Confusing the Psychiatrists

Well, I just returned from my second psych evaluation. I never blogged about the first, I don't think? I can't remember. Well if I did (or did not) here's a brief review.

Of course with my "doctor anxiety" I was nervous as hell. Add to the fact that I hadn't had a full consult in about seven or eight years. I had no idea what to expect. It went alright, however. The psychiatrist at this "institution" had a gentle demeanor and a soft voice and we actually ran over the allotted time. I felt okay with it and he allowed me to ask as many questions as I needed.

Alright, I thought, this whole evaluation thing isn't so bad. Granted, it was difficult to pack your entire life's woes and psychological/neurological history into such a brief time span. I didn't cover everything in perhaps as much depth as I wanted with this man. The reason being, this consult was a "one off" and I did not expect any further appointments or follow ups with him. And again, I was nervous, unprepared and it was difficult. However, we went through Medication History, Family History/Trauma, Bipolar Disorder, Self Injurious Behaviour, Hospitalizations, ADD and a little bit about Aspergers.

After it all, he said he would "try and put something cohesive together" for my GP. I had to laugh a bit at that one.

Today was a bit different, however. I was mistaken about a lot of things. First, my appointment duration. I was told an hour, I only received 30 minutes. Also, I was under the impression I would be seeing this psychiatrist on an ongoing basis. Nope. But more on that later. Also, this man was not as...well, he certainly had a different "demeanor" than the first psychiatrist I saw.

It was a good thing I was a bit more prepared for this appointment. 30 minutes! We very briefly touched on all of the above mentioned in the first appointment. He asked some fairly simple and straightforward questions and I answered them. I gave him my prepared "dossier" and he flipped through some of the pages. Basically some self-prepared notes about ADD and Aspergers and some highlighted notes from referenced materials etc...

He asked if he could keep all of it. I told him the copies were his.

He basically told me about a counselling group (i.e group therapy) for women who are trauma survivors and how I could take advantage of that. He also told me that I would not benefit from ongoing psychiatric treatment from a psychiatrist due to my problems with functioning and other issues. I have no idea what this means. I don't know if this is an allusion to the fact that I have Aspergers or not. He said that seeing a psychiatrist would only exacerbate my problems. He said that I already have a therapist, see a neurologist and have a GP so that is good enough. Well, then why offer me group therapy? During all of this I simply stated that people with Aspergers do not usually do well in therapy. He agreed.

I still remain confused.

I did manage to get out of him his med recommendations. He had five. Ooh, decisions, decisions! He also casually mentioned one of them, Risperdal, would be helpful with both Bipolar and Aspergers. I told him that yes, I knew this. I also had to remind him of another med that would probably be helpful. He agreed and wrote it down. I so often wonder what doctors think of me when I stroll into their offices and spout such things.

So at that point, time was pretty much up. I felt unfulfilled. I asked him what he thought of the ADD and Aspergers. He said it was hard to tell due to "other issues" and the trauma I had been through. Alright. I understand all about truama and it does not preclude neurological disorders. I also argued high comorbidity rates (and even had that reference material with me.) I asked him if he planned on reading what I had brought him. He said that yes, he would. As I was putting on my coat, I asked again, "So it wasn't all in vain, then?" He said that no, it wasn't.

Yes, I can be terribly blunt.

Now I understand that clinicians can not provide diagnoses on the spot and I did give him a fair amount of documentation to review but a little more feedback would have been helpful.

Shoot, I can't stream the song I wanted for my new MP3 so you'll just have to go with my second choice. "One In Ten Words" by The Spoons. Canadian Band and the poppy little song is from my youth...it makes me laugh about communication.

Warning, Estrogen Filled Post Ahead...

Well, that was a brief hiatus. I swear, this blog is rather reflective of my life right now: confused, chaotic, without direction? I thank everyone for their comments, emails and support of late. Some have said to rest, some have said to keep blogging, some have just "been there" and commented. And people are still out there, frighteningly enough, reading this! I still don't know what to do. So I guess I shall keep living (and blogging--or deciding about it) day by day.

So I woke up with a real clanger of a headache this morning. At first I thought it was a migraine as it hurt that bad and I had good old "shovel neck." Did one of these two guys try and "whack me" while I was trying to sleep?

My period should be here. Any.Minute.Now. But more on that later. It made me wonder...oh dear, could this be some sort of PMS-induced migraine? Oh shit, I hope not. With my wacky noodle, what next, Catamenial Seizures? Good thing, one of the meds I already take (Clobazam/Frisium) seems to be the drug that's just the ticket for that. If you're in the US, try Diamox/Acetazolamide as apparently that has shown some promise in this area and Clobazam isn't FDA approved.

