Articles – Walker Clarity Centre

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The Problem: Mental Health Care Can Be Expensive

One of the most daunting aspects people face when attempting to manage their mental health is managing the financial cost of the care. Between the bills associated with counseling, prescriptions, and time away from work, the mere thought of beginning a therapy plan is often enough to cause most people to want to hide their wallets.

In the interest of making the process a bit less expensive and terrifying for you (our reader), we’ve compiled a list of ways to approach starting a mental health treatment plan while also saving on costs.

Options For Solutions

1. Start Sooner Rather Than Later – It can be sooo tempting to think that you’ll save money by putting off looking into care, but if you condition is worsening while you’re avoiding seeking help, it will be all the harder to improve when you get around to beginning care. Save yourself time and money by acknowledging the reality of your situation.

This is not a matter of mind over matter, so don’t waste time blaming yourself for needing a bit of support. If you wouldn’t scold an asthmatic for not being able to force themselves to breath, you can afford to cut your brain a bit of emotional slack. Begin researching your options for getting the care you need, and then be smart about how you get the help. Which brings us to…

2. Pick The Right Kind Of Mental Health Professional – One of the best ways to save time your mental health expenses is to select the most appropriate kind of professional from the beginning of your care. It saves you the time and expense of paying to switch professionals after being screened and recommended to receive a different type of support.

In most cases, the decision will focus on choosing between starting with a professional who provides treatment by counseling versus medicines. Although it’s very common for people to receive support with both therapy and medications (frequently at the same time), more and more mental health professionals are tending to specialize in one or the other.

So if deep down in your heart of hearts, you know that you need a medicine to stop the slide and get your mental health back on track. Start with a professional who writes prescriptions, because doing anything else will probably cause you to spend more money without making much progress in the long run. The same goes for counseling. If you’re desperate for a safe space to vent and process internal struggles, start with psychotherapy. Even if you are eventually recommended to start a medication with another treatment professional, you’ll be more able to advocate for yourself and potentially need less medicine support because of your improved coping skills.

One last thing in this area, people often ask if they need to see a psychiatrist or a psychologist for provision of their respective medicine management or therapy. The truth of the matter is that there are now many professionals who are licensed to provide medicine prescriptions without being psychiatrists or provide therapy without being psychologists. Without getting into the politics associated with this area, patients are probably best served by going with two simple rules of thumb.

Look for a professional who is well-versed in supporting people with your kind of concerns. You may be able to tell if this is case by reviewing the professional’s profile information. If nothing in their descriptions or reviews sounds like your situation, you may need to look elsewhere.
If you have complicated care needs, seek a more advanced professional. As explained earlier, mental health professionals have different levels of experience. The level of skill required for management of inattention with mild depression is simply not the same as the skill set required for management of intense anxiety in the presence of a thyroid or seizure disorder. If you know your situation is more complex, pay for the support of a more skilled professional. Their abilities will allow you to achieve more rapid results – thereby saving you the frustration and expense of struggling for years only to find out that you could have received more effective treatment.

3. Use Your Resources – If you have health insurance that covers mental health appointments, you may use their website or customer support line to request the name of mental health professionals near you. At the same time, you’ll probably also use search engine reviews to identify a few options of your own. If you have supportive friends or family, they may be able to provide references to people they’ve found helpful. Finally, don’t forget to ask your primary doctor’s office if they have good mental health team members to recommend. It’s very common for generalists and pediatricians to refer to local mental health professionals, so you’re likely to receive a few glowing reviews.

Also, by using the network of people and resources at your disposal, you’ll save time and avoid the expense of having to transfer from a professional who turns out not to be the best fit for your needs.

To help our local readers with this process, we’ve included a list of some of the therapists that Walker Clarity Centre patients have positively reviewed. It isn’t all inclusive, but it gives an idea of the kind of quality professional you should be seeking.

4. Screen While You Make Contact – Once you have your list of names, do some digging. Thoroughly read the reviews for your favorite candidates and visit their websites. Once you think you’ve found a potential fit, contact the professional. If you plan to use your insurance, find out if they are in network. Do they see patients during days/times that you are able to make an appointment? Pay attention to the interaction between yourself and their staff. Is it a good fit? If so, congratulations! Schedule an appointment to finish screening with the professional in person. If not, congratulations on saving yourself time and money by avoiding a poor fit! Move to the next in your list of names, and start screening the next option.

If you take this approach to beginning your mental health journey, you are much more likely to save time, money, and frustration. You’ll seek care before your symptoms progress to the pont of being overwhelming. You’ll determine the best kind of mental health professional to see first. You’ll use your support network to identify the best candidates to provide your care, and you’ll properly screen through your list of names to find the professional and office team that best approach your preferences for mental health care support.

