Archive for the ‘Reader Questions’ Category

Reader Question: What if my daughter’s therapist cancels appointments?

Saturday, May 23rd, 2009

   A  Reader Question for Julie

Hi Julie,

My daughter takes Lamictal and Lexpro and I believe she is going to talk to the new Psychiatrist about increasing the dosage, when she finally gets to meet him this week. My daughter has found a therapist that she likes but the therapist has cancelled some appointment- two I think. My daughter has very limited time due to her job so she cannot reschedule in the same week and it’s a time that she really needs the appointment.

I have to say it ticks me off considering this persons job. I’d think the therapist would be more aware of the effect, for many reasons. Is it unusual for a patient to ask for a phone apt.? Just a thought. I don’t want to react with the anger I feel and would like to make a helpful suggestion.

Thanks again, and at your convenience,

Kathy

Hi Kathy,

Therapists can play such an important role in bipolar disorder management. One way they help is to teach their clients how to live consistent and stable lives. If your daughter’s therapist has cancelled two or more times, I see this as a problem with consistency.

I have had to change times with my therapist- and she has had to change times with me- but it’s always done ahead of time and it’s rare. If the therapist is exceptional and really helps your daughter, I would suggest your daughter talk to her and say that sticking to appointments is essential. It’s important to remember that we PAY health care professionals- it’s not the other way around. When we pay for something, it’s natural we want value for our money.

People defintely have therapy sessions on the phone. This usually works if you have already seen the therapist a few times. I would still insist on the therpaist sticking to an exact time.

I think that talking with her therapist and being honest about her concerns is the first step. It may be the therapist is in crisis with something and has not told your daughter. But even then, if she cancelled again, that would be too much stress for me personally and I would look for someone else.

I have been with my therapist Robin for five years. She is essential to my stability.

Julie

Where do I find a good psychiatrist?

Saturday, May 2nd, 2009

Where Can I Find a Psychiatrist?

I often get letters from people throughout the US asking if I know of psychiatrists in specific areas.

Hi Julie,
Maybe you can help? I’m bipolar and on Medicare trying to get a psychiatrist in the San Jose, CA area and am having a hard time finding someone. Do you happen to know someone in this area? Thank you.
Brent

Hi Brent,

I don’t know of psychiatrists in certain areas- but I do have a suggestion. If there is a teaching hospital in town, I would call and ask to make an appointment with the head of the psych department. It’s not likely you will get in, but they will definitely have great references for other psychiatrists! If there is no teaching hospital- it’s fine to call any hospital and see if they have an outpatient psych program. They will even be able to direct you to private doctors. The Medicare makes it difficult, but if you keep calling, you will find someone!

I also suggest that you look for a psychiatric nurse practitioner. They are an excellent resource and often much easier to find than a psychiatrist. I always suggest that a person get fully diagnosed by a psychiatris and then if possible, move to a psychiatric nurse practitioner for medication management. There are not enough psychiatrist in the US. We often have to find qualified alternatives. In your case, it will probably depend on who will accept medicare.

Good luck. I have been lucky with my health care professionsals and hope the same for you!

Julie

Reader Question for bipolarhappens.com newsletter

Saturday, March 7th, 2009

I like to answer as many reader questions as possible – and this is a great one. I answered it and then realized the question was so good, I wanted to send it as a newsletter. So, here is the question- the newsletter with the answer will arrive soon.

Hi Julie,

You wrote, “I know what I want my future to look like.” I know it’s a huge and possibly unanswerable question but how did you find that out? What you want your future to look like. My doctor and therapist are constantly bugging me to make goals for the future and figure out what I want my life to look like in 5 years. I don’t know! I find it really difficult to make long-term goals because I know reasonably-well that I am probably not going to get there. I crash, and lose everything. It sounds pessimistic, and to a point it is, but looking at my past and my history of episodes and hospitalizations and their outcomes it’s not completely untrue. How do you get past the fear and pick what you want your future to look like? How do you keep the hope alive and keep going when you don’t want to or feel like you can’t survive?

Michelle

If you have not signed up for the newsletter, you can find a link at the top of www.bipolarhappens.com

If you would like to read past newsletters, there is a menu button to the right for newsletters! Thanks to Michele for this question.

Reader question: Mania and irritation

Wednesday, October 29th, 2008

Hi, I just received this question from Sandra:

Julie, is irritability a sign of hypomania? I’m also going from calm and patient to incredibly angry in minutes (seconds?). Any ideas? I do have an appointment to see my therapist today.

Answer: Oh yes, mania can cause irritation and anger. It’s called dysphoric mania. You can also be scattered, unable to do tasks calmly, snappy and weepy. The main problem is that it affects your sleep. If you have dysphoric mania and depression- it’s a mixed episode. If you go from mania to depression and back, it’s called rapid cycling.

 You will need to check your meds- if you’re on an antidepressant, it’s possible it is causing this- if you’ve recently had a stessful event in life, that can be the problem as well. I’ve found it’s usually medications or a trigger that starts something. Or, it can just be the darn illness. There are many meds that can cause irritation, that’s for sure!

If you go to the right of the blog, you can click on the mania tab and read a lot about the different kinds of mania. I’ve had a lot of mania the past week. It’s tough!

Julie

PS. If you’re reading this from amazon.com, you can visit www.juliefast.com/bhblog to see the blog from my server.

