Tardive Dyskinesia

Some of you probably know what this is.

I may be developing/have developed this.

For those who aren’t familiar, tardive is a potentially permanent side effect of antipsychotics. Presents as minor mouth tics, muscle tension and generally feeling physically uncomfortable. It’s on wikipedia, you can look it up if you’re interested.

Anyway, I’m apathetic now. I just am so used to shit hitting the fan I don’t care that it’s raining shit.

I hope any of you reading this will never run into this condition. It’s a nasty bit. And any of you who have switched antipsychotics know that the process can be very, very harsh.

Good luck,

unconstructed

Psychiatric Medication: A Primer In Medical Frustration

Imagine you have something like leukemia.

In order to know you have that the doctor has to in effect prove that you have it. Which can be done (though I know nothing of the complexity involved in diagnostic).

Now think if the doctor had to diagnose leukemia without modern instrumentation, so he’d have to just watch you and see what happens.

Look up the signs and symptoms of Leukemia and take out all those that require physiological testing outside of visual analysis.

http://en.wikipedia.org/wiki/Leukemia#Signs_and_symptoms

“All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.”

So if you don’t have medical tests, you have nothing to go on.

Now think about the brain. How do we know what part of the brain does what? Two ways that I know of are analyzing case studies of people who had brain damage at a specific location and look for deficits or stimulate that part of the brain and analyze what the person says he or she is experiencing.

And that’s just the low level analysis.

Consider than how difficult it is to diagnose something like bipolar, which is diagnosed via the DSM IV (or V if it’s out yet).

 

• The presence of a hypomanic or major depressive episode.
• If currently in major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode. No history of a manic episode.
• Significant stress or impairment in social, occupational, or other important areas of functioning.^[13]\

 

How many of those do you think can be explained via medical testing? The answer is, at present, none. The other problem is that it’s not at all clear that bipolar II has the same cause in all cases.

So we now approach medication.

In our leukemia example, there are treatments that attempt to control it to the point of remission. Granted, this is very very hard to do and leukemia is a terrible disease, however…

How does a psychiatrist pick a drug for bipolar II?

He can’t. Or at least, he can’t obviously pick one. Except possibly in the case where only one medication exists for the specific noted behaviors. In bipolar II this is not the case. Further consider that a few of the major drugs for bipolar were originally used for epileptic patients to keep their seizures controlled or at least lower the occurrence.

This is not to say that psychiatric intervention doesn’t work. I myself am currently on a medical cocktail that seems to work (although lately I’ve been experiencing a level of depression that I haven’t felt in a while…).

But I’m on Pristiq, Wellbutrin, Lamictal, Provigil, Adderall, Cogentin and Abilify.

That’s a lot of meds.

Now what do I do when something goes bad like it has recently?

All of those drugs are working to keep my bipolar in check.

So how do you figure out which one is failing to help? Or how do you switch out one med for another?

It’s not easy. On the patient or the psychiatrist.

This becomes extremely frustrating.

And this is all without mentioning the fact that many of these medications have extreme side effects. In many cases the patient has to decide what they’re willing to live with. Do you accept the possibility of Tardive Dyskensia? Or do you accept psychosis? Do you accept the possibility that one of your drugs will stop working, because at the moment it works pretty well?

These are all hard questions.

And I don’t know the answers.

 

unconstructed

It’s just in your head

Mental illness is a condition. We must remember that. A recent comment on a post led me to make this a post, since it was getting a bit long for a comment and contained issues that I wanted to express to the general public readers.

Some people have “pulled themselves out” of depression. But what does that mean?

If you pull yourself out of mental illness and get back to normal functioning… I don’t know, I’d be hard pressed to call that mental illness. Sure, you might be able to get to some form of function, but completely recovering by yourself to the same place you were before in my opinion is not mental illness.

Clinical Depression is mental illness.

Mental illness is by definition highly debilitating.

“In addition, for a diagnosis of major depression to be made, the symptoms must not be better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.”

—http://psychcentral.com/disorders/sx22.htm

One of the problems with depression is that people treat it differently than bipolar or schizophrenia, because for one reason or another only bipolars and schizophrenics are “crazy”.

For many people I would argue that they cannot get out of it themselves. I mean, think of a broken leg. Ya you can let it heal, but you’ll often be debilitated for life because of very badly healed bone.

People often do not treat mental illness and “physical” illness the same way. For some reason antidepressants are a “crutch” that isn’t necessary, while a physical crutch is at least temporarily necessary if you want to be able to deal with anything more than laying down. Antidepressants are more like a wheel chair in many cases. A paralyzed person can work without a wheelchair, but it’s damn near impossible. I don’t see why people assume depression or bipolar or schizophrenia is necessarily different.

There are cases of temporary mental illness, that is, mental illness that seems to be healed after a certain amount of time. And I do believe that can be real depression. Just like pneumonia is a temporary illness if you get it dealt with, in some cases depression can be temporary.