Mental Health Education

14 Ways To Start Feeling Better Now

May 19, 2019June 11, 2020 Web Manager

Everybody has times when they feel slightly less than wonderful about themselves or the world around them. Fortunately, periods of blue mood can clear on their own. At other times, friends or family members may be available to help us get past an emotional low point.

… But what’s a person to do when they’re feeling low and there isn’t anyone there with a word of encouragement to provide an emotional boost? Consider using the following list to safely improve your mood until you have access to your support network and additional positive reinforcement.

Be patient with yourself. – According to the World Health Organization, more than 300 million people (of all ages) on our planet suffer from depression.¹ In the U.S., 40 million adults (age 18 and older) experience symptoms of anxiety.² What exactly does that mean? That you aren’t the only person to feel this way, so don’t beat yourself for struggling. Instead, focus on taking any small steps that you can to help yourself see some good in yourself and the world.
Distract yourself with something you like. – Is there a hobby that you love but have been to busy to enjoy? Or maybe it’s a movie or miniseries that you’ve been meaning to watch? A writing or art project that you’ve been meaning to start? Or taking time to hang out with your pet? There’s no time like the present. Check two boxes at once! Distract yourself from negative emotions and give yourself permission to do something that you enjoy.³
Change the lighting in your room. – Research has shown that lower lighting tends to have a calming effect,⁴ while natural or phototherapy lighting (especially during the morning and earlier parts of the day) encourages positive mood.⁵ Don’t believe what you’re reading? Try it out and see!
Get a bit of exercise. – From walking in place to stationary cycling to going for a brief walk or jog, it all counts toward improving your mood. According to the American Psychological Association, your outlook can begin to brighten within 5 minutes of moderate exercise, and the mood elevating properties of regular exertion can help to lift depressive symptoms over time. They suggest that some of the times that we least feel like moving are when we need to exercise the most – simply for the happy hormones that activity promotes.⁶ So why not put on some headphones and dance your troubles away?!
Go outside. – In a study published in The Journal of Positive Psychology, researchers found that spending as little as 5 minutes in nature resulted in the improved emotional state of their subjects. The effect was so consistent, they were even able to document a smaller amount of mood elevation for people who were asked to look at photos of natural settings.⁷ So get out into the wild blue yonder – or pull up a picture of your coveted island getaway and dream to your heart’s content!
Laugh it off! – The Mayo Clinic affirms that, in addition to calming the stress response and reducing muscle tension, a good belly-laugh can improve your immune system and provide long-term improvement of mood and anxiety symptoms.⁸ So grab some popcorn, fire up your favorite comedy, and settle in for some laughs!
Enjoy a wonderful scent. – Aromatherapy oils have been found to encourage more positive mood, relaxation, and better sleep.^9,10 Why not enjoy some of your favorite scents while attempting some of the other activities on this list?
Find a safe way to physically express your frustrations. – Needing to vent some pent up anger? Experts suggest anything from hitting a tennis/golf/volley ball to punching a pillow/mattress/boxing bag or breaking dishes/eggs.¹¹ Although some of these options are likely to be much messier (and more expensive) than others, the idea is the same – to find ways to safely transition past the irritation of the present without doing something that you are likely to regret later.¹²
Listen to music. – Research has show that music can lift our emotions by bringing us pleasure, acting as an unseen friend by mirroring how we feel, and reducing our perception of pain in life. In some cases, it even seemed that study participants derived the most benefit when they chose their own musical selections.¹³ So pick the songs that feel healthiest for you in the moment. As your mood starts to lift, feel free to adjust the music accordingly.
Shut off social media. – Although our social media networks allows us to share the joys and triumphs of our friends, family members, and acquaintances, it can also be a double-edged sword. Whether it be Facebook, Twitter, Instagram, or some other corner of the internet universe, social media also allows us to share the negative emotions of our network,¹⁴ increase our addictive behaviors, create an unhealthy fear that we are missing out on life by comparing ourselves to others, throw off our sleep patterns, and ultimately trigger long-term lowering of our mood.¹⁵
Investigate it. – Sometimes an episode of negative mood requires a bit of detective work. So pull out a pen and paper and see if there are any patterns to the emotions that you’ve been feeling. No sure where to start? Here are some sample questions to help to get you going.
1. Is putting off that upcoming project starting to get to you?
2. Do you need to get help addressing an unhealthy relationship?
3. Was your mood change triggered by past experiences or memories?
4. Has the lackluster emotional state hung on for so long that there is no clear solution? That’s okay. You’re making progress simply by realizing that it might be time to seek out a professional for more advanced help.
Make a list/jar/shoe-box of the good in your life. – If it’s something that makes life better for you, add it to the list, collage, or collection. It doesn’t have to start off as a large group of items, it just needs to be yours. Save your list or collection in a place where it can remind you of the good in and around you – a mirror, dresser top, or electronic home screen might be a start. Add to your collection over time, and when the sad-bad days strike, remind yourself that this too will pass.
Get some rest. – There’s scientific data showing that curling up with a soft blanket in a quiet place has the ability to help a person feel more positive and relaxed.^16,17 So why not get some sleep? You may wake to find yourself with a fresher and more positive perspective on the situation.
Place a phone call to ask for more advanced help. – Sometimes the best way to feel better is to acknowledge that you need outside help. If you find yourself in that situation, here are two 24/7 phone lines for help.
1. SAMHSA’s National Helpline: A confidential and free treatment, referral, and information service available in English and Spanish.¹⁸ Phone: 1-800-487-4375 or 1-800-662-HELP or TTY: 1-800-487-4889
2. National Suicide Prevention Lifeline (NSPL): A confidential and free phone line providing crisis support and suicide prevention resources in English and Spanish.¹⁹ Phone: 1-800-273-8255 or TTY: 1-800-799-4889

