Coming off Psychiatric Medications?

Recently, my friend's cousin who lives in China messaged me and told me about her mental health situation. It's very unique. She used to be a happy and positive person, with no mental health issues whatsoever. When she was 19, she was a rebellious teenager. It wasn't typical at the time and it was extremely unacceptable in China. She was always angry and disrespectful towards her parents. Thinking that she was schizophrenic, her mom found a doctor and put her on antispychotic medications. Fast forward, 11 years later, she is still stuck on these medications and she is experiencing severe health issues, such as high blood pressure, tremors, poor quality of sleep, inability to control her tempers and emotions, high risk of breast cancer, inability to have children, etc. She is on an antipsychotic drug called Olanzapine and an antidepressant called Luvox. The amount of information on these drugs are very limited in Chinese and her psychiatrist claims that these drugs are "import", therefore they are "awesome", even though he confirms that she doesn't have schizophrenia, he thinks it's not a good idea to come off these medications. Indeed, when she tried to quit cold turkey once, she wasn't able to sleep for 5 days.

After Googling these two drugs, I found a lot of valuable information in English, including other people's terrible experience trying to come off it. In a woman's story, she even had a minor stroke as a result of her withdrawal from Olanzapine. Here is her story: https://rxisk.org/olanzapine-withdrawal-sallys-story/

I then remember that I was on Olanzapine for a while as well, it didn't do any good to my mental health, and I was then switched to what I am taking now, which is Seroquel. I am aware of the fact that I am fully dependent on this medication, if I accidentally skip a dose, I won't be able to sleep for that night. But my dosage is only 150mg, it's the minimal dosage and I cannot go any lower than that. With the help of another medication called Epival (500mg), my bipolar disorder has been well treated. I have been doing great for over 11 years, I have not had a mental health breakdown for 11 years! I don't plan to come off my medications, I don't experience any side-effects. Aside from the fact that I might not be able to carry my own child, I don't see my life being affected in anyway by my medications.

Anyway, after doing more research, I came up with a few tips that could help my friend alleviate her side-effects by lowering her dosage. In this post, I want to share my findings, as well as some personal experience in lowering my psychotropic medications to achieve optimal mental health.

First of all, I don't think a person who actually has a mental illness, who actually has psychosis should come off antipsychotic medications completely. It will most likely cause a relapse, therefore a major set back in their life. The goal is to lower the dosage to a point where side effects are most minimal, or replace it with another type of antipsychotic that works better. 

1. Slowly and gradually. It's like quit smoking with Nicorette patches. Take off 5% the dose every 4 weeks. I am speaking from my personal experience. After landing the right medication, it took about 2 years to finally figure out the right dosage. And my mom actually "adjusted" my dosage without my awareness, and she dared not telling my doctor about it. I was doing better and better mental health wise. I had normal emotions, and my creativity, memory, and other aspects of my mental abilities were all enhanced. When my doctor was about to move to another city, I finally told him the truth on our last meeting. He was like, "oh, I can understand that."

2. Keep a diary. My mom had a small journal, every day, she would write the amount of meds I was on, the quality of my sleep and my mood. If you are writing the diary yourself, you can rate your sleep, your mood, and your physical symptoms out of 10 or out of 100. Monitor the changes you experience after a dosage has just been reduced. If you experience insomnia for days, and withdrawal symptoms that you cannot tolerate, you should slow down your pace, and add a bit back to your dose.

3. Have a healthy and structured life style. Quit smoking and drinking. Do more exercise, and eat food that are considered clean and healthy. Mental healthy is part of our overall physical health. In my experience, I was overweight at the time, therefore, I went swimming every day, I ate oatmeal for dinner instead of white rice. I lost about 40 lbs in the process. I felt like my mental health was restored right about the point when I was in a much better shape physically.

4. Work with a Psychatrist on a long term basis. Again, the goal is to lower your medication to a point where your side effects are minimal and your mental functions can be enhanced. The goal is not completely coming off the medications because you have a mental illness to treat! Sometimes, we need to come off a medication when we are switching to a different type of medication. That's why it's important to have a psychiatrist on a long term basis. When someone is acute, the type of medication prescribed is usually very strong and "toxic", but during maintenance stage, if the meds have bad side effects, a milder type of meds should be used. In my experience, I have tried many different types of meds and combinations before landing on the right meds, and my doctor played a key role in it.

5. Lastly, and most importantly, do not lose faith in medications just because you have a terrible experience with one type of medication. If one doesn't work, keep on trying until you find the right one and figure out the right dosage. I have heard people say, I don't take meds, I just try to deal with it, I have good days and bad days, I have to shower myself with inspirational quotes during the bad days. But speaking from personal experience, if your mental illness is well treated by the right meds, being happy and positive is effortless. You will find that being human is a complete different experience than you have ever known.

