Some words on: Splitting the atom with pill-cutters and patience

Logically, as I move on to lower doses of medication, also the adjustments on the way to the next smaller dose need to become finer. Pill-cutters work great when it comes to halving tablets, or even splitting sufficiently large, round tablets into quarters. But unless you can get hold of low-dosage pills, the utility of this gadget has its limits. More often than not, my attempting to cut pills into exact portions smaller than one half, has resulted in me plucking minute white crumbs out of the pill-cutter and piecing them together to approximately one day´s dose. Some pills simply resist being cut precisely. To avoid such hassle, I prefer using my pill-cutter in combination with a method of spacing out the intake of the old, higher dose in favor of the next lower one. The underlying idea is to gradually diminish the average amount of the respective substance in my organism until reaching the following lower target dose. Here is an example of how I have been doing it:

graphic sertraline withdrawal

I came across this procedure in Dr. Peter Breggin´s book Psychiatric Drug Withdrawal, and have mentioned it briefly in an earlier post on this blog as well. The graphic above does not reflect the exact way Dr. Breggin helps his patients decrease their drug intake, but it is an adaptation of his idea to my own circumstances. Another way of doing it by blocking high and lower doses according to a weekly plan would be to take the new dose on one day of the first week, two following days of the second week, three following days of the third week, and so on. It could look something like this – red spaces represent the old, higher dose of a drug and blue spaces the new, lower one:

suggestion weekly withdrawal plan

As you can see, the concept is flexible. You or your doctor may come up with other variations, even shortening or lengthening the duration of each step in your withdrawal process according to your own needs. In addition, I have to point out, once again, that I am not a professional in the medical field. This blog documents my individual way of handling medication withdrawal, but I am in no way qualified to give anyone else instruction in this matter. My hope and purpose is to encourage you to acquire the means and the support you need to improve your health. If you believe the method of psychiatric drug withdrawal I am describing in this article might also be helpful in your case or for someone you know, please seek further information with professionals and consult relevant literature. I am sorry if I am repeating myself with this sort of disclaimer, but I truly do not wish for anyone to get hurt in the execution of domestic experiments with psychoactive substances.

Up to now, I have been faring well using this method of dose reduction. All that is necessary is to keep track of where you are at in your plan – and to have your plan for each dose reduction written out for your reference. Personally, I keep a handwritten list of days and corresponding dosages, and tick off day by day. This way, each decrease in dosage takes me around five to six weeks. After completing the change, I wait for another couple of weeks before I make any modifications to my intake of the other drug I am using. Thereby, I hope to make sure each alteration of my medication plan is well under control in that I can recognize any adverse reactions and, most importantly, relate them directly to specific changes I have made. In order to take psychiatric medications, and also in order to wean off them safely, it is vital to notice the effects using them – or ceasing to use them – has on you. When you experience negative side-effects or withdrawal symptoms, you need to find out what caused them. A clear-cut medication and withdrawal plan helps generate such transparency, provided you follow up on it diligently. Being structured also allows for making well thought-through modifications to your plan if things should not go smoothly. Suffering adverse effects is, in itself, a destabilizing experience. The less panic-driven and better informed your subsequent actions and decisions are, the more likely you are to get back on track and prevent a full blown crisis from developing.

At this point, I would like to remind you always to remain process-oriented, rather than goal-oriented. Diminishing psychiatric drug intake is not about reaching the lowest dose possible in the shortest amount of time possible. Your success in this area is not defined by numbers. Drug withdrawal is not a sport. It is a process, which in turn will be accompanied by further processes regarding your overall health, your attitude towards life, your relationships with others, and your personal development. All those processes and gradual shifts are what you are after. Do not attempt to force spectacular changes. Instead, care for yourself and intend to remain grounded enough to weather your everyday life. If, at some point, looking back you can say you are feeling better about yourself than a while ago, you are headed in the right direction. Let every step forward and every choice be the natural result of your inner development and a subtle stimulus for further growth. Do what you can, but never try to find out where your breaking point is by challenging yourself to your limits. Do not hurry. Keep in mind it is better to walk calmly and securely than risking to stumble, fall and having to pick yourself back up all over again. Take all the measures you can to stay at peace. Protect yourself, nourish yourself.

Funnily, at present I am reading a book about writing and just came across a sentence I wish to quote here: “We´ll see progress in time. But we can´t expect to every day.” (Louise De Salvo, The Art of Slow Writing). In other words: do not drive yourself bonkers with undue pressure, nor let anyone else do so. As long as you are honestly working towards your health and your life´s improvement, you are doing well. Or, regurgitating a quote De Salvo took from Stephen King, describing his return to writing after a devastating accident which forced him to undergo long and painstaking rehabilitation: it all is about “[…] getting up, getting well, and getting over. Getting happy, ok? Getting happy.” King was referring to his writing, but really these words describe the essence of healing. Take note, in particular, of how King uses the verb “getting”, which clearly denotes process. PROCESS! This is what you are looking for. Getting healthier and, why not, happier!

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Some words on – “Stability”

I haven’t looked it up, but there must be several posts on my blog where I mention the importance of waiting for periods of emotional and existential stability in order to make changes to your medication regime. I believe it is important to remember that such stability is oftentimes ephemeral and can vanish without notice. This is not to scare anyone or to make them renounce from weaning off their drugs, but I´m saying this to make sure no-one out there is waiting in vain for a complete standstill of affairs that may never occur.

Many changes in life are not initiated by us, but by external factors we cannot control. On such occasions, we may find ourselves sucked into a stream of events we never chose to be a part of. One day, we can be enjoying great peace and contentment, and the next day all hell can break loose, with us at the center of it. All we can do is try to limit the damage through appropriate reactions.

