Making the decision about psychiatric medications and treatments

There are times I wish there was one drug to work for everyone.  I went through years trying to find a combination that worked for me, to be stable (if that is possible), keep the psychosis and mania to a minimum and depression at bay.  Part of the issue I faced in the early years of my diagnosis was being in the military, I moved around a lot.  So, just when I found find a good doctor and felt comfortable with them, it would once again be time to move.  I got to the point where I didn't care much anymore, especially when it came to one of the last doctors I had.  He rarely listened to what I had to say, I was on two medications and I was having awful side effects, I begged him to change them.  He would sit behind his desk and fill out his insurance forms for the visit.  After a few visits and no help I did the only thing that sounded logical to me, I weaned myself off all medications.  I'd had enough.  

Fast forward to a year and I crashed, hard!  It was then I realized that I was not going to be able to do this alone, I had to be on medication in order at least keep some level to stability.  The journey would become harder than I thought, but after three psychiatrists and psychologists, I found not only a medical team I could trust, but also a medication combination that was helpful.  It was not an easy road however; it took several attempts to find out that my system rejected just about every new drug that had come on the market.  In addition, the Anti-Depressants I was taking were actually causing some of my mania.  With that off the list it came down to relying solely on mood-stabilizers, anti-psychotics and anxiety medication, but as we slowly ticked off the list of medications I could not take I became more discouraged.  The main hurdle we faced, in my eyes, was the extent of my diagnosis, Schizo-affective was simply the tip of the iceberg, it also included General Anxiety disorder, PTSD, and Dissociative Disorder.   Thankfully I had a doctor that would not give up.    

In the end we came up with a combination of Lamictal, Neurontin and Klonopin.  The first two keep me stable, for the most part (not drug is going to make this go away completely) and the later helps me not only sleep (my brain refuses to shut down, especially at night), but I can take it during the day if I am having an anxiety attack.  It is important to add that medication alone was not the answer, at least for me, and while we discussed medications he decided to approach the subject of ECT, (Electro-Convulsion therapy).  The idea more than scared me, but I was desperate and I trusted my doctor.  I checked into the hospital, was admitted to the psych ward and for the next 10 days had five treatments, and then I had three treatments as an outpatient.  The experience as not what I expected, my only side effect was bad dry mouth afterwards, and a headache.  

Now being the challenging patient that I am, and while the ECT worked to ease my depression, it brought on mania.  We didn't see it at first, it was subtle, but there was something going on.  12 months later I was back and had a second round after I hit bottom again after losing my cousin to suicide, his death destroyed me and sent me into a severe mixed episode.   Since the last sequence of treatments had help with the depression, this time my doctor knew we had to take a different approach.  It is most common to administer the treatment to one side of the brain; however, for me he decided he had to administer to both sides in order to balance out the depression and mania.  It was like my mind was fighting itself for control and he was making every effort to call a truce.  There was some success with the treatments and balance was restored, but there was a part of me that had hoped that it would make it all go away, I was growing more and more tired of it all. 

I began tracking my symptoms a few years ago; I watch how my mania, depression, anxiety, psychosis and sleep fluctuate from day to day. With the graph I can see what may have been going on that day to cause more a depressive state and what may have caused anxiety.  It’s not fool proof, but it can give a general overview of what may trigger some of the mood swings and then I can make any changes I may need to. 

In the end, yes the ECT did help and the medications continue to keep things in check - for the most part.  Over time I realized that we must live with these illnesses as they are, work with a good medical team, and have a strong support system.  Without all these pieces in place we run the risk of continuing to hide behind our mask and tell the world we are “OK,” when what we really need is help.  

N - is for Natural Remedies

For years medication was known as the best way to treat mental illness, along with therapy and hospitalization.  A change is happening, however, to a more holistic way of treating these illnesses.  There are reasons people step back from traditional medications, side effects top the list, with many people feeling they are simply taking too many medications and what they can to do to our bodies.  In many cases, the drugs cause irritating side effects, which in turn is treated with more medication to alleviate the symptoms. 

The search for different treatments has been my goal in recent years, with my own mental illness; I have been on too many medications to mention and often they came with debilitating side effects so I would not be able to take them, this lead me on a journey to find another way.  i still take a couple medications and they do help, but there are ways to treat these illnesses without making weekly trips to the pharmacy. 