References:

¹ https://www.who.int/news-room/fact-sheets/detail/depression Retrieved: May 18, 2019

² https://adaa.org/about-adaa/press-room/facts-statistics Retrieved: May 18, 2019

³http://web.csulb.edu/~psych/deptinfo/faculty/thayer/ SelfRegulationofMood.pdf Retrieved: May 18, 2019

⁴ LFB – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507869/ Retrieved: May 20, 2019

⁵MNL – https://www.mercurynews.com/2019/01/03/use-lighting-to-improve-your-mood/ Retrieved: May 20, 2019

⁶ https://www.apa.org/monitor/2011/12/exercise Retrieved: May 18, 2019

⁷ https://www.travelandleisure.com/trip-ideas/nature-travel/natural-wonders-happening-in-may-2019 Retrieved: May 19, 2019

⁸ https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-relief/art-20044456 Retrieved: May 20, 2019

⁹ https://www.health.harvard.edu/newsletter_article/In_Brief_ Aromatherapys_benefits_limited_to_mood_improvement Retrieved: May 20, 2019

¹⁰ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588400/ Retrieve: May 20, 2019

¹¹ https://psychcentral.com/blog/7-simple-ways-to-break-your-bad-mood/ Retrieved: May 19, 2019

¹² https://www.psychologytoday.com/us/blog/heal-the-mind-heal-the-body/201805/7-creative-ways-express-hot-anger Retrieved: May 19, 2019

¹³ https://www.healthline.com/health-news/mental-listening-to- music-lifts-or-reinforces-mood-051713#3 Retrieved: May 19, 2019

¹⁴ https://www.theguardian.com/media/2014/mar/12/social-network-bad-mood-friends Retrieved: May 19, 2019

¹⁵ https://www.avogel.co.uk/health/stress-anxiety-low-mood/6-ways-social-media-affects-your-mood/ Retrieved: May 19, 2019

¹⁶ https://www.psychologytoday.com/us/blog/design-and-the-mind/201106/sad-times-call-soft-textures Retrieved: May 20, 2019

¹⁷ https://www.huffpost.com/entry/silence-brain-benefits_n_56d83967e4b0000de4037004 Retrieved: May 20, 2019

¹⁸ https://www.samhsa.gov/find-help/national-helpline Retrieved: May 20, 2019

¹⁹ https://suicidepreventionlifeline.org/ Retrieved: May 20, 2019

Mental Health Education

Not Happy During The Holidays?

December 20, 2018May 20, 2019 Web Manager

With its opportunities to share time with family and friends, take much needed breaks from the hurried pace of work and school, and pause to regroup before starting a new calendar year, the holiday season can truly be a most wonderful time of year. Unfortunately, the glittering portrayal of this season seems to regularly fall short of what most of us experience. The difference between heightened expectations and the cold reality of the year’s ending can easily leave a person feeling stressed, depressed, overwhelmed, and/or irritated. Here are a few suggestions on how to navigate the season, while extending emotional grace to yourself and others.

