Tag Archives: modern medicine

Antidepressant Turnover

You may have read (here: Back in the (Rx) Saddle Again) that I have been experiencing a significant enough decline into depression to warrant attempting an antidepressant again. Being home with my boyfriend who has a broken shoulder on a daily basis has been quite exhausting, and despite my typically treatment-resistant symptoms (and negative reactions to new medications in the past) I have a new psychiatrist who seems hell-bent on un-wedging me from my latest foray in desperation.

Her latest idea was to start me on 12.5 mg of Zoloft (sertraline). Previously I tried 100 mg of Zoloft and started to vibrate out of my own skin with manic energy so we were hopeful that a tiny dosage might be enough to nudge me out of the black abys without launching me sky-high like some kind of slingshot of euphoric destiny.

As much as I find myself feeling like an emotionally unstable lab rat I admit, I’ve always been interested in science and how the body works. I’ve spent the last six years documenting my symptoms several times a day to try to help me understand where they are coming from and what helps me negate them. This has led to a complicated system of notes I sometimes see my boyfriend trying to read but tends only to result in a lot of head-scratching on his part. That said, even though my doctor has recommendations for my health and what might help, I have worked hard to pay close attention to the process for every medication we’ve tried, even those that were meant to help curb side effects and several that haven’t been related to psychiatry at all.

I guess it helps that I am interested, but much of my documentation has come out of necessity. Living with a mental illness has been super hard to get a grasp on and for many years I didn’t know exactly what was coming from bipolar disorder or anxiety and what was me. My rigorous note taking was what allowed me to show something like physical evidence that my doctors could contemplate to diagnose me in the first place, and beyond that it has been necessary because having treatment resistant symptoms (and often unusual side effects) has made it hard to know if something is helping or potentially hurting me overall. I have enough experience with physicians at this point to know that they are much more likely to believe what I tell them when I can present it in a formal and organized way. Rationality doesn’t hurt either, but sometimes that is hard to come by.

On a personal level, these notes have been totally invaluable when it comes to situations like trying Zoloft again a couple weeks ago, not just because they are something I can show my doctor but because living with a mind that can have trouble judging reality from fiction can make it difficult to believe in myself and the conclusions I am drawing at any given time. Having something tangible I can go back to so I know that I’m making important decisions (like whether to start or stop a medication) based on my experience and understanding of my situation and not a psychotic delusion has made me more confident about understanding my own health than I feel about any other aspect of my life.

As helpful as that can be, it can undermine me as well. Being confident about how I have assessed the results about any medication I’ve tried tends to leave me on the defensive with some doctors and I can come off as hostile or difficult to work with. When faced with the wrong doctor, one who tries to push their own agenda rather than listen to my point of view, I know I can become volatile. That’s why having the right doctor has been equally as important to me as the note taking.

So everything I’ve said about note taking was to get to this: the last two times I tried a new medication each one was a repeat of something I tried many years earlier. 5-15 years earlier. It is the oddest thing because I would almost swear that I’ve become even more sensitive to medications and develop more side effects than I did a few years ago. I don’t know if that is possible, but that’s the way the data seems to lean.

Ultimately this time around 12.5 mg of Zoloft had more adverse effects for me than the original 100 mg did. Yes, last time I was manic, but this time I waded through several days of intense dizziness, nausea, and GI upset only to be blindsided by 8 straight days of severe headaches in a row.

By the time I reached the seventh and eighth day my irritability was rising exponentially, to the point of being more reactive and depressed from the pain than I was before I started the Zoloft in the first place. I didn’t want to gamble the pain continuing(or even worsening) over the weekend since both my boyfriend and dog are relying solely on me for their care and I was already irritable to the point of arguing with every commercial that was coming on tv.

I called my psychiatrist’s office and the nurse suggested the headaches were a product of allergies (due to the intense tree pollen bloom this year) but if I really felt sure I should stop the medication over the weekend and call on Monday to report any changes.

I went with my own gut and stopped the Zoloft and within 24 hours I felt totally fine physically. The 8 day headache was gone, as were the other issues -all except the irritability that took more time to reduce itself. I admit, I did a little jig -both because the headache was gone and because I was happy I had made the right decision.