Some months ago I perceived myself to be walking a pleasant, smooth path. Everything seemed wonderful, including my new job. It took nothing more than a co-worker, whom I scarcely even knew, to walk through the door and furiously accuse me of a serious infraction I had – honestly – not committed. She herself had not been a witness of it, but was acting upon hearsay. She also reported me to the superiors. With me being the new one and her well established at the workplace, she had all the credibility. She also informed me very loudly that “everyone” was talking badly about me anyways. She refused to tell me who “everyone” was, but insisted it was literally the whole staff of the institution. My immediate impulse was to grab my bag, leave and never go back. It took quite a bit of willpower to continue my workday and remain halfway functional. The following weeks, I was internally boiling over with outrage and couldn’t help but look at other colleagues wondering “Is so-and-so among those who are talking badly about me?” As for the woman who attacked me, to this day she has been unable to look me in the eyes. I believe this speaks for itself. I also admit I now find slightly perverse amusement in facing her with a calm I-am-Buddha smile whenever our paths cross.

To make a long story a little bit shorter – lightning strikes wherever it wants, whenever it wants. Even out of the blue. So how can you make sure life doesn’t throw you a curve ball as you are in the middle of a dose reduction? You can’t. There is just no way of telling. Yet, you can do a lot about how you react, and about whether you look for support from people close to you.

Let’s talk about the support. If you are trying to recover from psychiatric crisis, undertaking a medication switch or readjusting your drug dose, you should have a personal support system mapped out. Let people you trust know what you are going through, and ask them to help you with careful observations, attention, honesty, good judgment, constructive input, friendship and love. An open conversation, a firm hug and an outside point of view can work miracles when you find yourself in distress. Plus, when you have a history of mental illness and psychiatric treatment, you are probably very vulnerable to self-doubt. Am I crazy? Am I sliding into a crisis? Is my reaction healthy? Commonsense could calm down such self-interrogation, but it is very reassuring and comforting to hear from someone else they understand you and think you are actually doing fine. And, in the opposite case, should you really be at risk of derailing psychologically, having this pointed out by someone is a vital contribution to preventing the situation from getting out of hand.

Now let’s move on to the reaction element. Depending on your personality, obeying to your momentary impulse may or may not be best. In my particular case, it is generally not. Impulses typically cater to an ancient fight-or-flight mechanism which is very useful when you are being chased by an enraged mammoth. In an office or other postmodern setting it is less practical. As you can tell from the incident at my workplace, my spontaneous, gut-driven response was to wrap it up, show off my middle finger, shout “Fuck y’all!” and leave with flying colors, in pursuit of unspoiled horizons. Similarly, upon receiving offensive or otherwise inappropriate e-mails, my impulse consists in proving to the unfortunate emissary of the message that my rhetoric is better than theirs, and that I can be an even bigger cunt than they are attempting to be. It can take a few re-edits before my response becomes suitable for sending at all. Experience has taught me that cooling heart and mind down improves the outcome of my actions. This also goes for emotions other than anger. Fear is another bad adviser. As simplistic as it sounds, succumbing to impulses fueled by negative emotions is never a good idea. As refreshing as spontaneous displays of affection, generosity and joy are, as devastating can the uncontrolled liberation of their opposites be – for others and for yourself.

This does in no way mean you should sugarcoat all your negative perceptions. They are there for something: they warn you of unfavorable situations, toxic relationships, bad intentions others hold, and so on. You need to recognize unhealthy circumstances for what they are in order to protect yourself from harm. The art lies in distinguishing impulse from intuition. Impulse is a reactionary force which can be laden with either positive or negative emotions, and serves to vent those. Intuition, on the other hand, is your inner voice expressing the observations and needs of your personal essence. Impulse is the lightning that strikes where and when it wants, blinding you as you act out. Intuition is subtle, constant and truthful, providing you with insight and strength. Impulse will say: “So-and-so is such an asshole, I totally hate him/her!” Intuition will simply advise you not to engage with that person because they might be harmful. The coworker who attacked me was being impulsive, and I almost would have been the same in response.

The million dollar – or yen, or euro, or pound – question is: how to make out your intuition among all the thoughts, feelings, images and ideas scrambling about inside you? There is no standard recipe, and finding out how to do it is one of the great tasks in life. It seems nobody ever masters this skill completely, otherwise disgrace would not continue happening all the time and everywhere on our planet. However, everyone is able to improve.

Finally, I shall tie the know with the subject of psychiatric treatment and life skills. Even if you have been in crisis and are taking one or more drugs, you can and should exercise your intuition, as well as other life skills. Never assume that, because you have been labelled mentally ill and prescribed neurochemical crutches, you are doomed to be handicapped forever. Consider yourself in the process of rehabilitation and keep in mind that most people are in need of healing, too. Just because they have not been diagnosed does not mean they are healthy. Society is sick in many ways, and will imprint some of its illness upon its members. Within countless families, toxic emotions and destructive behavioral patterns are handed down through generations like old, creaky furniture. And one traumatic experience with an abusive individual can throw formerly strong people off kilter for years to come. It so happens we call such wounds “psychiatric illness” when they are particularly evident or render someone dysfunctional in regard to the current social norms. However, it is a type of injury everyone suffers from in varying degrees. There would be nothing for us to learn and grow by if this were not so. Walk ahead. Always walk ahead.

How it´s going – Completion of phase three

Hello Everyone!

I am now taking half of my original dose on both medications. So now I am on 75mg of Sertraline and 150mg of Quetiapine. There have been no unfavorable reactions to the dose reduction whatsoever. Again, I have to stress that I do not simply switch to a smaller amount of any of my medications from one day to the next. Every decrease in dose takes me about three weeks to complete. Also, I never modify the dose of both medications simultaneously, but do it one after another. This adds up to a total of six weeks for the change to be complete. I always start with the antidepressant, and finish with the anti-psychotic.

Given that I am feeling so well, I have decided to continue dose reduction throughout the month of December. I will take the Sertraline down to 50mg. In January, I will be travelling abroad, which is why I intend to wait with the further reduction of the Quetiapine dose until after the trip. I should point out that we will be visiting my partner´s family, and that I have made this same trip twice before. In other words: we will not be exposed to exotic stimuli and strange locations, but rather be welcomed into some sort of home from home. I find this important to mention because dose reductions are safest when there is no stressful situations or emotional turmoil ahead. Of course, these can come up unexpectedly at any moment and even in the middle of a dose reduction, but why deliberately risk any instability in the face of anticipated psychological pressure?

