Thursday, September 04, 2014

The Quandary He Breezed Through

At Thomas's last appointment with Dr. N. the suggestion of another anti-depressant being added to Thomas's repertoire of drugs was brought up. Thomas, at first, said he wanted them but when Dr. N. said he could print up literature on Cymbalta, the med we all chose for Thomas, Thomas jumped on that and took the literature. That surprised me and I talked about that in an earlier post but I wasn't sure he'd actually go home and read it. After 2 weeks of procrastination he read it yesterday. That's good. I'm happy he did it. But then he came to me and handed me the literature and said,

"I don't want to take this."

"Why?" I asked, curious what his reason would be.

"It's the side effects, I don't like the side effects."

Okay, I know this is going to sound bad but I responded by laughing and saying,

"Side effects? That's what you're worried about? Have you read the literature about your anti-psychotics? They are worse than Cymbalta."

Just so you know that comment was received just fine but then I backtracked a bit and talked to him about side effects and what they mean REALLY. The truth of the matter was, I was very worried that he was using this excuse not to take a med because I didn't want this to become a "thing" in the future for any other meds that might come our direction. I explained to him that when a drug company tests a drug on people, they are told to report ANYTHING they feel. I explained to him that what this means is that if someone, while taking the med, has a headache, they have to report that. The problem is, sometimes a headache is just a headache (or a stomach ache etc.) but because these people are in a study they have to report it. That does not necessarily mean that the drug caused the headache. He seemed to take all of this in but was quiet. Then I got down to what my biggest concern is.

"Thomas, if it were me, I wouldn't take the medication but only because I can see your depression isn't too bad, am I right?"

He kind of hesitated there so I went on.

"What is your depression level number on average nowadays?"

"A 1 or 2."

"Is that an uncomfortable level for you to live at?" I asked

More hesitation. Then finally he said that it wasn't. I pointed out that turning to another antidepressant would be a good idea if he reaches a 4 or 5 or 6. I did say though,

"Thomas, my worry is, though, that you will get hung up on the side effects so much that you'll let yourself get to an 8 or 9 or 10 and will be suicidal and you'll choose to remain in that state thereby putting yourself at risk of killing yourself because the pain is so bad. I would still say that I think it's a good choice not to start it now since you are a 1 or 2 but don't rule it out completely for the future."

"Okay." came his response so I dropped it.

I don't want to push meds and I can see it would be s serious waste to have him start it up now but this thing with worrying about side effects is a recipe for a disaster in the future. The more he focuses on that the more he'll become delusional and we all know how that ends.

Delusion in place = I'm never going to get him to change his mind no matter how I reason with him.

Not cool.

So, for now, we're going to treat this whole thing as an educated decision on his part since he's been doing really good lately and seems pretty clear-headed but now I have something I need to be mindful of for the future. I think I might give him the literature for his other meds so that he can put it all in perspective because when you look at clozaril, especially, he will see that there are myriad nasty side effects only really 2 of which he deals with that are livable.

Well...I don't know...what do you guys think? Should I give him the other literature?

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