In this complex world people at this site would be advised to get to know something about mental health.-Ron in Australia
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Don't forget psychiatry. There is much anti-psychiatry in the popular culture. Here are some notes I kept from my last two visits. Part of my aim here is the destimatization of BPD and mental health in general as well as suggesting to others that taking charge of one's life is more than getting the body fit and positive thinking up at the front.-Ron
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A. Discussion & Decisions From Psychiatric Consultation:30/11/07
1. CONCERNS ABOUT SLEEPING:
From my wife’s point of view I am “falling asleep all the time.” My behaviour was not frenetic and overactive, as it had been before I had gone on this new package of meds and as it was the main reason for going on these meds. My behaviour was somnolent, far too sleepy for a normal person. It was this concern of both my wife and I which led us to feel that a visit to my psychiatrist on 30/11/07 would be useful. The new pattern of sleeping behaviour that has become apparent after eight months on this new medication package(4/07 to 11/07) contains the following details:
Alternating periods of fatigue, a slight shortage of breath and sleepiness on the one hand; and energy and enthusiasm for my academic/literary work on the other—often within a few minutes. To put this sleeping pattern in a more precise way, there are several aspects of sleep, sleepiness and wakefulness that I would now like to outline:
(i) when I stop working(i.e. stop reading and writing), I fall asleep: (a) in front of the TV, (b) when I am just gazing out the window or (c) when my mind is not engaged to its full extent, as it is in my mental/writing work;
(ii) often when I am reading and writing I get so sleepy I have to: (a) go for a walk, (b) take a break and/or (c) have a sleep;
(iii) I sleep for: (a) 1 to 2 hours in the afternoon or evening and then go to bed between 1 a.m. and 5 a.m.; or (b) 1 to 2 hours on going to bed at 11 p.m. with my wife and then wake. About 1 a.m. in this pattern, I get out of bed and stay up for 2 to 4 hours. I then go back to bed for 4 to 6 hours-getting out of bed finally at 10 to 12 noon; and
(iv) (a) I am awake until the very late hours of the night, as I indicated in (iii) above, usually until 2 or 5 a.m. Then I sleep until 10 to noon with an hour or two of sleep in the late afternoon or after dinner; (b) My reading and writing tends to be in short bursts adding up to an 8 hour total of literary work per 24 hour period; and (c) I have short bursts of other activities: domestic, social and, personal--adding up to another 8 hours.
2. CONCERNS ABOUT OBSESSIVE-COMPULSIVE DISORDER:
I seem to exhibit more OCD, obsessive-compulsive disorder, behaviour: straightening & squaring bits of paper, magazines & newspapers on tables and desks and other forms of tidiness much more than in previous years on lithium—again this is of more concern to my wife. After my description of what I felt to be OCD behaviour, my doctor felt my behaviour in this area was not OCD, only a behavioural abnormality associated with my activity base and style of life.
3. CONCERNS ABOUT URINATION:
I am urinating on average every 80 minutes. I calculated this statistical average in September and the psychiatrist said this was normal/average.
4. CONCERNS ABOUT DREAMING:
I have a nightly dream pattern that is more extensive than ever before in my life. This leaves me with a dense-and-heavy, somewhat disoriented, feeling on waking, a feeling which goes away quickly. Often it takes me an hour or so to get to sleep; I often sleep lightly. On waking I often: (a) stay in bed and go back to sleep, (b) get up and go back to bed and sleep or (c) get up anyway and get a rested feeling after a shower, etc. The doctor said this extensive dreaming was also a normal reaction to effexor.
5. CONCERNS ABOUT WEARINESS & SIGNIFICANT OTHERS:
5.1 I get a feeling of emotional and psychological weariness, what used to be popularly called tedium vitae, late at night after 8 hours of literary work and a degree of hyperactivity in the previous 24 hour period. In some ways this a somewhat natural feeling given the extent of my literary and academic work. A quiet and low-key death wish usually accompanies this feeling. My psychiatrist was not concerned about this theme/topic since we had talked about it on several occasions in the last six years, since 2001, and neither he nor I felt the need to discuss it during this consultation.
