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Psychiatry Strikes Back

I had my second appointment with the APN on Friday. It was at 4:30pm and I was a little late so I guess that played into it because it was near closing time but… she seemed very rushed. The hospital where I’m trying to schedule a sleep study needed more information and had called her, so she tried calling them back at the beginning of our appointment. They were probably closed for the day, so she left a message asking them to call her back… but I have no idea whether or when both sides will be available to talk in real time. She doesn’t seem to have time outside of appointments with clients to do anything relevant to their cases; I think that’s stupid and inefficient and a symptom of bigger problems in the U.S. “healthcare” system. But I digress.

I showed her the self-report measure she’d given me to track symptoms such as depressed mood, mood swings, irritability, food cravings, anxiety, sleep issues, difficulty doing things, and physical symptoms. I’d marked most items somewhere from “mild” to “severe” on most days. She asked questions about how I’ve been and family history of “mood swings” and filled out a form on the computer as I was answering her. She cut me off in the middle of trying to explain my family history, so she doesn’t have all the relevant information. At first she thought I’d never been on medication before; this freaked me out because I’d spent so much of our first appointment telling her about my experiences with the generics for Wellbutrin, Lexapro, Zoloft, and Buspar. I had to tell her a lot of the same information a second time. But she didn’t have any time to glance through my file before meeting with me, and there’s no way she could remember my specific case from meeting with me once a month ago. So I don’t hold it against her, personally … I just find it a bit difficult to feel safe working with someone under these circumstances. (And, well, she could have worded things a bit differently.)

Lacking the results from my blood work (I can’t find my copy and the doctor’s office has been closed every time I’ve called to have them faxed to the APN) and sleep study, aware of the problems I’ve had with medications in the past, and faced with some fairly severe self-reported symptoms, she said she would like to try putting me on Lamictal. I’d never heard of it before, so I asked what it was. It’s an anticonvulsant typically used to treat epilepsy but also bipolar. She said something about a possible rash and it takes a while to start working and you have to work up to the therapeutic dose slowly… at the time, it all sounded fairly terrifying. I’m not sure exactly what I expressed, probably a mix of anxiety and confusion, so she wrote the name of the medication down for me, told me to research it, and offered to meet again “as soon as possible.” Session over. I’d wanted to ask if she could refer me to group therapy for people with depression and anxiety, but there wasn’t any time for it.

I asked the receptionist for an appointment as soon as possible and she said the next available appointment is on September 26th! Another month. I … I can’t even comment on that. Another month before I even get to find out whether Lamictal might work for me … or I might be deathly allergic to it. Another month before I can even hear the name of another medication that might be worth considering. Hell, another month before I can ask her why she thinks it’s worth trying!

The receptionist made an appointment for me on the 26th, but also made a note to contact me if anyone cancels between now and then. I thought that was very considerate of her. It’s the same place Fox and I are going for our marriage counseling (which has been quite effective), so I can also check in with the receptionist before and/or after our weekly appointments. I appreciate her willingness to take that extra step to help me out. As frustrated as I was at the time, I also appreciate the APN encouraging me to research the medication instead of dismissing my concerns.

I haven’t been able to find anything particularly useful about Lamictal online, just a terrifying list of side effects. Most of the psychological side effects have become the norm for me, so I’m not too worried about them … I’m kind of “damned if I do, damned if I don’t” in that department. The thing that concerns me the most is that the online sources I’ve found so far claim Lamictal has only been found effective in preventing episodes of depression or mania, not treating current episodes. I really don’t want to take something that has the risk of adverse side effects if there isn’t any evidence that it might help me.

A friend of mine who has bipolar and works in a mental health setting told me that Lamictal is one of the bipolar medications that have been monitored (and found to be safe enough to continue using) the longest. It’s considered to be safe and effective, particularly for treating depressive symptoms. The severe side effects are very rare, so it’s unlikely I’ll experience them. Basically, I’d be crazy not to give this medication a try.

My friend also made a very good point: I’m not going to be able to have a productive, in-depth conversation with the APN. If I want to know something about Lamictal, I have to do my own outside research. I have to make my decision on my own, before I meet with her again. I already know the answer to the question, “What do I do if I get a rash or experience other severe symptoms?” – go to the emergency room. She won’t be available whenever it happens; I’ll have to wait a month to meet with her. So when I do talk to her, I need to ask the one thing I can’t get answered anywhere else, in order to make the best use of our limited time.

I’m going to ask her what the plan is for getting me started on the medication and adjusting the dose to find the one that’s effective and safe for my body. That way, we can work together to create one… or I can at least hear her thoughts and have a basic idea of what to expect. I need that in order to feel safe working with her.

If you’ve taken and/or know someone who has taken Lamictal, would you recommend it? Anything I should be aware of?

Can you recommend any resources that might help me make an informed decision?

Any thoughts about navigating the system?

