Talking to Your Psychiatrist – How To Guide

I get really bad doctor anxiety and have trouble saying what I want to say at appointments. I find writing things down as I think of them days in advance helps. Here are some pointers on making appointments with your psychiatrist effective for both of you.

Be honest. This is important. Don’t lie to your psychiatrist. Don’t exaggerate. Don’t hide symptoms. Don’t be embarrassed. He’s probably heard it all before.

If you think a medication is or isn’t working, tell you psychiatrist this and why. It’s important to be informed on your medications. It’s important not to control your medications, because the psychiatrist is the one with the MD and training, but if something isn’t working, you have the right to say so.

Psychiatrists don’t often offer therapy much anymore*, but they do need to know about your life and general health. A psychiatrist is trained in diagnosing mental illness and treating it with psychotropic drugs, or a referral for therapy or other care, like a medical doctor would diagnose a physical illness and treat it with the appropriate care or medication.

Don’t focus so much on your diagnosis, focus on your symptoms(1). The diagnosis is generally used in communication with insurance companies and too many people get caught up in the diagnosis hype. Treating symptoms is most important. Right now, the DSM has just changed over to the DSM 5(2), and things are confusing. It can take a while to reach a diagnosis, so focus on eliminating the symptoms and getting better.

Be reasonable with your psychiatrist. There is no magic pill (I’ve been told this by so many doctors) and you have to work at it, too. Mood trackers, therapy, keep track of medications, go to all appointments. Don’t stop a medication unless you’re having a side effect that could kill you. Some medications require blood tests – get them done. Work with your psychiatrist.

A psychiatrist is a doctor and is going to have good and bad days. There are good and bad psychiatrists out there, trust me, I’ve had a couple of bad ones. Fortunately, right now, I like my psychiatrist. It’s not always easy to change doctors, especially if you’re in a country like Canada (where I am) and there’s a doctor shortage. A psychiatrist should always remain professional and never be rude to you.

*A psychiatrist is a doctor trained in psychiatry with an M.D. A psychologist is more often referred to as a therapist and you spend more time working on issues with them. Very few psychiatrists offer 50 minute appointments with a couch, a notepad and psychotherapy anymore, unfortunately.

 

Signs of a good psychiatrist:

•  They listen to your concerns and don’t ask the same questions over and over.  They will ask relevant questions, about your mood, your current situation, and current meds.

I had a psychiatrist that asked me, every appointment, if I had quit smoking “dope” yet. I had never smoked “dope” in the entire time I saw him.

•  They respect your concerns, needs and what you say.
•  They stop medications if they don’t work, or if the side effects get bad.  I had a psychiatrist bitch at me when I had to stop lithium due to diabetes insipidus. He said I “complained too much”. Same one that accused me of smoking dope. I had two doctors telling me I couldn’t take lithium, and that psychiatrist was being a jackass, he had never heard of the condition. Fortunately, he retired. (Note: I only stayed with him because of how hard it is to find a doctor in this area)
• A good psychiatrist respects your wishes with medications and doesn’t intimidate you about them. You should be able to be open about medications – you live with the side effects of them and you also pay for them one way or another.
•  No psychiatrist should tell you you’re going to fail or never get better. If they feel that way, they should refer you.
•  They should schedule appointments appropriately. Some people need to be seen every few months, some need to be seen more often.
•  They should have open time to see a patient in crisis. Sometimes they can’t get you in that afternoon, but they should be able to get you in fast.
• Keeping you waiting for hours in the waiting room is not good. They should also return phone calls in good time. It’s disrespectful and unprofessional not to.
• You should feel comfortable and not threatened with the doctor.(3)

(1) Talking to a Psychiatrist
(2) DSM5 HomePage
(3) Makings of a Good Psychiatrist on Shrink Wrap

Self Diag-nonsense

We’re all guilty of this. With the internet, it’s even easier to diagnose yourself. Everybody has taken the personality disorders test, probably multiple times. (How many times have you scored the exact same? I don’t keep track, so I don’t know)

Wake up call. Those aren’t diagnostic tests. The same way as an online IQ test can’t tell you you have an IQ of 180: only a few people in the world ever have scored that high in real life, they don’t come around often, based on the Stanford-Binet test. A psychological test has to be carried out by a psychologist or psychiatrist in person (with the new teleconferencing stuff, maybe, I’m not sure) and can take a few weeks or months. I was assessed over 6 months after multiple hospitalizations and treatments. An IQ test is similar, it cannot be biased, and the person has to be assessed by the tester for their reatctions. A lot comes into play.

Basically, an online IQ test is just a test with different scoring. Instead of 0-100% it assigns a number. An online psychological test is the same thing, but they have disclaimers: not a diagnostic tool. (Don’t ever pay for either one!)

