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I’m terrified.
After my suicide try and subsequent psychiatric hospitalization in 2014, all my remedy was modified. I used to be began on a unique antidepressant (Pristiq, 100 mg.) and a unique antipsychotic (Abilify, 15 mg). In 2018, following my stroke I grew to become severely depressed and returned to remedy. My therapist, Dr. Lev, added a second antidepressant (Remeron, 45 mg.) to my cocktail. I’ve been steady on these medicines ever since.
I began a brand new job this 12 months. Which means new insurance coverage. After I ran out of the Pristiq, Dr. Lev needed to ship in a refill to the pharmacy which triggered a previous authorization request from my new insurance coverage firm. Sadly, by the point she obtained notified that prior authorization was crucial, I solely had one pill left, which I took this morning.
In an article revealed by the AMA, Jack Resneck, a dermatologist and fast previous president of the AMA, writes about prior authorizations, “A few years in the past, medical health insurance plans got here up with this course of, and on the time it was only for brand-new, costly medicines that had simply come to the market or new remedies that they needed to restrict use of.”
I can handle one or two days with out the Pristiq, however greater than that I begin to fear. I’m anxious that I could begin to undergo withdrawal or what’s extra formally referred to as antidepressant discontinuation syndrome which might occur when you cease taking your remedy abruptly.
In response to The Cleveland Clinic, “Antidepressant discontinuation syndrome (ADS) can occur when you cease taking your antidepressant when you’ve taken it for a minimum of six weeks. It’s extra more likely to occur when you abruptly cease taking the remedy as an alternative of slowly truly fizzling out below the steerage of your healthcare supplier.” Moreover, “ADS causes a number of signs, together with insomnia, nausea, and flu-like signs.”
ADS sounds crummy, however it’s one thing that may be endured. What I’m actually frightened about is: What if the insurance coverage firm denies the Pristiq, or denies the 100 mg. dosage, citing that fifty mg. is the utmost?
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Resnick’s AMA article states: “As we take a look at what issues require prior auth … it used to actually be a slender set of brand-new issues that had simply come out, however now it is utterly unpredictable.”
I fantasize about Dr. Lev, within the peer-to-peer evaluation with an insurance coverage firm rep on the opposite finish of the telephone, or nevertheless they do it lately, telling this individual, who might or might not be a psychiatrist, that this affected person has a historical past of extreme psychotic melancholy, that she has tried suicide 4 instances, that she has been steady of the 100 mg of Pristiq for 10 years.
She’s going to inform them that there’s a likelihood that if she is denied the 100 mg. of Pristiq, she is going to grow to be so severely depressed that her suicidal ideation will return. And she is going to quote a examine revealed in The American Journal of Psychiatry and inform them “A previous historical past of suicide try is taken into account one of the crucial sturdy predictors of ultimately accomplished suicide.”
Will I matter to them?