Thursday, April 28, 2016

Medication and treatment.

I wanted to talk a little bit about medication on here since it is not addressed a whole lot, especially in specific terms and experiences. There is a lot of resistance in the world to taking psychiatric medication, but I really believe they can do a lot of good for those who need them. There are many people living lives significantly impaired by poor mental health that keeps them from accomplishing things, focusing on tasks, feeling satisfied with themselves, and being happy and content in their life. Untreated mental illness can result in a person spiraling downward, losing friends, opportunities, jobs, etc., or even turning to self harm or substance abuse to cope or taking their own life. All of these are travesties that could be avoided if we all took mental health more seriously and encouraged everyone to take preventative measures (cutting back on stress, building a positive outlook, learning good coping mechanisms, etc.) as well as monitor their mental and emotional state and get help and follow medical advice when things get bad, just as you would seek help for a fever that wouldn't go away or a broken leg.

Going on psychiatric medication is a really big treatment step. Personally, I was resistant to it for years even though I knew I had mental health problems that were affecting my life. I wish I hadn't waited until things got as bad as they did before I sought help, and it saddens me to meet many people dealing with mental illness who refuse to consider medication or any other treatments. I know it's a difficult step to take and it should be done with thoughts of thought and discussion with one's doctor and psychiatrist.

Here, I want to offer some advice to other people dealing with mental illness who are considering going on medication. I'm not a medical expert, of course, so don't take my words as gospel truth, and everyone's experience is different, but as someone who has gone through the process of going on medication, I wanted to share some recommendations to those unsure or anxious about this new step.

First off, I'd like to address when you should consider seeking psychiatric help, such as counseling, hospitalization or rehab programs, or going on medication:

