My most recent visit with my psychiatrist was a week ago as of this writing. During this meeting it became apparent to me that I should have been keeping more detailed and frequent records of my changes in medications, dosages, mental state and behavior, and that I should have started doing so much earlier. I am not completely confident that my doctor's own notes were as comprehensive as I had assumed them to be. In recent years we have conducted trials with a wide variety of antidepressants and anti-anxiety medications, with a wide variety of mostly poor results, before arriving at the combination of 4mg of Clonazepam per day in four 1mg doses, and one 100mg dose of Sertraline (generic for Zoloft), per day. After a few months of positive results, the Sertraline seemed to become less effective, and was increased to 150, with no remarkable improvement.
My condition going into this appointment was not terrible and not great. I found both depression and anxiety to be within tolerable control most of the time. However, the ability to comfortably engage with others socially was gone. The courage to leave the house for any non-mandatory reason was gone. I was curious if there was any way forward that could return me to some social activity, particularly going to see local bands, book readings, etc. Additionally, some common side effects which I had been tolerating for quite some time became a matter of concern for me. I wanted to determine if such problems could be mitigated, or should be accepted as permanent. Any intelligent reader can read between these lines. I was willing to compromise, trading a setback of one kind for an improvement of another, but of course it isn't that simple. The brain and body are massively complex and we're basically just throwing pharmaceutical darts at it to see what happens.
Nonetheless, based upon some presumptions based upon poorly documented past experience it was decided that I should taper back down from 150 to 100 of Sertraline, begin 100mg daily of Bupropion (generic for Wellbutrin) immediately, and keep Clonazepam as-is.
At this juncture I have completed the decrease in Sertraline and have been on Bupropion for a week. It is too early for conclusions, but a good time for noting changes thus far.
I have become more irritable, which is very disappointing because I had quite enjoyed being less reactionary and paranoid. Related or not, my cognitive function seems to be in a slow and steady decline since before the current trial. I still feel no closer to returning to social function, or to "domestic function". I realize now that I spend most of my time with passive distractions, to avoid thinking about the very things about which I am writing. Introspection is my enemy, as it always leads me to either despair, or failing the energy to be dramatic in my self pity, to the logical conclusion that I am simply done. My story, such as it was, has long been over, but I'm still here for no compelling reason. I feel obligated to remain alive to putter incompetently through the few practical tasks for which I am still useful, but grow weary of how I seem to constantly disappoint.
To complicate matters further, I have had inconsistencies in the scheduling of my dosing, and have even made errors were some doses were entirely skipped, or two doses were apparently taken much too close together in time. I use a 4 by 7 weekly pill organizer, which helps some, and is the primary source of evidence for discovering my lapses, but I think I need something more comprehensive, either an app of some kind, or a simple handwritten journal of what I take and when.
The Clonazepam had saved me from a lifetime of internal terrors I do not wish to describe, but I regret ever attempting a pharmaceutical approach to my depression.
Hey, I just ran out of motivation to keep writing this shit.
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