Tag:

Antipsychotic

Do I Still Need Antipsychotic Medicine?

by Kristina Randle, Ph.D., LCSW January 10, 2010

written by Kristina Randle, Ph.D., LCSW

I was finally diagnosed in April 2008 with both Bipolar Disorder and Borderline Personality Disorder, after hiding this and not getting treatment for my entire 29 year life.

I became very unstable in the summer of 2008. I was highly suicidal, and had three suicide attempts and one manic episode in a two month period. I was hospitalized three times.

My psychiatric nurse practitioner put me on Zyprexa to stabilize me. It did work. But I also gained 80 pounds and became almost diabetic.

She finally switched me to Invega which doesn’t cause quite as much weight gain. I did lose 15 pounds quickly, but then gained it all back. It doesn’t help that I am also a binge eater and food addict.

The Invega makes me extremely tired for a full 12 hours from when I take it. I have to plan my entire night and morning around it. I am not able to drive anywhere after I take it, because I am too drowsy. So I cannot do any shopping or errands after work at all, or attend any events. If I forget to take it until too late, then I’ll sleep too late and be late for work or be very groggy the next morning. I just started a new job and cannot afford to be late even once. But if I skip just one pill, then I do not sleep at all the entire night. Zero hours at all.

I have been getting free samples because I was unemployed. But I now have a full-time job, so she said she may stop giving me samples. Even with insurance, the Invega costs $350 a month. I was unemployed for 9 months, and before that I was in & out of the psych hospital for several months so I missed a lot of work and racked up a lot of medical bills. I also had some crazy spending sprees before I was stabilized. And all our savings is tied up in a bad real estate decision. So we are not doing well financially. There is no way I can pay $350 a month. Yet we are not low-income enough on paper to get assistance from the pharmaceutical company.

And beyond the cost – I don’t truly understand why I still need an antipsychotic anyway. I have never been psychotic. I have only been manic for brief periods. I was unstable in 2008, but I have been very stable for over 18 months with no suicidal thoughts whatsoever. I am also heavily medicated with 400mg of Lamictal and 1200mg of Lithium. Do I really need Invega? Why?

I asked her about this twice recently, and she doesn’t really give me a clear answer, she just says I still need the Invega.

Do you think I still need Invega? Why or why not?

How do I get her to listen to me or at least explain why I need it?

I cannot know with certainty what medication would work best for you. Your doctor may be in the best position to adequately answer your specific medication questions. I can only give you a general answer.

You have never been psychotic and you do not believe the medication is helping. Because of this, an antipsychotic drug may not be needed. On the contrary, some doctors prescribe antipsychotics for nonpsychotic disorders and some patients have found them helpful. Results vary from individual to individual.

You mention the fact that you have gained a substantial amount of weight. The medication is also making it difficult for you to function at your new job. These are serious concerns which need to be addressed. If your doctor is not willing to alter your medication or answer questions about why you need to be on a particular drug, then I would suggest seeking a second or third opinion. Your doctor may be concerned about you relapsing, possibly attempting suicide again or trying to keep you out of the hospital. Those are legitimate reasons to continue prescribing a medicine but if there are negative side effects then alternatives need to be explored. If she is not willing to adjust the medication, then you may want to consult another doctor.

Based on your letter, it seems that medication is your only form of treatment. I would strongly urge you to consider psychotherapy. Medications can be helpful but in many cases they work best when the individual is concurrently in therapy. How would therapy benefit you? Therapy, for instance, could help you address the reason why you tried to commit suicide. There is a reason for why you attempted to end your life. It’s a very serious matter that should be explored in depth.

Therapy could also address issues related to decision-making. You stated that at least in part your current problems are related to prior bad decisions in regards to real estate as well as spending sprees. You and the therapist could explore what led to those bad decisions. He or she could help you to alter your thinking and learn how to make better decisions in the future. Gaining better decision-making abilities could be a very important step in improving your life now and in the future. No one can be free of mistakes but the goal of everyone should be to make as few as possible.

