Some Words on: Nightmares and Restless Sleep on Psychiatric Medication

As for all states of distress, APA also has a fancy name for nightmares: nightmare disorder or dream anxiety disorder. It is known that everybody has nightmares from time to time. They are believed to be caused by our mind trying to process conflicts, fears and stressful life events. In other words: nightmares are a healthy and necessary phenomenon that helps us deal with our issues and move on. Yet, when unsettling dreams become so frequent and so intense that they disrupt our sleep patterns and affect our mental and emotional balance during the day, they no longer help us to cope, but they add to our problems. Not only do nightmares leave an ugly aftertaste and cloud our mood. Deprivation of restful sleep can exacerbate already existent psychoses. Sleep, and in particular restful sleep, are a vital component of mental health.

Although it is meant to improve symptoms of mental illness, psychoactive medication commonly causes sleep disturbances, including nightmare disorder. In general, psychotropic drugs will affect your sleep cycles in one or the other way, for whatever acts upon your mental functions during your waking hours, logically also does so when you are asleep. Both my antidepressant (Sertraline) and my anti-psychotic (Quetiapine) list nightmares as a frequent side-effect, along with other sleep abnormalities, such as insomnia or excessive sleepiness. So far, I have gotten away with only the nightmares.

Ever since I got on psychoactive medication, I have had hardly one night without unsettling dreams, and this is not an exaggeration. The topics are nauseatingly repetitive. Being far from home at a place I perceive as threatening and fearing not to be able to leave, is a classic. Typically, in my dream I am anxious to leave that place before the onset of winter with its cold and darkness. A variation of this scenario is my having to travel to a threatening place. Luckily, my dream-Self has learned by now to just say “I am not going. I have a right to be where I feel safe and happy.”. Often, these dreams are coupled with scenes of confrontations between me and relatives whom I am also in conflict with in real life. Typically, they would attempt to tear down my self-confidence or force me into life choices I feel strongly opposed to. Before I moved in with my partner four months ago, I also used to dream I was living in a house that was crumbling. Cracks would appear in the walls, or big chunks of plaster would fall off them. In those dreams, it was understood that the structure could collapse and crush me any minute. I believe I can see clearly which fears all these nightmares spring from. My interpretation is that, after having seen my existence and my personal autonomy disintegrate during my psychotic break, my psyche is still fearful of it to possibly happen again. Over the last years, I have returned to a good life. In fact, I would say my life is now happier than it has ever been before. To me, it seems only logical that my not-so-subconscious is afraid of losing it all again.

Plane crashes are another frequent dream. I am actually afraid of flying, so the source of this scenario is also quite obvious. The origin of other nightmares is less evident. An interesting one is the vision of a cataclysmic volcanic eruption or simply a nearby active volcano that scares the crap out of me, but apparently out of nobody else. In my dreams, I regularly find myself in groups of enthusiastic people who absolutely want to climb up to the crater, while I am desperately trying to convince them not to. In reality, I do live in the proximity of three volcanoes, but I have never witnessed an eruption. I realize such an event is a possibility, but it is not something that occupies my conscious mind. So far in my life, I have scaled five volcanoes and slept at the foot of another three without being overly concerned about it.

A few posts ago, I had already mentioned that I am beginning to have less intense nightmares than has been usual for me over the last four years. And finally, last week, I got a break from my nightly horror-marathon. I actually dreamt something pleasant! I will abstain from going into details, but the sweet afterglow of that dream stayed with me throughout the day. It has been a while since this last happened to me. I am quite delighted! Placing the dream in the context of my current life situation, I have to assume a huge part of the improvement is certainly due to my moving into a new, lovely home with my partner and us both making healthy changes to our lifestyle. And although I have only just started to wean off my medications, I also hope the reduction of my medication dose to have something to do with the improved quality of my sleep. Could it be that my brain was too numbed down to process topics of conflict and therefore brought them up again and again through my dreams, similar to a broken record that can’t get past a certain content, but replays it in an endless loop? Could the dose reduction have begun to reactivate those parts of my psyche, allowing me to finally deal with and eventually overcome the unresolved issues? I cannot know for sure, but it is a hypothesis that I find logical.

Whether or not you consider weaning off your medications, you can – and should – attempt to improve the quality of your sleep. Actually, some speak of “sleep hygiene”. Taking measures of sleep hygiene is recommendable for everyone, even “healthy” individuals. The equation is simple: the more restful your sleep is, the better you feel all over – mentally and emotionally – and the better your cognitive functions are. If you are tormented by insomnia or by nightmares to a point that you perceive sleep as an unpleasant duty, try the following:

  • Establish regular sleeping habits. Try going to bed and getting up approximately at the same time every day, and allow yourself at least seven hours of rest. Even if your sleep gets interrupted during the night or you can’t fall asleep in the first place – stick to those seven hours and get out of bed at the established time. Eventually, your organism will recognize this resting period as its opportunity for distension and revitalization.
  • Create an optimal sleep environment in your bedroom. Make sure your mattress is comfortable and your pillows allow you to rest your head without straining your neck and upper back. Switch off all the lights and, if possible, do not keep any electronic devices in your bedroom. Use curtains or blinds which block street lights and the morning sun effectively. Try out if you prefer complete silence or soft noises like the gurgling of a small fountain or the regular ticking of a clock. Make sure temperatures in your bedroom are moderate. Neither excessive heat nor cold will help you sleep.
  • Avoid caffeinated beverages, stimulant medication or other energizing substances during the late afternoon and evening. Funnily, although alcohol can make you feel drowsy in the beginning, it is a major sleep disruptor because it messes with your sleep cycles. Same as for stimulating substances, take care not to have booze right before going to sleep. Personally, I know some people who actually have a cup of coffee or even espresso right before going to bed. They insist it helps them sleep. If you are one of that kind, fair enough, but probabilities are that you react to caffeine like most other mortals do – by staying wide awake. To be on the safe side, stay away from coffee and maybe have a glass of hot milk or soothing herbal infusion before going to sleep.
  • Just before going to bed, give yourself 30 minutes of time out. Spend them on a relaxing activity: meditation, reading, cuddling with your pet, chatting with your partner, watering your plants or just putting things in place around the house. Give yourself an opportunity for winding down and cleansing your mind and emotions at the end of every day. Studying for an exam or watching an action movie and then hitting the hay immediately is not a good idea. Just like a train can’t come to a dead halt, you need to gently let your mind come to rest.
  • Eat at least two hours before going to sleep. Going to bed with a full stomach is almost certain to make you toss and turn. If your schedule doesn’t allow for this, prepare a light snack rather than a full meal in the evening.
  • Exercise! Any type of workout, especially if performed several times a week, will not only help you burn off calories, but it will also improve your mood significantly. It is not necessary to do anything extreme or spectacular. Yoga and long walks are perfectly fin. Of course, if you wish to go for something more intense, feel free! Regular exercise will help you find a more restful sleep and balance your mood. Just remember that, if you exercise intensely in the evening, you need to come off your adrenaline rush before going to bed, so don’t hop right from the treadmill into bed. Maybe do a short yoga routine, have a nice warm shower or engage in some activity you find soothing.
  • Follow a healthy diet. Prefer whole, fresh foods to highly processed ones. Processed foods are typically rich in all the wrong things: sugar, fat, sodium, artificial sweeteners, preservatives, colorants. At the same time, they are almost devoid of vital nutrients and contain very little dietary fiber, which you need to cleanse your intestines. Thinking you can make up for your dietary deficiencies by taking supplements is a wrong assumption. Cover as many nutritional necessities as you can through your food intake. My partner and I, for example, are going low carb and mainly eating vegetables, lean meats, soy and dairy products. We have also developed the habit of drinking vegetable smoothies every morning. They taste great, and depending on which veggies and fruits you combine you can obtain different flavors, colors and nutritional benefits. We use kale as a main ingredient, and from there we just improvise according to what we have at home: spinach, strawberries, beets, celery, raspberries, carrots, apples, lettuce, and so on. Be creative, it’s your call to design your own liquid salad!

As you can see, there is a lot you can do for your sleep quality, even if you choose to stay on psychiatric medication for now. Try any or all of the above measures before asking your prescribing doctor for tranquilizers or sleeping pills. Adding medication to your treatment plan may seem like a quick fix. Yet, it only delays your getting to the root of your problems, compromises your liver and will make it even more difficult for you to ever wean off your medications. When you’re lost in the jungle, don’t add more trees. Consider taking further medication as the very last resort, or as an emergency solution to treat acute insomnia or psychosis temporarily.

Last, but not least, make sure you have the support of those living under the same roof with you. You can make your room as dark and as quiet as you like, but if your roommate insists on having noisy reunions or listening to loud music during the evenings, you will have a hard time finding sleep. Whoever you share your space with – family members, your partner, friends or fellow patients – explain to them why and how you wish to improve your sleeping habits. You might even be able to make them join in! Everybody needs restful sleep, and certainly everyone enjoys it. Personally, I find it extremely helpful that my partner and I are on the same page in terms of looking after our health. We share the same diet, do yoga together and follow the same sleeping schedule. Doing all of these things together is also a beautiful occasion for bonding. We research and discuss new food recipes, try out different yoga routines and have a small chat before going to sleep. Incorporating healthy habits into our lifestyle has been a wonderful contribution to a harmonious relationship and a happy home.

I would love for you share your own experiences with nightmares or other sleep disturbances, and with measures you have taken to overcome them. Feel free to comment. I will read through everything you send me and publish it here on my blog. Looking forward to hearing from you!

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Some Words on: Inner Strength – Your Contribution to Your Healing Process

There are many forms of treatment for you coming from the outside – medication, psychotherapy, creative therapies, physical exercise, and so on. Health care professionals and loved ones can be looking after you and trying to help you surmount your conflicts. Yet, there is someone whose participation in your recovery is indispensable: you. The least you can and must do is to accept help, but there are more active measures you can take to allow for healing to set in.

