Letter to Doctor

[Beetzart]

Just looking for a little advice really.  I am thinking of sending a letter to my pdoc outlining everything that is going on at present.  I find it really hard to get my message across on the phone and it might take a while to get an appointment.  Starting to run out of options at present and have seriously considered hospital but I want one last chance to get my meds changed as suicide thoughts keep consuming me.  A and E is 30 miles away for me and I know I would only be sent home again as no-one ever seems to believe me anymore, plus I would feel guilty being surrounded by injured people with me wanting to commit suicide.   

This isn't a life anymore, just an existence.   But I would like to think one last med change might do it.  Ideally I'd like to drop buspirone, add quetiapine/olanzapine, increase venlafaxine/mirtazapine, stick with lithium.  After that I don't know.

What a mess!

If anyone has any advice I would be very grateful.

Beet

[Buttercup]

Only an idea but how about cutting and pasting some of your posts and writing the letter in a diary form.

Xxx

[Sweetpea]

Think Buttercups idea is a good one.  I also think you need to put in the letter just how desperate you are feeling and stress your thoughts about suicide and that you really can't cope with how you are feeling and that you need/want help.

S x x x x

[Zaf]

that sounds an excellent idea to me xx

[mamalou]

Beetzart, I know exactly where you're at. I'm on the combo of meds you mentioned Lithium, Quetiapine and Venlafaxine. According to my psych this is a very successful combination. It is what he calls an optimum medicine cocktail ! At the moment not much is working for me but that doesn't mean that it won't be absolutley perfect for you. It's a good idea to be specific with the medics sometimes and I also wrote a letter of sorts outlining exactly how dire my situation is.
I tend to be tongue tied or mute during my face to face appointments so it feels like I'm wasting time so a written summary is always helpful for both parties.

I think what you are proposing is really sensible.

Louise x

[Beetzart]

Exactly, Louise!  I do just tend to sit there and let them gently steamroll me into what I should be thinking.  Almost as if they are trying to downplay how bad things are.  I had one pdoc once who had a go at me for feeling suicidal, he even said 'Look at David Blunkett, he's blind yet hugely successful'.  Oh thanks, that made me feel much better!  Needless to say I never saw him again.  I told a junior doctor once I was really paranoid, and she just looked at me in the way she might look at an alcoholic throwing up on the pavement.  Although the pdoc I have now is really nice and seems to be quite good at placebo based psychiatry, ie his kind words can make you leave feeling better when all he has done is acted pleasently.  But he is willing to try different combinations, infact one of them I was very interested in and that is the combo of venlafaxine and mirtazapine which he called 'Californian Rocket Fuel'!  It hasn't done a lot though so I've asked if I can have the doses increased.  I have also asked to have quetiapine added. 

Do you mind me asking, Louise, as to why you take lithium?  I ask because I take it but I'm not diagnosed with bipolar.  It's meant to be for recurrent depression.

Beet

[mamalou]

Beet,

I take a strong therapeutic dose of Lithium every day. I am not diagnosed bipolar either. There seems to be alot of skirting around any sort of diagnosis for me. I am treatment resistant and that's all that's definite !

But all the drugs are fairly "industrial strength" !

The David Blunkett comment is just in very poor taste ! OMG they are supposed to be in touch with us and our foibles !
And is it really funny to be prescribed and sort of rocket fuel ? 

It is so true that they try to undermine our symptoms. I used to be fairly eloquent but that goes straight out the window the minute I step over the threshold of the building !

I really hope you are able to get what is needed.

Louise x

[Beetzart]

Louise,

I agree.  I cave in when I have an appointment, after spending days rehearsing what I will say.

 With regards to the Californian Rocket Fuel quote, it wasn't my pdoc who named it that but some doc from San Diego, it is actually mentioned on venlafaxine's or mirtazapine's wikipedia page.  But I can hardly say it has lived up to it's name, but maybe at a higher dose. 

At times I feel that people with chronic mental health problems, with the help of the net, and a little knowledge of chemistry, can be just as informed as any pdoc.  I asked mine if ibuprofen interacted with lithium, knowing it does I was testing him, he erred and had to refer to his BNF book, saying it can raise levels of lithium so don't abuse it!  I could understand a GP doing that but not a pdoc!

[mamalou]

Funny you should mention ibuprofen - my GP didn't even bother to check - he just said "it's fine " !! The other thing is no-one seems to keep a check on my lithium levels either ?!

I agree, about the net ! I am a very unwell, well informed depressee  - I check everything out online just so I feel a slight level of control !

Louise x

[Beetzart]

My GP was quite happy to give me tramadol (for back pain), along with lithium and venlafaxine, what with tramadol being sort of an SSRI.  He didn't even query it.  Nothing happened though so I must be quite apt at absorbing such drugs without recourse.

[Beetzart]

This is the letter I sent him.  I have tried a different approach with some analogies that he may appreciate; appealing to his intelligence.  But he is a really nice doctor so hopefully he can help, afterall he must be used to madness by now!

I have decided to write to you as I find this an easier means of communication; I often forget things or can’t get my message across when I use the phone. 

