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Considering ECT

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Major Depressive Disorder. poorly functional. I go to work. Medication resistant, i have tried them all. I have tried all the medications out there for depression and bipolar. Abilify etc. I have been seeing a therapist for eight years. She is highly respected in her field. I am in the process of changing therapist because I feel stuck and this is the only thing that I have not tried. I’ve seen several Psychiatrist and have been told this may be as good as it gets and I would just have to try and cope with it or find a way to transcend my depression. I fired this guy. I’m exhausted from this daily struggle. occasionally think of suicide. cant hurt my kids that way. I am thinking about ECT. but am afraid. I don’t know how to find the best dr for this and am afraid of cognitive loss, memory loss. I also have learning disabilities and ADD. So I don’t want to aggravate these conditions. I am also aware that my depression could be causing the learning disa and ADD or at least making them worse. I feel like I’m on a merry go round with this. How safe and effective is ECT?

I’m sorry to hear that you have been struggling. It is very encouraging that you are in the process of finding a new therapist. You felt “stuck” with your former therapist. Changing therapists can make a major difference. You are already doing what I would’ve suggested that you do.

It is also good that you fired your psychiatrist. You did not believe that he was helping. You may want to consider seeing another psychiatrist but if you are not interested in medication, then maybe not.

You are in the process of changing therapists and it is very possible that this change will be quite beneficial. You may not need ECT, depending on the outcome of therapy.

ECT is usually the recommended treatment when other treatments have failed. I would suggest giving the new therapy a chance before making a decision about ECT. In the meantime, you should research ECT from every possible angle. Do as much research as you can. The following resources should help you get started:

An Overview of ECT Treatment

ECT Treatment from the Mayo Clinic

Shock and Disbelief from The Atlantic Monthly

The most common side effect associated with ECT is memory loss but that typically only occurs after many treatments. There are numerous myths about ECT and they are commonly based on fear and ignorance. ECT both looks and sounds frightening but many people have claimed that it has saved their lives.

I would encourage you to review its advantages and disadvantages. Do your research and let that include speaking with others who have undergone ECT. Withhold judgment and a final decision about ECT until you have completed your research. Only then will you be in a position to decide whether ECT is right for you.

I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Need Help With My Psychosis Diagnosis

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have been hearing voices for about 12 years. Sometimes I can hear them very clearly and cannot determine if they are real or not. Other times they seem faint and I cannot clearly make out what they are saying. When I go to the store, I believe that I hear people talking about me in there heads, as though I can hear their thoughts. I became very depressed about 3 years ago and the voices were telling me to kill myself, and one night I actually tried.

For as long as I can remember I have felt as though someone is watching me all of the time. I’m even afraid to step out the house at times. I finally started seeing a doctor about a year ago. He prescribed Abilify for my symptoms and after a few weeks, my symptoms started to become minimal. I asked him for a diagnosis and he said that I have psychosis NOS. I don’t like this diagnosis because it does not clearly tell me what I have. My 13 year old daughter is starting to hear the voices too. She thinks that I am saying negative things to her or thinking them in my head, but I’m not. Is it possible that we have some form of schizophrenia? Thanks.

Psychotic disorder not otherwise specified (NOS) is a diagnosis often given to individuals who experience psychosis symptoms but who do not match the criteria for other psychotic disorders such as schizophrenia or schizoaffective disorder. It may be possible that you have a type of schizophrenia and were diagnosed incorrectly. If you are unsatisfied with your current doctor you should seek a second or even a third opinion.

The fact that your daughter is hearing voices is a major concern. If you haven’t already done so, have her evaluated by a physician. During the evaluation, be certain to report your symptom history. This information can help the evaluator better understand what may be happening with your daughter.

Seeking out alternative opinions may help. The only way to know for certain would be to try. What I find encouraging is that medication has almost completely eliminated your symptoms. It is important to emphasize this great news.

Be careful not to spend too much of your time and energy searching for the “right” diagnosis. Psychiatric and psychological professionals use the diagnostic and statistical manual (DSM) as a guide for diagnosing mental health disorders but it is not a perfect system. Individuals often report being evaluated by several mental health professionals and each time, receiving a different diagnosis. Each evaluator believes his or her diagnosis to be the most accurate. It is difficult to know which one is the most correct.

Does the cause matter more than the cure? I am not certain. It is a difficult and perhaps impossible question to answer. Legitimate arguments can be made for both sides. In my experience, it seems that finding the best and most effective treatment is much more important and meaningful than finding the “right” diagnosis. I wish you the best. Please take care.

