Bipolar Tip: Winning at Your Next Pdoc Visit!

A lot of us with bipolar disorder think appointments with the psychiatrist rate somewhere between hell and a trip the dentist chair.  Anxiety, trust issues, differences in treatment beliefs, and communication difficulties can interfere with your medication management appointment.

On top of that, in less than 20 minutes you are expected to provide an update of your condition, explain symptoms, address intrusive thoughts, moods, make sure prescriptions get refilled, clearly recall important facts and events, discuss emerging or persistent issues, manage meds and doses, navigate convoluted billing and insurance practices, and maintain good composure.  Whew!

That means no weird laughing moments, tangential comments, or other unusual gestures.  Remember, you are dealing with an individual with the power to have you involuntarily committed to the friendly neighborhood psych hospital!

My Perspective

Okay, I need to say that I do not believe the patient/doctor relationship should be a win/lose or us versus them mentality.  Rather, it is better for all if the patient and doctor work together building a healthy, supportive, and respectful relationship.

Try to consider your treatment successes as wins for your doctor as well.  It should be a win/win partnership as they say.  If lowering your lithium levels made it more tolerable while still keeping your moods stabilized, then it's reason for both of you to celebrate.  Here is a writeup on my last psychiatrist visit back in January.

Approach

Because drug treatment can be effective and therapeutic it is in our best interest to make sure it goes well.  Assuming you are on good terms with your doctor, there are three straightforward things you can do that will make you feel like a winner after your next appointment:

Roles.  It is important that roles are understood. Good communication requires each person to know their respective role in the patient/psychiatrist relationship.  My preference is to have the patient take the lead role.  I believe this because (a) you are the best interpreter of the effects from prescribed drugs; (b) you will add value to your treatment program from increased participation; and (c) you will receive higher quality treatment overall.

Responsibilities.  And the winner is, You!  Because it is your life and you are the lead of your patient/doctor relationship, you should be acceptable with being the responsible party for your mental wellness.  You should also acknowledge and remember that you are ultimately responsible for your behavior.  Become committed to better mental health for yourself and be prepared to put forth effort required to do so.  It really is imperative that you take the drivers seat on this.  You should be the lead.

The Plan Man

I have a three step plan for making sure your consultation with your pdoc is effective.  The plan below is the same one I use for my psych appointments.  It is brief and simple, but gets results.

1. Prepare.  Write down any and all questions/concerns you can think to ask.  Go through them and get rid of the ones that aren't really necessary.  Pick a reasonable number (like 3) that you want to talk with the doctor most about.  Unless this is your initial evaluation with a new pdoc, there won't be enough time for too many topic items.  Think about these questions and concerns ahead of time.  It only takes five minutes to do this.  If you can go further, try to get some time for a quick internet search about each question.  This will make the appointment even more worthwhile.  For more on planning and preparation go to this Mayo Clinic bipolar webpage.

1. Perform.  Arrive at least five minutes early in a presentable manner.  Play your role as an empowered mental health consumer and think of your pdoc as your personal service provider, which they are.  Be engaged in the conversation.  This is your health at stake here!  Take notes on important items for later review and reminder.  This is where your committment to being mentally healthy will make you shine!  Your doctor will notice this and be more willing to work with you.

1. Persist.  Do any prescribed follow-on activity from your doc as prescribed.  Remain in contact in case you have any adverse health effects, issues with medication, or worsening of bipolar symptoms.  Be assertive if necessary.  Assertiveness is healthy.  It involves standing up for your rights and respecting the rights of others at the same time.  
2. Never, never, never quit!  Don't give up on your treatment in between appointments!

Execution

Here are some things to consider as you talk with your treatment provider.  You need to be prepared to address these issues and still maintain a good relationship.

• Is he or she okay with not playing the lead role?  If not, what will you do?  I haven't had problems taking the lead role.  Most doctors prefer a patient that takes an active role in their treatment.

• Are we in agreement concerning my issues and questions?  How does this get resolved if they are not?  Be prepared not to get everything you want all at once.  There are probably valid reasons why your provider is not in agreement with you.

• Playing the lead role does not involve being overbearing or contentious.  Simply remain calm and present your ideas, question, and concerns.  Remember, it's supposed to be a partnership!

• Be reasonable.  Your doctor sees a lot of patients each day and they are human.  Forgive them if they aren't perfect.  But at the same time do not hesitate to change doctors if you no longer receive quality care. 

