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Pebbles, Potholes, and PerspectiveMedications, Micronutrients and Mental Health (Part I)
by Sarah Hancock
I had my first psychotic break in 1998. Initially I was diagnosed as having bipolar disorder and placed on a mood stabilizer. With the exception of Lithium, every mood stabilizer can double as an anti-convulsant. We're talking serious medication with what can be serious side-effects.
The first notable side-effect was weight gain. At my first diagnosis, I weighed 104 lb (dripping wet). Not because I wasn't eating, but because everything I ate vaporized. At the time, my parents and doctors were doing all they could to encourage me to gain weight.
It wasn't that I wasn't trying--I ate enough for a football team--the weight just didn't stick. Three months after being put on my first mood stabilizer, I weighed in a full 60 pounds heavier. That's like becoming pregnant with a small hippo--in three months! I'm sure my stretchmarks were comparable to any seasoned mother--without the cute little ones to go with it.
As my illness progressed, the doctors concluded that since the psychosis occurred regardless of my mood, that I really had what is called Schizoaffective disorder--Bipolar type. Basically a combination of schizophrenia (where your brain plays tricks on all five of your senses) and bipolar disorder (where your mood fluctuates from suicidal to unimagined elation--sometimes within hours). Doctors decided that in addition to taking the mood stabilizer, I needed an antipsychotic.
Having grown up with a mother who had Type I Diabetes, the idea of not taking my medication never crossed my mind. As a child, I grew up privy to many phone conversations with doctors and nurses about insulin. I witnessed what insulin could do to help her feel better and I understood what it could do to make things worse. I knew from a very early age (FHE lessons at three years old) that medication wasn't something to be messed with--and neither was Diabetes. I learned medication was something that could save a life. I also learned that the wrong medication can cause severe side effects, especially if allergies play a role.
Taking my childhood experiences into account, when the doctor put me on a medication, and told me that I had to take it every day, it was simply a given that I would take it daily. As far as medication compliance was concerned, it wasn't an issue. I took it because I had the faith that it could make me better--until it didn't, and then we'd just try something else.
From 1998-2008, I tried 37 different cocktails of medications. Medication changes came when a psychiatric drug would spontaneously stop working, when I had allergic reactions (like a sudden drop in white blood count) or embarrassing side effects (spontaneous bladder loss) or when they simply made things worse.
Unlike other types of medications, psychiatric medicine is not a very refined science. There are medication categories and a doctor will just try you on a med from a specific category (antidepressant, mood stabilizer, antipsychotic, antianxiety, etc.) aimed to help that type of symptom, but there is no blood test to know exactly which medication will work the best for you. They call it practicing medicine for a reason.
There is something that you have to understand about mood stabilizers and antipsychotics, even when you are on the right mix, you still experience symptoms--they just aren't to the intensity of what they can be when you aren't on medication. Medications enable the voices and the bizarre to be softer and less convincing--but they are still there. They just become easier to ignore or brush off.
While some medications did better for me than others, all medications had side effects of some sort. I guess that's the truth for all medicine. But let's face it, when the nickname for a medicine is the H______ Hundred, you know that side effects aren't just rumored. No, the "hundred" does not refer to the dosage, it's referring to the vast amount of weight a person gains when on that medication--like the more commonly known Freshman Fifteen for new college co-eds. And yes, when I was on that medication, my 5'4" frame soared over 250 lbs.
One reason why people are so willing to go off psychiatric medication cold turkey (something I will never advise) is because of the far-reaching and often embarrassing side-effects. Surely there had to be a better way, but in my 18 years of the illness, I certainly hadn't found one.
Since I began having severe symptoms back in 1998, I've met people again and again who would end up in the hospital because for whatever their reason, they'd quit the meds. The silly thing was, during that entire time, I was religious about taking my meds--and still regularly experienced symptoms so severe I required hospitalization. It was the most bizarre game of damned if you do, damned if you don't. Since severe mental illness is the result of a chemical imbalance within the brain--even if the medical community cannot precisely identify which chemicals are out of whack--the only way to fix the brain is to get those chemicals balanced.
