Every three months or so, I see my psychiatrist for a few minutes on zoom (or Doxy, actually, a platform specifically for medical appointments), because he decided not to go back to in-person visits after Covid. He asks me how I’m doing with my antidepressant medications, and I say “fine,” and he takes notes and refills my prescriptions and makes a new appointment for three months in the future, and then we’re done. Of course, there have been times when I didn’t say I was fine, and he raised the dose of one or the other of my medications, which led to a one month follow up instead of a three month follow up, but for the most part, everything has been stable for quite a while. To fill out the four- or five-minute appointment, we tend to chat about my teaching, or my other doctors and the new medications they’ve added to my regimen, but for the most part, he asks me if I think I need to raise the dose of my meds, and I say no, and we wish each other well. But at my latest appointment, when I said a variation of my usual “I’m fine,” he said, “but what does that mean?” and I didn’t know how to answer.
In the end, I must have said something reassuring, because he kept everything the same and we made the usual appointment for three months in the future, but when I closed my laptop, I wasn’t sure if “I’m fine,” was really the truth, or just something I’ve gotten used to saying. I don’t remember if I was more willing to go into details back when I actually had to leave the house for those five-minute session every three months, but there’s definitely something about the virtual appointments that encourages me to keep it simple.
The fact is, I don’t really know if I’m on enough anti-depressant medication, or the right medication. I have no idea if this is the best my mental health can be, or if there are medications or other treatments that could make things better. The few times I’ve been willing to risk changing my medication were when I was feeling so awful that I wasn’t sure I’d be able to function otherwise.
Antidepressant medications are a mystery, and not just to me. Doctors still don’t really understand why they work, or why one medication works for one person and not for another. It’s a lot of trial and error and guesswork, and a little too much Russian roulette for my liking. When I was first trying medications, years ago, the doctors would try a few from each family of drugs, and I had to spend weeks, and even months, dealing with weird side effects while waiting to see if something positive would happen. There was one medication that the psychiatrist (a different one) insisted on trying even though it was meant for bipolar disorder, which I don’t have, and within 24 hours I felt like I was going to jump out of a window, or at least scream until my head exploded, and I refused to take another dose. The doctor didn’t seem to think my reaction to the meds was all that bad, and he wanted me to stick with it for a least a few more weeks to see what would happen, but I felt strongly that I shouldn’t be taking a medication that made me want to kill myself and he reluctantly moved on to another class of drugs.
Psychiatrists, and other doctors who prescribe these medications, also tend to be unusually terrible at diagnosis, because there is almost no consistency in how different doctors interpret the words of the DSM (Diagnostic and Statistical Manual of Mental Disorders), and the words used in the DSM are generally unrelated to the way patients actually experience and describe their own symptoms. Sometimes it feels like the doctors are waiting for certain magic words to be said, and don’t know what to make of the metaphors, sentence fragments, and shrugs that real people use to describe how they feel.
To be fair, medical doctors are just as terrible at diagnosis when they don’t have hard and fast results (from blood tests or scans) to determine what’s going on inside. The pain medication I’ve been on for maybe fifteen years now (after trying a lot of different drugs meant for any number of different diagnoses) has only ever reduced the pain by half, and usually less than that; and the same is true of the psych meds: if they reduce my symptoms by half, that’s a good day.
In an ideal world, I would sit down with each of my doctors and describe in detail how I feel (what hurts, how it hurts, what I’m struggling with, and what I’ve tried) and be answered with curiosity, understanding, respect and investigative questions to help me pinpoint and articulate my symptoms as clearly as possible. But, to be honest, that has never, ever happened. I have certainly attempted it, with dozens of doctors, but they tend not to hear what I’m saying over the noise of their own assumptions, and it ends up being easier to keep things short.
I’ve been on my current anti-depressant medications for more than ten years now, and while they have caused weight gain and nervous system disruptions and a bunch of other side effects, they allow me to function most days, and they give me the leeway to do the therapy work that helps me move forward. And for me, to be able to say on an average day that I am fine, that I am not in a panic spiral or falling into depression or obsessing over this or that awful thing coming up in my life, is huge. It allows me to live my life each day and accomplish some of the things that matter to me, and experience joy, and even do the laundry. It may not be miraculous, but, at the very least, it qualifies as fine.
