New Psychiatrist

I have been with my therapist and psychiatrist for seven years. I love my therapist! He is a walking contradiction. He's tatted up, has piercings, and wears combat boots. He curses freely. And is awesome at what he does.

My psychiatrist on the other hand is different. We didn't gel as easily. He's a little stoic. And over the past few months I have not been happy with his care. I was hospitalized twice in a year on his watch. In February 2013 the Tegretol made my liver sick, so I had to come off immediately. (I've had a number of side effects over the years from my psych meds). I had been stable for six years so he did not replace the Tegretol with any other meds. I was only on 100mg of Seroquel. I spoke to my friend/colleague/acupuncturist about my sick liver. She suggested I increase my water and fiber intake and start adding chia or flax to my food. I took her suggestions and within two months my liver healed itself. The liver can do that.

The second hospitalization occurred in June 2014. About two or three months prior my psychiatrist took me off of Lithium because it was subtherapeutic (meaning, there wasn't enough of the medicine in my system to be doing any good) and it was also exacerbating my psoriasis. Again, he did not replace the Lithium. And I was only on one medicine. Within two or three months I was manic again and hospitalized for five days. I don't last long on one medicine. I need to be on two medicines at all times.

When I was in IOP (intensive outpatient therapy) I got suggestions from the nurse on great psychiatrists. She gave me two women. This past week I had my initial visits with both of them. They were both great. However, one is in my insurance network and one isn't. The one that isn't in my network charges $450 for the initial visit and $200 for each subsequent visit. The one in my network takes my insurance and I don't have a copay. Of course I liked the more expensive one more! Thank god I make a great salary and can afford to pay so much for my healthcare.

The psychiatrist that I ultimately chose was amazing. She was very thorough. She spent an entire hour with me. She painstakingly went through my medical history: asking about mental and regular health, asking about my family history, asking about my six episodes (three manias and three depressions). She then made some suggestions. I was impressed with her care and look forward to working with her. 

The psychiatrist that takes my insurance suggested I take a third medicine. I informed her that the Latuda has given me anxiety and restlessness, she said she could give me a medicine for the restlessness. I declined. My original psychiatrist lowered the dose and the restlessness seems to have gone away. I am not trying to add any more psych meds to my regimen. 

I just want to encourage you all to actively self-advocate when it comes to self-care. You have to control your care. Know what questions to ask. Know your rights. And don't blindly take any medicine. Listen to your body. Know how you respond to different medicines and medicines at different doses. To be quite honest with you, the majority of psych meds come with side effects. But the side effects can be managed or minimized. The sucky thing is that it is trial and error. So please be patient. It takes time.

Here are the holistic suggestions from my new psychiatrist.

Medicine Side Effects

I've been on a number of medications. I'm currently on Lithium (the only drug specifically for mania) and Latuda (an atypical antipsychotic). I take Temazepam and Lunesta for sleep. This is my third time on Lithium. It works very fast and is my favorite medicine.

During my first hospitalization in 2007, I tried the following drugs before I found a combination I responded to: Depakote, Risperadal, Lithium, and Seroquel. In fact, I was on 2500mg of Depakote, the highest dose possible but it did nothing for me. That's how psychotic and manic I was.

I left the hospital on Lithium and Seroquel. I respond to very low doses of Lithium. After my 17-day hospital stay, I did 6 weeks of IOP (intensive outpatient therapy, for 3 days per week, from 10:30am to 2pm). While in IOP, you continue to see either a nurse practitioner or a psychiatrist and a therapist. I've found IOP to be incredibly helpful. I'm looking forward to going back on Wednesday, June 11th.

With Lithium you have to get frequent blood work done to check the therapeutic level of the medicine in your system and to make sure the medicine isn't toxic. It gets toxic rather easily. "Lithium acts on a person's central nervous system (brain and spinal cord). Doctors don't know exactly how lithium works to stabilize a person's mood, but it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior" (WebMD). Lithium side effects can: affect kidney function; hand tremor (If tremors are particularly bothersome, an additional medication can help); increased thirst; increased urination; diarrhea; vomiting; weight gain; impaired memory; poor concentration; drowsiness; muscle weakness; hair loss; acne; decreased thyroid function (which can be treated with thyroid hormone) (WebMD). The Lithium has exacerbated my cystic acne and psoriasis. 