All too often it seems that doctors are more than willing to force me into a position of feeling much worse before I can begin to feel better, and while I understand the concept of waiting out side effects long enough for them to dissipate, in my particular situation of treatment-resistance it has never once paid off. Either the side effects become debilitating to the point of requiring a trip to the ER or hospitalization or I manage to get through the side effects after several weeks or months of struggle (like with lithium) and find I receive no beneficial effect from the medication.

Thursday I will be meeting with my psychiatrist to go over the notes I took from the trial and I’ll see what advice she has for me next, if any. Writing about the situation in this forum allows me the space to really think about the situation and try to understand it without feeling overwhelmed or sad or angry. I guess I am just ready and willing to accept that this is how things are for me, and even though I would say that is some serious progress I still hope to find whatever it is that will allow me to move toward wellness -or at least the best approximation I can afford.

 

 

 

 

Advertisements

John Oliver Responds to the Topic of Mental Health

If you haven’t seen it yet, why not start your week by checking out John Oliver’s Last Week Tonight responding to political candidates using the topic of mental health to divert attention from gun control questions?

You can check it out here or find it on youtube.

I always appreciate a logical explanation, especially one that uses actual facts from studies coupled with humor to help make a touchy topic approachable. It isn’t often I consider this to be a topic broached without making my head spin, so thanks John Oliver!

Cheers!

Reveal or Conceal; Suicidal in Therapy

First I must be clear that I am not recommending people avoid being open with their therapists, especially about being suicidal. I simply have found myself in an odd situation that I want to write about because I think I am not alone in facing this conundrum.

When visiting my new psychiatrist last week I told her that her inability to help me with drugs (something I somewhat expected due to the treatment-resistant nature of my current symptoms) was really only secondary as to why I wanted to see her. I also desperately needed someone, one person in my life I felt confident I could talk openly about my symptoms with.

“Don’t you have a therapist?” she asked.

I replied rather hesitantly that I did, but then made an effort to describe the issues that arise from being so open with my therapist (or GP or any other doctor, really).

The first problem generally arises from the conversation itself.

It is not uncommon for me to have symptoms that involve thoughts of violence or suicidality, and when expressing these symptoms to people they have generally produced a sort of… physical and emotional recoil. The result is something similar to taking a bandage off a wound and showing it to someone who can’t stand to look at it, and they say, “oh yes, no, that looks just fine…” but their body language denies these words completely.

As one might imagine, being able to express that these thoughts and feelings even exist within oneself takes an incredible amount of courage and vulnerability, and a reaction like this tends to make the pain from that exposed wound pulsate even more deeply.

It took me many years to begin to believe that I am not something horrible, a creature, or a villain, or unworthy of help or kindness because of these symptoms I experience. When I see the pain and fear in peoples faces when I even just mention them (when I have been living with them for ages on my own), sharing begins to feel less helpful and more like salt in the wound.

Keep in mind, I have never had a friend, relative, doctor, or therapist who could avoid presenting this kind of reaction. The only people who I have ever been able to talk openly about my symptoms were psychiatrists because the ones I have met have had the best totally blank poker-faces I have ever encountered.

Realistically, I am capable of blowing right past this issue if I genuinely need help managing these symptoms or if I require immediate medical attention. At that point, let people grimace all they want, I am usually in too much emotional turmoil to care.

The problem I have with discussing suicidality or other symptoms with my therapist(s) come most often from discussing symptoms that are present but within my ability to withstand. Which leads me to the second problem…

In Therapy, every second of suicidality is an emergency.

Today I told my therapist about the last two weeks, and it didn’t occur to me to edit anything out or omit certain details. Normally I like to be open and honest all the time, so what benefit could I possibly get by editing myself (in therapy, the one place I want to be the most open)?

The mention of last week’s suicidal thoughts put my therapist immediately into red alert.

I am happy that therapists have been taught to take every mention suicide seriously, however this method has also left a big black hole in the area pertaining to issues we can talk about involving my symptoms.

My therapist was so revved up all she wanted to talk about for the rest of the hour was suicide and while I tried my best to try to explain to her that suicide isn’t a “one hit wonder” for me (only popping up in times of emergency), the notion that anyone could live with suicidal thoughts for long periods of time and be able to simply sit with them, to prolong one’s existence by constant negotiation with these thoughts… or that there might be varying degrees of suicidality, well, it was all lost on her.