Our attitude playing a decisive role in creating success in all sorts of aspects of our lives is a generally accepted idea. Medicine has begun to recognize that both psychosomatic illness and healing actually do exist. Attitude, thought and intention appear to determine the outcome of our actions more than western science has been willing to admit so far. On the other hand, in philosophy, spiritual practice and even folkloric wisdom all over the globe, this idea is ancient.

You can play an active part in your recovery and cultivate your Inner Strength even when your mind is broken. Deep in your core there is a source of energy that cannot be destroyed, and that will only disengage from your body upon death. You can put whichever name you please to it, depending on your world view: Inner Strength, Survival Instinct, Inner Self, Essence, Spirit, or Soul. No matter what you believe or do not believe in, you possess this energy. It is what carries you through all good and bad moments of your life. Often, we only notice it is there when we are in crisis. Maybe you remember situations where you told someone, or where you heard someone else say: “Looking back, I have no idea how I made it – I must have been very lucky.” Well, that was the Inner Self at work. Something inside you is determined to see you through your ordeal. You must give it room to act.

Again, depending on your beliefs, there are many ways you can allow your Inner Strength to help you. First of all, you must connect with it. Religious or otherwise spiritually oriented people may resort to prayer and meditation, while rationalists who prefer a more practical approach can choose positive thinking, autosuggestion or exercises of willpower and mental discipline. It does not matter HOW you do it. It is just very important THAT you do it. Anyone insisting you need to belong to this or that religious group or a specific school of thought in order to achieve healing is misguiding you. Of course, if you feel it puts you on a good path, you can practise a religion! What I am meaning to say is that you need to find your very own way of dealing with yourself and your active role in this world, and no one should coax you into anything.

The following is how I, under consideration of my world view, attempted to drag my cart out of the mud. I repeat: this is not the only way to do it, and you need not share my beliefs in order to recover. It is just an example. Personally, I am wary about religious dogma and even more wary of people who try to impose it on others. However, I am a spiritual person. I do believe in a universal, conscious force some call God. I also believe in the existence of the Soul and its immortality. In my view, all elements of creation are energetically interconnected. As a consequence, I am convinced praying for others or the idea of sending them love or light is capable of reaching them through this energetic network. In a similar way, asking God (or The Force, or Maradona, or your Self) for strength and healing will help you activate those within you. No matter what or whom you invoke will come to your aid. As for myself, I know many people were praying for me or thinking about me caringly when I was hitting rock bottom. I firmly believe their good intentions made a huge difference. Also, despite cognitive difficulties during my psychotic break, I kept praying and meditating. I was terrified because my situation seemed completely hopeless. Nonetheless, I was unwilling to accept my condition as the endpoint of my life’s journey. The circumstances felt a bit like being adrift in the middle of the ocean and blindly firing flares into the night in the hopes of some ship noticing them eventually. Rescue was out of sight, yet not requesting it would have made it even less likely to ever arrive. How much of my recovery can be attributed to support from the forces I believe in is open to speculation. Still, I consider it must have been an important constituent of my healing process.

When your existence is in a fleeting state, being able to hold on to something edifying and encouraging also makes it easier for you to receive help from external sources. It can be your first step on firm ground. Just to use another metaphor: it is easier for others to extend their hand to you when you have managed to remain stable on the water’s surface, as opposed to panicking and chaotically panting and kicking around you. Inner Strength and hope can and should be stimulated even when you are at your weakest mentally and emotionally. Probably, no overnight miracles will happen, but look out for a gradual improvement of your state over time. A constant drop of water will finally fill the bucket.

My advice to you is to pick some entity you can ask for help. If you are religious, it can be your God or a saintly figure. If you are agnostic yet spiritual, it can be the universal consciousness, a deceased ancestor, your spiritual guide, an angel, or whichever other being. If you are a skeptic and non-believer, meditate over your own willpower, practise positive thinking or seek inspiration in motivational literature and time spent with loved ones. As you can see, the list of options is quite eclectic. If you do not feel up to any spiritual or intellectual commitment, you can still indulge in small rituals to invigorate you, such as the contemplation of beauty and nature. But be careful not to use your state of weakness as a justification for remaining passive. Your intention is what counts, and intention is active. You need to wish for healing. Your aim is to awaken your Inner Strength by whichever means you are able to use. This is your invaluable contribution to your recovery.

How It’s Going – Completion of Phase One

Yesterday night was, hopefully, the last time I ever took the old dose of Quetiapine, 300 mg. So from today onward I will be taking 250 mg of Quetiapine at night and 125 mg of Sertraline in the morning. If you have a look at my dose reduction plan, you will see that I originally planned to stay in this place for a while. However, as I have had no withdrawal symptoms or other adverse reactions to the dose reduction so far, I feel I should move on to the next dose reduction sooner. Thus, I shall begin lowering the Sertraline dose further next week, in the same way I have already done it once. This modification is to be followed by another dose reduction of the Quetiapine. My next aim is to reach a plateau phase with 200 mg of Quetiapine and 100 mg of Sertraline. This corresponds to a 30% reduction of the original dosages, which I find to be quite a significant change. Once I get there, I still plan to remain there for at least a few months.

The question now is whether I have noticed any changes so far. As for negative ones, luckily not! On the positive side, I do feel slightly more alert in the sense that I make faster decisions, seem to have an improved concentration and feel more open towards learning new things. A lot of this, admittedly, has to do with my recent changes in lifestyle and the accompanying shifts in priorities. Logically, I have some restructuring and decluttering to do. Nonetheless, I feel that I am mentally and emotionally better disposed to pull through with these reconfigurations. Lowering the dose of my medications may be contributing to that.

Physically, there have been slight improvements as well, although these most likely have to be attributed to factors other than medication withdrawal. My weight has been going down very gradually, which is probably mostly a consequence of my doing daily yoga routines and eating a low-carb diet complemented with veggie shakes. I have a very sweet tooth, but lately I have managed to steer clear of too much self-indulgence in this area. My partner and I have agreed we can be naughty – in culinary terms – every once in a while on special occasions, but certainly not on a daily or even weekly basis. Our naughtiness in other areas seems to be improving. Our relationship is thriving, yet it is impossible for me to say whether lower medication doses have anything to do with that. I suppose, and hope, that we are simply doing things right.

Lately, my sleep is less plagued by nightmares. I used to have them every night, and they were intense enough to have me wake up screaming every so often. Since I have moved in with my man, this has not happened again, although most of my dreams are still weird and unsettling. They very evidently deal with traumatic experiences as well as the fears and conflicts derived from those. As a result, my dreams are quite repetitive in topic, which makes me assume I have a considerable quantity of psychological knots to untie if I want to get rid of them. Several sources on psychiatric drug withdrawal explain that as you lower doses, emotions and thoughts may resurface that had been lingering under the surface of your drug induced stability. To me, that makes perfect sense, as the drugs do seem to suspend you from hammering away desperately at your worst conflicts. So, as a consequence of medication withdrawal, I expect some serious processing and coping challenges to lie before me. At this point in time, such challenges have not occurred to an extent that would make me consider seeing a psychotherapist. My partner is a great source of support, encouragement, comprehension and love. The list of his wonderful characteristics could go on and on. My close friends are caring and sincere. In other words, I have a support network that wants for nothing. Thanks so much for that!

All in all, I am happy about how everything is going. My initial fear of lowering medication doses has receded. I am still very careful and slightly apprehensive about the process, but so far I have felt motivated to think that as long as I proceed in a sensible way, I should be able to minimize risks. I am glad I have started this process.

Some Words on: The Sickliness of Hospital Settings

“Hospitals make you sick”, said a person whom I met during my psychotic break, and whose kindness and understanding make me remember her as some sort of angel who came to shine a light into my darkest moments. She had picked the saying up from her father, and I was soon to find out what she meant by it. Evidently, the main purpose of hospitals is to cure people. Yet, some characteristics of hospital settings are surprisingly out of tune with that mission.

First of all, there is that smell. Even if you are just a visitor, it can turn your stomach inside out. Naturally, hospitals need to be kept clean at all times, and strong disinfectants are to help achieve that – but heck, can’t they develop one that doesn’t make the place smell as if a tsunami of cough syrup has just rolled through? There must be a way of eliminating those sick smells and introducing more pleasant ones. Smell can improve well-being significantly. Otherwise, perfumes or aromatherapy would never have been invented. It isn’t even a new concept. Human beings have used fragrances for thousands of years in the context of religious cults, all kinds of celebrations, in their homes or on their bodies. Essential oils, for example, have been a coveted luxury good for countless generations, and continue to be that. Only think of this: who doesn’t like to use incense sticks, aroma lamps or room fresheners to improve their mood? Who doesn’t keep one or the other perfume in their bathroom cabinet? Scents help us relax, energize, concentrate, and feel sexy; they can make a home feel warmer and a work environment more dynamic.

Remember that we experience life through our senses, including the sense of smell. The stimuli our senses convey to us are immediately interpreted by us as positive or negative, and therefore trigger different emotional reactions. It is all about associations. During our lives, we learn to associate smells with certain circumstances, events, rituals, places and memories. Cinnamon smells of a cozy day at home, sunscreen smells like a beach holiday, burned cookies smell of wasted effort, and hospitals… smell of sickness.

It is true that there is a lot of sickness accumulated in hospitals, so it seems only logical for it to be reflected in the general vibe of the place. Still, hospitals should also be places of healing, and healing can and should be stimulated through strengthening stimuli. Scent is just one of them. Let’s move on to hospital food. It is probably one of the poorest diets there can possibly be. When all the ingredients on your plate – the salad, the veggies and the meat – have the same color, gray, you know they don’t have much going on in terms of nutrients. Vegetables and proteins are usually boiled to death, and salads often consist of canned yellow beans and the likes. Desserts mostly seem to have been made out of some instant powder mixed up with water and typically come in sickly pastel colors. And let’s not even talk about flavors and textures. “Urgh” says it all.