Once I am down to 50mg of Sertraline and 100mg of Quetiapine, which corresponds to one third of the original dose, I will not make any further changes for at least half a year. Frankly, I have not even clarified for myself if I should ever be completely medication free. The habit of popping those pills every morning and evening has become so strong and reassuring that the idea of not having them as a safety-net gives me vertigo. Knowing myself, I might be able to overcome that fear once I am getting closer to the right moment, but I am more of the one-step-at-the-time type, so for now I will be dealing with the next dose reduction and nothing beyond that. This tactic has worked fine for me until now, and not just regarding my medications but also other matters in life, so I shall stick to it.

I will keep you updated.

Felicia.

Finally, Moving On

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Hello Back.

I have kept this blog dormant for quite a while now, which I really feel lousy about. Luckily for me, it has been for all the right reasons. My life has changed considerably and kept me very busy.

After bringing a shitty contract with an abusive employer to a necessary end and having worked three jobs at the time throughout the month of June to bridge the gap, I am now very content with my new placement. Knock on wood, may it continue to go as well as it has begun.

Another source of stress is the disappearance of three of our pets, probably at the hands of a sociopath neighbor who had actually menaced us with “doing something” to them. We would love to denounce him, but unfortunately we have neither proof nor witnesses other than ourselves. Not knowing what happened to your little friends, nor where they are and how they are doing, weighs heavily on the heart. So does the inability to do anything about it.

Close friends have moved out of the country, but I hope to keep up contact with them – after all, this is the age of the internet! Hopefully, my partner and I will be able to visit them at some point. I do miss them.

I have even “survived” a reunion with close relatives without the feared psychological breakdown and without seeing anyone, including myself, resort to the dysfunctional patterns of behavior that have spoiled family meetings in the past.

My beautiful partner has supported me through all the changes and his part in everything having come out so positively is major.

I still have nasty nightmares on most nights. It had become better for a while, but they have returned. My subconscious keeps bringing up topics it wants to process and apparently fails at it, making another attempt the next night, and so on. In spite of this, I seem to get enough rest. I am productive at work and creative in my spare time, and enjoying both. My cognitive performance and concentration levels are fine.

A big setback, though, is that I am pretty much back to my original weight. It’s not like I have been binge-eating or anything. It has just come back on. Seven pounds lost, seven pounds gained. At least I am not heavier than I used to be. Still, I am frustrated at how I look. I have always had issues with certain body parts, as most people do, but these weak spots seem especially annoying now that I am not in my best possible shape. Back to square one! I’ll have to devise a good workout-plan.

Since my last post, I have not made any new modifications to my medication regimen. I decided that too much was going on to risk any additional instability. Today I’ve begun to lower my Sertraline dose. I have been taking 100 mg in the mornings for a few months, which is 30% less than the original dose. My next aim is to go down to 75 mg, which would be half of the original amount. Once this is achieved, I will follow up with the Quetiapine. I am confident it will work out. However, my partner will have a watchful eye on me and tell me if I act even weirder than I normally do.

I’ll be in touch.

Felicia

 

 

Some Words on: Hyperfunctionality Disorder

If you are following this blog, you likely do not have this problem, but to be on the safe side, go through this checklist:

  • You are successful in your career
  • If you go to school, you are an inquisitive and efficient learner
  • You have a good relationship with your family
  • You live in a harmonic relationship with your partner
  • You are nice to others
  • People like you
  • You never use inappropriate speech and always act gracefully
  • You dress neatly
  • You have kids and a full-time job and pursue academic studies, yet there are no dark circles under your eyes
  • You are well organized, your house is clean and orderly and you know where all of your important documents are
  • You handle money and other resources responsibly

Can you respond to more than six of these affirmations with “this applies to me”? If so, you suffer from a lesser or greater degree of Hyperfunctionality Disorder.  Now answer the following:

  • You are hot

If this applies to you on top of the common symptoms of Hyperfunctionality Disorder, you are not human…

Alright, so why am I writing an article on a disorder that does not appear in the DSM, for I made it up, and posting it on a blog about mental health? Because what society expects us to be ideally is abnormally perfect, and this expectation is driving many into despair and mental illness. Therefore, I suggest that it is a disorder in its own right. Yes, you do sometimes get people who glide through life with an almost spooky smoothness, but it is important to note it is not the rule, thus it is not normal. If you are not like that, there is nothing wrong with you! It merely means you are not fully and completely adapted to the ideals society promotes, and that is not necessarily a bad thing! Who ever said the societies we humans construct are healthy? I even believe it is an advantage to have a few bumps in your road and some edges to your personality, because they give you a chance to grow and enrich your life experience in ways no one could have foreseen for you.

So, the next time you come face to face with someone who shows signs of Hyperfunctionality Disorder, let them be. No need to get suspicious, or envious, or hateful. It is a natural, yet toxic impulse to feel any of these in the presence of people who unintentionally rub our own imperfection in our faces by being so relentlessly functional. And maybe they really are not that immaculate. Let’s admit it: we’re relieved every time we find someone seemingly flawless has a skeleton in their closet, too. It makes us feel a little better not to be the only deficient specimens around. And truth be said, you can never know what exactly is going on behind the façade. Of course you see your own weak spots with more clarity than those of a colleague, a fellow student or a neighbor. Even friends and relatives can have an inner life they never disclose to you. Still waters can run very, very deep.

But whether others are perfect or not should not even be your concern. You need to appreciate your own qualities, even the “negative” ones, because they nourish you through what you make of them. They all are energy sources you can use to move forward! Still more: you can be a gift to others because you, in your own, special way of being, contribute to the amazing variety of human existence. My message to you is: if you do not test positive for Hyperfunctionality Disorder, be glad, not worried! You have a challenging and unique path before you. Embrace it!

 

Some Words on: Generics

There is still no end in sight to the debate on whether generic drugs are – or are not – an equivalent substitute for the original brands. Generics use the same active ingredients as the originally patented drugs, yet a large party of both physicians and patients claim they do not work in the same way. And in fact, there can be slight chemical differences between original and generic drugs. Every medication, psychiatric or not, contains substances that are not meant to have any effect on the consumer, but have other functions, such as helping the absorption of the active ingredients into the organism or binding them so the tablet does not crumble. These compounds are called excipients. This is where variation can occur. Some generic drugs may not use the same excipients as their original counterpart, or the ration between active ingredients and excipients can be different. However, this does not necessarily mean generics are any worse, or that their users unavoidably will experience negative effects they would not be suffering taking the original drugs.

