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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.

Mental Illness and Weight Gain January 14, 2010

Posted by Crazy Mermaid in Hearing Voices, mental illness, Weight Gain and Mental Illness.
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Fat Fat Fat

Getting enough meds in me to keep sane and yet relatively un-blimpo is quite a balancing act.

Most mood stabilizers and antipsychotics are well-known weight gain drugs.  The “big names” like Lithium, Lamictal, Risperdol, and Seroquel are all famous weight gainers.  I was on three out of four.

Because I was on major quantities of Lithium (900 mg) while at the hospital for my three week “vacation”,  Dr. K, my new (at the time) psychiatrist,  went to work on the weight gaining aspect of my medications immediately after I left the hospital, weaning me off the massive quantities of Lithium and onto Geodon, the only anti-psychotic that doesn’t cause weight gain.  The process took months to accomplish.  Because I had to be relatively stable in order to accomplish the switch, the process took longer than it “should” have, having to arrange itself around my various “falling-down” eposides.  Saying the progress was not uniform is an understatement. There would be forward progress,  then an incident that caused back-peddling, then forward progress, then backpeddling. Back and forth for months and months, until finally, *we got entirely on the Geodon. All was well for several months.

But about 6 months into the “complete” Geodon  regimen, I heard what we called “break-through voices”, which means in layman’s language that the Geodon failed to work.  So Geodon was out.  And Lithium, though very effective for voices, has too many terrible side effects, so we didn’t want to return to that, although there was no doubt that it would have gotten rid of the voices. That left some brand new drugs with fewer side effects, but those newer drugs had price tags in the $500 a month and up range (all out-of-pocket), so my husband and I decided that they were out for financial reasons.  That left Risperdol, which was an older, effective, but weight-gaining, drug.

So I was weaned off the Geodon and onto the Risperdol, which took  time. You don’t just suddenly stop taking one drug and get the effects out of your body immediately or start taking one drug and get it up to full strength immediately.  Most mental illness drugs don’t work like that.  It took several months for the Risperdol to build up enough in my system so that we could begin reducing the level of Geodon. Again, there would be backsliding while the switch was being made.  Finally, over a period of months, I was weaned entirely off the Geodon and entirely onto the Risperdol. Then it was a matter of finding out whether the Risperdol was going to work.  That was a matter of watching and waiting. Or in my case listening.

For months, the Risperdol worked just fine.  It worked so well, in fact, that we were able to reduce my dose from 1 mg down to .5 mg, and then to .25 mg, with the intent of eliminating the drug altogether in the relatively near future.   But before that could be accomplished, I had a little “bump in the road” incident a few months ago. So instead of discontinuing the drug as planned, we raised it back up to .5 mg. That was supposed to be a temporary thing.

Before we could lower the dose back to .25 mg, I had a major setback about a month ago.  Suffice it to say that the voices came back so strongly that it was back to the Haldol  (the nastiest drug in the universe)  as we contemplated a return to the mental hospital. That’s how bad the symptoms were.  (Note: There was a major trigger to the incident, so it wasn’t that the drug was failing. It was that the trigger was too strong).  But as Dr. K and I talked it over, we decided that instead of continuing on Haldol (which I despise) or hospitalization, we would triple my dose of Risperdol and see if that worked before trying hospitalization or more Haldol.   So I went from .5 mg to 1.5 mg virtually overnight.  As it built up in my system the past four weeks, the voices have gotten quieter and quieter, finally tapering off entirely about a week or so ago.  That’s all to the good. But there’s a down side to the Risperdol:  Weight gain.

Until my Risperdol was tripled, I had come to relative terms with my appetite, despite the fact that I was on all of those other weight-gaining meds, including Seroquel, Lamictal, and a smaller dose of Risperdol.   I was taking Welbutrin in an effort to combat some of those pesky appetite-increasing side effects, and it was working fairly well.  But then the triple dose of Risperdol kicked in, and I gained about 4 lb in about 4 weeks. Not good.  I saw Dr. K yesterday, and I told him how out of control my appetite is. I can’t stop thinking about food food food. When’s my next meal? How much can I eat? How many calories have I had already? And on and on and on every second of every minute of every day.  He was concerned, as am I.  Concerned enough that we brainstormed solutions.  I talked about how well phen/fen worked for me back in the mid 1990’s.  He doesn’t like SSRI’s for me because they might flip me to mania, so we settled on Topamax, at least for now. So now, we’ve added Topamax to the mix in an effort to get the weight gain under control.