Give yourself permission to have a less than perfect season. – After all, it’s the holidays. If your holiday is anything like the rest of ours, your or someone close to you will get a cold. One main/side dish will be singed – if not burned to a complete crisp. There will be at least one small to medium-sized argument, and you’ll probably run out of tape/paper/bows/batteries while wrapping presents. 😊 Welcome to the club! Now go enjoy the year’s end!
Exercise! – Go for a walk, play with the kids, or take the long route to the neighbors house. Thirty minutes is great, but as little as 10-15 minutes can give your brain a boost. By releasing positive endorphins, you’ll improve your outlook and stress level – all while clearing your mind and burning off some of that last piece of cake!⁴
Get some sun (or a light therapy box). – Aim for 20-30 minutes of awake time in sun or in front of a phototherapy light. Sunlight exposure works best, but if that isn’t available, time spent in front of a light box within the first waking hour of the day can be a helpful alternative. Look for a light box of 10,000 lux that minimizes as much UV light as possible. Just as with the sun, there’s no need to look directly into the light.⁵
Keep your therapy appointment schedule. – It’s easily to rationalize missing a therapy session to get more done toward the year’s end. Unfortunately, one missed appointment can quickly turn into “Oh my gosh, it’s the new year already!” With all the events and interactions of the holidays, therapy sessions can provide vital opportunities to slow down, gain clarity, and revisit your overall goals for the season. Why would you ever choose to miss that?!
Remember to take your medicines. – The holidays can be amazingly busy. Consider using a daily alarm on your cellphone to help you take your daily medicines on time… because they can’t work if they aren’t taken.
Take your vitamins. – In addition to vitamins D and B (specifically B vitamins 3, 6, 9, and 12), studies also indicate that supplementing your diet with tryptophan, omega-3 fatty acids, coenzyme Q10, and vitamins E and A could help to improve your emotional well-being.^8,1,6,9
Avoid using alcohol or drugs to cope. – Although alcohol and substances can initially make a person feel less stressed or unhappy, there’s often an episode of anxiety or depression that manifests during clearance of the alcohol or drug from the person’s system.^3,2 These changes in emotional state can place a person at greater risk of engaging in dangerous or uncharacteristic behaviors.⁷ In light of that, is it really worth ruining your holiday?
Get your sleep. – When possible try to stick to your normal waking and sleeping hours. By protecting your sleep time, you’ll improve your ability to be more pleasant, patient, and even-tempered while awake.
Enjoy a quiet time out. – It’s okay to need time away from the hustle and bustle of it all. If you find yourself being overstimulated by the commotion of the season, find a quiet place to take a few deep breaths and clear your head. As little as 5-10 minutes alone could have rejuvenating effects for your ability to interact calmly with others. (Give yourself bonus points if your quiet time includes your favorite cup of tea!)
Avoid isolating yourself. – It’s one thing to take a bit of space to clear your head, it’s another to abandon interaction altogether. As long as mingling won’t be too triggering for your stress level, try to share positive interactions others. Even if it’s from the sidelines, the social time can help to lift your outlook during winter days.
Celebrate the lives of lost loved ones. – For those grieving, this time of year can be especially challenging. Consider setting aside time to celebrate and be grateful for times shared with deceased loved ones. Friends and family can share favorite items from past gifts, memory boxes, photos, and videos of their loved one.
Volunteer to help another person. – Sometimes the best way to forget the thing that is bothering you is by losing yourself in helping someone else.
Be mindful of your entertainment. – Spend your time on things that will leave you feeling positive. Avoid any kinds of media (music, movies, news, social feeds, etc.) that you know will leave you feeling dissatisfied, anxious, or down. The season will fly by, so spend your time wisely.
Maintain your relationship boundaries. – It’s okay to set limits on who you interact with during this time of year. If certain individuals simply aren’t able to contribute to your emotional well-being, give yourself permission to limit or forego interaction with them. After all, what better gift can you give yourself than starting off the new year with an emotionally healthier and happier you?

References:

¹ Al-Fartusie F.S., Al-Bairmani H.K., Al-Garawi Z.S., et al. (2018). Evaluation of Some Trace Elements and Vitamins in Major Depressive Disorder Patients: A Case-Control Study. Biological Trace Element Research, (2018). Retrieved December 22, 2018 from https://doi.org/10.1007/s12011-018-1507-7

² Anxiety and Depression Association of America. (n.d.). Substance Use Disorders. Retrieved December 23, 2018 from https://adaa.org/understanding-anxiety/related-illnesses/substance-abuse

³ Grant B.F., Stinson F.S., Dawson D.A., et al. (2004). Prevalence and Co-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry. 61(8): 807–816. Retrieved December 23, 2018 from https://doi.org/10.1001/archpsyc.61.8.807

⁴ Mayo Clinic Staff. (2017, September 27). Depression and Anxiety: Exercise Eases Symptoms. Retrieved December 22, 2018 from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495

⁵ Mayo Clinic Staff. (2016, March 16). Seasonal Affective Disorder Treatment: Choosing a Light Therapy Box. Retrieved December 22, 2018 from https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/art-20048298

⁶ Mehrpooya M., Yasrebifar F., Haghighi M., et al. (2018). Evaluating the Effect of Coenzyme Q10 Augmentation on Treatment of Bipolar Depression: A Double-Blind Controlled Clinical Trial. Journal of Clinical Psychopharmacology, 38(5):460-466. Retrieved December 22, 2018 from https://doi.org/10.1097/JCP.0000000000000938

