writings from the past

so - technically i have never officially been diagnosed with bipolar disorder. i’ve brought it up to my therapist but he always suggest that i ask my psychiatrist, because he believes he doesn’t have the correct expertise to diagnose me. i mean he has a doctorate in psychology but thats none of my business... 

anyways

i don’t think i have a good enough relationship with my psychiatrist to be able to talk to him about it. i used to have a very good psychiatrist when i first got out of the hospital, but he moved to wisconsin and i had to find a new one. and i don;’t really like him (the new one). he doesn’t seem to care about my well being as much as Dr. C did. he doesn’t ask as many questions and i really only see him for a few minutes at a time. i’ve told P about this but he says that’s how many psychiatrists are - they just simply do not have time to sit down and talk to you for an hour, thats your therapist’s job. i’m quite frustrated with that. i think if i brought up bipolar disorder to my new psychiatrist, he would make me fill out a questionnaire... 

When I came into the hospital, I told them my story. I knew I had depression and anxiety prior to being hospitalized, but I never sought treatment. I also had trouble sleeping at night. My anxiety constantly kept me awake until 2, 3, or even 4 in the morning when I had to be awake at 6 for school. At this point, I would have done anything not to feel so empty, to feel some emotion and to get more than 2 hours of sleep at night. So I caved, and I took the medication as prescribed by my psychiatrist. My first day in the hospital I was prescribed 10 milligrams of the antidepressant, Lexapro and 50 milligrams of the antipsychotic drug Seroquel.

To clarify for those who do not know, antipsychotics work by “blocking D2 receptors as well as a specific subtype of serotonin receptor, the 5HT2A receptor. It is believed that this combined action at D2 and 5HT2A receptors treats both the positive and the negative symptoms. The atypical anti­psychotics currently available on the market include clozapine, risperidone, olanzapine, quetiapine, paliperidone and ziprasidone.” (Tung & Procyshyn, 2007). More intense side effects of these drugs include tremors, inner restlessness, muscle spasms, sexual dysfunction and, in rare cases, tardive dyskinesia, while less severe side effects include weight gain, diabetes and lipid disorders.

I also want to preface my story by saying that I was never really into the idea of being medicated, nor did I know a lot about these types of medications, at the time at least. I was put on an antidepressant, which I just assumed would make me not depressed. I was also put on an antipsychotic, and I had no idea how that worked. My doctors initially told me they gave me the antipsychotic to help me sleep. It helped. But it helped too well. After just a week of taking this medication, I was finally sleeping for about 6 hours a night, but I still felt like it wasn’t enough sleep. I’m not sure if this was just my body reacting to finally getting sleep for the first time in years, but I’m pretty certain it was the medication that made me feel like this. I felt like a zombie. I was still exhausted, even though I felt like I was doing everything I possibly could to get a good night's sleep. This medication also made me feel emotionless. I felt like I literally couldn’t be happy and it made things worse. I felt that things would never get better, and I felt this way for about a year.

Almost a year after I got out of the hospital, I was at an appointment with my psychiatrist, who told me that he wanted to try to get me off of the antipsychotics. At the time, I was completely dependent to this medication. It was the only thing that would help me sleep, and I felt like if I didn’t take it, or if I took anything else, that the darkness would come back and my anxiety would creep back up and I wouldn’t be able to sleep. If I was off the medication, I felt like I would have gotten worse, and things could have gotten very ugly. But I accepted it. I knew I had to move on, and be able to figure out a way to sleep on my own, or at least without the intense medication. My doctor then prescribed me hydroxyzine, which is an allergy medication. He promised me that it would give me similar effects to the seroquel, but without all the side effects. I tried it a few times but I knew I definitely slept better with the seroquel. This medication only lasted a few hours, so I was back into this dangerous cycle of only getting a few hours of sleep. The days I took my new medication, I felt defeated, like no medication would ever work.

Eventually, we found medications that work for me, and what these are doesn’t matter. Some days I want to just stop taking the medication altogether, but I am also so scared of what would happen and who I would become if I wasn’t on the medication. I didn’t learn until about 6 months ago, the negative effects that these antipsychotics have on your body. Things finally started to make sense, and I understood why my body did the things it did. When I was first given the antipsychotics, that first month, I gained almost 15 pounds, that never went away, no matter what I tried. I felt sluggish, and even lazy, despite being a competitive cheerleader and working out 6 days a week. My exhaustion was a side effect of this medication.

Today, I am still coping from these side effects. I have learned a lot though. I learned that my doctors put me on antipsychotics because they thought I could possibly be bipolar, and instead of treating me correctly, they just gave me the medication and that was it. When I talked to my therapist about this rather recently, he suggested the fact that I might be bipolar, but that they definitely shouldn’t have treated me the way they did. To be misdiagnosed is very insulting, and to be mistreated is even worse. I feel like I could have progressed so much better while in the hospital and even afterwards if I have been treated correctly.

