My Experience So Far With Atypical Anti-psychotics

[Klo]

So some months ago I sought out treatment for PTSD and depression. This involved seeing a therapist and psychiatrist who work together at the same facility.

It hasn't gone very well at all. The therapist seems completely uncomfortable with me and frequently cancels our appointments at the last minute. I think maybe she might have her own unresolved issues that my own past/problems are somehow triggering.

The psychiatrist immediately wanted to label everything as mental illness. The very first appointment she decided that I must have schizoaffective disorder (schizophrenia and bipolar combined), even though she could never explain her reasoning. Even when I asked her how I can have schizophrenia if I always have insight into my symptoms (paranoia, hypervigilance, insomnia, etc) and she tried to persuade me that some people with schizophrenia have insight all the time.

So anyway it's been a rough ride but I was willing to give it all a chance, especially since after all I'm pretty desperate for some relief. The psychiatrist wanted/wants to do monotherapy with an anti-psychotic, nothing else.

It's been interesting.

First she put me on Latuda which had a mild anti-depressant effect but did nothing else, and then it gave me akathisia so I had to go off of it, anyway.

Then she gave me a medication called Risperdal. Now this one was interesting. First of all, no matter how sedating it was (and it was, it made me feel drunk), my mind could not go to sleep at night. I would still have intense nightmares, too. The nightmares actually started to become worse. Also what seemed to be happening was that as the Risperdal started to numb my anxiety and agitation, it opened the underlying floodgates of sorrow and pain. I started crying really deeply every single day/night, and my mind was flooded with old subconscious childhood fears, like my mother dying, which brought about all of this very intense, primitive emotion (one thing I experienced as a child/teen was my father threatening to murder my mother and he was completely serious, he even bought guns to do it and was eventually given restraining orders, like those things are somehow magical barriers that will save you).

All of this quickly became so bad that I started to feel extremely suicidal and quit the Risperdal on my own. It has been over a week now off of it, and I am back to just anxious, irritable and not sleeping well, with nightmares. But no more horrible, deep fits of crying and suicidal feelings.

So I think what Risperdal has inadvertently taught me is that feelings of anxiety, paranoia, hypervigilance, agitation, etc are all masking much deeper pain and sadness, apparently sadness that can be so bad it makes me feel extremely suicidal. As though in a way these other symptoms are sort of "protecting" me from my own self. It gave me a small peek into what lies down in the depths. Not very pretty stuff, either.

This upcoming Thursday I have another appointment with this psychiatrist. Since she really has her heels dug in about me being on an anti-psychotic, I think I'm going to request trying Seroquel to see if can improve my sleep, and hopefully improve other things in the process.

 

[Friday]

I would very strongly recommend that you look for both a new psychiatrist and new therapist. This current team sounds like a very bad fit, at best, and a disaster waiting to happen at worst.

The psychiatrist immediately wanted to label everything as mental illness. The very first appointment she decided that I must have schizoaffective disorder (schizophrenia and bipolar combined), even though she could never explain her reasoning. Even when I asked her how I can have schizophrenia if I always have insight into my symptoms (paranoia, hypervigilance, insomnia, etc) and she tried to persuade me that some people with schizophrenia have insight all the time.

While what she said is true about self awareness not being a disqualifying factor, (schizoaffective disorder & schizophrenia are only like "in the movies" when someone is in active psychosis -and nearly all disorders can progress to psychosis / all roads lead to Rome)... There is absolutely no way to properly diagnose someone in the very first appointment. Even if it was a 10 hour long screening appointment with a few 500 Q Psych Eval tests to get a head start on differentials, there has to be a full medical work up to rule out physiological causes, and there has to be several other steps (one of which is that ADHD & Bipolar disorder have to be determined, since they share so many symptoms, and unless it's already known which), which more than often means an in-house med trial of a short acting stimulant... All of which take several days in order to have an accurate view... Or it's just a guess. Not even an educated guess when dealing with comorbidity, but a dangerous & uneducated guess. There are far too many complexities when dealing with comorbid diagnostics to just slap a label on after a day can call it done. I not only would NOT go back to this psychiatrist, I would very strongly consider reporting them for dangerous and unethical practice. If it was an hour appointment? No question about it. I would report them to their governing body immediately.

((To be exceptionally clear :) Not saying you "should" report them, when I say that I would... I have long history with medico-psych (grandfather was on one of the governing boards, grew up in a medical family, have worked in healthcare myself as an adult, etc,), so it's a very easy thing for me to do. Don't stress yourself to do it. Let you NEXT team do it for you. Any good practitioner will be appalled at same day diagnosis without differentials, physical work up, appropriate testing, etc. And slapped on a series of meds. It's bad medicine. Period. A suspected Dx to explore & a Quickie-Dx are radically different things. I'm *furious* this was your experience.))

So I think what Risperdal has inadvertently taught me is that feelings of anxiety, paranoia, hypervigilance, agitation, etc are all masking much deeper pain and sadness, apparently sadness that can be so bad it makes me feel extremely suicidal. As though in a way these other symptoms are sort of "protecting" me from my own self. It gave me a small peek into what lies down in the depths. Not very pretty stuff, either.