I’ve met so many people who, like me, live with suicidal thoughts that linger for days, weeks, months, maybe even years at a time. If I were to immediately be hospitalized for every situation involving suicidal thoughts I’ve had, I would probably be spending at least 1/4-1/3 of my time hospitalized or have an extraordinary number of individual hospitalizations.

Over the years I have become very familiar with my suicidal thoughts. If they are out of control I absolutely have cause for immediate concern, but that might occur in the span of a few hours, or it might take months of constant nagging to reach that point. I find these thoughts, these feelings and urges to be as fluid as my other symptoms, and coming up against my therapist (and many doctors or healthcare professionals I’ve worked with) who believes they are as rigid as a diagnosis must not have ever experienced them for themselves.

Overall, I wouldn’t want the whole system to change. I think it is important that when people begin talking about suicide there can be immediate action taken to help the situation. I guess I just wish there was more room for suicide (or other difficult symptoms) in conversation, more room for a more broad understanding of how these symptoms operate and how absolutely strong the people are who live with them every day without being able to tell anyone (for fear of recoil or blind panic or unnecessary hospitalization).

It is unfortunate to enter into an arrangement (like therapy) where I expect to be able to talk about the things I might not feel comfortable talking to other people about and find myself having to edit what I say or hide the very aspects of myself that have led me to being there in the first place.

 

When There’s No Room at the Inn… Chill in the Barn?

Sometimes I imagine the Virgin Mary showing up at the inn, hours before giving birth to Jesus, and the inn keeper simply telling her, “err, well, sorry but we just aren’t a provider in your insurance’s network. Off you go!”

I basically just had the same conversation with one of the only TMS/ECT treatment facilities in Seattle. The woman on the phone was able to make it quite clear that people like me (on Medicaid) were not accepted at their facility. In fact, she wouldn’t even give me a figure of how much the treatment would cost without insurance. I felt like I had been marked in some way, as soon as she knew my socioeconomic status I was officially cut off from the prospect of hope.

This is an example of a relatively common conversation for me, and normally I wouldn’t complain, except that this woman had the audacity to go on and tell me that none of the other facilities I had listed to her would be interested in me either and I should just give up now. I told her that was excellent advice for someone currently going through a severely suicidal period and found myself missing the days of owning a phone I could bang on the receiver to signal my frustration upon hanging up on her.

While I am still making calls to other less convenient facilities (including the one I visited in this post and another that would require inpatient hospitalization during the full course of ECT treatment (yuck)), things are looking pretty grim on my treatment front.

To get you up to speed, my depressive shift after that manic/psychotic period a few weeks ago has gone from a walk down a hill to a rapid luge course at the Olympics. The speed and ferocity at which I am encountering extremely disturbing depressive symptoms is almost kind of impressive to me. Of course, I’d be more impressed if I wasn’t also watching it crack (not just strain) my personal relationships, my ability to communicate with friends and strangers alike, and all sense of self.

Part of me is hoping that the sudden intensity of this shift will also mean a rapid rise out of the pit once things have cooled off, but I already know that my mood-swing-predictor isn’t very accurate and in the situation where that doesn’t happen… this very well may be the biggest depressive punch I will have seen in a couple years.

I have unveiled all arsenal; special happy-feeling foods (donuts, cheese), sleeping when I’d rather not be conscious during the day, cuddling with my dog probably more than is healthy, The Muppets… but the depressive symptoms are progressing so quickly that they are almost near the point where none of my usual helpful coping skills are working.

Needless to say, a very bad time to be going separate ways from my psychiatrist of 5 years and my appointment with my new psychiatrist, although not condescending or bossy, did not go as well as I had hoped. She made it clear she didn’t really want to touch me with a ten foot pole and said that if she can help keep my symptoms from getting worse it was the best I could hope for.

If there was any time that seemed like revisiting the idea of ECT was a good one, this seemed like it was it. Unfortunately, now that I finally feel like I am at a point in my life where I welcome the idea of ECT (my mood swings being in the proper spot to warrant it), I have researched it thoroughly (including doing so while I was more rational and stable-ish) and the verdict in the psychiatry world is that I have pretty much exhausted all typical medication options… I’m having a hard time getting in.

I know that I can ride this the way that I always do. Hold on. Let my sense of self be stripped away completely. Check myself into the ER when things get too sketchy. Get agitated in the hospital enough for me to want to leave. Come home and continue to ride it out. Eventually it will get better. Eventually patch things up with my friends and family who haven’t heard from me in months. Hopefully the people around me can withstand it.

