After I posted yesterday’s update about the return of my Generalized Anxiety Disorder symptoms during my second trimester, I went to visit my psychiatrist. I love my new psychiatrist (in a completely appropriate way), because she has this power to immediately impart calm and reassurance whether it’s over the phone in five minutes or during a half-hour session in her office. Her demeanor and her voice just seem to say, “Don’t worry too much. Everything will be just fine, and this is all perfectly normal.” You can imagine that visiting her office last night helped me come to terms with this change.
I want to explain the changes she/we made to my medication regimen in detail, because psych meds are just so often misunderstood. I’m going to go over what each is of my medication is for and why I need two.
First, I take an SNRI, or Serotonin and Norepinephrine Reuptake Inhibitor called Effexor. Norepinephrine is a chemical that seems to help with anxiety, so having more of it in my brain is, apparently, a helpful thing. Serotonin, as you have probably heard, is a chemical that helps make us happy. If there is too little in your brain, you are more likely to become depressed. I started on Zoloft, the most commonly prescribed SNRI, but switched a few years ago to Effexor. (I am a big advocate for No Drugs Without Therapy, because eventually, every drug will stop working. Therapy teaches you coping skills that don’t stop working.) I was supposed to eventually only take an SNRI, but that didn’t work out. Anyway, here are the thoughts on Effexor, me and the second trimester of this pregnancy:
I am feeling more anxious all of the time, not at any one particular time, so that tells me that my “baseline” jumped up. Effexor (especially in the extended release capsules I take) is intended to do its work ’round the clock. To help me feel a little calmer all of the time, my doctor suggested increasing my dose by the smallest increment. She also suggested that I take 150 mg when I wake up and the other 75 mg in the afternoon, to help for all of the day.
Second, I take Klonopin, aka clonazepam, the benzodiazepine that has been such an important and yet difficult part of my treatment. We’re working with a fairly high dose already–3 mg a day (1 mg morning, afternoon and evening) is already half-way to the maximum recommended dose of 6 mg total per day. That’s my ceiling. At one point in my life, I needed that. If we end up going there by the end of this pregnancy, that’s fine with me. But my psychiatrist wants to move slowly, so we don’t hit that ceiling too quickly.
The new regimen (and it feels good so far!) is that I take a 1 mg in the morning, 1/2 mg mid-morning, 1 mg in the afternoon, 1/2 mg early evening, 1 mg before bed. If I didn’t already take pills 80 times a day because of all the vitamins for the baby and me that have to be taken with food or not taken together or taken with a meal that has saturated fat in it if possible (Vitamin D–that stuff does not want to be absorbed by me… what’s your deal, D?)… but I digress. The point is, I remember to take the half-pills, and so far, so good. Sometimes, I worry that I love Klonopin too much, but I have never been tempted to take more than the prescribed dose, so I’m not actually worried about addiction.
And I’m taking it one day at time, so that’s all for now, folks. Ask questions, if you like! I’ll be more generous than Lucy from The Peanuts and not charge you a nickel as I open up my psychiatry booth. ;)