I can say I hit a lot of DSM criteria, but it’s easy to say that about myself. Other people can say I hit different criteria. To get 3 psychologists and 5 psychiatrists to agree on my diagnoses was kind of amusing, but they did agree. (For the record, I was diagnosed with bipolar disorder type 1, rapid cycling with psychosis, schizotypal personality disorder, later on ADHD inattentive type and at that time, EDNOS, which is currently in remission). I did have to do that damn 500 question test. Apparently I exaggerated (that was what everyone who took the test got accused of: they exaggerated!) so the results weren’t clear. The psychologist had to use her head instead of the computer. Poor thing. Okay, enough about me.

Insight is good. Being a know-it-all and changing your treatment plan, double doctoring, doctor shopping and more are not good. In socialized health countries (pretty much everywhere but the US) most of that is harder to do. I work with my psychiatrist with medications, that is, if I really hate his medication decision, I’ll let him know, he’ll reconsider. When I was discharged from inpatient care, it was a mutual decision. If I’ve heard of a new medication, I’ll ask about it, and he’ll fill me in, about how he thinks it would work me me, and then it usually ends in, “and your insurance doesn’t cover it yet”. (It generally takes a year from the med coming out for my insurance to cover it!)

I have never told a doctor, “I think I have..”, partly because I think it’s rude and I’m shy, and partly because I’m not a doctor. Well, except for when I broke my jaw and ribs. “I think I have a broken jaw” fit. If you recognize symptoms earlier because you have heard of them and are able to seek help earlier, that’s even better.

Doctors are often guilty of self diagnosis, especially during medical school. They think they have every disease in the book. Medical studentitis is the name it’s given, as a joke.

“When you self-diagnose, you are essentially assuming that you know the subtleties that diagnosis constitutes.”

Not all mood swings mean bipolar disorder(1) for example. Self diagnosis can get in the way of proper diagnosis. Everybody has mood swings, but certain criteria has to be met. Bipolar disorder is actually not that common, despite hearing about it all the time. A GP should be seen before a psychiatrist so physical illness can be ruled out first. Sometimes physical illness feins psychiatric illness.

Even if you do not want conventional treatment for depression, you may want conventional treatment for a brain tumor.
Self diagnosis is underminig the doctor, too, not good for the relationship, and the doctor could just end it. The diagnosis isn’t what is being treated. That is used for insurance information, symptoms are being treated.

Here are a few problems with self diagnosis:

• – You can be missing something you can’t see, for example, focusing too much on one thing and forgetting the rest.
• – Thinking too much is wrong, or thinking not enough is wrong.
• – It can interfere with the doctor/patient relationship and agitate the doctor (they do get agitated)
• – It can get in the way of proper treatment
• – It can be hard to accept a correct diagnosis, and you could be disappointed that you’re wrong if the doctor disagrees.

Let your doctor do the work, that’s his or her job.

Even a doctor cannot diagnose or treat him or herself. For a lack of a better phrase, it’s a conflict of interest!

“Be honest and upfront with your doctor and make sure to let him know all of your symptoms, even if you do not feel that they are important. Also disclose any and all medications you are currently taking as well as supplements to make sure that your doctor has all the information necessary to treat your illness.”(2)

1.  The Dangers of Self Diagnosis
2. The Internet and Self Diagnosis

Be Nice To Yourself and Don’t Buy Supplements Online

Buying supplements online seems like a good idea, a cheap way to get supplements we want or can’t get in our country. I’m Canadian and some stuff just isn’t available here. I admit, I used to be a bit of a diet pill junky, or collector. I’d buy the stupid things and take a couple, get sick, and throw them all out when I got busted by my mom. I did that for 8 years. I wasted a lot of money. I admit, I still scour the Internet for diet pills. Bad habit. I don’t use them anymore, but I find them interesting.

I am a very pro-treatment and pro-medication kind of gal. I’ve never found that naturopaths or homeopaths have worked for me, but I know those they’ve worked very well for. I’ve tried over the counter stuff for my bipolar disorder and it hasn’t worked. If it’s worked for you, great. Feel free to share experiences. I won’t deny that over the counter stuff works, it has helped me with other problems (pain, PMS, cramps. I hate painkillers, for example). I also won’t deny that it isn’t as tightly regulated as it should be, and that it can be dangerous. People need to see their doctors before taking it and follow precautions, especially if they mix it with meds. These are medications, too, just not as tightly regulated.

People are wary of prescription drugs. In the US, in one year, they spent $26.7 billion(1) on non-prescription supplements. I’m making a guess at this, but there is less guilt in taking something over the counter, less embarrassment than asking your doctor? It seems the world is split, some avoid prescription meds, and some overuse them. The happy medium isn’t big enough!

The FDA and a subsection (Dietary Supplement Health and Education Act DSHEA) have found:
– Some supplements found in stores and online can cause heart, kidney and liver problems with no warnings.
– There is little to no quality control and toxic substances such as pesticides, heavy metals or (for some strange reason) even prescription drugs are being sold with no knowledge to the customer.
– China is a major supplier of raw ingredients, which are often contaminated, have never had their factories inspected by the FDA.
Many products also exaggerate their claims, meaning, they say the supplement can prevent, treat or cure a disease. This is harmful advice, and this is illegal.
Consumers of the products often have no idea
A lot of the users of the supplements don’t know what they’re getting. It’s like a surprise, but it can hurt or kill you! A lot of vitamins and supplements purchased online contain very little nutritional value and can kill you, your kids or your pet. Seriously, if they get into them. There are a few reasons why buying online is a bad idea(2).

