Last night was my annual pilgrimage to Beverly, Mass. for an appointment with the nurse who manages my Prozac intake. She has done better for me than my primary care doctor did. Here’s why.
Drugs used to treat mental disorders must be tightly controlled. Too little and it won’t help you. Too much can make your disorder worse.
When I first started taking Prozac in 2007, my primary care doctor was prescribing it. My depression and anxiety were melting a hole in my heart and I was at my wit’s end. I had resisted medication for a long time because I didn’t believe in them. I saw it as quitting.
That’s the thing about OCD. The craving for control blinds you.
But years of therapy, though helpful, hadn’t helped me break the spell of fear and anxiety, and that was limiting me. So at my doctor’s suggestion, I gave it a try.
The anxiety and depression evaporated within two weeks and I felt like a new man. But I would still be in and out with mood swings. I eventually figured out that my doctor wasn’t the best person to manage this drug. He’s a fine doctor, but these capsules have a complexity I think was beyond his expertise.
When I started seeing my latest therapist, he gave me a hell of an education. He was the first therapist to help me understand the science behind mental illness and the way an inbalance in brain chemistry can mess with your thought traffic. He also provided me with quite an education on how anti-depressants work. Indeed, there’s a science to it. Certain drugs are designed to shore up the brain chemicals that, when depleted, lead to bi-polar behavior. Other meds are specifically geared toward anxiety control. In my case, I needed the drug that best addressed obsessive-compulsive behavior. For me, that meant Prozac.
He also told me it was stupid to take my prescriptions from a primary care physician. Essentially, he said, that was like putting a 12-year-old in charge of a dynamite stockpile.
So he sent me to my current Prozac nurse.
Last year, she knocked my 60-milligram dosage back to 40 for the summer. With the longer days and extra sunlight, the logic was that I wouldn’t need as much. It worked until late summer, when a couple weeks of cloudy weather and earlier sunsets sent my brain chemistry out of whack.
I went back up to 60 and had some steep mood swings in the process. It evened out fairly quickly, but as far as I was concerned, those mood swings weren’t worth the experiment.
So last night, she decided to keep me at 60. If it isn’t broken, why try to fix it?
She asked how I was doing with my therapist.
“Excellent,” I said. “I walk in there with a large cup of Starbucks and he glares at me like a father who can’t get his kid to tie his shoes just right.”
She smiled. “Next time,” she said, “You should walk in with two large cups.”
To that, we laughed like schoolkids who had just shared a dirty joke.
My therapist has buttons I like to push. One button is that he thinks everyone should quit caffeine and do yoga. I’m apparently not the only one who likes to have fun with that. The beauty of it is that I can do that, he can take it, and I still get something valuable from my appointments.
As I’ve said before, drugs without therapy won’t work in the long run. Mental wellness requires a lot of things: Careful diet, therapy is a must if you have a disorder and sometimes you need medication, though that isn’t always the case.
When I have an appointment with the Prozac nurse I usually cuss about it. It takes me an hour to get to her office for something we could do over the phone.
Yesterday, I badly wanted to cancel.
Erin wouldn’t have let me, anyway.
“You need these appointments,” she said yesterday, as she frequently does when I balk at going.
And so I went. I’m glad I did.