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Is medication the right choice?

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

Q. I was wondering if medication is the right choice for a person who has only experienced psychosis once. I stopped taking my meds because they made me feel horrible! I couldn’t think, I moved slowly, my personality changed, I experienced muscle stiffness, shaking, rashes, etc… I am a single parent and I need to be able function well.

Here is a little of my history; I know that some of these factors probably had something to do with my psychotic breakdown. When I was 3 years old I was in a car accident and have a closed head injury. I experimented with some drugs when I was 17-18 years old, mostly ecstasy. Emotionally I have been tested; my father sexually abused me when I was 18. My mom passed away from the car accident that I received my head injury but not until 8 years after being in a coma. I had an extremely abusive boyfriend who gave me a concussion and my life has been less than perfect since I can remember.

Everyone said that my body would adapt to the meds and that I had to give it a few weeks but I swear they just made me worse. I don’t want to take meds the rest of my life if I don’t need them. Or, if I do need them, how do I find one that won’t put my life on hold or make me sick? I have a daughter that needs her mother and I don’t want to get sick again but I can’t function while on these meds! I have tried Risperdal, Seroquel, and many more while in the hospital, am I doomed forever? Is this the best that life will be for me or are there other options?

Thank you for writing. Please know that not knowing some of the specific circumstances that led to your psychosis or how long the psychosis lasted makes my opinion relatively uninformed. I will do my best to answer your questions with the information that you have provided.

You mentioned that you had experienced psychosis only once. Having one psychotic break does not mean that you will have another. If you have been stable for some time since this event, without medication, it is possible that you can stay off the medication and remain stable. But I believe it is imperative that you have a strong supportive network of individuals, including a therapist and a doctor, among others, available to you while you are medication free. If you worked with a therapist and a doctor closely, perhaps the three of you could come up with an agreement that states that you’re not going to take the medication as long as you are stable (as determined by either the doctor or the therapist) but, if you begin to show signs of destabilization, you will begin the medication immediately. My main point here is that you should not stop taking the medication without the advice and supervision of a mental health professional.

If you are currently in a situation in which you are under constant distress, you have little to no supportive friends or family, you do not have a therapist, you’re in an abusive or otherwise unhealthy relationship, and so forth, and you’re not taking the medication, this would be unwise. In this scenario, you would be at a very high risk of having another psychotic episode. Having another psychotic episode would not only be detrimental to you, but to your daughter. She would have to witness her mother become psychotic and behave in a very confusing and chaotic manner, and then would have to endure the time away from you while you were in the hospital. You are correct when you said that your daughter needs a stable mother and it could be potentially damaging to her if she had to bear witness to another psychosis.

Another option to consider is to keep trying different medications, on very low doses, until you find one that you can tolerate. I am currently working with a woman who is taking a new medication called Invega that she finds to be very tolerable (and she’s been on them all and has hated them all). Everyone is different and will not be satisfied with the same medications but maybe this medication, or any other on a very low dose, would be acceptable for you. You can also try switching the medication to a different time of day. For instance, you can try taking the medication right before bed. This may help to reduce any side effects associated with antipsychotic medications.

I hope that you will be able to utilize some of these suggestions. I understand that taking antipsychotic medications, or any of the other psychiatric medications, can be difficult. The side effects associated with psychiatric medications are one of the principle reasons that people have trouble sticking to their prescribed medication regime. I wish you luck in finding a treatment, be it a medication or therapy, that can help you stay psychosis-free. Take care.

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What are the dangers of mixing antipsychotics & alcohol?

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

My boyfriend is taking both Zyprexa and Seroquel simultaneously to treat the symptoms of his disorder. However, he continues to drink alcohol while on these medications. I have read up on both of them, and both say not to consume alcohol while taking either; nevermind both together… I understand that drinking while on these medications can emphasize the affects of the alcohol. What I want to know is: What is the worst case scenario of his continued drinking while on these medications? He is in danger of relapse, or alcohol poisoning? Any help would be greatly appreciated.
Thanks!

