Talking to Your Psychiatrist – How To Guide

psych
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

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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.

simpsons

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).

counterfeit

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.

roundup

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.

expired

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

Lithium Orotate – Consult a Doctor First

Consult a doctor

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.

Mania slowly eats your brain (seriously)

Mania, the horrible mistress of bipolar disorder. We sometimes take it for granted in it’s early stages, hypomania, but in a full blown out manic episode, everything can go to hell. Many people accidentally kill themselves in manic episodes. But did you know, that during an episode, you’re killing your brain?

“Episodes of mania and depression may cause damage to learning and memory systems”(1)

Long term patients showed more cognitive impairment than those younger, or newly diagnosed. Bipolar disorder and time are not your friends. After 5-7 years, the newly diagnosed showed some cognitive impairment.

It can be blamed on medications, but that’s untrue. They can cause cognitive slowing but they aren’t a culprit. Some medications even repair parts of the brain, and are considered to have neuroprotective properties.

The brain breaks down as the disease goes on, and it isn’t able to process information the way it used to. (Remember, bipolar is a kindling disease, if left untreated, it just gets worse and worse, and the damage increases per episode)

“People with bipolar disorder suffer from an accelerated shrinking of the brain”(2)

Gray matter in the brain is lost during an episode, in the areas of the brain that control memory, face recognition and co-ordination.

“Evidence has been overwhelming that bipolar disorder is a disease of the brain, like Parkinson’s or MS”(3)

Those with bipolar disorder have enlarged ventricles in the brain and extra white matter, for example. Impaired awareness (50% of those with bipolar disorder are aware of their disease, diagnosed or not) is because of decreased activity in the pre-frontal area. This is similar to a stroke victim.

Results of MRI’s from the mentally interesting and people without mental illness show that those without mental illness had more gray matter in their brains.(4) Gray matter is consisted of nerve cells. An essential amino acid, called NAA, was monitored in bipolar patients and the amount decreased as the illness progressed, which indicates damage to neurons. These findings are comparable in Alzheimer’s.

In conclusion, if you’ve been diagnosed with bipolar disorder and want to make the best of your life, take your medications, live a healthy lifestyle, don’t drink or do drugs and learn some insight to get proper treatment before an episode happens.

And just remember this: What goes up, must come down.

  1. http://www.healthyplace.com/bipolar-disorder/articles/brain-damage-from-bipolar-disorder/

  2. http://www.sciencedaily.com/releases/2007/07/070720103036.htm

  3. http://www.pendulum.org/disease.htm

  4. http://www.ehow.com/about_5245785_effects-bipolar-disorder-brain.html

The Stigma of Bipolar Disorder

This is based on personal experience and the experience of others. If you want to add your own experience, please do so in the comments. Bipolar disorder has a stigma attached to it, and it needs to go away! The more that speak up, the better!

Mental illness has carried a stigma (a mark of disgrace or infamy; a stain or reproach, as one’s reputation) not only with family, friends, and the general population, but also with doctor’s, nurses and pharmacists, for as long as it has been around. Which is a very long time. They don’t throw us in snake pits anymore or burn us as witches, but the effects still hurt.

Bipolar disorder is a disease of the mind. The current theory is that it is a chemical imbalance with serotonin, dopamine and GABA. In a nutshell, a typical bipolar person swings between depression and mania, of varying degrees. We are said to be more likely to do stupid things in a manic or mixed episode, but everybody does something stupid. I am pro-medication and pro-treatment, and yes, bipolar disorder can be controlled with proper medication, exercise, diet and a good support system. We aren’t all raving lunatics. (Look at the state of the world today, we’re the sane ones!)

(1) We often get told we’re overreacting. Duh, that’s a symptom. One of my favourite things I hear is “Everybody has mood swings sometimes”. These aren’t mood swings they are mood episodes. Everybody’s mood swings, but not to the extent of that of a bipolar person. Our mood swings/episodes can be set off/triggered, but a lot of the time, they just come out of nowhere. Most people have a reason for having a mood swing, like losing someone close to them, a change in health, or circumstances.

People hear “bipolar disorder” and either don’t know wtf it means and you have to explain “It’s manic depression” and they assume you’re crazy, batshit, bonkers. I had a girlfriend ask if I was dangerous to other people. It didn’t work out. I’m not a “sociopath” (the accepted name nowadays is “Antisocial personality disorder) and there are very few bipolar people that fit the criteria for a serial killer!

I rarely get told I’m normal, maybe its the tattoos and sometimes crazy hair, but people with mental illness hate being told “You seem so normal.” Do you have any idea how much work it is to seem so normal? It’s a daily job. We aren’t “What You See Is What You Get”, nor is anyone. Don’t even get me started on asking if it’s “that time of the month”, either!

