i was pretty shocked that my doctor even prescribed this within 10 minutes of meeting me. i was under the impression she will refer me to a psychiatrist but when i mentioned that she was like ‘bitch please’.
so yeah i consider her to be a drug dealer pretty much
USA too
Yeah iirc something like 1 in 5 or 1 in 6 American adults are on some kind of prescribed psychiatric medication to help them get through the day, much of which is SSRIs. I know people who have really been helped by them in the long term so I’m not totally against that but it seems very obvious that they are overprescribed.
Most doctors have no clue what they’re handing out to patients. I told a doctor I saw here after discontinuing escitalopram after the longest time I had taken it for (9 months) that I thought I was experiencing withdrawal and he told me that this was impossible because “it’s out of your system in a few days”, there are not the words to express how totally full of shit that is. There is increasing recognition that SSRIs can cause long lasting withdrawal syndromes and may need long-term dose tapering to come off them in some cases (for example here and here).
That’s one of the reasons I said I was skeptical of long-term use. But it sounds like you’re approaching it with the right attitudes. That is, that what you need is some help to lift the mental burden for a little while, that your instinct is to limit dose size and treatment duration to what works for you, and that you’re skeptical of how cavalier the doctor is about dishing out psychiatric drugs. My first time (or first couple times? I actually don’t remember if I’ve been on it 2 or 3 times, it was years ago) I used it for maybe a couple months and don’t remember significant issues afterwards. After I took it for 9 months I had a bad time coming off it.
Standard.
Getting into an actual psychiatrist that your insurance will cover is not that easy in USA#1.
I think you mean anxiolthicks
Curious what the first med was? Fine if you don’t want to say of course.
I’ve been going nuts since on Saturday I was awoken by a strange squealing alarm sound. It sounded like it was coming from my closet. 2 more nights of that but alcohol helped out one night. I started googling and thought I was developing exploding head syndrome whereby the noises were all in my head and not actually real. Then last night, I couldn’t fall asleep at all. I woke up so many times, then went searching at 3 am through my closets and behind them getting a chair to climb on the shelves and taking all electronic devices out of my room. Checked the smoke alarm, the fridge, the toilet etc. I felt like a crazy person. Like I was actually losing it.
Then today I was trying to take a nap in my bed and I heard the whistle. It was from right behind the head of my bed in the baseboard heating. It turns out it was the fucking water heating control valve. When it closes, it’s started making a whistling sound. Just need to get condo mgmt on it now.
But, the main thing is. I’m not insane! It was real all along! Compos mentis, bitch!
After 23 years since I first got depressed, I finally got diagnosed before christmas with bipolar 2.
Just the one visit to the psych so far. (For the diagnosis).
He immediately recommended meds. “Lamotrigine”
I was a little skeptical and said I would think about it.
Over the last 3 weeks I’ve been pretty depressed. Before coming right up this morning. (On the plus side, I’ve come up with a brilliant idea to make a billion dollar company)
Going to sit on it for another month before deciding, and have restarted my mood journaling.
Well, at least not as far as you know.
I used to take lamotrigine as an antiepileptic.
If I wasn’t 11 when I was prescribed it, I would’ve thrown it in the trash. But my family didn’t know better and neither did I. It massively increased my anxiety issues that stayed with me for almost 25 years. Once I weaned off of it, not only did my seizures decrease but my anxiety declined considerably as well.
Not saying that my experience is everyone’s but that it isn’t everyone’s cup of tea.
Yeah. My current thinking is how to evaluate a risk that it makes things worse with potential it makes things much better.
All vs a baseline where I can reliably function at a fairly high level
Preface: This is just an anecdote about me that may not apply to your situation at all. I’m not trying to influence your thinking but rather provide an additional data point from someone who had that diagnosis and that drug at one point. It’s about the cognitive biases and thoughts I struggled with, not a commentary on the efficacy of any particular treatment.
I was misdiagnosed BP2 over a decade ago and prescribed lamotrigine. Unsurprisingly, it didn’t improve anything for me and I eventually discontinued after developing a drug rash. This rash was barely noticeable at first and they (a pair of psychiatrists) advised me to just monitor closely, but at that point I’d become paranoid about SJS, even though I knew that was quite unlikely. This resulted in even more sleep disturbance which was the main thing we were trying to fix, and I became hypervigilant with it lingering in my mind constantly.
In retrospect, I wish I would had have said sooner “hey, I’m not comfortable taking this anymore,” but I was desperate for anything to work at that point, falling into the trap of looking for improvements that didn’t exist in hopes that a higher dose might be the breakthrough (it wasn’t). At higher doses, the rash started to come on slightly more but was still mild when they asked me to taper off and consider lithium. For no good reason other than it being stigmatized, I had negative affect toward lithium, which I think pushed me harder toward wanting lamotrigine to work.
