Category Archives: Therapy

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

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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.

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On Therapy And Therapists: Why Not Just Drugs?

Think about what happens when someone does serious injury to their back. Sometimes surgery is required. Sometimes pain meds are required.

And sometimes physical therapy is required.

Why is this?

Physical therapy is required to help get the person back to normal movement or at least improve abilities to move. If you didn’t have one, any bad habits picked up to eliminate or minimize pain wouldn’t easily be fixed.

Compare this to therapy for the mentally ill. Consider OCD. OCD (Obsessive Compulsive Disorder) is marked by compulsions to do one thing or another. But what happens when you do something many many times? It becomes habit. A psychiatric medication may be able to make the obsessions escapable, but removing the habit will take more than that.

I had the potential to ruminate if I wasn’t thinking about enough things. Rumination would just bring back negative thoughts. So I multitasked to an extreme degree to keep the thoughts back. Some drugs I take help me to avoid the really deep depression where the negative thoughts emanate but they can’t remove the habit of overtasking, that is multitasking taken to a level such that nothing actually gets done. It was a defense mechanism against the horrible thoughts. I’m working on this at the moment, and I’m seeking a Cognitive Behavioral Therapist/Dialectic Behavioral Therapist to help me with that.

Medications can do a lot of things. I like to think of it as someone throwing you a rope when you’re in a very deep hole that you can’t get out of. You say ‘Well, I would get out of this hole, but what will I do then? I’m always in this hole. I’ve planned days, months even years relative to being in this hole. I can’t just leave!” Therapy is a method of getting the individual to grab the rope.

It’s not just the rope. It means you have a way of getting out. Therapy helps remove the habits revolving around being in the hole.

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On Therapy and Therapists: Introduction

I will be writing up some posts on therapists in the near future, but I really want to recommend this link

 

http://counselorssoapbox.com/2012/01/19/how-does-therapy-help-people/

 

The author gives very clear descriptions of different sorts of therapy and I think it helps to help people understand what’s involved and not believe simplifications some people give to devalue the practice.

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