It is hard to pick a side in the controversy, especially when you are a user of psychiatric drugs or know people who are. Obviously, you will be inclined to project your personal experiences into your argument. At the same time, being personally involved can give you a more hands-on approach to the matter and look at it without getting caught up in the technical details of medical studies and statistics, and without being influenced by professional links to the pharmaceutical industry or second-hand-anecdotes from colleagues in the medical field. This perspective is the one I am going to expose. I am not a health care professional, but I have been taking psychiatric drugs for slightly over four years, with an unknown amount of time still to follow. Moreover, some people who are very close to me have used them in the past or are still doing so, and I have seen psychiatric drugs in action on fellow patients in psychiatric hospitals. One thing I can say in advance – I have no clear-cut answer to the question if generics are as effective as the originally patented drugs. There is a huge number of companies producing generics, in different countries, under different safety standards, with differing levels of work ethics. Evidently, the aspect of safety is an important one, if not the most important one. Are generics as safe as original brands? Also this I cannot say. But then again, it is doubtful whether taking psychiatric medications in and of itself can ever be safe. The knowledge we have about possible side-effects and our ignorance of long-term effects on the human brain speak for themselves. If you must take psychiatric drugs, my first and best recommendation is to be careful about where you get them from. Further on I will go into more detail about this point. First, let me describe my personal experiences with generic drugs.

Pretty soon after starting on Seroquel and Zoloft, my physician switched to prescribing generic versions of the substances Quetiapine and Sertraline. Every three months, when I needed a new prescription, I would receive a generic by a different company, produced in another country. So far, I have never noticed any adverse effects, although I always feel wary about experimenting with my mental health. My level of trust in a generic is based – rightfully so or not – on where and by whom it was produced. All the generics I have used so far came from European countries, and they are available through the public health care system I am ensured in. All this certainly does not guarantee their effectiveness or safety, especially not considering that every individual potentially responds in unforeseeable ways even to minute changes in their medication plans. Still, I assume that the generics I am using must be safer than the ones you can acquire through the internet yourself. For those who want it, self-medicating is made relatively easy and also relatively cheap in financial terms. You can order psychiatric medications from India, for example, just as you can walk into a corner shop to buy candies. This is not to speak badly of any country, but I do believe one should be critical of online drug-discounters. As convenient as they may seem, their informality is also a risk to their customers. Within my close personal contacts is a tragic case of fatal medication abuse, greatly enabled by online drug commerce.

But even the safety of generic drugs that are approved by the health care system depends on how the individual using them reacts. A friend of mine tried a generic version of her antidepressant, for which she did have a prescription, and almost immediately experienced obsessive and profoundly unsettling thoughts. These disappeared almost overnight when she returned to the original brand. Did this incident occur because my friend had fallen prey to a low-quality generic or because her organism was very sensitive to changes? Hard to say. I cannot overemphasize how radically different people’s reactions to psychiatric medications can be. All you have to do to find out is log into one of the numerous forums on the topic. Drugs that are described as “zombifiers” by some are hailed as life-savers by others. Quetiapine and Sertraline, the substances I am currently taking, are no exceptions. I am doing fine on them, but I have read desperate posts on how they turn individuals suicidal, manic, emotionally numb, paranoid, and so on. The ugly truth is that psychiatric drugs – generics just as much as originals – are a Pandora’s Box. There is no way of knowing beforehand what exactly will result from using them.

And then, there are the many cases of people using original brands which either do not alleviate the symptoms of psychiatric illness or do so at the terrible price of disabling and humiliating side-effects. Defenders of original psychiatric drugs will argue they were patented and released onto the market only after a lengthy and thorough process of testing, and that therefore they are safe to use. This statement, unfortunately, is not accurate. Although a psychiatric drug can only make it into the pharmacies after having been institutionally approved, several incognitae remain. The biggest one probably is what the drug actually does to the brain, apart from potentially diminishing certain symptoms of mental illness. So far for example, no published study has explored the sequels of long-term psychiatric drug use. Typically, drugs are tested over the duration of several weeks or a few months, when numerous users are really taking them for years on end or even for life, in varying dosages and combinations. It is also unknown, and feared, what psychiatric drugs could do to a young brain in plain development. Children or teenagers being medicated has become common practice. Detractors object this might slow down or even stunt their cognitive, emotional and social growth and thereby cripple their lives before they have even begun. Last, but not least, it has to be remembered that the array of possible negative effects, also called side-effects, is virtually endless, some of them being extremely dangerous or horrifying at best.

On a theoretic level, considering the safety of psychiatric medications is debatable in the first place, I feel compelled to wonder if questioning the quality of generics makes any sense at all. From a practical perspective, I have seen evidence for their safety in myself and for their unsafety in others. My recommendation to you is to handle psychiatric drugs in general with utter care. I wish I could be more concise.

Here is a brief list of aspects you can take into account in order to protect yourself from unpleasant experiences or more serious dangers:

Means of acquisition – Only use psychiatric drugs you have obtained through prescriptions. Do not shop for them on the internet.

Ingredients – Make sure you are not allergic to any of the ingredients. For example, lactose is a common excipient. If you are lactose intolerant, you will need to find out which companies offer the same active ingredient with a different excipient.

Country of origin – Make sure your medication was produced in a country you find trustworthy in terms of quality standards. Unfortunately, there isn’t much you can do to find out if they really live up to your expectations.

Follow your doctor’s indications – Be observant of the doses and times your doctor established in your medication plan.

No spontaneous dose variations – Do not make any changes to your medication plan unless they have been systematically planned. For example, do not take more of your antidepressant when you feel down, or less of it because you are having an especially nice day.

Monitor your reactions at all times – Always watch out for any adverse reactions your medications may be causing. Constantly keep an eye on your general well-being. Also evaluate your performance at work or at school, your memory, your social capabilities and your emotional reactions to everyday situations. Have people you trust help you monitor all these aspects.

