treatment issues

Sleep and Bipolar Disorder – How I Cured My Insomnia – Guest Post

→ October 27, 2011 - 15 Comments

The Bipolar Burble welcomes Leslie Smile for today’s piece on how she recognized that sleep was affecting her bipolar disorder and how she worked to cure her insomnia.

  
I’ve lost many hours holding the wall up with my glazed stare. Unable to calm my mind yet unable to focus my thoughts clearly, I’ve been sleepless for days on end. I would go on through my days like a zombie. “Just keep going,” I’d tell myself. Some days I would come home from work and collapse on my bed until the next morning. I would wake grouchy, confused and still tired. Insomnia doesn’t keep you awake permanently… just until you crash.

Insomnia’s Effects on My Life

[push]I’ve always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed. ~ David Benioff[/push]

The tired feeling morphed into a bone deep lethargy; an energy sucking, crippling fatigue drained me. I began to feel like I could barely survive. I had begun the dip into major depression and bipolar behaviors. I don’t blame my mental illness on my poor sleep nor do I blame my sleeplessness entirely on my mental illness but as I’ve come to learn bipolar disorder and insomnia affect each other in such a way both deserve the attention and respect of proper self-care and good sleep hygiene.

What Didn’t Help My Insomnia and Bipolar Disorder

I had no concept of proper sleep hygiene. First I tried over-the-counter sleep aids, then doctor prescribed sleep aids. Some worked briefly but didn’t give me any sense of being in control of my mental health as their reliability was sketchy at best. Band-Aid solutions were not enough. What could I do?

How I Changed to Help Cure My Insomnia

I rarely gave myself the time for all the things my morning contained. This meant I constantly woke feeling rushed (a very anxiety inducing way to start the day). Focused on getting past insomnia, I started by taking my medications at the same time every day. I made my mornings peaceful waking experiences without coffee. (No coffee?! This was initially a cruel form of torture advised by my doctor, naturopath, and various sleep information rich websites alike.)

Mental Health and Sleeping ProblemsI Had to Want to Cure My Insomnia

At bed time, calming a worrying mind takes practice and effort. Quieting a busy, synapse-firing brain is tricky and left me feeling hopeless at times. Staring at the wall, numb and dissociated from wakefulness and sleep alike is dangerous. I had to want to change before my sleep habits started to improve. Maybe out of desperation or out of new found knowledge I wanted to change.

Training my brain to shut down and wake up at the same time every day is hard. Setting an unwind time alarm and a bedtime alarm felt a little silly at first. I didn’t want to go to bed at 10:30 pm when House was only half over. But I do want to be able to sleep well most nights. My health is more important than House.

More Ways I Cured My Insomnia

I added more artillery to my sleep war chest over time building a stronger defense against insomnia:

  • I removed the clock and any direct light from my sleep area. So many gadgets to hide with their tempestuous glow. No more looking at the clock and being exasperated at the hour I find myself *still* awake.
  • I take my relaxation techniques to bed. Deep breathing, and deep muscle relaxation exercises help put me in the sleep zone.
  • I eat breakfast. It helps keep me from going back to bed and helps my mood too.
  • I start my day with a big glass of cool water instead of fake fuelling myself with sugar and caffeine (did I mention that really sucked at first?).
  • I get out of bed after nine hours. Many people operate fine on seven hours of sleep. Good for those people. If I get up before the ninth hour I’ll take a cursed nap. These are terrible things that I love.
  • I don’t nap. Or I try not to. If I’m tired I try to be aware of that as I continue through my day/evening but it’s good to finish the day tired. That’s an almost guaranteed good night’s sleep. I skip the nap when I can.

Insomnia, Sleep and Me Now

I fall asleep a little easier these days. With the addition of the help of a new medication I’m on for my other mental health issues, I find myself drowsy near the same time nightly.

I still have to force myself many days to get to the kitchen and drink that glass of water. It takes time to make habitual changes. For me, insomnia really is a result of the culmination of habits surrounding my sleep (known as sleep hygiene). I’m sleeping more often than not these past couple weeks and that is an accomplishment. I’m finding the will to start doing the things I love again. I’m learning to follow my bliss in life. It’s the simple things that make the difference, like a good night’s sleep.

Leslie is a mental health patient in Atlantic Canada. She voices her experience getting healthy on Twitter, @SaltySmile. She is passionate about social justice issues, reading, writing, learning and sharing. Contact her at mysaltysmile@gmail.com.