I cannot say specifically what could happen to your boyfriend if he continues to drink while taking antipsychotic medications. But I do know that it is extremely unhealthy and dangerous.

First, his continued use of alcohol can increase and enhance his psychotic symptoms. Second, the alcohol can inhibit the ability of the medications to work properly. Lastly, there is a considerable danger in using alcohol with any prescription drugs, and this is especially true with Zyprexa and Seroquel. These are two medications that already have considerable side effects and can cause heavy sedation. Mixing them with alcohol may only increase that sedation.

Alcohol.org cites common side effects that can occur due to mixing prescription drugs with alcohol. They include:

  • Behavioral and emotional changes
  • Stomach upset, nausea, or vomiting
  • Headaches
  • Drowsiness, fatigue, or excessive sleep
  • Fainting/dizziness
  • Blood pressure changes or heart damage
  • Trouble with coordination, causing accidents

 

According to Drugs.com, “Antipsychotics are a large class of medications used to treat symptoms of psychosis such as delusions (for example, hearing voices), hallucinations, paranoia, or confused thoughts. They are used for other mental health disorders as well. They work by changing the balances of chemicals in the brain. Antipsychotics have central nervous system (CNS) depressive properties and should not be used in combination with alcohol due to the additive effects. The combination of antipsychotics and alcohol can increase sedation, respiratory depression, result in poor decision making or cognitive impairment, lead to low blood pressure (hypotension), and put patients at risk for a fall and injury.”

If you mix a prescription drug with alcohol, either by accident or specifically to get high, there is a high risk of overdose or damage to the body.

Specifically with Olanzapine (Zyprexa), NAMI, on its website, states, “Avoid drinking alcohol or using illegal drugs while you are taking olanzapine. They may decrease the benefits (e.g. worsen your confusion) and increase adverse effects (e.g. sedation) of the medication.”

Livestrong’s website quotes AstraZeneca (the biopharmaceutical company that makes Seroquel), who state that “ingesting alcohol with Seroquel may cause alcohol intolerance. This means a person drinking alcohol and taking Seroquel at the same time may feel the effects of alcohol more acutely than usual.” Additionally, AstraZeneca conducted a clinical trial and concluded that “Seroquel caused people to have diminished motor control, and they were not as coordinated at operating machinery when under the influence of the medication. The clinical trial showed that mixing alcohol and Seroquel together made coordination worse.”

I cannot give you a worst case scenario, per se, but I can assure you that nothing good can result from mixing medications and alcohol. Taking antipsychotic drugs and alcohol together can potentially lead to liver damage. It is extremely dangerous, not only for his physical health but there is a definite chance of illness relapse with this type of continued behavior. Make sure you do whatever you can to put a stop to his behavior. As one project website says, “Chronic polysubstance abuse can, over time, lead to deteriorations of your physical and mental health, negatively affect your relationships, drain your finances, and decrease your performance at school or work.” You might consider calling his doctor or therapist to inform them of his alcohol abuse while using antipsychotics. It may be the only way to put a stop to his harmful behavior. Take care.

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Will I Get Disability with Severe Bipolar Disorder

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

I have severe Bipolar Disorder and am applying for disabality: I have sever bi polar disorder and it is not ideal for me to work and be around people in fear i may be so upset i will hurt them. i have been to my doctor may times for this and i have an appointment with a phycologist soon to help with my treat ment. i am taking 400mgs of Seroquel currently and it doesnt seem to be working…I applied for disability because bi polar is a disability and i need the help while im trying to be treated and focus on only that…do i have a chance of getting it? will i be okay

It can be difficult to get disability but it’s not impossible and people do get it. Generally speaking, it’s commonly acknowledged that most people who apply for disability get denied on their first try. I believe the “official” approximation is that about two-thirds of the people who apply are denied on their first try. Whether or not you will be awarded disability can depend on many factors.