When I took Lithium, the second I said “Lithium” to a doctor of any kind, except a psychiatrist, because they’re more understanding (or should be) they’d immediately snap into attention and ask if I was bipolar. Lithium is often used to augment antidepressants and has a stigma attached. They would treat me differently. When I used to self harm, and needed medical attention, I was treated like a criminal in the ER.

Here’s a story. I used to be a competitive horseback rider but one day my horse refused a jump, I fell off, came down hard on it, and took the impact with my right upper arm and shoulder, protecting my head and neck, even though I was wearing a helmet. I thought nothing was wrong, so I put the fence back together, got on the horse, and finished my lesson. The next day I couldn’t grip with my right arm, and went to the ER. I had a fractured humerus and a shattered shoulder.

The doctor’s prescribed NSAID’s. I couldn’t take them at the time because they interact badly with Lithium. So I went without painkillers for a week until I saw an orthopedic surgeon. It was Sunday, my appointment was Tuesday. I didn’t want to wait in the ER because I needed a better painkiller, so I went to a walk-in clinic. I had been popping Tylenol 1’s (tylenol with 8mg codeine) but the pain didn’t fade. I was wearing a sling, so I gathered my meds (key note: when you see a doctor, always bring your medications or proof of medications, it makes life a lot easier) and my mom took me to a clinic because I hurt too much to drive.

The doctor was fine until he saw my medications and reason I was there. He made me submit to a drug test and yelled at me to see my GP (general practicioner). It was a Sunday. I told him the drug test would show benzos, as I take Xanax, and opiates, as I had been taking over the counter tylenol with codeine. He basically accused me of drug seeking and he yelled at me when the hospital was too busy to send my file. He did not touch my arm. “Hmm, you’re bipolar, so you must abuse substances”. He eventually gave me 10 Tylenol 3’s, and I left crying, from the pain and how I was treated.

I’ve had “friends” make jokes about self harm and suicide. I’ve had my parents not understand that my moods were cycling and the meds weren’t working. I was even fired by a psychiatrist once because I made a shitty attempt at suicide. I’ve been told to pull myself up by the bootstraps (whatever the hell that means) and get my shit together.

I’ve included these links below because I find they are helpful in explaining your diagnosis, and how you should be treated.

  1. http://bipolar.about.com/od/stigma/a/10-bad-things-not-to-say.htm

  2. http://bipolar.about.com/od/stigma/a/dont-challenge-bipolar-diagnosis.htm

  3. http://bipolar.about.com/u/ua/stigma/hurtfulthings.htm

  4. http://www.news-medical.net/news/20120913/Stigma-impacts-functioning-in-bipolar-disorder.aspx

  5. http://www.psychologytoday.com/blog/bipolar-you/201002/dispelling-stigma-revealing-your-bipolar-truth

  6. http://www.crazyboards.org

 Don’t let others get you down! You are a person too, probably a better person!

Does being born premature mean you’re more likely to end up bipolar?

The answer is “it’s possible”

Premature birth is something I’m familiar with, as I was born almost three months prematurely. I stayed in the NICU for 31 days after my birth, and I was never breastfed. I was given a blood transfusion my parents didn’t know about until I was ten years old and needed to be tested for AIDS. Fortunately, it came up negative, or I’d probably be dead by now. But let’s get to the main topic:

 Very premature babies were more than seven times more like to have bipolar disorder and nearly three times as likely to have depression.

 This research comes from researches at the Institute of Psychiatry in King’s College London and the Karolinska Institute in Sweden. Let’s break it down to the basics and examine their research.

A full term pregnancy should last 40 weeks.
One in 13 babies are born prematurely (before 36 weeks).

The researchers in Sweden and London studied a group of 1.3 million born between 1973 and 1985.

 

They found 10,523 people were admitted to hospital with a psychiatric disorders, 580 of those had been born prematurely.”

That’s 5.5% of admissions being prematurely birthed. Full term adults had a 2/1000 change of being admitted, a 0.1% chance, while premature adults had a rate of 4/1000, a 0.2% chance if they were born before 36 weeks, and those born before 32 weeks were at 6/1000, or 0.6%. An early birth can distrupt the developing brain1.

Dr Nosarti2 says:

“‘We believe that the increased risk of mental disorders in those born very prematurely can be explained by subtle alterations of brain development. The immature nervous system in those born prematurely is particularly vulnerable to neonatal brain injury resulting from birth complications.”

 However, birth complications have gone down since the study was conducted.