Reader Question: Lamictal doses

Monday, October 13th, 2008

Hi Julie,

 

You’ve mentioned taking Lamictal at 500mg a day a couple of times in your blog. Recently my psychiatrist has increase my dosage of Lamictal from 200mg to 300 mg and lately 400mg.The depression and anxiety are still taking a toll. I was wondering what type of relief you get from your dosage of Lamictal.

 

Does it take away the depression and anxiety or does it just keep it at a manageable level? I’ve been on the 400mg for a week now and the depression and anxiety are worse than ever. I’m facing going out on disability for awhile and I’m hoping its only going to be a couple weeks until we can get this under control with the new medication levels.

 

Thanks for your time.

R.

Hi R.,  Here is some good news! – You haven’t been on the new dose of Lamictal nearly long enough to get full relief from your symptoms.  It took me three months to see a lot of changes and it has gotten much better over the years. A friend of mine has a psychiatrist who says that Lamictal actually works better and better for years after the first dose. There is no question that 3 ½ years into my treatment the Lamictal is going strong.  You have to give this a lot of time. It’s not a fast acting drug at all.  

The dose is also all over the charts for people- I have friends who take less than 100mg and as you know, I’m at 500mg. I’m glad your doctor is working with you on this. Regarding symptom relief, when combined with my Health Cards, Lamictal reduces my depression, anxiety, psychosis, OCD and rapid cycling. It’s amazing.

 Meds take time to work. Now is the time to focus 100% on treatments you can do on your own. Get it Done When You’re Depressed can help a lot as it’s all about doing things when you don’t feel you can do things!  The whole goal is to have your personal treatments meet your medication treatments to create stability.  It is 100% possible to do this. I’m proof. My depression is still quite bad, but I’ve learned to live life to the best of my ability. Life gets better every day and it can be the same for you.  Julie    

 

Lamictal Side Effects: Reader Question

Thursday, September 25th, 2008

Hi,

Here is a great question from Dana regarding medications.

Hi Julie,

I’m on the Lamictal starter pack and still taking 25 mg a day. I’ve been increasingly manic, irritable and aggressive. I have no tolerance for other people and haven’t been able to attend school.  Is this normal?  Will it be better at 100mg?

Dana

**

Hi Dana,

First of all, it’s great that you’re aware of what’s going on. Sometimes side effects happen so subtly that people stay in a state of physical and mental agitation before they realize what’s happening.

Lamictal, like all drugs works in different doses for different people. For example, my mother gets a lot of help from 75mg and I’m on 500mg. If she goes above 75mg she gets the jaw clenching that comes with the drug. If I go under 500mg I get pretty bad withdrawal symptoms including bad twitching and super bad leg pain.

Your health care professional was really smart to start you on a small dose as going up slowly on Lamictal really helps minimize side effects.

It’s super important that you contact your doctor with your question. Any time a drug makes you feel manic, this is dangerous as it can lead to rapid cycling.

I have not heard of Lamictal causing mania and agitation, so that is new to me, but your health care professional will definitely know what do to. Here are questions you can ask yourself so that you can give your HCP the info needed:

Are you taking other meds that may be interacting with the Lamictal?

Did you stop a drug to go on this drug? IE, could you be having withdrawal from something else?
Have you had a trigger in your life that is messing with your sleep?

Speaking of sleep, the number one sign of mania is sleeping a lot less but not being tired. You may feel agitated and worn out, but not necessarily tired.

There are many things that could be happening, but it’s probably the drug. Only you and your HCP can work on dosage. Lamictal is notorious for withdrawal symptoms, so don’t do anything drastic. If you and your HCP decide to change the dose or the drug, do it slowly!

I hope this helps. Hang in there. It took me many, many years to find the right med at the right dose. It takes time, but you can find the same relief.

Julie

Thanks for the reader comments

Thursday, September 18th, 2008

Hi all, I just want to say thanks for the comments. I read all of them. I keep telling myself I will put a comment of my own on each one!   Here are some answers to your questions:

- True Hope, a supplement company that advertises they can help bipolar disorder was investigated by the Canadian government regarding their claims regarding mental illness. You can read more about it if you ‘Google True Hope Canada Investigation.’

-  I agree that exercise is a tremendous help with bipolar disorder. I love yoga myself. I have found that I have a lot of trouble with injuries when I’m depressed, so I’m working on that. As of now, I have finally healed a bad shoulder and am getting back into yoga. It’s never too late! Getting injured while depressed or manic is more common than you may think!  I have tried someone called ecstatic dance. It is interesting! If you go to www.meetin.org or www.meetup.org you may find some exercise opportunities you may not have thought of such as rafting or flag Frisbee.

Yes, there is still room on the Parents of Children with Bipolar Disorder teleseminar.  You can go here to read more about it:

www.juliefast.com/teleseminars.php

If you didn’t receive my last newsletter on mixed episodes, it may be a spam problem. Make sure you have comments@bipolarhappens.com on your email OK list.

- Regarding my future projects: I’m currently working on a new book. I can’t wait to get started. Of course, as you have read, getting started is one of our main problems!

- My column in BP Magazine will be out in January. It’s on triggers. It helped me to write it! I try so hard not to repeat my past trigger mistakes. Here is a link for the magazine:

www.bphope.com

And finally, thanks for all of the wonderful support I received at the DBSA conference in Virginia. It was a highlight of my short career.  I can’t believe I am well enough to work. I just have to keep going daily and the rewards definitely show up eventually.

 PS: I started writing books at age 37, so anything is possible! I’m 44 now.

Keep sending comments. I love them! Julie