Considering that science already knows how vital good nutrition is for our health, it seems insane how hospitals are still serving food that not only does not help patients to recover, but has the potential of making them even sicker because of its nutritional poorness. Even someone healthy needs a wide variety of vitamins, minerals, fats, and so on. Now imagine someone who has already lost their health and needs to regain it. This does not only go for physical illness, but also for mental pathologies. The brain functions thanks to elements our metabolism derives from what we consume. In every respect, hospital food should be absolute power-food, the very best stuff there is! The emphasis goes on the word “should”.

If you, or a loved one, are currently hospitalized, you may wish to complement the hospital diet with valuable snacks. Get fruit, or have fruit brought to you. Apples are a great choice. They are easily available and keep for a long time, even outside the refrigerator. There are, of course, bunches of other types of fruit, but none seems to be quite as practical as apples. Bananas, for example, are an excellent snack and very rich in dietary fiber, but their intense smell may bother your roommates. Also, they get squishy quite easily and attract fruit flies. Whichever fruits you decide to acquire, eat them instead of that awful, pale-yellow Jell-O with tiny beige chunks in it. Also, abstain from the mummified salad on your food tray. Alternatively, you can have a fresh cucumber cut in slices and with its peel still on. As a snack in the afternoon, you could enjoy carrot sticks dipped in peanut butter. All of these items – apples, cucumber and carrots – are relatively cheap, available all year round and do not need any preparation other than cutting them up. Also, drink a lot of pure water and squeeze half a lemon into it at least once a day. Whenever you have the choice between a soda and water or milk, choose any of the latter two. Avoid adding sugar to hot drinks. All these are small and easy hacks which help you improve your health.

Complementing the hospital diet with your own choices of fresh foods can also be an opportunity for social bonding with your fellow patients. During my last hospitalization, I was sharing a room with three other people. It was summer, so there was a lot of fruit on offer everywhere – cherries and plums from local farms, apples, imported peaches and so on. Spontaneously, some of us would go, buy a big bag of fruit and put it in a bowl on the table for everyone in the room to take. Other patients spontaneously formed salad initiatives. They would throw their money together and shop for ingredients for vegetable or fruit salads, prepare them together and share them among one another. All this does not sound like a big deal, but that little bit of human warmth and joyful interaction can make a huge difference for someone who has hit rock bottom. In this sense, bringing flowers to your room is also a small, but important boost for everyone’s psyche. And guess what, this is where smell comes into play again. The smell of flowers is always beautiful.

“Beautiful” is my cue for the next unfortunate aspect of hospital environments: visual ugliness. It must be acknowledged that, given the requirements of cleanliness and good illumination, the off-putting linoleum floors and ghostly light from uninspiring neon tubes are probably necessary evils. Still, a lot can and should be done to make hospitals look less cold and morgue-like. After all, it is in no-one’s interest to have patients slip even further into depression. Some clinics do make attempts to create a more mood-enhancing environment. Large windows, plants, colorful artwork and cozy sofas with coffee tables and magazines here and there go a long way. The access to green outside areas is another huge plus. Sometimes, all it takes to make someone feel less gloomy is to sit on the in the sunshine on a lawn or on a bench in the shade of a tree for a while – alone or with others.

And last but not least, hospital setting should offer ample opportunity both for socializing and for introversion and retreat. The last clinic I was in had generous outside areas with a park, benches and Ping-Pong tables, as well as an indoor sports court which was constantly open to patients who wished to organize volleyball matches or other activities. This was not a fancy private clinic – it was a public, if quite renowned, one. Admittedly, the place was guilty of giving out horrible food and committing several esthetic atrocities, but the overall intention was right. Another thing they did well was that the staff kept close contact with the patients. Not so much in a controlling way, but mainly by being available for communication and socialization. Patients would get to talk one-on-one with the treating doctors several times a week, and every morning both patients and staff would meet up to comment among one another on how everyone felt and on some randomly picked topic. Once every week the arts therapist would direct a huge cake bake-off, followed by a collective cake and coffee binge. On one occasion, as the weather was hot and sunny, all staff and patients from the station decided to go for a pick nick in a nearby park. You may guess by now this was not a closed facility, meaning that patients were not physically restrained or thought to be a danger to themselves and others. Still, some of them had symptoms comparable to those of people I had met in a closed facility some months before, possibly meaning that this clinic simply encouraged and trusted its patients more than other institutions. Along these lines, I remember being invited to a former patient’s birthday party on the other side of town. I commented to the nurse at the entrance that I might be back really late, and she just smiled and wished me a fun evening! All over, I felt that the staff of this clinic was more interested in motivating patients to return to functional life than in isolating them from it. This should be one of the core objectives of psychiatric hospitals, but as things are you have to be very lucky to find a place like this.

Being hospitalized at any psychiatric h clinic is always difficult and scary, because you are often so hopeless that you just can’t fathom a way out of your crisis. But definitely, the attitude of a psychiatric clinic towards its patients is crucial for your recovery. Being guarded by an institution whose staff works against you by violating your dignity and undermining your trust can be the last nail in your coffin. I am certain such places don’t even contribute to the destruction of their patients on purpose. They fall prey to an intellectual fallacy by thinking you have to recover by yourself, and all they have to do is medicate you and lock you up. If the day they examine you again you haven’t improved, they just assume you need some more drugs and additional time behind closed doors. Being locked in by people who disregard your personal integrity could drive a healthy person bonkers. Now imagine what it does to someone who is already weakened. If anyone ever comes out of there cured, it is a miracle rather than a medical success. Such clinics fail to recognize their role as active participants in your healing process, and therefore contribute to your sinking even deeper into illness. On the other hand, staying at a clinic that practices an attitude of encouragement and support towards its patients helps you greatly, if not decisively, in putting your act back together.

In my belief, the biggest shortcoming of hospital environments is how they isolate patients from life. When you are confined to a clinic, you logically cannot participate in society the way you do living freely. But it is that very sense of being stuck in limbo that can worsen feelings of depression and hopelessness in patients. Who if not the very institution our society provides for healing should allow the ill to gather new strength and return to active existence? I am sure the more life is brought to a hospital in the shape of social and artistic therapies, fresh foods, biological life such as plants, comforting scents, natural daylight, cozy areas for relaxation and fresh air, the more curative it will be. Staying at a psychiatric clinic may not allow you to be immersed in everyday life, but it must offer the clear perspective of equipping you for it.

Right now, many hospitals make people sicker. My acquaintance’s father was right about that. The practice of medicine and psychiatry is often still not humane, not loving, not caring, enough. To a culture devout to science and rational thinking this sounds amateurish and cheesy. Yet, it is a profound truth. If science has not been able yet to define or measure love, compassion, health and vital energy, it is by force also unable to produce those. It is one thing to give someone a pill for their intestinal cramps. It is another to attempt mending someone’s broken spirit in the same way. Our health system still has a lot to learn.

Some Words on: Drug Interactions

Being on psychiatric medication will force you to question some of your habits. It might also make you wary about other drugs that had seemed harmless to you so far. Little things you took for granted may suddenly become big no-nos. I am talking about interactions your medication may have with other substances. For example, if you are taking a tricyclic antidepressant, popping an Aspirin against your headache is out of the question. You may have to renounce to alcoholic beverages and quit smoking bong. Possibly, you can’t even have caffeinated drinks.

Before you consider suicide, I wish to stress that despite the many restrictions your medication imposes on you, you will still find ways of enjoying life. I am just saying you need to be careful. The first step you need to take is to find out about the interactions your medicines may have with other prescription and over the counter drugs. Personally, I am on Quetiapine (Seroquel) and Sertraline (Zoloft). As a result, when I have pain from flu, from a migraine or caused by some lesion, I pretty much have to rely on Acetaminophen to fix it. It is the only analgesic and anti-inflammatory I can use without putting myself at risk. Every time I am about to try a new medicine I have to check and double-check if it is really safe for me to take. I admit to feeling quite nervous whenever I experiment with a new drug, although it is reported not to interact with my psychiatric medication. However, sometimes there is no way around playing guinea pig. Once I have successfully tried out a new drug I usually stick to it like glue. My list of compatible drugs is still short. Luckily, I don’t get ill often. Yet, eventually I should definitely make a list of all the medications I have found work fine for me.

It can be frustrating to find an entire group of medications is counter indicated for you, especially when you’re having an acute and debilitating health problem. You may have read in my withdrawal diary that I had been suffering from back pain. Unfortunately, I had to stick it out because there seemed to be no compatible muscle-relaxants. Usually, though, in every medication family, there should be at least one variety you can use. For example, there are several antibiotics which would interact with my psychiatric medication, but some are alright for me. The same goes for anti-allergic drugs. A couple of them would be dangerous for me to use, but Fexofenadine (Allegra) is harmless.