⁷ Mental Health America. (n.d.). Alcohol, Substance Abuse and Depression. Retrieved December 22, 2018 from http://www.mentalhealthamerica.net/alcohol-substance-abuse-and-depression

⁸ Shabbir F., Patel A., Mattison C., et al. (2013). Effect of diet on serotonergic neurotransmission in depression. Neurochemistry International, 62(3):324-329. Retrieved December 22, 2018 from https://doi.org/10.1016/j.neuint.2012.12.014

⁹ Sinrich J. (n.d.). 10 Vitamins for Depression That Could Boost Your Mood. Reader’s Digest. Retrieved December 22, 2018 from https://www.rd.com/health/wellness/vitamins-for-depression-boost-your-mood/

Mental Health Education

33 Ways To Stretch Your Mental Health Dollars

June 19, 2018June 11, 2020 Web Manager

Most of us know what it’s like to have more month than money. It can be painfully frustrating to stare at the phone or computer screen while willing those dollars and cents to multiply in the account.

So what do you do when your mental health is on the line and the dollar just won’t stretch far enough? More and more, this question is becoming part of the daily conversation in American households. If you find yourself in this situation, consider downloading our resource describing 33 ways to stretch your mental health dollars and get more bang from your hard-earned buck. Through it, you’ll learn how to stretch your medications, mental health appointments, mental health payments, health insurance, access to local resources, and relationships with medical providers to get the most progress toward your mental health goals. Whether it’s by adjusting medication supplies, altering the frequency of medication appointments, or tapping that semi-forgotten flexible spending account, it’s important for everyone to know how to get the most from their local and national mental health resources.

To support individuals dealing with side effects and interactions from mental health medications, we also offer the PADRS-10, a 1-page checklist for screening psychiatric medication side effects.

Mental Health Education

Life After A Psychiatric Diagnosis – Finding Hope In Healing

February 18, 2018March 26, 2019 Web Manager

With 1 in 5 American adults currently diagnosed with a mental illness¹ and 3/4 of chronic mental illness being diagnosed by 24 years of age², it’s likely that either you or someone you care about has had to ask some tough questions about their mental health condition. During their course of psychiatric treatment, many people find themselves wondering, “What does this diagnosis mean for the rest of my life? Will I be stuck with these medications and their side effects forever? Even if I can stop them, is it safe to try?” It can be very confusing for a person when they first begin trying to manage their mental health and medications. It can be frustrating or intimidating to have to talk to your prescriber about side effects. Even so, there is hope, and you aren’t the only person to feel this way. Here are a few things to keep in mind as you tackle this particular challenge in life.

