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Suicide and Mental Illness August 19, 2010

Posted by Crazy Mermaid in Medication, mental illness, Mental Illness and Medication, Psychiatrists, Suicide.
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While at the NAMI Conference this past weekend, I was exposed to the concept of suicide in all its forms except for one.  With the exception of seeing someone actually commit the act in front of me, almost all other aspects were covered in some form by someone or something at the conference.

There was the mother/daughter team that dealt with attempted suicide many times as a symptom of the daughter’s bipolar disorder.  There was the wife who serenaded us about her survival from her husband’s unexpected suicide. There was the daughter whose father committed suicide during the filming of a documentary about him (“Unlisted”).  There was the woman whose son committed suicide (“When Medicine Got It Wrong”).  Suicide was everywhere. There was even a booth addressing the various aspects of suicide, all from the standpoint of the family.

Missing was in-depth coverage of suicide from the perspective of someone who considered it or tried it.  I know these people are around.  I qualify for the first part and know people who qualify for the second part.

Back in July 2008, after I was released from the mental hospital, I had a major relapse of symptoms.  The choice I was given by my psychiatrist was to either return to the mental hospital or go on a drug called Haldol.

Wishing to stay out of the hospital at any cost, I chose the Haldol. I should have had a clue about the task I was to undertake (stopping the psychotic symptoms dead in their tracks) when I had trouble filling the prescription.  The usual dose carried by pharmacies is .5 mg.  My prescription was for 5 mg.  Calling around to various pharmacies, we finally found a Fred Meyer pharmacy that carried the dose I needed.

Taking the pills the second I got in the car, I felt the symptoms subside within hours.  But the prescription said to continue the Haldol beyond the point that the symptoms disappeared.  As I continued the Haldol, I became more emotional, crying at nothing at all.  My husband took me to a very nice restaurant for our 25th wedding anniversary, and I could do nothing but sit across from him and cry. Fortunately it was summertime, so I had an excuse for wearing dark sunglasses. It was a miserable time for both of us.

At around the second week of taking the drug, I got the twinge of a desire to commit suicide. As the days progressed, my desire got stronger. I cried and cried, wanting desperately to end my life.  I spent hours thinking about the method I would use to do it.  That was my sole focus. My guns were gone, confiscated by my dad as a condition of my release from the mental hospital.  I didn’t think I could get away with a knife because someone would stop me.  The same went for pills. I was stymied. I didn’t care one ounce about the people around me, who it would hurt, what kind of a terrible wake it would leave behind me.  None of that mattered.  All that I could focus on was how good it would feel to be dead.

In the meantime, my psychiatrist had given me his emergency telephone number during my first visit with him a month before, with strict instructions to use it to contact him during a crisis. Interestingly enough, I didn’t want to bother him with my crisis. Despite my family begging me to call him, I repeatedly refused to call him to tell him about what was going on.  As I lay there suffering, my family swarmed around me, not knowing what to do.  They were helpless.  They were scared. They wanted to make the emotional pain go away, but they didn’t know how.

Finally, I was persuaded by my husband and sister that this was precisely the condition my doctor meant when he gave me his emergency number. So, after much cajoling, I made that call to my doctor. But he didn’t answer the phone immediately.  So I left him a message, and then I got up from the couch that I had been sitting on and walked around the room.  I felt a little better after having made the call, but I still felt like committing suicide.

Besides imparting the urge to commit suicide, one of the other side effects of Haldol was that it increased my anxiety level. Not able to just sit around and wait for his call, I decided to take a walk.  I thought the activity would be good for me.  My family didn’t know whether to leave me alone while I went on the walk, fearful that I might find a way to commit suicide while I was out.  In the end, they decided to let me go for the walk unaccompanied.  In hindsight, I realize that their decision could have been a huge mistake had I realized that all I had to do to die was to step in front of a moving car.

