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Losing Faith in My Treatment Team


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I very much like my nurse prescriber, but I'm starting to doubt she's the right person to help me. She's obviously an experienced psych nurse but has only had her prescribing qualification for a few months, I'm not even sure how many other patients she sees yet. It just seems that nothing she gives me really helps, she keeps starting me on really low doses and she keeps saying that I have to wait for meds to work - I understand the reasoning behind this, but at the same time my current situation is kind of critical, I've now had no sleep at all for two nights, and not much before that, and my mind is fraying round the edges, so I feel I need some kind of emergency measures while I wait for longer term benefits. She also keep talking about riding things out since I know my mood is cyclical so I will eventually come down regardless, and wanting to keep an eye on me, which makes it sound like she doesn't appreciate how difficult things are  - maybe I'm just not explaining what's going on well enough?

 

She said yesterday that increasing my mood stabilisers wasn't indicated because my mood isn't fluctuating, it's just way too high. But since it was starting depakote that finally brought me down in the autumn and it was depakote that pulled me through an episode that threatened to be nasty at the beginning of the year, it seems like it might be worth trying increasing that. I guess I'm going to have to ask her about it again.

 

I could ask if I can see the consultant but I don't know how long I'll have to wait for an appointment, and if I did start seeing her again it would only be every few months rather than the 1-2 weeks the nurse can see me. Argh, I don't know what to do!! As I said in another post I have the results of a second opinion assessment on Thursday so I'll ask them what they would recommend. 

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It is tough with psychiatrists and nurses. Many times you have to outright request for changes, if they won't do it for you. You need to be pushy or you need to find another psychiatrist. If you really feel like a certain medication has helped you point that out, and ask for a medication change. Pleading, and playing the I'm just trying to find the right cocktail stance, is all helpful tool. I outright told my doctor that Invega wasn't the best choice for me and specifically asked to be changed to Abilify, and my doctor even let me choose how many milligrams I believed would be best for me (as I had some minimal experience with Abilify in the past). If you feel the Depakote is helping and it could even more, you could ask for more (of course dose permitting), if you haven't slept in two days and you think you need more Haldol or another sedative, go ahead and request it, and if they say no, state your case, and sometimes you may have to implement pleading. And that is absolute crap, if she says that you aren't having "fluctuations" therefore you can't increase the dosage, call her out out on that part if she refuses to increase your dosage. And make a clear case, explain to her tactfully that you are manic, and controlling that mania is in-fact her job. You not sleeping for two days, should be a large concern for her, and I just can't believe you've told her this and she's ignored you. You should probably emphasize how this is affecting your life.  -_-

 

You've got to understand most of the time doctors have no way of understanding what you are go through, just by seeing you. Mental illness is very much subjective, and very few credible diagnostic tests (imaging, blood tests, etc) exist. You pretty much need to state your case, and make it clear that what may work for you, many not necessarily work for someone else. werehorse, good luck. I know we've had the chance to chat on certain occasions and I sincerely hope you feel better & of course get some sleep. It sounds absolutely miserable.  :wall:

Edited by Forbidden91
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I would try the things that Forbidden suggested and, if you're still not satisfied, find a new pdoc.  Being a consumer is very much about being an advocate for yourself.  Don't just wait to see what she wants to do, be proactive, do research, find things to suggest.  Especially, like forbidden pointed out, meds that have worked for you in the past.  And I totally agree that not sleeping for two days is something that needs to be addressed.

 

My pdoc and I have a give and take when it comes to managing my illness.  She is always asking me what I think about a particular med change.  And I think that's the way it should be, ideally.

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I agree with Forbidden. Since you seem to have trouble getting a new doctor, I think in this emergency situation the most important thing is to make sure you get the treatment you need. If you've been on high Depakote before and that helped calm your mania, I'd tell her what dose that was, if you have any experience with Haldol, I'd tell the nurse what dose you were at and ask her to put you on that.

 

From your other posts, it seems you can manage your illness rather well, you might not seem as manic as many other people she sees, even if you are doing much worse. Can you try to tell her how bad you are really doing? I'd tell her that you might seem like you are alright, but you are actually not, make 100% sure she understands how bad it is.

 

Not being taken seriously because you present well can be immensely frustrating, I hope you get the treatment you need.

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Thanks everyone. Yes, I think I need to be more assertive. I have some over the counter sleeping tablets to try tonight and if they don't help, or don't help enough, I am going to call my nurse in the morning and say I definitely need something to help me sleep, and ask if I can try increasing the depakote. I'm actually taking chlorpromazine now, because the haldol was giving me akathisia.

 

I'm also going for the results of a second opinion on Thursday, so I'm going to ask them what they would recommend given my current situation.

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I hope you get the help you need. I see you're in the UK (by your blog URL!) and I'm in a country with socialized health care also (Canada) and I know how damn hard it is to find new doctors. It's hit or miss, hope you get a good one the first try. It may be hard at first, but being assertive works best sometimes. I hope you get some relief.

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