Not just other drugs can interact with your medication. Natural substances and food products can, too. All beverages containing caffeine are stimulants, meaning that, if your psychiatric treatment is aimed at calming you down, you will have to cut those out at least for a while. It is no coincidence that mental clinics usually offer their patients decaffeinated coffee and tea throughout the day. This may sound off-putting to the coffee-gourmets among you, but the nice thing about non-stimulating coffee is that you can literally have it around the clock and as much of it as you like. Personally, I love having several cups of coffee and tea per day. Yet, in order not to let it disturb my sleep, I stop consuming caffeine before 5 pm. Alcohol, on the other hand, is a potent depressant. So, if you are already down, having a few shots at your neighborhood bar will dig your grave a bit deeper. Doctors will generally recommend you to abstain from alcohol while taking psychiatric medications, or to enjoy moderate quantities on rare occasions. Your medications are broken down by the liver, so anything that would affect its functioning or strain it unnecessarily should be avoided. Now, alcohol is often a staple at social events. For many, having a glass of wine, a beer or a cocktail is part of the fun of hanging out with friends or colleagues. Probably, you can drink a glass or two without risking any negative effects. As for myself, I can have a few drinks without difficulty. I have never been a heavy drinker, not even a regular one. When I am at a party or at a restaurant, I like my share of red wine or a round of sake at sushi places. I never have booze on an empty stomach and also never let myself get drunk. If you decide you’d like to try a drink, accompany it with a glass of water to dilute and help you flush it out. An exotic item on the list of forbidden foods is the grapefruit. It alters liver function and therefore should not be consumed in combination with any drug at all – psychiatric or not.

Then, there are psychoactive natural remedies, such as Saint John’s Worth or Valerian. Extracts made from those plants are tranquilizing. In other words, they act on your brain. Only use them if you can make sure they won’t interfere with the therapeutic purpose of your current treatment. For the ladies, it might be an interesting fact that Saint John’s Worth, on top of its psycho-activity, also diminishes the effectiveness of hormonal contraceptives. So, hands off this shrub if you would like to enjoy your freedom for a bit longer!

Talking of natural psychotropic substances, there is a host of them. Probably the most commonly used is marijuana. Although it is illegal in most places, it is probably less dangerous than many psychiatric drugs. Still, it should not be used in combination with them. I am acquainted with people who are on anti-psychotics and smoke weed at the same time, but it is risky and therefore not recommendable. It can go well, or it can go wrong, without there being any way of telling beforehand. Unfortunately, little data is to be found about the risk factor here. It appears to be that recreational drugs can actually trigger mental illnesses. During my last stay at a mental clinic, I came across fellow patients whose diagnosis of schizophrenia or psychosis followed the use of marijuana, heroin or other illegal substances. Spontaneously, I can recall four or five cases, just out of the people I got in closer contact with. There is no way for me of knowing whether the physicians at the clinic recognized the cause of mental illness correctly, or whether factors other than recreational drugs were in play. Still, it is a possibility.

Sometimes, an illness or injury can require extra medication with great urgency. If it so happens, you will have to grind your teeth and weigh possible interaction symptoms against the gravity of your condition, then choose the least compromising of the two. Note that not all drug interactions are necessarily dangerous. Depending on their severity, they are usually categorized as major and minor interactions. Hence, if you are seriously ill, you may be willing to risk interactions as long as they are not menacing to your life. Just as side effects, interactions may occur in some individuals and in others not. If an undesired symptom is expressed in a very small percentage of the sample population, the odds are on your side.

Most importantly, you need to find reliable information on the interactions your medication may have. The package inserts (or PILs – Package Information Leaflets), usually only contain a basic paragraph on the subject. You can, of course, ask your prescriber, but he or she will likely not be familiar enough with the specific combination of drugs you are going to take. Remember your doctor sees dozens of patients every day, all of them with their specific medication plan. It is virtually impossible to bear all possible drug interactions in mind. Then, there is the internet. Several sites offer interaction finders where you can type in the combination of drugs you wish to check for safety. It is hard to say whether these webpages have complete data at their disposition. New medications are thrown onto the market and new studies with already existing medications are conducted all the time, so there is a constant need for updates. The advantage of online interaction finders is that you can type in any number of substances, which allows you to learn about the safety of multiple drug use. You can also find interaction lists on the internet. But be warned: the number of interactions for your psychiatric drug can literally be in the hundreds, so prepare for a Sisyphean task.

Last, but not least, your using psychiatric medication may be socially and professionally compromising. Not because you may have to turn down friendly offers of alcoholic or stimulating beverages, but because your medication may render you unresponsive to everyday situations. One day, instead of taking my antidepressant in the morning, I accidentally took the anti-psychotic. What a knockout! That day, I had visits coming over. Later in the afternoon I was supposed to shop for a birthday present and attend a theater rehearsal. I am hard headed as a ram, so I forced myself to pull through with my agenda, but it felt like attempting to pull myself out of a swamp. I won’t forget that day so easily. Normally, I am supposed to use my anti-psychotic right before going to bed at night. Now, there are some evenings where you have no intention of going to bed any time before the early morning hours of the following day. New Year’s Eve is one of those occasions. As a consequence, you may end up flushing your sedating medication down with a fruit punch at 2 am or so. As long as you have nothing important to do the next day, it’s not a problem. Just make sure you have no job interviews, driving lessons or college admission tests coming up, because you will be feeling quite heavy. Luckily, I am not much of a night owl, so the anti-psychotic does not really get in my way much. If you are into clubbing or have to work graveyard shifts, you will need to make adjustments either to your activity schedule or to your medication plan. Discuss this in depth with your prescribing physician. You may have to modify your lifestyle in some regards, but do not feel discouraged. If an aspect of your life is really important to you, there should be ways to conserve it. Stay motivated and think outside of the box.

What Made Me Crazy And How Do I Deal with It?

When I broke down with psychosis, I had already been struggling with myself for many years, if not for all my life. Although as a teenager and as a young adult I had always been hopeful about my future – and I still am – I was also experiencing major insecurities which made me fear I was incapable of survival, let alone happiness. Even if other people praised me as a person or liked the quality of my work, I always felt like a cheat who is using a promising façade to hide a putrid ruin. I felt emotionally and socially disabled. During the years leading up to the psychotic break, I had been working hard to overcome my mistrust in myself, but I never shook off the fear that I might be a failure by design. Something seemed wrong.

Now, there are many definitions of mental illness and also many theories about its origins. As no clear answer has been found yet, the consensus is that mental illness results from mixed factors such as genetic predisposition, dysfunctional upbringing, traumatic experiences and substance abuse. The presence of any of these, or any combination of these, can push someone over the edge.

In my case, I can rule out substance abuse and traumatic experiences, not counting extreme stress as the latter. Thus remain genetic predisposition and a dysfunctional upbringing. I cannot prove nor disprove genetic disposition, but looking at family history on my paternal side there might be some. I would have to find out more about that issue. Just for the sake of argument, let’s say I am genetically predisposed towards mental illness, and my symptoms were triggered by a dysfunctional upbringing and other stress factors. An unhealthy upbringing I can prove to have had. I lacked nothing material, and also received a good academic education, but my close family was and still is emotionally damaged.

My parents had a miserable marriage, yet never split up. They shared a strange need to destroy, despise and blame one another for everything that had gone wrong in their lives. Fights and insults were their means of communication. My father retreated into a socially isolated lifestyle. He was super-sensitive and irritable, displayed signs of OCD (he feared the presence of germs and dust everywhere) and held no power of decision within the family. Hardly anyone took him seriously, or so I perceived it. My mother personified the theories about “schizophrenisizing” parenting you find in psychology literature. She loved me, but had no clue how to do it. She was possessive, controlling, over-protecting, manipulative, and eternally ambiguous about everything. She exerted power by instilling fear and feelings of guilt in me. Despite her addiction to control, she herself was desperately insecure and fickle. At times she was excessive in her demonstrations of motherly love, and at times she condemned me for being my father’s offspring. One day she could be encouraging and generous, the next she would make me feel unworthy. I could never confide in her because she might use whatever I said against me. My siblings, way older than me and living far away, just got the idea that I was a problem. My mother used to evacuate her complaints about me with them and other family members. When the first thing your cousin says to you, after a decade of not seeing one another, is “I know everything you’ve done to your mother”, you know for sure you’re the official fuck-up of the tribe. Now add years of bullying at school and you get someone who logically – with or without genetic predisposition – had to go nuts at some point.

So what was the ultimate trigger? My psychotic break was not my first crisis, but other than the previous ones it was cataclysmic. The breakdown was immediately preceded by the end of a long-term relationship (if not a very healthy one), a life-changing move to another country and a personal confrontation with my family I was unprepared for, and which threw me right back into my old conflicts with them. All of these together produced an acute feeling of having been uprooted and set adrift in existence. It was an extremely frightening and painful experience. There was nothing I could hold on to for catching my fall, most of all not myself. That is ultimate loneliness. I became shock-frozen in life, and a case for the mental clinics. Mental illness had always been presented to me as an incurable, invariably disabling and socially annulling condition. My terror was nameless when I got diagnosed as psychotic and medicated. None of the first bunch of doctors I saw gave me any hope of reconquering life ever again, and my initial medication regime also was not helpful. I literally became a zombie – wishing for an end to everything, but my body would go on functioning, keeping me prisoner in a biological existence devoid of meaning and direction. There was no curtain call for me yet. Back then, during my crisis, staying physically alive felt like a curse. I just wanted out! The winds began changing during my last hospitalization. After that, I hesitantly but firmly took up the reigns again. I cannot tell what exactly made me recover. A combination of many physical and immaterial factors must have come together in my favor, including an unknown energy deep in my essence that refused to let me go under.  Nowadays, I am glad I made it through. Nothing guarantees me psychosis won’t strike again, but as things are I am not fearful about it. Right now, I have a lot to live for and I love my life as it is – full of beauty and love. But getting here sure was heck of a trip!

Once you break down in crisis, society isn’t exactly forgiving, including people you had felt close to so far. They may give up on you for various reasons: they think you are just putting on an egocentric show and this unnerves them; in their opinion your problems are your own fault and you are an irresponsible fool for having invited them in; your shallower acquaintances simply don’t find you fun anymore; firmer bonds suffer because they find dealing with you and seeing you ill too painful. Your former co-workers or fellow students may prefer to forget your name forever. In the eyes of many, craziness is not an ailment which can attack anyone and eventually subside again. Society stigmatizes mental illness as an inborn, rotten part of the befallen individual, who is therefore worthless.

