Tag Archives: psychiatry

Thyroid Hormone for Depression

I mentioned recently that my psychiatrist has decided to change directions in how we try to treat the mood swings I have emanating from treatment resistant bipolar disorder (type 1).

In the past six years I have actively tried several benzodiazepines (like clonazepam, or lorazepam) , antipsychotics (risperidone, ziprasidone, olanzipine to name a few), mood stabilizers (lamotrigine, oxcarbazepine, gabapentin & more), and antidepressants (sertraline, fluoxetine, bupropion, etc.) but have always experienced either:

  • worsening symptoms
  • side effects severe enough to warrant stopping the medications
  • or tolerable side effects with no response from my symptoms.

The only psychiatric medication I’ve been able to keep taking regularly is Lithium, and while there is some debate on whether it is helping I’ve been taking it for long enough that I am having no side effects so the consensus is usually just to keep taking it.

Starting any of these new medications has typically made my mood swings worse (more frequent and more severe) so it has been a bumpy ride. After my new(est) psychiatrist got a good look at this happening she decided it is probably useless at this point to keep trying in these same classes of drugs I’ve had problems with. Needless to say, this was both a relief (hooray for no more psychiatric drug barrages!) and a little disheartening (alright then, now what?) but after all I’ve been through I’m more than willing to break away from this cycle and try something new.

Like anyone who finds themselves chained to the great lithium beast I have to go get my blood checked every few months to monitor the level of lithium in my blood. During these times I often also undergo other tests to check things like kidney and thyroid functioning.

Apparently my thyroid level doesn’t appear to be outside the range of “normal”, but my doctors have found that for me a tiny change can make a huge difference (as seen with my reactions to most drugs). My psychiatrist also told me that sometimes thyroid medications can be used to treat resistant depression, so our next route is to give liothyronine (cytomel) a shot and see what happens.

I always get a little nervous when I’m given a new drug to try and my doctor asked if I thought it would be better to start it when I am feeling more stable or unstable. That has always been a tricky question for me because if there are significant side effects a drug can easily take me from stability to a place of being unstable, and having less stability I tend to want to take advantage of those times as much as possible. At the same time if side effects occur when I am already very unstable I am less likely to cope in a healthy way so I told her don’t think there is a right answer here.

Ultimately, I’ve had the flu for the last week so as soon as I feel better physically I’ll start the liothyronine regardless of what my mood decides to do. This one comes with all kinds of obnoxious directions (take on an empty stomach at least 30 minutes prior to eating, no antacids for at least four hours after taking it, can’t be taken at the same time as vitamin or mineral supplements -sheesh!) so I need to do some work shifting all of my medications into a system that will allow me to follow those rules.

As scary as it can feel not knowing what will happen, I always feel some element of hope that this time might be different. If I didn’t feel that I’m sure I would have given up ages ago. It might be that I’m just stubborn or absurdly optimistic at times too, but it is easy to gamble when I feel like I don’t have much to lose and there is potential for increadible gain.

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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.

 

 

 

 

Back in the (Rx) Saddle Again

Living with treatment resistant bipolar disorder can be really frustrating, not just for me but also for those around me. With symptoms that have responded atypically (either worsening or not resolving and accompanied by outrageous side effects) to the traditional route of pharmaceuticals normally used to treat bipolar disorder I have to shift all of my focus onto using skills to help keep me calm and rational.

Even doing everything I have encountered; things like meditation, dialectical behavioral therapy skills, living openly about my illness and asking for help when I can, paying close attention to my diet, sleep, and exercise, -that bipolar spark in my brain remains elusive and unchecked. Under the right conditions, my big mood shifts can happen in whatever direction they choose and I find myself along for the ride.

Lately I’ve been seeing that frustration growing in my healthcare team. In the last two months I’ve been taking a significant shift into depression, enough that both my therapist and new psychiatrist (of about 6 months) have become edgy. My therapist let slip that, “well you would think something should be helping by now!” and my psychiatrist sat, horror-stricken, when I replied to her question about what we should do about my depression with, “well the past few years nothing has worked so we typically watch and wait, requiring hospitalization as necessary until the episode ends.”

Unacceptable!

Maybe so, but it is my life. As much as I dislike being subject to frequent mood swings and psychosis I have reached the point of feeling some form of acceptance over my situation. I can’t throw a fit (though sometimes I do) every time a new treatment option doesn’t go my way, but the slightly pissy attitudes of my healthcare team the past few weeks has initiated something of a domino effect kicking people into gear.

