Needing a little insight into how psychiatrists and their midlevels think...

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jjohnnym65

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First and foremost I don't want you guys to think I'm bagging on shrinks because I'm not. Also I don't want you to think I'm soliciting medical advice because that is certainly a mortal sin in the SDN universe. I'm really just looking for some perspective.

Ok, now to the point. I'm currently in an intensive outpatient program for depression and anxiety. I attend therapy groups 3x per week for 4 hrs per night. I see an NP for med assessment/adjustment once per week. I'm out of work and down on my luck. Lost my girlfriend, hurting for money, about to get evicted, my dog died, blah, blah, blah. Anyhoo, I've been on Valium 5mg QD PRN in the past from my family doc. I'm also on Effexor immediate release (generic) 75mg TID. Valium has worked well for me in the past if I get too stressed and need to sleep or take the edge off for a bit. I'll take 5-10 mg one time and not touch the stuff for another week or so. That way I don't build a tolerance etc. If i go 24 hrs without my Effexor I get horrible withdrawal symptoms and I'd probably knock off a pharmacy if I had to to make them stop. My question is how come whenever I c/o sleep issues or anxiety the answer is ALWAYS to increase my damn Effexor? Whenever I mention that Valium has worked in the past I get blown off. I know that there's potential for addiction, abuse, etc. etc. but the effexor is the drug that I MUST have or I'd lose my mind. I can go without the valium for significant periods of time. Again, I'm not looking for medication suggestions or anything of that sort. I just want some insight into what might be going on in this NPs brain that she refuses to freaking listen to me.

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I'm not even a medical student, let alone a doctor. Just a master's level counselor. And this thread will probably get removed, but I'm curious why your provider doesn't go with Effexor XR? The withdrawal effects from Effexor seem to be well known. Or even taper and switch to a different anti-depressant with less urgent withdrawal effects? You could certainly ask you NP these questions, right?
 
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I'm not even a medical student, let alone a doctor. Just a master's level counselor. And this thread will probably get removed, but I'm curious why your provider doesn't go with Effexor ER? The withdrawal effects from Effexor seem to be well known. Or even taper and switch to a different anti-depressant with less urgent withdrawal effects? You could certainly ask you NP these questions, right?

Effexor XR is extremely expensive. Even when I had insurance it was $70 per month. Immediate release was $15. 60 37.5mg immediate release tabs without insurance is 107 bucks so even if you use the generic it still isn't cheap in the absence of insurance. As far as a different SSRI/SNRI hey sure as long as I can afford it. Why would it get removed? I'm asking for an analysis of potential thought processes NOT medical advice. I can see how it may tread dangerously close but I want to make it clear that medical advice is NOT my objective.
 
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Effexor XR is extremely expensive. Even when I had insurance it was $70 per month. Immediate release was $15. 60 37.5mg immediate release tabs without insurance is 107 bucks so even if you use the generic it still isn't cheap in the absence of insurance. As far as a different SSRI/SNRI hey sure as long as I can afford it. Why would it get removed? I'm asking for an analysis of potential thought processes NOT medical advice. I can see how it may tread dangerously close but I want to make it clear that medical advice is NOT my objective.

The potential thought process in psychopharm is pretty damn complex. Every patient is different and their meds should be tailored to them. Sometimes that can be like pointing a shotgun and hoping you hit the target. But, keep asking your provider for an answer. I don't know much. I'm still trying to make sense of all the little pictures in Stahls.
 
I'm sorry JJohnny, but despite your disclaimer, this still comes within the realm of providing medical advice. I sympathize with your problem, and can only reiterate that you talk to your NP about the issue.

Good luck.
 
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