Right along the lines of supposedly being damned by birth, you will hear it said that what you didn’t receive in your cradle, you will never acquire. In other words: if you had a bad start you might just as well throw yourself off a bridge, because there is no remedy for you. To everyone out there who was lulled into believing this popular la-di-dah: it is utter and complete BULLSHIT. Certainly, teaching yourself is harder than having everything served to you on a tray. Still, your capacity of learning and growing is your lifelong gift. No-one but yourself can keep you from enjoying it. Never resign to thinking you are merely the outcome of your parents’ joined genes and educative efforts. Have you ever heard the saying “the sum is bigger than its parts”? It is true! There is much, much more to you. An unlikely source of wisdom, among many others, is the subtitle on the posters of the Hollywood movie “Gattaca”. It reads: “There is no gene for human spirit”. Neuroscience, in fact, backs this philosophy up. It turns out the human brain remains capable of rewiring its networks throughout our entire life. This ability is called neuroplasticity. How remarkably flexible and versatile our brain is, is impressively described in Norman Doidge’s book “The Brain That Changes Itself”. It is quite a fascinating and edifying read. According to the principle of neuroplasticity, any unhealthy behavioral and thinking patterns you fear were hardwired into you during your childhood and youth do not predetermine your future. You can modify them through willpower, practice and positive reinforcement. Thereby, you can even activate or deactivate certain genes. In other words: no matter where you are coming from, you are able to become someone you love and respect. Probably you will need help and also some powerful insights gained from difficult experiences, but you can mend your psyche. In this context, I would like to recommend another book. It is really written for therapists and the loved ones of people in need of help. Yet, as it portrays clearly which kind of help is the right one, I found it extremely useful for myself, because it taught me what my therapeutic needs are. This, in turn, allows me to seek out adequate help and instruct those closest to me how to deal with me should moments of crisis come up. The book I am referring to is Dr. Peter Breggin’s The Heart of Being Helpful”. This is a must-read for you, both if you are the one who is in crisis, and if you are a potential helper.

And finally, don’t let yourself become the problem. Also, don’t allow others to make you that. Unfortunately, even in the medical field, a mentally ill patient is treated as the personified problem. This does not happen to such a great extent in other areas of medicine. For example, a patient can HAVE a heart disease, but they ARE not a heart disease. Possibly out of general ignorance about the causes and nature of mental illness, someone with, say, schizophrenia, is considered to be inherently dysfunctional rather than suffering from a dysfunction that may well be temporary. Also, what if mental illness is actually not an illness in the conventional sense, not a medical defect? Could it be a reaction to the richness of observations an exceptionally sensitive and perceptive psyche is able to make of reality? Maybe some people are simply able to feel the pea under multiple layers of bedding, while others have a thicker skin and fall asleep anyways? It is easy to just stick the label of mental illness onto someone whose takes in a greater variety of stimuli, and who cannot always process their complexity. At first glimpse, you may judge extreme susceptibility as a weakness. In general, the psychiatric discipline and mainstream opinion fail to recognize that psychological hypersensitivity can also be a gift that stretches way beyond madness and alienation. In my personal view, it offers an opportunity for learning, healing, and growth that is less accessible to all those who are robust enough to just leave their conflicts unattended and carry on with their emotional load on their backs. If you break down under your world’s weight, you will be forced to sort the clutter and take only the useful things with you. Mental crises are a nightmarish ordeal, but they can also be your chance for renovation. I am not saying you necessarily need to become psychotic in order to make something out of your life. Of course not! What I suggest is that facing mental illness does not have to end in absolute defeat. Instead, it could well be the first step towards a more conscious way of living. I do believe that the destructive forces of madness can be turned around and redirected. Consider mental illness as a challenge, not as a final verdict. You can move on.

The following are links that lead you to people who are dealing with their conditions in inspiring ways, and to institutions which can help deal with your situation.

 

Websites:

Directory of organizations which can help people who are first diagnosed with a mental illness (UK based): http://www.bbc.co.uk/programmes/p01b3s86/features/info-and-support

This is the blog of Natasha Tracy, who fought herself back up to her feet despite her diagnosis: http://www.healthyplace.com/blogs/breakingbipolar/

 

Articles:

Christopher Tolmie writes about his documentary “Mental: A Family Experience”, which he exposed at the Scottish Mental Health Arts & Film Festival 2013 in Glasgow (http://www.mhfestival.com/). Here is the link to the article: http://www.changingmindschanginglives.com/2014/01/mental-illness-does-not-necessarily-incapacitate-someone/ Or go to:  http://www.mhfestival.com/news/interview/item/77-festival-blog

Audiovisuals:

“Ask A Schizophrenic – My Answers”: Questions and answers with Rachel Star (NOT Rachel Starr), who got diagnosed with schizophrenia and talks about how she manages her life and makes the best of her condition. To me, she appears quite admirable and inspiring. http://youtu.be/BAUlllDZqxg

This moving story recently went viral. In case you still haven’t come across it, it is about a man named Johnny Benjamin. He had been diagnosed with schizoaffective disorder and decided he was going to take his life. This was prevented last minute by a passer-by. After the incident, Benjamin began to turn his life around and is now giving thanks to his rescuer. http://www.bbc.co.uk/news/uk-england-london-25959260

Some Words on: Weight Gain on Psychoactive Medication

It is, very sadly, true. Using psychiatric medication often leads to substantial and rapid weight gain. When I was first put on an antipsychotic, which was Olanzapine (Zyprexa), I gained over thirty pounds in a matter of just a few months. After switching to Quetiapine (Seroquel), my weight stopped going up, and through a healthier diet I even managed to shed some of it, but I never went back to what used to be my normal weight. Now, I am constantly teetering on the edge of overweight. My BMI (Body mass Index) oscillates between 24.9 (which is borderline acceptable) and 25.1 (overweight). In addition to the weight, my entire body texture seems to have changed. Even without regular exercise, I used to be athletic and lean by nature. Now, I have cellulitis bumps on different parts of my body and look slightly out of shape. The only good thing about being fuller is that also my boobs have grown by one cup size. I’ve gone from A to B. This is not to say that you should try psychoactive drugs as a measure of breast enlargement. Absolutely don’t do it! Fact is, these medications mess with your metabolism on top of potentially messing with your mind and with all sorts of biological functions. So no games, please! Every now and then, marketing of psychiatric drugs includes enthusiastic statements like “does not cause weight gain” (the atypical antipsychotic Aripiprazole, aka Abilify, for example), which are to increase their attractiveness among the target group. This, more than anything, shows how common weight gain is as a side effect of these substances.

But what if you are already there? Is there any way of losing the pounds? First of all, it is important to remember that diets and exercise regimes which work fine on people who do not use psychiatric drugs, won’t be as efficient on someone who does. Weight loss will likely be slow and unspectacular. It is not impossible, but it is harder to achieve. Still, you should not feel discouraged. Both a healthy diet and regular workouts will boost your overall health and help you stabilize your mood. In fact, exercise has been found to be highly effective against depression. Also, physical activity offers a great opportunity for leaving the isolation of your four walls, getting among people, breathing some invigorating fresh air and catching lovely sunlight for some extra vitamin D. If sports and healthy eating habits fail to lower your BMI in a direct way, they can still contribute to it by making you less in need of medication. Both are, in any case, worth the effort.

If you decide to diet, do it responsibly. Please do not embark on a starvation course. Your body and mind need their nutrients, especially when your health is already compromised. Put together a balanced nutrition plan rich in fresh vegetables, fiber, “good” fats (red fish, avocado, nuts, etc.), protein and fruit. Avoid processed foods, refined sugars and carbs, sodium laden snacks and in general anything that reeks of junk food. Also, abstain from artificial sweeteners, preservatives or colorants. If you are on psychiatric medication, you are already consuming potent and potentially dangerous chemicals. Try not to add even more through your food.  As a rule of thumb, note that the less processed – or the more natural – a food is, the better. As for drinks: have no sodas; just water, teas and smoothies without added sugar. It is not necessary to take radical measures like turning vegan or saying goodbye to dairy products. If you associate the concept of healthy eating with a bunch of barefoot, skinny tree-huggers gnawing on raw carrots and celery, then you will need to reeducate yourself. Healthy eating means experiencing real food with real flavors made of real ingredients. Subsisting mainly on junk food is neither cool, nor manly, nor useful. Knowing what it can do to you, it is plain stupid and a waste of money, time and life. For those who sustain that “Junk food is so much cheaper”: Buying sodas and fries may save you a dollar in the moment, but an extra expense for whole foods can save you hundreds, if not thousands of dollars in medical treatment and work incapacity in the long run. I am not saying you should never set foot in a fast food restaurant again. I myself do it on rare occasions, and when I am at a party where a decadent buffet is winking at me… what the heck, I am at a party! So, be naughty every once in a while, but never let highly processed foods become a staple in your diet.

Nowadays, most foods are, first and foremost, designed to please our taste buds. The real purpose of food, which is to provide nutrition, is presented as a collateral benefit by the food industry. Creaminess, fluffiness, sweetness, crunchiness – all these are prioritized over nutritious value in food marketing. Most often, the “healthy”-tag is just another means of selling you virtual garbage as nutrition. Milk chocolate contains milk, which contains calcium, which is good for you. So, chocolate bars are healthy, eat as many as you like! Having been exposed to this type of discourses since childhood, many consumers have never developed a clear idea about what food actually is. They would never expect their car to run on soap water, but they do expect their own bodies and minds to run on meals and snacks devoid of nutrients. In other words, they eat things that are, in fact, not food at all. Popular wisdom such as “sugar is energy” or “if I feel full, then I have given my body what it needs” is completely misleading. You can feel stuffed after having eaten a shoe sole. Yet, your organism will get nothing out of it. You can fill a car tank with soap water – until it spills over, actually! It will no doubt be full, yet the car won’t run.

