucky we have a Centre for Addiction and Mental Health office close by for them to work out of…

      Thanks for the comment, Susan.

  2. fishrobber says:

    My daughter also talks about that mental inertia and all the steps it takes for her to shower or to do something beneficial for herself. I have the same problem, although not all the time and not as severe. … I’m interested that you mention EMDR. My therapist briefly mentioned this as something I could try. I’m curious and skeptical at the same time. Have you used that technique?

    • Gabriel... says:

      I’ve used EMDR for a few sessions with my former psychiatrist, and last Spring with my current psychotherapist. It really helped when I did it with my psychiatrist, the issues we worked on just went away. Not so much with my Spring sessions. I *think* it comes down to the person giving you the treatments. When it was done properly, it felt exactly like a muscle knot had been worked on / massaged away in my brain.

      So it works, I’m just not sure *how* it works. I recently read and commented on a blog post about EMDR that said “…[you] use your imagination to process your thoughts, feelings, sensations, and emotions.” And I said something like ‘…it seems to me I could so that at home with some online prompts, could you tell me *how* it works?’. And I mentioned the muscle cramp analogy. But they had no idea either because they replied with a “That’s it exactly”.

      But several peer-reviewed studies show it does work in most people… so there’s something to it. I did find this helpful:

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