What if there was a way to balance those chemicals naturally? During those 18 years, not once did a doctor talk about how I could do it naturally. Sure, cut out the caffeine, done. Cut out the refined sugars, tried . . . but I'm no saint when it comes to giving up sweets entirely. Healthy eating can take me to a healthier body, but I hadn't experienced any lasting mental stability resulting from anything natural. In fact, some of the "natural" remedies made me worse. Much worse. Consequently, time and time again, doctors gave me pharmaceuticals.
The hard thing about pharmaceuticals is that some can take a long time to work, and the patience required to get them into your system (six to eight weeks for antidepressants or mood stabilizers) can cost you a lot in terms of quality of life. Job loss, interpersonal relationship issues and housing loss are only a few of the devastating things I've seen happen in the lives of friends with severe mental illness who were waiting for medication to work. I cannot begin to discuss the numbers of people I know who have lost very important things while unmedicated or waiting for their meds to work. It's frightening what your brain can do when it's imbalanced. I wouldn't wish it on even the few people who've wreaked complete havoc on my life.
Last February, I found myself headed in the severely imbalanced direction. Logically I knew that because of the high dose of my antidepressant prescribed at the time (50mg over FDA recommendations) that to get things back on track, my doctor would have to detox me from that medication and then titrate me onto another one. Changing one medication can easily mean changing all of them and since I was on an antidepressant, mood stabilizer and antiphychotic, I knew it was quite possible that I would soon be searching for an entirely new cocktail--a process that would take (in the best case scenario) up to six to eight months, easily.
It takes so long because in addition to detoxing from one medication and the four to six weeks of getting on the new one, once you get on that new one, you still have to find the right dosage. Then once you find the right dosage for the one type of medication (i.e. mood stabilizer), they have to keep adjusting the dosages of the other types of medications that you are on (i.e. antipsychotic, antidepressant, etc) or detox you from a well trusted antipsychotic because it no longer works with the new mood stabilizer. It's a long and tedious process. No wonder it took me 12 years to find stability after my first psychotic break!
In short, I knew that changing my antidepressant would disrupt the equilibrium we'd found back in 2009, and I really wasn't interested in taking another 12 years to get it right again. I was in a desperate state. Even more so because it could cost me my job, my home, and even quite possibly my marriage--my husband is one of the most compassionate people I know, but living with an imbalanced brain really messes with interpersonal relationships. My illness was putting us both through the ringer. I was desperate to fix things.
Enter my friend who has also lived with severe symptoms of bipolar disorder. She'd tried this micronutrient supplement. She was experiencing an extended stability that I hadn't seen in other people living with bipolar disorder, medicated or unmedicated. She had talked to me about it for about six months, maybe longer. But the entire time I kept putting her off thinking, "well, I'll see how you're doing in eight months" (Six to eight months is typically the amount of time it takes for someone living with bipolar disorder to come crashing down after going off medication.)
But I was desperate. I had to fix the heavy depression without the detox and titration period of time required for standard medication. So I called her up, got the annotated bibliography of the twenty-five independently funded clinical-trials and took it to my doctor. He reviewed it with the standard skepticism I would expect of any trained physician. But as he continued through the abstracts, he raised his eyes to mine and said, "Well, the methodology is sound. Do you want to try it?" I was floored, expecting him to shew me out of the office with another prescription.
"Um. I think so. But do you think it will interfere with my other meds?" I held my breath, knowing that everything effects my meds.
He scanned the list of ingredients. "Nope. They're just vitamins and minerals that have been put through a refining, chelation process. They're micronutrients. That's not going to effect your meds. If anything it will help heal your body. You take a multi-vitamin, right?"