 

Beating Insomnia – How to Sleep Better – Part 2

→ October 19, 2011 - 1 Comment

Last time we discussed the routines involved around sleep, part of sleep hygiene, and how to train your brain to get a better night’s sleep. This time I’ll be sharing additional tips and information on how to beat insomnia and sleep better every night.

Daytime Lifestyle and Sleeping Well

What you do in the day can make a big difference to how to sleep at night. As some of the commenters pointed out after the last sleep better post, sunlight is key in getting your body’s rhythm set. If you can get up in the morning and stick your head into the sunshine for half-an-hour that would be ideal. That would trigger the signal in your brain that it was “time to be awake.”

[push]If you can get up in the morning and stick your head into the sunshine for a half-an-hour that would be ideal.[/push]

This though, isn’t the most practical thing for most people. While I dream of a time in life when I can wake up, get a coffee and croissant and enjoy them in the sun on my balcony, that time has not yet arrived. An alternative would be using a light box in the morning (more on light boxes in part 3).

You can also change the light bulbs in your house to full-spectrum lights (like a light box) so that when you turn on the lights, it’s like getting a little bit of sun. That way you can flood your apartment in light even on the darkest winter days.

Other daytime habits to help beat insomnia include:

  • Don’t drink coffee after noon
  • Exercise
  • Don’t eat or drink two hours before bed
  • Don’t nap (yes, I know I said it, but it’s particularly true)

Alcohol and Sleep Don’t Mix

Many people think alcohol will help them sleep. This is not true. Alcohol will make your sleep worse, not better.

How to Beat Insomnia

What alcohol does is induce sleep, which people think is a good thing, but in actual fact, alcohol will decrease the quality of the sleep to the point where getting to sleep sooner will be the least of your worries. Alcohol affects the brain in ways that prevent it from going into stage 3 sleep (or deep sleep) which means you never feel fully rested. This will also negatively effect your mood.

People who drink alcohol also tend to toss and turn all night as they drift in and out of sleep, but they may not remember this in the morning. If alcohol alone disrupts sleep, imagine what mixing alcohol and other drugs could do to your sleeping patterns.

Alcohol and quality sleep don’t mix. Really.

Other Bits of Good Sleep Hygiene

Make sure it’s dark at night. No, not just where you’re sleeping, but for the hour before that as well. Turn off lights and try to signal to your brain that it’s “sleepy time.” Ideally, do something quiet before bed like reading a book using a book light.

This includes not using electronics (yes, the TV and computer) at night. Electronics emit the type of light that makes your brain think it’s time to wake up, not go to sleep, so by staring at them right before bed, you are doing yourself (and your brain) a disservice.

Other tips on sleeping better:

  • Cover the time on the alarm clock – clock-watching leads to anxiety and stress which hampers sleep
  • Keep a worry book by your bed to write down your anxieties should they arise when you’re trying to go to sleep. This way it’s easier to let them go.
  • Sleep on a firm mattress
  • Stop doing mental work one hour before bed
  • Learn relaxation or meditation techniques

More on Beating Insomnia, Getting Better Sleep and Improving Mood

In part 3, I’ll discuss how important light and darkness is to your brain and how it might just help your mood. (Link to part one of the sleeping better series.)

(Yes, that’s my cat Oliver. Yes, he’s adorable.)

Coffee Good for Depression. Sybil Revealed. Bipolar Questions Answered. – 3 New Things

→ October 16, 2011 - 4 Comments

Keep up with mental health news. Three new things in mental health to learn this week:

  • The more coffee (caffeine) your drink, the less likely you’ll be depressed
  • Clinical records of real-life Sybil (part of the basis of “multiple personality disorder”) show likely falsehoods and unethical treatment
  • Get your bipolar questions answered by a clinical psychologist

More Caffeine Decreases the Risk of Depression

This is one of the most marvellous pieces of mental illness information I have heard in a long time – caffeine (coffee) consumption is inversely related to depression. (More on effects of caffeine on mental illness.) In other words, the more coffee you drink the less likely you are to be depressed! Crazy, no?

Well, I guess no. According to a 10-year study of 50,739 women, the women who drank more caffeine were less likely to be depressed. Compared to depressed women who drink one or less cups of coffee per week:

  • The relative risk of depression was 0.85 for women consuming 2-3 cups of coffee per day
  • The relative risk of depression was 0.8 for women consuming 5 or more cups of coffee per day
  • (No increase or decrease in risk was seen in those who drank decaffeinated coffee.)

