A unifying idea for psychiatric self help

This Blog is an invitation to discuss the predicament facing a person who feels, insurmountable and inescapable problems, total inability to act except to curl up cry and shake, fetal position with voluntary inertia. Day and night hallucinations with or without medication are common. Some relief can be obtained, assuming communication is possible through those few who have mastered their problems and can sometimes empathize and advise from their experience.

Help is often designed to fragment the problem, chipping away at issues that the health services has no staff or equipment to attempt alleviation. For many of us lifelong medication is needed and I have no problem with that if carefully and frequently reviewed by a good psychiatrist. GPs are often forced in the UK to the desperate step of prescribing drugs to render the patient unconscious until more appropriate care can be found; due to paucity of qualified mental care facility available this may be up to 6 months. GPs are neither trained to diagnose psychiatric illness, to understand the side effects of long term usage or to recognise signs of a patient reacting negatively. Death, despair and suicide follow.

There is comprehensive coverage of the psychoactive drugs on wikipedia at antidepressant list and these are all linked into wikipedia pages on depression and insomnia very well . There are, of course many other learned books and journals that both GP and patient should FULLY absorb building up a matrix of what works well for a specific patient and set of drugs, at what dose and at what time of day.

In my own case little consistent improvement was visible which led my GP at the time to prescribe a potentially lethal cocktail by adding oxycontin in high doses to the list alongside all the other depressants and SSRIs she was dishing out liberally.

Fortunately a drug induced coma led to many of the drugs doses being simply evacuated by over worked E&A staff pushing as much water and sterile solid though me.

As an absolute accident I missed two whole sets of medication in a row and found that I remained depressed, as expected, but was able to walk unaided, talk coherently and, vitally, from that point on formally refused any further medication from the amateurs employed as GPs at our surgery

9 months on I am, of course, unemployable having been ill for over a year but I read prodigiously and get plenty of exercise.

It really does pay to do your own research, checking with online qualified psychiatrists from time to time. If I had paid to get the treatment that I have needed we would now be a house-less, penniless grown up family of four all reliant on my pension.

At least we saved our marriage (just) and a very degraded relationship with the children who are now 23 and 26 but still at home thanks to the recession.

The other observation I would make at the "talking therapies" supported by Rethink and the governmant may cut costs and waiting lists by using cheap unqualified staff and they will work for those who do not have a clinical depression due to imbalanced brain chemistry or neural activity. For those of us with clinical depression talking does no good and, for me, is harmful.

Please do share your thoughts with me and I will help if I can (via private message if requested)

A word of warning - it is easy for the psychiatrically ill to seriously damage all those around them. This is especially the case where the patient is disruptive, violent or delirious.

The growing youtube collection of videos relating to depression may help those readers who do not understand why someone who is clinically depressed cannot "snap out of it". Brain dysfunction can defeat the strongest will.

Benzodiazepines and ADHD drugs for depression

I am writing to dispel some of the myths about the benzodiazepine and amphetamine families. They became a popular alternative to barbiturates and conventional amphetamines in the mid 1950s and have more recently been much criticised as addictive drugs likely to increase psychosis in the long run. This has not been my experience. I recently had a very prolonged bout of psychosis and depression due to a real life situation I found neither tolerable or soluble. I was initially treated with strong anti psychotic drugs and sedatives of the old fashioned kind (e.g. trazadone) pre-dating benzodiazepines. After many months I got temazepam back as a treatment for my acute daytime panic attacks but sleep remained disturbed and often led to sleep walks, falls and inappropriate behaviour. Because the UK health service has few psychiatrists the appointments were months apart so trials lasting months were carried out of many anti-psychotics such as amitriptyline, fluoxetine, mirtazepine, sertraline, trazadone and venlafaxine. During these months little was prescribed to ensure a solid period of night time sleep which led to my family having to deal with an individual in a state of anxiety and subject to bizarre behaviour. During my treatment every class of anti-psychotic was tried until a cocktail so strong was prescribed that I had a serious fall breaking my left acetabulum, pubic bone and lower sacrum. This led to not fracture clinic treatment but the prescription of oxycodone as a pain killer along with continued high dose sertraline as an anti-depressant combined with indomethacin. The combination rendered me delirious and so constipated that I had to go back to A&E once every few days to have catheter and enema treatment. It is a very effective formula for chemical castration. One night I missed my tablets and decided to stop the lot when offered the morning doses. Within three days I was walking again and alert during the day. True walking was difficult after the fractures but simple tramadol plus cocodamol helped a lot. I was aware of the need for long term pain killers and hence the need for something benign which I chose myself. As I recovered I found that a single fanatical doctor had brainwashed my entire family to see all benzodiazepines as the spawn of Satan. This led me to do a lot of research during which I found that there were many diazepines suited to different tasks and many patients who should not take them. It is fairly easy to identify someone who should not be given benzodiazepines; prescribe a week of short term acting bezodiazepines like temazepam and then tell the patient to take a break for a week. If they cannot go cold turkey then they are likely to ramp up doses and become addicted if treatment is resumed. Wikipedia has an almost exhaustive list of bezodiazepines listing the half life of each so the doctor needs to match drug to problem. I had insomnia so something with a long half life like diazepam is good as it helps at night and reduces my panic attacks in the day. For severe and acute panic temazepam is better and oral administration may be too slow. In my own case my depression took the form of not wanting to do anything at all and none of the medications helped with that. Once I did finally see psychiatrists both physically and online our conclusion was that the daytime symptoms should be treated like ADHD with drugs like adderrall and ritalin as daytime treatments. Unfortunately, although I still think this is correct, there is only one UK institute that is able to prescribe these drugs (Maudsley) and my place on the waiting list is likely to have a longer life than me. What I am trying to say is that few drugs are all bad. Even older drugs like phenobarbitone and chloral hydrate (prescribed as welldorm or chloral betaine now) have their uses. I understand the reluctance to dole out benzodiazepines like sweets but please do not throw out the baby with the bathwater. In my case careful and minimal use has been a vital part of my recovery. I am much more worried about the ability of a GP to dish out such high doses of oxycontin that I could not even get up for weeks. It would be good to hear from psychiatrists and patients about their experience

