Yesterday’s advice – “Focus on climbing tomorrow.”

Yesterday was a strange day for me.  I’m going through some medication changes and went from being extremely depressed the week before last to having a pretty good week this past week!  The change, for me, is like night and day.  I’ve been in pretty good spirits this last week and I’ve been climbing, which makes me happy.  There’s only one bothersome side effect going on, but that one can be dealt with, I think.  As far as functioning goes, I’ve faced aversive situations with a degree of humor and been able to laugh at them instead of letting them ruin my day, which my doctor really likes.  I’ve also been able to think a lot more.  By “think”, I mean having self-directed, cognitive processes going on instead of getting stuck and staring at a wall for an hour at a time while really thinking about nothing good and having mostly intrusive memories flood in.  I think that I may really have had a strong degree of that Apathy Syndrome going on from the high level of the medication that we lowered.  The really amazing thing, though, is how much better, and how quickly, the medication that we doubled has worked to improve my thinking, feeling, and functioning.  It was unexpected, but we’ve done it twice, now, both times having the same results, with this medication.  It doesn’t make sense, strictly speaking.  As far as indications go, we’re way off-label.  I don’t have a thought disorder, psychosis, or bipolar disorder, that we know of.  My doctor has a cognitive model in mind, as far as this medication class being one to squash my overactive limbic system and enhance my levels of functioning in the frontal lobes, and that maybe the pharmaceutical company just didn’t go after the off-label use with the FDA as an adjunct to pharmacologic antidepressant therapy.  Beyond that, we’re dealing with the simple result of success, and my doctor said, “I had a professor who said, ‘You can’t argue with success.’  So we won’t.  We’ll just ponder it.”  My doctor is a very by-the-book fellow until the book doesn’t work, so I know that this enigma bothers him.  It’s nice to feel better, but I’m intellectually curious as to why it’s working, too.  I like my doctor’s cognitive model and I’m sticking with that…while I do some heavy-duty research in my field of academic expertise – psychology.  I need to get my Ph.D. one of these days…

I had an unsettling and rather sickening thought last night that was horrific to me (the me that thinks I might not be completely insane), so I called my doctor and ran only half of it by him before he said, “Chris, you’ve got about three degrees of what-if’s here.  I want you to focus on climbing tomorrow.  Focus on what’s happening here and now.  Focus on having Easter with your family.”  He was concerned that I was thinking about the Desert again.  I was.  “I think you’re borrowing worry.”  I thanked him and took my medication, although it was a while before I went to bed.  I wanted to look up everything in every book I could think of that would help me figure this out immediately.  I could’ve spent all night doing that.  I woke up this morning thinking about it.  I would need to look in the DSM-5 for the current diagnostic criteria, my psychopharmacology textbook for the mechanisms and effects, my biochemistry, anatomy & physiology, and psychophysiology textbooks for the physiological effects and the receptor types that could be affected by Drug X, my medical dictionary for the definitions of any words that I had forgotten the meanings of in my long stint away from my studies, and several other books that I could think of right off the top of my head.  I went into my office and immediately found my DSM-5 and my most handy prescriber’s guide to psychopharmacological medications.  I did not touch them, though.  I thought about looking on MedScape, too, but I haven’t yet.  Something in me is very worried that I might find out something about myself that I’m not ready for – something I may not want to know.  I’ll try to let it cool a bit before I pursue it further.  No sense in borrowing worry, especially when I can climb and enjoy myself!!!

The climbing gym opens in about an hour.  If I can make it until then, I think I’ll be okay for a bit.  I have my theory.  No sense in dwelling on it.  Climbing is much more fun, and I enjoy it, so I’m going to focus on that, like my doctor told me to.  “I want you to focus on climbing tomorrow…”  Okay.  I will.  After all, yesterday’s tomorrow is today!!!

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