On one hand, it feels nice to know that my psychiatrist feels inspired to do everything she can to try to help me. On the other, after a constant barrage of negative outcomes from medication after medication the past few years I am pretty familiar with how it can feel to be a guinea pig. I’m not saying I am opposed to new options, quite the opposite. I want to keep trying, I want to move toward a life that is stable and more functional, I just need to find a balance where I can do that and not have to be pulled along in the wake of each drug that’s had a negative effect without being able to take a break. When psychiatrists take me on it can be easy for them to look at me as a sort of challenge and they feel eager to throw everything at me they can think of right away without giving me time to recover. It has tended to make me both more physically and mentally sick while this is occurring, so it is important that I can balance pursuing new treatment options and living some of the life I am working to improve.

After how hard it was cycling through medications the last go around (2010-2015) I have been floating around using my cognitive skills and sitting tight taking Lithium that isn’t helping. I have actually been doing better without the barrage of new drugs constantly eroding my mental and physical health, so I have just kind of been waiting for the right doctor, or something new to come on the market, or for things to get rough enough to push me back into feeling willing to roll the dice again.

I wouldn’t normally consider my current state of depression severe enough to make me desperate enough to move back into that place of uncertainty, but last week my boyfriend was gone for 8 days and I was really concerned about being home alone that whole time and having the added stress of taking care of our sick dog on my own.

My new psychiatrist is focusing on making tiny changes in medications (hoping that my big reactions to regular doses might be mitigated by tiny doses) and trying things that have a low chance for making my overall health worse.

We started with a huge increase in my fish oil consumption, up to 2400 mg daily of highly concentrated oil (with a bunch of other specific properties I can’t quite recall). I couldn’t tell if it was helping while my boyfriend was out of town, but I didn’t feel worse, so for depression that was causing me to steadily deteriorate that may have been enough to give me a more level playing field last week.

If the fish oil was helping keep me from sliding further into depression, the plan went to hell a little bit when my boyfriend came home from his trip with a broken shoulder. The immediate jump in stress level left me plummeting and I was frantic this week trying to take care of him, and the sick dog, AND me.

I found myself in a situation where I can’t really afford to be screaming at my neighbors or paranoid out of my mind at the grocery store so I called my psychiatrist and agreed to try an antidepressant again.

I tried Zoloft a few years ago in a similar situation and was manic within a couple days. My boyfriend found me feeling high out of my mind in our apartment jumping around uncontrollably and he thankfully had the frame of mind to point out to me that I was acting a little strange.

Naturally, the idea of taking an antidepressant isn’t one I’m too keen on (I’ve had several mixed or manic reactions over the years to them) but I find my psychiatrist’s theory about trying the tiniest little bit to be intriguing, mostly because I’ve had the same thought myself and anytime I’ve brought it up to a doctor before (or my sensitivities to medications) they always just prescribed a regular dose anyway.

Yesterday I tried 1/8 the dosage of Zoloft as I did the first time around. 12.5 mg, half of a 25 mg pill that is so small I keep losing them. I was able to sleep (which is a good sign) so I expect to keep this up and see if anything happens.

In the meantime I’ll be here doing the best I can.

Looking Back, Looking Forward

With the new year fast approaching I am excited to say that I will be starting 2016 with a new therapist and a new psychiatrist. I will also be continuing the DBT group I have been participating in for a couple months now which is great because so far I would say it has been helping me make a difference in my reactivity and emotional rumination.

Of course, it helps that Emotional Regulation was the first thing we covered because that is one of the more challenging things I have been facing. The funny thing is that now that I’ve got a few skills to help me see the big picture (instead of a pure emotional reaction) in situations it has been made clear that my other biggest challenge is communication and Interpersonal Relationships. That module of the group definitely can’t come soon enough!

That doesn’t mean I am miraculously cured, or that I am not continuing to lose my shit on a semi-regular basis. But… I may lose it for a shorter period of time, or only two or three times (instead of 12-16). Frankly I am willing to consider any and all progress progress.

Ultimately the way my perspective has been shifting around because of this class highlights an issue that I’ve known for a while but may not have given enough credit to. Stress makes a huge difference, in terms of the timing and magnitude of a lot of my emotional episodes. Stress is like… my death star. I might think it is a friendly moon at first but really it is a fully operational space station of mass destruction.