Increased Caffeine Decreases Depression RiskThat means that women who drank more than 5 cups of coffee per day had even less risk of being depressed than those who drank 2-3 cups of coffee per day. It’s astounding, really.

Now, I’m not suggesting you buy a Starbucks or anything, but the data is quite incredible. I know one thing, I’m not skipping my morning coffee.

(According to their data, 2,607 cases of depression were identified. That number seems really low so they may have set their bar quite high for what qualifies as “depression” and thus this relationship may really exist between caffeine and severe depression, I’m not sure.)

Real Story Behind Sybil and Multiple Personality Disorder

One the more popular pieces on the Bipolar Burble written by a guest author was Everything You Know About Dissociative Identity Disorder is Wrong by Holly Gray. In this article, Holly exposes some of the myths about dissociative identity disorder – previously known as multiple personality disorder. And, of course, multiple personality disorder was made famous by the book (and movie) Sybil.

Dissociative Identity Disorder and Symbil

Provided by Wikipedia

As Holly points out, there aren’t really “multiple personalities” or multiple people, inside one person with dissociative identity disorder, so the name was a misnomer and based on some very bad information – much of it from Sybil’s very public case. And A Girl Not Named Sybil in the New York Times aims to explore some of the problems with the story of Sybil, now known to actually be a woman named Shirley Mason.

Among other things, Mason’s therapist prescribes drugs in an unhealthy (addiction promoting) way and repeatedly administers sodium pentothal (truth serum as it has been commonly known). The article seems to suggest that Mason may have been making some things up and her therapist may not have been acting ethically, possibly making Mason actually worse. Do read the article. It goes to show you how one very loud, possibly untrue, case can overshadow reality.

Bipolar Question and Answer Session

Now, really, I’m your question and answer girl. You have questions, I have answers. But perhaps you’d prefer someone with a Phd to talk to. Well then you might try Dr. Rob (yes, I know). He’s hosting a live bipolar question and answer session on October 24th. You can submit confidential questions now or do so during the live session. If I can find the time I might just take a gander myself.

How to Get a Good Night’s Sleep – Part 1 – Brain Training

→ October 13, 2011 - 9 Comments

How to Get a Good Night’s Sleep – Part 1 – Brain Training

I get asked fairly regularly for insomnia tips or ideas on how to get a good night’s sleep. I actually have quite a bit of knowledge in this area as I’ve written many articles on sleep disorders for other sites. I know many tips and even rules for getting a good night’s sleep.

Read more

Free rTMS, Brain Changes in Depressed Females, Why Anti-Benzodiazepine? – 3 New Things

→ September 29, 2011 - 4 Comments

Last week I didn’t post three new things but don’t take that to mean I wasn’t learning because I certain was, and always am. For this week I have these three new pieces of information to share:

  • Repetitive transcranial magnetic stimulation (rTMS) treatment for depression to be free for (some) Canadians
  • Brain changes are noted in depressed females
  • Why are some doctors anti-benzodiazepine?

1. Free rTMS in Manitoba (Canada)

RTMS stands for repetitive transcranial magnetic stimulation and is a treatment for treatment-resistant depression. RTMS is considered a neurostimulation therapy, like electroconvulsive therapy (ECT), but is non-invasive. RTMS has its pros and its cons.

  • Pros – rTMS is drug-free, has few side-effects and can produce remission from depression in some people
  • Cons – rTMS is expensive, intensive and its therapeutic effects are generally temporary

Cost of RTMS

Most people don’t get rTMS due to the cost. Repetitive transcranial magnetic stimulation requires 2 sessions per day for 10 days (weekends off) plus and additional possible 5-10 sessions depending on the reaction to treatment. Needless to say, this is one expensive therapy. In Canada that works out to $5000 – $7500 and in the States lord only knows how much.

Differences in Brains of Depressed WomenFree RTMS

And Manitoba is taking the very civilized step forward of offering rTMS as part of the public health care system, which is how it should be. The only reason why it isn’t is cost. You can get rTMS in Canada, but this is the first time I’ve heard of it being free.

Congratulations to Manitoba for taking a step forward in helping people with a mental illness. I hope this is the sign of things to come across the country.