Hope this helps, God Bless!

A Shorten Version of Leap

Recently, it brought to my attention that for someone who is acutely suicidal, they don't have the patience to read a book. Here is my story in under 2000 words. It's also a much easier way to share. Thank you!

Click here for the PDF

Psychologist or Psychatrist?

Recently, someone reached out to me about her mental health condition. She is experiencing symptoms of depression that definitely needs medical treatment. She mentioned that she has seen a psychologist/psychotherapist a few times but she didn't find them helpful. I suggested her to see a psychiatrist because her mental illness is definitely beyond the scope of what a psychologist can do. It made me realize that many people do not know the differences between the two and that can be problematic if a person is seeking help for an acute mental illness.

A Psychologist is someone who usually has a PhD in Clinical Psychology. They have knowledge in psychotherapies, counselling and other treatment methods that improves some one's psychological well being. They are helpful to someone who experiences distress because something traumatic has happened to them. For example, someone who has witnessed the tragic death of a loved one, someone who has been robbed at gun point, or someone who has been abducted for decades and has just been returned to the society, or veterans who returned home with PTSD. In other words, they have very understandable reasons to be depressed. During treatment, the therapist will aim to help them with counselling and behavioral therapy, and if necessary, they might suggest the use of anti-depressants and anti-anxiety medications on a short-term basis. People can completely recovered from their condition after a series of treatment. There are other people who are not sick, but they see their therapist on a long-term basis because their therapist is like a good friend with a lot of wisdom, they can talk about their problems in a safe and therapeutic way. Most psychologists have their own private practice, their fees are not covered by public health care.

On the other hand, a Psychiatrist is someone who is a medical doctor graduated from a medical school. They treat people with mild to severe psychiatric disorders with the use of medications. From experience, when seeing a psychiatrist, they do not attempt to talk you out of your problem. They do not deal with the reasons and trigger of some one's mania or depression. For most mental illnesses, these external reasons are usually very trivia. The focus of treatment is to correctly diagnose the person and find the right type of medication for their condition. Since most conditions cannot be cured, a person should see a psychiatrist on a regualr basis to renew their prescription, likely for the rest of their life. Sometimes, a referral to a psychiatrist takes months in Ontario. When a person is acutely suicidal, they cannot wait that long. Therefore, the best way is to admit them into an Emergency department. A Psychiatrist is covered by Health Care.

If you are already depressed to a point where you are suicidal, it's very likely that you have a medical condition and you need to see a psychiatrist right away. If you are still able to function on a daily basis, meaning that you can sleep and you still have the desire to eat, and most importantly, the reason of your depression is big and everyone agrees with it, then, you are probably in a bad mental state that is temporary. You might not need to be placed on medications. Having a good psychologist/psychotherapist will help facilitate your healing process.

How to Help Someone who is Acutely Suicidal

Recently, I have a family friend who is experiencing an acute mania/depression. Helping his family go through it has given me an update on how the system works  (in Ontario Canada) for psychiatric patients and how to effectively help someone who is acutely mentally ill (which applies to all). 

It started a month ago when his mom told us that he had been acting strange lately. He had trouble sleeping, he was delusional and he was talking to himself all the time. His social media posts were disturbing.  His mom thought that he would eventually snap out of it and get better on his own. It was hard to convince her that her son must receive medical interventions. Then, he started to wander on the street during most of the day, she did not know where he had been to or what he was doing. Finally, she asked us to take him to the hospital. That’s when I saw him for the first time since he became ill. Honestly he didn’t look sick by just looking at him. Except I could tell that he was no longer the soft-spoken and nice guy that he used to be. His mom said that he had become a different person, really angry and verbally aggressive, which definitely gave me that kind of vibe.

But he refused to go to the hospital. So we called 911 on him. When the paramedics showed up he was furious and started to argue with them. Some of the stuff he said was nonsense and delusional. The paramedic told me that they had no authority to forcefully take him against his will, only the police officers could do that, but they were caught up somewhere and we had to wait for them. Almost 45 minutes later, two cops finally showed up. My friend did not resist at all this time. He got up right away and walked towards to ambulance. One of the cops told me that normally they would put handcuffs on a patient to prevent any incidence, but my friend looked relatively calm, they didn't think it was necessary. One of the cops went into the ambulance with my friend while the other cop followed the ambulance in his police cruiser.

After arriving at the emergency room, we were asked to wait for the doctor. The paramedics departed from us, while the police officers were sitting with my friend. We waited for almost 1.5 hours before it was finally his turn. Cops escorted him into the emergency unit. 

