My psychiatrist gets a bad rap. Mostly from me. I'll get back to that.
In the last week or so, I've had a bout of unexpected energy and drive to get things done, as though I've woken up from a long slumber.
That's actually not far off from the truth; I've been feeling tired for quite some time, and it's been particularly bad since I got COVID-19 again over the Christmas 2024 holidays (that's right, over a year). I thought at the time it was due to a stressful work situation, but when that improved my fatigue did not.
I got bloodwork and an ECG done, with nothing standing out. And my shrink kept prescribing me with more and more stimulants to try to help me stay awake, with little success.
But actually, my history with fatigue goes back much farther.
Like many people in Ontario, I don't have a family doctor, but I used to. My interactions with Dr. Fuckit, as I'll call her, left much to be desired:
When I told her I thought I might have ADHD, she asked, "did you Google it?" (not in a "Tsk, tsk, don't believe everything you see on the internet" sort of way, but as in "So? Go figure it out yourself. What do you want me to do?") No, doctor, I didn't Google it; I came to, you, ostensibly a medical professional, to seek advice. When did that stop being what you're supposed to do? She prescribed me some medication and sent me on my way.
It was the same Dr. Fuckit who, when I asked years ago why I was so tired all the time, she replied "well, maybe it's just you", shutting down my hope of doing anything about it.
It's just as well that she left the practice. And that practice, being a Family Health Team, kept me on as a patient just as when my previous doctor left. However even though the corresondence from the time suggests I got a new doctor in her place, I would only see Nurse Practitioners at the practice for primary care instead.
These nurse practitioners were a fair bit more helpful. There was one I remember seeing for some other matter, and when at the end of the appoinment she asked if there was anything else, I just blurted out sarcastically, "well not unless you can do anything about my fatigue," thinking back to the doctor's suggestion that nothing could be done. The strangest thing happened: she took the matter seriously and gave me some advice on things I could try: more exercise, more fibre, and better sleep hygiene. I didn't expect the world to change overnight, but it was worth a shot.
The next day, the world shut down due to the COVID-19 pandemic.
Fast forward a year, and my fatigue was joined by an utter lack of motivation, which was affecting both my work life and my home life. In a video call, my nurse practitioner told me that my bloodwork didn't show anything out of place, referred me to a psychiatrist on the family health team, and offered me some medication options. We chose a medication called "Abilify" (aripiprazole) to supplement the depression/ADHD meds I'd been on for years.
That was the first medical appointment where I started taking notes, which is helpful because everything I wrote about what happened earlier is... let's say "inspired by true events".
I don't have any notes from the follow up call because I was driving, but I remember it well. I was on Carling, turning left onto Bronson. She asked me how it was going with the new medication and I nearly broke down into tears. After so many years of living with "maybe it's just me", I told her that after starting this medication, I could be present for my work, friends, and most importantly, my family. I told her it was like night and day. This little miracle drug that does what it says on the tin: "Abilify"
I'd seen psychiatrists before. All through high school, I had regular hour-long psychotherapy (talk) appointments with one for depression. In university, I saw a different one, who eventually concluded that I had more or less figured things out and didn't really need the appointments anymore.
The new one, he's different. I'll call him Dr. Whatever. To start with, the appointments are only by phone, what with a pandemic and all, so I've never met him in person. He might have introduced himself on our first call, but subsequently, he'd just open the call with "hi, how's it going" as though my ADHD would ever let me to connect an incoming call from a private number with the fact that I had an appointment with a doctor that day (plus, like, who the fuck calls somebody and doesn't say who's calling?). His voice sounds exactly like my uncle's, which one time meant I got a few minutes into chatting with him before I realized he was asking doctor questions and not uncle questions.
Also making it harder to identify him as the caller is that he often calls anywhere from 30-90 minutes after the scheduled start time, by which time I've long forgotten that I had an appointment (I'm not exactly sitting by the phone waiting for his call). This means I have to block off my whole morning at work for my appointments to ensure I won't be in a meeting when he calls. The whole morning, for a call that sometimes goes as long as 10 minutes.
So anyway, the first appointment, we talk about fatigue, high-functioning, low motivation. He'll refer me to a sleep study at the Royal. I asked if increasing my Abilify might help, and he said I probably wouldn't get anything out of increasing it (but then he increased my dose anyway).
I remember asking him about getting a proper diagnosis. I know I'm neurodivergent: I was in the gifted programme in grade school, I certainly have a lot of the symptoms of ADHD, and I have strong opinions on punctuation. I felt it would help me understand my brain better if I were properly diagnosed (what I would later learn is called a "neuropsychological assessment"). And I also remember him shrugging off my request and saying something dismissive about "labels". He prescribed me some stimulants to help with the fatigue.
I had regular appointments with him every month or two. The sleep study came and went, nothing abnormal there. The fatigue remained. Here, have some more stimulants. Still not working? Try taking more per day. No? Try adding this other one. I tapered off my antidepressants for a while at one point to see if that did anything and concluded I should go back on them.