  1. If you find yourself in a near-constant state of emotional distress and/or mental stress for a significant amount of time, particularly if that distress is unrelated to any particular circumstances in your life.
  2. If you find that your anxiety, depression, mania, or other symptoms are inhibiting you from living a fulfilling life, functioning each day, engaging in social activities, and/or being reasonably content. If your mental illness is affecting your work and school performance and relationships, it's definitely worth seeking treatment.
  3. If your emotional distress is causing you to engage in dangerous or harmful behaviors, such as self-mutilation, drinking or substance use (particularly to numb emotions or lower social inhibitions), extreme dieting or exercise, or purging behaviors, etc. (If you have thoughts of suicide, plans to take your life, or just a desire to die or end your life, please do seek help. Those thoughts are reflective of a shift in the chemicals in your body and don't need to make you lose hope or choose to end your beautiful life. If you are experiencing such thoughts or temptation to harm yourself, please text "GO" to 747-747, the Crisis Text Line to speak with a trained, compassionate counselor. You're worth it!)
  4. If you have multiple mental health issues (called comorbidity) that don't go away. I think particularly of those with anxiety problems and depression and perhaps even panic attacks as well. While all of these issues can be experienced at one time or another by most members of the population, experiencing them every day for long stretches of time indicates that one has a brain more predisposed to these issues. Also, having multiple mental health issues that are recurring or consistent can be an indicator that your issues are chemically-induced and need to be addressed with medication or medical supplements in order to be managed. This, of course, isn't a hard and fast rule, but is something to consider.
  5. If you are having difficulty sleeping or are sleeping too much because of your problem. This can indicate bipolar disorder in some cases (not sleeping - mania, over-sleeping - depression) or panic disorder (I was only able to sleep three hours a night for a month because of bursts of adrenaline at night resulting from panic disorder and had to go on medication to address the issue) or depression (lethargy and sleeping too much) or other anxiety or mental health issues. If your sleep patterns are being affected, this can definitely indicate that your brain and body chemicals are out of balance, Not to mention,your interrupted sleep cycle can take a further toll on your emotional, mental, and physical health and work, job, and relationship performance, so it needs to be addressed.
  6. If your principal care provider, therapist/counselor, caring friend or family member, or other medical care provider recommends it. They want what's best for you and can tell something is wrong...consider taking their advice. The process is difficult, but consult them for help and support.
In any of these cases, I would recommend taking the following actions:
  1. Speak with your primary care physician, counselor, or a trusted friend or family member about your decision to seek help and get their recommendations as far as treatment options and local psychiatrists or rehab or out-patient centers.
  2. Consider enlisting a psychiatrist on your medical care team and/or a licensed therapist as well. You can Google people near you, ask friends who you know have seen some one, go to your school's counseling center (if you have that option), or look on Psychology Today's psychiatrist or therapist finder. Read their website, search for reviews, and call and ask for a preliminary 30-minute or so consultation before committing to them, particularly with a psychiatrist, to make sure you feel comfortable with them, feel relaxed, and are able to connect well. I really recommend seeing a psychiatrist for guidance if you are considering medication because they know a lot more than primary care doctors about different meds, the way they interact, etc. and have a smaller caseload and have more time and ability to follow up with you about your medication than GPs. Medication can get complicated so it makes sense to go to a specialist, y'know. It's expensive but once you get settled in with the doctor, you may only need to do 15-minute visits every so often or even phone calls. Consider the money an investment in your health...money well-spent, indeed, because you matter! (Yeah...it's still hard to part with)
  3. Do your own research on your condition and the medications and treatments available. Some good resources are the National Institutes of Mental Health, the Anxiety and Depression Association of America, and the National Alliance on Mental Illness. Also, all medications have extensive information about them online, and you can typically find reviews from people who have taken them through a quick Google search. I definitely recommend doing some of your own research on medications in addition to getting a doctor's guidance because, sadly, there are some not-so-great doctors out there as well. Perhaps enlist a trusted, supportive friend or therapist to help you with this task and do some research of their own. Check to make sure this is a medication advisable for someone of your age, gender, and medical state to take. Make sure you don't take a conflicting medication or have another health condition that could be made worse by that particular medication. Ask your doctor about these things as well.
  4. Develop a healthy exercise, diet, and daily routine with the help of your primary care physician and therapist, if you are in a stable enough mental state to do so. This can help with reducing stress and anxiety.
  5. Pair medication treatment with therapy or other similar treatments. Make sure you have all your cases covered and are getting help with processing through what you're going through as well as developing healthier ways of thinking and coping with stress. Most of the time, treating a mental illness requires a change in lifestyle and thought patterns in order to really help resolve the issue. If you're not much for talking, consider art, dance, drama, music, or writing therapy to give your emotions an easier outlet (you don't have to be talented in any of those areas to seek therapy in it!)
Should you decide to go on a medication as part of your treatment plan, I have a few recommendations based on my own experience, positive and negative, going on medication:

