Monday, December 9, 2013

Drugs and BPD

I wanted to talk about psychiatric medication that is only available with a prescription.

My "journey" with mental illness started around the time I entered high school, but I only started to receive treatment from the age of 17, as by this stage things had become fairly critical. This was also the age that I started taking antidepressants.

There are many different forms of antidepressants, but the one I was given, Effexor (venlafexine), is what is known as an SNRI. This stands for Serotonin and Norepinephrine Re-uptake Inhibitor. This differs from SSRI's, which most people have heard of, in that it effects two brain chemicals, not just serotonin.

Effexor is commonly used and has been seen to be quite effective in the treatment of depression and anxiety disorders.

Now I will say that to begin with Effexor worked really well. I'm pretty sure that it helped me to actually finish college and function fairly well for the next few years.

The problem occurred when my dosage was increased after a relationship breakup. 

One thing that is fairly common amongst drugs classified as antidepressants as that they often make the consumer feel a smaller range of emotion. It can be very helpful if you experience crippling lows, but it also means that it's harder to feel "highs" as well. While this effect for me was quite mild for the first few years I was taking Effexor, once my dosage was increased it became much worse.

Now just to note, my experience with Effexor cannot be used to indicate what someone else will experience. Everyone's brain is different, and as such it is very difficult to predict the effects that psychiatric medication will have on an individual.

I began to notice that I struggled to feel any empathy, which was previously very natural for me. When friends talked to me about problems, or I watched or read something upsetting, I would have no emotional reaction to it, where as previously I was emotionally moved very easily.

Unfortunately for me, the numbness became so bad that I began to self harm.

I changed medication twice and have been on my current medication for over a year.

Since my diagnosis (and acceptance) of BPD, it has been more difficult to notice whether or not my medication actually works. It is incredibly frustrating as I commonly get asked this question by health professionals and my answer is always "I don't know." 

Also having been taking antidepressants for 6 years, and especially during the years I was really forming and establishing my identity, I honestly don't know what I am like without them, and I'm not completely convinced that I would be the same person now had I not been on medication this whole time.

I have been lucky however in that the health professionals that I have seen since being first diagnosed were very careful about prescribing medication. Too often I have heard of people having medication basically thrown at them, and people being on so many drugs it honestly scares me, especially psychiatric medications.

I have only very recently been prescribed an antipsychotic (quetiapine). This class of drug is commonly used in patients with bipolar disorder to aid in the treatment of mania, but is also used in psychotic and personality disorders, as they can also experience mania like symptoms, or simply high distress.

I was hesitant to tell people this had happened, but it became difficult to avoid as I had to take it at night, at least an hour before bed, and it makes me quite drowsy (it really helps me sleep). This has had a significant impact on socialising (most of which I do in the evenings). It's also quite a horrible name for a class of drug, as people can immediately jump to the conclusion that you are now actually a crazy person, and to be honest I feel like this too sometimes. It's not uncommon for someone to be on antidepressants. In fact, it's incredibly common. But antipsychotics? Not so much.

It's hard not to feel like I'm officially a crazy person now. While I haven't been messed around medication wise as much as many people I know, this still feels like a step downhill in terms of my illness, and only seems to increase my sense of things getting worse instead of better over the last 18 months (if not longer).

Anyway, I made the decision after being prescribed Seroquel (quetiapine) that I would stop drinking alcohol. Upon reflection I know that I am not good at self control when it comes to alcohol consumption, and that more often than not it would cause me to become very depressed, make unwise decisions that were bad for my mental health, as well as spending money that I really don't have. It's already advised not to drink while on anti depressants, so now that I am also on medication that makes me drowsy at night it just seemed like a good time to make that decision. It is hard, but even after only a couple of weeks I am feeling generally better, and have been able to enjoy social activities without drinking. 

I don't like being medicated, but I am personally better off for it.

Diagnosing Borderline

I was not officially diagnosed with Borderline Personality Disorder until very recently.

The thing that I must emphasise about being diagnosed with any mental health disorder is that it is meant to aid the direction of treatment, not be a constricting box that you can't move outside of, and not a life-sentencing label that will damn you for the rest of your life. The likelihood is that someone with a mental illness will have aspects of more than one illness, and there are some illnesses that are very often concurrent because they feed off each other.

Also a mental illness, unlike a physical illness, is not consistent from person to person. The differences in each individual's brain is enormous, and it's important to remember that the same illness can present differently in those individuals.

Borderline Personality Disorder is diagnosed when a person has shown consistent and repeated behavioural patterns in at least 5 of the following ways:
  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
The fact that only 5 out of the 9 criteria need to be met for diagnosis is very important as it can mean a significant variation in the presentation of BPD in each individual. In fact, there are 256 different variations.

There is a great deal of negative stigma attached to BPD. Here is a website dispelling some of the most dangerous myths about Borderline sufferers.

My first diagnosis from a Clinical Psychologist was Major Depressive Disorder and General Anxiety Disorder. I was 17. For several years this seemed accurate, and medication helped me to retain a sense of functionality.

Last year though things appeared to be getting worse rather than better. Then earlier this year my psychologist said that I should look up BPD and see if I felt that I fit into the criteria, and that we would discuss in the following session how to go about treatment if we both agreed that BPD was a more accurate diagnosis.

After a great deal of research I felt certain that BPD made a great deal more sense than depression and anxiety. After talking to my psychologist, we decided that my treatment needed to move in a different direction to be more effective.

I really struggled once I came to terms with being someone with BPD. I had thought of myself as someone with depression and anxiety for so long, and had become to accustomed to seeing myself that way that I had to change my perception of how my illness affected me. Depression and anxiety symptoms are very common in BPD however, and once I realised this was the case, I started to tell people.

While BPD is relatively common, most people didn't seem to actually know much about it, and honestly to begin with, neither did I. So instead of just saying "So hey I have BPD" I included information on the disorder and types of treatment. I also made sure that I had enough of my own information to dispel any misconceptions people had about the illness, and emphasised the individuality of presentation.

I am now comfortable with my diagnosis, and am not ashamed of it. I answer people's questions with frank honesty and am constantly keeping updated with information on research and treatment. I stand up for my rights with the way that I am treated by professionals and keep my supports close and informed.