Depression

We don't count as people to talk to? Come on, bruh.

I'm barely able to make personal connections face-to-face. You expect me to connect to ghosts on the interwebs?

So cops were sent to my house on a welfare check. Apparently they tried calling me and I didn't respond.

I fucking sleep in the mornings because I work the graveyard shift motherfucker.

Maybe you should just be glad that someone cares enough to make sure you aren't dead even if it's just the crisis line or your counselor you fucking ingrate. That's more than a lot of people have.

They're doing their jobs.

A lot of people don't just clock in and out. They deal with that shit daily and bring it home, carrying the burden for the rest of their lives.

People that work on those hotlines do it from a different place than "just doing their jobs". They're pretty much insane bleeding heart sons of bitches whose sanity I tend to personally question... but they do tend to be sincere.

They're not even covering their asses. If they'd found a corpse instead of a bleary eyed just woke me up DaTroll, it's not like anyone in the world would have blamed them. The cops would have thanked them for giving them the information to go check.

You can trust sincere when there is no penalty to insincerity. It might be one of the few times you can ever trust it.

Hoss_sl said:

Since you guys have experience with this, what do you think about a physicians assistant (for a General Practicioner) prescribing anti-depressants? Daughter went in today because she'd been feeling sick, came out with scripts for methylprednisolone and escitalopram. She's 19, so only she talked to the PA, but the escitalopram is supposed to be an anti-depressant. I'm kinda blown away that a non psychiatrist would prescribe anti-depressants. Is that something I should be worried about?

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Don't PAs have to confer with doctors before doing things? I would trust a good doc and PA combo, but GPs w/ or w/o a PA aren't going to be as knowledgable as a psychiatrist.

My worry would be with meds for depression in general. It's such a crapshoot, and, in my experience, there aren't objective measures for improvement. Depression meds can exacerbate things, and you need to have a prescriber who's accessible.

The only real difference between an MD and a PA is that an MD working as a General Practitioner is wildly overqualified for the job whereas a PA working as a GP was trained specifically to be a GP. It's like the difference between an Opthalmologist and an Optometrist. An Opthalmologist is perfectly capable of getting you a new pair of glasses but that would be a waste of a lot of his schooling if eyeglass prescriptions was all he did. PAs are allowed to write prescriptions, even for controlled substances. The MD's name should also appear on the prescription because a PA is acting as the MD's agent, but a PA doesn't have to go get permission from the MD to write a prescription.

As for the Lexapro, it's also an anti-anxiety medication. Regardless, there are only two types of prescriptions, general prescriptions (like Lexapro) which they just fax over to your pharmacy, or controlled substances which must be recorded in a DEA log with the prescribing physician's DEA number. You also can't call in or fax a controlled substance prescription, you have to physically pick up and take the original copy of the prescription to the pharmacy every month. There's no specific taboo on GPs writing prescriptions for 'mild' stuff like Lexapro or Zoloft, although they probably wouldn't write a prescription for a heavy duty anti-psychotic like Geodon or Seroquel unless you'd been a patient for a long time, and even then they probably would have already referred you to a psychiatrist.

Incidentally, they're called Physician Assistants, not Physician's Assistants. A PA is a physician who is also an assistant, they are not only an assistant to a physician.

PA's are basically "Dr. Junior". They do one year of classroom education then another year of clinical rotations (physicians do two of each and then a residency). I have never known a PA to work in psychiatry because the very generalized education they receive does not prepare someone for the special world of psychiatry.

Having said all that, Lexapro is a reasonable choice for an antidepressant. Unless she is having severe problems, a primary care provider can adequately manage mental health problems.

Shit's about to get me down. Since I lost the ability to walk it's really impacting my mental welfare. I'm a person that is outside 99% of the time if I'm not working. I backpack on vacation. I don't even own a TV. I used to take walks in the woods on a daily basis.

Shit's getting old fast.

Well I believe he's mentioned having MS in the health problems thread, so a lot of things are going to become a lot more permanent for Borzak.

Borzak_sl said:

Shit's about to get me down. Since I lost the ability to walk it's really impacting my mental welfare. I'm a person that is outside 99% of the time if I'm not working. I backpack on vacation. I don't even own a TV. I used to take walks in the woods on a daily basis.

Shit's getting old fast.

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I hate to be so blunt but you're either going to have to make adjustments or ultimately live with depression and/or anger with a slight chance of alcoholism. It sucks, but you can find interest in other things and focus yourself in new areas if you want to. It won't be easy but managing your expectations now and shifting your energy into other areas is only going to pay dividends later when you run out of ways to ignore life going on around you.

Hoss_sl said:

Since you guys have experience with this, what do you think about a physicians assistant (for a General Practicioner) prescribing anti-depressants? Daughter went in today because she'd been feeling sick, came out with scripts for methylprednisolone and escitalopram. She's 19, so only she talked to the PA, but the escitalopram is supposed to be an anti-depressant. I'm kinda blown away that a non psychiatrist would prescribe anti-depressants. Is that something I should be worried about?

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Probably not. GPs often do anti-depressants/anti-anxiety meds for people, unless they feel the issue is severe or really requires the aid of a Psychiatrist. Lexapro is one of the better anti-depressants. It also helps with anxiety.

My GP prescribed my meds and I'm quite happy with them - they have made a significant improvement in my life. It's more about the person's knowledge/ability than the specific initials they've earned.

Hoss_sl said:

I missed it, is your not walking thing permanent?

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They don't know. Apparently none of the neurologist including two MS specific clinics can't come up with a dead on diagnosis.

I can still "get around" with a leg brace and a cane.

Out of 17 neurologist 16 say it's not MS. Apparently I have a multide of vitamin deficiences which may have also led to the ADEM (short duration mass attack on the central nervous system brought on by an infection or virus - shingles in this case which is very similar to MS). They say it will take time to get them all in balance again.

One day I can walk and ride a mountain bike. The next I can't walk. I don't flunk any of the physical test they give you like stand on one foot, hope on one foot (if it's a day I can walk), walk one foot in front of the other like a DWI test, and a host of other odd stuff they make you do. I can do them in my sleep now.

So basically nobody knows.

Consider speaking to the head of neurology at Dartmouth. He was able to diagnose and treat (as much as possible) an exceedingly rare disorder. Their research campus is a bit out of the way in Lebanon, NH but the person had been through a dozen specialists before he looked at the case.

Borzak_sl said:

Shit's about to get me down. Since I lost the ability to walk it's really impacting my mental welfare. I'm a person that is outside 99% of the time if I'm not working. I backpack on vacation. I don't even own a TV. I used to take walks in the woods on a daily basis.

Shit's getting old fast.

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Yeah, depression is not always an inappropriate response.

But like Palum said. Concentrate on can rather than can't. I know it sounds like a platitude, I know it does. But life is long. Time to look at a road less traveled and suchlike.

And if your mystery illness goes away -- the bonus points. New shit to do when it's raining outside.