Care Plan

June 2016, when I was diagnosed with Emotionally Unstable Personality Disorder (EUPD) / Borderline Personality Disorder (BPD), the doctor spoke to me about my ‘Care Plan’.

I had not heard of a care plan before. I wondered ‘shouldn’t my GP have discussed a care plan with me, instead of keep giving me antidepressants?’… I was never told properly about managing my own mental health, taking control. I feel like the GP ‘palmed me off’ with antidepressants. I guess though that it didn’t help that I could not articulate my feelings and thoughts. But aren’t doctors trained for recognise that in people?!

I remember when I first went to get antidepressants. I didn’t know at that point that I needed therapy. Well, I sort of did, but I don’t know… that’s just what people do when they’re depressed, get antidepressants – isn’t it? That is the norm?! We went through the ‘test’ that they do to see if you could be depressed. Yes I passed the test. Antidepressants – Fluoxetine were my reward. Whoopee. But I didn’t take them properly. I missed doses and doubled up some doses. It was a shambles.

In the beginning of 2015 I started taking Citalopram. It made me very tired as first, gave me diarrhoea, and made nauseous. Messing with my gut! Not good. My doctor said that my body would get used to the medication and that I should persist with the treatment, soon those symptoms would not be a problem. The symptoms did ease off. I started taking the Citalopram at night before bed to battle the daytime tiredness. After 6 months, I started to feel better. I don’t know if that was actually the drug or the placebo effect. Either way, they seemed to help. After taking the Citalopram for 6 months I had around a year with little depression. I was still low sometimes but I had started to feel motivated again.

In the beginning of 2016 I was struggling to manage my emotions. When my daughter went with her father, I would lay in bed on my own for the majority of the time. So, I asked my GP for some more antidepressants to see me through. I didn’t want Citalopram again as it made me put on weight. I wanted to try an antidepressant that a friend had recommended and that I had researched – Sertraline. I took them for around 4 months. They made me nauseous and affected my libido. They didn’t make me feel tired though which I was glad about. I started to read more and more comments online from people who had taken Sertraline and reported that their sex drive never returned. I was very concerned about this. I thought that I’d started to feel better whilst I was taking them, but that effect soon wore off.

I had a lot of negative influences on my mood at that time in the spring / summer of 2016. I am slowly getting better at eliminating the negative influences on my mood. It’s a learning curve. I haverealised that I’d spent too much of the last year with the wrong people and not enough time with the right people. Too many negative influences and not enough positive ones…

Mid 2016 I was having mood swings. I was prescribed Lamitrogine, to stabilise my mood. It did not stabilise anything. I actually refer to those tablets as ‘The Murdering Pills”. They made me feel so angry, the kind of anger that you can feel in the pit of your stomach. I was just on-edge the whole time. They also gave me a rash on my stomach that I was concerned about, but a rash was a common side effect so I thought it would pass. I was aware of keeping an eye on it to see if it got any worse. I was taking this medication when I smashed my guitar up in the garden. I remember that morning, I woke up, looked to my partner that I knew was lying to me and manipulating me (but I could not prove it) and in my head I thought – ‘something has got to break – right now’. I literally woke up, got out of bed, picked up the guitar and went into the garden and smashed it up on the pavement. It broke within a few smashes and I was still feeling angry so I went back to bed to sleep. I had kept the anger in for too long and it exploded. My daughter was with her father she did not witness that. I instantly stopped taking the Lamitrogine after that incident. I told my doctor that they were making my mood swing worse. I even told him about the guitar and said that they were “murdering pills”. He seemed surprised by this as the medicine as it should have improved my mood. I was surprised by this too! He seemed disbelieving of what I was reporting. I think that that appointment was when I finally demanded that he sent me to see an actual Psychiatric Doctor.  I stopped going to the GP for anything to do with my mental health after that. Thankfully, I now have access to the community mental health team.

Below is a screenshot that shows that other people have also suffered the extreme anger brought on by Lamotrigine. I was on a low dosage, I think it was 25mg. I didn’t have murderous impulses, I didn’t want to kill anything, but I imagine that the cases below also felt the same kind of rage.

Screen Shot 2017-05-14 at 17.19.23

https://www.ncbi.nlm.nih.gov/pubmed/24736088

At the end of 2016 I was prescribed fast-acting Quetiapine – to stabilise my mood and because I was not sleeping properly. I had to undergo an ECG to check my heartbeat for any irregularity before I took them, and then I had another letter asking me to come for another ECG – possibly because of my family history of irregular heart rhythm. But I had already stopped taking them by that point. I did not take much of that medication as it made me so drowsy. I literally could not wake up in the morning. I was in a haze of confusion, not quite asleep but not yet awake. My eyes felt heavy like they just needed to close. I actually had the best sleep on that medication, but I can’t be like that with a child to tend to. I took them for about a week, they did help with the moods, I felt calmer, but the drowsiness was too much. I even took them at night before I went to bed. And I even took a low dose. At 25mg the drowsiness was still an issue but I was not confused in the morning. At 50mg the drowsiness was way too much and I was confused, in a haze. Quetiapine can have some very serious side effects. These are the some of the less serious side effects (that are quite typical of antidepressants / antipsychotics):

  • dizziness
  • drowsiness
  • dry mouth
  • sore throat
  • stomach pain
  • upset stomach
  • nausea, vomiting
  • constipation
  • breast swelling or discharge
  • missed menstrual periods
  • weight gain.
  • headache
  • mood or behaviour changes
  • appetite changes
  • decreased libido

I was also prescribed a sedating antihistamine, to try instead of the Quetapine. But that too made me too drowsy for comfort. I actually do not like taking any medication, preferring the natural route whenever possible. I have tried a few different medicines though as I figured out the best care plan for myself.