How It’s Going – Completion of Phase Two

I am now permanently on 200 mg of Quetiapine (Seroquel) and 100 mg of Sertraline (Zoloft), which means I am concluding phase two of my withdrawal plan. According to this schedule, as I had originally laid it out, I am supposed to stabilize these doses over the course of two to three months. However, given that I am experiencing no withdrawal symptoms or other anomalies at all, I might reconsider the duration of the stabilization period and possibly reduce it to somewhere between one and two months.

My current doses correspond to a 30% reduction of the amount I was prescribed when I first started taking my medications. I believe my organism is already perceiving some degree of relief. My overall well-being has been improving, certainly also thanks to a healthy diet and regular exercise. Mentally and emotionally, I feel perfectly functional and healthy. My partner is a great source of support, and I know I can trust him to report any unusual observations to me.

I am also pleased to see how each prescription of a hundred coated tablets now lasts one month longer than it used to. The medication supply that was meant to be good for three months is now sufficient for four. One could say I am 30% less stressed about getting my new prescription.

As for this blog, it has been slowly, but steadily, attracting more readers. My hope is for them to find useful or at least interesting information on its pages, be it for themselves or in order to help loved ones. I want to stress once more that your comments, questions and suggestions are more than welcome. Reader’s contributions make this kind of blog so much richer and so much more helpful. Feel encouraged to send me your thoughts and experiences – they will all be considered and responded to.

When Meds Get in The Way

Life is full of little things we take for granted to such a degree that we don’t even ever think of them – until they’re gone. When you begin taking psychiatric drugs, an unexpected plethora of such details opens up before you. What you once considered pleasant, but petty aspects of everyday life suddenly are luxuries you will have to do without, or cut down on, from now onward. You will need to revise and likely modify several of your habits in order to stay safe, and you may feel restricted in your personal freedom. To put it in plain English: you will be forced to redefine the terms “fun” and “freedom” for yourself, at least partially. I know how off-putting this sounds, but the good news is that it is possible as long as you keep an open mind. The following is a list of everyday luxuries I have had to reevaluate since getting on psychiatric medication.

Luxury #1: Booze

Officially, you are not supposed to consume any alcohol while you are taking psychoactive medications. Booze may alter the way your organism assimilates the active ingredients, and it also acts as a depressant. So, if you are already suffering from depression, regular pub-crawling is a no-no. Now, alcohol is an almost ubiquitous substance. What is more, we humans use it as a vehicle for social bonding. Drinking with others is not just about tickling our taste buds and our nervous system, but it is a social ritual. No matter if we are with friends, family or business partners: sharing a drink equals declaring you are on the same page with them, and on friendly terms. As alcohol is known to lower inhibitions, it also serves to break down barriers between people. As a consequence, being offered one or the other alcoholic beverage on all sorts of occasions is virtually unavoidable. Depending on your psychological equilibrium, you may have to reject those offers altogether. Personally, I have found I can have a few glasses of wine or juice with a shot of rum without experiencing any negative effects. As I have never been a heavy drinker, needing to set limits to my alcohol consumption has not been a big issue for me. Essentially, I am having the same amounts as always, only that when I first started taking psychiatric medication I had none at all for a few months and then carefully started experimenting with half a glass here or one shot there, until I felt certain it was doing no harm to me. However, if you are a customary drinker, you will need to become more self-disciplined.

Luxury #2: Caffeine

If you have ever been hospitalized in a psychiatric clinic, you may have noticed they offer decaffeinated coffee or decaf teas to their patients. Needless to say, caffeine is a stimulant. Depending on your diagnosis and your medication regime, you may have to say goodbye to your cuppa or at least reduce your intake. For someone with anxiety or mania, stimulants are not an option. In my particular case, I have found that coffee and tea do not affect me negatively, so I continue having them just as always during the first half of the day. I avoid caffeine after 5 pm, though, and given that I dislike most sodas, I never have coca cola or the likes. I also stay away from energy drinks or any other stimulants stronger than my habitual cup of coffee. Evaluate carefully, if possible together with your therapist or prescribing doctor, if sticking to your caffeinated drinks is alright for you. Try one cup of mild coffee in the morning and observe how you react both during the day and at bedtime, then make a decision based on what you experienced.

Luxury #3: Sugar and carbohydrates

In another article on this blog, I had written about weight gain as a negative effect of psychiatric drugs. Unfortunately, to limit the damage, you should reduce your intake of processed carbs and sugars significantly. Truth be told, if you are interested in healthy nutrition you ought to do so anyways. If you are on medication, avoiding processed foods becomes imperative. Eliminate them from your daily diet. Maybe allow yourself one eat-what-you-want day per week in order to keep cravings at bay. As I have a very sweet tooth, abstinence in this area is tough for me. However, I have found it extremely helpful that my partner and I have both decided to go low carb. In our fridge and around the kitchen, you will find no chocolate, no cookies, no cakes, not even white bread. If I ever felt like being “naughty” I would have to go all the way to the next grocery store, pick something out and stand in line for it, which makes breaking the rules a lot less tempting. Also, once you get the knack of maintaining a low carb and low sugar diet and explore some new recipes, your cravings for processed foods will diminish over time. As of today, I hardly experience any unruly longings and enjoy otherwise forbidden treats all the more when I come across them at parties or other special occasions.

Luxury #4: Foods you had never thought of as dangerous

If point #3 has motivated you to switch from drinking sodas to enjoying natural fruit juices, and you are sipping from a glass of refreshing grapefruit juice as you are reading this paragraph – stop! Grapefruit juice interacts with numerous medications because it alters the way your liver processes them. Interestingly, this fact does not appear on the label of juice packages, so you need to find out through research on the internet or consultation with a pharmacist. There are other natural foods under suspicion of interacting with certain medications: pomegranate is one of them, though studies haven’t yet confirmed how much it really interacts with medication. Some herbal medicines, such as Saint John’s worth and Valerian, potentially exacerbate or weaken the effect of psychiatric drugs. The same goes for some supplements. The following are links to pages with further information about drug-food interactions.