2. Brain Changes Noted in Depressed Females

Women are twice as likely to develop depression as men but no one knows why. This study takes a look at female brains to look for biological identifying markers between depressed brains and well brains.

. . . depressed women had a pattern of reduced expression of certain genes, including the one for brain-derived neurotrophic factor (BDNF), and of genes that are typically present in particular subtypes of brain cells, or neurons, that express the neurotransmitter gamma-aminobutyric acid (GABA.) These findings were observed in the amygdala, which is a brain region that is involved in sensing and expressing emotion.

BDNF and GABA in Depressed Brains of Women

BDNF is something I’ve mentioned before as to a biological cause of depression. Yes, just another fact to chalk up for all the people saying depression is just “in your head.”

And work toward identifying the gene that contributes to depression:

. . . researchers tested mice engineered to carry different mutations in the BDNF gene to see its impact on the GABA cells. They found two mutations that led to the same deficit in the GABA subtype and that also mirrored other changes seen in the human depressed brain.

I keep telling people: We’re getting closer to effective treatments and understanding every day.

3. The Religion of Benzodiazepines – Why Some Doctors Don’t Prescribe Benzos

I’ve taken benzodiazepines (benzos) of one type or another for a decade and never once had a problem with them, but many people do develop tolerance, dependence and drug-seeking behavior around this type of medication.

My opinion is that benzodiazepine medications can be used quite safely when properly handled, but that some people have the tendency to get addicted to medications, and for them, these medications may be contraindicated. In other words, it’s down to the individual and prescription of benzos cannot be characterized as “bad” or “good” in a blanket statement.

I plan on writing a whole article about this, but if you’d like a sneak peek about why some doctors are anti-benzodiazepine, check out this article in Psychiatric Times.

Until next week all, when I shall learn more and do better.

No Evidence of the Effectiveness of Psychotherapy? – 3 New Things

→ September 15, 2011 - 20 Comments

This week I learned three new things about psychotherapy and depression.

I’m a fan of psychotherapy for everyone. In fact, if we could get the mid-East folks to sit down for some good counselling, I think it would be more effective in bringing peace than anything you can do with a gun.

With that said, there are limitations to therapy and sometimes therapy is not all it’s cracked up to be. So this week, a look at three perspectives on psychotherapy:

  • Psychotherapy is no better than placebo in treating depression?
  • Which type of psychotherapy is better for depression?
  • How does psychotherapy change the brain?

1. Is Psychotherapy Better Than a Placebo in Treating Depression?

When the study came out  a couple of years ago alleging that antidepressants were no better at treating mild-to-moderate depression than a placebo, the antipsychiatry world went crazy (if you will). All their dire claims, it seems, had been proven true.

Well, the sky hasn’t fallen yet, but interestingly the same kind of analysis, when applied to psychotherapy, can also allege that psychotherapy is no better than a placebo too.

Can Psychotherapy Treat Depression?Placebo for Therapy

Of course, there is no such thing as a placebo in therapy. There is no “inert” counselling session. Scientific literature attempts to compare cognitive behavioural therapy (CBT), interpersonal therapy (IP) and others against wait-listed participants and those who have received therapy not containing the specific therapeutic technique being tested. Basically, they tell a therapist not to therapy. Which is a pretty tough thing to ask a human to do. And naturally, humans aren’t going to do it well.

Does Psychotherapy Work to Treat Depression?

I would say yes, therapy, various types, including cognitive behavioural, interpersonal and supportive therapy, all help treat depression. However, some suggest the jury is still out on how effective therapy really is in treating depression.

2. What Therapy is Best for Depression?

[push]Psychologist Gary Greenberg states CBT is more of an ideology and a “method of indoctrination into the pieties of American optimism.”[/push]

When selecting a therapy for depression one has many choices but the prevailing one in the scientific community right now is cognitive behavioural therapy (CBT). Everybody loves it. It’s the golden child. CBT is a highly intellectual and analytical therapy that is short-term and action-oriented so it’s no wonder that people like it.

In the same article as the one talking about therapy effectiveness in the treatment of depression, they also discuss which therapy is best for depression, and it kind of seems like none of the therapies are best. (This could be because, statistically, some people respond better to one treatment while others respond to other treatments and when you lump them all together, a similar percentage responds to each.)