In some ways, a psychiatric diagnosis is what you make of it. – If you say it’s the worst thing to ever happen to you, that might end up being the case. However, many of the people who experience better outcomes after a psychiatric diagnosis realize that this is just one aspect of who they really are. This discovery isn’t always immediate. For some people it comes during the course of therapy, but it’s important to understand that you are more than a diagnosis listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders). Although your psychiatric diagnosis can provide useful information to mental health providers on how to support you, it in no way reflects the sum total of who your really are as a person. This is a fact that is easily forgotten during the more difficult periods of mental health, but it is a truth that applies to every mental health patient – even if your diagnosis happens to be in the area that the DSM labels as “personality disorders”.
A psychiatric diagnosis could represent a hidden opportunity. – In some cases, our bodies can use our emotions and perceptions to bring out attention to issues that we may have been to busy/stressed/tired/afraid/traumatized/etc to deal in the past. Having a description for the process that is happening in your life provides an opportunity for you to begin learning how to improve things. The most important decision that you have to make at this point is whether or not you’re willing to change for the better. If you are, embrace the opportunity to learn as much as you can about your proposed diagnosis. Ask your provider to help you understand your symptoms and read descriptions of diagnoses at reputable sources like The Mayo Clinic, The National Alliance on Mental Illness (NAMI), and Mental Health America. Even if it means that you eventually decide that the label doesn’t quite fit for your experience, you will most likely be a wiser and more capable person as a result the self-education. In the case that you decide the diagnosis is appropriate, who could be better serve as an expert on the way your brain functions than you? Learn all you can; your mental health team and future self will thank you!
The dose of medication indicated during a crisis may not be needed to keep you stable over time. – Depending on your response to treatment, there’s a very real chance that your medication dose could be reduced over time. Although 1 i n 5 American adults have a mental illness, only 1 in 25 American adults are reported as living with a chronic psychiatric diagnosis². Not all diagnoses result in life-long medication management. Even when there is a need for chronic medication management, it is possible for the need for medication support can decline over time – given the right circumstances. That is because a patient who actively learns about their mental health condition is usually also the kind of person who gradually develops skills to manage their mental diagnosis. This is usually done with skills that are not limited to medication intervention. Individuals may learn to manage their concentration, level of work stress, periods of low mood, history of trauma, or mildly paranoid thoughts using psychotherapy. They may improve their nutrition and/or tendencies for disordered eating with the help of a dietitian. They may improve their sleep quality by receiving treatment for sleep apnea. They may see a chiropractor for reduction of chronic back pain. As a person’s brain and body heal as a result of healthier new skill sets, the need for medication intervention can decline. Even if a medication can’t be stopped, it can be decreased to the lowest dose that continues to provide therapeutic treatment. This approach further helps to limits the side effects experienced over time.
Before stopping your medication, please, PLEASE talk to your prescriber. – Even if you are cleared to stop your medication, you should be aware that some medications can cause serious problems when stopped abruptly. By serious, we’re talking about excruciatingly painful muscle cramps/spasms, withdrawal, and seizures. Doctor’s generally try to prescribe medications that will be forgiving and not cause life-threatening withdrawal symptoms if they are discontinued abruptly, but more potent medicines can’t always be avoided. If you find yourself in a situation where you’re running low on medication before you’re able to afford your next refill, consider contacting your provider to learn if your remaining pills supply should be used to temporarily tapper off of the medication. In some cases, the doctor may have sample medications to help cover your treatment until a full refill can be purchased. Finally, for those in the difficult scenario where your doctor disagrees with your decision to stop a medication, keep in mind that your provider may still be able to provide useful information about how to gradually tapper off of the medicine to protect your safety.
Medication doses often grow with the children taking them. – It’s important to know this fact for 2 reasons. The first is so you won’t be alarmed the first time your doctor recommends a dose advancement. The second reason is to prevent a child from switching from a perfectly good medication because of the perception that it isn’t working. If the dose hasn’t been advanced for 6 months and Junior has grown 2 inches and put on 10 lbs, his attention/mood might be off because he’s outgrown the old medication dose. When your child starts to come approach their adult size and metabolic rate, you’ll likely find that their medication dose stabilizes and no longer needs advancement.
You’ll get further faster if you let others help. – On the journey to greater mental health, a person will be aided by any number of people. Some will be professional providers; others will be social contacts. Your psychotherapist will probably come to know you better than any other member of your mental healthcare team. It’s a good thing because it allows this provider to be of greatest assistance to you, but it also means you need to choose this person well. Feel free to keep searching until you find someone who is good fit for your personality style and mental health goals. Similarly, a person’s psychiatrist will play a central role in making sure that their medications are working just as hard as they are toward improving their mental health. If you don’t feel comfortable asking questions or can’t get clear responses to the questions you ask, the arrangement may be a poor fit. You want a mental health doctor who will teach you how to use your medications to maximally improve your likelihood of remaining stable. Mentally healthy friends and family are an amazing resource for those fortunate enough to have them. Family and close friends can observe and help report symptoms that you may never have noticed. They can also help provide close monitoring for safety, which may permit some individuals to avoid psychiatric hospitalization. Trustworthy family and close friends can provide respite child care for exhausted parents, accountability for those recovering from a history of substance use, and distraction from frustrating days of work or less than cooperative mental health. If you are fortunate enough to have safe and trustworthy people in your life who honestly want to assist you on your journey to greater mental health, get out of your own way… Let them help.
If at first you don’t succeed, therapy, therapy, therapy… – Has it been mentioned that psychotherapy really helps a persons ability to manage a mental health condition? The reason is actually very logical. You therapy skills and self-discoveries will be carried with you for the duration of your life – long after your medication has been switched, decreased, or maybe even stopped. Most likely, your therapy experiences will assist the changes that gradually produce a new and healthier you. While there are plenty of situations where therapy isn’t effective until a medication is started, the fact remains that psychotherapy is very often the tool that allows people to accomplish changes that they weren’t capable of earlier in life.

These are just a few of the ways in which a psychiatric diagnosis may actually represent the start of a better chapter in your life. It’s unfortunate that the social stigma associated with psychiatric diagnoses often obscures the opportunity for wholeness provided through correct identification of a problematic process occurring in a person’s life. In spite of this fact, you should know that there can be hope in the process of mental healing and healthcare. You aren’t alone. Keep seeking; keep learning… keep the faith. Positive change will come.