Unfortunately, I am not the only one that gets mistreated or misunderstood by doctors. For example, take the case of Andrew Rios. When he was 5 months old, he had his first seizure. He was then put on epilepsy medication. At 18 months old, his medication gave him more adverse side effects, such as him acting violently and erratically. He was then prescribed the antipsychotic, Risperdal.

In Andrew’s case, he saw some of the most intense side effects of antipsychotics, at such a young age. His parents became very concerned when he started to scream in his sleep, and would talk to people that were not there. Once the family researched Risperdal, they found out that there were no antipsychotics that were approved for children younger than five years old. (Schwarz, 2015). The main issue here is that “the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Neurology have no guidelines or position statements regarding the use of antidepressants or antipsychotics on children younger than 3.” (Schwarz, 2015) It should also be noted that many doctors would theoretically like for there to be more studies of these drugs on young children, but they do not want to subject these kids to the dangerous and adverse side effects of the medications.

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The overprescription and misuse of antipsychotic medications greatly impact children specifically. This is not because most kids are diagnosed with psychosis or schizophrenia, but because doctors, teachers, and parents alike don’t always know how to deal with: autism or other learning disabilities, mental illnesses or other disorders, or just kids that are “bad” and “act out.” it is important to look at other reasons why these medications are being prescribed, such as looking at the doctors: how qualified they are to be prescribing these medications or what things may influence them to prescribe a certain drug over another. These medications are also prescribed because they are relatively cheap, and for a low-income family, it is much easier to just take medication rather than involve a child in therapies of any kind, mostly cognitive behavioral therapy or group therapies for the specific population impacted.

A reasoning behind why so many people are on these medications is that some doctors, teachers, parents or the patients themselves don’t really know how to deal with a patient's mental or physical illness. The most popular diagnosis among all ages of people prescribed antipsychotics was ADHD, which it is important to note that there is a whole other section of pharmacology dedicated to ADHD and ADD. (Penfold et al., 2013)

On “Last Week Tonight,” John Oliver talked about how pharmaceutical companies market to doctors in a very strange way, and that most psychiatrists are paid directly or indirectly by these pharmaceutical companies. Sometimes these doctors will even conduct research about certain drugs and have to say that it works because a pharmaceutical company is funding the research. The show mentioned a website where you could search your doctor and see if they got paid, how much they got paid, and what specific companies paid them. The psychiatrist that prescribed me Seroquel was getting paid over $850 a year, just from pharmaceutical companies. About $300 was from the company Astrazeneca, which created the drug Seroquel. (John Oliver, 2015)

My case isn’t the first and definitely will not be the last. Dr. Charles B. Nemeroff, chair of Emory University’s department of psychiatry reported to the university that he made exactly $9,999 from talks and research he did with the pharmaceutical company GlaxoSmithKline, but failed to report another $500,000 and also violated many of the university's policies regarding research with third party companies, in 2004 alone. (Angell, 2009)

Another influencing factor in prescribing antipsychotics is because they are relatively cheap, and much cheaper than therapy or other interventions. My parents spent well over $8000 for my hospitalization, $230 for monthly psychiatrist visits, $150 for therapy every two to three weeks, but my medication was only about $25 every month, and this was all under my private insurance. Through my research I found that therapy can treat these children that are acting out or are actually mentally ill, but it takes on average about 12 therapy sessions to see a full affect. For me, that’s 6 months of therapy, which would cost $1,800, and that’s just for my specific therapist. Medication for 6 months would cost the same as one single therapy treatment for me. It is also important to note that the “correct way” of doing things is to have “comprehensive psychiatric assessment prior to initiating psychotropic medication to determine the nature of the child’s illness and whether the antipsychotic medication is an appropriate course of action.” (Harrison et al, 2013)

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Many scholars, doctors and journalists alike have really questioned the ethics within studying antipsychotics on children. In 2013, the American Psychiatric Association issued a list of questionable uses of antipsychotics, basically setting guidelines for doctors prescribing these antipsychotics. Some of these limitations include: “Do not prescribe for insomnia in adults without a severe mental illness diagnosis and do not prescribe to children or adolescents for anything but psychosis.” (APA, 2013) While these guidelines are accurate and reasonable, it is obvious that they were not implemented for many doctors, or taken seriously. It’s great that we had these guidelines, but if there is no regulation or laws that essentially forces doctors to follow the rules then there isn’t much use in having the rules in the first place.

Just this year, Minnesota senator Al Franken proposed the Mental Health in Schools Act. This act promotes a school-based mental health program that is run with the Secretary of Education and the Attorney General. It increases government funding for mental health education and promotion in schools, and essentially insures that schools will have trained personnel that can deal with mental health. Although this bill is great, and it is good that we’re starting somewhere, there are not many specifics as to how this is all going to get done.