Notes from my first meeting with Dr. Joe Walker, who turned out to be a fantastic psychiatrist who I ended up having manage my medication for years.

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About 2 months ago, I was having daily stomach pain and I went to see a GI doctor. After the endoscopy discovered nothing, it was concluded that the cause was my anxiety. 

I was put on Lexapro for 4 days, but it was causing me to vomit, so my doctor had me stop. My condition began to worsen, to the point where I would wake up 1.5 hours after falling asleep and then would have a panic attack. I began to obsess over my treatment, constantly questioning whether my doctor had me on the right path. For the past 5 weeks, I've been taking Remron (15mg) to help sleep and Wellbutrin (150mg). For the past 2 weeks, I've been taking Prozac (10mg) as well. The Prozac was intended to eventually replace the Wellbutrin. My psychologist strongly believes I need to get a second opinion on my medications as soon as possible.

My current symptoms are: most mornings, I wake up and I feel like I have nothing worth getting out of bed for, or I feel overwhelmed with things I need to do. If I don't have an appointment/meeting, I'll stay in bed for hours. I won't go back to sleep, I'll just lie in bed.

Once I do get out of bed, if I keep myself occupied throughout the day (with work, exercise, or a seeing friend), I usually feel good by the time I go to sleep. However, even if I feel great when I go to sleep, I have the exact same struggle each morning. 

I've had two periods of 4-5 days when I felt completely back to normal, and then all of a sudden I'd wake up one morning and feel unable to get out of bed, and I'd feel overwhelmed again for days. I think generally I feel better on days where: I feel confident in my treatment plan and I feel like what I'm doing at work that day/over the next couple days is enjoyable and achievable, or after I accomplish something significant. 

I wonder things like: how much of this is me just thinking I’m depressed and how much is actually because I am? The less I obsess over my depression and how I’m going to get better, the better I feel.

Prior to this bad period, I wasn’t on any psychiatric medication/never had suicidal thoughts. 

Should mention ADHD medication for like 10 years. 

It's not that I burnt out, it's that I was putting all of my happiness eggs in one basket: work. I was getting all of my satisfaction from work, and when I felt like I wasn't getting satisfaction from work anymore, it was like I was depressed, what did I have to live for, etc.

I’m starting to wonder how much of it is just work dissatisfaction. When I’m feeling better, I usually have stuff that I’m going to work on/working on that I enjoy. The days where I slip I usually don’t have a strong idea of what I should be working on. Work was like my main joy and what I lived for for 2 years, and so when that is taken away I am left with an absence of purpose and direction. 

I am extremely drug averse. I don’t drink, I don’t do other drugs, so when I’m put on a drug I obsess over when I’ll be able to get off of it, how long it’ll take to get off of it, the side effects, exactly when I should take it. When I symptoms, I wonder what part is the drug and what part is just me. 

More things:
* My psychologist wonders if the depression is secondary to my anxiety.
* Feel a bit cloudy often, like my field of vision and my alertness is narrowed. 
* I really want to reduce my medications. I feel like maybe Remeron could be causing my morning tiredness.
    * Originally I was put on it just to help with sleep.
    * It's like I feel sedated during the day sometimes, not sure what it is. Like I feel like not as sharp, not as smart, usually.
* I always feel better right after a run, so what I used to do was go for a run each morning on the way to work and then try to ride the high.
* When I feel bad, every time I'm doing an activity that is keeping me occupied, I dread when it will end because I don't know what I'm going to do next.
* Prior to things getting really bad, I was worrying about many things that are out of my control or are far off, like my parents dying, where my girlfriend will go to law school, etc.
* Sometimes I feel like I just have some things that make me really anxious/that I don't want to have to think about or deal with at work or elsewhere, so I act like this to get out of that stuff.
* Something that helped was when Tara told me: 
    * The medications can only do so much. You have to also work on getting better yourself. You can't just wait around for the medications.
* Sometimes I feel like I'm going crazy. I feel like I am fully confident that I'm on the right path and things are going to start feeling better, and then 5 minutes later I am second guessing myself.
* Sometimes I feel like just after a couple hours pass in the morning I'm just back to normal, like I can handle things and I feel fully lucid and capable. 

Notes from what he said:

He believes in psychotherapy. 

He thinks I have generalized anxiety disorder. 

He thinks I should bring Prozac up to 20mg, the minimum therapy dose. I should take two of the tablets. 

He thinks I should stop Wellbutrin cold turkey now. 

He thinks I should stay on Remron for 1 month and then go off of it. He said I could see how I’m sleeping over the next couple of days with the Prozac and could try it sooner. But he said that the sedation of Remron is all-day, and so it could spike my anxiety potentially. No taper for the Remron. 

He says I should be able to go off Remron cold turkey at 15mg. 

He says I could see him in about two weeks, although it’s usually about four weeks he wants to support me. 

He says I should be able go off Prozac without really a taper because it self tapers. He would put me from 20mg to 10mg for 1-2 weeks, then down to nothing. People are usually on it for about a year. 

He says that GAD is very treatable. 

Basically during the meeting, I started getting really anxious when he said I should up the Prozac, and then I started wavering back and forth. He said he's not going to go back and forth over it 16 times. He was firm but rational. Prior to that meeting I was feeling totally fine. After it, I started feeling the panic in my chest and really tired, like I was feeling before.

How I'm thinking/feeling now: 
* Just stick with this. You're on a good path: medicine reduction. Just keep doing this and work as hard as you can to be happy and healthy!