  1. If possible, take a genetic test to determine which medications your body can process well. This is an emerging practice throughout the medical community (not just psychiatry), as I understand, particularly for people who are not responding to any medications they try. I had it done after I spent a year on a variety of medications but only saw my condition worsen. It pains me to think of all the heartache and misery I could have bypassed had I taken this test before plowing into trial-and-error territory and screwing up my body taking medications I couldn't actually process. Ask your psychiatrist if this is an option for you.
  2. Have your psychiatrist screen your for bipolar disorder, particularly if you are planning on going on an antidepressant. Antidepressants can trigger manic episodes in people who have bipolar disorder. Since people with bipolar also experience depression and often seek treatment for their depression and not their mania, they can end up misdiagnosed and in danger of making their bipolar worse by taking an antidepressant. Your psychiatrist or doctor should screen you before prescribing the antidepressant, but if they don't, ask them to (or maybe go to a better doctor), especially if you have a family history of bipolar. See the symptoms of bipolar disorder here.  (Symptoms of mania include speaking rapidly, needing little sleep, engaging in impulsive and reckless behavior, being extremely energetic, or sometimes feeling irritable. If you have experienced multiple symptoms for more than a day, please see a medical professional as you may have bipolar disorder. Nothing to be ashamed of...you're in good company! Some incredible people have had this disorder as well and today it is quite treatable.)
  3. Let someone trusted and supportive know when you're going on the medication and what the possible side effects are. Ask them to check up on you and give them the contact information of your psychiatrist, doctor or therapist in case of an emergency. Also, keep handy the contact information of some help lines (such as Crisis Text Line) as some people can experience a worsening of their symptoms while adjusting to medication, including experiencing suicidal thoughts. If this happens to you or you find yourself experiencing other problematic symptoms, especially physical ones, don't hesitate to get in contact with your doctor or therapist.
  4. Make arrangements with your health care professionals to check in. Talk with your psychiatrist before you start about how best to contact them to check in about your medication. I was never really clear on what the best way to contact my doctor was, which led to some issues in communicating about my medication reactions. I was never sure what to do if I had an emergency either. If I went back and redid things, I would have discussed this with my psychiatrist to keep myself safer and save some headaches. Also, I wish I had agreed to meet with my counselor twice (instead of once) a week during those times too, since I didn't do well on the medication and could have benefited from closer monitoring. Make sure you have plenty of avenues to communicate with people if you need help.
  5. If you are able, clear some time in your schedule to start medication. It can be a bumpy process to adjust to having new chemicals in your body, and many people experience side-effects the first couple of weeks even if they later have virtually none. Talk with your doctor about when might be the best time to start, based on your schedule, avoiding particular busy or stressful times or events when you need a lot of physical or mental stamina (final exams, business trip, etc.) Consider taking some vacation or sick days or at least clearing your after-work schedule for the weeks when you start and give your body and mind plenty of rest.
  6. Make sure you go on the medication very gradually. Increase the amount you take in small doses every few days to the amount you and your psychiatrist agree on in order to minimize side-effects. The same goes for going off of a medication! I think my psychiatrist caused problems for me by putting me on and taking me off of meds with only a week-long weaning period sometimes. It wasn't fun. Even when I went off of a pretty low-strength medication (this time properly gradually), I took almost a month to wean myself off of it and I still experience side effects for a while after.
  7. Keep a journal of your symptoms, side effects, and emotions while starting the medication. I really wish I had done this as it would have made tracking my side effects in order to report them to my psychiatrist much easier. Jot down a brief outline of any physical side effects you've had each day and your emotional state throughout the day (again, brief).
  8. If your bad side effects don't go away or get worse, consult your psychiatrist about ceasing to take the medication. I ended up suffering for over a year because I was on medications I was having a bad reaction to. I wish I had been more willing to say, "This isn't working" and communicate to my psychiatrist that I needed to get off of those medications.
  9. Keep taking the medication until you and your psychiatrist agree you should go off of it, in which case you should do so slowly and strictly following your psychiatrist's guidelines. Don't be cruel to your poor mind and body by suddenly going off of your medication, even if you start to feel better. Suddenly stopping your medication can give you terrible side effects and make your original symptoms come back worse than ever. Some medications need to be taken for the rest of your life, as those for bipolar disorder or schizophrenia, while others can be ceased after a time should you and your doctor decide it's best. Should you choose to do this, discuss it with your therapist and psychiatrist and see if they agree with your decision. Then agree on a plan to slowly decrease the dosage and stick to it to minimize side effects and stress on your body. 
  10. Be consistent in taking your medication. Remember to take your pills every day to prevent unpleasant relapses due to missed dosages. Pill cases, alarms, and scheduling times to take your pills are all good ideas, as is highlighting the days on the calendar when you can/need to pick up your next refill. Call in the refill as soon as you are able to give yourself ample time to pick it up (I'm terrible about doing this but maybe I will learn to take my own advice).
I hope this is helpful and not too intimidating! I know that seeking treatment and going on medication are difficult and intimidating processes to go through, but they are so worth it. Even if it is a bumpy ride along the way - you may get stuck at dead ends or get hurt at times - it really can lead to a better life. I didn't believe four months ago that I would ever get better, but I am living a contented life, functioning normally and happier than I've been in years, hopeful for the future. I'm still working through past hurts and present grief, but because of the steps I've taken to take care of my mental health each day, I am able to deal with difficult things without being brought down by them.

So, please, even if it seems like nothing will ever get better and all your options have failed you, continue to fight for your mental and physical well-being! You deserve it and it's worth the struggle. There is hope.

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PS - Here are two websites that have been of great encouragement to be as I have dealt with mental illness: To Write Love on Her Arms and The Mighty.

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