We must be careful though. Depression is not just the feeling or the apathy. If it is truly a brain chemistry issue, fixing your own physical brain is extremely difficult or possibly impossible. Depression can entail a lot of things that are very hard to deal with. In my case (with bipolar) I had psychosomatic aphasia and paralysis. I also have Tourette’s and OCD. Those two are often comorbid.

Attempting to deal with it completely by yourself is what people usually do before they get help. No one wants to think of themselves as mentally ill. You have to get to the point where you can’t get out of it yourself and are willing to admit that you’re ill. Or to the point where you’re a danger to yourself or others.

I really am not trying to single the commenting person. First, the position given was vague and I don’t want to impute intent or meaning when I’m not completely sure. Also it’s a common position and should be addressed to everyone. I’m not mad about what the person wrote. Honestly it gave me the inspiration to write this post. And I certainly do not impute all these beliefs to that person, I’m relatively sure that person didn’t mean everything that I wrote down. It just reminded me and I wanted to write out the possibilities thoroughly.

Quick note on mental health diagnoses

I thought of this when I read this blog’s entry on bipolar diagnosis..

http://counselorssoapbox.com/

I think he makes some very interesting points, and this guy knows his stuff from the counselor/psychologist point of view, so definitely if you’re interested in that he seems like a good guy to follow.

What I personally want to talk about is behavioral diagnosis.

Let us, for lack of better terms, draw a line between “physical” illnesses and “mental” illness. Physical illness usually invites us to consider a cause. A broken leg, for example. The cause of the pain is the broken state of the leg.

With mental illness however we don’t diagnose this way. We look at a patient and classify his behavior. Why? Because the brain is notoriously complex and we don’t always have the luxury of time.

Does this make the diagnosis any less real? Any less relevant? No, of course not. Just because we don’t know the combination of things causing these high level behavioral problems doesn’t mean they don’t exist.

And even if we could diagnose directly, how do we use that information? In the end, we have medications that help with certain conditions. These conditions are defined behaviorally. We won’t have medicine where “if neuron 17 is firing too fast we administer N17-Fire-Slower-XY” (all medications need excessive letters).

If someone is depressed, an antidepressant may help. One of many antidepressants may help.

And unfortunately at times none of them help.

I just think the behavioral vs physiological diagnosis leads people to come to the conclusion that mental illness isn’t really there. And that should be corrected. Hopefully someone will benefit from this.

Just a crutch

Is psychiatric medication “just a crutch”?

Yes. Under a specific definition it is.

What is a crutch? What is it for?

It helps you keep walking. It helps you keep moving. You can’t address the problem directly (magically repairing bone) so you take an indirect step where longer term medication and intervention eventually works out.

Some argue that psychiatric drugs are just a crutch.

Tom Cruise among them.

But I have to ask. Would you really take a crutch from a guy and tell him to walk it off? And seeing as a good chunk of mental illness is chronic, would you take a wheelchair away from a parapalegic and tell him to walk it off?

If I could directly fix my brain chemistry, I would. Problem is I can’t. The next best solution is to make things livable.

So are psychiatric drugs just a crutch?

Yes.

And please give me my crutch back, I need to get to work.

–Unthought

Relationships and Mental Illness Part I: Romantic Relationships

I want to address a concern of mine about relationships with one (or both) individual with a mental illness.

First I need to make this clear. It is legitimate to not pursue or end a romantic relationship because the mental illness is either too much to handle or is just making the relationship work is something you cannot imagine doing long term. We always have a right to end a romantic relationship if we feel it cannot be sustained.

Beyond that, how does mental illness affect relationships?

Well, I’ll start with the most physical and end with the least.

In a romantic sexual relationship, there is at least one side effect that can really make things difficult.

That is the problem of loss of libido or the nearly absurd increase in libido.

Both partners should realize this is a problem for the other. The mentally ill partner does not, in general, want this to be the case. Not being able to meet a partners sexual needs is a very frustrating issue on either side. We must understand that this is not of the volition of the mentally ill but rather something outside of their own control. And we must understand that it’s very difficult to accommodate a partner whose sexual needs seem to change drastically.

In my manic phases I suffer from hypersexuality. Some make the absurd claim “Wow, that must be nice”. It isn’t. It is in NO way a nice feeling. Especially when one has no outlet outside of oneself. This has nearly driven me mad as a single male, and if I were not single it would still drive me mad as it would be a bit much for any normative sexual person I think…

Similarly there’s the issue of sexual dysfunction. Anorgasmia I think is one possibility. This would be incredibly frustrating as you can probably imagine. If you love your partner you want to do your best to fulfill their needs, at least up to a reasonable standard, and being anorgasmic or having a partner who’s anorgasmic is frustrating.

I will write part II either today or tomorrow. Until then this is Unthought, signing off.