Monday, August 01, 2016

My Treatment Proposal Was Approved By My New Psychiatrist!

Sonia

I self-referred to the Rapid Access Clinic at Burnaby Hospital Mental Health and Addictions Services in July 2015. Your file remains open for six months after which another self-referral is necessary. By December of that year I called Burnaby Mental Health to make an appointment with one of their psychiatrists because the treatment recommendations were not working for me. On the phone while attempting to arrange an appointment, I was told that my file was closed. I checked the dates of my referral and knew for a fact that the six month period had not yet elapsed but still my file was closed. I was forced to re-refer myself. 

My referral went through in January but it wasn’t until June 29th that I received an appointment. Rapid Access is a misnomer. Then, a couple of weeks before the June appointment, I received a call to reschedule for July 8th. I was fed up by this point and barely hanging on. My anxiety shot up, panic attacks increased, my agoraphobia worsening by the day that I feared I would not be able to make it to the appointment. It was only through being heavily medicated with benzodiazepines and the support of my mom that I succeeded in driving the seven and a half kilometres to Burnaby Hospital. 

I have been a patient at Burnaby Hospital Mental Health on and off for years. Dr. Paul Waraich is the psychiatrist I usually saw. When I called to confirm the date and time of my appointment, I was told that I wasn’t in the books. The lady on the phone checked the schedules of the other psychiatrists there and said I would be seeing someone else. I misheard her and thought I would be seeing Dr. Jerome Lee. The night before my appointment, I was having trouble falling asleep and so I looked up Dr. Lee online. I was horrified to learn that he was the doctor who had treated Eddie Young. I didn’t know Eddie personally but learned after his suicide that he was the cousin of a former tenant. Not only that, I also learned that he was being investigated by the BC Coroner’s Office in the death of Eddie Young. There was also mention about a sexual harassment suit against him. Unfounded or not, these charges made me anxious. 

Somehow, I managed to fall asleep in the early hours of the morning of July 8th and when I got to my appointment, I learned I would not be seeing Dr. Lee but Dr. Ronsley instead. Luckily, it turned out Dr. Ronsley was just the kind of psychiatrist I was hoping for. He listened to me without rushing me. He asked a lot of questions, took a lot of notes and read the proposal I had written in which I asked for a specific treatment plan that I believed I needed in order to overcome my panic disorder and agoraphobia. 

And he agreed! I was so elated and finally felt like I was on the right track. Now, together with Dr. Ronsley and my family doctor, the three of us are working together in treating me. I feel hopeful for the first time in years and I am very aware of how lucky I am to have found doctors willing to listen and work with me. 

I know the mental health system is broken here in BC as I’ve been a patient for the last sixteen years. When I first began accessing mental health services back in 2000 as a minor, I found the system easily accessible and fast. But once I aged out, things changed. The resources for adults were fewer and harder to access. Whether that was due to changes within the system or differences in available resources for adults versus children and youth, I can’t be sure. What I am sure of is that for adults with mental health issues, services are severely lacking, especially in smaller communities on the island and here on the mainland. 

I can’t help but feel utter sympathy for the countless people trying desperately to access services they need and failing. That it takes months to even access a service, to me, is a human rights violation. The only advice I can offer is don't give up. Demand access to services. It's your right. Call the many non-profit organizations and ask to speak to mental health advocates; many have them on staff or as volunteers. Contact the media. Raise a fuss. Otherwise, nothing will change.

Remeron and Effexor Together (Mirtazapine & Venlafaxine)

Sonia
Mirtazapine 15mg Image by Garzfoth
My new psychiatrist thought it a good idea to try adding Remeron (Mirtazapine) to my current meds (Effexor and Klonopin) but I had to lower the dose of Effexor from 225mg to 150mg and only start with half a tablet of Remeron. The lowest pill form is 15mg so I split it in half and took 7.5mg at night, which really helped with my insomnia.

Since both Effexor and Remeron are antidepressants there is always a chance, though rare, of Serotonin Syndrome, a potentially deadly drug interaction. And hence the lower dose of Effexor. I've tried Effexor with other drugs in the same class and never experienced any negative symptoms.

I've been on this new cocktail (150mg Effexor, 7.5mg Remeron, 0.5mg Klonopin) for a few weeks now and I definitely felt better on 225mg Effexor and 0.5 Klonopin. I can't say whether Remeron is working or not for my depression/anxiety because I'm on such a low dose and because I know that 150mg of Effexor does not work for me. I've lowered it before and felt my depression worsen.

I've googled this combo and some people swear by taking both and they're at an even higher dose of both drugs than me. Some at 262.5mg - 300mg Effexor and 15mg-45mg of Remeron. I think the dosage caps depend on the country you're in and/or which form of the drug you're taking, ie. XR.

I'm not sure what to do. Up the Effexor and stay on the low dose of Remeron? Ever since I lowered the dose of Effexor and added Remeron, I've felt as if the Klonopin wasn't working at all. It worked wonderfully before I decreased Effexor and started Remeron.

This combo is not working for me so I'll contact my doctor as soon as possible to see if I can up my Effexor to my original therapeutic dose.


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