We Need To Talk About Von

Six months have passed. Time for my treatment plan review.

The opening visit was with my therapist. I swear, he’s going to write a book with all the one-liners I toss at him, describing my foray into socialization and the ensuing, consistent failures. I rarely get in to see him; he’s got 130 clients besides me, so when I do get to scratch out a 45-minute session, it’s usually me updating him on the latest and greatest, and, by the time all that’s unfurled – DING! – time’s up. We never discuss the whys, just that these things happen. It feels more like going to confession than experiencing healing. Absolve my sins, send me off with 50 Hail Marys. He’s a genuinely good person, and we do maximize our short time, but I don’t think therapy really helps if it can’t be consistent.

Leaving his office, I’m confronted by a cat caller on crutches, of all audacity. He receives my snub, but then gets loud with me. I swing back around, point my finger in his face and growl, “GET AWAY FROM ME.” Normally, this sends the offender on his way, but he decided to give chase, and I, like the seam of Iggy Azalea’s pants, just rip open.

Head over to the ‘med management’ portion of my review, and the technician checks my pulse, blood pressure and weight. The good news is, I’ve lost five pounds since my last visit, and my BMI has simmered down to 26.5. My pulse and blood pressure present her with concern, pulse too low, pressure too high, usually what happens when I’m about to go full rage. Fortunately, the next visit is with the psychiatrist, and I feel her witnessing me in this state will actually help the conversation we need to have: I’m not responding well to her prescriptions.

My therapist and psychiatrist tend to use the word ‘outlier’ a lot when I’m visiting with them, and I concede I am that. Any kind of chemical in my body, even at super low dose, I experience the known side effects. This last round of meds, Latuda, had me hunched over the toilet bowl, feeling clammy and shivery, unable to drive or even walk my dog. She had me on the pre-therapeutic dose! For those of you keeping score, that’s Latuda, Lamictal, Lithium, and hydroxyzine within the last six months. My body can’t deal with either of ’em.

I actually felt bad sitting across from my psychiatrist. I really wanted to come in and report I was doing fine, the meds were fine, I am safely incorporating myself into society, alles klar. She shared that she felt terrible that my body was responding negatively in low doses. This is where I decided to insert a question: are there options for alternative medicines, maybe things of natural origin? She mentioned St John’s Wort for depression and something else for anxiety, but as far as a natural mood stabilizer, there wasn’t anything of her experience that definitively aided mood swings.

Cannibis, anyone??

I kept silent.

Seeing that Prop 2 was a close but no hit in last week’s election, the consideration for marijuana as a medical treatment is naught in Florida, at least for the time being. But 56% is damn close to 60%, so I’m not losing hope. There’s way too many people like me out there who do benefit from proper dosage, and I feel I could qualify.

No talking about that in here, I reminded myself.

The psych got excited about Geodon, a fairly new psychotropic which wasn’t part of the family of drugs I was previously on. “It’s new for you. It’s different from the other medications, and, starting you at a pre-therapeutic dosage, it might be a better fit for your chemical makeup.”

“Different is good. Different is encouraging.”

“Yes, we should try that. Very low dose, and we’ll slowly get you up there. It comes in generic as well…”

“Great! Generic is good…”

She pulls out a Rx list to confirm my pharmacy participates in the generic distribution, and it does! We’re both happy. But then she goes back to her computer screen, “Oh, that’s right. You don’t have health insurance.”

“Yup. There’s that.”

She shakes her head. “The generic version hasn’t been in the market long enough to qualify for < > program.”

“Ah.”

“Yes, it’s too expensive on it’s own.”

“Back to square one.”

I sink back in my chair, just spent with the revolving horseshit. Your condition, if not treated, will get you locked up. We have a treatment plan that will avoid you getting locked up. You don’t have the means to pay for the treatment plan that will avoid you getting locked up. But if you get locked up, you’ll be immediately treated with this plan.

Asinine.

It’s a game of chemical click-clack. Roll the psychotropic dice, see which combinations land. Me? Been hitting snake eyes roll after roll after roll. With the holidays coming up, I really am ambivalent about being able to keep it together in social settings without some sort of assist. Sure, I can go see my weed guy, but then I’m rendered useless in a hazy stupor because DUH! no one’s testing the weed strains before they enter the market.

Sheesh.

Finally, I confess to my psychiatrist, with a preface of, ‘please don’t judge me as irresponsible,’ I ingested Valium while I was at a festival in Tulsa, Oklahoma and I felt okay, as in, level. Balanced. Unfazed by the strangers around me, even receptive to interacting with them positively.

She didn’t judge me, nor did she admonish me for taking a controlled substance she didn’t prescribe. However, it opened our discussion to the chemical dopamine, and how she senses for me, my particular imbalance comes from a disproportionate distribution of dopamine in and out of the cell membrane. And so, she considered oxcarbazepine, the generic form of Trileptal, and started me on a low dose. She sent the script to my pharmacy with a click of her mouse, then excused herself to visit the printer in the other office.

I sighed antipathy, sensing I’m about to enter once more into a psychotropic tail spin on this different-from-the-others drug.

She handed me my follow-up appointment sheet, and a handwritten prescription.

For diazapam.