1. Go in ready to ask questions
Do not just allow the psychiatrist to prescribe you a medicine you know nothing about. If the doctor is thorough, they will explain the medicine, its role, and potential side effects. However, if they are trying to get you in and out, they may write the prescription and try to send you on your way. To hold yourself accountable to asking questions, bring in a paper with them written down, and if that fails as well, bring a trusted adult, your partner, your parents, etc. with you to help remind you of the questions and concerns you expressed outside of the office. DO NOT feel guilty for taking up their time. It is their responsibility to answer your questions and ease your concerns.
2. Make sure the relationship is a match
This is your mental health journey, and you have the right to fire and hire providers as you see fit. One of my psychiatrists told me, “This is a professional relationship, and I will take no offense if you decide to fire me.” This is such an important aspect as you are trusting someone with your brain chemistry. If you are doubting your psychiatrist’s knowledge or understanding, the chances you stick with the drug they prescribed and take it on a regular schedule is not likely.
3. DO NOT be a “Yes-Man”
My boyfriend regularly calls me a “Yes-Man” meaning that I will agree with anything that is said especially by someone who holds authority. While I disagree that I am a so-called “Yes-Man” all the time, I definitely was at first with providers. I was striving to be the “easy patient.” I had opinions and frustrations, but I failed to express them in the moment during my appointment. I would then go home and kick myself over the fact that I had not voiced my concerns. It took me a solid three months, but I was finally so angry, fed up, and frustrated that I stopped caring about being “easy.” I realized that providers cannot read your mind, and it isn’t your job to make them like you. It is their job to sort through the complications, concerns, and hesitancies and that in no way makes you “difficult.”
4. Ask about GeneSite Testing
The GeneSite test is conducted by swabbing the inside of your mouth and mailing it in to Assurex Health. They then perform a full work up of your genes and how they interact with different medicines. They sort it in terms of red light, yellow light, and green light. Green light means there are no gene-drug interactions, yellow is moderate gene-drug interactions, and red is significant gene-drug interactions. In other words, green means “go,” yellow means “proceed with caution,” and red means “stop.” While there is a lot of controversy over the GeneSite test with some doctors swearing by it and others disregarding it, I have found it to be my saving grace. I was so sick of the “guess and check” or the “wait 6-8 weeks and let me know if you can tell a difference.” I had to weather the side effects, not knowing if the drug would even be helpful. I was sick of the uncertainty and the lax mentality of some providers. I wanted answers and a concrete starting point, and that is what this test gave me. After getting the GeneSite test done, I entered residential treatment where I started one of the only drugs that was in my “Green Light” column, and just like that, it has been the most helpful drug with absolutely no side effects.
March 13, 2019: Chapel Hill, NC
After leaving CAPS, my coach miraculously found a provider that was close to campus who had same-day availability. I headed over there prior to our team leaving for Athens, Georgia for a midweek game. The psychiatrist was incredibly nice, and not following my own advice, I was determined to be “bought in” to what she said and prescribed. I listened to her diagnosis of generalized anxiety disorder and panic disorder and felt relief that there was a reason for my frequent panic attacks, shaking, and instability.
She started me on Fluoxetine (10mg) and Klonopin (5mg) two times a day. I took this for a week and a half but was feeling no changes. The Klonopin was supposed to help with overall anxiety and panic attacks; however, it helped neither. I continued to experience both except now I was drowsy on top of it all.
March 19, 2019: Chapel Hill, NC
I went back to the psychiatrist, and she decided a stronger medication was required to ease the anxiety and panic. At this point, I was desperate for a solution. I asked no questions and agreed to take Ativan (5mg) three times a day. Ativan, just like Klonopin, is a benzodiazepine and is considered a prescription tranquilizing drug, often prescribed for seizures and insomnia. However, I did not ask questions or research the drug so I was not aware of its classification or the side effects.
March 26, 2019: Chapel Hill, NC
While taking Ativan three times a day, (8am, 12pm, 7pm) I was noticing that around 5 pm, I was going into a state of panic that was so intense I didn’t know what to do with myself. I would fall asleep almost all morning but as soon as I hit mid afternoon, I was so restless I could not sit still. There was one day where I walked ten miles around Chapel Hill because I could not think straight, and all I knew was that I needed to move to relieve the immense panic and anxiety I felt. I later found out this is relatively normal with this drug as when it starts to wear off, the person may experience a bounce back of intense anxiety that comes from being numb and sedated for a period of time. The psychiatrist decided this mid afternoon panic could be solved with a fourth dose of Ativan.
Again, I did not ask questions. I wanted to believe she knew what she was doing, had my best interest at heart, and that if I followed her recommendations things were bound to improve. However, my adherence to the recommendation even after I noticed something was not right was what led to my lowest point.
March 28-30: Pittsburgh, Pennsylvania
We flew to Pittsburgh for a three game series starting that Friday. I can only vaguely recall this period of time due to the amount of medicine I was taking. I felt incoherent, sedated, and was unable to eat due to a lack of appetite while taking the medicine. By this point, my eating disorder had started to make itself more apparent; however, food was my last thought when I was constantly fighting to keep myself awake.
That Saturday in Pittsburgh, I was pitching before the game as I always did, and I remember feeling unable to stand upright on the mound. I was so dizzy, and I had no energy, focus, or headspace to think about pitching, one of the only things that still gave me a sense of purpose. I finished throwing and while the other pitchers were getting warm, I just fell asleep in the back of the bullpen, something I would have never done. I felt unable to control my mind or body, and this sense of hopelessness started to overwhelm me.
That night, I experienced another bounce back with Ativan and went downstairs and ran for almost an hour, on an empty stomach, to try to get rid of this feeling of intense panic I had. I went back upstairs, took my Ativan, and within thirty minutes, I was experiencing really dark thoughts about hurting myself and just feeling a need to get rid of the numbness that was surrounding me. The following day, those thoughts continued to get darker.
That night, we had dinner at a teammate’s house near Cleveland, Ohio, and I was consumed by the thought of making a decision as to whether I keep going or give up. I remember feeling like I no longer knew what I was fighting for. I was taking all the medicines on a regular schedule, going to therapy sessions, and instead of getting better it was getting worse. I won’t pain you with the details, but during that team dinner, I had made a decision that I no longer wanted to be here.
I was obviously in no headspace to be making coherent, rational decisions. When I got back on the bus after dinner, I had a realization that I was not thinking clearly and needed help. “Why am I thinking these thoughts?” I had never struggled with anything like this, and I knew I needed to tell someone how scared I was of my own thought process. I talked to my coach, and she and I decided the following morning, when we returned to Chapel Hill, we would go to the hospital to get a psychiatric evaluation.
And that cluster will be the next part of this story.