1. A medication can be “counterfeit” and dangerous. (I’m picturing a pill in fake Adidas with an Ak-47)
2. The product has probably expired, if it is real, and the seller has repackaged it for resale.
And for the best one 3. It’s stolen. No quality control.

If you can’t get it at home, don’t order it online. This includes even Amazon.

Counterfeit?
Counterfeit basically means “fake”, or “ripped off”. This is different from medications where there is a brand name and a generic, because the generic actually has real ingredients in it. A counterfeit mediction just looks real. It doesn’t act real. It’s never going to have as much active ingredient as it claims, and if you check out the link to where I’m getting this info, you’re literally paying a lot for a little bit of sawdust, according to the FDA.

Note: The criminals rarely get charged because it’s too hard to figure out who to charge, where it began and so on. Sad. This is costing a lot of money, $600 billion, to be, well, estimated, which is almost as much as terrorism costs. Cheap is so tempting, but it’s not legit.

Expired
All medications expire and can do weird things after they do. They can become more potent, less potent, or make you change colours and see things (or make you see yourself change colour?) It’s a bad idea to take that expired cough syrup. You’ll probably cough it back up into the toilet, for example, if you’re lucky. Generally a medication or supplement is good for 6-12 months after being filled at the pharmacy. Sometimes longer. Selling an expired product is illegal, its dangerous, because the product may or may not work, it could make you sick, and all the criminal has to do is slap a new date on the package.

They can get any amount of $ they want. The pills aren’t counterfeit. If someone complains it doesn’t work, the “seller” and throw them a few good pills, or ignore it. Nobody knows exactly how effective this stuff is anyways. It’s a dangerous game when you buy online. Here’s a link on expired medications: http://www.rxlist.com/script/main/art.asp?articlekey=87599

As for stolen, well, that’s self explanatory. You could get a good product once, a bad product another time. Hit or miss.

When In Doubt
If you’re going to use supplements:
1. Don’t buy them online. Go to a local health food store.
2. See your doctor and pharmacist. Check for interactions. Get that physical every year, or every other year. Some doctors are very open to supplements. I know many that have a few concoctions for PMS and cramps!
3. Don’t take anything for weight loss, sexual ehancement or building muscle.
4. If it’s from the US, or you’re living in the US, it has a “USP Verified”(3) mark on the bottle. Their website is linked below with everything they verify.
5. You CAN overdose. More is not better.
6. If something feels wrong, tell your doctor. If it’s really wrong, go to an emergency clinic, or the ER.

Safely Buying Supplements
1. Buy from the manufacturer or a reputable operation in your own country. Try not to cross borders. Do not import things illegal in your country. (For example, ephedra, easy to get OTC in Canada, is illegal in most USA States)
2. Reputable companies supply a lot more information, ingredients, quality control info, and websites with more info, and even have phone numbers.
3. Avoid really cheap stuff.
4. Avoid sites like ebay and amazon, this is your health!

1. http://www.consumerreports.org/cro/2012/05/dangerous-supplements/index.htm
2.http://www.garyshealthtips.com/why-you-should-never-buy-supplements-on-amazon-or-ebay-a-must-read-by-former-fda-special-agent-gary-collins/wn

3. http://www.usp.org/usp-verification-services/usp-verified-dietary-supplements

I suck. And I’ll start updating more, too.

August 1 2008 I had been discharged from my longest hospitalization.

October 7th, 2013 I was hospitalized until October 24th because the stress of life, the universe and everything kicked in and I broke down. Of course, no beds on my Dr’s unit, so he loopholed me through PERT – Psychiatric Emergency Resource Team. They had an emergency room physician come in and put me on a Form 1. 72 hour involuntary hold. Dr N, my pdoc, was not impressed. He took me off it when I was transferred to Unit B, the ward he works on. I was a danger to myself. What crap.

I had a panic attack when they handed me the Form 42 (copy of the Form 1). PERT is just seclusion rooms. Luckily, I wasn’t locked in. They nurse gave me some Ativan and a heated blanket. I slept. BF showed up. He brought McDonalds. My friends took my car back to the apartment. The next day I was transferred to Unit B, where my pdoc works. I had a private room. It was BF’s birthday. He saw me anyways. I owed him big for that!  They tried to give me Ritalin at 10pm, night meds. I refused it. They charted I was “refusing meds”.  My pdoc laughed the next day, thankfully, saying it was good I knew to refuse Ritalin at 10pm! He then told them to NEVER give it to me after 4pm.

Pdoc was good to me. Saw me daily. I had a pass for Canadian Thanksgiving. It sucked, my dad was drunk and being an ass. It was a short pass, thankfully, I had BF with me. “Oh, back so soon.” Oh, yes. BF went for his MRI results: No change in the tumor since his diagnosis a year ago!! MRI’s are yearly, now. At the best cancer centre in Canada, only 45 min away from us. He had a seizure last night. His neurologist is still working on the meds. Less bad, shorter seizures, but still minor seizures. No unconsciousness, no disorientation, but still.