Dr. Kristina Randle

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Combat Vet needs help

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

I am a Combat vet, Iraq 05-06 right before I deployed I lost both of my parents within a month( natural causes) three weeks later I was in the thick of it in Bagdad, when I came home I was fine for about 4-5 months then I started getting depressed and having anxiety attacks. I sought treatment from both the civilian and military doctors, nothing helped. I just recently lost the last of my family, my brother due to cancer. I am still experiencing all of the symptoms and now I am starting to see things out of the corner of my eye, dark movements. I do not want to talk to anyone or be around people, I also find myself almost wanting to put myself in situations that that would give me the chance to hurt someone, especially when I am angry. I also am starting to have thoughts that (Not that I would do it) things might just be better if I were not around never been born etc.the doctors have given me all sorts of meds Cymbalta, Abilify, Xanex, Welbuitrin nothing helps “try Deep Breathing” “relaxation” whatever it doesn’t work. I know I need to go back to the doctor but I know all they are going to do is say ” try this drug, or try that one” what do I really need to do?

A: You’ve experienced multiple losses and trauma. Your whole system is saying, “Enough. I can’t take any more.” It’s understandable. It’s normal for symptoms to return. It hurts. It hurts because it is emotionally painful. And it hurts to feel like you’re losing control. Of course you’re depressed and anxious.

By all means, go back to your doctors for a medication evaluation. But I don’t think medication and calming routines are enough. I think you need the “talking cure” as well. Underneath the depression and anxiety is a layer of grief and rage. Although medication can help you feel better, those problems can’t be just medicated away. You need time and a safe place to mourn your family and to work through the trauma. If your local VA doesn’t offer group and individual treatment for PTSD, I urge you to find a clinic that does. Specifically look for a therapist who has experience working with military personnel. If you have a spiritual life, I also urge you to look to your chaplain for support for your losses. It’s especially hard to feel orphaned and without the comfort of family when we feel out of control, confused, and emotionally upset. Do try to remember that you carry the people who loved you within you and they would want to help you get to the other side of this.

Finally, make sure you are getting some exercise. As tempting as it is to withdraw and do very little, that will only contribute to the problem. Inactivity reinforces depression. A power-walk or run or playing a little basketball (or whatever other sport you like) can reduce your anxiety and produce endorphins that will help mitigate the depression. Unless your doctors advise otherwise, commit to at least 30 – 60 minutes of breaking a sweat every day.

Thank you for all you’ve done for the rest of us. I am truly sorry you are now going through such a hard chapter in your life. I do believe that honoring your experiences and your grief with time and therapeutic attention will get you to a better place.

I wish you well.
Dr. Marie

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Worried About Getting Worse

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have been diagnosed with major depression, but I think I may have something else. I am worried i could be a danger to others.

I often have fantasies of poisoning and hurting other people. I feel an incredible urge to poison and when I did I felt a rush of adrenaline. I actually liked it. I have already poisoned one woman I roomed with. I was kicked out of that lodge for that and sent to the hospital. They put me on wellbutrin XL for my depression and abilify for my psychosis. I don’t think they are working. Aside from my violent fantasy’s I am a cutter. I have intentionally overdosed to hurt myself. I am often suicidal. Everyone in my family is dead and I have not really dealt with that yet. I am a binge eater and sometimes I throw up my food to get rid of it. I have an imaginary world I escape into even at my age. I often feel like crying. I want a relationship but always break them off after around 2 weeks. I don’t have many friends because I am very self conscious. I sometimes steal small things from other people’s houses and cars. I feel no remorse for this but I know it is wrong. At this point I have been able to fight my urge to hurt someone else, but It is a struggle and I feel I will eventually lose. I often feel the best way to make sure other’s are safe is to kill myself.

I am at a loss as to what I should do. Somebody please help me! I am miserable and I hate myself.

If you believe that you are a danger to yourself or someone else then go to a hospital immediately. The hospital can keep you safe. When you go to the hospital tell them what you wrote in this letter which is that you have a strong urge to poison someone. You should also inform them that you have harmed someone in the past and that you’re worried that you may do it again. They will likely hospitalize you and you can get the help you need immediately.

My main concern is that you seem unable to stop yourself from harming people. You have succumbed to your impulses in the past and that is concerning. You may need to be hospitalized at this time but you also should consider entering an intensive treatment program. Perhaps it is the psychosis that is driving you to want to hurt yourself or someone else.

Perhaps there are other explanations for why you want to harm yourself or another individual. As you mentioned you feel a sense of pleasure when you think of hurting someone. That sense of pleasure needs to be addressed and extinguished. That may be accomplished with a partial hospitalization program, a competent therapist or a team of therapists. The desire you feel to harm others or yourself is not something that should be ignored. It is not normal or healthy and it may be dangerous.

