Thursday, August 4, 2016

Adventures with my legal drug dealer!

That's a normal nickname for your psychiatrist, right? Since I had already established a relationship with a therapist and the hospital obviously started me on medication, it meant I had to find a psychiatrist solely in order to keep being prescribed the meds. I didn't know much going into this process, mostly because I'd grown up terrified of being dependent on outside help and believed I should be able to handle everything on my own. And lemme just tell you how well that worked out (spoiler alert: it did not).

For whatever reason, when I started seeing a counselor at 16, I also had to make monthly visits to a psychiatrist. If that was part of a master plan to get me on meds, then thank god I was a minor and my parents could weigh in. When my dad was in the Air Force, he briefly worked in a psych ward for the returning veterans with the worst-of-the-worst PTSD and addictions. He watched as the nurses forced pills on them and basically they became medicinally lobotomized. The patients shuffled around mindlessly like zombies, he recalled, and that's something he wouldn't stand for when it came to his daughter. Granted, that was the late 70s/early 80s and psychiatric medicine has come such a long way, but we had no familiarity with the field and it just didn't feel right then. I don't know if the psychiatrist was personally affronted by this decision but he sure as hell wasn't happy with me. I remember him being very cold and dismissive of me, which let me clue you in, dear anyone working in mental health: NOT A GOOD WAY TO DEAL WITH PATIENTS. Short of abuse, it has to be one of the worst things they could do.

After a while, my counselor decided I was in a good enough place to terminate the sessions, and I really felt like I was. When the violent mood swings resurfaced, I felt so much shame at the thought of having to continue therapy, but it was my distrust of psychiatrists that kept me from returning. Fast forward a decade and I found myself checking in at a treatment facility where medication is essentially mandatory. You can refuse to follow the doctor's suggestions or medication plan, but that results in an AMA (Against Medical Advice) and that will almost certainly lead to your insurance company not covering your stay because there is "no active treatment." Which, to the tune of $700/day at the hospital I chose, hahahahaha no.

So there I was, fresh out of my eight-day stint in the loony bin, with two brand-new medicines pumping synthetic chemicals through my body and some pretty intense reactions. Being bipolar, you have to carefully monitor the ratio of anti-depressant to mood stabilizer (the fancier name for anti-psychotics, so fancy!) and when it's off, oh, you'll know. I was thrown into an actual manic episode when the worst I'd dealt with were the hypomanic ones and at the same time, I started experiencing akathisia- think restless leg syndrome but in your whole body. Not awesome, 0/10, would not recommend to a friend. But I had a mission to find myself a psychiatrist, and dammit I was gonna do it by the next day! No problem!

... Except so many problems. So, so many.

My insurance may not be super great, but they still provide a decent network. I called and emailed every. single. doctor covered under my plan and only ONE emailed me back, because she actually takes time out of her schedule to respond to potential new patients, but unfortunately I just didn't feel a connection with her. In fact, I even called one number to find out it was a facility not even related to mental health but for whatever reason, insurance companies kept listing it. So fun! Now I had expanded my search to any affordable psychiatrist in the Cincinnati area. I felt most desperate when I called my last hope, a hospital with a behavioral therapy wing, only to find every last one of their doctors was booked indefinitely. Knowing I'd soon be dishing out a crazy amount of money, I finally asked my therapist for referrals. With a manic episode refusing to cease and hysteria escalating as quickly as my prescriptions were dwindling, I began leaving slightly frantic messages explaining my situation and could they please, please at least return my call to let me know if they were even accepting new patients. Silence. It wasn't until the next day that a psychiatrist fiiinaaallyyy called me back, but I hadn't even heard of her. She was previously involved with private treatment facilities and was now taking on patients of her own, working at an office with several of the doctors I'd called and heard nothing from. After over two weeks of searching, that was the most wonderful, joyous relief I could've ever felt.

Launching into this new phase of my recovery was wild. We talked about my meds and adjusted the dosages. Even though she wasn't particularly thrilled with my combination, she was hesitant to switch them just yet. However, the mood stabilizer gave her some concern, since it's known to cause heart problems in some people. Off to urgent care I went to get an EKG test read just to make sure there were no issues. Free and clear there, but we still weren't comfortable with the potentially damaging long-term effects (it did jack up my cholesterol). So we introduced a new mood stabilizer that has to be gradually built to the full dosage over the course of a few months to ensure you don't die. Literally. The tell-tale symptom is a rash most commonly found on the torso, but could appear anywhere on the body. If it shows up and you continue taking the pills, you're dead. And here I am, fairly heavily tattooed including a good chunk of my stomach, trying to keep my rising panic from making me run screaming out the door. Swallowing the massive lump in my throat, I agreed. Fun fact: it was initially developed to treat epilepsy and somewhere along the way scientists realized it was effective in managing bipolar disorder, what a world!