5.2 The significant others in my life are an important source of: (a) concern to me and (b) relevant feedback. Since I have been on this new medication my wife has come to accept my sleeping eccentricities, although both she and I wonder what would result from a reduction in the levels of effexor. She has noted that I am given to: (a) inappropriateness of verbal responses in some social situations, although this is not a major concern; (b) an increase in OCD behaviour, easy distraction by details or perfectionism--whatever one might call this behavioural pattern--and (c) speeding, a mild degree of rapid cycling, racing ideas or hyper-energetic behaviour when it was not necessary. The psychiatrist and I did not discuss these aspects of my behaviour.
6. CONCLUSIONS AND WHERE TO FROM HERE:
The above served as a basis for discussion and was altered after our consultation so that this statement, draft #2, would include the decisions we arrived at and the items discussed and not discussed, for my record. During our consultation on 30 November 2007(4:30-5:00 p.m.), we decided that the best course of action to take in relation to the above behaviour/symptoms was:
(i) stay on the present levels of effexor(150 mg/day) or (b) reduce the effexor by 37 ½ mg; then reduce it again by another 37 ½ mg. until a review with him at my next visit.
I went on effexor in April 2007 because I was not sleeping much, had what might be called agitation/insomnia and life was far too frenetic/active. This is not the case now. I am sleeping from 6 to 8 hours every day, but my sleeping patterns are abnormal/erratic/unconventiona l and I hope to normalize them by reducing the levels of effexor as suggested in section A above.
(ii) There may be no change in my sleeping patters, even if I reduce the effexor said the doctor. If I seem to be okay, that is, sleeping well, little agitation insomnia and not too active, as I am at present, or too sleepy as I was at first, then, perhaps, I can go off the effexor entirely after the 2 stages suggested in section A above.
(iii) I received 4 prescriptions: 3 for effexor(150, 37.5 and 75 mg. tabs) and one for sodium valproate. I will get the prescriptions filled when and if it is appropriate and apply them as I decide in the weeks ahead. When additional medications are required I will get a script from my GP not my psychiatrist.--Ron Price 3 December 2007.
B. Discussion & Decisions From Psychiatric Consultation:13/11/’08
The main purpose of this consultation was to review the developments in the last year since the last visit to my psychiatrist on 30/11/’08. Since that last visit in November 2007, I have reduced my effexor from 150 mg per day to 112 and ½ in 12/’07 and then to 75 mg in 2/’08, as suggested by the psychiatrist when and if I felt it was appropriate. Since the effexor was now(11/’08) functioning at what he called “a sub-clinical level,” he said that I needed to reduce the effexor further. It was, then, decided that:
(i) if: (a) the NAVAL level was within the normal range of 350 to 700; (b) the creatinine level was ‘satisfactory’, (c) the eGFR level for kidney function and (d) the index of liver function was ‘satisfactory,’ as determined by the eGFR(the globular filtration rate). All of these measures would be determined by a blood test on 18/11/’08. I would then: (i) reduce the effexor level to 37 and ½ mg for two weeks and (ii) go off the effexor entirely; (10/12/’08) and (ii) if any problems arose during the above process, I would contact my psychiatrist right away.
The most common sleep pattern/rhythm that has developed in the last year has been as follows: (a) go to sleep between midnight and 3 a.m., (b) go to sleep until anywhere from 9 a.m. to 11 a.m.; and (c) then sleep another hour during the day and/or evening. My wife and I have adjusted to this pattern. As my wife puts it: “when I stop writing at my computer or doing household tasks I often/ immediately get sleepy.” This problem was discussed and it was decided that:
(a) I would continue with this sleeping pattern until my wife and I wanted to see a change in this sleep pattern.; and (b) if she and I wanted me to have a normal sleeping regimen, that is, from midnight to 8 a.m., we would have to make a greater effort to regularize my pattern into this framework.
Finally, my lifestyle has become more hermetic since going on this new medication. I had been a more gregarious person in the past. No decision was arrived at in relation to this ongoing psycho-social problem of increased social isolation and hermeticism. Other topics were discussed during this consultation on 13/11/’08 such as: (j) symptoms of BPD before its clear onset in my life in adolescence, (ii) when to come for the next visit and (iii) when my psychiatrist plans to retire, but no notes were kept on these matters. The next visit will be, as this one was, on a needs basis.—Ron Price, 13/11/’08.
Note: the effexor was reduced to 37 and ½ mg/day on 26/11 and then eliminated on 10/12/’08. No noticeable change in behaviour/symptoms resulted, at least not in the first week, and, thus, there was no need to consult my psychiatrist. Again, I shall report on this in the months ahead.
Mental Health: Something To Pay Attention To
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