So, we had a lot of groups. I met a couple cool people. I had a day pass, I went to the barn, went riding.

That’s me on Sparkle. She’s a five year old, gigantic Thoroughbred filly. Her registered name is “Sparkle Tangerine”. I did some walk, trot, canter and a small jump. She was very good. Look how tiny I am on her!  I was exhausted when I got back.

I did all the groups. I got so sick of the religious crap from a lot of patients. There wasn’t a lot of super craziness like I’ve seen. No restraints used, no chemical restraints used. A few “code whites” (unmanageable or violent patient) called. I was going to go long term, but the beds weren’t available. Dr N saw staying on the ward was getting hard on me, and we agreed on discharge for the 24th. I start outpatient therapy next Tuesday for anxiety, stress. CBT, that sort of thing. One on one. The only cost is parking.

I now take Geodon (aka Zedox), Lexapro (Cipralex), Ritalin, Topamax, Clonazepam, mostly at lower doses, managing. and my normal meds for my health. I was diagnosed with endometriosis yesterday. BLAH. I start birth control (I’ve had a tubal ligation!!) after my period to try to ease the pain. If not, we do more drastic things. It’s not the worst thing in the world. The ultrasound could have shown a million WORSE things. (Endo is not detected on most ultrasounds) I’ve decided on rotator cuff surgery. Dr N was great to me in the hospital. I thanked him before I left, for his patients. The rec therapists were great. One I’ve known since 2002. We even had a ball pit!

That’s my life for now.

Lithium Orotate – Consult a Doctor First

Consult a doctor

Just a quick response to my lithium orotate article.
Lithium orotate is lithium. Simple as that, it is just a different chemical formation. I have been called all sorts of names, a liar, an advocate for “Big Pharma” and so on. Lithium carbonate is probably the same price – it’s an inexpensive drug and it’s monitored by pharmacies, labs and you can’t buy it easily online and you know what you’re getting (in an ideal world, at least, you should know). Levels should be checked.

Lithium is dangerous to the kidneys in any formula, yes. However, lithium orotate is more dangerous. It is an over the counter supplement. This does not mean “safe”. Tylenol is deadly to the liver, for example, and is sold anywhere. Take enough, and you’ll need a new liver. What a crap example, I know.

Lithium has to be at a certain level in the blood to be therapeutic for the patient. I’m in a country (Canada) with socialized healthcare. I get blood tests for free, I get my meds cheap, yes, I have that advantage. (I can’t take lithium, but it did help for many years, I did end up with mild kidney disease called “diabetes insipidous”) It’s not the safest drug, I know that from experience. It has shitty side effects. It hasn’t changed much over the years. But it works.

Lithium orotate is dangerous simply because anyone can get it. Online supplements are more dangerous because you don’t know what you’re getting. People tend to abuse something advertised as “natural”, because “natural” sounds safe. Look at things like diet pills from GNC, a year later, they get banned because people end up with heart problems. The “healthy living store”.

I’m not saying all natural supplements are bad. But they all say to take with the advice of a doctor. Self prescribing anything is a bad idea. Especially for a psychiatric illness as serious as bipolar disorder. Especially with something like lithium. Blood levels are generally reduced to every 6 months, sometimes less once a dose is established.

A few things to remember.
Natural is NOT always safe.
Always consult a doctor, whether it be a GP or psychiatrist, before taking any over the counter medication or supplement. It could interact with something you already take, or even eat.

Be cautious if you order something online. The dose might not be accurate. It could contain something you don’t know of. It could contain something you’re allergic to. It could contain something that could come up on a physical or blood test as a false negative or positive.

A health food store doesn’t exactly have the most qualified people to give medical advice. This is medicine we’re talking about. Your mind and body. Again, see a doctor.

If you experience any weird side effects STOP.

Be cautious. Nothing works the same way for two people.

This is all my opinion. I do not have any links for you.

2008 Breakdown, Hospitalization, ECT and Recovery

I went back to college in 2007, after a devastating year of psychosis, anorexia, multiple hospitalizations and an over-the-top manic episode. The first semester, fall semester, went pretty well, but as 2008 came and winter set in, I began to get more depressed. My first sign I was going down was when I bought several scales to watch my weight. The depression set in and I tried MAOI’s, which was hell, withdrawaing from SSRI’s for 14 days, then taking the MAOI, trying to follow the diet. I dropped to 90lbs.

I was failing all but one class. I couldn’t concentrate. The winter was hard on me. It was an especially snowy winter, and I lived up north. I broke down when I saw my mid-semester grades. All Fails except for one Pass. I dropped 2 classes and changed my graduation year from 2010 to 2011. I regretted that and tried to get back into the classes but they wouldn’t allow it, for some reason. It’s done differently at other colleges.

I had to go. I saw my counselor on an emergency appointment one morning and starting crying. I had to withdraw, I had to go home. My mother was upset. She made me get on the first bus back to Niagara Falls, and don’t drive to the bus station, for the love of g0d. My car was snowed in every day, so it wasn’t like I could get out.