In the meantime, while I was on my walk, my doctor called. As I wasn’t there to take the call, he talked with my husband instead. He probably did a better job of explaining what was going on, being more objective that I could have been. When I returned from my walk, my husband told me the doctor said to stop the Haldol immediately.  As I discontinued the Haldol, it left my system over a period of days.  As it left my system, my suicide desire gradually left.  But my family couldn’t be sure exactly when I was out of danger, so they continued to swarm around me, trying to assess when the danger was gone.  Finally they satisfied themselves that I was out of danger and life returned to normal.

Having lived through this episode of wanting desperately to commit suicide due to a reaction to a medication, I am convinced that most, if not all, suicides are caused by brain function impairment of some sort.  The brain chemistry of the suicide victim gets messed up, just like mine did.  But the difference is that they aren’t put on “suicide watch” and aren’t under the care of an experienced psychiatrist. Those two things are what saved my life.

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Mental Illness: Faulty Brain Circuits April 13, 2010

Posted by Crazy Mermaid in mental illness, Psychiatrists, Therapy.
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Faulty Circuits, an article in Scientific American magazine’s April 2010 issue, summarizes the leaps in neuroscience technology that reveals that psychological disorders have underlying malfunctioning physical brain connections, much like faulty circuiting in electrical wiring. This new evidence-based thinking is a paradigm shift in the way mental illness is thought of not just in the scientific and medical communities, but as this thinking infiltrates the mainstream, it will result in a shift in our perception of how people with mental illness are perceived.

The author, Thomas R. Insel, a psychiatrist and neuroscientist, is director of National Institute of Mental Health, the federal agency that supports the study of mental illness. In describing new findings in the neurocircuitry of mood disorders, Insel tries to bridge divisions between biology and psychology by highlighting the inter-relatedness between neural activity and behavior.

For the first time, we can see in real time problems in brain circuitry by the use of the newest imaging technologies, called neuroimaging.   While the details of each disorder’s “circuit diagram” are still emerging, the new views are already producing seismic shifts in the way we think about mental illness. We’re getting insight into their underlying causes, and that means quicker and more accurate diagnosis as well as better and more effective treatment.

With the new neuroimaging techniques, brain circuits are diagrammed out like electrical circuits, allowing scientists to see exact locations and nature of specific problems.   Some of the problems are coordination problems, where areas that are usually synchronized are out of synch. Other problems involve activity levels in, or communication between, brain areas.  Areas that should be talking with each other aren’t.

One of the more interesting points the author makes is that the behavioral and cognitive symptoms that we perceive as a mental illness may be late manifestations of dysfunction in a circuit. He points out that it wasn’t that long ago that heart disease was diagnosed only when a person had a heart attack, just like clinical depression is diagnosed today only when a person exhibits clinically depressed symptoms.  But in reality, it’s quite likely that in clinical depression as in heart disease and a whole host of other illnesses, observable symptoms only emerge after other compensatory mechanisms no longer suffice.

With this new view of mental illness, we will no longer have to wait until those other compensatory mechanisms fail in order to diagnose mental illness. A Schizophrenia diagnosis won’t have to wait for a psychotic episode.  Not having to wait for the psychotic episode to show up will take some of the fear out of a diagnosis of schizophrenia, since with an accurate diagnosis will come a more targeted therapy that will mitigate some of the more extreme symptoms.

To take clinical depression as an example, we have come a long way in its diagnosis and treatment, and yet we have a long way to go. Back in the early 1960’s for example, there were no predictors of risk, the diagnosis was done by interview, interventions were limited to institutionalization, electroconvulsive therapy and insulin coma, and the outcomes were a very high risk of relapse and a high rate of suicide.

In 2010, we have come a little further. Predictors of risk now include a family history and/or history of trauma. Diagnosis is still done by interview. Interventions are antidepressants and cognitive behavioral therapy, and outcomes are a 50 percent response after 12 weeks. Mortality and relapse are still very high.