If you haven’t had a chance yet, please check out my novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.
Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?
rachelmankowitz 
I admire how you have the courage to share these reflections on your blog. I hope you continue to find equilibrium in your therapy journey.
Thank you!
Thank you for sharing and writing this raw and honest post.
Thank you so much!
You know it was only a few sentences in and I started to get angry for you and well, that didn’t subside. You are a better (wo) man than I Gunga Din, as my father would always say when he came about someone who would be stronger than he would be in whatever the periling situation might be. But still all this has to be some frustrating and maddening stuff. I have no answers, Lord knows I have no answers, other than to say there is this guy who also loves to write and likes to set aside time when he sees that new gmail in the inbox to read about your Rachel and your Rachel abouts this day.
I can certainly chalk up an issue or two here but know that it is never a bad thing to imagine yourself in some sort of movie kicking someone’s ass for just trying to pacify you just so they can about their day. My two friends, Jonna and Keryl, of a show I record with them, and have for quite some years now, would say to punch them in the throat but well, that’s a little extreme. Just stick with imagined movie scenes for right now. Cheers Rachel from me and my Bella and the Cricket.
Thank you!
A doctor’s inability to silence the ‘noise of their own assumptions’ is sometimes the biggest hurdle.
Absolutely!
Rachel, please write a book that features your dogs. The expressions and your assigned comments make me laugh.
I am so sorry that you need to go through this.
Thank you!
Hey Rachel, You’ve hit on the right formula (criteria, I guess) for using the mental health system (as it is now). Most docs use the scattergun approach (as you mentioned – try each drug to see if it works; if not try another one). The mental health field is sorely lacking in being able to trace issues to their causes. That is to say, they treat the symptoms. There are plenty of diseases that can cause mental issues: Lyme disease, for example. Wouldn’t it be nice to be able to get a blood test to see what medication is needed?
It would be awesome!
Sounds tricky to negotiate dealing with doctors.
Get Outlook for Androidhttps://aka.ms/AAb9ysg
Absolutely!
I feel for you so much. And I know what you have to go through. Honestly none of us with any sort of chronic illness or condition knows if we are being optimally treated. When you find something that makes you feel 50% better than when you started out, you are doing well. There may be something that can push that to 60% but I know for me, I don’t want to risk losing a known 50% chasing the illusion of an extra 10 or 12 or whatever %. If you can say you’re fine and your life backs you up, you’re doing better than most! Keep at it. I do and I always feel better knowing I have. I willing to say you do also.
Thank you!
sometimes ‘fine’ is the best word, especially if no one listens. Like saying someone is ‘nice’. If you’re not fine they will hear about it. I’m happy when i can say functioning well. That is all we can ask. And with your intricate life that says a lot. Good for you.
Thank you!
Doctors suck. Period. At least now they do, growing up in the 70’s and 80’s as a kid , doctors seemed to really care more. I am torn on head meds, my small dosage helps but my wife who is bipolar 2 takes nearly a dozen meds to stay on an even path and yet on the daily I still have put on my husband-therapist hat. But at least this recent combo is working, there are no hospital stays.
I don’t remember a time when doctors were better, unfortunately. Harrumph.
😕
that just sounds like the doc really doing the minimum and barely going through the motions to know you and to actually help you. I’m sorry. it should be much better than that
It should. Thank you!
💚
You do seem very self-aware which is wonderful! I wish you all the best and adorable photos. (chicken treats are always a good idea)
Thank you!
I consider myself very fortunate to have never needed any medication. I worry that doctors are too keen to prescribe medication rather than find root cause.
Root causes are definitely not their specialty today.
Thanks for sharing your honest and raw post. Perhaps consider sharing this essay with your doctor. Seriously, residents and medical students should hear stories like yours before they become complacent. V
From what I understand, many students who start out caring and empathetic have it squeezed out of them during the training period.
A friend of mine who was an ER nurse told me that if she intensely cared about every single patient, she would never be able to do her job because it would be too emotionally draining.