Nobody knows exactly how much damage our trashy diet is doing to us. We are likely to have seen barely the tip of the iceberg so far. Probably, more physical ailments, mental conditions and cognitive disabilities are a result of intoxication and deficiencies induced by our diet than we can fathom at this moment in time. Mainstream eating habits and ruthless food marketing have created a paradoxical scenario. People who consume processed foods can be morbidly obese and still malnourished. You can eat monstrous amounts of calories and still be dangerously deficient on nutrients. Many diets out there are just as much of a health threat as our trashy eating habits. Dieting is often misunderstood as selective starvation. The idea behind it is that achieving a lower weight will supposedly make you healthier. Every new issue of any women’s magazine will promote another grotesque diet, and each time it is advertised as finally being the real thing to get you into lollypop-shape in no time. Having only apple cider vinegar with chili powder for two weeks in a row while keeping your habitual level of activity should definitely make you lose a few pounds. But will it make you healthier? And remember, you are (likely) not a celebrity! You have no millions to spend on personal nutritionists, private doctors and plastic surgeons to patch you back up again. Celebrity diets can be survived only by celebrities.

So, masochistic dieting will not result in a healthy weight, but only being healthy will. In other words, the first thing you want to do is establish optimum health. You need to get rid of toxins, balance your hormones and provide your organism with the necessary nutrients. Reformulate your eating habits into a plan that leaves out damaging food products and embraces whole foods. And don’t worry: whole foods are at least as delicious as processed and prepared food. You will be astonished at the mind boggling variety in flavors, textures and colors nature offers you. No junk food can ever keep up with that.

If you are using psychiatric drugs, in addition to following a healthy diet you will need to make an extra effort in detoxing your metabolism and achieving hormonal balance. Very likely, your liver is working overtime to process the substances you are using. Give it a hand by consuming liver-cleansing foods and drinks. Mostly, that is going to be certain vegetables and teas. Cruciferous, slightly bitter veggies such as broccoli, kale, Brussels sprouts and cauliflower should be staples for you. In fact, cauliflower is incredibly multifaceted. It can be made into low-carb pizza dough, lasagna, hash browns and many other delicious dishes. Another advantage of vegetables is that you can practically eat as much as you like of them without putting your health at risk. Which other food allows for that? So, enjoy your greens! As for drinks, you can have freshly pressed lemon juice mixed with pure water, veggie smoothies and organic green tea. Many websites will also promote grapefruit juice as liver-cleansing, which is correct. However, remember that grapefruit can interact with your medication, so please abstain from consuming it in any form. There are more than enough safe options for you out there. For further inspiration, you can also browse health food stores for liver-cleansing herbal tea blends.

When you put together your new diet, there are three factors which determine what you will be eating: what your body needs, what you should avoid and what you like. If you keep an open mind, these three need not clash. Don’t be afraid to try out recipes you had not known yet. This is also a good moment for having yourself checked for food allergies. Give your eating plan a thorough clean-up! As a result, you may have to quit a number of eating habits, but you will also discover a wealth of new options to compensate for those. And always remember to go for the fresh and natural! Now, keep in mind you won’t drop three sizes overnight. Although your medication-induced weight may be bothering you, its loss is not your primary goal! Your primary goal is to become healthier and strengthen your body and mind. As a secondary effect, weight loss is likely to follow an improved overall health.

Websites:

For those who prefer a conventional approach to weight-loss, turn to www.weightwatchers.com or www.weightwatchers.co.uk.

Articles:

This post from the blog beyondmeds.com deals with the author´s personal experience with weight gain on psychiatric medication and weight loss after coming off the drugs: http://beyondmeds.com/2012/08/06/weight-psych-meds/ You may want to have a look at the rest of the blog, too. It is elaborate and full of valuable articles.

Here is a blog article in English by athlete Cathy Brown on how she successfully managed her depression and her anger issues through exercise: http://www.changingmindschanginglives.com/2013/05/sport-changed-my-life-for-the-better/

Audiovisuals:

Seminar on the functioning of the liver in English by nutritionist Barbara O’Neill: http://youtu.be/KAGEhkZ-ssY Should you wish to find out more about O’Neill, visit her website at http://www.barbhealth.com/.

Dr. Eric Berg has developed a nutritional theory based on different metabolic types. According to Berg, every person corresponds to at least one of these types. As a consequence, different individuals metabolize food in varying ways and function at their healthiest on different food plans. Berg does not refer to the added complication of psychiatric drug use, but still his discourse offers fascinating and useful insights. To learn more, watch the following videos in English:

Dr. Berg’s Body Type Seminar: http://youtu.be/_m-R4RqRQqM

The Body Type Diets – What to Eat for Each Type: http://youtu.be/xvOwfkg9p2o

If you are interested in more of Dr. Berg’s theory, go to http://www.drberg.com/

Some Words on: Mental Illness as a Sales Hit

“Mental Illness” has become a ubiquitous term in mainstream media. In many instances, they are promoted with the same nonchalance as over-the-counter medications, and little is said about their negative effects. As a consequence, consumers are more likely to start using psychotropic medications. At the same time, doctors are getting increasingly casual about prescribing them under the pretext of a hastily made diagnosis. Strangely, having a (not too scary) mental disorder is now almost a fashionable accessory to your personal presentation. Remarking at a cocktail party you have ADHD or anxiety disorder at the same time as being a successful professional makes you incredibly interesting. Don’t try this with schizophrenia or other spooky sounding conditions, though, unless you want to have the couch you’re sitting on all to yourself. Read more on social isolation and psychiatric conditions in my post “Some Words on: The Social Stigma of Mental Illness”.

The idea that you can have a “normal” life despite being mentally ill is one of the strongest messages the pharmaceutical industry uses for marketing psychiatric drugs. But they don’t only target potential consumers; they also offer attractive deals to prescribers. Tagging a patient with some or the other “disorder” and sending them home with a prescription is profitable for psychiatrists just as it is for pharmaceutical companies. As a consequence, prescribers with less than very sound work ethics are prone to over-diagnosing patients. Conveniently, the Diagnostic and Statistical Manual of Mental Disorders (DSM) gets thicker with every new edition, so more diagnoses can be cooked up and more prescriptions issued. Evidently, this puts patients at risk of being inaccurately diagnosed and unnecessarily drugged. They fall prey to the trust they learned to have towards health care professionals since early childhood. If something is wrong, Doc knows best how to fix it – or does he?

Where a psychiatrist draws the line between an emotional crisis and mental illness is up to his personal judgment. If you wonder why prescribers don’t simply test their patients for mental illness just to make sure they really need medication, the answer makes the psychiatric discipline appear in a rather unfavorable light. There are no tests. Not medical tests, in any case. No blood tests and no brain scan can reveal mental illness. Psychiatrists have no choice but to take at face value what the patient discloses about their state. In a clinical setting, doctors can also recur to observing patient’s behavior, but even that can be interpreted in many different ways. Apart from that, it is usually nurses or other clinic staff who deal with patients more directly and more often than the prescribing doctor, who therefore works with a lot of second-hand information. Then, there are the psychometric tests. Patients may be presented with a questionnaire, for example. Now, questionnaires are statistical tools, but they are no means of exact measurement. If you have someone do the same test twice, they are likely to give slightly different answers the second time – especially if the list of questions is long and graded answers are possible. Also, what does answering “no” to questions like “Do you enjoy social gatherings?” mean in psychiatric terms? Do you suffer from social anxiety or are you just not a party animal? And finally, what if a patient, out of shame or whichever other motivation, gives inaccurate answers? Again, questionnaires are a fine statistical tool, but they are not equivalent to a medical exam. Yet, this is what psychiatrists base their diagnosis on: personal accounts given by the patient, psychometric tests, observations of clinical staff or significant others. At the end of the day, the psychiatrist has to patch all these puzzle pieces together and try to match the resulting impression to one or the other mental pathology in the ever-changing DSM.

Just for laughs here: I got tested with those famous ink blotch cards by a psychologist when I was in my psychotic break. Her conclusion: I was “too creative”, because apparently my perceptions were not classical enough for her. Where other people would have seen an evil moth, I made out two dancing African ladies. When I remarked that I had a couple of degrees in arts and that it was therefore my job to be creative, she just said: “No, no, even as an artist you still need to be adapted.” In other words, I failed to be crazy in a normal way… Woman, I was immersed in psychosis and all you found wrong with me was my creativity??? No further comment.

So, a significant number of psychiatric diagnoses are given to people who are fundamentally healthy, but who are seeking medical help because they are naturally – and necessarily – struggling to overcome a personal crisis. Few psychiatrists will remind them emotions are our connection with reality, be they positive or negative. Instead, both prescribers and the pharmaceutical industry have a political and economic interest in making you forget that humans need grief, need sadness and need anger. In fact, it is questionable whether the feelings we call negative deserve such a bad reputation. After all, they warn us when things are going wrong, when we need a change, when we are in danger, when we need to take a break from our daily grind. Can it ever be healthy to suppress these signals? Wouldn’t it be better to acknowledge them and discover their source? Is conflict solving not the natural way of reestablishing balance and well-being in our lives? If you choose to numb your instincts with drugs, you may temporarily escape the discomfort of facing your problem, but you will also steer further and further into it without even noticing. What would be healthier: worrying about a difficult curve ahead or blissfully driving off the cliff? Not everything in life is made of pink cotton candy – it was never meant to be.

Then why are people so anxious about being “normal”? Whoever defined what normalcy actually is? Well, just look around you. Mass media bombard us with consumerist utopias 24/7. Wherever you turn, beautiful men and women with impressive careers live in stylish homes, throw hip parties, enjoy perfect health and, most importantly, have found the laundry detergent that makes all this possible. Tragically, the pharmaceutical industry has joined this very profitable ride. Feel imperfect in any way? Feel troubled, fearful or sad sometimes? Or have you simply not learned how to be happy? No problem, help is nigh. We won’t teach you how to resolve those issues, but we have a pill that can make you forget you have them. If your life is a mess, just sweep all that emotional clutter under the carpet and your existence will look as if it were perfect.

