I went into today’s appointment with Brent bearing a letter instead of my usual bullet-point notes. It detailed the past month of alternating compliance and non- with my prescribed medication, and ended with six possible changes we could make:
Reduce the dose of Latuda.
Change to a different antipsychotic.
Drop Latuda and add an anticonvulsant.
Keep existing meds and add an SSRI.
Keep existing meds and add a stimulant.
Drop all meds and suffer the consequences.
Brent immediately said that #6 was not an option. He didn’t specifically discount options #4 and #5, but I knew when I wrote it that they would not be options in his mind. He went with option #1, reducing my dose from 60 to 40 mg, and said that if I still had complaints about the Latuda when I see him in a month, then we can discuss option #3. He remembered that I had suggested Lamictal at one point in the past, and cross-tapering the Latuda and Lamictal would be the next step.
Brent said that he wants me to have energy and motivation; that he doesn’t want me to be overmedicated. I was so grateful he said that, because I feared he might be one of the many professionals who are content to keep the bipolar in a mildly depressed state so long as there’s no risk of slipping into mania. I’d be much happier with the opposite: staying mildly manic so long as I never, ever have to suffer depression again.
I had been receiving the 60 mg Latuda free from the pharmaceutical company, so that’s what he had available to give me. I told him that I believe my new(ish) insurance will cover it with prior authorization so he sent the prescription to my local pharmacy. When I checked with them it was awaiting authorization. So for now, I’m still going to be taking the 60 mg without sufficient calories at bedtime, until I have access to the new dose.
After meeting with Brent, I went back to the waiting room until my appointment with Sadie. It was time once again to update my ANSA and treatment plan. We went through the ANSA much more quickly than last time, tweaking some ratings here and there. Several needs went down in severity; none went up. I still ranked a 4 for level of need though.
For my treatment plan, we dropped the goal of reducing risk of suicide and self-harm. I’ve been doing much better at using coping skills to deal with those urges, and I’m much more aware of when I’m at risk enough that I need to seek emergency help. We made some minor edits to the details of the other two goals (improving interpersonal relations and daily living situation), and added a new one regarding increasing my self-esteem.
We also came to an agreement that scares the crap out of me. In discussing my previous blog post, which I had sent her to read, I summarized the situation with “You are my social life.” Sadie thought that seeing her less often might encourage me to seek other social situations, and though I didn’t like what she was saying I agreed that in September we could try meeting every other week. Given what I expect from my work schedule, that may be necessary due to scheduling conflicts anyway.
Sadie reassured me that I could try to schedule an appointment in-between if a crisis came up, and if it were very serious she’d be willing to stay late if she couldn’t fit me in otherwise. I was reminded that, though I don’t like these options, I can always contact the on-call therapist or go to the emergency room if necessary, and that I have learned numerous coping skills and have supportive friends to reach out to.