The goal for 2020 is ambitious and yet I hope doable.  As a predictor of risk, we will use gene and protein analysis as well as brain imaging.  Interventions will include preventatives such as a vaccine and/or cognitive therapy as well as treatment options tailored to individual need including improved medications, cognitive therapy and brain stimulation. The goal for outcomes is to have the patient respond to treatment within 24 hours, and to reduce relapse risk and mortality risk to low.

The author notes that although mental disorders are currently classified by their symptoms, which overlap in many conditions and aren’t linked to any particular biological evidence, he suggests that reclassifying disorders based on brain function would be very beneficial because it could yield a system of diagnosis based on biological signs such as chemical or structural changes to the brain specific to the condition. He argues that using this new classification system could allow disorders to be diagnosed earlier and with more precision, based on their biological markers.

Changing the way diagnoses are made from interview-based to biological-marker based will change public perception of mental illness in a major way.  A scientific approach to the diagnosis and treatment of mental disorders, he notes, could help eliminate the stigma associated with mental illness.

Source:  Magazine Article: Faulty Circuits, Scientific American, April 2010, pgs 44 through 51

Lithium March 13, 2010

Posted by Crazy Mermaid in mental illness, Mental Illness and Medication, Psychiatrists, Weight Gain and Mental Illness.
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Lithium Carbonate has many different uses, both in the industrial fields of glass-making and cement as well as in the pharmaceutical field. .  Used as a mood stabilizer, it treats the symptoms of depression and mania in bipolar disorder.

But from the pharmaceutical standpoint, there’s one giant problem with lithium carbonate: it’s almost free. There’s no money in it.  Because it couldn’t be patented (it’s a naturally occurring element), its use started in the 1870’s but died out, completely disappearing until 1949, when it was rediscovered by an Australian psychiatrist named John Cade. He got the idea to use lithium salts on mentally ill manic patients from an experiment he did on mice.  He tried it out, and it worked.  At that point, lithium carbonate (lithium salt) became the first drug used to successfully treat mental illness (again).

Unfortunately, many people died because the wrong dose was administered, or because a different type of lithium was substituted for lithium carbonate.  But through research, the right dosages were found, and we learned not to substitute one kind of lithium for another. It’s still tricky to prescribe the right dosage, though, because every patient reacts differently.

Because lithium has many unpleasant side effects, many people who were (and are) prescribed it refuse to take it.  They believe that their quality of life without medication is better than their quality of life with it, so they either stop taking it entirely, or they never start. They determine that they would rather suffer with depression or schizophrenia than lose the ability to walk or grasp anything, because by far the biggest side effect is something called ataxia.

Boiled down to brass tacks, ataxia is a lack of physical coordination.  It means that you can barely walk, and when you do you walk so stiffly and with such a shuffle that not only is it difficult to cover any ground, but anyone watching thinks you have a disease like Parkinson’s. It means that swimming or any sport is out of the question, since you drag your legs behind you like a beached whale. It means that you can’t peel a banana because you can’t grasp and hold on to objects. Many everyday tasks that we all take for granted, like opening lids and brushing our teeth, become difficult or impossible.

Running a close second behind ataxia is the tremors.  Tremors mean that your hands shake.  You can’t write because your hand shakes too bad, and you can’t use the computer because your hand shakes too much to touch the individual letters on the keyboard. Hands become almost useless when they’re shaking that bad.

Weight gain is one of the more famous side effects of not only lithium but almost every other drug associated with controlling mental illness symptoms.  Not only does your appetite increase, but the drugs also slow down your metabolism, which means that you’re hit with a double whammy, so it’s almost impossible not to gain weight on lithium. Some people gain 100 lbs, others gain 20 or 30 lbs, but almost everyone gains weight.