Side effects occur when you begin a new medicine or when the dose is increased. In 2007, the IOP psychiatrist increased my Lithium from 600mg to 900mg. Within a week I had a severe skin reaction. My face swelled up with about a half a dozen cysts. My cheeks were so swollen that my eyes were almost shut tight. I looked like the elephant man (see below). Needless to say I was taken off the Lithium and I had to go to my dermatologist to receive painful cortisone injections directly into the cysts. The Lithium has also caused my psoriasis to flare up; I have psoriasis on my scalp, palms of my hands, and on my legs.

I was on Tegretol from 2007 to 2013. I believe I was on 300mg. I didn't have any side effects on the Tegretol. But side effects can include: feeling dizzy, drowsy, or unsteady; nausea, vomiting, diarrhea, constipation, stomach pain; headache, ringing in your ears; dry mouth, swollen tongue; or joint or muscle pain and leg cramp (Rx List). I also had to get routine blood work on the Tegretol. And all of a sudden in February 2013, my liver function test came back toxic. I don't know how sick my liver was, but it was enough that both my primary care doctor and psychiatrist were concerned. I stopped the Tegretol immediately. Since I had been stable for six years, my psychiatrist did not replace the Tegretol with another medicine. So at this point I was only on 100mg of Seroquel. I spoke to my colleague/acupuncturist and she suggested I increase my water intake, start drinking Yogi detox tea, and add chia seeds or flax seed to my diet. At this point I was also exercising three days per week with a trainer. After two months, my liver healed itself; the liver can do that.

In 2013, they also tried to put me on Trileptal as it is a derivative of Tegretol, the medicine I had been on for 6 years. However, my roommate or one of her guests smoked in our room. No smoking is allowed on the floor. When I came back to the room after visiting hours, I smelled the smoke. When I am manic I am highly allergic to cigarette smoke. Within minutes a severe rash broke out across my face. It felt like a sunburn and I was screaming and crying hysterically. I had a blowout argument with my roommate who insisted that she wasn't smoking. I don't care who was smoking. The point was that somebody did. I was taken off after only 3 or 4 days.

The Seroquel made me gain 52 pounds in about 3 months! From 2008 to 2013, I was only on 100mg of Seroquel. I told you I can function on a really low dose. Well, after my 2013 hospitalization, the Seroquel was increased to 600mg. After I got out of IOP I started to have sleep problems, so my personal psychiatrist increased my dose to 800mg, the highest dose possible. Seroquel is heavily sedating; if I had a lot of grading to do, I would skip my dose. But if I didn't take it, I wouldn't sleep. I was definitely dependent. I didn't have any weight gain for the 6 years I was on 100mg, but as soon as the dose was increased I starting putting on weight. Seroquel makes you insatiably hungry. It makes you crave carbs and sugar. And it screws with your metabolism so your body processes the food differently. Seroquel side effects include: dizziness, drowsiness, tired feeling; dry mouth, sore throat, nasal congestion; stomach pain, upset stomach, nausea, vomiting, constipation; breast swelling or discharge; missed menstrual periods; and/or increased appetite and weight gain (Rx List). Despite the weight gain, I had to wait 6 months (and gain even more weight) because I was in a 6 month relapse window. I was tapered off the Seroquel in November 2013.

The picture on the left is from April 19, 2013 (the day I was hospitalized); the picture on the right is from Memorial Day 2013. I would go on to gain 20 more pounds after Memorial Day.

 This picture is from April 2013; a few days before I was hospitalized.

This picture is from June 2014, the night of the Janelle Monae concert; a day before I was hospitalized.

I say all this to say, every medication has side effects. If you need to take medicine, you have to make sure to do your homework and ask your providers lots of questions. For me, the possible risk of more skin reactions is worth it because I cannot function without the meds. Well, I could. But it wouldn't be ideal. I specifically asked to be put back on the Lithium. The psychiatrist was impressed that I came with my own treatment plan. He said but "unfortunately, he still had to charge me the full price even though I did his job for him!"