Psychiatric medications are made for halting acute, disabling crisis, and nothing less than that. They are not dietary supplements you can just take on a daily basis to supposedly optimize your performance in everyday life. Yet, that is how they are being marketed. In countries like the USA and New Zealand, psychiatric drugs can be advertised on TV, along with cars, shampoos and what have you. Those commercials make it look as if mental illness were as minor a thing as the occasional headache or dandruff. People are made to believe they can just try any psychiatric drug and see if it helps them get along better with their boss or feel less stressed out by the tornado of over-sugared brats who obliterate their homes every day. In fact, many prescriptions nowadays are issued to patients who demand a specific drug they know from an advertisement. Way too often, prescribers comply without much ado. After all, the waiting room is crowded with people and every minute saved on one patient equals money earned on the next one.

Mental illness has become a booming market. No doubt should we be grateful for the many life-improving medications we have at our disposal, including psychiatric drugs. But just where does care end and exploitation begin? How is a consumer to distinguish between information and marketing? What means does one have to confirm the prescriber’s diagnosis unequivocally? Few medical disciplines are as double-faced as psychiatry is at the moment. Try convincing a non-diabetic of injecting themselves with insulin, and try making someone believe their life could be even better if they took psychiatric drugs. While the first is virtually impossible, the latter is easy. It is what happens many times over, every day, all over the planet.

It would be futile to wait for the health industry to change. As long as consumers believe medicine is always altruistic and trustworthy, they will be vulnerable to manipulation. Medicine, and psychiatry, SHOULD have a humanitarian mission rather than being a cutthroat business. But not all health care professionals and pharmaceutical companies want to know about that. However, the situation is not hopeless. You as a consumer and potential target sit at one end of the lever. You can ask questions and have a right to utter your skepticism. If you are unsure whether you need a prescription for psychiatric medication or not, the following actions can help you obtain a clearer vision of things:

  • Go for a second or even third opinion from another doctor.
  • Have a general medical checkup. Nutritional deficiencies, allergies, a damaged liver or thyroid dysfunction may be causing your symptoms. Also, have a neurological exam in order to rule out anomalies in your brain structure.
  • Take a critical look at your lifestyle and habits. Are you getting enough sleep, and if not, why (do you ingest a lot of caffeine, do you have sleep apnea, is your bedroom not dark or quiet enough, etc.)? Are you consuming any recreational drugs (including alcohol)? Are you getting enough movement and fresh air? Do you eat well? Are you regularly exposed to toxic substances?
  • What is going on in your private and professional life? Which stressors can you change or at least shield yourself from?
  • Are you carrying around an old childhood trauma or other painful experiences? These have to be worked on!
  • What is your universe made up of? Is life cold and empty to you? Find things to fill in those existential gaps. I am not necessarily talking religion here. I mean bring something into your life to help you appreciate your existence.
  • If you have a prescription, evaluate if taking the drug is worth the risk. If its negative effects outweigh the damage you are suffering from your perceived problem, refrain from using it.
  • Talk to a psychotherapist or counselor. Maybe your problems can be solved through therapy rather than drugs. If you are a believer, you can also consult with a spiritual guide.
  • Ask close friends, relatives or other people you trust how they perceive you. Their perspective may vary greatly – and in your favor – from your self-perception. Don’t be shy to accept their support and their love. Those are invaluable gifts.
  • Read, read, read. Remember: knowledge is power.

Having gathered enough information, make an educated choice. Whether you wish to try psychiatric medications or whether you prefer doing without them, both of them are valid ways, and for both you deserve respect and support. There is no shame and no guilt about any of the two. All is about building a life you’re able to love. Pick the best help you can find to get there.

The following are links you can learn more from.

Webpages:

MindFreedom is a website defending human rights in the mental health system. On this page, you can find links to various articles on doubtful marketing strategies for psychiatric medications. http://www.mindfreedom.org/kb/psych-drug-corp

Articles:

“Inappropiate Prescribing”: Article for the American Psychological Association (APA) by Brendan L. Smith, in English. http://www.apa.org/monitor/2012/06/prescribing.aspx

“The Psychiatric Drug Crisis”: Article for The New Yorker by Gary Greenberg, in English. http://www.newyorker.com/online/blogs/elements/2013/09/psychiatry-prozac-ssri-mental-health-theory-discredited.html

“Drug Companies Just Say ‘No’ to Psychiatric Drugs”: Article in English for Psychology Today, written by Pulitzer Prize nominee Robert Whitaker. http://www.psychologytoday.com/blog/mad-in-america/201106/drug-companies-just-say-no-psych-drugs

Audiovisuals:

“The Marketing of Madness” is a documentary on the marketing strategies employed by the pharmaceutical industry and the prescription of psychotropic drugs to patients who would not have really needed them. A must watch, available in English language on YouTube. http://youtu.be/IgCpa1RlSdQ

“The DSM – Psychiatry’s Deadliest Scam”, in English language, documents the shortcomings in the edition of the DSM, and how the manual impacts the entire psychiatric discipline, thereby affecting thousands of lives – not always for the better. http://youtu.be/PcuhhJ1BaMk

“How to Read Your Body”, by Dr. Eric Berg, gives simple guidelines on how to assess your overall health, in order to help you and your doctor pinpoint any underlying problems. http://youtu.be/VaUAe-csKjY.

Another video by the same author is “The Ultimate Stress Lowering Technique”. Apart from proposing stress reduction exercises, Dr. Berg also taps into the subject of inaccurate psychiatric diagnoses in stressed individuals. http://youtu.be/lsoYk5rioyw

 

Some Words on: Psychiatric Violence

The term psychiatric violence, or psychiatric abuse, describes the mishandling of power and authority health care professionals in psychiatry, or entire institutions, can expose their patients to. It comprises all sorts of aggression – active or passive. Psychiatric violence can occur on all levels of interaction between treating professionals and patients: social, psychological, chemical or physical.

Progressive thought currents in psychiatry advocate equality between the treating and the treated. More and more often, the right of patients to make choices and utter demands is recognized and respected. However, the outdated model of an authoritative doctor and his dependent and subdued patient is still very much alive.

Psychiatric violence occurs wherever doctors and nurses assume that someone who has been diagnosed with a mental illness is a person of diminished worth and respectability, and where psychiatric institutions consider it their main purpose to keep the mentally ill our of society’s way, as opposed to helping them reintegrate. Violent psychiatry robs distressed individuals of their humanity and punishes them for being dysfunctional. Humane psychiatry, on the other hand, dedicates to them attention, support and empathy – in short, authentic interest. I have experienced both models in action and guess what: humane psychiatry is the one producing positive results.

I’ve mentioned here on my blog that I was hospitalized a bunch of times during my psychotic break, in three different clinics over the course of nine months. The first two institutions operated quite a lot through psychiatric violence, which ranged from physical restraint to psychological abuse. Ironically, one of those two clinics had posters in its hallways, inviting patients and the general public to talks on psychiatric violence! It was the first time I ever heard of the concept.

Violent psychiatry will attempt to coax patients into compliance. In fact, their definition of mental illness hinges on the degree of compliance (or non-compliance, for that matter) an individual under examination displays. The discourse used reminds of the twisted logic of medieval inquisition trials: if you admit to being mentally ill, well then you of course are. And if you insist you’re just fine, that belief in itself will be considered a symptom of your craziness. Catch twenty-two! The same goes for the acceptance of psychiatric medication. If you are docile and willing to take your pills, that’s recognizing you are ill. If you refuse, it means you’re mentally deranged, too, because your fail to admit you need them, so your perception of reality must be distorted! In other words, if you come across the wrong sort of psychiatrist, you are destined for disaster the moment you set foot in their office. One way or the other, you will be diagnosed with something – accurately or not.

On occasions, psychiatric violence can get rather blatant and bizarre. During my second hospitalization, a doctor yelled in my face in front of a group of fellow patients that I was sick to my head. An arts therapist at the same facility communicated to the prescribing doctors that I had “distorted vision” – she was convinced that every time I looked in another direction but hers, I was actually looking at her! In retrospect, I think it might have been nice of me to offer her some of my antipsychotic. Unfortunately, the prescribing doctors and higher ranking staff believed her without subjecting me to any kind of exam. They had no interest in finding out if I really had “distorted vision”. After all, the arts therapist was a qualified health care professional and I was just a nutcase whose words were not to be trusted, and who had been caught displaying yet another weird symptom of craziness.

Another genius of a psychiatrist asked me a handful of questions to find out if I showed any symptoms of schizophrenia. I answered all but one or two with “no”. His diagnosis after barely 10 minutes: “You’re schizophrenic. But that I already knew when I saw you sitting in the waiting-room.” And then, he added: “Oh, by the way, you’ll have to take pills for the rest of your life. I assume that’s clear to you.” I may have been psychotic at that time, but that made me neither stupid nor insensitive to inappropriate behavior. Fuck you very much, Doc! Or, yet a bit more blunt: during my first hospitalization in a “renowned” private clinic, I got physically restrained by one guy (who was a favorite patient and watchdog to the psychiatrist in command of the place), another man forced my jaw open and the doctor himself poured a medication cocktail into my mouth in order to knock me out. Again, I may have been psychotic, but I could still feel dread and I also remember the scene perfectly. That same doctor also had the unsettling habit of interviewing patients in his office with the blinds closed and sunglasses on. Even for someone perfectly stable, this setup would have been disconcerting.