One of the best I have found is simply being out side in the fresh air and sunshine.  A short 15 minute walk can change your outlook on the day or situations that are ruminating in your mind.  I have discovered over time that when I am not able to be outside my moods tend to cycle more and I become moody.  I am a simple person, I enjoy the woods most of all, surrounding myself with the sounds of birds chirping and trees rustling around me.  During a hike the distractions are only a memory and my mind will once again focus on serenity and peacefulness of what is around me.  In addition, we receive Vitamin D from the sun which is also known to help the mind. 

in addition to spending time outside there are other medical treatments that do not include medication.  ECT (electric Convulsive Therapy) or TMS (transcranial magnetic stimulation) are common ways to treating mental illness.  ECT has received a bad rap over the years after movies and the media have shown it as barbaric, when it is a simple procedure today lasting no more than a few minutes while the patient in under anesthesia.  TMS uses a simple MRI type machine that stimulates the brain with magnetic pulses. 

I think one of the best treatments, next to be outside is journaling.  Writing down feelings and thoughts keeps them from ruminating and clears the mind of disturbing thoughts and ideas. 

There are many other treatments including vitamins and supplements to help stave off the symptoms of many illnesses.  The trick is to find the one that works best for you and you alone.  

D is for the Many Faces of Depression

We all feel it at one time or another, the feeling of sadness and hopelessness; to a point it’s normal phase of life.  Different situations affect us and we go through a period of time where it seems nothing can go right.  For some,  however, that feeling doesn’t go away, lingering for days and weeks at a time and interfering with everyday life.  The most important aspect of depression is for those who live with the illness and more so for those who do not  is to know that it is not a sign of weakness or being negative, it is a legitimate health issue and treatable with medication, talk therapy, and lifestyle changes.   

Depression is not as clear cut as many may think there are many faces to depression and I want to touch on a few of them here.  The diagnosis of the type of depression is critical is finding the right type of treatment.    

Major Depression is the illness that is most commonly heard of.  It is characterized by a loss of interest in previously enjoyed activities, loss of weight, or weight gain, a feeling of being sleepy most of the time, a feeling of worthlessness, trouble concentrating and thought of suicide.  Five of more of these symptoms must be present for at least two week for a diagnosis of Major Depression.  Once you have a diagnosis, your doctor can then begin to work with you on the best way to treat your illness. 

Persistent Depressive Disorder:  This type of depression follows the same pattern of Major Depression, however, the symptoms must be present for at least two year.  This would be considered Persistent Depression and is treated with medication and therapy. 

Bipolar Disorder:  While it mimics the symptoms of depression, there are also periods of extreme highs, called manic episodes.  The most important thing here is to use medication to stabilize the moods swings, these are called mood stabilizers.  Anti-depressant is not commonly use with Bipolar Disorder because they tend to increase the chance of a manic episode.  

Seasonal Affective Disorder:  This is most common during the winter months when there is less sunlight and the days are shorter.  Major depression occurs during this time and is treated with anti-depressants and light therapy.  Light therapy is most common and requires the person to sit in front of a natural light box for 15 to 30 minutes a day.  

Psychotic Depression:  This is a diagnosis of major depression which includes with it symptoms of psychosis, including hallucinations, delusions, and paranoia.  Anti-Depressants and Anti-psychotic drugs are used to treat this type of depression. 

PostPartum Depression:  This has also been known as the “baby blues,” and occurs in the weeks and months after the birth of a child.  Anti-depressants and therapy are known to help with this illness.  

Situational Depression:  While there is not a technical term for this type of depression, but it hits all of us at one time or another when a stressful event occurs in life.  The death of a loved one, the loss of a job, divorce or any occurrence that makes you feel unsure of yourself and the world around you.  Therapy is the most common treatment for this type of depression

As you can the illness of depression is not cut and dry, one size fits all type of illness.  There are many facets and anyone can fall under one or more diagnosis.  The more we talk about depression and mental illness the more we can come to understand that it is a medical condition and that 1 in 4 people live some sort of mental illness, most often you do not know who it is.  

“N” is for Natural Remedies and Nature #atozblogchallenge

In recent years using natural remedies for any sort of illness has become popular and mental illness is no exception.

Side effects are the reason most people turn to natural ways of treating mental illness, I cannot tell  you how many medications I have been on or tried and the horrible side effects I have endured.  I got to the point of telling my psychiatrist that he would have to find another solution to keep my Bipolar Disorder under control because I would not be trying anymore medications.  I am lucky that he agreed, and we have tried, ECT (electro-convulsion therapy) and TMS (trans-cranial magnetic stimulation) as alternatives.  These treatments may seem extreme, but when the alternative is side effects of medication, it is the best option. 

One of the best treatments I have found is simply being outside in the fresh air.  The desire to spend time in the fresh air has become more of a necessity right now, due to our harsh winter here in the North East and now as we move past mid-April and the cold and snow continue to fall; my moods are changing quickly, and I find it hard to stay on a regular cycle. I am anxious for the weather to warm up and the opportunity to go for a walk in the park or local trail and enjoy the sun on my face again.  