Now my period can be quite the prima donna. Oh, I know she's coming. I have plenty of warning signs alright. But she always keeps the audience (me for the most part) impatiently waiting with no respect at all. But as a longtime subscriber to all of her shows, I can't ever seem to get my money back.

I will sit in the front row, as I always do, surrounded by many other women. Sometimes there are a few gents there as well but they are usually bored to tears or asleep, snoring loudly. Finally, at long last, she takes the stage! Her performance is always terrible, horrendous! I don't understand how she gets such rave reviews the world over! She is called a "gift," a "miracle," "something everyone should be proud and honoured to have bestowed upon them!" I slump down in my seat a bit longer until I can't stand it any more.

I remove myself and waltz out to the box office in the foyer and demand (yet again) my money back for this so-called "performance." I am treated like a lower-class frump for not appreciating the prima donna's beauty and grace and all of her ethereal and natural qualities. I scream at the box office attendant (for I do now feel like a lower class frump as I have become irritable, bloated and in pain ever since the prima donna first set foot on stage.) It's of no use. I can not get my money back. But as I storm out the door, I feel a tap on my shoulder. The ticket agent slaps in my hand my next month's passes to the theatre to enjoy yet again, my prima donna's next appearance.

Message To Suicidal Searcher?

I just looked at my stats and someone typed in "will 3 imovane 7.5mg kill you"

That brought them to this blog. Nowhere did I ever write this or anything about suicide and Imovane. Search engines are funny and pick up all sorts of things that are unconnected.

The answer is "highly doubtful." Nonetheless, don't fuck with your meds! Take them as prescribed. If you're not doing well on them, discuss it with your physician. It can actually be more difficult to overdose on medication than you think and you can do more damage to your body in the long run.

To the person who searched this, if you do come back to read this blog and you are feeling suicidal, please get help. Talk to someone, anyone. Things can and will get better. Trust me on that.

Did I Hear That Right?

I forgot about this. I meant to post about it the other night. I was watching Law and Order (too bad Dr. Deb is on vacation, even though it wasn't SVU--I could have ran over to her blog for a quickie on the topic.) Anyway, I wasn't really paying attention. There was too much going on in the house and it was late...anyway, my ears pricked up when I heard that a character died while overdosing on Depaquel(sp?). Huh? They said it was an antipsychotic. And just to be sure that I wasn't hallucinating, they repeated the drug name three times during the episode.

Okay. Now I know that certain drugs can be sold around the world under various generic names but Seroquel is fairly new and I don't know if the patent has run out yet for other companies to start producing it under another name other than the generic Quetiapine. So I was thinking, is this some new hybrid between either Depakote or Depakene and Seroquel? Why anyone would want to do that is beyond me. And you thought Zyprexa would pack on the pounds HA! And speaking of Zyprexa (aka Olanzapine,) it's the only antipsychotic that I know of that has been souped up with another med, an SSRI--Prozac (aka Fluoxetine.) That is Symbyax and I'm sure that was years in the making.

I have yet to hear of any plans to combine anticonvulsants with antipsychotics. To me, it doesn't make any sense. Granted, I'm no psychopharmocologist but anticonvulsants are too hit and miss. And although they may be considered mood stabilizers, technically they are not. They only true mood stabilizer as a class of drug is Lithium. The whole point of Symbyax was to assist with the depressive aspects of bipolar. So far in clinical trials (if memory serves,) the best drug in the anticonvulsant class (and what I've heard anecdotally--see, anticonvulsants are a crap shoot when it comes to treating the depression side of bipolar!) is Lamictal. So maybe the drug in the television show should have been called Lamiquel?

That got me thinking, maybe my spelling was off. Maybe it was Depoquel! That got me going down a whole different pathway. Maybe it was a combination of Depo-Provera (birth control) and Seroquel! Now this makes sense (and the victim of death was female...) This just might be marketable. Sometimes those manic episodes do lead to some pretty bad decisions... Hey, with the *new* "Depoquel" you certainly won't have to worry about racing to get the "Morning After Pill!"

Now I googled every spelling variable possible and I can't find anything. If someone in some country somewhere takes this version of an antipsychotic, please let me know. Nothing makes me angrier than misinformation in the media. I don't know if there was some sort of copyright thing going on but if so, then they could have resorted to good old Haldol/Halperidol and leave it at that.

Medroll, Please!