3. What Does Psychotherapy Do to the Brain?

As I have mentioned several times, depression decreases brain volumes over time – ie, depression shrinks your brain. It does this through decreasing neurogenesis (the creation of new neurons); however, electroconvulsive therapy (ECT) and antidepressants have both been shown to increase neurogenesis and brain volume.

Interestingly, so does psychotherapy.

More on brain changes as a result of psychotherapy here.

Until next week all. I’ll learn more and do better.

How to Get Off Antidepressants Effexor/Pristiq (Venlafaxine/Desvenlafaxine)

→ September 12, 2011 - 94 Comments

How to Get Off Antidepressants Effexor/Pristiq (Venlafaxine/Desvenlafaxine)

Or other bothersome antidepressants.

Generally, following the rules I wrote about last week on how to stop antidepressants while minimizing withdrawal work, and most people can successfully withdraw from antidepressants with few side effects.

Some Antidepressants Are Hard to Get Off Of

Unfortunately, some antidepressants are not so easy to get off of no matter what you do. (You can learn more about this through http://drugabuse.com/ and other similar sites.) Some antidepressants:

  • Resist a taper strategy
  • Have intolerable withdrawal effects anyway *

People Have Trouble Withdrawing from these Antidepressants

Any antidepressant can feel impossible to withdraw from, but the antidepressants people have most trouble withdrawing from are:

But by far, venlafaxine and desvenlafaxine (Effexor and Pristiq) are the ones I hear about. In my opinion, these two drugs are a nightmare to come off of for most people. ^ (I’m not saying everyone has trouble with these antidepressants, just that many do.)

Here are tips on how to get off of horrible~ drugs like venlafaxine (Effexor) and desvenlafaxine (Pristiq).

Did I mention yet I’m not a doctor? Ah, well I’m not. None of this is to be considered medical advice; this is an informational article only. Never alter your treatment without talking to your doctor. Thanks.

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Antipsychotic Warning, Saffron for Depression, Polypharmacy – 3 New Things

→ September 8, 2011 - 2 Comments

It’s a bit of a short week what with the holiday and all, but still, there is time for three new things about mental health. Today’s three new things are:

  • A safety warning on the atypical antipsychotic drug asenapine maleate (Saphris)
  • Saffron and depression
  • Multi-drug (polypharmacy) treatment of mental illness

Serious Allergic Reactions Reported with Asenapine Maleate (Saphris)

Asenapine maleate (Saphris) is an atypical antipsychotic drug recently approved for use in the treatment of bipolar type 1 mania and mixed episodes (as well as schizophrenia).

In slightly less than two years of approval, about 87,000 people have been prescribed asenapine maleate. The FDA’s Adverse Event Reporting System (AERS) has had a significant number of serious allergic (hypersensitivity) reactions reported. These serious allergic reactions were reported in 52 cases and are considered Type 1 hypersensitivity. From the FDA:

“Signs and symptoms of Type I hypersensitivity reactions may include anaphylaxis (a life-threatening allergic reaction), angioedema (swelling of the deeper layers of the skin), low blood pressure, rapid heart rate, swollen tongue, difficulty breathing, wheezing, or rash . . . Several cases reported multiple hypersensitivity reactions occurring at the same time, with some of these reactions occurring after the first dose of Saphris.”

Any such reactions require immediate medical attention.

You can report serious allergic reactions to the FDA’s MedWatch program here.

FYI, asenapine maleate’s label has been changed and updated with this new information.

Saffron used to treat depressionCan Saffron Help with Depression?

Saffron (crocus sativus) is the most expensive spice by weight and is integral in French bouillabaisse. And someone asked me this week, “Can saffron help with depression?” Initially, I did a search on the Alternative Medicine Index at the University of Maryland Medical Center and turned up nothing. This alternative index lists most everything so my immediate answer to “can saffron help with depression,” was no.

However, I may have spoken slightly too soon.

Upon closer inspection I did find one study that asserts, in treating mild-to-moderate depression:

“Saffron petal was significantly more effective than placebo and was found to be equally efficacious compared to fluoxetine and saffron stigma.”

Now, hold on a minute. This is not a good, particularly scientific, study. This is just a review of studies, some of which are very questionable in nature. The above statement is premature at best. All that can really be said (in my opinion) is that saffron deserves further study and that some formulation of it might work.

Prescribing More Than One Drug for Mental IllnessWhy Are People Treated With Many Drugs At Once?

