Dear Dr.

In December of 2013 I was feeling great. Better than I had felt in years. I had started planning a real future for me and felt better about myself than I ever had.

When January came around my insurance company switched me from a name brand medication, Cymbalta, to the generic version. Soon after I started to fall apart to the point where I had missed some work. At the beginning of February I saw my psychiatrist, S Q, and he believed that it was the change from name brand to generic. We switched back to name brand, but I didn’t get any better. There was no holding and I started to get worse.

Soon after he switched me to another pill, I don’t recall the name, and I stabilized, but I also didn’t get any better. Several times a day I fantasized about killing myself in various ways and planning how I would do it. Then the new drug started giving me major cold sweats. I’d sit in my off on a nice spring day with the window open and no breeze and suddenly I’d start sweating so bad that it would bead and run off my nose and I would leave a sweat print on my seat.

Again, we changed drugs. The sweats went away, but my depression deepened. I also started experience major stomach cramps. The cramps were so bad that I would walk about two dozen steps and then have to stop before I could move again. I nearly killed myself – I had everything ready to go – but my brother, sensing something wrong, visited for a few days and I lived to see my next psychiatrist appointment. At that time I insisted that we change drugs.

It was at this time, January 2015 I think, that I was put on Viibryd.

Viibyrd boosted my mood up enough that I stopped fantasizing all the time about killing myself. But it hasn’t given me enough to regain my old level of concentration or bring me out of my mental and emotional exhaustion. Also, I’d still rather be dead than alive, but my thinking is “clear” enough that I know I shouldn’t shoot myself or lock the garage and turn on the car.

Instead I think about how I could kill myself by not giving a shit about myself and that the people who know me are far less likely to be upset. What I mean is that if I have a heart attack in my apartment, can’t reach the phone, and die of dehydration a few days later, people will be sad and think it was preventable, but they would be much more upset if I tied a rope around my neck and jumped off a bridge. Same thing if I become diabetic and start losing toes and fingers and eyes and eventually die or if I get so fat that I just stop breathing, forever, in my sleep, people would be less upset than if I took an active hand in my demise.

The main reason I came to see you, beside good recommendations, was because my psychiatrist kept saying I needed a GP and when I went into the Prompt Care for my stomach cramps the MD I saw freaked out about my blood pressure and insisted that my stomach cramps were a symptom of my high blood pressure. So I came to you and I feel bad because it’s not that I don’t hear what you say or don’t read what you’ve given me, it’s that I don’t really care. I take my pills each night before I go to bed. I try to follow some advice from the papers you given me. Ultimately, though, I don’t care and can’t bring myself to care.

Which leads to the ultimate question: Why haven’t I asked to switched drugs?

There are two parts to this answer:
The first is that I spent the better part of 2014 fighting to not actively kill myself because I was switching drugs. I wanted a break from that. And if there’s one thing Viibryd does for me, it keeps me from actively working toward death. No ropes, no hoses, no guns.

The second is that my psychiatrist is retiring at the end of the year. I will see him one last time, next week. I don’t want to be working on a new drug while interviewing the few psychiatrists who take my insurance to make sure they will be a good fit to me. Maybe if I find one we can discuss changing to a different pill, after we get through the whole – “So, you’re depressed?” Yes. “Why do you think that is?” I don’t know, but it’s been in my life for a long, long time. “But what triggers it?” Nothing. “Something had to have happened.” Not recently. “How’s your job?” It’s okay. A bit boring, but I don’t hate it. “Having a problem with your boss?” Nope. I like my manager; even better, I respect her. “What about your coworkers?” They’re all okay. I don’t deal with them a lot, though. “Friends?” I have a few friends, but they live a long way away. “That must be lonely.” Not really. I rarely crave companionship. “That’s not true. Everyone likes to be with other people.” (Words that a counselor actually said to me.) I don’t. I never feel more lonely than when I’m surrounded by lots of people, even if I know everyone there. “Okay. We’ll come back to that. Girlfriend or boyfriend?” Nope. Not ever. “Not ever?” Not ever. “Why?” You don’t recommend a movie you don’t care for to a person you like, do you? – thing.

If you wish to speak with my current psychiatrist, please do:

How Santa Does It.

There is only one Santa, one sleigh, one sack of toys, and eight reindeer.

Santa and his elves spend the year carving largest, the most clear, most pure ice into a prism with so many facets that's impossible for the eye to find the edge.

Christmas Eve is the darkest day the North Pole experiences.

That night the reindeer pull the Santa and his sleigh into the air. They circle the pole gaining speed and altitude. When they graze the top of the atmosphere they turn and head straight down.

As they gain speed their physical form begins to shed until they become beings of pure light energy.

They hit the prism in this form and refract, a new sleigh, Santa, and set of reindeer fly from each facet.

These Santas each rocket off to their designated sectors to deliver gifts to the children of the world.