I hope I’ve answered your questions. I truly believe that therapy could be very beneficial to you. Beginning therapy does not mean that you have to stop the medication; you can and should do both. In fact, it should be a major component of your treatment. If you would like to find a therapist please consult this directory. You may be able to find a local therapist who can address your needs. I wish you the best of luck.

January 10, 2010 0 comments

Can Therapy Make Depression Worse?

by Diane Walcutt, Ph.D. June 29, 2009

written by Diane Walcutt, Ph.D.

From childhood through high school, I was never a “happy” child but I got by. Looking back at my worst I was “difficult,” sometimes moody or irritable. But I guess everyone around me chalked it up to puberty/PMS because no one ever said I should get help. In college, I developed an eating disorder. It was a major source of tension to my family, whose response was anger. They yelled at me to “eat” that I was “too skinny” as if I was doing it JUST to make them mad. They never offered to take me to a therapist, and when I tried to talk about my feelings about my body and food my mom’s response was that she didn’t want to hear it and I was over reacting.

So, I took it upon myself to get counseling at school. My mom didn’t care about my emotions, but forced me to see her GP so she could weigh me and give me a physical. Upon seeing this GP, she took blood work which revealed that my liver was inflamed from taking Tylenol PM on a regular basis to sleep. When I tried every other herb and natural supplement and nothing else put me to sleep, the GP prescribed me Seroquel.

When I told my counselor this, she consulted the school’s Psychiatrist. He said the Seroquel was a terrible idea for me. After meeting with him, he said I should be on medication for anxiety, not an antipsychotic. I told him I really didn’t want long term medication, all I wanted was to sleep so I could finish the semester’s classes.

He prescribed me Ativan, which worked wonderfully at helping me sleep. But he said the Ativan was really a band aid on a bigger problem and felt I should be on Celexa. After some consideration, I agreed to try the Celexa. I have been on 20 mg of it for a little less than a month and have been continuing to see him and my regular counselor for therapy. (I have to lie to my parents about where I am going since they don’t believe I need any therapy. My dad does not even know about my meds, my mom knows and strongly disapproves, claiming “you’re not depressed you’re neurotic”).

Anyway, lately I feel even though I care less about my weight, I generally don’t care about life because I am extremely unhappy. I hate my living situation (at home financially dependent on parents), I think I am ugly, I have no self esteem, and I just feel like a basket case. I know therapy is supposed to increase self awareness, but I think all this self awareness may be making things worse. I don’t know what to do. Sometimes I want to just “break up” with my therapists but I fear that things could be EVEN WORSE if I do that. Are some people better off without therapy? Or should I keep trying?

Hello and thank you for your question:

Goodness, you’ve had an awful time getting the help you need. I’m sorry that you have struggled so. I’m not a psychiatrist, so I can’t prescribe (at least in my state), but what you need to know is that if the Tylenol PM was working for your sleep, it wasn’t the Tylenol itself that was working, it was the diphenhydramine (Benadryl). Benadryl has side effects like any other drug, but it was the Tylenol that irritated your liver, not the Benadryl. Many people use the generic Benadryl with great success for sleep. What you need to know about it is that occasionally, it stops working. It is not addictive and you cannot develop a tolerance for it, but if you take a break from it, it will again begin working. The reason I know this is because I taught psychopharmacology at the graduate level for many years and have learned a lot about medications.

That being said, I wouldn’t break up with a therapist unless you think that particular therapist isn’t helping. Understand that therapists are like blue jeans. There are tons of them, but not all are a good fit. You might consider finding one that fits better. Or, you might just stick it out with this one. Things often get worse before they get better, since in therapy you have to dig into stuff that isn’t fun.

The other thing is that it sounds like your family doesn’t have very good boundaries. What is “wrong” with you isn’t their business since you are legally an adult now. Never mind who is paying for your schooling, if you don’t want to be weighed, and you don’t want mom prying into your personal issues, tell her in a very nice way, “Mom, I have to figure these things out for myself. I know you mean well, but I need some time to sort things out. I can’t eat what you tell me to eat, and I won’t be weighed anymore.”