As I mentioned above, if you believe that you may harm others or yourself then go to the hospital. If there is no immediate danger then the hospital may not be helpful but treatment for these issues is strongly recommended. You should contact a therapist or an intensive treatment program as soon as possible and enter treatment. A therapy program could help you address your issues. Perhaps you could learn to redirect your unhealthy impulses toward a healthier outlet.

I am encouraged that you recognize that there is something wrong. I hope this recognition means that you are willing to attend treatment. You have already harmed someone and were punished, albeit not very harshly. At this point in time you recognize that those destructive thoughts have returned and you feel the urge to repeat your actions. Now is the time to do what is necessary to prevent a tragedy. At this juncture, your thoughts are only thoughts. Thoughts cannot harm another person but they may eventually lead you to engage in a serious or deadly crime. It is your responsibility to seek help for this problem. If left unchecked there is a chance you could seriously harm or kill another person and may be imprisoned for the rest of your life. You may even be given the death penalty. For the sake of yourself and the lives of innocent individuals please seek help immediately. Here is a website that may assist you in finding a therapist in your community. I thank you for your question and hope you will get the help that you need.

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Mom With Auditory Hallucinations

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Hi! A blessed day to all! I want to ask how to deal with my mom who has auditory hallucinations. She always (all the time) hear voices of her cousin saying many negative things such as our unit was previously owned by her cousin and wants it back. She also hears that they are going to kill us. That causes her to panic and believe that all she heard was true. My mom does not see her cousin for about 30 yrs. Last Christmas eve i brought my mom to the church to attend the Christmas eve mass and she ask her seatmate if she was her cousin. She also thinks that there is a camera in our sprinkler in our unit. I brought my mom to the psychiatry and the doctor does not addresss us what she’s been through. The doctor only prescribe Thozarine and take this medicine at 200mg a day (50mg on breakfast, 50mg on lunch and 100mg on dinner)for 2 weeks but after taking the first 100mg she does not want to take anymore because she feel very drowsy and cannot concentrate in her work. She also thinks that we are thinking shes crazy. Please help me what can i do to help her. She does not accept that what she hears are all came from her mind. Please also advise me how will i deal with her. I love my mom so much. I will do anything in order my mom can live the way she had before. Thank you very much and Godbless!!

I am sorry to learn about your mother’s condition. It seems as though she is experiencing auditory hallucinations, delusional beliefs as well as paranoia. It’s good that she was willing to attend a doctor’s appointment. But now the problem is that she doesn’t like the medication because it makes her drowsy and interferes with her ability to work.

As you said, she does not believe that what she hears is originating from her mind. She believes that what she hears and thinks is completely real. For this reason it must be a frightening experience for her to believe that her cousin is attempting to kill her and her family. Living in a world of psychosis is a frightening way to live. Those who can recall the experience and are willing to speak about it recount it as a hellish and confusing time.

As you recognize the idea that a cousin is out to murder your family is delusional. So is the idea that there is a camera in the sprinkler unit. Even though she believes in these ideas it’s best not to argue with her about why you’re right and she’s wrong. That’s because no matter how much evidence you provide to prove your point it’s probably not going to be enough to convince her otherwise.

The best way to deal with this situation is to convince her to take the medication. Medication is the most effective way to reduce or eliminate psychotic symptoms. Without the medicine her psychosis will likely become worse. That’s why you need to do what you can to ensure that she takes her medicine.

At this time, the main reason she cites for not wanting to take the medicine is drowsiness. Suggest to her that the both of you revisit the doctor to ask if he can lower the dose of medicine. Maybe your mother would be willing to take a lower dose of the drug. A lower dose might reduce her side effects.

You and she could also ask the doctor for an alternative antipsychotic medication. I am not sure what medications are available in your country but in the United States there are several newer antipsychotic medications patients can choose from other than Thorazine. In fact, U.S. doctors rarely prescribe Thorazine. That’s because it has many unpleasant side effects that can be difficult to tolerate. Some of the more common, newer antipsychotics prescribed by U.S. physicians include Zyprexa, Risperdal, Seroquel and Abilify. Inquire whether any of these drugs are available. Recent research shows that newer antipsychotic drugs are equally as effective as some of the older drugs (e.g. Thorazine or Haldol) but their side effects are more tolerable.

Many people with psychotic disorders do not believe that they are ill and thus refuse to take their prescribed medications. Because of this it can be a struggle to convince them to take their medicine. Approach this situation with the goal of making certain that your mother consistently takes her medication. This might be the only way you can help your mother restore her quality of life. I hope this helps. Thanks for writing.