Those three side effects were by far the worst that I had that were lithium-related, but there were others that I fortunately didn’t experience, like alopecia (the loss of all of your hair), polyuria (loss of bladder control), and a host of others that I won’t go into here.  As if all of that isn’t enough of a problem, those side effects don’t always go away once the dosage is decreased.

Having said all of this, it’s important to note several important facts. Fact one: When mental illness is initially diagnosed, lithium is typically prescribed at a higher dose and then the dosage is backed off. Fact two: There are second generation drugs like Geodon that take the place of lithium nowadays, so sometimes lithium is never even given to a patient. Fact three: Most importantly, life with my mental illness more or less under control is so much better than life without it.

Psychiatrists January 27, 2010

Posted by Crazy Mermaid in mental illness, Psychiatrists, Recovery.
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There’s nothing more important to a person with a mental illness than their relationship with their psychiatrist.

Some people, not realizing the critical difference between a psychiatrist and other medical disciplines, make the mistake of substituting their General Practictioner (GP) or other “mainstream” doctor or nurse for the services of a psychiatrist. That’s like going to a podiatrist (foot doctor) to get a mammogram (breast exam).

The primary difference between a psychiatrist and another type of doctor is that the psychiatrist has been trained in diagnostic evaluation of mental disorders. This is an under-appreciated fact in the medical community as well as in the general public.

For example, if a patient comes into a GP’s office and announces that he has a broken ankle, the GP won’t begin treating the broken ankle without taking xrays and verifying the patient’s self-diagnosis. Generally, the GP will have the skills necessary to perform those tasks.

But that same GP won’t hesitate to begin treating a patient coming into his office complaining of depression. Without verifying that the patient has depression rather than bipolar disorder or a number of other psychiatric disorders, the GP begins treatment of the patient. He has neither the knowledge nor the skill necessary to do the diagnosis, and yet he has no qualms about treatment. This type of thing happens more frequently than not.

The right psychiatrist assesses the patient, diagnoses the patient, and then helps the patient manage his symptoms (not cure the illness) the quickest and least painful way possible, while a GP messing around with psychotropics (mental illness drugs) is likely going to do the patient more harm than good.

GP’s, being very conservative in trying to treat something they really don’t understand, have a tendency to prescribe only one drug at a time to a patient with symptoms of a mental illness rather than the cocktail of drugs needed to combat all of the person’s symptoms.  They don’t know how the mental illness drugs interface with each other, and  they’re afraid of doing the wrong thing.  So their one prescription drug usually does little or nothing to help the mental patient.  In fact, sometimes the patient gets the (wrong) impression that a particular drug isn’t working for them at all when the real problem is that the supporting drugs are missing from the cocktail.

A good psychiatrist gives the patient confidence that there is no problem that is insurmountable. He has “been there, done that” so there are few surprises. And when there is a surprise, he knows how to trace the cause so he can find a solution. The average person has no idea how much of a comfort this is.

A good psychiatrist gives a specific timetable of how long a drug will take to kick in. In my own case, upon my discharge from a mental hospital, my (new) psychiatrist told me straight up to expect several months worth of bad side effects as the drugs built up in my system. He said “give me two months” to get the side effects under control. Not gone, but under control. So I had an end in sight. I could put up with the terrible side effects for two months, whereas I couldn’t do it for an indeterminate span of time. In fact, some of the side effects were so bad that had I not known how long they would last, I would have discontinued my meds (as many people with mental illness do) rather than face a potential lifetime of those side effects.  A good psychiatrist will help keep the patient on his medication so that the medication can do its job.

Having to manage with a broken leg for a lifetime is completely different than having to manage a lifetime living with the symptoms of a mental illness. How long can you stand having voices constantly talk to you before you want to jump off a bridge just to get away from them?  How long can you stand to see terrible pictures when you close your eyes before you want to die to get away from them? The psychiatrist’s  reassurance that all problems are fixable puts the patient’s mind at ease. Whatever the problem, I have confidence that my psychiatrist, Dr. K, can fix it.