Massive high

[SteveW]

The Solhull Project waiting time is difficult to estimate. In Leicester the wait for short term Cognitive Therapy is about 6-8 weeks. The waiting time for long term psychotherapy is not far short of two years. Shorter term and group therapies tend to be way shorter than individual ones. All you can do is make a phone call and see what estimate they give you.

I am not sure of your medication. You have been stable for a while but whether this is due to Venlafaxine or just one of the ups and downs of Bipolar it is difficult to tell. Then there is the question of diagnosis. I have been working on the basis that you are suffering from Bipolar but I am not a psychiatrist although I had had a job that involved diagnosis. You really need a proper diagnosis from a proper clinician. This needs a referral to your Community Mental Team.

I had a look at guidelines for dealing with Bipolar. The advice was in the event of hypomania or Mania, take the person off any anti-depressant they were on. So if the guidelines were followed you shouldn't be on Venlafaxine. Probably.

When it comes to work all you can do is explain what you have been experiencing but stress that psychiatry has treatment and that many people are stable on medication.

Hope that is of some use.

[SteveW]

The Solhull Project waiting time is difficult to estimate. In Leicester the wait for short term Cognitive Therapy is about 6-8 weeks. The waiting time for long term psychotherapy is not far short of two years. Shorter term and group therapies tend to be way shorter than individual ones. All you can do is make a phone call and see what estimate they give you.

I am not sure of your medication. You have been stable for a while but whether this is due to Venlafaxine or just one of the ups and downs of Bipolar it is difficult to tell. Then there is the question of diagnosis. I have been working on the basis that you are suffering from Bipolar but I am not a psychiatrist although I had had a job that involved diagnosis. You really need a proper diagnosis from a proper clinician. This needs a referral to your Community Mental Health Team.

I had a look at guidelines for dealing with Bipolar. The advice was in the event of hypomania or Mania, take the person off any anti-depressant they were on. So if the guidelines were followed you shouldn't be on Venlafaxine. Probably.

When it comes to work all you can do is explain what you have been experiencing but stress that psychiatry has treatment and that many people are stable on medication.

Hope that is of some use.

[Russell]

Hi Steve,May I take chance to tell you how much I appreciate your continued support,it really is helping me through a very difficult time.I go back to GP tonight after 4 weeks on venlaflaxin to see how things are. My best attempt at vocalising my experience would be last week so up I felt like a child on Xmas eve all week. This week I feel as if a loved one is in a critical condition in hospital and I have to put on a super-human defence just to get through the day to day. Is this Bipolar? Do I need to increase the dosage? Should I go back to Citalopram? These are the questions I shall be asking.

[SteveW]

The only reason for going back on Citalopram would be if you had a diagnosis of unipolar depression, and you don't. There lies the problem in that you have a prescription but no diagnosis. The area you are experiencing can be difficult. People with normal depression experience variations in their mood. They have good days followed by bad ones and good periods followed by bad one. But people with Bipolar cycle more often and in a more extreme way.

Someone has to be prepared to say that you are depressed or you are bipolar. It isn't looking good for this being your GP so you are going to have to see your Community Mental Health Team. I think I would ask my GP if he is prepared to state that you have bipolar or have simple depression. If not then he has to refer you to the local CMHT.

You could ask him if he would give you a trial on a mood stabilizer. For various reasons that comes down to Depakote.

I don't think increasing your Venlafaxine is much of an idea. It hasn't made much of a difference for you. It doesn't make sense for a GP to increase a drug when he doesn't know what he is treating.

I would be happiest fpr you to leave your GP with a tentative diagnosis of bipolar, a referral to CMHT for a definitive diagnosis and a prescription for Depakote. Whether you can get that I don't know. Stressing the continuing cycling and the suicidal thoughts might just sway your doctor.

[Russell]

So the upshot of my meeting with the GP is that it didn't happen! Waited 40 minutes and had to leave. I am giving the Sertraline a try and they seem to be okay so far.I have my Healthy minds appointment for next week, so I will plug on with Sertraline until then. Last week was a bummer,but this will happen. One thing I have learnt is that it is alright to ask for help. Until now I have muddled on alone and seen this as a sign of weakness,but I'm learning it is quite the opposite. Much happier today!

[SteveW]

Hope Healthy Minds goes well for you. One downer I ought to mention just in case it happens to you. Some projects see people to assess whether the service is suitable for the person. If they are they get put on another waiting list. We have one large counselling project in Leicester that does this. It causes endless frustration. Hopefully Healthy Minds works differently.

Hopefully Healthy Minds will have clinicians who can make diagnoses as well. What these projects do varies tremendously. Hope you can find time to let me know how you get on.


Steve

[Martin]

How are you doing Russell?
Your 'high' sounds worrying. Phew. I haven't had chance to read all the follow-up replies yet but will do - I just wanted to comment about the medication as Steve also mentioned it.

2 things that have helped me more in the past few months than at any time in the past 30 years... Becoming friends with my wife (letting her in to my darkness) has had a massive (positive) impact and, secondly, opening up a bit more to my doctor which led to a better prescription.

I decided to mess around with my medication intake last winter and it was a big mistake. I've been spiralling all over the place emotionally for years and hiding it all away, including plodding on with the same prescription without mentioning my ups and downs.