"Yeah." I shrugged. This product wasn't a multivitamin in the standard sense.
"Then let's just dump the multivitamin for now and take the micronutrient instead." He tilted his head and reached up to remove his reading glasses. "Keep taking your other meds and call me in 72 hours. Sarah, I don't have to tell you how severe your symptoms of depression have become. I don't want it getting more out of hand than it already has. I'll let you try this micronutrient thing for 72 hours and then we'll begin the process of your med change."
"72 hours?" I panicked. Flashes of hospitalizations, restraints, ECT and forced shots fired through my brain. "I can't get worse. Maybe we should start the detox process now." I clamped my hand over my mouth thinking about work and my apartment and my husband. "Wait. I can't get off work right now. I am in the middle of a major project. My husband is worried about me."
I sat in his office on the verge of tears, suddenly realizing I hadn't showered in probably a week. It was all I could do to drag myself to work, come home, sleep for 14 hours and begin the painful process the next day.
"Sarah, the problem is, things are getting worse."
"I know." I whispered, shaking my head. Tears overflowed, making hot trails down my cheeks.
"It's time to change your meds. You've been five years on the same meds, a rarity for someone given your history. Medicines just stop working. You know that. We just have to find something else."
"Do you think that adding a micronutrient will help?" I searched his face for even a hint of the usual laughter I got from Doctor In when I suggested something related to my suggestions. There was no laughter. His face was very serious. He was taking me serious.
"Well, this research is pretty solid, but I've never recommended this product to anyone and I'm completely unfamiliar with it."
"But I can't take off work for a detox at this time."
"You can't afford to live like this for much longer. I'm surprised you're even able to make it to work. It speaks to your determination, but I'm not sure it's healthy at this point."
"But I have to pay my bills. We have to make rent." I blinked back the tears, forcing images of my husband and I out on the street back into the darkness from which they'd sprung.
"Well, let's do this. It's Tuesday. You're clearly stressed about missing work. Go ahead and start taking this micronutrient for 72 hours and then call me Friday so we can begin your antidepressant detoxification process over the weekend. In the meantime, you should talk to your boss about getting some time off. If this research is as sound as it seems, maybe that micronutrient can take some of the edge off of this whole process."
"Sure." I mumbled. I was in a daze. I left the doctor's office, went to my car and sat sobbing. Twelve years. It took 12 years to find this magic cocktail that no longer worked. I was scared to tell my husband about what he might witness as my brain began the detox process. Instead I called my friend about the micronutrients. I began taking them with that evenings' dinner, deciding to hold off on telling my husband about the detox process until my doctor and I came up with a plan. Today was Tuesday. Life would begin to unravel over the weekend.
Friday morning I woke up without my alarm for the first time in years. I showered, made a lunch and got to work on time for the first time in more than a month. (Gratefully when I am late, my employer allows me to shift my hours later.) I sat in the office, dutifully checking things off my to-do list, humming. My boss noticed, telling me she was grateful I was feeling better. It hadn't even occurred to me that I was. In fact, it hadn't even occurred to me that getting out of bed that morning hadn't been the usual laborious process associated with severe depression.
I sat at my desk, processing her comment. Oddly, I was feeling pretty light-hearted, a far cry from how I'd felt only 72 hours previously. In fact, I was feeling better than I'd felt in months. It had to be a placebo effect.
At lunch, I called my doctor and told him that I wanted to hold off on the detoxification process. He worried that my motivation was simply my determination to stick with work, but I told him I was feeling substantially better. He invited me to call him first thing on Monday morning. I agreed.
I sat at lunch combing through the micronuturient annotated bibliography, searching for answers. It was pretty basic. The micronutrient was having the same effect on my mind as it had in the four-continents of twenty-five independently funded clinical trials. But the question remained, was it a placebo effect? If it wasn't, how long would the change in mood last?
Tune in next- time for Medication, Micronutrients & Mental Illness (Part 2).
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