Talking to Your Psychiatrist – How To Guide

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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

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

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

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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.

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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.

ECT vs. TMS

TMS vs. ECT

ECT (electroconvulsive therapy, it used to be called “shock therapy”) has been around for a long time. For unknown reasons, it helps with depression and bipolar disorder. I wrote an article about my personal experience with ECT earlier in the month. Some people still think it’s a brutal, gruesome treatment but it really isn’t. My ECT doctor said it was 75-85% effective, and it helped me tremendously.

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What is ECT?

During electroconvulsive therapy, a patient is anesthetized and a small amount of electrical current is used to stimulate the brain. This produces a modified seizure, which, in turn, changes the activity of the brain. Some of these changes are similar to those seen with certain antidepressant medications in the way they relieve symptoms. The medications used for anesthesia prevent injury and patients feel no discomfort during the procedure.”(4)

 

TMS stands for “transcranial magnetic stimulation”(2) and works under the impression that the brain can be stimulated by magnets, something becoming more common. Magnetic fields easily pass through the skull and into the brain, but to effect the neurons inside the head, there must be a lot of magnetic energy flowing. TMS machines send a pulse through every three seconds and were made for diagnostic testing. It is non-invasive with very few side effects and capable of modifying the brain.

 

The magnetic field in TMS works by magnetic fields being produced by a passing current in a hand held coil(2). The shape determines properties and size of the field. The coil is held at the scalp, and no contact is necessary, unlike ECT, when the electrodes touch your scalp.

 

TMS has less side effects. There has been reported that there is no memory loss and no seizure. It was invented in the late 1980’s, while ECT has been used since the 1930’s(3). ECT is 70% effective.(5) Both procedures cause headaches. TMS takes more time, up to 5 times a week for an hour. A doctor, a nurse and an anesthesiologist are required for ECT and the patient wakes up confused and often disoriented. TMS doesn’t have these side effects, you get up and walk out.

 

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What exactly is TMS?

Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adults with major depression that uses magnetic stimulation of the brain to help modulate mood. The procedure was approved by the Food and Drug Administration in October 2008 after more than ten years of clinical investigation in patients who failed to achieve satisfactory improvement from depression from one course of pharmacotherapy (medication). For this reason, transcranial magnetic stimulation (TMS) is particularly helpful for people with depression who have not experienced significant relief from antidepressant medications or have difficulty with side effects.”(4)

 

ECT is a quicker fix than TMS. It takes 7-10 sessions, on average, for ECT which is only a couple of weeks. TMS is 5 days a week, for several weeks. It is not known exactly how ECT works. ECT has a durability of six months, on average. Generally, a patient is taken off of meds before ECT, while during TMS they can stay on the medications and get a “boost” from them. In many cases, the patient still has to take medication after, but not as much, and it’s more effective.

 

One of many theories of ECT efficacy is that the electric field releases a torrent of neurotransmitters.”

 

As for price, TMS runs at about $10,000, while ECT is about $24,000 because of the team needed to administer the treatment. ECT is still considered the best and quickest acting therapy for treatment resistant depression.

 

  1. http://www.ncbi.nlm.nih.gov/pubmed/18580559

  2. http://www.musc.edu/tmsmirror/intro/layintro.html

  3. http://www.elata.org/tms-faq.shtml#_How_does_TMS_1

  4. http://www.mclean.harvard.edu/patient/adult/ect.php

  5. http://truth-out.org/news/item/11833-tms-breakthrough-new-hope-for-treating-severe-depression-with-few-side-effects

 

Bipolar Disorder The Latest Epidemic Book Review

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This book looked interesting when I saw it in the Kobobooks store. So I downloaded it and started reading. There were very vivid descriptions of abuse she sufferedas a child, including when her mother hit her so hard with a 2×4 she broke her back, leaving her ermanently disabled after the age of 30 and multiple surgeries that were unsuccessful.

But then.. she starts talking about God and Jesus Your Savior. It starts off small, and then it gets bigger and bigger, until almost every sentence is talking about how Jesus and God will cure what ails us. We should still take our medication (she is pro-medication and pro-therapy, at least, but against ECT) but we need to accept Jesus in our hearts.