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No Meds for 4 days…and counting

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Q. I have not taken my medications for four days. I want to know if I should be having negative impacts from not taking the medication yet, if not when should I expect to see any of that? I am on Abilify 10mg, Prozac 20mg, and Adderall 30mg. My diagnosis that I recall off of the top of my head are PTSD, Borderline Personality Disorder, Anorexic Tendency/Behavior, Generalized Anxiety Disorder, ADHD (Inattentive Type), and Major Depression. (at least this is most of what was listed on my last psych evaluation in 2004.)

At my last psych appointment my Doctor advised me to have the pharmacy call her in regards to any refills that I needed aside from the one that she wrote for the Adderral. When it came time to get my medication last week I was and still am quite reluctant to do so. I have a tendancy to avoid things for no good reason, other than the interaction and possible negative outcomes that I foresee.

For these reasons I am reluctant to call the pharmacy, I have dialed the number to the pharmacy, only to hang up while on hold. I think I feel like I will be bothering them, or maybe they will tell me that I need to have the paper prescription in order for them to fill them. I thought about calling the Psychiatrist and asking her to write them out for me, but I know she is busy. I guess another thing to mention that I have a strong feeling I will be judged for getting my prescriptions filled late now by my doctor as well as the pharmacy technicians. I am also feeling reluctant to see my Doctor later this month because I did not fill them on time.

On a good I am actually feeling really good surprisingly. Aside from the fact that I have not been sleeping much, I have gotten a lot accomplished. I don’t want to go to bed. I think that I am really enjoying the peace of my four children in bed to get things done and have some “me” time. I have been doing projects with my kids, took them on a leaf hunt today for my daughters homework assignment. I called about 3 friends today, though only one of them actually answered and could only talk for a short time. ( I guess that is what I get for avoiding there calls so many days) I am not completely isolating from people outside my home since I actually took some time to attempt to talk to some people on the phone. I packed up all four kids in the car and ventured out to get a coffee this am and even gave my seven year old money and let her pick out muffins for all four of them. We Sang songs on the way home.

I don’t feel depressed at all as of yet, only a little overwhelmed with everything i need to do, which is actually somewhat normal and a little down on myself for the medication issue. The only adverse effect I am having so far is that I start to do something and I get too deep into the project and then end up doing 5 other projects or ideas but never complete any of them, which I am guessing is symptoms of the inattentive ADHD? For instance… I sat at my computer to print a worksheet for my daughter to practice her penmanship, then I started to sort digital pictures I have on my computer when I could not find the worksheet to print out because I was frustrated at how disorganized my files were. This was at about 7:00 pm, since then I never did get to printing the worksheet, I have signed up for a blog site, downloaded a time management tool. Wrote a poem, started to look for a picture to go with the poem, started to completely revamp the poem for the picture that I picked to go with it. I looked up what kind of projects I could do with the dremel tool that I have gathering dust, and of course somehow wound up here in the process of doing those things. It is 2:08 am to give you an idea on the time frame that this took place.

Part of me really wants to just quit taking the medication all together. Wouldn’t I be feeling worse by now if I needed to be on the medication still? How long would the adverse effects of not taking the medication take to arise in my moods? Are some medications more important than others to be taking?

You are suffering from the “I feel better and I do not see why I need these medications anymore” syndrome. What this means, from what I can tell from your letter, is that you have made a conscious choice not to take your medications. This is probably because you are feeling good and think “if I am feeling so good then why are these medications necessary?” The problem with this thinking is that it is very likely that in the near future you will not be feeling so well and your symptoms (the symptoms that caused you to begin the medications) may return. You may also have adverse effects from the abrupt discontinuation of your medications. To know for sure what these adverse effects will be, I strongly advise that you to contact your prescribing doctor.

I can understand not wanting to take the medications anymore. Many people have unpleasant side effects and medications do have a tendency to alter a person’s personality. But please know that there are healthy ways to discontinue taking medications and there are unhealthy ways. It is not in your best interest to stop taking your medication on your own. This practice is very unhealthy and potentially unsafe. If you want to discontinue your medication regimen, then I strongly suggest that you contact your doctor or make an appointment to discuss the proper way to titrate safely off of the medications. You also should consider calling or making an appointment with your doctor to tell him or her that it has been four days since you last took the medications and you want advice on what to expect with regard to adverse effects.

I am sorry that I could not be more specific with regard to telling you what negative effects to be on the watch for in the next few days or weeks but that is because your medication-specific questions are most appropriate for your doctor. I know that you do not want to “tell on yourself” for stopping the medications but it is better to get the advice of a trained medical doctor who knows your case well than to just “wait and see” what happens to you. Take care.

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