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.  

O - is for Obstacle

Picture for a moment a sporting event, no matter the sport there are obstacles in the way and there is a challenge to move around them in order to win the game or race.  It takes determination, practice, precision and most of all a dedication to what it will take to win.  So, you may ask what does this have to do with mental illness, well it takes that same determination and dedication to achieve stability despite the challenges that are placed in our way. 

When it comes to treatment my doctors consider me a challenge.  I have tried more medications than I could mention, not being able to take the majority due to side effects and my system being so sensitive.  I’ve had my psychiatrist sit and shake his head at me and smile, telling me I am a challenge.  I will take that as a compliment to him, as he has found ways to treat me that work and not give up because of my sensitivities.  Each medication or treatment that does not work is an obstacle I must overcome in order to stay healthy.

My diagnoses in itself is an obstacle, the initials or names may not mean much to people, but to me they make up part of who I am and why I do the things that I do.  I face the challenge of PTSD (Post-Traumtic Stress Disorder) because of years of abuse.  I have spent many years fighting to get back what was taken from me.  I have hope that I will find my way until then the wall is there and one brick at a time I am chipping away at it. 

Bipolar disorder and Anxiety create a world of havoc in my life that can last for days or weeks, even months at a time.  Each of these illnesses on their own can create chaos, put them together and the challenge can become monumental.  What is most important with these illnesses is learning the triggers, or obstacles that find their way into your life and cause the mood swings. 

Putting this all together into one single post is difficult, but in the end we are all the same.  We are each faced with challenges and obstacles on a daily basis that challenge us or make us doubt our choices.  It’s normal and with each obstacle we face we know that we become stronger as people and learn what we are truly capable of.

What are some of the challenges in your life?  

“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?