Beyond the Protocol

This morning was my halfway point (4 weeks done, 4 weeks to go) appointment with the psychiatrist.  I love Dr Sedney.  I have been thru a LOT of psychiatrists over the 40 years of depression and none of them like her.  She is so personable and calming and more about me and not pushing her med agenda which I love. 

This was the point to discuss where I am and where I want to go and what my options are moving forward.  It was so helpful and gave me a lot to think about. 

She asked me how I have been doing and I told her that I was a problem child those first few weeks with my getting sick all the time and having my meltdown that it wasn’t working on session 3.  I told her how helpful Caitlin has been and how I have been taking the magnesium as well as meditating before the therapy which has really helped.  I also told her that I started to feel a slight change and noticed my score went up on the survey so felt positive about that.  I expressed how when I started the survey I noticed there was no option to choose “every day” for the questions like “I feel suicidal”…every day, “I feel like a failure”…every day.  The only option was “almost every day” which was ambitious but the lowest thing I could pick so for me to just get to a point where it is not EVERY day is a step forward. 

My worries are that it won’t last and that when this is over I will just slide back down. I was also curious where I am on the spectrum of patients.  Sometimes I see people claiming that they had one treatment and were all healed.  So I didn’t know how different I was from normal people and not these miraculously healed folks.  She said that I am exactly right in line with my healing and I need to consider that some people who say that are simply either feeling a bit of the placebo effect or maybe have not struggled with depression as long as I have. 

She explained that the neural pathways in the brain need to rebuild and that takes time.  It does not happen overnight and I have YEARS of damage (almost 40 to be exact) so that is going to not heal overnight and I need to know that every treatment is a step toward better. 

She also asked how I feel about dropping down in dose now heading into the 2^nd half.  I told her that due to my schedule and Jym’s and being so far from the clinic it is actually a relief for me but of course I wonder if I am getting enough.  She explained that this is no different from, for example, a steroid.  You give a high dose to kick start the treatment but then you level off and the meds still work.  Years of research went into determining the right doses and the right times and so I should not feel like less will mean less healing.  That is not the case. 

She also addressed my concerns over moving forward beyond the protocol required 12 sessions.  Apparently my insurance has approved me for a YEAR of treatment and beyond the initial protocol (as long as I adhere to that) I can continue treatments as needed!  If I decide I want another month of once a week or maybe once every other week I can do that.  She has someone who has done it for 2 years straight and just keeps doing it so she doesn’t backslide.  She did tell me that I can do this as long as I feel the need and that is totally up to me and my needs.  She also said there is a maintenance lozenge that I can buy (not included with insurance) that will be like a once a week at home treatment which will not be as intense of course as the Spravato but will be a good fill in and help with maintenance. 

Those run $125 for the first month (so 4 treatments) and beyond that once the dosage is determined I can usually move on to the $175 for 2 months.  I of course would also have to see her periodically which is understandable and I can also supplement the Spravato with these.  Like if I did Spravato in the clinic every other week then I can do the lozenges on the “off” weeks. 

I told her this is a lot to consider so I plan to think this out over the next month and then make my decision but if I am being honest I can work it out I think that I would like to continue.  I feel like if this is healing my brain I need it to be able to do that.  What I liked about this treatment is that it has the potential for remission but I need to get there first.  If I stop abruptly and then go back to where I was I would have to enter the entire protocol again.  I do not want that.  I also know that for months I did acupuncture to get to a place where I felt remission and could walk away with only an occasional booster so I would hope that this will be similar. 

Again I have a lot to consider and will need to discuss this with Jym at some point but I have time to make these decisions.  I am glad I have all the information and that I don’t just get kicked out and end up done with no options.  I did make a follow up appointment with her in August so I can decide from there where I want to go.  I hope by then I will have a better idea.