Normally I would just close the book and delete it, but for this review I thought I’d keep going because the book is such a clusterfuck. She is abused at home, by her mother, in gruesome ways, and her father turns a blind eye. She is considered the “toad” of the family while her sister is the Princess. She takes out her anger by bullying kids at school.

She has a lot of misinformation on bipolar disorder, treatments, ECT and more in the book. Her belief is that the bipolar disorder was caused by the abuse as a child, but she also has a diagnosis of PTSD and borderline personality disorder, which, to me, seems like the abuse as a child would fit those two diagnoses better. I’m not trying to diagnose her. She also says that schizophrenia is “that one with multiple personalities” which is very untrue, schizophrenia is a thiought disorder, while multiple personalities is now known as Dissociative Identity Disorder and is much different from schizophrenia.

She has a lot of borderline personality disorder traits. She takes risks and abuses her own son. She got pregnant while drinking and doing drugs, so she had an abortion as not to bring a handicapped child into the world.

One big pet peeve in this book for me is that she’ll end a sentence with “it’s often seen in bipolar disorder”. She does this frequently through the book, mentioning symptoms and adding “often seen in bipolar disorder”. Her descriptions of mania and depression are vague and look copied and pasted from a website that hasn’t looked at the DSM. ANother pet peeve is that she says “bipolar disorder is like very bad manic depression.” Manic depression is the old term for bipolar disorder, it isn’t used anymore and isn’t in the DSM. Bipolar is it’s new name.

She has lost chunks of time in her childhood, and doesn’t remember being raped, though her friends and family do. She marries twice, both times in abusive relationships, with her being abused and the abuser. She has one son who turns out all right, but there was a huge custody battle for him.

Because of her broken back she is bound to stay in bed and watches religious videos and Podcasts every day. She goes into detail about her many surgeries, but is very vague about her “suicde attempts” which are basically her taking a handful of pills with a bottle of vodka, and then calling a friend, the police get called, she gets hospitalized for 72 hours.

She says that mental illness is an illness, which it is, but she also says that you can’t blame your actions on your illness. That’s one thing that irks me, when people blame everything on a mental illness. She says to turn to god for sinning, and that suicide is a sin. She also recommends that people see multiple doctors until they get the answer they want.

She knows very little about medications, saying that they contain serotonin and she has too much serotonin in her blood, therefore she can’t take them. This is untrue, because if there was serotonin in our blood, a blood test could have diagnosed many mental disorders years ago. She uses bad analogies and has a very frustrating sense of humour. (Serotonin is in the brain as a neurotransmitter)

This book is more of a self-help book, or “Abuse for Dummies” because she writes so simply. There isn’t much about the bipolar disorder in it. She does have some good advice on dealing with past abuse, and how to handle it after it’s over. I don’t see this book as a memoir, though. It was quite a boring read, and I wouldn’t recommend it to somebody that knows little about mental illness due to her ignorance of a lot of the disorders and treatments.

She warns about allergic reactions to medications, which is rare. She constantly mentions it, though, basing it only on her own experience. She later says that the only way one can get better is to take god into their hearts, to pray, to attend church, to be spiritual. She also uses marijuana to control her bipolar disorder and rages. Her cure for mania? Look it up in the bible.

There is a section on the different episodes of bipolar disorder, but a lot of it has been repeteated again and again throughout the book, with her giving a little bit of input on her personal experiences. I was expecting this to be a memoir, rather than a (bad) information book. It is getting to be a really frustrating read.

She assumes that bipolar disorder stems from abuse, that the abuse causes the chemical imbalance. She also assumes that doctor’s give too many medications, but she encourages researching medications and being knowledgeable about them while they are being discussed at a doctor’s appointment. Another frustrating aspect is her misinformation on ECT, something she refuses to try.

All in all, this book sucks. There are a few things I agree with, that bipolar disorder is overdiagnosed, that medications are good, therapy is good and abuse in childhood can bring major prolems in the future. The book is just very disorganized and not a memoir at all. Not what I was expecting. I don’t recommend it. I couldn’t even finish it.