She may have a hard time hearing these things, but you are an adult and should be treated like one. Set some boundaries, stay in therapy (even if it is with a new therapist) and take good care of yourself. You deserve it. If you want to find a therapist outside of school, look at the our therapist directory for one in your area.

I hope this helps,

Dr. Diana Walcutt

June 29, 2009 0 comments

Sister Have Schizophrenia?

by Kristina Randle, Ph.D., LCSW February 23, 2009

written by Kristina Randle, Ph.D., LCSW

My younger unmarried sister thought that she is married with an unseen person and she feels and talks him mostly. I m here for my sister’s problem. Don’t understand what kind of problem she had and what sort of treatment should given to her. Some says that she has schizophrenia and some says that it is schizotypal. Actually we have no reliable doctor here and also our family not support us, some members are not trying to understand that she has any problem. They thought that she is acting or something like that for some unknown reason. Some of the immediate family members thought that this mental stage will recover itself as time passes.

She is an educated montessori teacher for 6 years, unmarried having no other emotional relation. Suddenly left her job 2 months before with the reason that everybody of my co workers were against me and don’t want me to job there. Now her condition is that she thought herself married with somebody which cannot be seen by any one. He give her commands in her mind how to live and she left the job because he ordered her. One day she told me that i m 2 months pregnant having 8 kids without the person who married me touched me. She feel her all the time that he is with her, she is talking him most of the time while watching any wall.

We talk to a psychiatrist and he advised to give her medicines for about one year and she should be admit in the hospital for early treatment. Now nobody in our family want to give her any kind of drug for such a long time and me myself against to admit her in hospital. Kindly advise me what to do? Is this schizophrenia or schizotypal? what kind of treatment she needs? and most important is this thing curable?? I will be very thankful to u please help us. kindly tell me what is the criteria to know is the doctor reliable or not? she saw the same person (now she thought married with) since an year, when an year back she told me about it that i saw him somewhere in the market or in any public transport i said that its all ur illusions but now she saw or feel him in her home, as she said. The other problem is that if some doctor suggests any medicines then how to make her agree to take the meds, i tried to give her some sleeping pills and she refused. She thought herself perfectly well. Also want to know that is the situation needs hospitalization??

You are dealing with a challenging though very common situation. You sister may have schizophrenia. She is clearly delusional. She has imagined that she is married to a person who no one can see. She apparently is aware of his presence and claims to be able to see him. She also takes commands from him about how she should behave.

I do not know whether she has schizophrenia or schizotypal personality disorder because I do not have enough information to offer a diagnosis. A doctor who met with her in person would be better able to judge what she may be suffering from. What is clear is that she is delusional and is refusing help because she does not believe anything is wrong. It’s very common for people with schizophrenia and other psychotic-based disorders to not be aware that they’re experiencing symptoms. Their lack of awareness can make it very difficult to convince them to seek help. Why would they seek help if they believe nothing is wrong?

You sister could benefit from antipsychotic medication. This type of medication can stop her from believing in things and people that are not real. It can stop her delusions and can help restore her to her “old self.” Antipsychotic medication may not “cure” her but it has the potential to greatly improve her life. Psychiatrists prescribe these types of medications. This is the kind of doctor she needs to see.

My suggestion is that you do what you can to get her into treatment and to take medication. Is there a way you can convince her to get help? Could your family convince her? Is there anyone in the family who could persuade her to see a psychiatrist for an evaluation? This is what she needs. Otherwise, if she is experiencing psychosis related to schizophrenia or another similar psychotic disorder, her symptoms may only intensify. She may even become so delusional or paranoid that she becomes a danger to herself or others.

Tell her that the medications can help her feel better. Explain to her that you are worried for her safety and you are trying to do what you can to make sure she is safe and well. Express to her your concern for her well-being and that medication and treatment by a mental health professional is a way for her to feel “normal” again. Utilize the help of your family or friends if you believe it will convince her to attend treatment. As I mentioned above, your situation is challenging but with your help and continued attempts to get her into treatment there is good chance she can stabilize. Please write again if you have any additional questions.

February 23, 2009 0 comments