Good question. This is called polypharmacy and most doctors agree it’s a bad thing. The reason polypharmacy is bad is because it greatly increases the chance, and severity, of side effects. (There are other reasons too.) People who have been through rounds of polypharmacy will tell you this is true.

However, doctors continue to prescribe many drugs simultaneously for a condition. This article explores why polypharmacy is so common.

The article may make you take a look at your drug regimen and talk to your doctor about reducing some of your medication. This isn’t always possible, but a good idea if you can get away with it.

Note on Polypharmacy

It’s worth noting some conditions do warrant polypharmacy.

According to the Psychiatric Times article, the best indications for polypharmacy are few and well established:

  1. Bipolar depression
  2. Psychotic or agitated depression
  3. Co-morbid conditions that require independent medications (e.g., ADD and major depression)
  4. When partial response to the first medication requires adding another adjunctively
  5. When there is a combination of psychiatric and pain problems

OK all. Until next week when I will learn more and try to do better.

Saffron pictures provided by Wikipedia.

How to Stop Antidepressants While Minimizing Withdrawal

→ September 6, 2011 - 15 Comments

How to Stop Antidepressants While Minimizing Withdrawal

While antidepressants can absolutely be life-saving medications, sometimes antidepressants aren’t the right medication at the right time for you. Or sometimes, it’s just time to try to get off of antidepressants. (For simple depression, this is often done if you have been stable for 6-12 months.)

Can't Get Off Antidepressants

But the key to getting off antidepressants successfully is to minimize withdrawal symptoms because otherwise you may feel like you’re trapped on the antidepressants. Additionally, the withdrawal symptoms may get mistaken for returning illness symptoms, which you do have to watch for, but if possible, it’s best not to get withdrawal and returning symptoms confused.

So, here are some tips on the best way to get off antidepressants while minimizing withdrawal.

Learn About Getting Off Antidepressants

Firstly, by reading this you are taking the first step. Learning about your antidepressant, the time it takes to get off, and what might happen, is an excellent first thing to do. Your doctor can guide you in this process.

DO NOT STOP ANTIDEPRESSANTS SUDDENLY.

DO NOT STOP THEM ON YOUR OWN.

ALWAYS TAPER ANTIDEPRESSANTS UNDER THE SUPERVISION OF A DOCTOR.

(And as always, I am not a doctor and none of this should be considered medical advice. Only your doctor can offer that.)

Taper Antidepressants More Slowly

How to Stop Antidepressants

I can’t comment on individual doctors, but I will say in studies and in the literature they take people off medication, including antidepressants, way too fast. This is likely because they don’t want to wait around to do it the right way, but still, it gives people the false sense that you can get off antidepressants quickly – you shouldn’t.

Track Your Mood During Antidepressant Decrease

I know, it seems like I’m trying to strong-arm you into tracking your mood, but during medication tapering, it’s essential. You need to track your mood every day during medication changes – this goes for all mental illness – as well as write down when you change dosages because:

  • You need to know if you’re getting worse
  • You need to know if you do better at a lower dose, but not off the drug completely
  • You’ll have those records should you try to do it again in the future (or with another medication)

Please, please, please, even if you track your mood at no other time, do it when withdrawing from medication. (More on mood tracking here.)

(If you don’t want to track every part of your mood, then at least track the global assessment of functioning (GAF).)

Wait Six-Eight Weeks between Antidepressant Dosage Decreases

Seriously.* You are waiting so long between antidepressant dosage decreases because:

  • You want to prevent withdrawal
  • You do not want to induce mania, cycling or a mixed mood which is a real danger in bipolar

Changes to the Antidepressant Taper Schedule

You may want to slightly alter the antidepressant dosage decrease schedule:

  • Increase speed if feeling better as dosage decreases
  • Decrease speed if anxiety is a factor
  • Decrease speed if feeling worse on a lower dose
  • Decrease speed if feeling good at a specific dose (that might be the right dose for you)
  • Decrease speed for any reason if you feel the need

Never try to decrease or get off an antidepressant when:

  • You’re in a time of stress
  • There is an upcoming holiday

Decrease the Antidepressant in the Lowest Dose Possible

Slow Antidepressant Taper

This does not mean cutting your current pill. Some pills cannot be cut for safety reasons. This means getting a prescription for the smallest increment available and decreasing the antidepressant dosage by that much.

