Psychiatric Meds Providers: I need to talk about how you prescribe meds.
In the United States, HealthCare is abysmal. Mental health care specifically, flounders. So many people just don’t get the help they need. But this isn’t about that. My issue is more scaled down to when it’s time to get into medications for certain conditions and their symptoms. My issue is how it’s done, and how people are treated in office.
For some background, I was diagnosed/identified as being on the Autism Spectrum a few years back. Specifically, Aspergers. I’m not getting into debates on semantics about correct terms. What and how I identify is my concern and choice. Period. During that time, I was dealing with A. Lot. of interpersonal crisis with my husband, most notably with his mental health as well. Our relationship became tumultuous; our household a proverbial psychological war zone that has traumatized myself and our children, some of which also have their own mental health issues to begin with.
So, in efforts to deal with my own mental health so that I could cope with the breakdown around me, I’ve been in constant therapy, supplemented with lots of reading and other content consumption. Much of that had to do with learning about my new diagnosis of course, but also Cluster B disorders, namely Borderline Personality Disorder, as my therapist suggested my husband may actually have it based on how I’ve described our relationship, and my husband’s behavior overall. Once I dove into the research, pieces started coming together about my husband and who he is. And why our relationship was the way it was. Don’t worry, the ‘arm chair diagnosis’ as some like to call it, did later turn into an actual diagnosis after much pushing on my part, among other comorbidities such as Bipolar II, Dissociative Identity, and a slew of other disorders noted as ‘high traits of’. That research led me to look into appropriate therapies for him, as well as medications for his symptoms. My husband and his crisis became my special interest, something we on the Spectrum tend to have when we hyper-focus on a particular topic with intensity. One that has also helped me in my own therapy and progress. So it was twofold.
In my quests for educating myself and ending stigmas around mental health, especially around severe disorders, and making sure my floundering family got the help it needs, I took some time to research medications. In order to cut out the guessing games, I had myself, my husband and one of my children that needed psychiatric meds utilize providers that offered genetic testing for meds compatibility, called GeneSight. When it came time for me to try a new antidepressant, as I’d been on and off of them for a decade, my results were the same: an emotional flat lining that made me just not care about anything or anyone. Lack of affect. Which caused further issues with my already emotionally explosive husband. My lack of feeling and expression made him anxious, and fueled his Borderline symptoms. Which in turn fueled symptoms from his other disorders. And of course, I didn’t feel any better. One particular medication my provider wanted me to try though, didn’t even get past Day 2 with me due to its side effects on the heart. I have a heart condition already that I have to take a beta blocker for.
This is where my issues with providers began: when I told her I was dealing with the increased palpations, which is what my heart medication is supposed to reduce, she downplayed it as anxiety. I had to chew her out for being dismissive of a very real medical problem, that she was well aware of. I stopped seeing her, and stopped all attempts with medications shortly after that. Later I ventured into alternative treatment for depression, namely TMS therapy, when my therapist could see I was edging to crisis and suggested I try a mood stabilizer. Upon looking at my GeneSight results, there were only 2 stabilizers that were compatible, and both had side effects on the heart, and my eyes which I also already have the listed conditions for. Needless to say, stabilizers were a hard no. But my therapist respected this and supported TMS, even though he didn’t know much about it. He trusted my ability to deep dive into research. Needless to say, TMS has been a blessing. And a curse. But that’s for later, I suppose. Anyways, it’s that dismissiveness from my meds provider that is at the forefront of many issues for people trying to seek help and get on and STAY ON the right meds.
With my one child that needs medication, it was a little of the same recently. I could see she was close to another crisis and needed an antipsychotic. When I brought this up, her provider was hesitant to get it for her, but not for the same reasons I was seeing with her. He looked at her depression, I was looking at her chronic, OCD-like ruminations that led to some bouts of paranoia, impulsive behaviors that led to unsafe behaviors, and inappropriately explosive responses to otherwise benign situations. At 16 years old, she was able to talk her providers out of pushing her to take the new medication, so instead family therapy was recommended even though she wasn’t in our family home at the time, but rather with her grandparents. A month later, she almost committed suicide due to her failed romantic relationship. She is now on the antipsychotic and is notably doing better already. And she’s back home with me where she can be kept watch of, because her grandparents also failed her in keeping her modes of self harm out of reach when I instructed them to do so.