Free PDF on drug and food interactions for downloading by the FDA: http://www.fda.gov/downloads/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseofmedicine/generaluseofmedicine/ucm229033.pdf

Article by the Academy of Nutrition And Dietetics: http://www.eatright.org/Public/content.aspx?id=6442477646

Again, none of this means you necessarily have to avoid these foods and beverages completely, but you need to be moderate in the amounts you consume and extremely attentive about possible negative effects.

Luxury #5: Spontaneous sleepovers or travelling

Before I say anything else: ALWAYS carry one or two extra doses of medication with you! It is rare to be unexpectedly confronted with the option of spending a night away from home or prolonging a trip for an extra day. Yet, in good theory, it can happen. Your flight may have been delayed or cancelled, you are too tired to drive home after a get-together or weather conditions are too bad to get on the road, or you simply wish to stay somewhere nice for a bit longer. All those situations can turn into a problem if you don’t have enough medication with you. Therefore, make sure to take an emergency backup wherever you go – near or far. The longer your trip, the larger your extra supply should be. On a normal work day I will carry a tiny pillbox with one spare dose in my purse. When I go on longer trips, I habitually put enough medications for an extra week in my luggage, and I also keep them in different bags in case one of them gets lost or stolen. Once we’re at it: also record your medication plan – names of substances, doses and schedule – in your agenda or on a piece of paper to keep in your wallet. Accidents happen, and the medical team scraping you up from the street must know about your using psychiatric drugs. Don’t forget to add other basic information, such as your blood type or any chronic conditions and allergies you have.

Luxury #6: Over the counter meds

Have a headache? Before you head to the pharmacy for some Aspirin, make sure you can actually take it. Many over-the-counter drugs interact with psychiatric medications, which can turn a vulgar flu into an adventurous slalom around dozens of red flags. For more information, go to my article on drug interactions.

Luxury #7: Sunbathing

This is an issue I luckily escaped. Some medications, including the ones I am taking, potentially render you more sensitive towards UV radiation. Depending on your individual case, you may need to apply sunscreen to your skin before leaving the house or quit sunbathing and tanning sessions. As I said, my tolerance – and love – towards sunlight is unaltered, but I advise you to monitor your response to it for as long as you are on medications.

Luxury #8: Overall independence

By overall independence I mean the ability to adapt to your surrounding circumstances without having to worry about where you get your medications from. It is only a few exceptional situations that would really challenge your flexibility in this regard: wars, cataclysmic natural events such as floods, hurricanes or earthquakes, social upheaval or economic collapse. Even though these events are not the most likely to occur, they are an inconvenient possibility. When your well-being hinges on the availability of any type of medical treatment, you realize how dependent you are on civilization, the integrity of your society and a functioning infrastructure. You cannot simply revert to an ancestral lifestyle or an existence of scarcity the way most others could – if grudgingly. Unfortunately, I have not yet come up with a way of getting around this problem. Probably, precaution is the best protection from shortages in supplies. Just as it is wise to keep a few gallons of drinking water and some emergency lanterns or candles in your house, also have a backup of your medications. In addition, stock up on your drugs in time. Do not leave picking up your prescription for last minute, but create  a safety margin of maybe a few weeks.

Luxury #9: Hardcore partying

For some, parties aren’t over before daylight. However, if your medication plan includes taking a sedative or tranquilizing drug in the evening, you may have to retire from power-partying and clubbing. Even if you can force yourself to stay awake, you may not be in condition to leave the house or, let alone, drive anywhere. And much less will you be able to enjoy the party. My longest night is usually New Year’s Eve, and even then I hardly make it beyond 2 or 3 am. I take my anti-psychotic at that time and then sleep in the next morning. On all other occasions, I am in bed before or roughly around midnight. Before you give in to feelings of rebellion, take into account that altering your sleep cycle also implies tampering with the regularity of your medication plan, which in turn can affect your psychological stability and performance at everyday activities. Ask yourself if it is worth it.

Luxury #10: Recreational drugs

I have never used any recreational drugs, but now that I am on psychoactive medications I also should not consider trying them. They interfere with your mental functions just as psychiatric medication does, which means all sorts of unforeseeable interactions are possible. Some recreational drugs are actually believed to trigger psychosis. Stay away from them if you can. I have met people who continued using recreational drugs, mostly marijuana, despite taking psychiatric medications, and who were claiming it was not harming them. Yet, in my opinion it is preferable to play it safe. Mental health is one of our most valuable goods! Should you be addicted to street drugs, please consult with your prescribing doctor and/or therapist before making any decisions. Special considerations need to be taken to handle your case.

These were the luxuries I could come up with based on my personal experience with psychiatric medication. If you can think of more aspects of everyday life that turn into luxuries when you are in treatment, please leave a comment.

Coming out of The Dark – How I Recovered My Cognitive Abilities

I have mentioned before that during my psychotic break my cognitive functions were severely restricted. My concentration was below zero, and so was my ability to make even the simplest decisions. I was unable to put a list of items together that I wanted to have in the clinic with me, and it took me ridiculously long to pick an outfit for the day. Partly, this was due to my perceiving that even tiniest decisions could change the course of events obeying to a sort of butterfly-effect mechanism. The complexity of this idea was literally mind smashing. But to an even greater extent, I just could not hold on to an idea and follow it through. A thick broth of thoughts and notions was bubbling in my mind, and there was no way for me to put them in order or assign adequate degrees of relevance to them.

Being prescribed the anti-psychotic Olanzapine (Zyprexa) did calm the storm a bit, but it did not help my cognition. I still could not put two and two together. Even trying to complete an easy Sudoku was a major challenge. In addition, the Olanzapine seemed to dull my will and thereby actually accentuated my lack of direction. During my last hospitalization, the Olanzapine was substituted with Quetiapine (Seroquel), and I also took part in a structured program of coordinated therapies and received more thorough medical supervision for the first time. The therapeutic menu included arts therapy, social interaction practice, stimulation of sensory perceptions, psycho-educative sessions (basic information about mental health and illnesses), sports and outdoor activities and one-on-one conversations with the doctors. In your spare time, patients could do pretty much what they wanted: have a walk, go downtown, visit friends or family, sit in the park, organize table tennis or volleyball matches with other patients, etc. I soon became “famous” for devouring almost any sort of written text. With swarms of anxiety-ridden thoughts still frantically revolving around my mind, it was almost impossible to take anything in, but I knew I had to do it somehow in order to find even a little bit of peace and focus. I tried books at first, but I noticed I was not ready to follow the development of complex discourses, so I switched to reading articles in magazines. I read article after article, even if the topic of some was really outside my areas of interest, until I had read the whole magazine. Whenever I was done with one issue, I would go buy the next or lend new ones out from fellow patients. Gradually, I was able to digest longer articles, and eventually I returned to books, reading anywhere between one and three in a week’s time. Reading did not rid me of my anxiety and my racing thoughts, but it forced my mind to engage in the present moment and function, at least to a certain extent, in spite of the chaos.