• Is this person really looking out for your best interest?   Are you in disagreement with your pdoc about treatment, uncomfortable for whatever reason, or just don't trust your provider.  These are valid reasons to consider changing doctors.

Conclusion

You really need to make sure your medical treatment is as good as it can be.  Medication management is a critical element of the journey to wellness.  Having an effective partnership with your psychiatrist will make your treatment a more positive and worthwhile experience.

Do you have any past visits to the psychiatrist that can shed light into the experience?  Horror story or a good example of a consumer/provider relationship?  Let us know by commenting below (you can do so anonymously).  Remember to have a good day and take your meds.

Bipolar and Continuous Change

Society is becoming increasingly connected and dependent on digital technology.  In all aspects of our lives we are changing alongside, together with, and within our digital world. 

Today's digital world imparts to us its own sources of change stemming from its characteristic of continuous innovation.  And we're also experiencing change at an increasing rate.  Meaning all this new technology is requiring us to change with it, at a faster and faster pace.

I don't know the relationship between change and bipolar disorder.  But I do know if change leads to excessive stress then it surely will contribute to more and worse bipolar symptoms.

Technology Innovation

Technological innovation is the process of developing, making, using, and disseminating better or more effective products, services, technology, or ideas.  It is the innovation component that drives change in society, economics, business, and people's lifestyle and quality of life.

Innovation in the computer industry has been and remains remarkable.  From my perspective, information technology really started taking off in the mid 1980s when my dad brought home the Commodore 64.  It was one of the first popular take home computers.  For me it went like this:

• 30 years ago, 1982 - I knew of computers and some of their capabilities.  I remember being fascinated by the ability for computers to talk to each other through the modem and phone line. 
• 20 years ago, 1992 - Universities, businesses, and some people had email.  All students had email accounts and many their own x86 PC (or Mac).  I got my first computer then. 
• 15 years ago, 1997 - Everyone's getting on the web.  Which browser should I use?   Everybody has at least one email address.  
• 10 years ago, 2002 - Now most grandparents and relatives have email accounts.  Internet utility, traffic, and web capabilities are clearly known and being utilized by businesses.
• 5 years ago, 2007 -  The new iphone brings the cell phone to the web.  Portable devices are making home PCs less desirable.  Social media is popular.  I thought it was a fad.  Wrong!
• 3 years ago, 2009 - I'm using my iphone during all waking hours.  It is ridiculous.  Wi-fi in use everywhere.  Facebook is at 150 million active users and starting to explode.
• Now, 2012 - I have 3 Blogger accounts, 2 Twitter, 3 Facebook, 3 G+, and 5 email addresses.  I have two PCs, a printer/copier/scanner/fax and my iphone for devices and wifi in my home.

Technological Change

It is clear that today we experience massive amounts of change because of technology.  Also, this burden of change is increasing as society becomes more interconnected and dependent on the digital world view.

Can it be that technological change is the primary driving source for the development of human civilization?  Think about all the areas in your life touched or even controlled by technology.  Car, work, communication, leis

As an example, consider social media.  How has your involvement with online social media changed over the years?  How has social media changed the way you communicate with your friends, relatives, co-workers, businesses, and other interests and communities?  Does any of this add stress or activate bipolar symptoms?

I saw a family at a table in our local diner.  They were all looking down and praying before their meal.  I thought to myself, it's good to see people are still grateful for their food.  But I looked closer and realized they were all looking down at their cell phones and texting!  Or were they sexting?

Change Affects Your Life

Changes in life and society from technological innovation can be helpful or harmful.  We tend to think of the benefits of change because innovation is associated with improved efficiency, comfort, convenience, and capabilities

For example, when I changed from a regular cell phone to a new smart phone I become more efficient (e.g., faster messaging), could now conveniently send and receive data through my phone, and I gain a tremendous amount of wireless computing capabilities.

You will not likely find a person who owns a smart phone dwelling on its harmful elements.  Can you see someone saying that they are worried because their new smart phone is going to take jobs from U.S. workers?  How about someone saying that their modern cell service hurts small business because the industry has become monopolized?

Innovation significantly effects the mental illness health care industry with new drug development; greater knowledge from research and clinical practice; mobile apps for capturing and analyzing mood data; and improved communication. 

Within 24 hours I can get my blood tested in my home town, take a flight to Paris, access my results from my iphone from Europe, analyze the results with my new iphone medical app, and comment back to my doctor about my latest theory about thyroid levels and bipolar symptoms (which I quickly researched from my iphone).  Amazing.