It sounds like you are doing good things and thinking clearly. My situation at the time may have been substantially different from yours: I was under extreme pressure at work to find a solution which influenced my thinking for the worst I believe. I recall wrestling with the thoughts of trusting my gut (“this treatment isn’t working for me and causing me to worry too much”) versus hope (“maybe it will work if I keep going or try a higher dose”), not that there is necessarily a correct answer between those. Instead, it can be a legit tough internal conversation you’re having with yourself–perhaps even subconsciously–that’s simply another source of uncertainty, doubt, dissonance, or whatever in an already difficult situation. So my point is that I wish I had been more mindful of that at the time.
How were you misdiagnosed BP2?
I’m not sure my case is particularly severe. As far as I can tell, theres an arguable case that BP is essentially a spectrum, at least up until some of the crazy manic episodes in BP1.
With a relatively mild case. I figure the risk reward is a little different.
I had something rare which can have psychiatric manifestations as a symptom and can sometimes masquerade as primary psychiatric illness. Plenty of cases in the literature where that happens and most of the patients I’ve met had at least one misdiagnosis. They just sort of assume you don’t have anything like that because they don’t know those diseases and wouldn’t be able to identify them anyway. To be clear, there was a 0% chance a psychiatrist was going to figure out what I actually had and there’s no reason why you’d expect them to either.
Maybe they couldn’t figure out exactly what you had, but I’m pretty sure psychiatrists are trained to consider non-psychiatric medical conditions as things that might cause psychiatric symptoms. So, I don’t it would unreasonable for one to say “Hey, we need to make sure this isn’t due to some medical condition, you should see an internist (or whatever) and get checked out”.
I think that would be a reasonable expectation of the psychiatrist. Of course, if you’ve got something really rare, then the other guy will probably miss it too, so it doesn’t really help you any.
Yes, of course they consider other conditions. I was screened for a few things that are relatively common. In terms of rarity, it’s not necessarily the rarity itself that makes it challenging. For example, I can’t think of anything rarer than blue skin, but it’s pathognomonic and you’ll have a good idea about the cause when you see it. Conversely, there are things that masquerade as common disorders, are poorly understood, and/or present atypically, so if it behaves like that and is rare then usually you’re gonna be buying a plane ticket to get diagnosed.
That’s all fine, but my point is if you are relying on the psychiatrist to diagnose you precisely, then your expectations are off. All the psychiatrist ought to be expected to do is say, “Hey maybe this isn’t purely psychiatric” and then refer you to someone who can look into that. I guess if the psychiatrist tries to do that workup themselves, that might be a little odd, but it’s not something that I imagine the typical psychiatrist would do.
I specifically said a psychiatrist wouldn’t be able to make an accurate diagnosis and put a number on those chances: 0%.
This isn’t the expected outcome though, it’s the best case scenario. If you present with psychiatric features secondary to a disease they’re not familiar with, the most likely outcome by far is being initially diagnosed with and treated for the closest fit to those psychiatric features. I think the thing you’d hope for in that situation is that your doctor doesn’t get married to the initial diagnosis and will reevaluate if the treatments don’t seem to be working instead of doubling or tripling down.
Well there are a couple of reasons that might be true
With a lead in of "They just sort of assume you don’t have anything like that because they don’t know those diseases ", I assumed that you were implying #1. If you were really trying to say #2, I think you picked a weird way to say it.
I think you’re placing too much emphasis on a “disease they’re not familiar with”. The disease itself doesn’t matter that much. All they need to be able to do is consider purely psychiatric cause vs. not purely psychiatric cause. I would think that is something most psychiatrists do as a matter of course and I do think it is a reasonable expectation.
What is not reasonable is to expect them to get that right 100% of the time (and I’m not saying they do that) or wrong 100% of the time (which what I think that you are saying, since being right 100% of the time would be the “best case scenario”).
For instance, as a completely hypothetical example, if the psychiatrist’s thought process is “Well this could be due to some medical condition, but he was referred to me by his internist who has evaluated him and didn’t think there was any underlying medical condition that would explain it and there is nothing in my own evaluation to suggest otherwise, so that makes a psychiatric cause most likely and I will treat it as such”, then I don’t think the psychiatrist did anything poorly, even if an underlying condition is later found to be the cause.
Psychiatrists are terrible at finding primary medical conditions, and it can be extremely difficult to find certain conditions on top of that.