My Treatment and Progress

I have to regularly keep an indicative log in an exercise book about how I’m feeling. I suggest everyone with issues starts to do that.

Ie: Sat 29/9 Feel like I don’t want to get out of bed. Like I could explode. Keep thinking of everything I should do. Stuck in fight or flight apprehension loop. Stuck and frustrated.

And the entries arn’t every day, but I have to make enough to give a clear indication of what I am asking to be fixed. My mistake 9 years ago was I expected my psychiatrist to draw the info out of me. It doesn’t work that way. You learn that you have to document your issues. In the case of your psychiatrist, all the FEELINGS you feel are OTT, and in the case of your psychologist, the ISSUES you feel are OTT.

Personally I’m trying to combine the exercise book I keep for my shrink with my psych because it would be much easier. But one wants to know inappropriate ideas, the other inappropriate feelings. Yes they are related, but you are suipposed to tell THEM what help you need. This is the problem. Compared to normal GP doctoring where you show them a rash around your genetallia, and they run the show, this is way different. YOU run the show. YOU have to explain what the problem is because it’s not physical. You basically drive your own treatment. It is so different from how physical medicine is practiced. It feels awkward, even complaining and manipulative, at first.

In my case, I keep quantifyling the degree and nature of my “frantic” or “cluttered” thoughts and he keeps reassuring me that an increase in my “Prozac” dose can help, and every two weeks we have upped it from half a tablet (10mg) to now, 40mg (two tabs) per day and I have been reporting some really quantifiable differences in how my mental frustration has relaxed. At first it was my severe depressed states reduced on half a tablet, but at two tablets (40mg) it’s now actually reducing my ADHD symptoms. I would certainly be a party to take it a bit further. I have actually taken 50mg a day now. I read 60 or even 80 is often done. In the end, you get control of your drugs. But it’s a partnership. Mutual respect and understanding.

My psychiatrist knows I want to try ADHD-specific drugs like Ritalin and/or Aderall but those are very low dose amphetamines and there seems to be a reluctance to give them to adults unless they NEED them. The irony is children can get them easier. He says the Lovan may be enough. I had doubted it but he is an expert with ADHD and the extra dose of Lovan (I prefer to just say Prozac because people know it), is actually reducing my anxiety and ADHD issues.

So far, Prozac has helped my ADHD symptoms a LOT. I am more relaxed, thinking a bit more stable which has precipitated more confidence. Hey, my thinking isn’t all over the place! I feel stronger mentally, even physically in fact. I would say it has helped me about 50% or more. I really noticed the difference when going up to 2 x 20mg of Lovan. I’m thinking a dosage up to 60mg might be ideal, but it’s a negotiation with your doctor. That’s how it works.

Whether I THEN get to try Ritalin or Adderall, I don’t know, but I expect to remain 50% partner (not more) in this project and I expect to argue for testing some ADHD drugs, but, I’m afraid to say, the antidepressant is going a LONG way to helping address the problem.

As my Dr Barry has explained to be, with the SSRI to normalise my serotonin, I may be able to handle my foot-loose mind again. It doesn’t have to be a matter of slowing the thoughts down as much as strengthening my ability to manage it. At the time he said that, I was just wishing I could get some ADHD medication to slow things down, but as time goes on, he is correct. I am feeling more empowered to manage my brain. I’m starting to feel like I’m running it instead of it running me.

And that’s merely using a good dose of Prozac to re-empower the brain so more normal serotonin exists. Ie: so I have as much serotonin in my brain as my peers. It’s no more of an enhancement than my pair of glasses. That’s a key people need to understand. IT’s not “drug taking” any more than wearing glasses is enhancing people’s vision.

 

 

 

 

 

Psychiatrists and Psychologists (We need BOTH!)

I’m lucky in that I found Silvan Lodge Clinic in North Caulfield which has both the main psychiatrist and offices for psychiatrists so you can get both services under the one roof. But there’s no need to have both under one roof.