It will depend on how much money or assets you have access to. For instance, if you have little money in your bank account but have an IRA worth over $2.000.00, it is possible (and likely) that you will get denied. It can depend on how much of your life you have spent working. The disability office will take into consideration how many years you put into the work force and if you do not have “enough”, they could deny your application. Please read the official social security disability insurance website to read further about their specific guidelines.

Your doctors will need to document the length and severity of your condition. You should also keep a good record of the medications you take, the number of doctors appointments you have and who with, and the outcomes of those appointments, your symptoms, and so forth. I know of two individuals who both recently applied for disability. One person kept extremely good records of each and every appointment they had with any doctor and frequently updated the disability office on any new developments in this regard. This person was ultimately awarded disability. The other person did not keep a detailed record yet this person had the more severe and chronic mental illness. I cannot say for sure that the person who kept the more detailed records was awarded disability because of their thoroughness with record keeping but it certainly may have helped.

I do not know if you will be awarded disability but I would strongly encourage you to apply. Do not become discouraged if you are denied on your first attempt. If you are denied, do reapply or consider contacting a lawyer to fight on your behalf. The good news about disability lawyers is that they can really help in getting you disability once you are denied with little cost to you. Most lawyers only take a small portion of your award if they are successful at defending your case, and those awards are capped depending on what state you live in. But the bad news is that even with a lawyer (there are exceptions to this) it can take a long while to get your case reconsidered.

It is a true shame and frankly a disgrace that many people who are in need of disability are denied and have to continually reapply, sometimes waiting years before they are helped by this program. This country, unfortunately, especially within the past couple years, has an extremely poor track record when it comes to assisting individuals who are most need of help. I wish you luck and be sure that you do to apply for disability and keep applying until you get it. Don’t give up. Please take care and thank you for writing.

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I Keep Hallucinating

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

Earlier this year I started to have tactile hallucinations as soon as i turned to go to bed, It felt like rats crawling on my bed. I have a slight phobia of rats and mice so i thought it was just that. I told my mental health doctor and they upped my seroquel to 1000mg from 200mg.

Since then these hallucinations are getting worse, now its not just bedtime I am constantly seeing a box but i cant see any details although there is some sort of device like an antenna protruding from the top. I also hear children crying and calling my name I try to ignore them but its getting worse and my friends are noticing “looks of terror” in my face.

I no longer drink alcohol but i occasionally smoke marijuana and very rarely take mdma (about 83mg once a year) I tell my doctor but its a different person every time and I freeze up and cant open myself to these people, hell i cant even talk to my long term girlfriend how are my supposed to talk to a complete stranger. Anyway they just write me a script (1000mg seroquel 200mg in the morning 800mg at night). I try to be regular about my sleep pattern always going to bexd at 11 but the meds make me sleep through my alarms or maybe its the fact im laying there for at least 8 hours in terror at what i feel is going all around me which has moved from small sensations on my body to a feeling of being in a busy train station being buffeted from every side.
I cant work, i hardly eat or wash these days im constantly tired and my moods are up and down on a near daily basis, and im no longer sure this is all in my head.

The symptoms that you described are concerning. You are taking medication but continue to experience significant symptoms that are disrupting your life. Part of the problem may be that you are not fully reporting your symptoms to your psychiatrist. If your psychiatrist is unaware of all your specific problems, the risk is that he or she will not treat the correct symptoms.

A related issue is that you are taking a high dose of medication which doesn’t seem to be helping. Again, this likely stems from the fact that your psychiatrist is unaware of what is truly going on.

It may also be that you are taking the wrong medication. Finding the right medication or the right combination of medications often involves a great deal of trial and error.

Since it is difficult for you to speak candidly to your psychiatrist, it might be helpful to make a list of your symptoms to take with you to your next psychiatry appointment. You may even want to take this letter to your next appointment. It clearly describes what you have been experiencing. It’s not unusual for patients to bring notes to their appointments. I would recommend it.

It would also be advantageous to consult a social worker or a case manager, in addition to your psychiatrist. They may be able to assist you with your psychiatry appointments in various ways including advocating on your behalf, speaking to your psychiatrist for you, or finding you a new psychiatrist if necessary, and so forth.

