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Old 09-05-2013, 04:30 PM   #1
beautiful_seclusion
 
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Should psychiatrists account for the outliers, or people with rare responses?

Please let's not turn this thread into a debate about pro or anti psychiatry. That's gotten heated enough in the MH board and not my intention at all to restart. But the thread got me thinking about something else that I would like to debate and discuss.

First, some background on why I even came up with this question. I've had about every "rare" psychological reaction you can have to medication. I've had anti depressant induced mania and suicidiality. I've had drug induced psychosis, which was allowed to continue for a year because the doctors thought I was just developing a mental disorder. I had to figure it out on my own in fact and later was told by a psych that they were glad I took myself off the meds. (What are the doctors there for then?) One anxiety drug made me scarily compulsive in taking it, which I luckily noticed more quickly than the psychosis stuff. And psych drugs in general (other than klonopin and ritalin which have actually helped me) make me unable to function and have unstable mood and emotions. All of which disappeared when I stopped taking them. My life literally turned around when I got off the meds. I'm also sure the effects of institutionalization didn't help, from all the times I panicked and admitted myself because of the unexplainable suicidal thoughts I couldn't control. (Which I think should have been a red flag since there is generally a reason for suicidal feelings and usually they do not scare someone like that as far as feeling out of control of them) But none of those suicidal thoughts occurred off meds. They were very specific in their presentation too. In short, I have been admitted to the psych hospital 12 times. In all cases, I was on antidepressants, antipsychotics, mood stabilizers, or a cocktail of these. I have never even felt the need to seek hospital help off meds.

So I know I am certainly an outlier here. Most people are either helped by meds or just nothing different happens. I was actively harmed mentally and I know this is not normal. However, I also know I am not the only one. It was a combination of the medical conditions (migraine w/ aura), psych conditions (ADHD and possibly PMDD) that I had, as well as just some strange sensitivities to meds that allowed this to both happen and remain undetected for several years. I could explain that, but my explanation is already long winded enough!

So should psychiatrists be watching for rare cases like this... the theoretical outliers of studies that were never accounted for because the numbers were too small, assuming a study would've even had the luck to include them? The people that aren't on paper but do exist. They don't exist as numbers but they are people with lives. While yes, my experience may not be the norm and I am not discounting the benefits of psychiatry in some cases, it's also my life we are talking about here. Over three years destroyed because I was an anomaly. The do no harm rule failed in my case. And is that acceptable? Should psychiatrists, when faced with a patient who is getting worse and is appearing to not respond to treatments, be expected to look at non conventional options? To consider that somebody fell through the cracks and that their treatments are making things worse? Is this their responsibility since it doesn't happen often?

So I know this is long, but I wanted to give some background. I know my experience is rare and even rarer to be discussed. And I know a lot of you have seen the pros of meds. So there are two sides to it, and I am honestly interested in hearing any sides, not just my own. Hopefully my description helped show the side I don't think is often or well conveyed.

So lets debate whether psychiatrists should be doing more for the people that don't respond like they expect and may have rare yet life altering negative reactions to treatment.



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Old 09-05-2013, 06:55 PM   #2
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I agree with thumbelina.

And I think that if someone has a rare side effect with meds a lot they should watch out for that kind of stuff to happen with other meds as it may be that the person is more sensitive to meds as others.



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Old 09-05-2013, 10:19 PM   #3
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I agree, it's easy for a doctor to initially mistake symptoms. I can understand not getting it spot on instantly, but what about when it goes on for a very long time? In my case, it didn't help that I was under state care and being shuttled to a new dr every few months because the clinic literally couldn't keep a doctor for that long. But I wonder if maybe more education on how to look for abnormal or rare reactions in medical schools would help? What can we do so that people aren't seriously injured by treatments or serious disorders neglected because its so easy to diagnose something as psychiatric? Maybe the way psychiatrists are allowed to diagnose should be changed? Should there be more repercussions for doctors that harm a patient? This also becomes an issue of patient trust in the doctor to not overlook something for what might be "easier" to treat.