When I first decided to try antidepressants around 2011, I was not in the right frame of mind to be properly monitoring myself. Going to the GP and asking for antidepressants was really more of a cry for help. I didn’t know what else to do. I was depressed and not thinking straight. I didn’t want to take a drug like that, as I said I prefer a natural route. I also knew that my depression and anxiety issues ran deeper than a quick fix in a pill. I knew that the antidepressants would ‘mask’ the depression and that it would come back when I stopped taking them. I didn’t want to put those kind of chemicals into my body for X amount of years, knowing all of the serious side effects that antidepressants have, just to mask the problem. The side effects of antidepressants can be very serious, I worried about them. I worried about the effects of the medication altering my body’s natural processes. I worried about addiction, as many people do get addicted to antidepressants. Some people are on them for life. One friend told me that her GP had said “take the time that you have been depressed and times it by 2, that’s how long you should take them”. My GP told me I should take them for “at least 2 years”. People have to be weaned off of antidepressants, and suffer horrible withdrawal symptoms.

With all of this mind, I concluded that antidepressants are not really a drug that I needed or wanted to be taking.

The evidence for antidepressants increasing serotonin and other neurotransmitters is underwhelming. Read this interesting study by Claire Wilson for more information on this.

Below is an excerpt from that study by Claire Wilson:

‘One factor behind the growing acceptance of antidepressant use could be the widespread belief – started by their manufacturers – that the drugs work by correcting a chemical imbalance in the brain. They are said to replenish levels of the feel-good chemical, serotonin.

This probably isn’t true. While the medicines do boost this chemical, it has never been proved that depression is caused by low serotonin levels. In fact, though theories abound, we still don’t know what causes depression.’

 

Depression and mental illness is being misreported worldwide.

Clinical depression has risen by 1000% worldwide over the last five decades. More and more people are being treated for depression, and suicidal thoughts. Could this be a collective response to the conditions that we find ourselves in? Poor living conditions, poor working conditions and poor family life can make people depressed. The world that we live and is causing depression. A good study of this is Is Our Society Manufacturing Depressed People? Written by Mel Schwartz. Psychotherapist, Marriage Counsellor and Author.

When I was diagnosed with BPD, the doctor told me that I would benefit from one to one psychotherapy, but I was to wait for some time, in order to feel mental stronger as the psychotherapy would be intense. The doctor also said that I was also to have some anxiety work and emotional management work. None of this transpired.

I was designated to see a doctor every three months, but I started seeing a doctor once a month at my request. During those appointments I was also diagnosed with Recurring Depressive Disorder and Personality and Behavioural changes due to brain injury.

I was offered this tablet and that tablet to try. My care plan was not really taking shape or going in a direction that I was happy with.

I have been trying to manage my own care plan for some time now, but it is met with some resistance by the mental health community. I had to keep asking to be referred to psychotherapy. In September 2016 I even enquired about inpatient treatments for patients with BPD. I kept asking for support but my requests were ignored / not discussed. My psychotherapy requests were not discussed either. It was not until my most recent appointment in April 2016 that my requests were discusses and now I have an assessment for psychotherapy and some group work. At that recent appointment I  requested an MRI scan to prove that I had personality and behavioural changes due to head injury. The mental health team said that they wouldn’t do that. Why? They said “because we just wouldn’t”… So I asked for it to be removed from my records. It has been. Recurring Depressive Disorder was also removed, for reasons unknown. We did not discuss removing that from my diagnosis. Perhaps the depression that I face is just a part of the BPD / PTSD. I asked the doctor to explore cPTSD. She asked me did I want BPD taken off of my diagnosis? I said that I did not. The doctor also added to my record that I do not respond well to medication, so I will no longer be pushed into taking new medications. I was happy with that. I was happy with the whole appointment, it went well. I feel like that appointment was the second appointment only that I was ever taken seriously. The first was when I got the BPD diagnosis. I was discharged from the mental health team, but with a letter saying that I could return to a doctor if I needed one, and that I could still access the community mental health team for support if I needed to. So now I am just waiting for therapies. I have an assessment for therapies in a few weeks.

I also have other precautions for my care in place, such as having friends and family that I can ring during a crisis who will come over and be with me, or take my daughter for the night. People are more aware that I need support while I am on this road to recovery. Without the right support there is the possibility that I will relapse back into the major depression.

Effective Care for People Experiencing BPD – This is possibly the best website that I have ever come across when looking for the most effective care for people suffering BPD. Engaging and comprehensive, very informative and non judgemental… NOTE: The link has now changed – follow its path and then sign up and then find the ‘Working with people who have BPD’ course. It is all free. Don’t let the sign up questions put you off of signing up and accessing the material!

People with BPD need effective care plans while they recover. An ineffective care plan can prolonging the BPD symptoms. If possible, patients should be placed with a psychologist that is an expert in Personality Disorders. The delay of psychotherapy can cause BPD symptoms to worsen.

An effective care plan can be the making of a BPD sufferer 🙂

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