well the rest of the day wasn't so great, my wife drove to the pdoc since the gastro folks told me not to drive, she drives quite slowly and we were running slightly late and I don't like to be late for anything, so I got anxious, then upset when she got annoyed. It was a tearful kind of anxiety where I just start letting my arm shake and try and take deep breaths to bring it under control. Its not a panic attack, that is a different and even worse beast from the past, instead this is more a feeling of extreme frustration/anxiety/sadness over a lack of control over what is happening to me. I was able to even say, though, that I knew this would pass, but I have yet to find a way to stop it in its tracks. So we get to the pdoc , who when she last saw me said I was doing very well, and after some thought she laid out what she thought were the options at this point. She mentioned Seroquel because of my sleep and anxiety problems but I was not keen on that, she also said that I should try and inch up on the remeron with a view towards eventually replacing the pristiq. I was a bit surprised I thought maybe the pristiq might need more time, but she said probably not. I also told her how I read how its so difficult to get off of, but she said if I can get to a higher level of remeron that would negate the withdrawal effects to at least some degree. The thing is, though, I don't like the fact that the stupid pristiq is a pill that is not supposed to be broken, though she said folks do it anyway, and I have read such, but it seems like the company has never come out with a recommendation on how to go down on it other than every other day which sounds like a recipe for disaster to me. She didn't think going back to Lexapro was an option either. Since I had a bad reaction when I did a whole 15 mg of remeron (didn't sleep so great that night had anxiety and brain fog the next day), she thought that going more slowly up from the 7.5 that I am on would possibly work better, helping with sleep and anxiety. I did sleep great on the 7.5 the first night and did have brain fog the next day but that went away. She also gave me a prescription for propranolol, a beta blocker, she said I can take half a 10 mg tablet if I feel one of those agitation states coming on, her reasoning being that I worry so much about the pulse and blood pressure that if I could control that it wouldn't develop into a anxiety feedback loop. So if I feel my pulse going fast at 2 in the morning tonight, I will try it, but chances are I might have a decent night, as she figured there were triggers that worsened this weekend for me. When I compared it to past episodes she said its different this time in that my parents are dead, I am married, and I am a different person than when it struck twice before. It still is a matter of finding the right med for me she said. She had also mentioned the new one fetzima, but I want to go slow on whatever we do especially while I am working, and I am not keen to be a guinea pig for another new one unless there is some overwhelming reason to try it, like it works great and is actually healthy to take, unlike so many of them.