Friday Conversations With My Psychiatrist

I’ve learned a great deal in my discussions with my psychiatrist. Which is good, because we’ve been meeting regularly for four years now… mostly for an hour every second Friday afternoon.

So it occurred to me after a meeting last month to start posting the things we’ve discussed somewhat immediately after the appointment.

Admittedly for the first two years (at least) our discussions weren’t entirely… memorable. Mostly because the PTSD was still raging, and the years and years of untreated manic depression was only in the early stages of treatment.

I started the Lithium as soon as I got back home, but the Seroquel and the Wellbutrin didn’t come until much later. So for that first year mostly I was raw and angry and during our meetings I was trying in that moment to justify my moods on whatever interactions I could remember from the previous week.

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But when the medications gave me some lucidity I started to be able to see who I had been untreated, and being able to talk about my life openly and honestly became vital to my recovery. Especially since I had no understanding of the disease, or how to deal with the clinical depressions the disease had been masking.

I’ve been lucky to have a doctor, period. Finding a psychiatrist in rural regions in this country is not easy. Finding one who I’ve been able to have a conversation with is one of the reasons I moved back here.

Some of the most intense and personal posts I’ve published since starting Salted have come from issues brought up for the first time in his office. But he’s also perfectly willing to spend an hour with me talking about technology or politics when my mind is too unwilling to talk about my recovery.

This is what we discussed this past Friday…

One of the things I’ve been thinking a lot about recently is the connections between diseases. As devastating as it was to my mind and body, the manic depression also prevented me from recognizing the diabetes. Left untreated for so long the diabetes has “encouraged” or increased the damage caused by the periodontitis, which has left my teeth barely attached to my face.

Individually the random and prolonged depressions thrown at me by the manic depression, along with the diabetes and the inflammation of my gums caused by the periodontitis all dramatically increase my risk for heart disease and heart attack. Put them together and my life expectancy has definitely been shortened.

But the manic depression is under control. And the diabetes is being treated, albeit slowly and sporadically, with changes to my diet and medications. And, despite losing another tooth this coming Tuesday, the dentist says the damage caused by the periodontitis is slowing, and my other teeth are clean and healthy.

The physical damage these diseases have on us can be repaired. Which, as someone who quit smoking after seventeen years and fifty weeks of two-packs a day, I knew… at least in terms of damage to the body. But it hadn’t occurred to me until my doctor brought it up on Friday that prolonged depression, natural or otherwise, causes brain damage… which can be reversed.

It was the reversal bit I hadn’t really thought of… at least, in terms of my recovery from manic depression, I hadn’t thought about brain damage in a while.

Basically chronic depression damages the areas “vital to learning, memory, and higher thinking”. I don’t know enough about this to really get into it (which is why I’m quoting from Wiki), but brain-derived neurotrophic factor (BDNF) is a “protein coded by the gene that is also called BDNF. In humans this gene is located on chromosome 11.”

“BDNF acts on certain neurons of the central nervous system and the peripheral nervous system, helping to support the survival of existing neurons and encourage the growth and differentiation of new neurons and synapses. In the brain, it is active in the hippocampus, cortex, and basal forebrain—areas vital to learning, memory, and higher thinking. BDNF itself is important for long-term memory.”

Research has linked low levels of BDNF to conditions such as “depression, schizophrenia, Obsessive-compulsive disorder, Alzheimer’s disease, Huntington’s disease, Rett syndrome, and dementia, as well as anorexia nervosa and bulimia nervosa, though it is still not known whether these levels represent a cause or a symptom.”

Preliminary studies have also shown the existence of a link between “development of depressive illness [manic depression] and regulation of BDNF”.

Studies have also been published showing exercise, diet, “intellectual stimulation, curcumin and various treatments for depression (such as antidepressants and electroconvulsive therapy) strongly increase expression of BDNF in the brain, and have been shown to protect against this atrophy.”

So I thought that was kind of cool.

We also discussed drug interactions… when my tooth recently became an issue I started gobbling Extra Strength Tylenol, but switched to ES Advil because I thought I needed the anti-inflammatory. But when you’re taking Lithium you should avoid Advil, or anything containing ibuprofen, because they can mess with your Lithium levels.

In order to be effective the levels of Lithium in your blood has to be high, almost to the point of toxicity. Which is why we have to drink a lot of water and make sure we’re not outside on a hot summer day for too long. And why we should be having regular blood tests done.

A few days on the Advil isn’t a big deal, at least not at the recommended dosage. But I was way over the recommended dose, and I was popping them constantly for about four days.

So… generally it’s just a bad idea.

I also found out the new drug I’m using to fight the diabetes can, in extremely rare circumstances, interact badly with the Seroquel. Basically there’s a potential for them to fight each other.

And I found out my psychiatrist has an iPhone. He used it to find out about the interactions. I don’t know why but I assumed they weren’t available in this region… weird.