When you’re closing in on getting off the antidepressant completely, slow down even more. Cut the pill if you can. If you can’t, alternate on the higher dose for one day and then the lower dose for one day.

Exceptions to the Antidepressant Withdrawal Rules Above

As with all things in life, there are exceptions:

  • If you’ve been on the antidepressant a very short time you may be able to get off of it quickly
  • Fluoxetine (Prozac) may sometimes be tapered more quickly
  • Venlafaxine (Effexor), desvenlafaxine (Pristiq) (and sometimes other antidepressants) can be too hard to get off of using this method (see next article in series)

Getting Off an Antidepressant Takes Too Long

Look, you are getting off a medication that has altered the chemicals in your brain. This is not a minor event. While this method is slow, it gives you the very best chance of successfully getting off the medication without inducing withdrawal or worsening illness symptoms.

Don’t Freak Out When Coming Off Antidepressants

Remember not to freak out. Some withdrawal symptoms and some bipolar/depression symptom fluctuation may occur and you’ll still be all right. Just maintain a close relationship with your doctor to make sure it isn’t the start of something more serious

How to Get Off of Antidepressants with Minimal Withdrawal Series

Previously we saw:

Up next is:

—————————————————————————————————————————————–

If Your Doctor Doesn’t Get This, Send Them to Psycheducation.org for Their Own Education

* This information (and other information in this article) is provided by psycheducation.org and Dr. Jim Phelps.

Bipolar Disorder – When to Get Off Antidepressants

→ August 31, 2011 - 18 Comments

I try not to give medical advice here because I am not a doctor. But so many people ask me about this I felt I had to address getting off antidepressants without withdrawal. So many people with bipolar disorder (depression and others) need information about getting off psych meds and they are not getting it from their doctors.

This is the first in a three-part series:

  1. When to Stop Antidepressants in Bipolar Disorder
  2. How to Stop Antidepressants in Bipolar Disorder While Minimizing Withdrawal
  3. How to Stop Taking venlafaxine (Effexor) and Desvenlafaxine (Pristiq) – as they are particularly nasty to get off

This is an informational article only and should not be considered a recommendation. Talk to your doctor before any and all changes to your treatment. I’m not kidding about this.

These recommendations are primarily from PsychEducation.org and Dr. Jim Phelps with some commentary by me.

Bipolars Shouldn’t Take Antidepressants

Some doctors are on the fence about this, but more and more bipolar specialists are recommending people with bipolar disorder not take antidepressants. There are lots of reasons for this, and I have to tell you, they are compelling.

Why Shouldn’t People with Bipolar Disorder Take Antidepressants?

Some reasons people with bipolar shouldn’t take antidepressants:

  • Antidepressants may not work in bipolar disorder – believe it or not, the literature is mixed on how well antidepressants even work for bipolar depression.
  • Antidepressants can induce mania or hypomania (known as switching) – most of us have seen this and it happens all the time to bipolars who are prescribe antidepressants by non-psychiatrists because they just don’t understand the danger. And it is very dangerous because once switched, this type of mania or hypomania can be treatment resistant.
  • Antidepressants can induce rapid-cycling or mixed moods – same as above, this cycling can be treatment-resistant.
  • Antidepressants can worsen a bipolar’s illness overall – this is more controversial and I suspect varies case by case.

Bipolar Disorder and No AntidepressantsTo be clear some people with bipolar disorder will always need antidepressants temporarily, or long term, for their mood, but more and more, doctors are saying to avoid them whenever possible. (Alternatives will be presented in a future article.)

When to Stop Taking Antidepressants

Here are some guidelines from Dr. Phelps about when to stop taking antidepressants in bipolar disorder:

  1. If they have been on antidepressants a short time, I stop them.
  2. Less than a week, stop; two weeks, cut in ½, a week later stop.
  3. Likewise, if they just increased their antidepressants dose I will do the above, decreasing to their previous dose and get rid of the rest later.
  4. If manic or severely hypomanic, get rid of antidepressants now.  Usually can stop abruptly.
  5. If cycling or mixed get rid of the antidepressants.
  6. If they are not getting better after several add-on meds then slowly decrease.
  7. There are more exceptions to the above rules than there are rules.

