22/06/17

I’m in the mood for some philosophical thinking around psychology/psychiatry.

Reality is defined as the state of things as they actually exist, as opposed to an idealistic or notional idea of them and psychosis is defined as a loss of touch with external reality, as per Google of course. These seem like simple definitions, but lines get very blurry very quickly.

Let’s start with religion, so many people claim that they hear or see God. a very minimal percentage of this group get a psychosis diagnosis. But if you hear voices that are from other not visible beings you’re “psychotic”.

Some scientists believe that it is more likely we live in a simulation than not. We could be the Sims 100. Imagine if all my depression could be attributed to some loser picking the gloomy trait for their sim…

Anyway, this whole thought came about because the psychiatrist asked if I had ever heard voices. Which I have but only when I’m trying to get to sleep so I don’t think that counts, well hopefully not.

 

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…..

Lost, confused and going in circles 

I don’t know where I am right now, I don’t know if I’m going forwards, or backwards, uphill, or down hill? I’m getting increasingly tired and I don’t know how I’m supposed to do what I’m expected to do. Other people don’t seem to be very helpful and it’s almost like talking to a wall. At least if I really was talking to a wall it would likey live up to my expectations of helpfulness. I just seem to be going in circles and don’t know where I will be when I stop.

08/04/17

So after the last time when I tried to ask for help with my studies I was told to make a Dr appointment, I did. They increased my medication so that’s something. But they said they would refer me to the mental health team because I would be better suited there. Which would be great if I wasn’t already with mental health a month and a half ago, but they decided I wasn’t sick enough. Typical mental health care, it’s all just circles. 

I’m supposed to be getting some free councelling though, through another seperate thing that is short term. Even though throughout my medical records it specifically says”needs long term psychological support “.

Asking for help….

A few days ago I was sitting in a group of people getting the overly generalised talk about looking after mental health. My little sub-group was supposed to brainstorm ways to break down barriers. Well in the real world there are lots of barriers, eg. Money, hours of work, finding someone useful, and then there’s the when you ask, people tend to not know what to do. The response is usually do you need to go on medication, this is especially awkward as I’m on two medications not just one. Others are book another Drs appointment and buying me hot chocolate. Of these too be honest the most useful is probably the hot chocolate. 

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?