I'm going to kill blogger. For the third time I am re-writing this. It keeps eating my posts. Anyway!

For those who like to keep score, here are all of the meds that I have been on. They've invariably caused me some sort of wacky/ugly side effect and some have not even bothered to work at all. As always, I welcome any questions and if you don't recognize a med here, just ask!

- Oxazepam/Serax
- Diazepam/Valium (just a few days but what the hey)
- Sertraline/Zoloft
- Lorazepam/Ativan
- Venlafaxine/Effexor
- Buproprion/Wellbutrin
- Clonazepam/Klonopin
- Zopiclone/Imovane
- Liothyronine Sodium/Cytomel (I know this looks funny on a head med list but it was used as an adjunct to Effexor)
- Mirtazapine/Remeron
- Moclobemide/Manerix
- Nefazodone/Serzone
- Temazepam/Restoril
- Fluoxetine/Prozac
- Carbamazepine/Tegretol
- Citalopram/Celexa
- Lamotrigine/Lamictal
- Divalproex Sodium/Depakote (eh, three days in-patient but again, why not?)
- Topiramate/Topamax
- Rizatriptan/Maxalt
- Olanzapine/Zyprexa
- Clobazam/Frisium
- Atomoxetine/Strattera

I am currently taking 200mg Topiramate, 10mg Clobazam, 7.5mg Imovane and 10mg Rizatriptan prn. Oh, and 40mg Esomeprazole/Nexium but that's a Proton Pump Inhibitor--for my stomach not my head haha. And it's not really working but that's another post!

So, I guess that pretty much covers every class except the tricyclics, the "old school" or "typical" APs and the stimulants.

I have an appt. with a new psychiatrist (scary!) in March and I really want to discuss stims with him as Strattera was a disaster. It's kind of my own "fault" as I completely forgot that it's basically an antidepressant--an NRI (norepinephrine reuptake inhibitor.) I can not even be in the same room with an AD! Okay, it's not that bad but they make me go positively nuts. In 13 days, Strattera reduced me to a quivering, mumbling, mixed-state, ultradian cycling pile of rubble. Hey, at least I gave the drug 13 days. And the physical side effects were hell too. A gastronomic disaster and waking up at the crack of dawn just for the fun of it, basically.

Yep, developed in Sweden as an AD with disastrous (or simply null?) results and now it's an ADD med! I wonder if it actually helps ADD folks. No really. I'm not being snarky. I do wonder. Show me some studies.

Don't get me wrong. I would never discourage someone from trying a med based solely on my experience! That would be silly. We are all neurochemically diverse and unique.

Hey Baby...What's Your Diagnosis?

Even though this blog is free, you are paying for it with your time so I guess I'll let you know a bit about me, your host(ess?--I hate gendered words). And at the beginning of relationships, it is proper form to introduce yourself...or did I read that somewhere, maybe in an Anthropology textbook on "Primitive Human Customs?"

So about my mental diagnoses/history. Well, it's a little lengthy and I tend to run off at the mouth so I'll try to be concise.

In my late 20s, I started to have trouble with lack of concentration, insomnia, loss of appetite etc... and after reviewing these with a friend who had suffered with depression for many years he pegged me. I went to see a psychiatrist and he immediately diagnosed me with unipolar depression. We never really touched upon bipolar symptoms but I wouldn't have clued in. You see, I had been living in a continual hypomanic existence for about 7 years. Hypomania was "normal" for me so if he had ever asked me about symptoms, I would have clearly said, "nope."

Antidepressants threw me into a tailspin and finally, the medical/psychiatric establishment have tapped in to the idea that they can actually exacerbate bipolar symptoms in some patients with the disorder. Of course, no one seemed to figure this out with me. Fast forward a few years and I actually figured it out.

I went to my then GP and told him that I actually thought I had bipolar disorder and we switched to anticonvulsant therapy. Wow. The (hypo)mania was halted. But the depression still lingered. At least we were on the right track, however.

While researching anticonvulsants and their more traditional use in epilepsy treatment, I suddenly realized that I had been experiencing simple partial seizures all my life. It was like, "Oh, so that's what those were!" I'd had them since I was a kid! Not to mention the fact that two of the antidepressants known to drop seizure thresholds (Effexor and Wellbutrin) that I had taken in the past did exactly that!

So, off to a neurologist for a diagnosis of "seizure disorder" but not epilepsy proper.

Betwixt and between all of that, focusing issues and concentration were always a problem. I brought up ADD to my ex-GP and he confirmed that I have that too.

Oh yes, I'm also a migraineur.