Ive just seen so many of these happen, where they assume its not likely and so not worth checking out. Some even worse situations were regarding friends. One friend was on multiple medications that increased serotonin as she was being treated for cancer and had some mild depression as well (mostly related to having cancer). They kept piling on meds for every side effect, and apparently multiple meds she was on increased serotonin. She ended up having serotonin poisoning, a very rare but life threatening condition where the body is literally poisoned by too much serotonin. She called the dr when she began experiencing symptoms and they told her it was rare and not likely she had it and to go ahead and take her meds and "sleep it off". She decided not to take them and went to the hospital. She stopped breathing twice, had multiple seizures, and hallucinated for days. The hospital told her that had she taken the night meds, she would have died. Yet she can't even seek legal action because she fully recovered. Another friend, as a child, (she grew up with me), had a leak in cerebrospinal fluid in her brain that was causing severe neurological symptoms. For over a year, she kept being told it was psychiatric and it was attributed to her mother being murdered a few years before. Finally, the principal of our school got scared because this friend was literally laying down in the parking lot near cars and said she had to have a neurological evaluation before she could return. They found the fluid and rushed her to brain surgery, saying she would've died very soon from the pressure on her brain had they not found it.

I guess it just scares me that being able to diagnose psychiatric disorders so easily can lead to such serious repercussions when people are misdiagnosed and given treatments they don't need or serious problems are neglected because "it's just mental illness". I just wonder what we can do as a society to keep doctors from dismissing rare but serious situations by quickly diagnosing something as psychiatric/claiming a patients concerns are invalid because its "rare"? Perhaps it's an attitude problem that needs to be addressed with doctors, or maybe they are far too overworked. Should doctors more often err on the side of caution, even if it costs more? Is it really ok for doctors to generalize when it's people's lives we are talking about?

I also wonder if there have ever been any studies on doctors and harmful misdiagnoses involving rare conditions/reactions. It'd be interesting to see what the scale of the problem is at a societal level. Also, all my and my friends' experiences are in the US. Anyone notice this problem in the UK? Other thoughts? I'm really interested in discussing this as it seems I don't read or hear much about this type of thing, but I seem to have it happen to me or others close to me a lot.



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Old 10-05-2013, 11:32 PM   #4
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My doctors have been pretty ok here in the UK. Well, they're refusing to give me new meds now because I'm stupidly sensitive to anything with a sedative effect and just sleep all the time, and am intolerant to SSRIs, and with all my other meds for migraines with aura, they can't give me anything else (apparently).

When I had the reaction to the SSRI I was given, I just stopped taking them and phoned my psych a week later, who told me not to touch the things again. It was just accepted as an intolerance and I was given a different pill to try next time - another disaster due to the sedative effect.

The only time I've had a really bad reaction lasting any significant length of time was where my mood went scarily high and I lost all inhibitions after they put me on mood stabilisers for my migraines. My psychologist rang my GP after seeing me 2 weeks after I'd started them because I was totally unable to sit still and I apparently talked about engaging in potentially dangerous things without seeming to realise that there would be consequences for it. But I had no recollection of most of the time I was on the tablets after a GP rang me in a state as soon as I got home and told me to stop taking the things because the psychologist thought I wasn't safe on them. Again though, it was recognised that it was the tablets.

I'm constantly being told I can't be 'that' tired on my tablets, when I feel like I've not slept in weeks, it doesn't matter how low they keep the dose, it just seems to happen, even if I don't know that there is any possibility of even slight sedation. My body sucks in that sense. I slept for 13 hours on the lowest dose of a sleeping tablet, my psych refused to believe me.

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Old 13-05-2013, 09:36 PM   #5
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My brain is on a go slow so I'll have to come back and talk more about this cos it's interesting and I agree with you. The one thing that strikes me is that it's my understanding it is important to be diagnosed with something to get insurance cover for treatment in US where in UK you can access talking therapy (theoretically) and certain meds without diagnosis (you can actually be given shed loads of big meds by some GPs although you shouldn't). I wonder if this would account for some misdiagnosis due to the time constraints/resources. Again this is my understanding and could be b*****ks

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Old 14-05-2013, 06:25 AM   #6
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Yes, I think it is true that they have to have diagnoses for insurance and it makes sense that this causes them to be rushed and potentially wrong, which can be dangerous. I certainly feel that's what happened in my case. Also, talk therapy and psych treatment are very separate here; they have hardly any interactions between therapists and doctors. So the doctor who barely knows you is prescribing you meds while the therapist who should know you much better has no say. Is it like that in the UK too?

I guess my problem is that here they don't seem to recognize that meds can actively harm, even if it is the minority. Like the other poster said (sorry can't quote on my phone), certain people are intolerant to meds. All bodies are different and I really wish doctors would recognize that they don't know everything about individual human bodies.



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