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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 special antidepressant (Pristiq, 100 mg.) and a special 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 secure on these drugs ever since.
I began a brand new job this 12 months. Meaning 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 bought 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 health 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 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 in case you cease taking your remedy out of the blue.
Based on The Cleveland Clinic, “Antidepressant discontinuation syndrome (ADS) can occur in case you cease taking your antidepressant in case you’ve taken it for at the very least six weeks. It’s extra more likely to occur in case you out of the blue cease taking the remedy as an alternative of slowly truly fizzling out underneath the steering 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 slim set of brand-new issues that had simply come out, however now it is fully unpredictable.”
I fantasize about Dr. Lev, within the peer-to-peer evaluate with an insurance coverage firm rep on the opposite finish of the telephone, or nonetheless they do it today, telling this particular person, 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 secure of the 100 mg of Pristiq for 10 years.
She is going to inform them that there’s a probability that if she is denied the 100 mg. of Pristiq, she is going to change into so severely depressed that her suicidal ideation will return. And she is 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?