After receiving the results from my clinical evaluation, I sent my psychiatrist an email. The evaluation hit me hard. I ended up begging for Provigil. The text of my email is below.
The clinical evaluation confirmed much of what we expected. Bipolar disorder isn’t present, instead Dysthymia, major depression and adhd are.
I’m, I don’t know. The antidepressants I think are helping some, I don’t know. The best part of my day is still the first few hours of Vyvanse, I get to feel alive.
Having read the eval, I am really defeated. Nothing is shocking in this report, it confirms our expectations. I just, I, I am so tired of being sad. Dan deserves more.
The paragraph below I found most depressing, particularly the bold part. It sounds right, and it feels right. My personality makes me unlikely to “experience pleasure in life.” And even if the pills work, none claim to change my personality, to help me experience pleasure. It is so damning.
The patient’s profile was developed using the D (depression), Pt (psychasthenia – fear, anxiety, tension, depression, intruding thoughts, and obsessive-compulsive symptoms); and, Pd (psychopathic deviant – rebellious, non-‐conforming; family problems; impulsive, angry, irritable, and dissatisfied) scales. Patients with this pattern tend to exhibit a pattern of chronic psychological maladjustment. The patient appears to be quite anxious and depressed at this time. He may be feeling some tension and somatic distress along with his psychological problems. He endorsed several items related to suicidal ideation and should be monitored for risk. He indicated a history of impulsive acting-out and substance abuse for which he expressed guilt and remorse. His personality is such that he may have only a small capacity to experience pleasure in life and tends to be pessimistic in outlook. It appears he is experiencing disturbed interpersonal relationships. Patients with this profile are prone to substance use and abuse disorders and all treatments involving medication should be carefully monitored.
I have been Googling about medications, I need, I don’t know, more help. Like, this can’t be it. I hope not.
Provigil is the only thing I find particularly hopeful. It would likely wake me up a bit, give me a bit of energy to get up off the couch. It has been used off label for depression and adhd. It has a lower rate of addiction, it being a category IV and Vyvanse being a category II. Tolerance is much less likely with Provigil, having had studies go as long as three years.
I just, I don’t know. I guess part of me is still hopeful. There must be something else out there, something that can help a bit more.
I am trying really hard, really. I just want to feel alive.
Current Medication: Vyvanse 40mg, Lamictal 200mg, Pristiq 100mg, Seroquel XR 200mg, Strattera 80mg