A good, quality, competent and well qualified psychiatrist is not easy to find these days. Until this past year, this was not a huge issue for me. Over time I developed rather low expectations for my psychiatrists; if I happened to find a good one, it was a plus. Once, my psychiatrist and I started treating me for bipolar disorder and we found a good cocktail, things were fairly steady. It was less expensive to see my PCP than my psychiatrist, so when possible I would just see the PCP and have him or her prescribe and renew my medications. To be fair, the psychiatrist who started treating me for bipolar disorder and worked with me to find the right combination of medications, was excellent. I was referred to him by my PCP and they regularly communicated regarding my treatment, which I believe was helpful. As noted, I have not been overly impressed with most, though not all, of my psychiatrists (remember, I have moved a lot so I have seen a quite a few). In 2012, I started seeing a new psychiatrist whom I had been referred to by my previously noted, excellent psychiatrist. This new psychiatrist had little bedside manner; he asked the questions that he was supposed to ask at each appointment… how is your appetite, how is your sleep, have you had suicidal thoughts, etc.? After seeing him for about 2 years, I started having some new and significant problems. I was losing my ability to focus, experiencing memory loss and my insomnia was getting worse. Over the course of the next few months, we discussed these new problems and he made some suggestions. As the problems progressed, my ability to work became more and more challenging, particularly because my job required a significant amount of focus and memory. Finally, my psychiatrist referred me to a psychologist who specialized in ADHD evaluations. Over the course of the next 6 weeks, I was evaluated - there were “take home”, in office, verbal and computer evaluations, totaling about 5 hours altogether. As noted in a previous post, I was diagnosed with ADHD, but the psychologist also found a significant deficit in the executive function portion of my brain. The results were sent to my psychiatrist and he began talking to me about trying ADHD medications. Although, the focus and memory problems were making my job more and more difficult, I was extremely hesitant. When I was in the hospitalization program, there were a number of people with a bipolar diagnosis. One caution that was repeated over and over was, once you had established your medications, you should never go off of them and be extremely cautious about taking any medication that would destabilize your mood. I had taken that to heart and protected my cocktail of medications carefully over the years. I was extremely hesitant about trying the medications because all the ADHD medications listed “mood changes” as a potential side-effect. With my focus and memory getting worse, I finally agreed to try one. Within a week, I had to take FMLA. Perhaps the medication was helping me have better focus, but it was nearly impossible to tell because I felt like a windup toy, I could barely sit still, I would go outside and walk and walk to try to work off the relentless wound up feeling I was experiencing. I eventually took a yoga class to try to cope. I probably lasted less than 2 weeks on that medication. We tried a total of four medications in the course of about 5 months. During that time, I never lost that relentless wound up feeling in addition to ever increasing anxiety. Both my body and my mind felt wound up, I couldn’t walk enough to make it go away. I don’t know how to explain what I was experiencing, but I felt like I was losing my sanity. Throughout the five months, following each medication trial, I would take weeks before I would agree to try another medication. The only reason I kept at it was that I was on FMLA and I figured there would never be another time when I could afford to feel so poorly. Throughout the months, I would tell my psychiatrist how badly I was doing. His response was, “the medication is fast acting and then out of your system. You have been off the medication for a week (or however long it had been), the medication can’t be causing you problems any longer.” As the months progressed, I began experiencing extreme anxiety, which was seriously impacting my ability to have any social interaction, in addition to the tremendous psychological pain I was experiencing. Again, I went to him and told him how poorly I was doing and that I needed help; I told him that I felt like the medications were causing a manic reaction. His comment was, “you don’t look like someone who is manic and if you were you would be in the hospital”.
That was it, it was clear he did not believe me and I was in serious need of help. I asked my psychologist if he could recommend someone. At this point, I had lost my job as I was unable to work in any kind of setting; this also meant that I had lost my health insurance as well. I certainly couldn’t financially afford to see a psychiatrist, but I couldn’t emotionally afford not to. Another frustration I had during this time was the unwillingness of my psychiatrist to communicate with my psychologist, which could have been very helpful in identifying my needs and getting me the proper help more quickly. I will discuss this more in depth in another post, but I believe better and more timely care could be provided to those with mental illness if a more holistic approach were taken. Thankfully, my psychologist was able to get me an appointment with the psychiatrist who practiced in his office. My first appointment, was was a night and day difference from my appointments with my previous psychiatrist. She was well educated and current on every issue I was experiencing. She explained that what I was experiencing was a result of the ADHD medications destabilizing my mood. She also explained that she would never prescribe ADHD medications to her clients with bipolar disorder unless they were and had been totally stable for a very long time and even then she would be extremely hesitant. She also explained that some people’s mania is manifest in the form of severe anxiety. None of what she told me was based on some small obscure study; this should have been information that my previous psychiatrist should have known. She immediately increased my mood stabilizer and after 6 long, painful months; I was able to experience some relief from the severe anxiety. In addition to helping me find some relief she took time to share a great deal of insight and education about bipolar medications. I walked away from that first appointment feeling incredibly grateful to my psychologist and to her. A month later, at my follow-up appointment, she sadly told me that she would no longer be able to see me; she was closing two of her three practices. I was devastated; I asked her for a referral, the pickings were slim, but she referred me to a psychiatrist with whom she had worked with about 30 years ago. Depending on the psychiatrist, it can take one to three months to get an appointment as a new patient. So about a month later, I saw my new psychiatrist. I explained my situation of the past year and why I had left the two previous psychiatrists. I also explained that I still needed help to stabilize my mood and address the other symptoms I was experiencing as repercussions from the ADHD medication trials. The first appointment seemed good and she seemed very compassionate about