With my husband, again, more of the same. A previous provider ignoring the aggression and agitation side effects from putting him on ADHD stimulants. While he was able to work and focus better, he was lashing out at the family, specifically me of course. The provider basically told him I could suck it up when he brought up my complaint to her. He doesn’t see her anymore obviously. But his current provider has done no better. His complaint that he’s waking up an hour before his alarm, led her to want him to wean off his clonidine and prescribe him the antidepressant, Trazadone, just because it makes people drowsy. Ignoring the fact that he’s already on an antipsychotic, antidepressant, and a mood stabilizer she just recently increased the dose on to help with seasonal depression, and the fact that he’s Bipolar and comorbidly diagnosed with other things.
You see, too much serotonin, caused by too much or a combination of any drugs known to increase serotonin in your system like the above mentioned, can lead to serotonin syndrome, a potentially fatal condition if left unchecked. For a person with Bipolar disorder, if you give them an antidepressant, it could trigger mania. My own therapist said it aptly: give someone an antidepressant for depression, and if they do a complete 180 and go off the cuff with mania, you have a patient with Bipolar Disorder. Even though my husband is Bipolar II, he’s also rapid cycling. So his hypo-mania can still be unsettling, especially coupled with his other conditions. I told him if he takes that new medication, he can’t stay here.
As for the clonidine she wants to wean him off of? It’s a non narcotic sleep aid, blood pressure medication, and in its extended release form, Kapvay, a non stimulant ADHD medication that is also know to help with agitation and aggression, as well as help you stay asleep if taken at night. My kids are all on the same med in both forms, for combinations of the aforementioned reasons. He did call her back and address the issue of triggering mania, and she said the low dose she prescribed to him shouldn’t do that. But, she did go ahead and get him a script for Ambien instead. On my husband’s GeneSight, Trazadone is a no go for him. So that low does could very well trigger mania. Unfortunately, she isn’t the provider who initial did that testing on him. It’s a bit of a story as to why he doesn’t seen that one anymore.
Here is where I get to the point of all of this: meds providers need to do better in knowing the medications they prescribe to their psych patients, as well as treating the patient as a whole, not just the individual presenting symptoms. And most importantly, LISTENING to their patients/caregivers.
I’m not saying they need to know every single side effect of every drug they suggest. But a bit more effort would help. And if they don’t know, but their patient found out, to actually listen and learn from that patient. We know our bodies and brains better than providers ever will. The provider’s job is to match the medications to our needs as a whole person, not just our individual symptoms.
Knowing the alternative uses for these meds is great, but if they aren’t applied appropriately, the results can be disasterous to not only the person, but their families. Just as much as an untreated mental illness can. A more holistic approach should be taken when writing scripts for these meds in order to achieve the best outcomes. Tacking on another antidepressant to address sleep issues shouldn’t be the go to for a person already on serotonin creating medications, ESPECIALLY a Bipolar person. Antipsychotics aren’t just for psychosis and hallucinations, but can also treat OCD symptoms, aggression and can improve overall cognitive function. Autistic children are given meds like risperadol to treat stereotyped behaviors and aggression. And yes, I’m aware the active ingredient in Kapvay is the same as clonidine. It’s the different delivery mechanisms and how that reacts with the brain and body that draws me to utilizing both with my kids. And it works, which is why I’ve suggested it to my husband as an alternative to Trazadone. But, as a parent and wife, it really sucks that I can walk into an office with this level of knowledge, and be looked at so dismissively. I am constantly trying to learn something new, and I tend to fill in the blanks on things these providers never thought of. Whereas many of these providers will quite literally have a personal arsenal of their ‘go to' drugs that they prescribe all their patients, and refuse to learn something new.
Psychiatric meds providers, you’re here to help us. And sometimes that also means considering our families too. Because our mental health issues dont exist in a vacuum. Please do better.