Nature is one of the best remedies for depression, stress, anxiety and most importantly for our overall well being.  A short 15-minute walk can change your whole outlook on the day or a certain situation.  I have discovered over time that when I do not have the time outdoors, I become more moody and cycle faster than if I have that time to myself.  I am a simple person; I enjoy the woods most of all, surrounded by the sounds of birds and rustling of the trees; it is soothing.  Distractions of the world are only a memory, and the mind begins to focus on the serenity and peacefulness of the surroundings.  

Many studies have been done on the effects of spending time outdoors.  An article on PsychCentral website, states that “Even if you don’t have hours to spend outside, taking 15 minutes to step outside and take a few deep breaths can greatly help clear your mind and relax your body.  Being in the sunshine, even if only for a few minutes, helps the body absorb vitamin D from the sun, which is known to improve the mind.”   

We have become, over the years, a culture of hermits; living through the computer or phone and forgetting what it is like to be part of the world.  It is for this reason that I decided to talk about nature in this post, because even if you have just five minutes in your day, go outside and breathe, you will be surprised at how you feel.   When we were kids, we wouldn’t have dreamed of staying in the house, why do we do it now? 

I will be the first to admit I do not get out as much as I would like, this illness plays with my brain and there are days where I am lucky to get out of bed and accomplish anything, but when I do manage to be outdoors, it makes all the difference in the world.  I know the sunshine will not cure me; I don’t expect it too; I still need my medication and doctor visits, but it does help and whatever I can do on my own to feel better I will do, and most importantly it’s free. 

Personality and Anti-Depressants

Image via Wikipedia

It is known that taking an antidepressant can help alleviate the feelings of depression, but studies are showing that it also changes a person’s personality. Those taking the drug Paxil may feel less stressed and more outgoing, alive and confident – and not merely because they are less depressed.

Two main personality traits linked to depression are neuroticism (a tendency toward emotional instability and negative mood) and extraversion (Tendency toward outgoingness) – while taking the drug Paxil, for instance, there is a drop in neuroticism and a jump in extraversion. The more the personality shift the patients will be less likely to relapse.

While Paxil is not prescribed as much anymore due to side effects, other drugs such as Prozac and Zoloft, have the same effects on a person’s personality.

There are researchers, however, that believe it may not be the drugs themselves that are changing the persons mood, but that is simply that they are feeling less depressed.

On a personal level it is hard for me know if this study is right. I have taken Prozac for a short time; I didn’t like how it made me feel. I am now on Zoloft and have been for years – I can’t say that my personality is that different, I just see me as me. The same person I was before I took the medication. Maybe it is because I live with Bipolar Disorder and a not only depressed – that could complicate the idea. My brain is divided to begin with, so the challenge is too keep it balanced, to function as close to normal as possible. I am outgoing when I am feeling good and can be when I need to be (even if I am feeling bad) to me it is all in my brain.

I hope the medication does help with it all, my social interaction that is. If not, my hope is that it will at least keep me balanced.

Placebo Power - the effectiveness of “fake” drugs

Image via Wikipedia

Do we have the power to make ourselves better? Most people would say no, but according to recent studies it may be a reality. Maybe.

A study, done over a 19 year period found that an average of 30 percent of those who received a placebo instead of an anti-depressant, improved. The higher numbers seem to be found in younger groups. In one study, where children were given either Zoloft or a placebo – 59% of those given the placebo improved, while 69% of those given Zoloft improved. What does this tell us?

As you can imagine there are several schools of thought – one could be that commercials are so convincing that this is what you need to feel better that it becomes so, psychologically. So is it the drugs or our own ability to “get better?”

When referencing the study of children and Zoloft, it is thought that the results are due to the prevalence of depression in young people and that they have fewer bouts, leaving open the idea that it has not taken a hold on their lives yet. Also, it is thought that placeboes may work because of the support and attention received during such trials, these things alone may help improve a person’s mood and out look on life.

Drug companies see this as a problem since they are using these trials as a way to show their drug works for the particular illness, but if those in the trial are improving on the placebo and the drug, it makes their case more difficult.

One more factor that may play into the outcomes, is today those entering clinical trials are not only the most severely depressed, but also those who may have a milder form of depression. These milder cases may respond to the placebo just as well as someone with a more severe case responds to the actual medication. How then do we tell the difference if it is the medication or our minds?

We can’t know for sure, everyone is different. It’s trial and error and requires further study as well as getting to now the individual person, what their personality and history are and what will work for them.

Maybe we can rely on ourselves more?