And even though he was the doctor and I was the one with ADHD, I had to be organized enough to remind him to renew my prescriptions for all of these meds. Oftentimes he would renew some, but not all of them. Or he'd remember one dose but not the other dose that I take at a different time of day.
I got pretty good at reminding him, because when my refills run out, it takes multiple faxes from my pharmacy and multiple follow-up calls from me (each time first calling the pharmacy to confirm it still hasn't come through) before he finally sends it in. By this point it's out of sync with my other refills that I had carefully coordinated so I don't have to make several trips per month to the pharmacy. But more than once I've had to ask the pharmacist (such a helpful, understanding person!) to give me a few days' worth to cover me off until my next appointment because Dr. Whatever hadn't responded to the refill requests.
Can we just take a moment to appreciate the fact that this is probably the worst doctor for people with ADHD, who are easily distracted, have difficulty remembering things, get easily distracted, and easily forget appointments? The cruelty of being in a situation where I have to overcome classic traits of ADHD and be hyper-organized to compensate not just for my own shortcomings, but for my doctor's too?
Fast forward to a couple of months ago. I had an appointment in early November, but on the day of my appointment I got a notification that my appointment had been rescheduled... to January! I promptly called the office to inform them that a couple of my medications wouldn't last that long and could he please send a refill to the pharmacy. Nothing happened. By December, he still hadn't called in the prescriptions, so I got the pharmacy to send another fax and I called the office again (or at least I tried. Most of the times I remembered to call it was while their receptionist was on lunch or outside their business hours). It was getting close to Christmas, and I could tell that one of my meds would definitely run out over the holidays, and with Abilify coming close. Finally, on Christmas Eve, after telling the receptionist that I would need to start rationing my pills so that I would have enough to be functional on my first week back at work before my appointment, I got a call from the pharmacy that my prescription was ready.
Relief.
Except, he only refilled the prescription for the stimulant. As my appointment got closer, I realized that my Abilify would run out a day or two before.
That's no big deal, I thought. I can last a day or two without it and then pick up my meds after he sends in a refill after my appointment.
And then my January appoinment was rescheduled to the end of the month.
Fuck!
After some prompt hounding on the day of my appointment, I managed to get the doctor's office to send in the refill to the pharmacy, who refilled it.
I didn't feel like picking it up on the Friday though. Then it snowed on the weekend and I didn't want to go out.
Then I felt too busy at work on Monday to go. I'd been busy on the weekend, too.
And not just busy, but productive. I had a sudden drive to spend my workday just keeping doing work. And energy.
The last week or so I've been actually working on personal projects instead of wasting away all of my free time on snacking, watching YouTube, playing mindless phone games, and napping!
Something was different. What the hell was going on?
Over the last few months, after watching many YouTube videos about ADHD, I came across a channel called "Auticate with Chriss ∧ Debby" who talked about something called "AuDHD", a combination of autism and ADHD, two diagnoses with seemingly contradictory symptom profiles, that is more than the sum of its parts. The description fit me to a T. I started watching their videos, and others on the topic, and kept learning more and more.
So maybe I had ADHD and autism? Has that been the case all along? Why did I have to learn about this through a fucking YouTube video? Oh, right, because my psychiatrist didn't want to help me pin down a diagnosis because doesn't care about "laaaaabels." THAT LABEL WOULD HAVE BEEN REALLY HANDY FOUR YEARS AGO, BUDDY!
This got me thinking about how my life might have been different if I had known this a lot earlier. Was it just a coincidence that my parents had so many friends with kids on the spectrum? (I mean, likely yes; there was no thing as a "spectrum" and all of their friends' kids had much more prominent signs that if anything worked against identifying anything in me) Was my "gifted" status a misdiagnosis? Or does it still apply, piled on top of the other neurodivergences? What about the depression diagnosis? WHY COULDN'T DR. FUCKIT HAVE REFERRED ME TO A HUMAN DOCTOR FOR A DIAGNOSIS INSTEAD OF TO FUCKING GOOGLE?!?
So how could I tell if not stopping the Abilify triggered this energy? I took my doctor's advice: I googled it.
Specifically, I reviewed reputable websites' information about drug interactions and side effects for each of my brain medications. "No known interactions" for Abilify. Nor for any of the others. Strange.
And as if "did you Google it" wasn't bad enough advice a decade ago, the answer this past week came from an AI summary: Abilify (used to treat ADHD) and stimulants, "have opposing mechanisms of action (one is an antipsychotic, the other a stimulant) that can produce combined side effects". Sigh. (Oh, also while editing this I also found an AI search summary that said combining Abilify with my antidepressant can worsen side effects like fatigue and insomnia, but that "doctors monitor [their patients] closely due to these significant interactions." Oh, sweet, innocent, society-destroying AI summary...)