After I signed the forms I hopped a bus to the terminal. I bought diet pops to get me home. I listened to my iPod and cried. My mom picked me up. I couldn’t look at her. I had a psychiatrists appointment the next day. I was put on a list to be hospitalized in the GNGH psychiatric ward and then a wait list for an opening at a psychiatric hospital in Hamilton.

The next Tuesday a bed was ready for me. I had no privileges. I could only go out for smokes supervised, usually in a group, and I was weak from not eating. I was given Ensure 4 times a day and never drank it and kept purging. They would force me to eat, and I would purge. They spent weeks going back and forth with a schizophrenia or schizoaffective diagnosis. They decided to sent me to an assessment ward at St Joe’s in Hamilton. The wait began.

I was put on Zyprexa, a terrific antipsychotic if you don’t mind being hungry out of your mind 24/7. I started eating again, not necessarily by choice. I HAD to eat, the Zyprexa made me. I was 100 pounds and not allowed to exercise and still had to chug the Ensure. I started giving it away. It tastes terrible.

I was granted a few hours to go home with my parents daily. Random drug tests caught me using diet pills, they showed up as opiates for some stupid reason. I had to admit to using diet pills and I was fucked from every angle. It sucked. They drug tested me every single time I came back on the unit. I got accused of painkiller (opiate) abuse. I’ve never abused a painkiller, not even when I shattered my shoulder in 2011 and was prescribed Percocets. I took those in half doses and was still knocked loopy. I don’t like what painkillers do to me, so I have no desire to abuse them

Finally when I was reaching my last straw, so sick of that hospital but unable to leave, even as a voluntary patient, because it would drop me to the bottom of the list for a transfer, on a Sunday night after returning from my parents, I was to be transferred the next morning. My parents were allowed to drive me, as I was a voluntary patient. I packed my stuff and smoked a lot of cigarettes in the washroom. I took showers, lit my smokes, and puffed in there.

I went to St Joe’s and was nervous as hell. I had a soft spoken doctor named Dr. B who was very nice to me. I had a social worker at appointments as a patients advocate. After I turned myself in a month later for cutting my wrists I decided that ECT was the answer. It wasn’t the first time it was brought up. I had been put on Clozapine and several other medications I can’t remember.

We had a lot to do at St Joe’s. My first day I wasn’t allowed off the ward, even though it was an unlocked ward. They trusted people more there. My nurse was very nice. He gave me nicotine replacement for the day and allowed me to sleep, waking me for meals. My roommates, I was in a 4 bedroom, comfortable ward with a nice bed with electronic adjustments! it didn’t look like a hospital room.

The nurses were young and nice. I didn’t have a bad nurse when I was there. My doctor was very nice and never got angry with me, not even when I slashed up my arm. He simply said if I was to leave the ward, I had to be with someone for the rest of the day, that I had punished myself enough. He LISTENED.

I gained weight, but I didn’t care. Food was buffet style and nobody forced me to eat or to drink supplements. I just ate what I felt like eating and gained weight. A rec therapist took us shopping, bowling, to movies and whatnot. It was nice. We had a schedule every day. I was assessed for personality disorders, mood (affective) disorders and psychotic disorders.

When we decided on ECT I had a physical, a Holter monitor and an echocardiogram of my heart. I was cleared and met the ECT doctor, a nice man whose name I forgot. He diagnosed me as being bipolar, not schizophrenic. The ECT nurse came to talk to me, and there were to be 12 treatments, 2 a week. ECT patients were allowed to sleep all day after the treatment, because of the potential headache and tiredness from general anesthetic. 

My first treatment I was very nervous. Dr. ECT and the nurse came in and covered my in heated blankets and the anesthesiologist knocked me out while I was being reassured by the medical team. I woke up with the IV out, a slight headache I took 2 regular strength tylenol for (I had never had a headache before) and allowed to sleep all day.

My roommate was going through ECT and she went from never leaving her bed, eating or anything, to coming to groups, going on outings, seeing her family and hanging out with some other women and I in the art room and painting or doing other crafts.

After 6 ECT sessions, being switched from bi-lateral (both sides of the head) to uni-lateral, I brought up stopping, as I was feeling much better. My social worker and Dr B agreed, and my assessment was finished, I was re-diagnosed as being bipolar, type 1, rapid cycling with schizotypal personality disorder.It has been changed to bipolar type 1, rapid cycling with psychosis in the past few years.

ECT upped my lows and shot down my highs. I don’t get full out psychotic manic anymore. I don’t take 10+ different medications a day. I take 4, plus one for a physical ailment called diabetes insipidus. I haven’t had a true, bipolar depressive episode since 2008. I’ve had circumstantial episodes, such as when my grandma and grandpa passed away.