Dr. K’s not thrilled about adding another drug to the mix (this will be #5), and yet we’re caught between a rock and a hard place. Trying to reduce the Risperdol and/or the other meds invites a return of the voices in full force.  Leaving the drug levels as is tips the scales to diabetes and all of the problems it entails.  So it all comes down to this: which is the lesser of two evils:  Voices or substantial weight gain?

In the end, we decided that adding that 5th  med is better than risking diabetes. So that’s the way we’re going.  The caveat is that instead of seeing me in 6 to 8 weeks, he’s seeing me in 2 weeks.  We’ll see how we do.

* I use the term “we” because Dr. K and I work together as a team. It’s not just “I” or “Him”. It’s “us” and “we”.  It’s been that way from the very beginning almost 2 years ago. I consider myself very, very fortunate.

Hearing Voices and Cortisone Shots November 18, 2009

Posted by Crazy Mermaid in Hearing Voices, mental illness.
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What do you get when you cross a mentally ill woman with a cortisone shot?  Voices!

Yesterday, I saw a rheumatologist for the first time in my life. Not to bore anyone with the details, but suffice it to say that my arthritis is getting worse. My new doctor recommended trying a cortisone shot in my hip to see if it reduced or eliminated the pain. The pain is in both hips, and sometimes cortisone shots work for people, and sometimes they don’t. So we decided to try a shot in my left hip, never considering for a moment the possible effect of a cortisone shot on my mental health.

I noticed a significant reduction or actually elimination of the pain within a few hours. It felt better than it had in years, in fact. I was thrilled. Until this afternoon, when I started hearing voices again.

At first they sound like an echo of thoughts. I’ll think something, like “I need to take out the garbage”. Normally, that thought would just be a flash, not even verbalized in any way. But that changes when the voices kick in.  I’ll hear a voice in my head say “I need to take out the garbage”, as if I’m talking to myself out loud. But it’s not out loud. Then, about ½ a second later, there will be an echo voice. “I need to take out the garbage”, then a pause, and then “I need to take out the garbage” again. Always in my own voice, and never out loud.   It’s annoying, but not scary.

From there, it escalated to what I like to call “the commentary”.  That’s when the commentator starts.  Say I’m listening to someone talk to me (in real time) about something. Suddenly, a voice (not mine) inside my head talks over the real person sitting in front of me talking. That voice tells me to ask the person sitting in front of me a certain question, or to tell them a certain thing.

For example, today a dear friend took me to lunch. As we sat in the restaurant, she told me about her recent trip on a Mediterranean cruise.  It was fascinating listening to her stories. But every so often a voice(not mine)  popped into my head as she was talking. It talked over her voice (in my mind) as she continued talking, saying “Ask her what the temperature was like, Kathy”, and then a little later in the conversation it said “Kathy, ask her if the desserts were good on the ship”.  A little while later, it told me to tell her something about my son. But the voice telling me what to do isn’t my own. It speaks to me in the 3rd person, as if I”m standing right in front of it or on the phone with it. I have a choice of whether to obey the voice, and sometimes I don’t. But the voice is not my own.  It’s not me.

These voices (the echo is different from the commentator) differ from the voices I heard when I was psychotic (before my hospitalization). First of all, I have no misconception that the voices are somehow coming to me via ESP. Second, there are not a whole bunch of voices. There are only two: the echo and the commentator.  Thirdly, the voices aren’t those of friends, co-workers, and family members like they were when I was psychotic. I know the voices aren’t me, but as bizarre as it sounds,  the voices are never scary.

I waited a few hours before calling my psychiatrist, Dr. K, hoping that they would go away on their own. That’s the mistake I’ve made before.  I kept thinking they’d go away on their own if I waited long enough.  But I’ve learned my lesson there.  So when the voices didn’t go away on their own by 6 pm, I decided that I had to tell Dr. K  about the voices.  I called his office number, but they told me he was gone for the day. So even though I hate bothering him on his emergency phone, I knew he would want to hear about the voices. So I took a deep breath and called  Dr. K on his emergency number, just in case it was an emergency. I didn’t think it was, but you never know with these sort of things. As usual, he answered the phone just like he always does.  For that I am always eternally grateful.

As usual, he was very reassuring. When I explained about hearing the voices today and about having the cortisone shot yesterday afternoon, he told me that steroids are famous for causing voices to return. Surprisingly, he also told me not to adjust my medication at this point. He said to give it three days, including today. So if I’m still hearing the voices on Saturday, I’m supposed to call him.  Of course if they get worse, he wants to know about it right away. But I’m not worried and he’s not worried. At least at this point.

But I must say that the cortisone shot gave me such relief that I wouldn’t hesitate to get another one, even if it means living with the voices for a few days.  Unless the voices get worse or stick around for longer than a few days, that is.  But so far, so good.