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Goals, not wishes-- I'm a doctor, not a genie.

Saturday, February 24, 2018

The Rational Inquirer

Posted by fxckfeelings on July 23, 2015

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While the whole concept of “shoot first, ask questions later” sounds cool to many of us, it obviously has some detractors (namely, those who were shot before they could have been vindicated through question-asking). In reality, as always, you need to strike a balance, because, while asking questions can sometimes interfere with action, taking action can be a way to avoid asking difficult questions. So, instead of assuming that either is good without the other, learn how to limit your questions to those that are necessary and how to take action, hopefully unarmed, even when you’re not sure how things will turn out.
Dr. Lastname

I’ve been taking a medication for several years that has been very good for my depression, but now I’m having obsessive thoughts and my doctor thinks I should take a larger dose and see if it reduces the OCD. She says there’s always an advantage in taking one medication instead of two, and that a month of taking a larger dose every day will tell me whether this medication can help all my symptoms or whether I need to try something else. It’s hard for me to take the same dose every day, because the medication makes me jumpy, so I always take less when I need sleep and then I take more when I need to be awake. In addition, I read on the internet that larger doses might make me fat, or, in some cases, suicidal, so I have a lot of doubts about this increased dose, and a lot of questions that nobody seems able to answer. My goal is to find somebody who has the answers (you?) and figure out the best way to deal with my obsessive thoughts.

If you’re having obsessive thoughts, and both you and your doctor acknowledge this to be a problem, then maybe you shouldn’t take your endless doubts about medication at face value. You can’t alleviate obsessive thoughts by entertaining them, which is what you’re doing here.

It’s valuable, of course, to make careful decisions about medication, and your questions would be useful if your medication were really designed to work quickly and help you stay awake. Instead, it’s designed to help you stop obsessing about factors like these, and to do so at its own pace.

Medications for depression and OCD work very slowly—for reasons we don’t understand, they require two to four weeks to have an effect—so you’ll never figure out whether this medication is good for you unless you can be methodical, reach the right dose, and take it regularly for a month.

Of course, if it gives you the jitters and they don’t go away after a few days, you’ve got good reason to reject it. Frequently, however, anxiety improves, and persistence pays off. But that’s something you can only really figure out through trial and error, not doubt and fixation.

Yes, of course this medication poses risks, and they may increase a bit with a higher dose; you’ve tolerated it well for years, however, so the risk is low, and, if a higher dose causes weight gain, you can stop the medication long before you’ve gained more than a few pounds.

So stop asking questions and start taking (calculated) risks. You’ve done a good job of educating yourself to the dangers and have reason to believe that, as a way of avoiding additional medications, increasing this one presents the lowest risk. Now the question is whether you can control your obsessive reaction to side effects and take the same dose daily for 30 days. You’re the only person who can really judge the severity of your OCD symptoms, how well they respond to non-medical treatment, and whether medical treatment is really necessary.

So don’t feel you’re taking it because someone told you to, because you know what’s going to happen, or because you feel perfectly safe with it. Instead, focus on your need to get information that will tell you, once and for all, whether this medication can help you. Don’t use questions to avoid doing an experiment, once you determine that it’s worth doing in spite of the risk.

Now that you’ve assessed the need and risk, do the work that will tell you whether this medication is worth increasing. If you’re obsessiveness starts decreasing, then you’re on the right track.

“It’s hard for me to take a medication regularly without worrying about side effects every day and wanting to change the dose, but I know the risk of the medication very well and I need to know what a higher dose, taken regularly, will do for my OCD. So I will get the information I need by following a fixed plan for a limited period of time.”

I’m a contractor, and whenever business gets slow or I get anxious about getting hurt or finding work in general, I come up with good ideas about how I would deal with an on-the-job injury, or diversify, or advertise. I push myself very hard to stay on my goals and keep focused, but sometimes the anxiety is just too powerful and I can’t see any way of surviving. That’s when I really feel like I could have a breakdown. My goal is to find ways to ensure that I stay in business, so my anxiety won’t destroy my sanity.

Getting going when you get scared is a good survival technique that works well in most situations. Worrying about your next job motivates you to hustle to find new business when it seems to dry up. Fear provides nature’s own stimulant, adrenalin, to those who would otherwise relax and get disorganized. As you’ve noted, however, worrying too much about a business meltdown can put you into a spin, particularly if you can’t find a solution.

To the degree your confidence depends on solving the problem, you’re bound to have a personal breakdown if solving it is just not possible. Your fear is right in telling you that, sometimes, there’s no solution to be found. And with no solution, there’s no plan, and with no plan, there’s no hope. And then it feels like there’s no air in the room.

When confronted with that possibility, the best course of action isn’t emotionally spinning out or even taking deep breaths, but reminding yourself that life is unpredictable and unfair sometimes, but you don’t take it personally. Your job is not to find impossible solutions, but to make changes whenever necessary and do your best to find employment, or, if necessary, a plan B.

If your business is in trouble, use your anxiety to explore every option for restoring it. Then, if necessary, consider possible alternatives, i.e., things you can do if the business fails. Then assure yourself that you’ve done everything possible, and it’s time to take it easy and keep doing your best.

Don’t make yourself responsible for controlling economic tides or declare yourself a failure if the tide goes out. Respect your work ethic, your willingness to start over if necessary, and your right to feel that you’ve done a good job even when you don’t have any jobs lined up.

“I’m haunted by the fear of running out of work, but I will use that fear and not let it define me. I will take credit for thinking through all my options and not blame myself if I wind up doing something I don’t particularly like or enjoy.”

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