I was discharged August 1, 2008, taking 3 medications. Seroquel, Effexor and Valium. I now take Seroquel, Epival (aka Depakote), Cipralex (aka Lexapro) and Xanax, but much lower doses. It hasn’t been easy. I moved to Burlington with friends and everything fell apart. I went back to college, and had to retake a class before graduating in 2012 with a degree in computer engineering. I don’t currently work due to a physical injury that might require surgery. I do freelance jobs online, though, for extra money.

I have a boyfriend. My psychiatrist, who is new, Dr. N, is always questioning my social life: most of my  friends are male, and I have very few close friends. I was diagnosed with the possibility of mild to moderate AD(H)D, inattentive type. I have flashbacks from the times I did drugs, and when I was at my worst.

I still get angry, sometimes out of control. I can get scary. I am devastated that one night I was out of control angry and took it out on my mom. I can’t forgive myself for that. But the next day she called me and asked me if I wanted to go to Canada’s Wonderland in the next couple weeks, she’ll book a day off of work so we can go ride coasters together.

My boyfriend is supportive. He’s great. He unfortunately has a brain tumor and has complex partial seizures every couple of weeks. We’re waiting for an expensive medication to be approved by the government to stop the seizures. I don’t know how he deals knowing he’s going to have a seizure, that he has a tumor. So far the news has been the best we can get: it’s small, probably benign, and it hasn’t changed at all.

I have a small support group, but I love them. My boyfriend is so supportive. He’s always there for me and I can’t thank him enough. I will always be bipolar, but treatments are getting better, and i honestly owe my life to St Joe’s, Dr. B and ECT.

“April is the cruelest month”

 

It’s true.The sun is shining, the snow is melting, plants are growing, everything is just out of whack!

I live in Canada, southern Ontario to be more specific, and well, we have a lot of weather change here. This can set off moods like a rocket and definitely unsettle people. I get hypomanic in the fall, and somewhat depressed in the winter, and mixed in spring. Happy Easter everybody! (Even though I don’t understand that holiday at all) 

Springtime is high time for manic episodes, but they aren’t exactly sure why. (Surprise, surprise)

 Admissions to psychiatric wards, in Ontario Canada, is April, mostly for mania. This was confirmed by Dr. Levitt, a psychiatrist at Sunnybrook Hospital in Toronto(1) Many patients go from blah, depressed, to BAM! Manic!

 Remember, mania can be just as debilitating as depression. It’s not all fun and games and it can land you in a lot of trouble. Irritation and grandiose ideas are two problems that accompany mania, as well as excessive spending and irresponsibility. This is known as “seasonal bipolar”.

 Daylight savings time can also throw of the proverbial bipolar clock. There are more hours of light in the day and this can be very confusing to the mind and body. Myself, I get extraordinarily tired. All of this can activate bipolar disorder, even if you’re properly medicated and cared for. If you are properly medicated and cared for, it makes the transition easier, but it still sucks. For bipolar students, the stress is increased as the end of the school year is in sight, and it’s time to cram for exams.

 Cutting down on caffeine and eating properly can help through this transition, as well as getting the same amount of sleep at the same time at night. And take your meds!

 March Madness and September Sadness are no joke, they have been in history as far back as we can go in studying mood disorders. There is no real explanation, just hypothesis on what might cause this scenario. You may or may not end up hypo (or full out) manic, but take precautions. A manic episode can be devastating!

If you live in an area without as dramatic seasonal changes, unlike Canada, you may be getting off lucky.

1. http://www.nationalreviewofmedicine.com/issue/2006/04_15/3_patients_practice02_7.html

2. http://www.psychologytoday.com/blog/bipolar-you/201103/spring-has-sprung-and-so-might-your-hypomania-0

Medications Part 4 – Atypical Antipsychotics Aren’t Just for Schizophrenia

A lot of people hear the word “antipsychotic” and shy away from the medication, or think they’re doomed. But in fact, atypical antipsychotics are quite useful in the treatment of bipolar disorder and depression.

 A few are even FDA approved for the use of either augmenting an antidepressant for someone with clinical or major depressive disorder, or as a mood stabilizer for bipolar disorder. I’ve been on atypical antipsychotics since I was 18, and must say, they have less side effects than the first generation ones, and they’re much more helpful. One, called Symbyax, is a pill of Zyprexa and Prozac paired for use in major depression and approved for bipolar depression as well.

 The main atypical antipsychotics are Abilify, Saphris, Fanapt, Latuda, Zyprexa, Symbyax, Invega, Seroquel, Risperdal, Geodon/Zeldox and Clozapine*.

 Antipsychotics, unfortunately, have the risk of major weight gain. I gained 40 pounds while on Zyprexa, it seemed to even out when I switched to Abilify. This can be off-putting for many of those prescribed these medications. Geodon, Clozapine and Abilify are considered “weight-neutral”, meaning they do not cause weight gain or loss(1) but your mileage may vary. I lose weight on Geodon.

 I found Risperdal to be a little sedating for a bit. But the big problem with many atypical antipsychotics (or AAP’s, for short) can cause your prolactin (a hormone) to go up. This, in females, can stop your period and cause “leaky breasts”. It’s not as much fun as it sounds, it’s downright gross and embarrassing to try to explain to your 70 year old shrink that your tits are leaking! Before I took Risperdal, I actually had to take medications to increase my prolactin levels, and I was taken off them before starting Risperdal.