You compare it to Russian roulette, a dangerous game to be sure. I was thinking it’s an art and a science because human brains are unique with different chemistry and in that context, what works for you might not work for someone else. Or even future Rachel.
Absolutely.
Sounds like one of my sessions these days. Thank you for sharing. I know it is hard to do.
I’ve had one, maybe 2 doctors that actually took the time to listen to me.
The first was a neurologist. She finally got my headaches under control. Then she disappeared. Not thrilled with the new one, but he’s continued to write prescriptions for what I need.
The second was my first psychiatrist. Until she lost her visa. Three docs later, I’m finally on a med that has stabilized my depression without leaving me in a daze.
Keep at it and don’t be afraid to send a note to your providers when meds aren’t working. You deserve to be as happy and healthy as you can.
Thank you!
I feel you. I have switched twice and finally love my new doctor. The first one really didn’t listen to me and when I told him real true things, he said I was being grandiose. I didn’t stay with him long. The second wouldn’t work with me. My new doctor seems to actually hear me. I am very hopeful. Sending prayers you find someone who is truly check in with your needs.
Thank you!
This really resonated with me. I have video appointments with my counselor and the doctor who prescribes my antidepressants, but I have always had more than five minutes with the latter. We talk about things other than the drugs, such as incorporating exercise into my daily life. However, I am having a hard time getting the right stuff since I had to make a switch when I turned 60. For the first time I think I am experiencing weight gain as a side effect! (the other times I gained weight it was my love of food). Sorry, didn’t mean to run on. I hope you get doctors who listen and you find something that works. I’ll have to try those chicken treats!
Wouldn’t it be great if chicken treats were the solution to every problem?
I know, right!
kind of sounds like you need to find a new Dr. Anyone needing help, a few minutes screen time very much sounds like “phoning it in”.
Yep. Except that there seems to be a severe drought of Psychiatrists lately.
I’m glad I was only on anti depressants for 6 months, then weaned myself off them over the next six. I remember Hubby and I flushing them all down the loo in a little ceremony in the new year of 1990. There were so many of different colours, we stained the toilet bowl and couldn’t get it clean, so used one of those loo blue cleaner things in the cistern.
Hubby has a zoom call for an hour (she has to book it in two half hour sessions as she can’t figure it out) with his ‘psychiatrist’. She is actually a trainee, and he has been having sessions with her for a few months every couple of weeks, though she has had to cancel and reschedule some either due to stress or holidays! We are thinking of kicking her into touch as she seems to be doing more harm than good now and are waiting to hear from her supervisor.
Oy. That doesn’t sound good.
Long time ago now. I’m on my cancer meds for 10 years (4 to go) and no-one has told me if there will be any withdrawal effects.
Here’s hoping everything will be okay.
I’m doing OK thanks and the last mammo was clear. Feeling good!!
You know your body, more than anyone. You know how medication makes your body feel. Keep on be,Irving in your insights! 💜🤗
Thank you!
Typo. ‘believing’
I wish we still lived in a world when our medical practitioners took the time and we took the time to properly consult. To properly share what’s bothering us and to be properly examined and assessed. Like how medicine has been practised for generations until modern technology and money created “six minute medicine.”
That would be awesome!
My main volunteer at work always says she’s fine when I ask her how she is when she arrives. I know it’s not true, so I start asking about her knees, etc. Too bad docs don’t do that.
Absolutely.
Medication can only do so much.
The good news is that someday we will be living in a perfect world and a world where our joy is made perfect. It’s a tough fight to get there – but this world is not our home. We are just passing through. May God bless you.
I’m sure I’m not the only reader who can relate to how you described depression, meds, and drs. Or even just medications and drs. I’ve tried a slew of antidepressants over the past 20 years. Recently I switched after the one I’d been on for over 10 years stopped working as well. The good news is I don’t have hot flashes anymore. The bad news is it’s as effective as my last antidepressant was when I switched. So, currently I’m investigating ketamine infusions to try something different for hopefully longer and better results.
Good luck!
So other than your doctors, who else do you trust the most to lead you in the right direction when you doubt medication remedies?
Honestly, it’s a struggle to know where to go for good information. But I trust my own experiences. At least I have that.
I feel the same dealing with blood pressure issues .