Psychiatric violence goes far beyond treatment. In fact, critics of the psychiatric discipline accuse not only specific institutions, but the entire legal system of allowing for psychiatric patients to be robbed of their autonomy, their dignity and their human rights. This, the argument goes, is the case even when healthy patients are wrongly diagnosed.

For example, in some countries, legally assigned caretakers look after psychiatric patients. They are usually social workers who are authorized to decide on the patient’s behalf (yet not always in their best interest). They control communication with the prescribing doctor, survey the medication plan, and are authorized to have their protégé hospitalized whenever they deem it necessary – or convenient because they are planning a vacation and therefore need to get rid of the ill person for a week or two. I know this sounds cynical and certainly does not do justice to the many social workers who actually do have sound work ethics. Yet, I have come across sad cases. Families can turn to the legal system to have their problematic relatives hospitalized by court order and forcefully kept there for quite long periods of time. If they succeed in legally establishing the “insanity” of their kin, they gain complete control over his or her possessions and decisions. Families may legally be the closest instance to an individual, but they aren’t necessarily protective and well-intended. In fact, dysfunctions within the family are suspected to be a major cause of mental illness. Yet, by default, the legal system considers them the first ones who are entitled to decide in the ill person’s name. Thereby, family members can become yet another source of psychiatric abuse.  When a legal system is lenient towards psychiatric abuse, all sorts of parties can acquire power over the patient – psychiatrists, clinics, family.

The interface between psychiatry and the legal system acts very much like a fly-catcher: once someone gets stuck there, it will be very hard for them to ever free themselves and recover their autonomy. This is not an idea I have made up. Countless psychiatric patients spend years or their entire lives in and out of clinics, supported living facilities and under the “protection” of restrictive court orders. I need not go into detail about how that affects their chances of ever finishing an education, pursuing a career, or building a relationship and founding a family with a significant other. When I expressed my fear of ending up just like that to a nurse at an abusive clinic, she readily answered: “Well, the moment you set foot in here that became the track you’re bound to travel.”

Last but not least, another form of psychiatric violence is simple neglect. My second hospitalization was at a clinic where the prescribing doctor saw you for ten minutes once a week, if at all, and where the nursing staff refused talking to you if you had already addressed them with some kind of problem earlier in the day. Their therapeutic program was also utterly stimulating (yes, I am being ironical): the once weekly “gardening” activity consisted of grazing the parking lot for trash and discarded cigarettes for an hour or so. Hell is a place on earth.

Another feature of violent psychiatry is its propensity to sucking patients into a downward spiral of aggression and forced treatment. Whatever is done or said to you is supposedly all “for your own good”. How can psychological cruelty and neglect ever be for your own good? If your common sense is still functional enough to make you unappreciative of this kind of “help”, it is interpreted as another symptom of your desolate mental state. In short: if you allow psychiatric violence to be applied to you, you are being compliant and it is understood that you recognize you need it. If you speak up when feeling mistreated, guess what? You are deemed to be too ill to speak for yourself and the intensity of aggressions will likely be increased until you finally give in and shut up. Sounds familiar? I’ve talked about old school psychiatry’s witch hunt logic at the very beginning of this article.

The million dollar question is how to protect yourself or loved ones from psychiatric abuse. The keyword is “information”. Ignorance equals impotence. Gather information about your diagnosis and learn about your rights and treatment options. There is a lot of literature on psychiatry which is comprehensible and helpful for laymen (see the sources & reviews page). Luckily, mental health has gone from being a purely scientific matter to becoming a subject of general interest. If you are already caught in an abusive dynamic, your attempts of self-empowerment may be judged as paranoid, especially when you suspect your doctors or your family to be harmful to you. Even then, do not let anyone discourage you. Some doctors are in fact careless and some families are in fact harmful. As long as you are kept in the dark about your circumstances you will never be certain if you are as paranoid as they say or whether you are simply recognizing things for what they are. Do not let yourself be labeled as pathologically distrustful, ungrateful or obsessive. Seek information. You may eventually come across a piece that helps you find a new perspective, communicate more efficiently with your therapists and take informed decisions. In the end, it is irrelevant whether your inquisitiveness springs from paranoid ideation or healthy hunger for knowledge. It is your fundamental right as a human being to educate yourself about your condition. You are the one who is most deeply affected by it, so it is only fair if you know what is going on.

Psychiatric violence is a vast topic. I will stop here, at the boundaries of my personal experience with it. If you are interested in reading more, you can browse the internet or look for literature in online or local bookstores and libraries. If you Google search “psychiatric violence”, you will find that an overwhelming number of entries are about psychiatric patients developing violent behavior as a consequence of their illness or as a side effect of their medication regime. Searching for links on “psychiatric abuse” or “violent psychiatry” may yield better results. To save you some effort, I put together a small selection of links that offer information and are a good starting point for further research:

Websites:

Webpage on psychiatric abuse in English: http://www.psychiatric-abuse.org.uk/

Website in English on human rights in mental health: http://www.mindfreedom.org/

Webpage on different types of abuse, including psychiatric abuse, in English language:                http://we-are-survivors.webs.com/psychiatricabuse.htm

Website of the Citizens Commission on Human Rights in English. Apart from getting information, you can also report psychiatric abuse here: http://www.cchr.org/

Webpage in German, strongly biased against conventional psychiatry: http://www.zwangspsychiatrie.de/

Articles:

Wikipedia entry on involuntary treatment in English: http://en.wikipedia.org/wiki/Involuntary_treatment

Wikipedia entry on the psychiatric survivors movement in English: http://en.wikipedia.org/wiki/Psychiatric_survivors_movement

Article in the Journal of Medical Ethics: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1376496/

Article in English by The Guardian (British newspaper): http://www.theguardian.com/society/2011/mar/15/mental-health-patients-forced-detention

Article in German by the weekly magazine Spiegel (you can run it through a translation program): http://www.spiegel.de/gesundheit/psychologie/zwang-in-der-psychiatrie-das-letzte-mittel-a-836111.html

Blogs:

A British mother shares her experiences with psychiatric treatment in the UK: http://psychiatricabuseuk.com/

Personal experience of a former psychiatric patient in the USA: http://www.experienceproject.com/groups/Am-A-Psychiatric-Abuse-Survivor/239188

Audiovisuals:

Interview with a survivor of psychiatric abuse by the Citizens Commission on Human Rights:  http://www.youtube.com/watch?v=ve92-PFytAU

The (Scary) First Step – Test Dose Reduction

The time has come! From tomorrow onwards, I will be taking a slightly reduced dose of my SSRI antidepressant. I will go from 150mg of Sertraline in the morning to 137,5mg for a week or two. This corresponds to a reduction of slightly less than 9%. Various sources recommend not to start with dose changes any greater than 10%. Therefore, although my next short term goal is to reduce my dose of Sertraline to 125mg, I will be going there through an intermediate step that will function as a test period at the same time. Both I and those closest to me will be monitoring my response – or the absence thereof – to this initial dose modification.

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My new toy – a “deluxe” (of course, I’m posh) pill cutter.

Now, how do I go about the dose reduction technically? I have 100mg and 50mg Sertraline tablets. They are of an oblong shape and dented in their middle in order to make halving them easier. But if I wish to try 137,5mg for a while, I will need to quarter the 50mg tablets. Even with my pill-cutter, that will hardly be possible. Reading through Dr. Peter Breggin’s book Psychiatric Drug Withdrawal (see sources), I found an easy enough solution to this problem. Breggin describes several drug withdrawals he was helping his patients with, and especially with very small dose modifications it was sometimes necessary to be inventive. This is what I’ve learned:

 

  • If a pill cutter won’t do the job, you can find out if your medications are available in liquid form as well. If they are, you can control your doses drop by drop.
  • Some drugs come in capsules filled with tiny pellets. Same as with drops, this gives you the possibility to make very gradual changes by removing some of the pellets from the capsule.

But careful: your mathematics must be very precise for both the drop-by-drop method and the pellet removal strategy. You need to figure out how much of the active ingredient is in a drop or in a pellet. If you are taking generics, you also need to make sure you are always using the same manufacturer, as concentrations and excipients may vary from brand to brand. And needless to mention, if you have trouble concentrating due to cognitive impairment caused by either your condition or your medication, you need to put an extra effort in getting your doses right. In the latter case, you may keep lists or put up sticky notes to remind you of how to proceed. If you live with someone who is willing to support you, you can also ask them to double check if you are handling your medication correctly and according to plan.

  • Given that I haven’t got hold of either Sertraline drops or capsules, I decided on another dose reduction method mentioned by Dr. Peter Breggin. I will be taking 125mg instead of 150mg every other day, simply by halving the 50mg Sertraline pill with the pill cutter and taking it together with the 100mg pill. Over time, the alternating doses of 125mg and 150mg will result in an overall dose reduction of 12,5mg.

If I tolerate this initial step well, I will proceed to definitely reducing my Sertraline dose to 125 mg. I am quite optimistic it will work because of experiences I have had with involuntary – alright, neglectful – dose reductions. For varying reasons, I have skipped taking my Sertraline altogether a number of times. Normally, I am rather disciplined and take the antidepressant immediately after getting out of bed and brushing my teeth in the morning. However, if a day is particularly eventful or something unexpected gets in between my waking up and my going to the bathroom, I run a slight risk of forgetting my Sertraline. The first few times it happened to me, I was extremely worried the omission was going to cause weird withdrawal symptoms or render me useless temporarily, but none of it was the case. My suspicion is that having used the same amount of Sertraline for about four years now, there might already be a certain concentration in my blood that keeps me stable even if I forget one pill every once in a while. This is just my personal hypothesis. Right now, I can name no sources to back it up scientifically. Also, so far I have never skipped more than one dose. Hence I don’t know how I would react to a permanent, if small, dose reduction. Still, for the above reasons, I am confident it should be no problem.

I will keep you updated on how things are going in my “withdrawal diary” section.