References:
¹ Mental Health America. (n.d.). 2017 State of mental health in America – report overview historical data. [Brochure]. Retrieved February 18, 2018 from http://www.mentalhealthamerica.net/issues/2017-state-mental-health-america-report-overview-historical-data
² National Alliance on Mental Illness. (n.d.). Mental health facts in America. [Brochure]. Retrieved February 18, 2018 from https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf

Psychotropic Side Effect Burden

Why You Can’t Sleep – Signs of “Medication” Sabotage

February 7, 2018May 18, 2019 Web Manager

It’s 2:18 in the morning. The walls stare down as the clock peeks sleepily at you from it’s silent perch. Either you’ve just awoken to realize that it’s nowhere near time to get up or you’ve simply been lying in bed for what seems like a small eternity – waiting for the arrival of those blessed zZZzzz. Either way, it’s freaking early, and all is not well… As exhaustion builds, you think of the upcoming work/school day, and the frustration rises. You curse your brain. You curse your luck. You curse the fact that at least half the world seems to be sleeping, and you haven’t been deemed worthy of rest. You’d go on cursing, but that would only keep you awake longer, so you turn to your phone and find yourself flipping through a blog… about you – not sleeping.

If the story sounds eerily familiar, don’t be alarmed. According to the CDC, a review of state date from 2014 revealed that around 28-44% of adults reported getting less than 7 hours of sleep in a 24 hours period.⁶ Meaning anywhere from 3 to 4 of every 10 adults reported getting less than the recommended amount of sleep in 24 hours. Additionally, the American Sleep Association recommends that adults get 7-9 hours of sleep, while teenagers are encouraged to get 8-10 hours. Children of younger ages are encouraged to get even more, as much as 14 hours a day when including time taken for naps. At the same time, the American Sleep Association, reports that “50-70 million US adults have a sleep disorder” with 30% of adults reporting short-term sleep issues and 10% reporting chronic insomnia. This helps to explain why insomnia is the most common sleep disorder.⁷

So if you find yourself reading this article at 3:27 am, rest assured that you aren’t the only one. We’d welcome you to the club, but considering that you’re reading this, it would appear that you’re tired of being awake and tired. Considering that insufficient sleep is associated with increased incidence of motor vehicle accidents, decreased attention during daily tasks, worsened libido and fertility, and increased rates of obesity, heart disease, and diabetes, you’re right to be concerned.^7,8 Keep reading to find a quick list of the 6 “medication” related issues that might be chasing off those wonderful nighttime Zs.

The Saboteurs:

Alcohol – Yes, our first entry is more of an, shall we say, over-the-counter “medication”. Oh, I know that you would never use alcohol in an attempt to get a good nights sleep, but for all those other people who might, what follows is an extremely simplified explanation of how alcohol can be associated with insomnia. Because alcohol is a central nervous system depressant, it can help to provide a feeling of relaxation and/or sleepiness – depending on the “dosage” consumed. However, alcohol also suppresses the drive to breathe, which leaves your body with a problem. How to sleep in the presence of alcohol but not stop breathing? Your brain accomplishes this feat by activating centers and hormones that promote the process of remaining awake.³ Thus you remain awake (and alive) enough to continue breathing while the alcohol is around. Meanwhile, your liver goes about the process of clearing the alcohol from your system. Once this happens, there is nothing to counteract the hormones and processes that have been working to keep you breathing in the presence of the (now gone) alcohol. So what happens? You wake up,… but because your body can clear the alcohol you consumed faster than it takes to get to your late(r) morning alarm time, you wake early.² You turn over and want to go back to sleep, but remember all those waking hormones. They’re tap dancing through your brain singing the Wakey Wakey song. Lather, rinse, repeat cycle, and… Hello; it’s our old friend insomnia again. Be advised that some of the short-acting benzodiazepines can result in the same pattern of early morning waking when used to induce sleep, which is why they’re not really recommended for long-term treatment of insomnia.
Cannabis – “No worries,” you think. “Alcohol might not help me get a good night of sleep, but marijuana will.” Perhaps, but if it doesn’t, it might be because of the following. There’s a growing body of evidence that long-term cannabis use is associated with disruption of sleep – not its improvement.^1,4 In 2014, researchers at the University of Pennsylvania at Philadelphia reported finding that people cited problems with “difficulty falling asleep, struggling to maintain sleep, experiencing non-restorative sleep, and feeling daytime sleepiness” in relation to any history of cannabis. The researchers found that the frequency of cannabis didn’t seem to correlate with the amount of sleep disruption, and people who began use prior to 15 years of age where more likely to report more severe sleep disruption.^4,5 Additionally, past marijuana use was also associated with sleep disruption.⁴
Stimulants (including caffeine and nicotine) – In the case of stimulants, a person may find him/herself wired for daylight as a result of either prescription or over-the-counter agents. Even so, if you aren’t going to abandon use altogether, your best bet is to manage the timing of administration. In layman’s terms, this means manage your stimulant use so most of it has been cleared from your system by the time you are attempting to go to sleep. This is fairly straightforward in the case of caffeine, nicotine, and immediate-release prescription stimulants because you just have to make sure they’re wearing off before you go to bed. The same concept applies when trying to manage extended-release stimulants, but each person’s body metabolizes extended-release stimulants slightly differently. You might have to track how long your medicine seems to work after taking it, which will give you a better idea of when it needs to be taken to avoid interfering with your sleep.
Antidepressants – Although it is common for some antidepressants to initially be prescribed for administration at bedtime, that doesn’t mean that you can sleep on the medications if they continue to be taken at that time. Many antidepressants have side effect profiles that allow them to increase a person’s energy level as they first enter the bloodstream. Other antidepressants have a time-released capsule system that allow them to be released into the bloodstream over a longer period of time (i.e. hours instead of minutes). Combine a time-released capsule with stimulating side effects, and you can probably start to see how this scenario could have you tossing and turning until the early hours of the morning.
Akathisia – This is a disorder associated with an internal perception of restlessness or inability to remain still. It often manifests as a medication side effect. In the field of psychiatry, antidepressant and antipsychotic medications are some of the agents more commonly associated with this disorder. If you spend your nights feeling as if you have ants in your pants (or bed), it may not be you. It might be your medicine.
Hypomania – In layman’s terms, hypomania is a disorder that is associated with a person experiencing reduced or no need for sleep in association with symptoms that include racing/rambling thoughts, rapid speech, unexpected shifts in mood/irritability level, and sudden urges to complete tasks or activities (often at bedtime or the middle of the night). Hypomania is different from mania because the symptoms haven’t been around long enough to meet criterion for a full manic episode. Hypomania can present as part of a mental health disorder, and not as a result of any kind of medication plan. However, it’s important for people to know that any antidepressant that works (i.e. isn’t a sugar pill) is capable of causing mania or hypomania. Stimulants prescribed for ADHD (Attention-Deficit Hyperactivity Disorder) can produce similar kinds of side effects if a person’s daily dose is higher than what is needed to treat their symptoms. What is most important to know is that hypomania and mania are not disorders that you want to try to manage alone at home. Talk to the doctor about restoring balance to your sleep cycle.