Finally, are there friends or family members who can assist you? For instance, perhaps they can attend your next psychiatry appointment with you and speak to the psychiatrist on your behalf. Utilize the support of others around you. I hope that you are able to receive the help that you desire. Please take care.

Dr. Kristina Randle

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Voices a Sign of Schizophrenia?

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

I am a 22 year old woman who has dealt with mental health problems for most of her life. I was diagnosed with depression at a young age and still get depressed from time to time. My question though, is about recently problems. I have been having internal auditory hallucinations for a long time. They are like real loud thoughts, but each has its on unique sounding “voice”. Sometimes these voices are silly or give commentary on things, but sometimes they can criticize me or repeat words like “freak” or “your stupid”. I also have had these strange fears at night. For example, I kept thinking about the singer Kurt Cobain one night. I started to get worried that he would be mad at me and that I would see him in my room. I am always worried that i will see dead bodies or that ghost will come after me. I know that these fears are irrational most of the time. I have a family history of mental illness and psychosis. When I told my psychiatrist about it he said it sounded like anxiety or OCD. I see a therapist regularly and have been prescribed celexa, and seroquel to help with depression and the voices. My worry is that, since there is a family history of psychosis, that my symptoms will develop into a severe illness like schizophrenia. Do my symptoms sound like the beginning of schizophrenia, or do you agree with my doctor that this is a form of anxiety or OCD. Thank you so much for taking the time to read this I know you must be very busy. Your advice is greatly appreciated !

This is a difficult question to answer. Many people describe having an “inner voice” that they hear on a regular basis. It is quite normal. On the basis of a short letter, it is difficult to distinguish that inner voice from the voices associated with psychosis.

Individuals with schizophrenia (or other psychotic disorders) who hear voices often describe them as being external. In other words, the voices they hear are not their own. They seem to be the voices of others. They also tend to be derogatory in nature. The voices you hear are sometimes derogatory and critical. The latter would be consistent with the types of voices heard by individuals with schizophrenia or other psychotic disorders.

Having said that, you are presently being treated for depression and other symptoms. Anxiety commonly occurs with depression and OCD. Low self-esteem is also related to depression, anxiety and OCD. The derogatory nature of the voices could be related to depression, anxiety or OCD.

Having family members with serious mental illness can increase the likelihood of your also developing one but generally speaking the risk is slight. Whether or not you will develop a mental illness can depend on many factors, such as biology, drug use, traumatic experiences, environmental conditions, and so forth.

In summary, it is possible that the voices you hear are a sign of schizophrenia or other psychotic illnesses. Your treating professionals (who are familiar with your case) do not think so. They do not believe that you are developing a psychotic disorder and I find this to be good news.

I would encourage you to read more about the experiences of individuals with anxiety, OCD, depression, and psychotic disorders. It might help to answer your remaining questions. I hope this helps. Please take care.

Dr. Kristina Randle

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Personality and Bipolar Disorders, Is It Me or Them?

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

I am a 25 year old female that has come a long way. I was diagnosed as bipolar at age 18; from there I was institutionalized on many occasions by the age of 21. I was in such a bad condition that when my mother applied for disability on my behalf I was accepted immediately. I was told people are normally denied on their first attempt. The challenge was to find the right medication that would control my depression, insomnia, and suicidal/homicidal thoughts. At age 22, I was placed on Lamictal and Seroquel. I was able to cope, I recently graduated with an A.S. degree as summa cum laude and I received the president’s cup. I have earned various I.T. certifications and I am now studying to be a biomedical engineer. School has been difficult for me, not so much as learning but working in groups or speaking in front of the class. I am not fond of school but I want to earn more money so I can purchase a house in the country. I would have never pictured my life changing in this matter; for the first time in my life, I can honestly say I want to live.