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11 thoughts on “Psychiatry Strikes Back

  1. Hi there, I’m from ‘down under’, in our private health system, my doctors only do med changes while monitoring me inpatient to check for symptoms. I’m not knowledgable on that med, I ALWAYS talk to chemists about meds, as that’s their area of speciality. Sending positive vibes….that sounds very hard to deal with…hope you can see the doctor earlier…lol
    Love Ziggy

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  2. Hey, a very effective fix to your anxiety and depression include positive affirmations, and cognitive behavioural therapy. You can download apps or even search a list of positive affirmations and you can print them out. Say them everyday and ESPECIALLY when you are talking/thinking in a negative manner (ie. I am stupid, i don’t belong, life sucks..you get the idea). As for CBT, you can google free cognitive behavioural therapy and there are many free options for you to use. Remember that meds only fix things temporarily – it is up to you to change. Stay strong, stay positive. It will get better! As for the doctor, its the same everywhere and it sucks… doctors don’t have the time.

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    • I know CBT has a ton of research supporting it, but do positive affirmations? Can you link to some research articles (studies that analyze the data from several controlled trials are best) that show a significant improvement in depression symptoms as a result of using positive affirmations? It’s important that the population used is people with moderate clinical depression, not healthy people who occasionally feel sad.

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      • You can look for articles yourself. Yes, they do work as long as the patient continues to utilize them on a continuous basis. The idea is that many depressives tend to participate in negative self-talk, whether they are consciously aware or not. By acknowledging that and reframing the thoughts, patients begin to think along a more positive, beneficial continuum. I know many patients, including myself, who have benefitted.

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        • So your evidence is personal experience and anecdotes. Thank you for clarifying. How have you and the other patients dealt with the tendency of negative self talk to undermine one’s ability to feel inspired by positive affirmations? So far I’ve interpreted most of the affirmations I’ve read as critical of me, saying I have no hope of succeeding because I’m depressed, or outright lies.

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          • You have to pick some positive affirmations that speak to you personally. That being said, many people have a hard time believing the affirmations, especially at first, that is why they are to be repeated often, with meaning, and consistently. For example, a perfectionist will have difficulty with the phrase, “It is okay to make mistakes. I am allowed to make mistakes.” At first the person will not believe it but with time, they will realize that it is human to make mistakes and don’t have to hate themselves or become angry when mistakes occur. There are many positive affirmations out there and sometimes the best ones (most effective) are the phrases you come up with on your own. Some examples for you, based on our conversation, could be: I am tough and perseverant because of my experience with depression. I am capable of so much more than I currently think. I allow myself to be loved. I love myself. I forgive myself. As I work on becoming more positive and seeing the good in the world, my depression becomes less and less. I am kind to myself because I know I am doing the best I can at the moment.

            Remember, seeing any progress takes time and (continuous) effort! These affirmations begin rewiring your brain so that you respond with positive self talk rather than negative talk that further darkens your mood.

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          • Also, evidence for positive affirmations can be seen within CBT studies as they are part of the therapy. CBT attempts to reveal patterns of negativistic thinking in an individual and provides ways of changing behaviour to support a more realistic (usually more positive) outlook.

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  3. I’m a 56 year old stay home wife. I’ve suffered with depression most of my life and recently started paranoia. My GP recently put me on a new med and I had a bad reaction. I became truly suicidal, my husband took me into the ER.
    The triage nurse asked “what do I think they should do”. I asked to see someone from the Behavioral Science Dept. They put me into a blood draw lab type of room close to the ER central desk. We sat there for over 2 hours, every 20-30 minutes a security guard would stand at the door and shout over to the desk “How much longer will this psych patient be here”. We had techs nurses and such ask “why do we have a psych patient in here”. And I must say not to quietly.
    My husband finally got mad and asked how long it would be before we would see a Dr. at which point a nurse was sent in to collect blood and urine. Finally after 3/12 hours and never seeing a Dr. we left. It was a very long week-end for my husband but with his love and support we made it through.
    When I finally saw my GP on the Monday I learned the blood and urine where a pregnancy test and drug screen. If anyone had bothered to ask I’d had a hysterectomy 25 years ago. All I can say is be sure you have someone you trust with you when starting any new drug, because if it says it may cause depression it should say it can make your depression even worse

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    • Wow, that’s just horrible! I’m honestly not surprised that they didn’t tell you what they were doing, but I am surprised they let you leave without seeing a doctor. Did they know you were suicidal? I’m really upset that so-called “professionals” would be so insensitive to a patient in distress.

      It’s great that your husband was so supportive! I’m kind of fortunate in that my husband and I live with my mom and we’re all home most of the time, so I have 2 people I can rely on in an emergency situation. I’m also about a half-hour drive from some friends I know I can trust, and even closer to the nearest hospital. I don’t know how good that ER is at dealing with psych issues, but I have observed their inpatient psych unit as a volunteer/student; while it’s not ideal I think they could handle someone being suicidal in response to meds.

      Thank you very much for the warning, and for sharing your story. I actually just started taking lamotrigine (Lamictal) today.

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  4. Pingback: A New Hope | a day with depression

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