Very, very well done! :D

That attitude right there? Priceless. It will serve you exceptionally well.

 

[Klo]

I would very strongly recommend that you look for both a new psychiatrist and new therapist....

I believe I may have had a psychotic experience last year, although I am unsure of the cause (though I know what the trigger was, or at least I think). I am open to the possibility that I may have a mental illness. I am just frustrated with the lack of concern about the trauma, from the psychiatrist and the therapist, who acts like she thinks I am completely crazy and also stupid. I ideally wanted to have both mental illness and trauma given attention and treated. I think it's very important that they be treated together, because they seem to feed into each other a lot. So trying to deal with one but not the other, just allows the "other" to take over and sabotage things. Unfortunately my current team wants to chalk everything up to mental illness only, and it's like a pill is supposed to completely fix me. Just frustrating.

What happened was that I was working at a gas station. In the interview I was told I would be a food prep worker and not have to interact with customers, which was good. I was trained to be a food prep worker (working in the back, just making fresh food items), and then at the last minute they made me be a cashier. I gave it an honest try but it totally destabilized me. Customers were often angry, hostile, confusing, creepy, etc. This kept triggering my fight/flight response (mostly flight and actually freeze a lot), which kept increasing my stress levels even more. I started having panic attacks, not sleeping and throwing up before work.

Then one day there was a customer who reminded me exactly of my father, the same subtle malicious smirk, the psychopath eyes (which is hard to describe beyond it's a very hollow yet intense predatory stare) and the way he spoke, a sort of sly, provoking tone. A panic attack went off, and combined with very little sleep for weeks at that point, I just started to completely trip balls. I was terrified of everyone, couldn't go to the register, I hid in the back of the store, and when approached by a coworker, I looked up and he had no eyes, just black energy holes where his eyes should have been. I left the store in a state of shock and then never went back. By days later I had recovered and that was the only psychosis I experienced.

My psychiatrist really hones in on that experience that I shared, and it makes her think I am schizophrenic. So in a way I can kind of see where she is coming from, even though I didn't see that diagnosis coming since the whole time I knew that what I had seen wasn't real and that I was struggling mentally. However it upsets me that she doesn't take note of how all the factors, like how I was triggered and how sleep-deprivation was playing a major role in things.

 

[Friday]

My psychiatrist really hones in on that experience that I shared, and it makes her think I am schizophrenic. So in a way I can kind of see where she is coming from, even though I didn't see that diagnosis coming since the whole time I knew that what I had seen wasn't real and that I was struggling mentally. However it upsets me that she doesn't take note of how all the factors, like how I was triggered and how sleep-deprivation was playing a major role in things.

Yep.

PTSD? Can lead to psychosis.
Sleep Deprivation? Can lead to psychosis.
Bipolar Disorder? Can lead to psychosis.
Most of the DSMV? Can lead to psychosis.
A good number of physical conditions (from sleep dep above, to malnutrition, to hormonal imbalance, hypoxia, dehydration, etc.) can also... lead to psychosis!

One episode of hallucinations? Does not equal Schizophrenia or Schizoaffective Disorder. No more than a fever equals Malaria. It just doesn't. It's asinine, incompetent, and unethical. Again, very strongly recommend you kick this idiot to the curb and find a trauma specialist. I think you've done really well making the best of a bad situation, but there's no benefit to be gained from trying to continue on in a bad situation, when there are so many other -good!- options out there.

 

[Klo]

Yep.

PTSD? Can lead to psychosis.
Sleep Deprivation? Can lead to psychosis.
Bipolar Disorder? Can...

Yes I think I might see someone else if this upcoming appointment on Thursday doesn't go very well. My last appointment, I explained to her that I had been crying at night, getting intrusive thoughts and not sleeping very well. Her response was that I seemed fine and she didn't want to change anything. So I wound up stopping the Risperdal on my own as it continued to get worse. When I see her Thursday is when I must tell her that it got worse and that I stopped the medication. If she acts like I did something wrong or tries to downplay my experiences, I think that will be my signal to move on.

 

[joeylittle]

Get a new team. @FridayJones covered it really well - you are really clear about what you want to be working on, and at the very least you deserve a second opinion.

Schizoaffective disorder is not incredibly-well understood, and as a diagnosis it takes some real finesse. It's not quite as simple as a halfway between schizophrenia and bipolar; it's used to accommodate a small percentage of people who, in essence, have an atypical form of schizophrenia.

You might get another diagnosis along the same lines from a different psych; totally impossible for any of us to say. But if you did, at least you'd be much more likely to consider the possibility. I'm curious - how many forms asking questions about symptoms did you fill out (do you remember)?

Regardless - what would you say you need the most help with right now, symptom-management wise? What is the stuff that is making it very or extremely difficult for you to function on your own?