The only negative thing is a recent diagnosis of having a personality disorder at age 23; I care not to name this disorder because I don’t want to limit myself but I was told it’s a very passive disorder. This does not surprise me, I am uncomfortable in social gatherings, I live alone, and although I have a decent job I dread finding new employment as I would have to be social. I currently work 3rd shift by myself, if I am not there I am in school, at the gym, or home; I like the way I live my life.

Now, the issue at hand: last week, someone keyed my vehicle. I just got that vehicle it is a sports car Mazda6 2010, it is my first car and I worked hard to earn money and balance my bills. I didn’t even want this vehicle I just wanted a car to get me to and from my destination without breaking down. My mother persuaded me into getting it; she drives a Chrysler 300 and she is very materialistic. This incident has thrown my entire process off-balanced. I can’t sleep, I don’t know how I feel but something just isn’t right.

I don’t care about the vehicle or that someone keyed my car; only that I didn’t deserve it. I stay to myself, I rarely speak, and I haven’t done anything wrong to anyone. After the incident I put a $500 dollar security system in my car that takes pictures of people near my vehicle. Against my better judgment, that same day I brought a gun. I know I shouldn’t have but my homicidal thoughts are back in full force. I am tired of people doing things to me when I haven’t wronged anybody. I keep the gun in my glove compartment it’s not considered concealed there.

This is not a good situation so my question is how do I control this? Although I am not that fond of people, I don’t want to hurt anybody but I can’t stop thinking about getting even. It’s frustrating when people just won’t leave me alone. I believe I am a good person to a certain extent (psychological flaws), I am trying to live a somewhat peaceful, normal, and decent life. I don’t want to throw it all away, because I know I would definitely shoot it out if things took a turn for the worse. I don’t want to tell my psychiatrist that I am having these thoughts she may try to hospitalize me; I don’t need that right now, so is there anything I can do to try and help myself? The ironic thing about this situation is, society will portray me as the psychologically damaged individual; everyone else is innocent.

First: Congratulations on all your hard work to meet your goals. I’m sure it hasn’t been easy to achieve so much in school when academic environments are so difficult for you. Do take pride in that. You deserve to feel very, very good about it.

As you well know from your own experience, people can do exceptionally well in some areas of life and still have issues in others. From what little you were able to share in a short letter, I suspect that taking responsibility for your own decisions is a struggle for you. Your mother couldn’t “make you” buy a car you don’t want. An anonymous stranger who keyed your car didn’t “make you” think you had to buy an elaborate security system or a gun. Other’s can’t “make you” obsess about revenge. As you rightfully point out, you could lose everything you have worked so hard for if you don’t get hold of this issue.

I’m not very impressed by labels. Whatever the diagnosis, you need to work with your psychiatrist to learn some new ways to cope with being in a world inhabited by sometimes thoughtless (and sometimes even mean) people. You take things very personally – even when there is no reason to think they are personal. You then go over and over your hurt and anger until you work yourself up into quite a dangerous rage.

Even when you aren’t feeling targeted, you don’t know how to fit into the social world. Isolating yourself and limiting contact with other people is one strategy for reducing your stress, but it doesn’t help you learn to manage those times when you simply have to interact. Unless you go out into a desert and live as a hermit, interacting wtih others and sometimes being slighted or misunderstood is part of the human condition.

If your psychiatrist only presecribes medication and doesn’t provide some talk therapy as well, I strongly urge you to find yourself a psychotherapist to help you learn the skills you need to function with others. You’re a smart person. When you are determined, you do what you have to do to learn things. There’s every reason to think that a combination of medicine and some therapy will help you feel more in charge of your own decisions and less anxious around others.