What does that mean, exactly? I am not sure, but I know I need to be addressing stress more aggressively (eh, not me being aggressive but more seriously) and not fail to recognize it or deal with it before all the firing sequences have been completed and it becomes a giant laser heading straight for me.

I can’t control the stress, but I am hoping that if I can recognize it early enough there will be time for me to react before the laser hits the fan.

Anyway, even with the intense illness and surgeries of 2015, spending summer in bed, and most of my plans being totally pulled out from under me this was somehow a better year than 2014. While 2014 was almost a year of being comical because of how many things could go wrong, 2015 was great because “at least it isn’t 2014.”

I don’t know if it was because I spent 2014 operating on a totally empty tank but this year it was like I could feel parts of my brain beginning to operate that hadn’t been used in ages. I can’t make a final word as to if I should be chalking that up to hypomania or simply 2014 acting as a hard-reset of my brain but it leaves me hopeful that in 2016 I might be able to dust off a few more parts and put them to good use again. We’ll see.

Ultimately, this year I learned that there is still a lot of improvement to be had in terms of the treatment of people with mental illness and mental health crisis. It bewildered me that so many people were willing to reach out and to respect my space when I was having surgery (for a physical problem), but the treatment I have received both just having a mental health problem or during a mental health crisis is wildly different. I am hoping that going forward I can learn and discern new or better ways to communicate this problem and what we can all do to help solve it.

In the mean time, however, I will wish you all a happy new year! Thanks for reading!

Personal Progress (well, maybe not exactly) on the ECT Front

After a series of uncomfortable phone calls and leaving voicemails for everyone in Seattle capable of administering ECT, bits of useful information started to trickle in. The information was useful because it let me know that my options are extremely limited (many hospitals here that provide ECT have apparently moved away from treating patients with medicaid) but I was able to set up a consultation with one of the leading psychiatrists at Northwest Hospital’s ECT unit.

While I’ve been interested in ECT for a while now, previously my mood swings were not in a position (predominantly depressive or manic, more ultradian cycling and mixed) to lend themselves to the immediate requirement of electroconvulsive therapy. Having my symptoms take a much more noticeable downward turn into depression lately made this seem like the perfect time to look into it again.

Beyond that, though, I wasn’t sure if I would be a good candidate for ECT right now. After all, I have just undergone some pretty significant physical health problems and two surgeries, one being relatively major. Ultimately, the consultation was to learn if I could even undergo the treatment right now in addition to finding out if it might help me.

I tried my best to explain this to the receptionist who tried to schedule me for ECT the following week before my consultation had even began.

The consultation itself was… uneventful. I’d already gone through one of these before at another hospital, but I wasn’t really expecting this psychiatrist to have a significantly less optimistic view on how ECT would probably go for me. While he said he wouldn’t tell me absolutely not to try it, it seemed unlikely the treatment would help my symptoms (based on the point I have reached trying almost every medication available with no improvement). He said that each medication I have tried and been resistant to has made the next subsequent medication more likely to fail. I don’t know if that is true or not, but that is the word on the street.

He also told me that he would suggest I (here’s the baton) seek treatment through DBT (and the handoff) first before trying ECT. Unfortunately this proves to be a program even more difficult to get into than ECT in Seattle as it requires a lengthy wait on a waitlist (I’ve actually already been on the waitlist for two months before last weeks consultation) or about $5000 and a somewhat shorter wait on a waitlist.

I left the facility feeling surprisingly optimistic despite the news. I guess it was just nice to have someone tell me that even if they don’t know if what they have to offer will help me they could suggest something else. Normally people just tell me I’m screwed and do I “have any questions?”

For a while now I’ve kind of felt like “all roads lead to DBT” -at least, given my symptoms and everyday problems with human interaction, working, mood swings, etc. This time I am hoping that seeking out a case manager might be a better option than trying to do all the footwork myself. People don’t respond well to my… aggressive tone on the phone, and I don’t respond well to dickheads on the phone either.

At any rate, I will be shifting focus to moving toward DBT. The hospital said they would keep my file open and get all the necessary paperwork ready in case I changed my mind about doing ECT in the next month or two if I can’t get in to DBT.

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.

 

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.