Bipolar Impacts

Don't think for one minute I'm going to try and explain how technological change impacts those suffering with bipolar disorder.  There are too many significant other factors like family, health, relationships, environment, genetics, occupation, stress, and medicine.  This makes it difficult to understand the true impacts from change.

I do know impacts from technological innovation are positive or negative depending on the person and their circumstances. Negative effects might be social isolation/withdrawal, increased anxiety, or a decreasing attention span.   Positive effects could be increased social interaction (online at least) and increasing self-help power to the individual. 

Technology Trap 

Regardless of anything you do, technological innovation will continue to change you, your life, society, business, and culture.  Tomorrow will never be the same as it was or is today.

The modern view seems to prefer trying to keep pace with technological innovation.  They say we can solve the problems of man and surely correct any associated "negative external issues" from technology development and advancement.  This means as a society we collectively agree to continue changing and evolving at the rate of technological innovation.  

Survival is the catch 22 of our technological landscape.  If you do nothing, technological change will continuously reduce your skills until you are absolete.  If you participate, then you are now an indentured servant to the 24/7/365 technology innovation process.  Welcome, to the matrix.

Using social media as an example again, you should certainly expect continued, rapid innovation in social media that will inevitably bring significant change.  How much it affects you depends on your relationship to social media.  If you do nothing you will be like the old folks now that don't use a cell phone.  

For those in the marketing and social media industry, it is now about how well you adjust, adapt, and survive with the continuously evolving technology.  For someone who likes to shop online that means they will be able to friend, +1, and tweet their favorite stores. 

Moving Forward 

It is no secret that we are in the middle of lot of change and societal evolution.  Nobody knows where all of this is going or what impact these changes are going to bring.  Society has collectively come to an agreement that technology is necessary and we will adapt to its changes.

Since we are expecting continuous change to happen, it is a good idea to stay "tuned in" to changes going on in your life.  Be ready to embrace change in a positive, proactive way.  Educate yourself areas important to you and use your knowledge to better navigate the change.  Finally, be aware and mindfully manage your life challenges, especially your mental wellness.

Bipolar Treatment Update - Withdrawal Wars

Changes are underway with my treatment plan.  I'm getting off of my antidepressant Cymbalta (duloxetine).  I've been on the drug for over 5 years now.  The reason for withdrawal is not for side effects, but for efficacy and safety concerns.


Cymbalta  

I've determined Cymbalta is no longer helping my bipolar depression.  And I recently discovered there are serious adverse effects from taking both Cymbalta and Wellbutrin (bupropion) at the same time, which I do.

I used an online drug interaction checker tool from Medscape.  It said "Serious - Use Alternative duloxetine + bupropion duloxetine increases toxicity of bupropion by unspecified interaction mechanism. Serious - Use Alternative. May lower seizure threshold; keep bupropion dose as low as possible.  Oh, my.


Psych Meds

• Cymbalta:  Remove.  Starting 3/20/12 I am tapering from 120 mg/day to 60 mg/day over three weeks (20 mg decrease each week).  Evaluate, then continue tapering until 0 mg/day.

• Lamictal:  300 mg/day.  No change.

• Wellbutrin: 450 mg/day.  No change.

• Xanax: 0.9 mg/day. Slight increase in use.

• Abilify: Completed withdrawal in December 2011.

Supplements

NAC: 2000 mg/day, started two months ago. Not sure of response really.  Will continue during Cymbalta withdrawal; fish oil - 300 mg/day; multivitamin; aspirin; and caffeine.


Additional Information

• Psychotherapy.  My therapy sessions are going well.  I go once a month.  This therapy gives me a clearer sense of what's really going on with me and I receive helpful feedback and insight.
• Withdrawal effects.  I am concerned about possible adverse effects from Cymbalta withdrawal.
• Supplement interactions.  Possible adverse health effects from supplements with psych meds.  I need to figure this out myself.

Conclusion

I am continuing to actively manage my medication treatment. I have some alternative/novel antidepressants I am interested in trying after Cymbalta withdrawal.  However, the pdoc is not so hot on it.  Something about side effects and hallucinations or something.

I am fortunate.  Because of high tolerance to psych meds I am able to use them and stop them with minimal adverse effects.  But who knows with Cymbalta?  This could be a protracted, agonizing period in my life like it is for an unfortunate percentage of those who suffer severe (sometimes debilitating) withdrawal symptoms.

I don't expect that, but then again this could be just the beginning of my fight against adverse withdrawal effects.  Could this be the start of "Withdrawal Wars?"