At any rate, if there’s no room for me I’ll just stay in the barn. Maybe if I close my eyes and breathe deeply the sweet smell of the hay will make me forget why I’m there.

Tug-of-War Psychiatry; Fighting for Better Policies

This week is one of those rare weeks where I find myself in limbo, last week was my last appointment with my psychiatrist and next week is my first appointment with a new (potential) psychiatrist.

The last five years I have grown very close to my recent psychiatrist, and I could tell both over email and when we met that he was deeply apologetic that we wouldn’t be able to work together anymore.

After he told me why he was leaving the hospital he was currently working at though, I abandoned all regret and any frustration I may have been harboring. He was making the decision to leave because a group of psychiatrists (the majority) quit after the hospital was implementing new policies to try to make their office visits with patients shorter (mind you, they were already 15 minutes a month) and forcing psychiatrists to pass some patients off to primary care doctors to make room for new clients (among other things).

The first thing I did was blurt out, “um, no I think you’re doing the right thing!” and he looked at me perplexed. Even though his departure from this hospital means we can’t work together anymore, I was thrilled to hear the reason he was leaving.

Obviously I am not thrilled that the hospital is trying to implement policies that treat patients in the mental health arena as little more than cattle that need to be herded in and out as quickly as possible, but I AM thrilled that the mental health professionals acted in such a way as to denounce these efforts and protect the right of their clients to receive proper treatment.

“Most of my clients have responded the same way you just did,” he said to me. Unfortunately, this is just a situation where our doctors leaving us means they are protecting our rights, they are standing up for us (in places we can’t stand up for ourselves) and I am happy to think that if I have to work to find a new psychiatrist (trust me, not an easy task) it is because there are other good, ethical people fighting for me and my rights to be treated fairly.

From what I’ve heard, the hospital has began to backpedal in regard to the new policies they were attempting to implement and while some psychiatrists may be returning to work there, mine isn’t. I don’t blame him, think being put in an environment where major decisions about patient care are being decided by board members (and not their doctors) is ridiculous.

In the last five years I have been down this road twice, finding myself without a psychiatrist (and not of my own accord). The first time was when I was put on the state disability program and was no longer allowed to see my regular doctors. After six months they still had not paired me up with a psychiatrist so I dropped the program. Being able to see my competent doctor through a charity service was a much better investment for me at the time than $200 a month and being able to afford the medications I couldn’t get prescribed without the doctor!

The second time was during the healthcare reform, the psychiatric department at the hospital did not want to accept my medicaid insurance but I managed to pick the one subgroup my psychiatrist was able to accept. After several months I was able to start seeing him again.

To say I am not nervous about finding a new doctor and explaining all the odd quirks about my mental health, about my resistances and intolerances to so many medications, and potentially finding someone who is capable of listening as much as they speak would be… well, a lie. However, I have three things on my side that I didn’t have the last few times I went looking for a psychiatrist.

1. I have insurance. Say what you will about Obama, about politics, I don’t care. Ten, even five years ago in Seattle doctors were lined up to turn me away without having hundreds of dollars to make a deposit before a psych appointment or insurance to cover the appointment. Though I am lumped in with a group of people, many who desperately need psychiatric care (with very few psychiatrists to treat them) I cannot be turned away completely. For that, I am grateful.

2. I know who I am. I know so much more about my symptoms and how they effect me than I did five years ago, and also how my body reacts to medications (generally poorly). Knowing these things makes communicating them much simpler, to say the least.

3. I can tell the difference between a good doctor and a bad doctor. In my life, a pychiatrist is the one person I want to be able to trust explicitly. Luckily, I have also formed bonds with many of the good doctors in the city, each of whom has passed on the names of good doctor colleagues to me in case I might need them. I am not willing to see a doctor who is going to be detrimental to my mental health by being manipulative or uncommunicative. Period.

Ultimately I know all of this is just another situation of fallout coming from the healthcare war that happens every day. As much as I don’t like finding myself in a stressful situation, the fact that it has come around because my doctor is trying to be the best advocate for me that he can be is uplifting.

Thank you, Seattle psychiatrists who have been willing to make big life changes to advocate for better mental health policies. I know I am not alone when I say it is appreciated.

