My psychiatrist isn’t the brightest crayon in the box

Has anyone ever thought that their psychiatrist was prescribing inappropriately? Mine has prescribed 450mg SR and I’m supposed to take it all in the morning. But all the reason ems I read say that for the SR formulation the maximum dose is 400mg per day and should be taken as no more than 200mg in a single dose and doses should be eight hours apart. I’m not concerned about the 450mg vs 400mg as in my country we only have 150mg tablets, so 400mg isn’t an option. 

Doc said to take in the morning as otherwise I won’t sleep. But I’m no expert but I think I would rather take my chances on the insomnia than decreased seizure threshold. But doc’s risk benefit:analysis isn’t particularly strong.

I have already been taking them as prescribed but I’m considering just moving 1 150mg tablet to the evening.

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My Psychiatrist is an Idiot

My Psychiatrist is an Idiot

So last week I saw the psychiatrist, in short, they were an idiot. They, first of all, wouldn’t shut up about therapy bullshit. It’s not that they were wrong, but the reason I was referred to a psychiatrist was that the general consensus of the people who had assessed me was that I was too busy to be able to do therapy properly. Which is true.

That wouldn’t be too bad but the medication option was to switch out venlafaxine for sertraline. The Psychiatrist was all like, have you tried sertraline? And I was like, no, but I have tried fluoxetine and escitalopram. For anyone who doesn’t know their antidepressant pharmacology, which apparently includes psychiatrists… Fluoxetine, escitalopram and sertraline all fall under SSRI. General guidelines say try one SSRI for about 8 weeks if there is still no response switch to another SSRI for another 8 weeks or you can increase the dose it varies a little bit. But overall once you have tried two SSRI you then switch out of class, which is when I was put onto venlafaxine.

Fluoxetine, escitalopram and sertraline all fall under SSRI. General guidelines say try one SSRI for about 8 weeks if there is still no response switch to another SSRI for another 8 weeks or you can increase the dose it varies a little bit. But overall once you have tried two SSRI you then switch out of class, which is when I was put onto venlafaxine.

Venlafaxine is classed as a SNRI so instead of only inhibiting the reuptake of serotonin it also inhibits the reuptake of noradrenaline. A lot of Drs will use venlafaxine to switch out of the SSRI class as it offers some additional opportunity for response with a minimal increase in side effects. I also take mirtazapine which is an atypical antidepressant so is also not a SSRI.

Anyway back to me, because that is the real importance of this rant… My main point isn’t what the guidelines say, it’s that when I tried both the SSRI’s I had no response at all, they did nothing. I got no side effects, but also no response, it was like they weren’t there. When I took venlafaxine above 150mg I have an improvement in my concentration, but other than that not a lot happened and long term I got a lot worse purely because my depression just wasn’t being treated.

Then sometime late last year I managed to convince my GP to add mirtazapine on top of the venlafaxine. Which within a week actually did something. I mean not fully recovered but at least it pulled me out of my suicidal phase.

The thing is the fact that my response to mirtazapine occurred so fast would suggest that the venlafaxine may have contributed to the response. Don’t get me wrong this combination is far from perfect but it is doing something and to seriously rock the boat by removing one for a fucking SSRI is just stupid based on my past history of response.

Anyway please tell me someone else follows my logic. If anyone got this far that is…..

Thymia

Sometimes I wonder if I am actually bipolar because I sometimes just get really hyper, I don’t really think hyper is the right word. And I know full-blown mania is like next level, but hypomanic? I think in the past I have blown it off because I don’t think it has ever lasted long enough.

It’s hard to judge for yourself. But the thing is I am so weirdly the other way naturally, really quiet and withdrawn, not very spontaneous. But I just have these out of character bursts where I can’t stop talking, more impulsive, confident, really awake compared to normal. It’s hard to tell what’s normal.

What even is euthymia anyways? Is it different for different people, or should we all have the same level of… thymia?

Christmas

Merry Christmas everyone. This isn’t really my sort of thing. I have never been into anything that is overly happy. 

Christmas used to be such a magical time, believing in Santa and all. But it quickly seamed to change. My parents made us gift presents to the poor kids who weren’t going to get any. This confused little seven year old me, why did Santa leave out the poor kids? And from then on Christmas became less and less magical. 

Why Do People In Mental Health Suck?

Why Do People In Mental Health Suck?

I have probably complained about this one individual before, if I haven’t, I most definitely should have. Actually, I’m sure I have complained about them. Anyway, let’s start with their most recent mistake. I got this lovely phone call that borderline dragged me out of sleeping. I was called to inform me that I had missed my appointment two weeks ago… I am just going to ignore the fact that at the last appointment they told me that they would call me the day of my appointment to remind me. TWO FUCKING WEEKS. You work in mental health, I could have been dead.

This specific individual probably deserves to have this whole post dedicated to them. But I probably won’t, there are multiple bad people.. The fact that I was not functionally impaired enough, and I was not a risk to myself or others. That is not the criteria to be seen by a fucking mental health nurse, it’s for being hospitalised against your will! So many people haven’t even experienced a mental illness, it’s like there is this extra stigma within mental health against mental illness. What is that? If a person had severe asthma themselves they would be a good respiratory specialist. If a person has experience within a field it allows for an extra level of empathy that all patients appreciate. But all this bullshit about “resilience”. You can be 1000X more resilient than someone and be more mentally ill than them, because what you went through. All this fucking bullshit claiming you see some horrible stuff, you’re in health care, that happens. But on top of the obvious, you’re only seeing it, people with mental illness have been through it, seeing it doesn’t even compare, it’s a walk in the park. All this tells me is that you have no idea about what you are talking about.

But this shit is fucking drilled into the mental health system. They don’t want to change, their system sucks, they blame the funding. It’s more than that. The funding means we don’t get seen often enough. It doesn’t cause you to be shit at your job. Take responsibility for your own work. Mental health is an area where it should be so easy to make a difference to an individual. You just have to show that you give a fuck. You should give a fuck, so show it. The amount of time I have been treated like I was a number, like I was disposable is unacceptable.

I must admit this is a bit of a “pet peeve” of mine, people who suck at their Job. I think it stems from the amount of difficulty I have had finding a job in the past. The worst part is that these people don’t even realise they suck at their jobs, nobody tells the, and if they do, it was just because they are mentally ill. Therefore when in a job interview, their not lying when they say they’re good, that actually think it’s true.

You can read some of my other blog posts to get more information on my bad experiences. I tend to complain a lot. I feel there is too many to tell you about them all in one post.

I apologise for the swearing, but that’s who I am. It called expression it adds emphasis, gets the point across. Being offended is a choice, none of the words I used is offensive to a group of people. #sorrynotsorry