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I’m terrified.
After my suicide try and subsequent psychiatric hospitalization in 2014, all my treatment was modified. I used to be began on a distinct antidepressant (Pristiq, 100 mg.) and a distinct antipsychotic (Abilify, 15 mg). In 2018, following my stroke I turned 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 drugs ever since.
I began a brand new job this 12 months. Which means new insurance coverage. Once 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 acquired notified that prior authorization was crucial, I solely had one pill left, which I took this morning.
In an article printed by the AMA, Jack Resneck, a dermatologist and quick previous president of the AMA, writes about prior authorizations, “A few years in the past, medical insurance plans got here up with this course of, and on the time it was only for brand-new, costly drugs that had simply come to the market or new therapies that they wished 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’ll begin to undergo withdrawal or what’s extra formally known as antidepressant discontinuation syndrome which may occur in the event you cease taking your treatment out of the blue.
In line with The Cleveland Clinic, “Antidepressant discontinuation syndrome (ADS) can occur in the event you cease taking your antidepressant in the event you’ve taken it for at the least six weeks. It’s extra more likely to occur in the event you out of the blue cease taking the treatment as a substitute of slowly really fizzling out underneath 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 have a look at what issues require prior auth … it used to essentially 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 overview with an insurance coverage firm rep on the opposite finish of the telephone, or nonetheless they do it today, telling this individual, who could or is probably not a psychiatrist, that this affected person has a historical past of extreme psychotic despair, 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’s going to turn out to be so severely depressed that her suicidal ideation will return. And she’s going to quote a research printed in The American Journal of Psychiatry and inform them “A previous historical past of suicide try is taken into account one of the crucial strong predictors of ultimately accomplished suicide.”
Will I matter to them?