 I find Risperdal to be a good “once in a while” medication. It doesn’t have the mood stabilizing effects that a lot of the others do. It helped with my irritability, but I’ve never been on it long enough to see it’s full effects. But my boobs went from a C to a DD. It is also available in a long acting injection. I don’t like long acting injections because once its in your system, it stays there, and until its completely out, you get the side effects.

 Saphris is a newer AAP and is not available in Canada, to my knowledge, and when swallowed, is only 10% effective, so, like Zyprexa Zydis, it has to be dissolved under the tongue. Reports say that it’s horribly disgusting tasting but it works. You also get a numb mouth for a little bit, which is always heaps of fun. Zyprexa Zydis doesn’t cause as much weight gain as Zyprexa itself, for some reason, and is good at knocking you right out, but there’s always that chalky feeling in your mouth the next day. Ick.

 Seroquel is one of the most well known AAP’s out there and is also known for causing a lot of weight gain. I never really gained on Seroquel, to be honest, and it made me stop smoking so much for some strange reason. Unfortunately I had weird side effects from it (heart arrythmia’s and trouble swallowing) so I had to stop taking it. At one point I was taking 900mg a day, enough to sedate a horse. No wonder I kept falling asleep in class! The dose I’ve noticed most people take is 300-600mg a day, usually at bedtime. It’s good in tiny doses (12.5mg, 25mg) for anxiety or a PRN (as needed) medication. It is also approved to be used with an antidepressant in bipolar and unipolar depression. Some people call it Slurrrroquel because of its sedating effects. It can be used as a mood stabilizer without a combination of an anti-convulsant.

 Geodon is one of my favourites, I honestly shouldn’t have switched to Abilify. Some people find Geodon (called Zeldox in most of the world, I’m using the USA name) very sedating, but I found it not-so-much. I often have trouble sleeping or staying asleep on it. It works as a mood stabilizer as well. It’s weight neutral but can cause akithasia, inner restlessness, something I’m feeling now due to Abilify. Abilify is considered a third generation antipsychotic, while the rest are second generations.

 Okay, this isn’t a review on AAP’s, so I’ll continue on with how they work, how they differ from “typical” antipsychotics and side effects.

 How do they work?

Like most psychiatric medication, they don’t really know how or why they work.(2) The theory is that they act on dopamine (a neurotransmitter) and block other neuroreceptors. Rispderal is said to block the creation of serotonin and dopamine, so the symptoms don’t show up, and Invega works the same way. Zyprexa, Seroquel and Clozapine block several receptors and try to fix the chemical imbalance in the brain, but unfortunately, do to this specific mechanism, type 2 diabetes is a possible side effect, as is weight gain. Abilify is unknown and Geodon is completely different, helping with positive and negative symptoms of schizophrenia, making it a good mood stabilizer.

 Side Effects

They say side effects only occur in 10% of those taking these meds(3) but honestly, I think its much more than that. Common side effects are: weight gain, tachycardia, insomnia, akathisia, agitation, anxiety, headache. It’s kind of funny because some of those side effects are what those medications treat.

 Rare side effects include: Dystonia(4), Parkinsonism(5), tardive dyskenesia and neuroleptic malignant syndrome, and sometimes type 2 diabetes.

 Atypical vs. Typical

Typical antipsychotics are sometimes called neurloeptics because it means “seize the neuron”(6) They tend to control symptoms such as mania, delusions and hallucinations, also called “positive symptoms”. (Do remember, that schizophrenia and bipolar work similarly in the brain) Side effects are similar, but worse, and can cause tardive dyskenesia (7), sometimes they are paired with medications like Cogentin to stop this.

 Though typical’s can treat positive symptoms, the negative symptoms are still there. In the 1980’s, researchers found a way to treat both sides of the spectrum, called atypical antipsychotics, that work on more receptors and have less severe side effects.

 “Researchers speculate that traditional antipsychotic medications completely block one kind of dopamine receptor, leaving other types of dopamine receptors unaffected. Atypical antipsychotics appear to block many kinds of dopamine receptors less completely.”

 

• Clozapine is often used as a last resort medication due to a serious side effect it can cause: lowering the white blood cell count. Weekly blood tests are needed for quite a while, then bi-weekly, and then monthly.

• (1) http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml

• (2) http://www.virtualmedicalcentre.com/treatment/atypical-antipsychotics/109

• (3) http://www.virtualmedicalcentre.com/treatment/atypical-antipsychotics/109#C4

• (4) Involuntary movements of the cervical spine, tremor, neck spasms.

• (5) Symptoms similar to those found in Parkinson’s disease.

• (6) http://www.health.am/psy/more/schizophrenia-typical-atypical-antipsychotic-medication/

• (7) Involuntary movements of the tongues, lip and neck.

What would you like to hear about?

My audience, I’m writing for you. Any suggestions?

Also, Shanon Larratt of bme.com passed away today. I’m in shock. His website connected me to so many people I would have never met otherwise. Great guy.