But along with this new medication came a new side effect. Insomnia. I tried for several weeks to naturally fall asleep, like keeping up with my melatonin, increasing the dosage to over 20mg. Making sure I wasn't watching tv or checking my phone right before bed. Taking baths. Working out. All of this to no avail. I wasn't sleeping, it was causing an enormous physical strain, and so the only option became sleeping pills. I'm now officially on medicine for my medicine. I've been at my final dosage of mood stabilizer for a few weeks and am feeling incredibly stable. We may or may not have to adjust my anti-depressant again, but we're just playing that by ear. The sleeping pills are absolutely necessary; after a few days of intense physical work I'd fall into bed exhausted as soon as I got home and without fail, just like it used to be, I'd wake up around 3am and stare at the ceiling for hours. While the pills don't knock me out cold, they help me to stay asleep, but I started noticing that once again it was becoming increasingly difficult to get out of bed. And again, we made another dosage adjustment. When my horrifying panic attacks-meets PTSD-meets psychotic breaks started creeping back in, we threw in more pills, a mild sedative that for now I only have to take as needed. Fingers crossed the changes made at this most recent appointment will be the ones to unlock the magical combination.

I've been on my psych med journey for five months. I'm incredibly lucky to have made this much progress this early on, but I'm guessing it has something to do with having avoided medication for so long. Aside from the mood stabilizer, my doses are very low and my doctor makes sure we're only focusing on non-addictive, effective solutions. I only see her for 20 minutes once a month, but I absolutely cherish her and I'm so happy I ended up as her patient. No matter what kind of mental health professional you choose, the very most important thing is to have a connection with them. I can't emphasize that enough! If you don't trust the person you have to be completely 1000000% open and honest with, you are not going to like it. Even worse, it will be wholly non-beneficial to you. 

There are only a few more things I want to address and then you can get back to playing Pok√©mon Go or making memes or whatever it is you do on the interwebs. The only difference between a therapist/counselor and psychologist/psychiatrist is the former are certified professionals with or without degrees while the latter have received advanced degrees, almost always doctorates. Also, psychiatrists are required to be medical doctors and because of that, they're the only ones who can write prescriptions. It's best to let your mental health guide you to which professional you choose- for serious mood disorders, medication is almost a must. Maybe you feel like simply talking and having a mentor there to help you sort out issues is best. Or go the route I did! I'm thrilled with my treatment team and wouldn't change anything. I have my weekly sessions with my therapist and monthly med check-ins with my psychiatrist. But keep in mind: it's going to cost. A lot. If you're one of the chosen few, your insurance may cover everything. Thankfully, incredibly, my meds are covered but the session fees are all out of pocket. Typically psychologists and psychiatrist are a wholeee lot more expensive; it's an absolutely necessary cost, but it can add up quickly.

This last bit is huge and I don't think I can stress it enough. When you are prescribed medication, know that it will be a process. Be completely honest with your psychiatrist. Some people receive prescriptions from their primary care physician which isn't necessarily a bad thing, they may not know! But those doctors only have a limited knowledge of mental health and it casts too wide a net and lumps too many disorders into general groups. Or even worse, deciding to take someone else's prescription because "they have depression and I have depression and it must work for both of us, right?" NO! Wrong, so wrong. Everyone reacts differently to medication and it must be something you start under the supervision of a doctor! Also, I've heard too many in the healthcare field adhere to, "well if there's a pill to make it better, why not?" Long-term side effects aside, the point of psychiatric medicine isn't to erase your disorder completely. In an ideal world, your prescriptions help you become ready to delve into your treatment with the end goal of recovery and being able to manage on your own. But sometimes the best treatment means you may be on medication for life, and that's ok! It's a piece of the puzzle that is immensely helpful when you integrate it with therapy, drawing on resources and mindfulness to build yourself back up from the foundation that mental illness works so hard to destroy. When you feel you've reached that point, it is highly, highly important you discuss this with your doctor so you can begin tapering off.  I can't tell you how many people I saw in the hospital who take their meds, feel great, decide they're ready to quit, and end up being admitted as a patient yet again. It broke my heart to see them so confused in their regression, so that's why I'm fighting so hard to educate anyone and everyone. Through being vulnerable, as uncomfortable and terrifying as it can be, we share our experiences and come that much closer to fostering a community and showing the rest of the world we are not our diseases: we are fantastic, remarkably strong humans with such potential!

"Don't be ashamed of your story, it will inspire others." Unknown

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