I wasn’t the only one who instinctively turned to cognitive stimulation. Just as you would find me reading anything anytime and anywhere, a group of ladies used to crochet together. They tried to convince me of joining them, but I preferred to stick to reading. Although they were using a different activity, their need for focus also stemmed from an impulse to overcome anxiety and recover some degree of functionality, even if on a small scale.

As of today, my concentration and capacity for learning are healthy, possibly even improved in comparison to before my psychotic break, given that I have found myself embarking on explorations of my possibilities I hadn’t been able to open myself up to in earlier years. Maybe this is a sign of better cognition, but it may also be that after escaping a terrifying episode of zombie-like existence I have become more intrepid and willing to seize life. This is really not for me to determine, and I also feel my cognitive development has not yet come to completion. Many new – and positive – things and people have come into my life, prompting me to unlearn past thinking and emotional patterns to learn new, more constructive ones.

Although all of the aforesaid is based on my subjective perception, I would like to back it up with a few lines on recent trends in neuroscience. The regenerative powers of the human brain are being studied intensely, and the traditional idea of mental illness and brain damage as being irreversible conditions seems to become gradually dismantled in the process. In this context, it turns out to be untrue humans lose their ability to learn as they grow older, or that senile dementia is an unavoidable consequence of aging. What seems to be the case, instead, is that the brain can be exercised and strengthened through persistent stimulation just like a muscle can, throughout all stages of life. Cognitive training helps the brain stay fit and even regain lost functions. The term coined to denominate this property is “neuroplasticity”. I lack the scientific knowledge to competently explain neuroplasticity in depth, but I would like to recommend a book on it I believe everyone should have read, no matter from which background they come. The title of the book is The Brain That Changes Itself, written by Norman Doidge. It describes cognitive processes and neuroplasticity in terms understandable for the layman, illustrating its point through the narration of actual cases where a radical regeneration and reconfiguration of the brain appears to have taken place in an affected individual thanks to cognitive stimulation. The Brain That Changes Itself inspires without being inspirational in the sense of trying to lift anyone’s spirit by rhetoric means or philosophic meditations. The hope and encouragement inherent in this text derive from the portrayal of real people and real occurrences. Not in all cases described in the book all neurological functions are regained, but the overall improvement observed in the treated individuals’ quality of life is undeniable.

Personally, I acquired and read The Brain That Changes Itself before my psychotic break, and I am glad I did. More than one psychiatrist and more than one website with supposed information on mental illness transmitted the idea that mental pathologies equal a life sentence in some existential limbos – that the affected face perpetual residence in a state of forced stillness, not really participating in life, yet not biologically dead. Now, in retrospect, I can see how wrong they were. Here I am, living a happy and active life. But back then I had no idea if there was any hope for me or not. I certainly wanted there to be a way out, yet indications that there would actually be one were scarce. The Brain That Changes Itself, I believe, has the potential to be a source of valuable information and invaluable hope for someone in crisis.

Looking back at the insanely lucky and very unlikely concatenation of helpful people and circumstances that lead me back into life, I have to believe some benevolent power has laid its protective hand on my shoulder to lead me out of the darkness. Subconsciously, I also must have vehemently refused to give up, even though my conscious mind was paralyzed with terror. Now I recognize that every chunk of driftwood floating by can carry you the missing extra mile. The Brain That Changes Itself could be such a piece of driftwood for you or for someone you know. I really hope you read it, even if you and all your loved ones are doing fine right now. One day, they may need strength to overcome a crisis, or maybe you just wish to explore your potential and tread on a new path. This book is an eye-opener as to what your mind is capable of doing (and no, I don’t receive any commission for recommending it).

Websites

Norman Doidge’s official website, where you can get informed on his book The Brain That Changes Itself. http://www.normandoidge.com/normandoidge.com/MAIN.html

Here are links to the stores selling it: http://www.normandoidge.com/normandoidge.com/LOCATING_THE_BOOK.html

 

Audiovisuals

An impressive and inspiring testimony by Barbara Arrowsmith-Young, a psychologist who overcame a severe congenital learning disability through cognitive stimulation techniques: http://youtu.be/o0td5aw1KXA

 

Some words on: Inspiration and Creativity

Mental illness is a dark, lonely and scary state. It brings with it a blackout of basic survival skills and thereby exposes the individual to the whim of circumstances and people surrounding them. Uncaring and abusive treatment facilities, health care professionals and relatives can turn such an existence into hell on earth. But even if you are in the best of hands, your recovery depends on one indispensable ingredient: you. It is understood that you may not be able to take care of yourself. Still, you can attempt to stimulate your mind and emotions.

In fact, many clinics offer arts therapy, music therapy, sports activities, animal therapy, walks, and other stimulating experiences. Those are not meant to simply kill time and break the monotony of another day in a dull hospital setting, although these are certainly important aspects. In the first place, they are aimed at “defrosting” you. Mental illness is, so to speak, a general paralysis of the spirit. Thoughts and feelings, which help a healthy person to evaluate situations, take action and define their direction in life, fail to develop that traction in someone going through a mental crisis. Instead, they form something like a ball of yarn, if you will, with no visible loose end to pull at. In more rational terms, the confusion and erratic choices associated with mental illness derive from the impossibility of prioritizing thoughts and feelings functionally. The result is a disabling, smothering information overload. Therapies providing sensory stimuli intend to focus the patient’s mind and reactivate its capacity for healthy judgment, in the hopes of making the individual find the end of the metaphorical thread again.

