New Doctors!

I just got back with my meeting with the director of AustinOCD, and overall I think the meeting went well. The director of the center is Dr. M and he kind of looks like Richard Attenborough from Jurassic Park. The meeting was mostly "patient education" about OCD and what happens in the brain with this specific disorder. Dr. M refers to it as a "neurological glitch." This glitch happens in your frontal cortex, so you perceive danger where there is none.

Here are some of the other relevant things I learned from the meeting:

Medication: Dr. M discussed the medication switch I went through recently, and said that because I had such a hard time when I was starting the new medication, it might actually indicate that this particular med is going to be a good fit with my brain. It's kind of complicated, but because of something called "downregulation," when an SSRI is a good fit with your brain, it floods your body with serotonin, and so (at first) you end up producing less and so feeling worse. In the long term, though, once I adjust, it might indicate that the particular chemical in the Sertraline will help me a lot.

Prognosis: I had been nervous because when I first spoke with Dr. M he had referred to my condition as "severe." That totally freaked me out. I mean, yes, things have worsened with my condition, but it's scary to hear someone say you have a "severe" illness. He addressed that today with me - he said it sounds like the anxiety/"suffering" I've been going through is severe. However, he says he's very optimistic about my treatment based on my history with OCD and current disposition.

Rituals: My homework this week is to "poke" at my OCD - just try to change little things in my rituals. I had been trying to tackle some ritual-changing on my own, and told him I started with trying to stay out of the house later because it was such a "big" ritual and so obnoxious. He asked why I'd started with something big and suggested I try to do small things instead. He emphasized I take on modest goals at first. Especially at the beginning of recovery, he said, it's a mistake to do too much.

Overall, I'm pretty positive about things right now, but it's soooo hard to just make slow, small gains. I am impatient and want to fix every problem right now.

Yesterday I successfully did my homework of staying out of the house until 4:15! I was also out of the house for 6 hours total. Yay! Today, however, I woke up feeling really anxious. Dr. E said this might happen. She told me that I might have a "mid-week crash," but that ups and downs in my anxiety are to be expected at this point. So, I guess that is what is happening today? My body is still adapting to the new meds and coming out of its funk.

Mostly, I'm regretting looking for information about SSRIs on the internet. I linked to the Wikipedia entry on SSRIs in one of my last posts, and the entry was all about how it's widely doubted if they even work! I did not need to hear that, internet. I'm trying to chalk it up the the internet being a weird, scary place that's not always full of the most accurate information.

Doctor's Visit

I just met with my psychiatrist, Dr. E (who I've been calling my "doctor" in my earlier posts). She wanted to see me today to check in about how the recovery was going and see if we needed to make any adjustments. She's this shorter, perky lady who is very, very smart; so, it's very nice to see her. Also there are only particular types of women that I know who legitimately look good in pantsuits, and she is one of them.

In list-form, here's the situation:

Medication: My mood has been getting better, little by little, over the past two weeks. Dr. E says this is a good sign since that means I'm responding to the newer medication, an SSRI called Sertraline. Because I'm responding to it, I won't need to be put on an additional, heavier, medication in order to amplify the effects of the Sertraline. However, we are going to increase my dosage of my SSRI, starting today. I'm going to stay on the supplementary, short-term medication (Ativan) for the moment. Over the course of the next three weeks I'll wean myself off of that one.

Mood Stuff: I should continue to feel better, and the crying jags should start to taper off. I've been getting stuck in them only every other day or so. Dr. E says that I might have a some rough days, but that that's ok. Overall, the strings of "good" days should continue to get longer and longer.

Rituals: The increased dosage of the meds should eventually, in conjunction with my work with my counselor, help the rituals reduce in number and duration. I've had several little victories this week: I went back to work, I cooked dinner for myself, and pushed my rituals back to 5:25.

For the future: I'm going to see how I adjust to the new medication and check back in with Dr. E in four weeks.

Right now Mom's still staying with me, and she might be here for the next two weeks. I'm really grateful that she's been able to stay, even though I feel bad for keeping her here so long.

Mostly, right now I'm feeling really bummed because of something I talked about with Dr. E. Up until now, I'd been living with the assumption that my OCD was mild. Because of recent events, though, I've had to talk with Dr. E about the extent of my anxiety and she seems to think that the condition wasn't mild at all. According to her, I was, sort of just managing, and working my life around my OCD. Today in her office, I was asking (as I often do now),

"How did this happen? My OCD used to be so mild."

And she responded, "Was it really mild?"

Even a few hours a day spent performing rituals adds up. That's a lot of time. I guess I've been enjoying feeling like mine was a marginal, super-mild case of OCD. I felt like I didn't really have to think about it that much. I'm trying to come to terms with the fact that I actually have, for realz, OCD. I'm trying to stay positive about this - because my doctors know the full extent of my condition, and I'm not trying to pretend like everything is fine, they can treat the disorder better. But it's hard to admit the way I've actually been living - it means owning up to the depth of the problem.

This is a blog about my recovery from OCD. I thought it might help for me to start of with some basic details about my condition, and how it has changed in the last month.

2009 - 2012

I was diagnosed with OCD in the spring of 2009. At that point the condition was very mild, and my rituals (physical things I do to reduce my anxiety) were not very intrusive in my life. I was put on a low dose of an SSRI (Lexapro) to manage the condition, and began work on Cognitive Behavioral Therapy (CBT). CBT is a type of therapy where patients gradually exposes themselves to anxiety-provoking scenarios. I was successful with the CBT and the medication. Though I had a few ups and downs, overall, I was improving steadily with my OCD recovery.

2012 - 

According to my doctors, OCD naturally waxes and wanes. This past January I had a series of panic attacks and experienced a sharp increase in my OCD symptoms. Basically, my anxiety and rituals both increased a lot. In order to manage my anxiety in the short term, I've been put on a heavier, temporary anti-anxiety medication (Ativan). My doctor wanted to see if my anxiety would stabilize and return to normal levels on its own. We waited for two weeks, and my anxiety levels had not improved. Therefore, my doctor decided I needed to be on a different medication, and on a much higher dose. So, about a week ago, I switched medications, and increased the amount I was taking. 

Details about my OCD

Rituals: OCD is a condition where an individual experiences distressing thoughts (obsessions) and tries to use rituals or physical acts (compulsions) in order to mitigate their anxiety. Right now, my rituals take up most of my evenings. I'm working on minimizing, little by little, the rituals that I perform. 

Medication: Right now I'm on two medications, a temporary anti-anxiety medication (that I mentioned above) and a long-term SSRI (Sertraline). The SSRI will take some time to kick in, so right now I'm waiting to start feeling the full effects of the medication. I have a meeting with my doctor next week to talk about reducing the temporary medication, and increasing my SSRI dosage. 

Complications: Adjusting to the new medication is a little tricky, and my body has been doing some wonky things during the transition period. I've been experiencing on-and-off nausea, intermittent crying jags, and some nocturnal myoclonic jerking. According to the doctor, these side-effects should wear off as I adjust to the medication. 

Prognosis: My counselor (psychologist), who specializes in anxiety-related disorders, has been having me do little pieces of "homework" every day. Basically, I try to do one thing each day that makes me anxious, such as breaking a small piece of a ritual. My doctor (psychiatrist) says that my ability to do this homework is a very good sign - most people going through medicine transitions aren't even able to do that.  So, it's very positive for my recovery that I'm able to tolerate the anxiety of working against my OCD, if only in small pieces.