The best I can conclude is that Dr. Whatever prescribing me more and more stimulants was like adding more wind to a sailboat with no sail. As soon as the Abilify stopped, the sail went back up, and whoosh! Off went my brain at a mile a minute. Despite helping with my motivation when I started it, by now felt was more like it should be called "Disabilify" or "Fatiguify".
Why did Dr. Whatever never think of Abilify as the cause of my fatigue? Maybe because I'd gone off Abilify before, and each time concluded that I was better off on it? But we'd never tried dropping it since we added all the stimulants. My nurse practitioner didn't notice it when I went to discuss my lab test results with her, but maybe she would have if Dr. Whatever had bothered to let her know that he'd ordered the tests and why, so she could have come to the appointment prepared. I didn't think of it because I associated it with the seemingly miraculous effect it had when I first started taking it.
So maybe I'm too hard on Dr. Whatever. Maybe he gets a bad rap and he's actually thinking four steps ahead—
NO! HE'S NOT! This was entirely an accident due to his incompetence! His only answer was to keep pumping more stimulants! Starting or stopping medication (willingly or otherwise) without discussing it with your doctor is a terrible idea! (As is doing so based on reading some random blog, in case you're getting any ideas) Four steps ahead? If he deliberately postponed my appointments to force me off Abilify without discussing it with him first, that would be even worse! I'd report him for malpractice if it weren't for the power dynamic whereby I need him for continued access to my meds! Or if there weren't a severe shortage of doctors in this province! Exclamation points for emphasis!!!
Oh, and to top it all off, when I reviewed my old notes to write this up, there in the margin of my notes from my very appointment with the nurse practitioner who introduced me to Abilify, is a note in my own handwriting: "can be sedating".
Facepalm. It was there all along.
If Dr. Whatever hadn't postponed my early January appointment, I would have been off Abilify for a day or two already by the time I picked up the prescription, which might have been long enough to start feeling different and come to the same conclusion. I don't know where I'd be if he hadn't cancelled the November appointment. I mean, he was trying, by ordering blood work and a sleep study, but the solution he hadn't tried was sitting right there on his prescription pad.
I'm not taking it for granted that going off Abilify is an all-around good thing. It's unleashed the full power of my ADHD, which for now feels like a superpower but I was taking it to address a problem and maybe that problem will come back. Will the energy fade? Will other symptoms crop up? Will hyperfocus compromise my personal life? I guess only time will tell, since at this point I don't expect Dr. Whatever to.
Maybe Dr. Whatever keeps postponing my appointments because he now realizes I'm going to read him the fucking riot act (or maybe this blog post) the next time I talk to him.
I'm bitter about a year or more of lost productivity, of lost time spent doing things I enjoy, of looking for a new job in hopes the change would make me feel better, of wondering if something was fundamentally and incurably wrong with me.
I'm bitter about four years of not learning I (probably) have AuDHD, and not understanding the implications, because of Dr. Whatever's apathy toward "labels". I remember being asked on medical forms about whether I've been diagnosed with anything, and I genuinely don't know because Dr. Fuckit and Dr. Whatever have just given me medication after I've speculated that I'm depressed, or have ADHD, or whatever, but no doctor has actually told me, "you have these conditions."
I'm bitter that I have to become an expert, and an advocate on my own behalf, and that I have to remind my own doctor to do his job, all so I can try to manage a condition whose major symptoms include difficulty in doing these very things. I have a whole "family health team" yet I feel alone in my medical journey. (I've inquired about getting a new psychiatrist and was told that was not possible)
And I'm bitter that I don't have a proper psychotherapist to help me talk through these issues. Maybe if I did I wouldn't feel compelled to rant about it on my blog.
Okay... let me take a breath.
At least I'm not out of pocket (beyond transit fare) for any of my medical appointments, and my job's benefits plan brings the cost of my meds down to a reasonable price. I also have a job where I can usually step away for a bit when my brain decides to turn off.
I'm cautiously optimistic about my recent bout of energy after dropping Abilify (which, I must remind myself, really helped me when I started taking it), but because I'm terrified that this energy will not last, I've been setting aside other things (like keeping my work area tidy or going outside) to finish some projects while I can. At the same time, maybe I don't need so many stimulants now that their effects aren't being nullified.
I feel like my brain is moving faster and probably burning more calories, while the hyperfocus is helping me avoid snacking reflextively, and the energy is helping me go out and get more exercise: maybe I'll be able to work off the significant weight I've gained over the last couple of years. But I've also noticed that I've felt an obsessive urge to work on both my work and personal projects (like writing this blog post, which ironically is longer than my attention span would let me finish reading). While this is better than having no motivation at all, it risks keeping me from going out and enjoying life just as much as constant fatigue used to.
I'm hopeful that my productivity persists, and that I'm able to take advantage of it where I can and keep it under control when I need to.
With any luck, this new energy will last and I'll be able to get on with my life.
And maybe I'll even go out and get a new shrink.
