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.  

“T” is for TMS (Trans-cranial Magnetic Stimulation Therapy)

TMS, short for Trans-Cranial Magnetic Stimulation Therapy, is a fairly new treatment for those who live with depression and have had an issue with medication where they either did not work, or the side effects were too great.  TMS is also used with medication to help diminish the depression symptoms.  Still in it infancy, as a treatment for depression, TMS is already being used widely and with great results. 

TMS works by generating high magnetic fields that turn off and on very rapidly, the same strength used by MRI (magnetic resonance imagining) machines.  A treatment coil is placed on the head above the prefrontal cortex, the part of the brain that regulates mood.  This procedure does not affect the entire brain, reaching only 2-3 centimeters beneath the coil.  Small electrical currents activate cells within the brain that are thought to release serotonin, norepinephrine, and dopamine.  Depression is believed to be a imbalance of these chemicals, TMS restores the balance, in turn relieving depression.  

To read the description of what it is and how it works may sound more like something out of a Frankenstein movie, but the reality is it works and the wonder of modern medicine is giving hope to many to suffer with depression and no medication seems to work.  The treatment, however, is far from barbaric.  I began TMS 4 weeks ago, the normal course runs for six weeks with 30 treatments done over that period of time, with results normally being seen by week 3 or 4.  I can say first hand, it works; but, mine was not a simple case,  I managed to confuse my doctor, and we had to adjust things.  The treatment coil is placed on the left side of my head, as is normal for most people, however, for me after only a week I became manic, it had taken away the depression but left a mess in its wake.  To balance things out, we moved the coil to the right side and hoped for the best.  By week 3, I was feeling better and the fog that had covered me was lifting; I was smiling and felt alive for the first time in a long time.  I have 8 more treatments to go, after which I will return for what are called maintenance visits once or twice a month.  It’s a small price to pay to feel well and function normally. 

As with any treatment, it may not work for everyone, but I am thankful for it.  I had, ECT (electro-convulsive treatment) done in January, a series of eight treatments done in the hospital; it helped but left depression in its wake, leading us to today and TMS.  I am thankful for my psychiatrist, the only one where I live who uses this and the fact I had the opportunity to be part of this new way of treating depression.   We turned to these procedures because I am medication resistant, and I was tired of trying an endless list of medications.  For me it was worth trying and am thankful I did.  Is this something you would try?   

B is for Barriers #atozchallenge

One of the biggest challenges (no pun intended) I have found with blogging for this month is that  there are numerous choices for each letter, I may end up having to write more than one a day.   The one that jumped out first this morning is barriers.  Yes, we all know those things we do or don’t do that keep us from accomplishing tasks, but all too often for those with mental illness it that stubbornness that leads to additional problems, though they may not be seen right away.  

In an article titled, Barriers to Mental Health Treatment: Stigma or Self-Sufficiency?, The reasoning behind this practice is looked at more closely.  It is an assumption that stigma would be the first reason why people do not seek treatment, surprisingly it ranks at number four, self-sufficiency is the top reason.   There is a profound belief that mental illness can be handled without doctors, medication and other treatments.  I can disagree with them because I have done that myself.  It took me almost seven years to realize that I could not take care of this my way; I believed I knew better than anyone else.  Eventually I realized I  had to look for help in other places and trust that the doctors I turned to would be able to guide me to wellness in a way I had been unable to do on my own. 

Another side to the self-sufficiency decision is all too often the inability to find the right doctor and medicine cocktail.  These two factors are probably the most common reason why treatment is cast aside.  I cannot begin to tell you the number of medications I have been on, over the last 18 years I have tried more medications than I could name.  Few have worked; however, many more have left me with side effects that I would not wish on my worst enemy.  The last one landed me in the emergency room with stroke like symptoms.  It was at that point that I told my psychiatrist; I was done with medications, and if I was to be treated, we had to find another way.  Her response, she referred me to another psychiatrist who has become a godsend, and we are using, ECT (Electro-convulsive Therapy) and TMS (transcranialmagnetic stimulation) to treat my illness along with CBT (Cognitive-BehavioralTherapy) with my Psychologist.  I still take two medications, and for now; it seems to be the right plan for me.   

We are taught as children to be self-sufficient, to find the answers on our own and follow a different path, we have to understand though that there are times when looking for a treatment alone is not the best plan.  Persistence is the first course of action and for some, it can take years, but when you find the right doctor, medications, and treatment it makes all the difference in the world.     

Additional reading:  What prevents people from seeking help