However, I wonder if you have read Catch-22 by Joseph Heller.  At the start of the book Yossarian, the protagonist, is in hospital with suspected jaundice, but not quite jaundice so the doctors can treat him, but ill enough to remain in hospital, almost stuck in a limbo land, so to speak.  I feel like this most of the time and can apply it to many of the failed endeavours throughout my life.  It seems I am just capable to survive, exist, but unable to live life happily/contentedly.  Yet, I feel suicidal and death is a comforting idea; this has led me to want to admit myself to hospital but I know people wouldn’t take me seriously.  This conviction has been confirmed recently with regards to my bullying situation at work (I am still currently signed off).  I had a grievance meeting three weeks ago and consequently they found my claims to be ‘unfounded’, so no further action will be taken.  The main witness I named, I can only assume, decided against supporting my claims, thus providing me with no evidence.  But I know what happened and this is the frustration. 

So what I am really saying is I feel near the end, this is my last appeal for help.  I can barely function anymore, I eat poorly, sleep poorly, irritable, scared to leave the house, keep getting infections, and look longingly at the pile of lithium I have.  There is no ambition, no fight, and no drive in me any longer.  I used to think I would be a great musician and had wonderful plans only to realise I wasn’t good enough.  Then spend hours writing music over many weeks only for people to show scant interest.  I soon realised this pattern kept repeating itself, over and over.  There were good times when I could feel full of life, make big plans, but get into huge debt, than it would all collapse into a heap of depression.  So I am used to failure, but fed up with this cycle and the conclusion of suicide is starting to seem the only solution. 

Then there is also the paranoid thoughts and anxiety about what people think of me or say behind my back.  I rarely go out unless I really have to, so I have become a prisoner in my own home.  My only comforts, when I can fight off the malaise for a brief spell, is playing the piano (Beethoven, Mozart, Clementi, Hummel mainly) or reading science books.  I enjoy reading about cosmology, evolution, and have a particular fascination with organic chemistry and the structure of molecules.   Sometimes I wish I could understand the maths required to fully appreciate science, I did try but failed at that too.  The trouble is I find it very hard to find people with similar interests as my own.  I have given up now just concluding that I am odd and no-one is really interested. 

Like I said I’m running out of ideas and can’t go on like this.  This depression has ruined my life and it keeps winning. 

Would it be possible to change my medication slightly?  I think I may benefit from using an antipsychotic again like quetiapine or olanzapine.  Mirtazapine seems to have lost it sedating action, but saying that I have had no noticeable side effects from any of the medication I am taking but would like to try a dose increase of venlafaxine, maybe.   

Anyway, I hope you can help in some way.  I have fallen into a pit and have gradually lost the will to get out of it, and feel stupid for writing a letter but it is the easiest way for me at the moment. 


Yours sincerely

Colin

PS  I am trying to read The Trial by Franz Kafka at present, and that also bears some metaphorical resemblance to my situation, or indeed life.  Also, I hope you don’t mind the literary analogies, but I find them rather apt.

[Got]

I'm going to reply to this when I feel less capable of sensible communication.

Look after yourself,

Steve

[mamalou]

Beetzart,
What a beautifully eloquent letter ! I can totally relate to the Catch-22 analogy ( it's one of my favourite books). Always something new to find and understand there.

I so hope you are able to get a positive reply from your doctor. Surely, there is more that can be tried with regards to your medication.

Louise x

[Got]

My opinions only, hope I don't upset you.

Agreed its a nicely written letter, but is your aim to write something artistically pleasant or something which has maximum impact and moves you closer to having a face to face meeting with your psychiatrist? He is a psyhciratist whos job it is too look and treat psychiatrict dissorders -This is only my opinion of course, but I personally would gear my letter towards this direction.

If I was your pyschiatrist I would be looking for any new symptoms and would also be looking for an indication that your life or someone elses is in danger. Bearing in mind that he is probably very busy and is having to deal with suicidal people, people with acute psychosis, and sociopaths who may be dangerous, you need to make yourself a priority - because you both need and deserve to have a meeting with your psychiatrist.

Your letter contains a strong message....that you are contemplating suicide and view it as an option. Perhaps you  can strengthen this by adding what a struggle it is for you to carry on, and the mental pain you face daily. By telling him about your passions and interests you may be indirectly suggesting to him that you will be ok because you have books and interests which you enjoy and that you use as a coping mechanism.

Also food for thought...goal orientated behavior, getting your family into debt and then crashing into depression.....what does this sound like to you? It is just an idea but also a possibility.

I hope you get your meeting.

Steve

[Beetzart]

Thank you for your reply, Steve.  Nothing you said has upset me in anyway; but makes sense.  I just can't see a future at the moment, and yes the music, and science is a coping strategy but I don't think it'll hold for much longer in that respect.  Yet smoking and drinking are coping strategies (I smoke and drink occasionally) but I suppose because they are harmful a doctor takes them more seriously.  But I don't think someone suicidal, who is a smoker would not take their own life because they wouldn't ever have a fag again.  Sorry that is slightly warped logic but the best I can come up with.  

Thanks again, Steve it means a lot that you took the effort to reply.

Beet