Speaking more openly to my wife has allowed us to become friends - something I had prevented by never coming clean about how I'm feeling. She is now actively involved in my 'coping' and I even had her come to the doctors with me to make sure I didn't forget to say anything important. She also now understands what the modified prescription was done for and what happens next.

I guess, in summary; I started talking and it helps.

[Russell]

Into my second week of Sertraline 50mg and things seem to have calmed down. Healthy Minds meeting this Wednesday morning. One side effect seems to be occaisionally feeling "out of it", like I've had few drinks. Is this normal? Also what are the guidelines for alcohol with Sertraline? As regards sexual side effects, I haven't experienced any real change,which is good news!

[Grace]

Dear Russell,

Good to hear from you and that Sertraline is making you feel better. Your feeling "out of it" ma be a side-effect, and if it is, it will abate by time. About alcohol my advice would be to refrain, though some wine during meals may be allowed. Though others here can perhaps advise you better. Though in my case I do take some liqour every if an opportunity arises, but surely not on a regular basis.
Your healthy minds appointment is very soon so the best of luck ..... in that I hope you'll find some professional who really listen and maybe make a clear diagnosis!

Grace

[Grace]

Dear Russell, I have just read what I have wirtten and here is the revised vesion:

Good to hear from you and that Sertraline is making you feel better. Your feeling "out of it" may be a side-effect, and if it is, it will abate by time. About alcohol my advice would be to refrain, though some wine during meals may be allowed. However others here can perhaps advise you better. In my case I do take some wine furing meals and some liqour if an opportunity arises, but surely not on a regular basis.
Your healthy minds appointment is very soon so the best of luck ..... in that I hope you'll find some professional who really listens and maybe make a clear diagnosis!

Grace

[SteveW]

Hi Russell. The majority of anti-depressants can cause a spaced out feeling, especially at higher doses. Pfizer, who synthesized Sertaline, published the side effects that people experienced in clinical trials. 13% of people experienced "somnolence." I guess what you get could be termed that without stretching  the meaning of somnolence to breaking point. I would say what you're getting is a side effect.

Pfizer recommend avoiding alcohol. They also advise avoiding grapefruit juice. But I have known people drink on all the SSRI's and nothing has ever happened. What you are usually being advised to avoid is potentiation. This is where taking two drugs produces an effect that is greater than the simple addition of the effects of the two. I don't think Alcohol and Sertraline have that relationship. But Pfizer do recommend avoiding alcohol so there must be some kind of possible hazard.

Good luck with Healthy Minds. I hope their package of services matches what you need.

Love

Steve

[Russell]

Just back from first Healthy Minds session. Bi-polar is suspected and also that I may be on the wrong meds! Counsellor was surprised at how my case has been dealt with by GP's so far and is referring me to a specialist. Feel totally drained and very tearful after this first session,is this normal? Have to go into work now,but truthfully feeling like going to bed for 6 hours. Got another appointment for next week,so things should start moving now.

[Grace]

Hello Russell,

Thank you for the good news! In fact many of us here were suspecting this kind of diagnosis and that you were probably not on the right medication! I do understand your feeling drained and tearful. These appointments do take a lot of energy ..... but isn't it a relief to know that you will be in better hands, and that your depression will be better delat with?
You are in my thoughts Russell!!

Grace

[SteveW]

I am glad things went well this morning. I can remember writing a while back that I would like to see you with a tentative diagnosis of Bipolar, a referral to your Community Mental Health Team for a definitive diagnosis, and a prescription for Depakote. Well you have achieved two out of the three. Healthy Minds obviously don't have the personnel to write prescriptions.

I am afraid you may be about to enter your second waiting list. I have never run across a CMHT that didn't have one. I decided I wanted to see my psychiatrist and was given an appointment 8 weeks into the future. And I am already on their books. But many CMHT's don't confine diagnosis to psychiatrists. In the team I deal with all the different professions except the Occupational Therapists see new patients and make diagnoses. That speeds things up and cuts waiting times.    The psychiatrist gets to see the complex and problematic cases. That certainly doesn't apply to you.

Diagnosing you as Bipolar is pretty much a formality. The symptoms you have experienced will scream Bipolar at any clinician. But Bipolar comes in two varieties One and Two and it will be necessary to work out which you are experiencing. Then there is the possibility of you entering your third waiting list. Unless you see a psychiatrist for your first visit you'll need to see one to prescribe appropriate medication. I acquired a diagnosis and then had to wait 6 weeks to get hold of a prescription. The team I use is unbalanced. It has 8 or 9 Community Psychiatric Nurses, half a dozen Social Workers but only one Psychiatrist. An additional psychiatrist would transform the service they are able to offer. Hopefully Solihull have their staffing better sorted out.

If I were you I would give some thought to what you are going to do with your GP and with Sertraline. I would be going to my GP and telling them that I now had a tentative diagnosis of Bipolar. I would ask to be taken off Sertraline and put on a mood stabilizer on a trial basis until things are finally tied up with the CMHT. You seem to have been pretty stable for a while but I can't help thinking you have had a strong element of luck. For a while you were quite ill and your mood cycling was rapid. The working definition of rapid cycling is more than three or four complete cycles in a year. You were certainly exceeding that.

It doesn't seem right that you should have to work your way through the CMHT system before you are on an appropriate drug. I'm assuming that Healthy Minds have taken you on for once a week counselling. That is significant progress. Good luck with waiting times.

Love


Steve