After I had given it a week and the anxiety wasn't improving (per Tara's instistence, I wanted to go back on Prozac immediately), I had a call with my psychiatrist, Dr. Joe Walker.

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- [ ] Reminder about my background: 
    - [ ] I had a very severe anxiety/depression breakdown 2 years ago. I first saw you then. I broke down in front of you and you were very kind but stern that I stick to a certain path, which was exactly what I needed. 
    - [ ] You put me on 20mg Prozac and took me off everything else (Remeron, Wellbutrin, Ativan) that my former psychiatrist had put me on. I improved drastically and felt incredible. 
    - [ ] 1 year ago, I asked how I could go off Prozac because I had gained 50 pounds and wanted to lose that weight. 
    - [ ] I've now lost that weight, but I'm now struggling with a lot of the same issues I had back then. 

- [ ] It started 7 days ago. A friendship ended which I think was the real trigger for all of this. 
    - [ ] I have a huge difficulty getting out of bed. 
    - [ ] I wake up in the morning and have nausea in the exact same way I had it 2 years ago. 
    - [ ] I am completely overwhelmed by anything involving making a decision, especially in the future. 
    - [ ] My chest feels very tight at times. 
    - [ ] I just generally feel tense. 
    - [ ] I can't control my thoughts. Sometimes it's hard to even focus on watching TV. 
    - [ ] This is all basically exactly how I felt two years ago, when you put me on Prozac. 
    - [ ] I might feel completely fine going to bed, but when I wake up it's like I'm a different person. Depressed, incredibly anxious. This has happened a couple times now. 
- [ ] Although I think the trigger was the friendship ending, I think there were some things that built up to this: 
    - [ ] Work stress, not having a lot of control over certain things like which interns accept our offers. 
    - [ ] Isolation from living alone. 
    - [ ] Obsessiveness about furnishing my new apartment. 
    - [ ] Not spending time relaxing in my free time; even relaxing hobbies I end up turning into work 
- [ ] The worst this time isn't as bad as it was last time. 
    - [ ] With the exception of a couple nights, I've been able to sleep most of the night. 
    - [ ] I do have some good days where I feel mostly back to normal. 
- [ ] I've been staying with my girlfriend and going on runs regularly, which is the only thing that takes me out of a bad state. 	

First couple of days: Headache, naseu, diaherra. At least a couple weeks to kick in. Right off the bat, sexual changes delay in ejaculation.

Only thing is going straight to 20mg rather than 10mg. Likely what happened in it. Not necessarily going to take longer to kick in. Likely to be a slow improvement over time.

asked questions about weight gain, and where I was now.

this appears to be a cycle with you, that's almost to be expected, it's just a question of how long between cycles. Since SSRIs worked last time, we should try that. We could do prozac, but there's the weight gain. Could try another SSRI to avoid that, but could still have weight gain and don't know if it'll work as well.

July 28th is next appointment. 2 months from now. Originally said wanted to check in in 4 weeks, but I said I was paying out of pocket so would like to start with 2 months (default) and can schedule an earlier one

Recommend taking it in the morning, better to take it first thing in the morning with food.

Nothing they can do on the bill, because he works for a company so they decide the prices. Could talk to the company, though. Told him I'm paying out of pocket.

- [ ] Do you think I should go back on Prozac? 
    - [ ] Yes. 
- [ ] Is there anything else I should do? 
- [ ] Is there anything my girlfriend can do to help me better? 
    - [ ] Hope you don't mind my candor, but anxious people can be very annoying, tend to be very needy. Just be patient. 

If I am going on Prozac: 
- [ ] Can you please put in the prescription right now so that I can start tomorrow morning. 
    - [ ] Yes, I'll do it right away in the next 30 minutes.
- [ ] I have a phone number and address for a 24 hour pharmacy I can go to.