Nine years ago I went to a shrink (psychiatrist) and there was barely any discussion. He just asked “how are you feeling” and that’s it. He gave me some pills (Aropax, an SSRI similar to Prozac) as I requested but I didn’t understand my issues or really dtect what the drugs did. It’s a real pity, because I was unknowingly on the right track but I dropped it because I didn’t understand what was happening. It all seemed like a waste of time to me at the time. I only re-visited all these issues when I had a name and was more desperate, and THEN I started to realise what was going on in my head and also what SSRI drugs do. And what to expect and what not to expect. And the difference between a psychiatrist and psychologist on the ground.

The key wisdom is to realise mental issues (such as depression) are BOTH psychological and neurological. Some issues are more one or the other, but you can’t separate the two. Unfortunately, treatment is separated because no matter what a psychiatrist says, they mainly deal with the chemical issues, not the psychological issues and vice-versa.

For example, I have realised I suffered from depression. The clear time was coming home from work, I knew people shouldn’t feel that crap and believed there was something chemical. Turns out it’s low serotonin. I was right. It’s not even a theory, it’s a fact. I needed to boost my serotonin, which is best done these days with an SSRI like Prozac (or one of many generic forms since their copyright expired). I’m taking Lovan. It’s Fluoxetine in the end. It’s the original SSRI.

The problem is people with issues need some drugs from their psychiatrist to “normalise” their neurotransmitters. If you have low serotonin, you’ll feel like crap no matter what a psychologist says. But even when you get to normalise your serotonin with the help of some SSRI (or your unique issue), you almost always need to have a chat to someone, a psychologist, just to process things. The main thing a psychologist usually (not always) does is “Cognitive Behavioural Therapy”.

Personally, I think I’m unique in my understanding of CBT, but I’m still seeing a psychologist to support my progress. There is no question about the neurochemical and psychological joint approach. It’s sad it’s not one person in this age, but it’s two. But don’t fear any of it. Both those people are gentle and understanding and helpful. I want to encourage people to take the plunge. Typically a psychiatrist won’t say you need a psychologist and vice versa. Don’t believe it. Explain to both that you want to also see the other. They will understand. If you want to speak personally, let me know.

If you live in Australia, almost all of this is now covered under Medicare so anyone can access these services. Psychology has been covered under Medicare in Australia since November 2006. Psychaiatry always was. You can use both if you hold a Medicare card. There is sometimes a “gap” though.

 

 

 

The Process

Stage One was trying to establish I had ADHD which involved bringing together all report cards and as much as possible historically which indicates a long-term issue. ADHD isn’t like depression that can just occur spontaneously. You have to have a life-long history as it’s almost always inherited. You’re not only expected to show indications going back to VERY young, but also expected to identify relatives with indicative behaviour, especially alcoholism etc since it is supposed to be a genetic uniqueness. If you can’t identify all these sorts of issues, it is assumed you may be manifesting ADHD symptoms, such as can coincide with depression. ADHD can cause depression and depression can cause ADHD symptoms. A psychiatrist prefers to get as close to the cause as possible but in the end, all adults are likely to have depression either as the primary or secondary cause. Whether it’s primary or secondary, the depression is always treated FIRST and foremost. You start an antidepressant, not Ritalin (or whatever).

Cluttered Thinking

I’ve been seeing a psychiatrist and psychologist and doing some quality reading since June/July and although there are many manifestations, I would mostly describe my problem as “cluttered thinking”. One very significant manifestation is very low working memory. Mine was marked at 37-percentile in an examination. I may have been able to do better if I was more relaxed but there’s no denying it’s indicative. Someone can tell me something one minute and I’ll get distracted and not commit what they said to memory. Growing up I was told it’s because I didn’t care about the issue, and I understand that’s how it looks. I have seen friends who forget things after 10 mins as being non-committed to the friendship, but I now see that’s often (or mostly) not the case. The problem with committing things to memory, the theory goes, is one of being able to focus long enough on what it is you’re trying to memorise. The other big problem is all the problems appear inconsistently. That tends to make people assume “ok, he can focus when he wants to” sort of thing but it’s not true. There are times and issues where it’s simply NOT possible and it’s not our fault. We’ve been beaten up for it (psychologically) all our lives, especially by ourselves.