  1. http://www.bbc.co.uk/news/health-18289197

  2. http://www.kcl.ac.uk/iop/news/records/2012/June/Premature-birth-linked-to-increased-risk-of-mental-health-problems.aspx

ECT and Me

I said I wouldn’t post personal experiences, really, on this website. Just research and opinion. But here’s my story of undergoing electroconvulsive therapy in the summer of 2008. I had 1 bilateral (both sides) and 5 unilateral (one side) ECT treatments.

ECT is often known as “shock therapy” and the mind goes to “One Flew Over the Cuckoo’s Nest”, Sylvia Plath and other scary sounding stories. In truth, it’s a safe procedure. This is how it’s done:

The patient is put under with a short acting general anesthetic via IV. Muscle relaxants are put in through the IV as well, and a blood pressure cuff is attached to one arm, so they can see fingers twitching to see if you’re having a (tonic-clonic) seizure or not. They may also record brain waves (EEG) to tell the duration of the seizure.

Dosage, duration of the seizure, type of anesthetic and muscle relaxant are determined by the psychiatrist in charge of the patient receiving ECT, as well as the anesthesiologist. Bilateral means they shoot electricity through both frontal lobes. Unilateral means they only go through one, which reduces memory loss.

The hospital I was at, St Joe’s in Hamilton had assessed me thoroughly before deciding to go ahead with ECT. It was 100% consensual and part of the reason I had been sent to that hospital. Nobody forced me into it, I signed a lot of papers and I had several counselling sessions. I was inpatient at the time and released shortly after. I met with my social worker and psychiatrist, who agreed with going ahead with ECT. He then had me meet with the ECT psychiatrist who gave his opinion of me to the pychologists and my psychiatrist at the hospital.

It was a go. I suffer from sinus tachycardia, so I underwent an EKG, echcardiogram and Holter monitor to make sure my heart was health and could stand up to the anesthesia and seizure. The seizure only happens in the brain and sometimes the fingers, the body isn’t jerking around, like the movies like to portray.

It was a surprisingly easy procedure. The nurses were not allowed to give me any medications that stop seizures (such as anticonvulsants like Depakote, or my regular Valium) at night. I was not allowed to eat or drink after midnight, and around 5am the ECT nurse came and gathered the patients going for ECT and we would pile into the St Joe’s van and go to the main hospital at the bottom of the hill.

We were to undress and leave only underpants on, no bra, and put a hospital gown on, open in the back. We were assigned a gurney numbering who was up first. It was done early in the morning because they used the Recovery Room for post-surgeries, and at that time, it was least busy. We were on the tenth floor, and went far down for the Recovery Room, in order. I was usually third out of six or seven people.

It is nerve wracking and very scary. I declined a sedative from the nurse, and a small-bore (little needle) IV was placed in my arm and a saline drip started. They covered me in hot blankets and we took the elevators down to the Recovery Room and waited. The noises were scary, you could hear the machine screech. I always wished I was first, so I didn’t have to listen to it. Some people, mostly smokers, had to have some suctioning done in their mouth from things coming up. You could hear the gurgling.

We wore oxygen masks, and when the ECT doctor, anesthesiologist and nurse came to the bed it was switched to an AmbuBag being pumped by a nurse. The ECT doc was always friendy and the anesthesiologist put me out quickly and painlessly (some people report intense pain after being given the anesthesia, before they go under, but this has never happened to me and I’ve been under general anesthesia 8 times in my life) I don’t remember waking up.

The whole thing takes about 5-10 minutes. I remember eating a muffin, being given tylenol for the headache. Some people said they had headaches so bad they needed morphine, but 2 Extra Strength Tylenol did it for me. I remember bumming a smoke from the ECT nurse while we waited for the van to take us back up the hill. I also remember a breakfast burrito, which has turned me off from them since.

I don’t remember a lot of detail in that month I was being given ECT, it is very fuzzy. I had written down all of my computer passwords and important information, but I didn’t lose any memories. The worst was when a rec therapist made me go put a scrapbook together one day. She did get in shit because patients were supposed to, and allowed to, rest all day after ECT. I would come back on the ward, take my medications and go to bed for the day. I had 6 treatments over 3 weeks.

Would I do it again? Most definitely, it brought me out of a crippling depression nothing else would touch. It has made my high’s lower and my low’s higher. I have’t had a full-blown manic or depressive episode since then. I still have mood episodes and I take medication, but not nearly as much as before, and it works better.

It is a serious procedure, because of the use of general anesthetic, but I’d rather get zapped again than go to the dentist. At least you’re unconscious for ECT! One woman in my room went from catatonic to being very active, talkative and started eating again after a few sessions. I saw it help people, and I saw the benefits in it myself. The ECT doc told me that ECT is about 85% effective in treatment resistant mood disorders.