 

[Klo]

I'm curious - how many forms asking questions about symptoms did you fill out (do you remember)?

There was just one form, and it was basically about like personal history, substance history, what meds have you tried before, etc. I think there might have been some bias against me because I admitted to self-medicating with marijuana in my early 20s, and my psychiatrist made a comment implying that if I have schizophrenia then it's my fault for smoking weed. So I think the form may have played a part.

Regardless - what would you say you need the most help with right now, symptom-management wise? What is the stuff that is making it very or extremely difficult for you to function on your own?

It's mostly anxiety that makes everything so hard. and feeling so mentally/emotionally "aroused" all the time. It's hard to sleep. When I sleep I have nightmares, and then I feel messed up for hours after waking up. I get anxious interacting with people. I get anxious being alone. I get especially anxious at night. I constantly get anxious intrusive thoughts. I feel stung out and don't sleep. I become very isolated and avoidant, and become irritable. Less stable over time as it goes onward. Eventually I get so bad that I am a total wreck, and then I dissociate and there is a period of calm/numb. Then the cycle starts all over.

Ideally I would like to break this cycle and just be "normal" and "okay".

 

[joeylittle]

There was just one form, and it was basically about like personal history, substance history, what meds have you tried before, etc.

Wow. Personally - I would not even be wasting my time going back. This combined with the lack of concern for the extreme emotional reaction you had to the risperdal, just sounds like a doc who is kind of checked out.

My 'I am not a doctor' opinion, given what you said, above, is that seroquel could help, but I don't know that you want to go into medication that hard, right away. The biggest thing to get right with, first, is sleep.

They are psychiatrists - so, they are always heading towards a diagnosis. But there's a difference in having one that is really interested in getting it right, and with a philosophy of minimal medication, vs. one who is happy to batch together symptoms and pick a class and get you going on a drug without much deeper investigation.

This one is medicating you for mania. That the risperdal increased depression and suicidality should have been an indicator to her that you were on the wrong thing, and she was barking up the wrong tree, most likely. Unless she is willing to re-consider her diagnostic view on you, I don't think you will have much luck. With the schizoaffective 'diagnosis', there are a lot of things she won't consider having you try because they are contraindicated for bipolar, and if you are not sleeping and 'wired', to her mind, you are in hypomania at the moment.

Of course - you have to take this all as internet opinion. I've taken lots of these drugs and have a really excellent psychiatrist; I'm treatment-resistant in depression, so we've had to get creative about it. I also had a super-shitty psychiatrist, and get bothered when they seem to be really wrong, which yours strikes me as being.

 

[Klo]

This one is medicating you for mania. That the risperdal increased depression and suicidality should have been an indicator to her that you were on the wrong thing, and she was barking up the wrong tree, most likely. Unless she is willing to re-consider her diagnostic view on you, I don't think you will have much luck. With the schizoaffective 'diagnosis', there are a lot of things she won't consider having you try because they are contraindicated for bipolar, and if you are not sleeping and 'wired', to her mind, you are in hypomania at the moment.

Yes I think you are right. When I asked her about letting me try an anti-depressant, she said no. She didn't explain why, but it made me assume that she thinks I am manic, because I am not sure why else she would say no to anti-depressants even though at the time I first saw her, I was so depressed I hadn't showered in 2 months.

 

[joeylittle]

Is going through a more formal, extended diagnostic process a financial option for you? If I recall, McLean in MA does something like it. Since you are dealing with some different possibilities, given your experiences, it might be worth it to try and get off on the right foot with a more considered diagnosis and beginning medication plan.

 

[EveHarrington]

Run like the wind my friend.

Given such a serious disorder on the first visit?

Being pushed to take antipsychotics?

I don't think this is a quality mental health practitioner.

IME the best docs are independent. It's not a hard and fast rule, but docs that are associated with clinics and such have a lot more leeway with being just plain bad. They're hired to do a job and if they suck, so what? There will always be more clients coming through the door. Private docs must be good or they're going out of business a lot faster.

I've noticed that there are others who have had problems seeing practitioners that are part of a large group. Maybe it varies from location to location, but none of the good trauma therapists around me are associated with a group like that. Most are independent or are associated with only a few other therapists. None are in a group practice where you must see the resident psychiatrist.

 

[Sideways]

My sister got handed the Schizoaffective label by a p-doc at one point, and it was sheer laziness on the part of the doctor. She had a (yup, one in over 15 years of diagnosed mental illness) mild psychotic episode, and because she's had major issues getting properly diagnosed, the doc pulled out the SA label.

The doc's reasoning was "there's evidence of psychosis, and obvious mood disturbance". The "obvious mood disturbance" would be (like you) a very profound and treatment resistant depression, which took a back seat once the doc decided to latch on to the "psychosis" part, which appears to have been a red herring.

Lazy. Unhelpful. Damaging. The only benefit to come of it was her subsequent p-doc was able to legitimately hold on to the (patently bogus) SA diagnosis so that she could access cheaper medication (and she's on the pension, so that was a really big deal).