Particularly artistic therapies challenge the patient to reawaken their power of judgment and decision. Creativity relies on the processing of given resources – materials, techniques and motifs – and their elaboration into a product that represents the uniqueness of its author’s interpretation. In a nutshell, creativity is the application of preexisting, generic ideas to a specific situation, in order to produce a new circumstance or object, the creative person’s individual experiences and capacities of judgment being the catalyst for this process. In plain English: when we are baking an apple cake, recipe in hand, and notice all our apples have gone bad, we will evoke the generic idea of “fruit” and look around our kitchen to see if we have something that could work in a similar way to apples. If we are lucky, we’ll find pears or plums, and use those. That is creativity. As the culinary example shows, creativity occurs not just within the fine arts. It is the motor of our survival and evolution both as a species and as individual beings. All our life decisions are necessarily creative, because we constantly attempt to adapt our circumstances to our individual needs and wishes. No matter how unadventurous and conventional a person is, they will always need to take decisions and create situations nobody else has ever taken before in the exact same way, simply because nobody else IS them.

Interestingly, numerous theories on the causes of mental illness sustain it can be triggered by dysfunctional or abusive relationships – may they occur in childhood or in adult life. If we try to define “dysfunction” or “abuse”, we will likely conclude that the destructive manipulation of the individual’s capacity to make healthy choices is an important part of these concepts. In other words, dysfunctional and abusive relationships affect or stunt the victim’s creativity, thus injuring their survival skills.

Herein lies the relevance of therapeutic approaches that involve the stimulation of creativity. Painting or making mosaics is more than a nice pastime producing pretty results. It stimulates vital cognitive functions and can contribute significantly to a patient’s return to a functioning and satisfying life.

Another aspect of creative therapy that should not be underestimated is the fostering of self-confidence. Not just mental illness, but also the stigma associated to being in psychiatric treatment can shatter your self-image. I have come across more than one person who suffered a painful transition from successful professional to hospitalized nutcase. Among them was a woman who used to be a psychotherapist and, after collapsing and having been diagnosed with schizoaffective disorder, will likely spend many years in supervised living facilities or in and out of mental hospitals. What I wish to say is that people who were socially “normal” can end up with the label “crazy” stuck on their foreheads. The stigma of it alone, even when it is the result of a misdiagnosis, is powerful enough to down individuals who so far had been high-flyers. While creative therapy will not magically reestablish anyone in their previous position, after a catastrophic collapse it can be one of the few things left showing you that you are actually able to accomplish something. Every ounce of hope counts. Accumulate many of them.

Now, at the top of the present article I stated the importance of the individual’s wish to get better. Mostly, what counts is for you to just give something new a try. Some people may argue they are not the artsy type, but as I have argued above, that is also not was creative therapies are mainly about. Creativity is an indispensable life skill because it empowers you to take your life in your own hands and make the best out of past experiences. Creative therapies also help individuals lessen the weight of trauma on a deeper level than spoken or written words ever could. Fear and pain can be nameless, but it may be possible to encrypt them in color, shape, sound or movement. Also, the socially established connotations of verbal language often provoke feelings of shame and defeat, especially when it comes to describing a victimizing situation. Not so the arts. They allow even humiliating experiences to be expressed in a shrouded and abstract manner, therefore being emotionally less taxing than a verbal account. Words are powerful on a conscious level, but in order to release pressure accumulated in the subconscious, the arts can be more efficient. Any activity that helps you exercise your creativity will ultimately strengthen your self-confidence and enhance your coping skills.

Creativity is also a source of joy and social interaction, which are also pillars of mental health. Just to add another anecdote, from my last stay in a psychiatric hospital, I remember a gentleman who, if I am not mistaken, worked as a transport entrepreneur and was treated for depression. He looked anything but an artist. Yet, through arts therapy, he discovered his passion and talent for oil painting. In an amazingly short period of time, he became skillful enough to produce a series of remarkable, very expressive floral still lives, which the clinic decided to display in its corridors. Both staff and fellow patients openly admired his work and encouraged him to stick to his new found love. Frankly, I have no information on whether he ultimately recovered from his depression. The last thing I know, before I myself was discharged from the clinic, was that he had become an outpatient and gone back to living at home. I would not go as far as saying that his mental health improved due to arts therapy, but I am convinced that his motivating experience within the clinical setting must have given him a good push forward in everyday life as well.

Personally, I believe the all-encompassing benefits of creative activities are the reason why so many people engage in crafty pastimes. On the most immediate level, creating something beautiful or practical is an uplifting experience. It makes you feel productive and gives you aesthetic pleasure. But also, making something which has not existed before tells you that you are able to shape your surrounding circumstances. You may have only crocheted a doily or lined a shoe box, but spiritually it is a symbol for your power to contribute to reality and bring the things you desire into your life. It means you are capable of making choices which lead to a good result on a small scale, which in turn should encourage you to believe that, on a higher plane, you will succeed in the making of bigger decisions as well.

Arts therapy, as the term suggests, includes an element of systematic psychological support in addition to the application of creative skills. But even if you, or someone you know who is in need of help, have no access to arts therapy, taking up a creative hobby is always an option for you. Depending on the materials and the equipment some arts require, they can be more or less costly. Therefore, consider your budget before you get started. Also, if you don’t feel like committing to one specific activity right now, browse the internet for DIY blogs. They are literally everywhere, and many of them offer tutorials on smaller, varied arts and crafts projects. You can even look for tutorials on how to redecorate your home in an easy and low-cost way, or how to pep up your wardrobe with self-made accessories, if you wish for a practical rather than a purely aesthetic approach. Creativity has no limits, so take your time and enjoy the many ideas buzzing around on the www. Feel free to share your thoughts on creativity and mental health below in the comments section.

Websites:

The Art Therapy blog offers descriptions of various types of creative therapies, articles on related topics and information on educational options for people who are interested in becoming therapists. First and foremost, this blog is informative and inspiring. It is not a support website for those in crisis or otherwise in need of help. Still, remember that knowledge is always empowering. So, no matter on which side of the table you sit, it is a useful website to visit. The Art Therapy blog also runs a Facebook page. http://www.arttherapyblog.com/