We also talked about my nomination by the Canadian Blog Awards in the Best Health Blog category. I’m grateful to be nominated, but I feel awkward it’s in the Health category.

…and we talked about a Canadian filmmaker who, having lost his right eye, wants to replace it with a tiny camera. I recognize the guy from a documentary a while back on why the rest of Canada hates Toronto, and he has a blog about the process which I’ve put in my sidebar.

Basically it came up because we had been talking about my need to document my life using my little digital camera.

There was some discussion about where I am in my recovery. But other than that… there would have been more but it was a short appointment because the person giving me a ride was running late for her own appointment.

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About Gabriel...

...diagnosed with manic depression in 1989, for the next 14-years I lived without treatment or a recovery plan. I've been homeless, one time I graduated college, I've won awards for reporting on Internet privacy issues, and a weekly humour column. In 2002 I finally hit bottom and found help. I have an 8-year old son, and a 4-year old son... I’m usually about six feet tall, and I'm pretty sure I screwed up my book deal. I mostly blog at saltedlithium.com....
This entry was posted in Appointment Day, Bipolar Disease, Bipolar Disorder, crazy people with no pants, Diabetes, Health, Manic Depression, Salted Truths. Bookmark the permalink.

6 Responses to Friday Conversations With My Psychiatrist

  1. thordora says:

    Crap, am I still depressed, which explains my worsening memory, or am I only now seeing the consequences of my depression? Erk-too much thought for a Sunday!

    I don’t much talk to my shrink-very concious of the eyes on the clock, which keeps me clammed up for the most part. Funny-last appointment my levels were down (and I knew it-I could feel it) and she told me to STOP drinking so much water, that I was dliuting it. Can’t win for trying I swear.

    You’ve made so much progress. You’re really an inspiration dude.

  2. bromac says:

    Interesting stuff about the atrophy. I feel like I have a terrible memory and am quite interested in how depression has played a part in it.

    I get along very well with my therapist. He is eccentric, intuitive, and quite brilliant. I have been seeing him for four years and, like your early visits, I didn’t get to start treating the actual disease until I got on the mood stabilizer. Prior to that it was just trying to get through the day.

    FYI-Started work on a blog. It’s up, but there isn’t anything but the “about” done. I did a “history” post but it is very long and I need to break it into parts before I post it. It’s on wordpress and called Swirly Aura… if you’re interested.

  3. bromac says:

    Now, Gabriel, have you seen this on Seroquel? Could it actually be the cause of your diabetes? I copied this from Furious Seasons and it is a statement that was used in pre-trial for a lawsuit against AstraZeneca.

    “AstraZeneca Global Safety Officer Wayne Geller concluded there was ‘reasonable evidence to suggest Seroquel therapy can cause’ diabetes and related conditions, according to documents presented yesterday in federal court in Tampa, Florida. Geller drew his conclusions following a review of available studies and internal trials, according to the documents

  4. Gabriel... says:

    G’day Thor… I’ll agree with the “progress” part, but the “inspiration” part kind of makes me feel the way I felt the first time I drove into a sharp corner not knowing if the wheels would stay gripped to the road.

    In my experiences with Shrinks they’d like to talk about the “life stuff” but not if you’re hesitant to get into it… the next time you’re in their office, and there’s something you’d like to talk about, give it a shot.

    Hi bromac… I’ve seen Furious Seasons posts about Seroquel, he does some good work on his site. But my symptoms predate my use of Seroquel, and stopping my use of Seroquel did nothing to reduce my blood sugar levels. One of the side effects of taking Seroquel is diabetes. Just as one of the side effects of taking Lithium is kidney damage. But the chances of either side effect happening is in the slim to none range.

    Just like politics it’s very important to understand the language of these kinds of announcements… “can cause” is not “will cause”. It’s not even “may cause”. Because of the potential range in numbers and percentages a statement like “can cause” is meaningless without the actual percentage and numbers afterwards.

    While Lithium “can cause” kidney failure, and Seroquel “can cause” diabetes, compared to the number of people taking the drugs the amount of people getting those side effects are tiny… albeit still tragic.

    Can: improbable, not impossible — I “can” get to the moon, if I was strapped to a rocket.
    May: unlikely, but possible — I “may” get to the moon, now that I’m strapped to the rocket.
    Will: probable, not guaranteed — I “will” get to the moon, since the rocket is firing up.

    Congratulations on getting the blog started, I think you’ll be great at it and I’m looking forward to seeing your avatar. When you’re ready please email me the address. If you need any help with the WordPress stuff don’t hesitate to ask…

  5. jennyspeaks says:

    you’re really brave. soldier on.

  6. exactscience says:

    My psychiatrist deals with the drugs and drugs only. So there is fifteen minutes to discuss how my mood, sleep, concentration and memory are doing. Occasionally I can drop in the “I know I am feeling better because I am writing” type thing. But basically mood, sleep, concentration and memory.

    I do like the idea that the disease is making me more stupid. Mainly because it means there is hope that I can be smart again.

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