Doctors and mental illness discrimination

This isn’t really an educational article. This is going to replay the last few weeks of my fight to get help.

My psychiatrist retired immediately after changing my meds and leaving me with nobody, except my GP to refill the prescriptions. My GP has referred me to every psychiatrist in the area, I have done my own research, and be damned if I can get in with a new shrink.

I like to have things set out and planned. I like knowing what’s going to come next. This lack-of-psychiatrist while going through bad restlessness from the Abilify (it works great, but I am restless as hell) just doesn’t work for me. My GP seemed fine at the beginning, like he’d prescribe everything for me, he took care of the diabetes insipidus, he’s been great. Except, he will not change any of my psychiatric medications.

He told me to take Cogentin for side effects, but Cogentin has worse side effects than the medication causing the side effects you’re trying to get rid of. So I was prescribed Artane, same deal, then Mirapex, which seemed good, until I read the PI sheet. “May cause you to fall asleep at random”. No. I eventually settled on generic Benadryl, and it takes the edge off. (Many people take beta-blockers for the restlessness, but my blood pressure is low, even lower with the HCTZ, so there is a chance I’d pass out)

I got in with a psychiatrist, all my problems were solved! No, she does a one time consult, reports back to your GP and makes a suggestion. She had no suggestions for me, really, except to swap antipsychotics, which was my idea, too. But my GP doesn’t feel comfortable doing this. I was referred to Telemedicine. They do a one time consult, I’m not even wasting my time, and their time, either.

So after I saw the first consult psychiatrist I decided to go to the ER of W-town, the city I was in at the time. It wasn’t busy and I was immediately put into Seclusion, where my boyfriend kept me occupied with his Nintendo DS, and I texted my friend to see if we could bump lunch up a little later, I was in W-town and to get back to S-town it would take extra time.

A doctor came in. i explained my problem, I needed a psychiatrist, I need a medication change. So he orders blood work and an EKG, which I refused (BIG mistake) because I just wanted to leave. By this time I knew I wasn’t going to get anything sorted out. I sat and waited for them to discharge me, and a nurse came in and we got into an argument over the blood tests. I said, I just had them done 2 weeks ago at a physical, they test everything, call my GP. She bitched at me, I finally asked “How long for the results?”

“An hour”

Okay, I can live with that. I let her take my blood, which she did really fucking badly, I’m not sure if it was because she’s incompetent (I very rarely, if ever have had anyone screw up drawing my blood that I can remember and I get blood work done very frequently, at one point, it was twice a week) She leaves, the doctor (it was his first day) comes in holding a piece of paper.

It was a form 42. 72 Hour Hold. Involuntary. I hadn’t been hospitalized since 2008 and this jackass, on his first day had just committed me. I demanded to speak to a patients advocate (that’s my right as a patient) and he refused. I called my mom to get her to call her lawyer, they took away my phone. So I ended up in the psych ward for 24 hours, left with a “Call Dr. P and take more Xanax”

Need I say that they refused to give me Xanax while I was under their care? I went into withdrawal, I was shaking, and they blamed it on recreational drugs, even though I tested clean.

I got out, gave up. I tried talking to my GP about all the bullshit, he can’t really do anything.

Nobody will do anything. Psychiatrist 1 sends me to another, to another, back to GP, to another. Etc. It’s a circle.

There is a huge amount of discrimination via doctors with mental health. Especially since I’ve been in the system for so long. 14 years. I was told before being discharged that I would not get a psychiatrist to see on a regular basis and “well, life’s not fair”.

My old psychiatrist always told me, “you’ll never be 100%, so why don’t you settle on 70 or 80% and live like that?”

Fuck. That.

Still jumping through hoops. I can’t afford a therapist, though they can’t do shit about my meds, they do help. My GP won’t alter my meds, nobody will see me more than once.

They have no clue whatsoever. I have been chewed up and spit out by this system and I really can’t take much more. I was put on a 72 hour hold because I attempted suicide 11 years ago. I was calm and fairly collected (I didn’t run around yelling and screaming) during the intake process. I didn’t rip the Form 42 up and kick Dr. First Day in the balls. I complied, because I know what happens when you don’t comply. It’s not pretty.

On the other hand, I broke my shoulder last year and there’s a 9 month waiting list for physio. My insurance doesn’t cover most physio and at $150/hr, yeah, right. My shoulder is, in medical terms, “very messed up”. So I suppose the mental health system is no better than the entire system itself.

Also, they wrongly diagnosed me with borderline personality disorder (something that has been discussed since I’ve been in treatment) by asking me only borderline personality disorder questions. Then they’d ask “why do you THINK you’re bipolar?” Because, um, well, 9 psychiatrists and 4 psychologists have assessed me (once was over a period of 6 months inpatient) and they TOLD me I was bipolar. I don’t want a disorder!

I tried to speak up. I tried to ask for help. It was denied. I was put in a locked ward and denied a medication I need. I’m more irritable. I’m afraid of telling the truth so they won’t lock me up again.

Something has to be done.