I wish you well.
Dr. Marie

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Confusing Ex-Boyfriend

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

My xboyfriend whom im inlove with is bipolar and confuses me so much…. wel my exboyfriend left me his excuse was he was abusing drugs and needed to clear up his act on his own and didnt want to drag me down with him….ever since we have not lost touch… but he has said soo many things… we kept seeing ea other up til nov.. i went on vaction to miami.. and a week before i left he said he loved me… and jus 1 day before my trip he told me he never loved me… on my way back we started txtn again..and he told me he jus wanted to curl up and die … and how horrible he felt..and stuff we kept in touch since again and out of nowhere he tells me he is in love with another girl who he lost his virginity to in the 8th grade.. that was about 7 yrs ago!how could that be.. he said he always loved her…so that made me feel so foolish and that he never loved me…any way about 2 weeks ago.. we met up and i poured my heart out to him…he explained to me he cared about me and didnt want to hurt me again and that he wanted to get married and he couldnt be with me bcuz i cant (im still in divorce process) he says he jus cant be with sum1 who is married… apparently he confeesed this was bothering him alll along… sumthing i was not aware of.. any way well the past 2 weeks he has been a total sweetheart telling me he loves and and jus on monday he said he wanted to work things out with me and wanted to give us another chance… but yesterday i called him and he was very mean and said very hurful things.. he said to txt him what i wanted to say so i did and he replied with vulgar words calling me names and sayin he wanted nothin to do with me.. i dont understand i love this guy and i’ve tried lookin past things like this many times but this time it was jus soo from one day to the next and it hurt me very much… i want to know if this could be a cause of bipolar disorder or he is jus like that? also he never told me he was bipolar i know this because one night he told me he ran out of seriquol which he said was for imsomnia but i know its for bipolar depression..which couldve been a cause of his meth use.. i jus want to know if i should take things personally or try not to and jus be patient with him…..and do i need to leave him alone when he reacts this way to me give him space or somthing?

This is a complicated relationship. He wants to be with you one day and the next he says something very mean and hurtful. It is difficult for you to determine what is happening. One thing is for certain: if he is using drugs it will be very difficult or impossible to have a stable relationship with him. People who are using drugs are not thinking clearly. Their judgment is impaired. They do not make good candidates for relationships. Individuals who are in relationships with addicts liken their significant other’s drug of choice to having a third person in the relationship (i.e. “the other woman” or the “other man”). That’s because their significant other often chooses the drug over them, or at least that is what it feels like. Until he stops using drugs and is more mentally stable, I would advise against pursuing this relationship.

You wanted to know if having bipolar disorder could explain his behavior. Part of why you believe that he might have bipolar disorder is because he is taking the medication Seroquel. Seroquel is an antipsychotic medication that is typically prescribed for psychotic disorders such as schizophrenia or schizoaffective disorder. It may be prescribed for other uses such as bipolar disorder, specifically for an acute manic phase or possibly insomnia but generally it’s prescribed to reduce symptoms associated with psychotic disorders. He may have bipolar disorder but it is possible that he has a psychotic disorder such as schizophrenia or schizoaffective disorder. The only way to know may be to ask him if he has been diagnosed with bipolar disorder or any other disorder.

You also said that he was out of the medication Seroquel. If he has not been taking it as prescribed then this could possibly explain his irrational behavior. If medication is not taken properly it can cause mental instability.

How should you move forward in this relationship? You should suggest that he seek psychiatric help. I suggest this for two reasons. One is because he is abusing drugs and alcohol. He may need to enter rehabilitation or at the very least to see a therapist to examine why he’s using drugs and alcohol. Secondly, you should suggest that he contact his doctor. If he’s out of his medication then he needs to let the doctor know. Once back on the medication his behavior and overall mental health may stabilize.

As indicated above, I do not think he’s in a place psychologically where he can have a healthy relationship with you. He’s dealing with many issues that are unresolved (i.e. drugs, possible psychotic disorder). I do not think it is advisable for you to pursue a relationship with him at this time. Perhaps after he receives professional help he may be in a better position to have a relationship with you. Until then I doubt it will be possible. Thanks for writing. Please take care.

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Can Therapy Make Depression Worse?

by Diane Walcutt, Ph.D.
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

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Why Do I Fail at Getting Myself Help?