depression

I hope this blog will enable those who are depressed to recognise someone who shares their feelings and those who study psychiatry as a test case.

My depression is about inability to change or tolerate a mind set. It sometimes leads to tears or rage. Every victim either dies or finds a release mechanism; in my case medicines were required to break the loop and remains the only way to break the shell

It sometimes involves weeks of horrible night and daymares formed from all the terrible things I've seen humans do to other humans.

In retrospect I can see that the seeds of the problems were visible from childhood manifesting as nightmares and inability to relate normally and hence almost always ending out the odd one out.

Perpetual isolation results from the perception that I understand no-one and vice versa which means that there is a persistent tendency to shut the world out lest misread emotions lead to enmity rather than friendship. It would be good to talk but bad to do anything that might upset my own emotional balance or that of others.

Nothing is worth doing because nothing is interesting because nothing helps.

If that meant the mind was at rest that would be something but instead it is perpetually engaged in the analysis of its own dysfunction stuck in loop of the insoluble dilemmas

From 14 until 18 I self medicated on amphetamine and nembutal with a group of friends who I will aways remember fondly as kindred spirits. This worked surprisingly well on all fronts. I was able to make new friends, concentrate on my studies and felt quite happy. But I guess I always knew it had to end.

When I went to University I decided that prescription drugs should replace self-medication. This consisted of nitrazepam to help me sleep and later amytrityline for depression then I left and moved to London.

I found London both at work and home very stressful. The only change to medication on moving to London was that nitrazepam became temazepam and Welldorm plus 30 mg amitryptyline

This remained much the same except I started using temazepam as a social lubricant and to control panic so took a lot more ot it when, at age 44, I had to spend a week with two psychotherapists on a routine week long residential management course. This led to a severe reaction both physically and mentally. I had to be helped home by a colleague. It took weeks to recover. Two course members were affected in this way but the other seemed to recover more quickly.

After 6 months new drugs were put in place (40 mg amitriptyline, 150mg, 2800mg Welldorm and 150mg sertraline

I could cope again until 53 at which point feelings of isolation, exhaustion, emotional overload, anxiety and futility reached breaking point over a year. Lots of pain but no gain to anyone. Just total isolation and then psychosis.

In December 2009 came psychosis which was terrifying in that the chamber of horrors continues but mind and body become dissociated so if you try to move you have to first find a connection with a body. Furthermore the hallucinations continue day and night.

This acute phase lasted two weeks controlled by a mixture of quetiapine, chlorpromazine, venlaxine, welldorm, trazadone, mirtazepine

I was weaned off the basket of acute control drugs and onto just venlafaxine and trazadone with my usual welldorm for sleeping. This did not help with the personality problems, anxiety, rage / frustration.

Each of the members of the initial cocktail was then tried with three month gaps in turn each with negative results.

I was left with chronic depression and despair finding it hard to get up let alone do anything. No medication was found in any of the classes of antidepressants UK psychiatrists use despite trying the whole range from major sedatives through the many tranquilizers, antipsychotics and antidepressants over 9 months.

I discovered that the z drugs zopiclone etc made me very much worse so they are on my allergy list.

Last week Lyrica was abandoned and an increased dose of diazepam prescribed and sertraline at 200mg which is what I had before the psychotic episode in December. I've found so far that I do feel calmer and can compensate for lack of energy with liberal doses of yohimbine and caffeine. Nightmareless recipe ended up as 100mg doxylamine, 2800mg Welldorm, 10mg diazepam, 300mg trazadone. I do realise that I won't know if the new cocktail is working for many months but I do have hopes for it.

I've taken an interest in my own condition and a pressure group for promotion of mixed disability assisted living which is something outward looking and the end of the my own hallucinations is a huge plus

I have now seen the psychiatrist 6 times (twice privately). Diagnosis is never very clear but we seem to have ended up with a conclusion that there is an element of autism spectrum disorder and one month supply of adderrall helped so that seems to be the case but since each prescription costs me £300 there will be no more. Instead I am on a long waiting list to the Maudsley Centre but their priority is children. So awkwardness and anxiety in public will remain since I'm advised that the wait will probably exceed my life expectancy.

One morning I just refused all daytime medication and suffered for this oer the next week but then I found I could cope if I was careful during the day. At night sedation is my only solution.

The hallucinations are gone, I can drive again, I can use my PC for hours rather than minutes so all is not lost and there is always the hope of the drug that will fix my serotonin balance, regulate my sleep, control my panic (when allowed enough diazepam) and even enable me to interact with people in a normal ways sometimes though this can rapidly turn into panic.

If you are reading this and seeking help I fear that you will find that the UK NHS will be unable to provide proper care and treatment. If you do raise the money for private care I would warn caution since many private practitioners have hobby horses and also an interest in a continuous income stream.