Tailoring Your Mental Health Treatment

We would like to say a special thank you to Nick, the author of this post, for writing this guest blog and telling his story. Nick is a wonderful, influential person and a great blogger. If you are interested in his journey, you can follow him on Twitter at ManicGrant.

Finding The Right Diagnosis 

I was never content to accept the first diagnosis and the first treatment that I was offered, or the second, or the third... and so on. I'm glad I never settled - by pushing harder for treatment that worked for me, and questioning my diagnosis, I've learned so much about how to manage my illness.

Starting out with a diagnosis of clinical depression - also known as unipolar - I was offered Prozac (fluoxetine) which I knew had undesirable side effects and would take 6 weeks to become effective. It was also a smart decision, because I suspected that my mood disorder was more complex than depression - I'd had lots of mood swings where I was hyper-productive and gotten burnt out, so I was reluctant to accept the diagnosis.

It took a few years before my doctors (and I saw more than one) finally accepted that I had type II bipolar disorder. The clinical label just seemed to fit the range of moods that I would experience: highs & lows.

Hypomania vs Mania

Next came medication. At first I was treated as an outpatient, but the psychiatrist was only concerned with treating my sleep problems and depression. I started taking Remeron (mirtazepine), which left me feeling very groggy each morning.

I should state here, that this is not a prescriptive guide to choosing the right medication for you. I'm just explaining my own journey. What works for you might be completely different from what worked for me.

My mood became so low that a crisis team was called and I was then assessed to see if I needed to be kept in hospital. I was taken to a day hospital. There I met a fourth or fifth doctor who confirmed my diagnosis but treated it as if it was the more severe form of the illness - type I bipolar disorder, which used to be known as manic depression.

The distinction between hypomania and mania is an important one. People who experience mania can have psychoses (seeing and hearing things that aren't there) as well as having very pronounced delusions of grandeur and behaving in extreme ways. My hypomania has caused periods of sexual promiscuity, reckless money spending, risk taking, not sleeping, irritability, not eating and working on very ambitious projects.

The way I think about the difference between hypomania and mania, is that it's very hard to judge when somebody is hypomanic, but it's much more obvious when somebody is manic.

I was treated with Seroquel (quetiapine) and the side effects were intolerable: daytime sleepiness, dry mouth and an insatiable appetite for fatty and sweet foods. Without a doubt, if I'd continued taking the high dose of Seroquel that I was taking (600mg/day) I would have become an overweight miserable zombie.

When I stopped taking Seroquel, my mood rebounded: it triggered instant hypomania. The big problem I have when I'm hypomanic is that I think "I'm cured" - I stop seeing my doctor, taking any meds and I go back to work.

Hypomania at work can be amazing, because you can be hyper-productive. However, the irritability and over-confidence causes me to say things that are not appropriate in a corporate environment, and I've lost a bunch of jobs. Sadly, too many companies have a "fit in or get out" culture.

Being Hospitalized 

I ended up being admitted to a psychiatric hospital, because I was a danger to myself.

Psychiatric hospitals and wards are hugely varied. I've been a patient on 5 different psych wards, so it's worth discussing the differences.

The first hospital was super comfy. The bedrooms were really nice, there was a nice garden to take walks in and a gym. The food was great. You'd think the food wouldn't be an important consideration, but if you're going to spend weeks or months in the same place - often with restrictions on whether you can leave - then you need to like the food.

The second place was called a crisis house. There were very few restrictions on what you did with your day at the crisis house. There were peer groups, art groups, music groups and other activities on a daily timetable that would occupy your time for the whole week. Alternatively, patients were free to leave and do what they wanted. The rooms were spacious and light. It was a very nice place.

The third hospital was much bigger, so there were many more patients in the groups. As well as art and music, there were walks in the local area - to a nearby park and along a canal - and there was a pool table on the ward. The hospital was secure, so you couldn't leave without permission, but my room was nice enough. Each shower was shared by several patients, but that wasn't too much of hardship.

The fourth hospital was absolutely huge, and the wards were divided by sex: male only and female only wards. There was a ward for extremely unwell patients, called a Psychiatric Intensive Care Unit (PICU). The PICU ward had high fences and an airlock-style door to stop anybody escaping. There was also a seclusion booth that was padded and soundproofed. Patients on this ward were forced to take their medication, with staff restraining patients and giving them injections, occasionally.

I was transferred from the PICU to a regular ward. At first, I had my own room with an ensuite toilet. The ward had over 20 patients, and it was extremely noisy - TV blasted at full volume and lots of patients had radios, which blasted out different music stations in an acoustic assault that was not at all calming or relaxing. Patients were aggressive and there was a lot of door slamming and hitting of things, making loud sudden noises. It would not have been a nice environment for anybody of a nervous/anxious disposition.

Determining The Best Medication For Me

Through this journey, I tried a bunch of psych meds: Abilify (Aripiprazole), Depakote (sodium valproate) and Zyprexa (olanzapine). By far and away the worst of the bunch was Abilify, which left me literally dribbling - I couldn't even speak without spraying spit over whoever I was talking to. Abilify was awful and it took a long time before I returned to normal, which was scary.

Most of the psych meds seem to make you sleepy and hungry. If you work a job where you might have to work 8am to 6pm, that doesn't leave a lot of time to eat your evening meal and get into bed, to get enough sleep and avoid a terrible struggle to get out of bed. It's really hard to have a regular job AND take psych meds.

The two meds I found worked for me, after a long and difficult journey, were Wellbutrin (bupropion) and Lamactil (lamotrogine). For my depression, Wellbutrin is brilliant, because it's fast acting, it lifts my mood and gives me back my energy. For my hypomania, Lamactil seems to allow my mood to lift naturally, but doesn't let it get too high, while also not having terrible side effects.

If I have insomnia, I would still use a small dose of Remeron, Seroquel or better still, some Ambien (zolpidem) or Imovane (zopiclone) but these medications are addictive so you can only take them for a short while.

Continuing My Journey

I think that exercise, good diet, regular routine - particularly bedtimes and getting up in the morning - and work/life balance, are the pillars that good mental health are built upon. It's really hard to get that though, when you become unwell, which is where medication can work as the crutches to get you back on your feet while you recover. Certainly, my journey is nowhere near complete: I need a new job, to reconnect with friends and repair family problems. All the good work you put into building a healthy life can crumble to dust when you get really sick.

I've tried yoga, acupuncture and other alternative therapies, but these things are not magic bullets. Mindfulness can be a useful practice to calm your mind - it's especially useful to me at nighttime, when I'm trying to get my brain to stop bombarding me with thoughts.

There are good and bad hospitals, wards, psych meds and doctors. It's really important to shop around and find what works for you. Also, the little things can really throw your world into chaos - too much alcohol, recreational drugs, late nights, stress at work, money worries, housing worries, conflict with people. It sounds like I'm talking about a really boring and drama-free life, but I feel a lot better when I'm kind of strict with myself about what I will and won't allow to happen in my protective bubble.

Getting all the pieces of the puzzle in place is super hard, but it's necessary for recovery. Often times, circumstances will conspire against you, and I've thought about giving up and have even attempted suicide. It's worth fighting for your right to enjoy a happy and contented life though - you CAN recover.

If I can offer once piece of advice: it's that you should never settle for second best; if something isn't working for you, try to find something better.