Wednesday, October 29, 2014

I Wanted To Be Wrong

After writing the last couple of days about what Thomas's symptoms were, a part of me wanted to pretend that what he and I had talked about wasn't true. Perhaps I had misheard, perhaps I pushed him to say things that weren't true for him, perhaps he misunderstood my questions and perhaps, maybe, in the face of scrutiny by his doctor that he would deny that he was having any issues. Well, I was wrong. My magical thinking, which is very maladaptive, I know, didn't work and I got hit right between the eyes with the truth yesterday in Thomas's appointment with Dr. N.

I began our afternoon by giving Thomas my notes that I had written for Dr. N. detailing what Thomas had told me on Saturday. I wanted him to look them over and let me know if he took issue with anything I had written. He rode beside me in the car and read, out loud, everything I had written there. There was no denial from him about anything I had written and he handed it back to me. My only thought at that point was, "good, okay, so I'm not misrepresenting what he had told me." It was all fine and dandy with that little green paper with the notes, I wrote them and had them read back to me apparently still in denial and we drove the rest of the way up to Dr. N.'s.

When Dr. N. came out to grab Thomas for his appointment I asked him if I could come in at some point. He agreed and then he and Thomas disappeared. I sat there absentmindedly doing things on my phone while I waited to be called back. Within a half an hour I was invited back and I sat down and listened to Dr. N. talk about his plans. I did interrupt at one point and began asking Thomas if he had told his doctor, first, about the "energy" he had been feeling. He had said something and Dr. N.'s solution was to reduce the Latuda because it could have been the culprit. I get this thinking but I wasn't sure that the Latuda was really causing it since he had been on it a while and was only now having that issue. I shifted in my chair, looked at my list of psychosis symptoms and wanted to protest the reduction of that particular med. Instead I asked Thomas if he had told Dr. N. about the auditory hallucinations.

He had.

The conversation shifted to his anti-depressant, Cymbalta, and Dr. N. said Thomas expressed that his depression was back and wanted to increase the Cymbalta. THAT I was on board with. Still, though, I wanted to know if Thomas had told Dr. N. everything. I brought up the body "possession" (again, my word not his) thing and Dr. N. seemed to finally be registering that Thomas was doing worse than he thought. He asked me then how I felt about decreasing the Latuda. Finally I could say what I wanted to say:

"With Thomas experiencing the symptoms he's having it seems to me it would be foolish to DECREASE the ANTIPSYCHOTIC since he was slipping into psychosis."

Helloooooo Dr. N., wouldn't you agree?

He heard me, thank God, and decided instead to take away the Wellbutrin since that has been known to cause paranoia in people living with schizophrenia. That's all fine and dandy but again, Thomas has been on that for years and been through several psychotic cycles and no one even touched that med. But okay, let's take that out and give it a try. Still not my personal choice but I agreed with the plan. Dr. N. had a little bit of a point because supposedly the Cymbalta would pick up where the Wellbutrin leaves off.

In theory.

You see, there hasn't been one single antidepressant that I, personally, have been pulled off of cold turkey that I didn't have some kind of withdrawal symptoms. Some were even nasty and made me actually worse for a while as I scratched and clawed my way off the drug. Cymbalta and Wellbutrin are completely different compounds so I don't think removing the Wellbutrin will be without it's own consequences. Dr. N. insisted there would be no problems whatsoever and I just shook my head having heard that from several psychiatrists myself that was true when in fact it wasn't. I figured, though, that I would just prepare myself to clean up that mess.

Then I asked Thomas if he had told Dr. N. about the auditory hallucinations. He had but Dr. N. decided to investigate that further. He asked Thomas if HE thought they were just ambient noises and he asked if Thomas had investigated them. Thomas, at the time since he was at work, had not been able to. So Dr. N. asked him,

"If you had to guess, what do you think the sounds were?"

This is where the knot in my stomach tightened as Thomas said,

"I would say they were hallucinations."

There it was. Right out there in the middle of the room for me to really, truly, finally process it. No more denial for me, no more hoping I had heard him wrong on Saturday, no more magical thinking, he was directly stating, in his own words, that they were in fact hallucinations.

I felt sick.

So, there it all was, out there for everyone to take in, Thomas is, in fact, becoming (or is?) psychotic. I wanted so desperately to be wrong. I wanted to rewind the whole session, rewind everything back to last Friday and just forget it all.

That was not to be.

So here is where we stand. Thomas will stop the Wellbutrin today, he will double the Cymbalta and he will remain on both the Latuda at it's original dose and the clozaril. At least we're keeping the antipsychotics. We also have an appointment in less than 2 weeks with Dr. N. to reassess. At least we won't have too wait long.

All in all, the appointment went well, at least as well as it could given I'm not the doctor here and Dr. N. had a plan so we'll go with it and I'll just pray that the cold turkey removal of the Wellbutrin won't have any effect on Thomas. As we drove away from the hospital, I told Thomas to be sure to tell me anything he feels that is out of the ordinary. He promised he would.

Thomas works tonight. We'll see how the day and the night go with this new plan in effect. His working will definitely put it to the test. Let's hope my experiences with antidepressants were an anomaly of mine alone and that Thomas will handle it like a pro.

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