Cops came out and asked us:"what do you think his illness is?" They were not at the scene earlier, apparently they could not tell if there was anything wrong with him. We told the cops about his strange and ill behaviours. The cops warned us by saying that he might be sent home tonight, “We have seen people who look sicker than him, and they got sent home. There was a guy here couple months ago, his wife took him to the hospital. They did not keep him but sent him home. He jumped off the building on that night. The ones who get to stay usually look very ill. They don’t take care of their hygiene, they look like homeless people or people who have obvious cuts on their body. Unfortunately, that is how the system works. We cannot hold someone against their will, especially when they appear to be okay. Unless you go to a judge or a doctor to sign what’s called Form 1: Application for Psychiatric Assessment. With this form signed, it would give you the authority to hospitalize him by indicating that he is not mentally capable of making decisions on his own. That way, he will be kept in the hospital for up to 72 hours. After that, an assessment will be made to decide if he should be kept for a bit longer (up to two weeks, then reassess again)“. 
“Where can we get this form signed at this time of the day?” We asked, it was 10pm on a Saturday night. 
“Unfortunately, he might have to go home tonight and you will have to come back tomorrow with the signed form. He might go home, he might, I don’t know, it depends on the doctor’s decision tonight.” 
There is no way that we gonna let him go home on that night, especially after hearing what happened to that poor husband and wife. After more pleads, the cops winked and said: “ you gotta tell them how severe he is. And maybe more severe than he actually is. . . hope he gets better soon.” The cops left after that. We were lucky that the paramedics and the police officers were very patient, compassionate and helpful.

Another 45 minutes went by, a nurse came to speak to us after speaking to my friend. She asked his mom about what happened and what kinda behaviours and symptoms he had lately....Did we exaggerate his condition? Maybe, but honestly after my own struggle with mental illness, I know that a sick person’s outward behaviour only reflects a small part of what they actually have in mind. Their minds are probably 10 times darker than their actions. Therefore, we were probably right on about the severity of his problems. We told the same story to the psychiatrist who came 20 minutes later. It helped when I told them how my suicide attempt put me in a wheelchair. The doctor agreed to hospitalize him and he will sign Form 1. Thank God he was kept in the emergency room that night and for the next few days. 

For the next three days, he was staying in the emergency department, having a bed but only separated from others by a curtain. He was not medicated yet, the doctor was trying to confirm what he had and finally came to the conclusion that he was having a manic episode. I learned from the doctor that he had his first episode three years ago when he was in another city. His medical record helped confirm the diagnosis, which is bipolar disorder. His first episode was effectively treated after almost two months in the hospital, but he did not keep on taking his medications, because of severe side effects. Though he had been doing well for the last 1.5 years, being off medications was like a ticking bomb. Another episode would inevitable occur.

When a bed was available in the mental health ward, he was then transferred there. He stayed in the hospital for a total of 3 weeks. He was taking his anti-psychotic medication. After he came home from the hospital, there were still times that he would say things or do things that were problematic. But fortunately, as of today, he is no longer at risk of suicide. 

There are couple important things to keep in mind when attempting to help a loved one who is suicidal 

1.    Call 911! The chance of a person staying in the hospital is higher if they are brought in by the paramedics and the police. 

2.    When someone who is sent home right away after being seen by the doctor, it would actually facilitate their determination to commit suicide because they have now lost all hopes that anyone is able to help them, they have lost faith that their condition is treatable. 

3.  When describing their behaviours to the doctors, make it sound worse than you have witnessed. Chances are, there are many troublesome symptoms that you are not aware of. You might not know just exactly how bad they want to die. 

4.   Keep them in the hospital for as long as they are allowed. Ideally, if someone is on medications and takes them consistently, they don’t necessarily have to be hospitalized. But for any types of psychotropic medications, it takes at least 2 weeks to kick in. During that period, staying in a hospital is the only way to keep them safe. When a person is mentally ill, they usually don’t sleep at night, therefore it’s impossible for family members to watch them 24/7.

5.    Taking medications in most cases is a lifelong commitment. The medication that my friend took during his first episode was very effective during his acute state. However, when he were at the maintenance stage, he should switch to a milder medication. He did not have a long-term psychiatrist who could follow up with him regularly to adjust the use of medications. That was a mistake. 

6.    Having a mentally ill person in the family is extremely tiresome, therefore patience and unconditional love is really needed. Most importantly, be educated about their condition and monitor them to make sure that they stay on medications. 

To learn more about my journey and insights, read a free PDF of my story at http://xianancy.blogspot.ca