I need advice or humble opinions on my pscychiatric treatment

[CircularNatural]

Hello everyone, I'm a 36-year-old male living with HIV since Aug 2021. Luckily, I had a gut feeling and got tested after the acute syndrome, after I have had protected anal sex with an ex sexual partner. My initial values were 590 CD4 and 11.500 VL. I'm a medical doctor (psychiatrist) myself so I got updated on HAART and asked my ID Doc to put me on Dovato if possible. 3/4 months later I am at 884CD4 and negativized VL so I'm grateful for that. So far I don't notice side effects and tend to be very organized so I am hopeful that I will be able to carry on with the treatment as suggested.

My current dilemma comes from other aspects, especially my personal life and mental health.
I'm a long sufferer of GAD (generalized anxiety disorder), obsessive-compulsive and depressive personality traits for which I've gone through various therapies (psychoanalytic, CBT) with some success. 3 years ago I started again therapy since I was in a monogamous gay relationship for 5 years, where in the last 3 years we stopped having sex after I started having hemorroids/anal fissure (sorry for going into details like these), the point is that this brought on lots of frustration on my partner, I was feeling he could not emphathise and his interpretation was that this was some kind of excuse for not even trying to work on our sex life. The point is that I started therapy after about 1 year of denial/procastination on these sexual issues. After quite some time I was able to go through the shame that represented to me even going for a protologic consultation to talk about having surgery as to be able to get my sex life back. I finally found a medical doctor that operated on my with laser on Oct 2020, with partial results only (and still unable to not feel pain on sex which I believe my mind was part of this too). I decided to go for a second surgery on April 2021. I now longer saw blood on stools after this which was very good, but still felt uneasy on approaching sex (my partner was shut off and frustrated all along so we could say we didn't really try that much if this could be a solution).
On the mean time, my partner disappeared 2 o 3 times on weekends (we were living together through the quarantine) to stay on his office without him saying much/disappearing. At one time he appeared after me texting him desperately that he had done cocaine and that was sorry for not having talked to me earlier to just say he would stay there for the night.
On one of this episodes, I have to admit that I recontacted an ex sexual partner (we weren't ever a couple just 2 or 3 encounters) to whom I even shared my worries about my partner's attitudes. One afternoon when my couple again left home in a bad mood (we could say he was temperamental) I decided to meet this ex sexual partner and had protected sex with him. That one time, God knows how, was the time I got infected.
Luckily, since my sex life with my partner was 0 after all of this I'm retelling, I did not put him in risk. The idea of having an open relationship or seeing other people was never discussed in an adult mature way, we would say between words: "If you were to be with someone else, at least don't make it so I know". I can't say he also had sex with other people while on drugs those weekends he disappeared, but I cannot discard it.
The point is that my positive status was the last drop that spilled the glass and he left home and we now got separated.

I'm currently experiencing both depression due to coming to terms with having a chronic disease and with the grieving process of our separation.
Every since I got diagnosed, I started with therapy twice a week, I was also taking an antidepressant and an hypnotic 3 years before all this happened due to my basal anxiety / depressive tendencies.
The point is that my new psychiatrist met me with all of this happening acutely and I believe she must believe that I'm bipolar, borderline or something on the likes (she mentioned the word acting-out in relation the sexual encounter that got me HIV).
She took away the antidepressant (that I was taking for 3 years) after hearing that episode and believes I should delve into accepting the grieving process without them. I'm currently having a real hard time coping with everyday life, tired all day, lost around 7-8 kilos (I was a little overweight so this was a positive side effect of not wanting to eat), feeling that I have to force myself for everything and tend to wanna sleep alot or avoid things that might be good for me. I'm also a psychiatrist so it's really heard for me to go through sessions with my patients myself, I'm even on a process of reducing my working hours so I don't end up so tired, but I feel deep down that this is has to do with depression more than wise decisions... Don't know really.
My friends tell me that I should consider switching psychiatrist since they believe she may be being "too hard on me", I'm honestly scared to even say to her that I'm not functioning well at this point. I'm only on alprazolam (Xanax) and Ambien (medication for sleep I don't seem to he able to come off).
Anyways, thanks for hearing my story.
Any comments or suggestions will be highly appreciated.
Best regards

[Jim Allen]

Sorry to hear about your pain and that there were relationship struggles.

Read your post a few times, I can't comment on the idea of dropping the antidepressants and the hindering the grieving process. From what you posted on this forum, I do know a lot has happened in a relatively short time, and you are still digesting your HIV diagnosis, which in itself seems to occur in waves for some people, similar to grieving.

Generally, people will hide or omit things for all kinds of reasons and/or fears, so I could imagine it's not uncommon for people to have barriers about telling a psychiatrist or therapist things, particularly how much they are truly struggling, but you would know this.

All I can suggest is to keep in mind that their job is to support you. You recently stopped the antidepressants, and if they don't know you are struggling following this change, then the support provided isn't going to be the best.

Anyhow, what do I know...

I just wanted to wish you well. All I can say is if it were me, I would prehaps give it a go, tell them how much I struggle, and consider changing psychiatrist only if I felt the response/treatment after that was not getting me anywhere.

[CircularNatural]

Thanks for taking the time to go through my long post! (sorry, hadn't realised about this).

After a couple of more times going through all of this, even with close friends, I decided to ask my psychiatrist if we could have our next appointment earlier, which will be held tomorrow. I have in mind to try and be assertive on this topic, especially my current need to improve my depressive mood.
I hope to be able to make my point, in case not I've decided at this point to continue my treatment with another profesional (I hope everything goes well from this poin onwards 🙏).

Thanks again Tim for taking your time to reply! A few days ago (13th of January) it was Depression Awareness Day here... it's always a good time for everybody to remind ourselves that we sometimes have to face struggles with our mental health, but it's important to keep on working on improving it, no matter what.

Take care and kind regards to all,

[CircularNatural]

Just a small update.
I had the appointment with the pdoc, and luckily it went on well. She said she had been feeling concerned about the possibility for the medication to inhibit the possibility of me to go through the bereavement process (due to the dissociation that can be associated with psychiatric medication). However, she realised this is being a hard time for me so she proposed a short term use of Escitalopram 5mg/day to address the anxiety/depression and to continue focusing my treatment on therapy.
I can already feel good about this and feeling less worried overall.
I can say that the fact that she had been against the antidepressant use had triggered in my mind rumination about the possibility of having to also accept having a more serious mental disorder (the HIV dg and having to come off from a difficult relationship had already been enough).
I guess it's just about accepting and adjusting to all of these changes I'm going through. Time will tell. 🙏
Thanks for being there.
Take care all of you!
♥️