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

Q. I just don’t seem to be able to let myself get help, and when I do, one would think it’s too late. I really didn’t want to go to therapy, but my psychiatrist insisted, and so I did. I’ve been going for 7 or 8 times, and I thought it was going fine, not great b/c of my lack of positive thinking, but I finally thought I was getting better. I was taking Seroquel XR + Trazodone (have tried many anti-depr in the past), and I just didn’t feel like it was making a big impact on me, so I talked to my psych that I didn’t want to take any more. I do confess that by that time I had already thought of going through some fatal accident and therefore prevent any more sadness. So I thought of starting by saying goodbye to the meds and then in 1 or 2 more sessions to the therapy. I don’t want to make anyone feeling guilty, and I bought life ins 4 my family.

Last time I saw my counselor she told me that I needed to change and let myself get help b/c it was not a good indication and that either meant I needed some time, or to change, or that I wasn’t ready for therapy. She then learned I hadn’t been taking meds and I guess was a little more understanding. She asked me if I had thought of the consequences and stuff. I recognize I’ve said I don’t want to change, but having that last session made me think about stuff, and so I did a Pro-Cons-and Don’t Know List. I gave myself until the following afternoon to decide. It took me a little longer, and so I decided to call my psych to ask him if I could re-start taking the meds. I do have to admit that in the past I’ve slightly overdosed and not followed direction regarding how much I’m supposed to take, so he asked me to write a paper where if I violate his instructions then he wouldn’t treat me anymore.

Lately I’ve been drinking and since I’ve a huge desperation for being able to sleep, I’ve been taking leftovers as well. So I called him, and he pretty much told me to go to somebody else. I have a really hard time opening up, and I don’t want to go to anyone and start over again, and it’s not the first time a doctor tells me to go to somebody else. I’ve been unkind with my job, so I’m not all that focused. I’ve been getting notices of paperwork I’m behind and being late, and not been getting good evaluations. What advice do you have?

With regard to getting help, I think you have to ask and answer honestly this question: “Do you really want help?” In some respects it does seem that you do want help. You do make an effort to see your psychiatrist. You have tried the advice of your doctors to seek psychotherapy. These are all good needed first steps to getting help. But the problem begins, and this seems to be a pattern, when you start treatment but you do not follow through. You give it a little time and then you seem to lose interest and decide that help may not be all that important to you, at least that is the message you appear to be sending. Your doctor(s) seem to perceive you as not wanting help. You ask for the help and then don’t take their advice. What happens?

If you really want help then you have to put in the full effort toward getting help. This means you must follow through and give treatment time to work. You can only get out of treatment what you put in. If you put in half the effort then you will likely have limited success. There are no magic pills that will cure you and there are no therapists who can help you get better overnight. Getting better requires work, time, patience, desire and effort on your part. A therapist can only facilitate the process of improving one’s life if that individual is ready for change. In this respect, getting better begins with you.

Without more information I am unable to precisely know why your attempts at getting help have failed. It could be that you have not met a good, qualified therapist and this is making your recovery difficult. This is very plausible. But it also could be that you are not ready to get better and therefore you are self-sabotaging all your chances of getting better. Maybe for you this is easier than doing the work that is required to get better. This may be why doctors feel as though they cannot help you and give you ultimatums. Again, with limited information it is difficult to answer the “why” questions with any real accuracy.

I would advise you to think about what it is that you want and if you truly want to get help. If you do then you will have to make a full commitment to the process.

There is an old saying that goes “when the student is ready the teacher will come.” For you I’d change the saying to “when the client is ready the therapist will come.” In essence it means that when you are ready, really ready to change and accept help, you may find it much easier to find help.

One final thought for you. Life can be good, very, very good. Many people with exactly your symptoms have made a full transition to a life better than they have ever known or even knew could have existed. You can achieve the same success and you will if you keep trying. Don’t give up.

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How angry is it okay to be?

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

Hi,

Two years ago I was living by myself 1200+ miles away from home. I was studying for a masters, but I was getting so depressed and going a little crazy by myself that I came back to live w/my family since this summer. I always thought of myself as lucky and blessed that my parents were married from the beginning (that they’ve been married for 25+ yrs).