my situation. Her first suggestion was that I go off my antidepressant. (I will address this more in depth in a later post, but this was the long overdue acknowledgement by psychiatrists of the problem that I had experienced with Paxil). The new recommendation is to pull everyone with a bipolar disorder diagnosis off their antidepressants (or that is how some psychiatrists have interpreted it). So I stopped my antidepressant, which I had successfully been on for over 10 years. The next thing I knew I was starting to have panic attacks and reorganizing every cupboard and closet in my house. I have an anaphylactic allergy to cat dander, which is very challenging to work around. In addition to the reorganization of my house, I washed every single item of clothing in my closet and created a management of my indoor and outdoor clothing to further control the dander. This actually turned out to be a good idea, but in the midst of it, I realized that my OCD had leapt to a whole new level. Thanks to my psychologist, who keeps current on psychopharmaceuticals. I regained control of my OCD and panic attacks by going back on the antidepressant and instead started reducing it very slowly, which my psychiatrist thought was nonsense. In the meantime, she was busy having me try new mood stabilizers and other medications. I seemed to be getting worse and started to have new symptoms. Once again, I got the impression that she was not taking me seriously and thought I was “faking” either my symptoms or at least making them into something more than they were. In an inspired move, I asked a friend, who is a nurse to come to my next appointment. I initially asked her because I knew that my cognition and memory were not up to par and thought it wise to have someone else start coming to appointments with me. Later, I explained to my friend that I needed to address my concerns with my psychiatrist and needed moral support because I was concerned about her response. My friend met me in the office, we talked about my symptoms and that the most recent medication, which was, as the others, causing an increase in anxiety. Near the end of the appointment, I got up the courage to address my concern. I tried to explain my frustration and my friend tried to help as well. The result was more disastrous than I could have ever predicted, she asked me to leave her office and then as I walked down the hall crying, she shouted- “you don’t ever give the medications much of a try anyway!”. I am careful to keep my composure in public, but I was distraught and in tears. I stood out in the parking lot, with my friend, sobbing. To note, I am not an angry person, I rarely raise my voice and if I am upset I do not yell, I just start to cry. This was not an instance where a psychiatrist had a client who was acting inappropriately or threatening them. I went home and sobbed, I was feeling pretty hopeless; here I was barely functioning with increased anxiety and social anxiety and my trained medical providers were not only not helpful, they were leaving me distraught. As terrible as this experience was, I thought about how much worse it could have been for someone else who may have been suicidal, who did not have a friend or who did not have the support system that I did. The results could have been not just traumatic, but much worse, even potentially deadly. I was having so many memory and sleep problems at this point, I finally gave up trying to set appointments with my psychologist; I was falling asleep for hours during the day and unable to recall things from moment to moment even with reminders. I continued to do poorly emotionally, but this ongoing emotional state and so many setbacks seemed to be affecting the rest of my body. As usual, a very bad incident resulted in my finally getting the help I needed. I had stopped all the new medications my psychiatrist had been giving me and stuck with the originals. However, I continued to very slowly reduce my antidepressant. One day, I woke up in the night incredibly angry, I don’t recall ever feeling so angry in my life. It was quite terrifying, I tried all the behavioral things I knew- music, meditation, writing, exercise, etc. Nothing helped, I was not only full of anger, I began to feel scared, not that I would do something dangerous, but because I could not figure out how to regain control. It was also such a terrifying feeling because it was completely unfamiliar to me. Don’t get me wrong, I get angry-- PMS, my ex-husband, drivers who cut me off, co-workers, bosses, bullies--fairly typical stuff. However, this was on a whole new level. The only thing left to do was pray, I spent the entire night unable to sleep and battling this anger. I pled to my Father in Heaven for help all night. I was exhausted, but still unable to sleep, in the morning, in an effort to try to distract myself, I decided to respond to email. I have a friend who has bipolar disorder; she has battled with it for her entire life and has many more years of experience. However, I don’t think of her, as my friend with bipolar, in fact most of the time I never think of it. That morning, I needed to respond to an overdue email from her. She immediately responded back. When I realized she was at home, I called her. She asked how I was doing, I told her about the awful night I had had and this terrible anger; she immediately responded, I know what you are talking about. I am not a doctor, but I would suggest you take an extra dose of your mood stabilizer. I had never done that nor thought to do it; I was certainly desperate and figured it was worth a try. I hung up and took the extra dose; almost immediately I relaxed and fell asleep. I slept for hours. I don’t recall if the anger went away completely, but it was no longer causing me serious problems. About two weeks later, I finally set and remembered to go to an appointment with my psychologist. He and I spoke about all the things I had been going through. When I told him about the anger, he immediately knew why it happened. He asked me how quickly I was reducing my antidepressant; I told him and he said that I was reducing it much too fast. He said he had clients who had experienced the same thing when reducing the same antidepressant too quickly. Currently, I am waiting to see a new psychiatrist (it takes three months to get an appointment with her). I am very optimistic because I recently returned to the PCP who I had been seeing 10 years ago when I was diagnosed and who had worked so closely with my psychiatrist; he is the one who recommended her. He knows and has worked with this psychiatrist for years. In the meantime, he can prescribe the medications that I need. In a later post I will address, in more depth, the antidepressant I was reducing, Effexor XR. On my own, I eventually made the decision to stop reducing it. I went back to my original dose- it made a significant difference and helped restore hope that my life was going to improve. As always, thank you for taking the time to read this post and please feel free to comment or contact me. If you have read my previous posts, you are now aware that they are very lengthy. I am trying to write in the most authentic way possible and this is how it comes out- in a lot of detail. Hopefully, the patience of wading through it is worthwhile. Thank you for continuing to share this blog with others, it is my greatest hope that my experiences will help someone.
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