On January 3, 2012 I had a consult with a nurse practitioner at The McClendon Center, Sara Carroll. She prescribes my medication. I was assigned to Nurse Carroll one month ago. Previously, I was seeing a psychiatry resident named Sara Jane Keiser, M.D. Dr. Kaiser switched my antidepressant to Paxil from Effexor. Paxil is more sedating than Effexor and I find that it helps me sleep better. Dr. Keiser started me at Paxil 30 mg/day, roughly equivalent to the 150 mg/day of Effexor I had been taking.
At my last consult with Nurse Carroll I asked her to increase the Paxil dose to 60 mg/day. She refused, and instead increased the dose to 40 mg/day.
Yesterday, January 3, 2012 I asked Nurse Carroll to increase my Paxil dose to 60 mg/day. She refused. She said, "Medication doesn't cure everything." She asked me why I felt I needed a higher dose of Paxil. What was I expecting? I said, "Nirvana." Note that she never made an attempt to determine the maximally therapeutic dose for me.
When I said I had a problem with insomnia, Nurse Carroll said, "You are getting older." True, but that doesn't address the specific reason why I suffer from insomnia and whether a higher dose of Paxil might help me sleep better.
Nurse Carroll explained that she could not justify a dose of 60 mg/day. That made no sense to me. Can she justify 40 mg/day? Can she justify 30 mg/day? Perhaps I should be on 20 mg/day. Perhaps I should be on another antidepressant altogether. How does she justify what she is in fact doing at this time? She never addressed that question.
My conclusion. Nurse Carroll has poor analytical skills.
And by the way, 60 mg/day of Paxil is the maximum recommended dose.