When to Stay On an Antidepressant if You’re Bipolar

More guidelines from Dr. Phelps: When a bipolar should stay on an antidepressant:

  • If the patient is doing well, no mixed state symptoms or cycling, leave it.
  • I usually wait until the patient is doing better to much betterto stop an antidepressant; why:
  • Trust is an issue.  If the first thing we do is make them suffer more they will be unlikely to stay around long and may not even go to another psychiatrist.
  • Even though we know the antidepressant is causing harm often time the patient thinks either the antidepressant is helping or every time they try to go off they feel much worse.
  • Waiting until they are better is usually a good thing.
  • Also waiting longer usually means that the patient is going to be more educated about bipolar in general.

When to Get Off an Antidepressant Recommendations

I think Dr. Phelps’ recommendations are good ones, otherwise I wouldn’t have them here, but note where he says there are more exceptions than he has listed, so keep in mind, you might fall into one of the unlisted exceptions.

And I think the part above where Dr. Phelps talks about trust and making sure the patient is better before messing around with their cocktail is key. It shows he’s respecting the patient and their health, not to mention the doctor-patient relationship which is very important.

Talking to Your Doctor about Getting off Antidepressants is Scary

I know it’s scary to think about going off antidepressants, even if you do think they are causing problems. But think about it, discuss it with your doctor and make the right decision for you. And don’t do anything until you read the next part about how to get off antidepressants without withdrawal.

Bipolar Disorder – Getting off Antidepressant Series

  • Bipolar Disorder – When Not to Take Antidepressants

Coming up:

Selling True Hope to People with a Mental Illness

→ August 29, 2011 - 24 Comments

The Bipolar Burble doesn’t sell anything, not to people with a mental illness, or anyone else.

It will one day. One day soon it will be selling my book. And then another book after that. We writers do stuff like that.

And maybe one day there will be ads here trying to sell you other things too – therapeutic lights or omega-3 supplements for mood.

But one thing I do not now, nor will I ever sell:

Hope.

I will never, ever try to sell you hope, true or otherwise. Hope is free and selling it is a lie.

Read more

Linky-Madness, Drugging Children and Anxious Hat Makers – 3 New Things

→ August 25, 2011 - 4 Comments

In my line of work I come across the most obscure information, which is why I love sharing it with you. This week’s three new things about mental illness include:

  • A weekly mental health link-party
  • How scientists want to drug children who might get a mental illness
  • How hat makers used to experience social phobia

How could you not want to know the details about that?

1. What I Like – Madness Mental Health Linky

I’ve been participating for a few weeks in the Monday Madness Mental Health Linky over at the WordsinSynch blog by Shah Wharton. As the name implies, there are fresh links every Monday.

[push]Anyone can contribute a useful mental health link. Shah features her own work or the work of others and then lists useful links.[/push]

(No offence to Shah, but the layout is awful and kind of hard to understand.  Here’s how it works: Simply read the Monday Linky article and at the bottom there are featured links. Below that is the “blog hop” where the reader-submitted useful mental health links are posted and below that you can enter your own link.)

Click. Read. Enjoy.

2. What I Don’t Like – Drugging Children (or anyone unnecessarily)

Drugging Children with AntipsychoticsI could just leave it there but what I especially don’t like is the drugging of children who might get a mental illness. This is one of the troubles with that fad diagnosis I mentioned last weekpsychosis risk syndrome. While we do, honestly, know what puts a person at risk for psychosis, that’s a far cry from actually being able to accurately predict who is going to get a psychotic disorder.

For example, I know smoking puts you at risk for lung cancer, but you still might not get it. (Although smoking’s a lot more clear cut than psychosis. Don’t smoke. Seriously.)

In this study, people age 15-40 were to be given an antipsychotic (quetiapine) to see if it would delay or prevent the onset of a psychotic disorder like schizophrenia. And – here’s the kicker – up to 80% may never get the disorder anyway.

So I ask you, is it worth exposing a 15-year-old to a powerful antipsychotic associated with an increased mortality rate on a guess? I think not. (More next week.)

3. What is Just Bizarre – Hat Makers, Mercury  and Anxiety

Think you have social phobia? Do you make hats?

Excessive shyness, embarrassment, self-consciousness, timidity, social-phobia and lack of self-confidence are components of erethism, which is a symptom complex that appears in cases of mercury poisoning. Mercury poisoning was common among hat makers in England in the 18th and 19th centuries, as they used mercury to stabilize wool into felt fabric.

(From Wikipedia, where else?)

See you all next week for an attempt at a smarter and better me.

PS: Have you entered to win yet?

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