Dear Doctor...

I'm supposed to talk to my doctor about my medications on Thursday.
I foresaw this being a disaster, frankly.  I tend to get intimidated and anxious easily, can't explain things and just shut down, communication-wise.

Which, of course, is really unproductive.  It's not that I'm trying to be difficult, it's just that I get really really anxious and overwhelmed and pretty much just feel like no matter what I do it's not what I'm supposed to be doing.

I guess that's it.

In light of all this, I thought it might help to email my doctor before the appointment and share my thoughts.
This way, he would know what I was thinking about before hand, I would have all the time I need to try to explain and he would have time to think about things also.

He seems to think that the buproprion should be adequate for the ADD and was wondering why I am on the methylphenidate ER. My biggest concern is that he wants to simply pull me completely off the methylphenidate right before the challenge of a fulltime semester [which I haven't done] at a new school in a new living situation.

It is quite obvious to me that this is less than ideal. Then again, I'm the mental patient- what do I know, right?

I've tried to go without the methylphenidate before. It was not pretty. That would be the time I went from a good clean A down to doing so poorly for about a month that it averaged my grade out to a C+ in the end.  So that didn't end well. It wasn't all the medication, I will grant that. However, it's kind of like pulling a net on a tightrope walker when they are at the half-way point.

I had no coping skills to manage that change.

He said that I am on a really high dose and he said he has concerns about me being on such a high dosage.  I'm willing to take that into account.

Part of what I wrote to him:

The problems that I feel have that have been helped by methylphenidate:

1. I think I'm multitasking but I'm not.  I feel as though I'm getting more done, but I'm actually interrupting production of several tasks repeatedly, stopping the flow of work and jumping between these projects/tasks/activities, only to attempt to pick up where I stopped last.  It is disorienting; usually it means I end up with either unfinished tasks or poorly done tasks or both.  In tasks that require some sort of continuity or coherence, a disjointedness is often evident.  

2. People like to laugh and call me scatterbrained.  I call me frustrated and occasionally pissed off.  Unmedicated, I don't remember/find it exceedingly difficult to find things or train myself to remember where they are.  I try to live by "always put it back in the same place", but when my brain runs off to a new exciting adventure every few minutes, "That goes back in it's place" is often cut off by "oooh, shiny!".  That is to say, before I can follow through with a controlled and thoughtful action, it is often interrupted by a new thought and action which is neither controlled nor well-planned.  

3. I am extremely impulsive, often doing and/or saying before thinking.  I have a terrible and chronic case of "foot-in-mouth" disease.  Being medicated does not necessarily tell me that what I am going to say is wrong but rather gives me pause. I have a buffer to think rather than my mouth simply running into the conversation with out me. Or, in another case it prevents me doing things like turning a half full cup of water over to look at the bottom.

The disorganization and the interruption of thought makes schoolwork extremely difficult.  This would explain why I had such difficulties for the month or so that I was off of concerta and ended up dropping my solid A in anatomy and physiology down to a C+. The last thing makes life in general difficult.

I am now entering what will probably be the most challenging semester I have encountered, in terms of adjustment, work load and stress.  Making drastic medication adjustments would probably be ill-advised.  I would like to, at first, have the methylphenidate reduced to 72mg in the morning from 108mg and leave the methylin in the afternoon as needed.  After a couple months, once I have adjusted more, it could work to have a further reduction if I seem to do well on that.

If he has an issue with this, I'm not sure what I'm going to do.

While I don't have huge problems with him right now specifically, there are things that may or may not be problems in the future.
If he's willing to accept that you can't just go at someone's cocktail with a chainsaw, that makes sense.
If he wants to start hacking away at everything while I'm in the middle of a huge life-change, that kind of raises a flag for me.

The fact that I changed psychiatrists, even though I was not thrilled with my last one, was a huge "leap of faith" in the first place. I'm not being totally resistant to what he's saying.  I just am not about to jump off a cliff, thanks.

I'm worried.

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