Like Black and White

The effect bipolar disorder has on my life is never quite as apparent as it is when I see two distinct periods book-ended together.

The way things have been for the last four years I generally have found myself in a “stable” headspace for a week (maybe two if I’ve been really good) each year. During these periods it feels like slipping back through time, and the sounds of birds and expansive sky are not blacked out by a wall of noise and fear in my head.

I admit (though somewhat embarrassingly) that it is has been pretty common for me to begin to believe I am free of it. That life will go on with birds chirping and the sun shining and everything I have experienced will fade like a bad dream.

The truth is that in my life, those stable moments have been both the bearer of exceptional hope and the product of immeasurable fear. Hope that I could once again live my life feeling relaxed and calm… but fear that the rug will be swept out from under me at any moment.

So this is what I mean by two distinct periods book-ended together. Sometimes the clarity I find comes from experiencing mania and depression back to back, but overall the moments I am able to truly see the difference between a stable, rational me and what I experience the other 95% of the time are when the chirping birds and blue sky are suddenly drowned out by the inescapable noise and dampening via my brain.

This has been my situation the last two weeks. Though I have done my best to “avoid stress” it isn’t possible for me to avoid my health problems and the surgery I need to help correct them. With this news came the curtain, and with the curtain has come a very interesting view of how dramatically different my brain works when cycling vs. not.

At any rate, I just wanted to mention that I may be absent from this blog for a few weeks while I get surgery and heal up. I need to focus on coaxing my brain through this emotional maze with as much cheese as I can get my hands on.

Lithium Nausea; Curbed By Tater Tots?

After four years of taking Lithium I have finally discovered a substance that nullifies lithium nausea.

This is big news, are you ready for this?

Potatoes! Or, more specifically, tater tots!

As I said, I’ve been taking lithium for four years now and though most of the initial nausea, tremors, and grossness has faded, I have always had trouble with the window between the time right after taking the lithium before I fall asleep. This has been especially bad if I can’t sleep (for whatever reason) and the longer I lay there, the more awful I feel… consequently making it even harder to sleep.

While I’ve tried just taking the lithium with food, I don’t like to eat a “meal” within two hours of going to bed because I have bad acid reflux and wind up with nasty heartburn. When I’ve tried staying up two hours after taking the lithium, I reach a point where my stomach empties (good for going to bed) but then the nausea hits me. In my experience, empty tummy = return of the nausea.

I discovered the method I’ve been using the last month or so when I began having really bad stomach problems (as a result of medication side effects). It only really works if I eat dinner at least three hours before I plan on going to bed (two hours before I take the lithium and tots so my stomach is empty, one hour before I expect to actually get in bed).

This has been my recent experimental tot-to-lithium nausea nullification ritual;

1. I bake up 6-8 tots (depending on my hunger level) and start them so they will be out of the oven an hour before I plan to get in bed. Keep in mind that involves subtracting oven pre-heat time and baking time (about 25 minutes total for my oven but each oven is a little different) from the time I want them done, so I start the oven up about an hour and a half before bed. Also, it is good to note that cooking 6-8 tots takes less time than, say, half the bag, so usually the full time printed is not necessary -I tend to knock off 3-5 minutes of the cooking time, but as I said, each oven varies.

2. Once cooled, I eat the tots (with a little salt), take the lithium, and enjoy a nice episode of whatever is on.

3. By the time I crawl in bed an hour later I have been surprisingly nausea free and slightly comforted by the tots. For whatever reason, this has made falling asleep significantly easier, and I have had less nausea upon waking up later than I did when I was taking the lithium before bed on an empty stomach.

The potato seems to have enough carbohydrates and starch to keep me feeling full even though it is only a few little tots, but not full enough that I feel bloated or have had to deal with acid reflux. I have not, however, been using any kind of condiments because this has generally just triggered heartburn once I am in bed.

I don’t expect this is a phenomenon specifically caused by tots, if you are a whole-food or organic eater it might be worth trying a few cubes of boiled or roasted potato instead. I just use the tots because they involve significantly less prep, and I find the thought of taking “potato pills” with my regular ones somewhat amusing!

I realize this is probably one of the weirdest things I’ve ever stumbled upon, but honestly it has really helped me so I thought I would share. Though I can’t guarantee this will work for you, a little experimentation could definitely be worth your while! Tot-on!