Anyways, about a month ago, my dad decided that he no longer could stand my mom and asked her for a divorce. Never mind that my mom has not worked since they got married (a decision they both had made since they got married), but anyways. I make more money than he does right now. Since I graduated from high school and though I lived w/my parents during my bachelor’s, I took care of myself financially. Throughout all of my undergrad I would help my parents financially. Since I was living by myself I did a lot of things and spent a lot of money, so my debt, though not impossible to pay, it’s quite high for right now. My parents, on the other hand have a larger debt.

I got really depressed when my dad asked my mom for the divorce. He had given me a brand new car (not paid for), that I felt like smashing myself and the car through a wall. Sometimes I have a hard time stopping myself from doing it. I see a psychiatrist. He alerted my regular physician. He prescribed me some Seroquel (I didn’t have a good reaction to other anti-depressants in the past). I see a counselor as well, but it’s hard to see her b/c she’s quite busy, and I don’t live in a big city.

I’m really upset at my dad; I love him still, but right now my anger is so much stronger. The other day, I felt like driving us both to the wall, I guess that if my mom and my sister can’t collect my life insurance money, then they can collect his and pay for the house. He was the head of the family, and I no longer feel this is a family. He told me stuff about how he feels about my mom and keeps on making excuses to leave my mom. I’m unsure whether he is seeing someone else. In a way he is leaving us too. He leaves and leaves me a lot of bills. He says he’s going to try to live w/us for a year, so to pay for some bills, but I doubt he’ll stay for that long. Oh yeah, and his mom and one of his sisters are really sick and he has been going constantly this past 1.5 month to go see them. We’ve never gotten along and my parents have never drawn lines with them even though they have been mean.

I’ve been taking the Seroquel for 2-3 weeks now, and to be honest, I still feel so down; I get upset so easily and have a hard time not getting upset at my students when they don’t bring the homework or pay attention in class. I’m behind on a couple of papers I need to turn in, and for some odd reason I think that my hormones are a little off balance. I don’t know how to behave with him. I tried talking w/him but he is just not honest about stuff. Any advice?

Thank you for writing. You are understandably upset and angry. But you know that hurting yourself or your dad wouldn’t help anything and would only make things worse for your mom. As difficult as things may seem right now, they are problems to be solved, not reasons to end your life. What you need most right now is a plan and some support. Here are some ideas:

First, you need to go back to your psychiatrist and confirm that he/she thinks Seroquel is the medicine for you. Psychiatrists specialize in psychiatric drugs. He/she may have a different idea than your PCP. Whatever you are feeling right now is either a side effect of the medicine or your depression. It’s not the Seroquel. It takes up to 4 weeks for people to get a benefit from Seroquel so it may be that you are almost at the time when you will get some relief.

Next, you need to get in touch with your counselor. However busy she is, a good counselor will respond when someone is in crisis. You need to be seeing her at least weekly until you get your anger and depression under control. Your counselor can provide you with some important support and help you learn some new ways to cope.

I hope one of the things you will talk about with her is how to untangle the many unclear boundaries in your family. You are not responsible for your dad’s debts. He is. You are not responsible for your mom, your dad is. You can certainly offer to help out but it isn’t fair for your dad to count on you to take care of his responsibilities. Tell your dad that he shouldn’t be talking to you about your mom. He needs to be talking with her. You can’t fix years of bad feelings between your dad’s family and your parents so please don’t try. That’s your parents’ business.

Next, please see a credit counselor to help you make a plan for systematically getting yourself out of debt. You are only in your 20’s. My guess is that no one has taught you how to make a budget. A credit counselor will help you figure out how to pay down those debts and put you back in charge of your financial situation.

Finally, I hope you have a couple of friends to hang out with. You need to have some place to relax and just be accepted for yourself with no responsibilities attached except the usual reciprocity of friendship. Make time to be with friends and have their support through this difficult time.

If you are feeling desperate, please call the National Suicide Prevention Lifeline at 1 800 273 TALK. There are counselors available 24/7 to talk to you.

I wish you well.
Dr. Marie

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