Psychopharmacologicalistic-expi-ali-docious

I feel pretty sheepish now about Dr. Two-Fifty's moniker. I really ought to make it a policy to meet the docs before I take the gloves off in the naming process. Dr. Two-Fifty, had I met her first, would be properly named something spirited and optimistic (such as Dr. Pluck), for reasons I'll explain below. But for the sake of continuity, Dr. Two-Fifty she shall remain.

The waiting room of Dr. Two-Fifty's office is filled with flowers. There are six vases full. (It's a large waiting room.) It smells a little like a funeral home, but it looks very nice. Dr. Two-Fifty emerges to greet me. She is smiley, quirkily dressed (for a shrink working in a hospital, anyway), and has a firm handshake.

She spends an hour with me, during which we cover my recent life history (egads), discuss the workings of insulin pumps (with which she was not familiar), factor in family-related issues, and talk about drugs. Particularly the latter, of course, since that's why I am there. Dr. Two-Fifty feels very confident that I am experiencing a biological depression. She has a lot of interest in prescribing Cymbalta for me. Three things point that direction: the clear compatibility with diabetes; the fact that it's a chemical cousin of Effexor, which Mrs. Violet (my mom) has used with great success, meaning that it might work for me as well; and the possibility of side benefits with a (non-diabetes-related) pain condition I've had for many years. Cymbalta is good for unhappy nerves of all sorts--it's used for diabetic neuropathic pain as well as depression--so it might be soothing to more of Violet than just the brain.

Ah, but then there is the problem of the NIP drug formulary, which, as noted below, classifies Cymbalta as a "step" drug. I bring out the formulary list of brain meds and show it Dr. Two-Fifty.

She wrinkles her nose. "What does 'step' mean?" she asks.

"It means that before they would approve Cymbalta, you would have to tell them that we tried other meds and they didn't work."

"Outrageous," Dr. Two-Fifty declares. "Well, that's no problem. I can do that."

"You can?"

"Sure. It'll take a few phone calls, so you probably wouldn't get the prescription for a few days, that's all."

I am impressed. This must be what part of those two hundred-fifty dollars are for.

Then I have a small light-bulb moment. It is 7 PM on May 31. The NIP insurance goes into effect at midnight on--yes--June 1. All I need to do is get the prescription filled tonight, assuming GOI (Gentle Old Insurance) will approve Cymbalta. Then I will have my pills. And NIP is supposed to honor all transferring prescriptions as long as the doc says it's okay.

Moments later, Dr. Two-Fifty is googling Walgreens. We find a 24-hour pharmacy 4 blocks away, and off I go.

I took the first dose this morning, GOI having been quite cooperative. I miss them already. Cymbalta is a small capsule the color of canned peas. (Ouch. I was hoping for purple.) I'm starting on half the usual starting dose, as Dr. Two-Fifty believes a gradual transition is much more comfortable and safe. I hope that doesn't mean it will take longer to work (if it works at all), but of course it might. Meanwhile, I have the satisfaction of thwarting NIP, which has improved my current mood considerably. A good start.