It would be possible to stop there, but all this information begs the question of “What now?” Should you resign yourself to a lifetime of longer-acting benzodiazepines and sedative hypnotics whenever you want to get a restful night of sleep? The most appropriate answer is likely, “Well, no… not really.” You have options. They’re just less well advertised.

Less Messy Medication Options:

Move Non-Sedating Medications/Substances To The Morning or Midday – If a medication doesn’t leave you feeling ready to go to sleep, consider keeping it away from your bedtime. This way it can potentially help you stay awake and have less of a chance of throwing off your sleep. You’ll probably want to take the same approach to any over-the-counter agents that tend to have a stimulating effect on you.
Move Sedating Medications/Substances To The Evening or Bedtime – This way the medication can help you wind down in preparation for going to bed and sleep.
Limit Alcohol Use In The Evening – If you absolutely must, use your nightcap to relax – but not to fall asleep.
Get Medical Help With Side Effects – Issues with restlessness or hypomania should be discussed with your doctor. They may start by simply chasing off your sleep, but left unchecked these problems can wreak havoc on your life. If you suspect your medications of not playing fairly with your body, consider taking the Psychotropic Adverse Drug Reaction Screen-10 (PADRS-10) to screen for some of the more serious mental health medication side effects.
Boost Your Brain’s Sleeping Power – Melatonin is a hormone made primarily by the pineal gland of our brains to encourage sleep. When the melatonin level rises, we are more prone to feel sleepy. When it is low, it is one of many signals to other systems that we should remain awake and alert. It is now possible to manufacture synthetic melatonin. So why not use it to encourage your brain to get some sleep? You might try 7-14 days of taking melatonin shortly before or at bedtime to see if it encourages your sleep to transition to a better schedule. You should know that melatonin won’t usually put you to sleep, but it could help you to feel sleepy enough to want to go to bed so nature can take its course from there.
Deploy Medication Counter-Measures – Consider talking to your doctor about use of trazodone or hydroxyzine for improvement of your ability to fall asleep. These medications won’t necessarily treat akathisia or hypomania, but they can improve sleep disruptions related to other factors. Trazodone is an antidepressant medication that wasn’t found to have much ability to aggressively improve depressed mood, but it had an noteworthy side effect of putting people to sleep. Hydroxyzine is an antihistamine that has mildly relaxing and sedating side effects. As a result, many people with high stress levels or anxiety find hydroxyzine to be helpful for getting to sleep. These are only a couple of the medications that can use to help a person achieve restful sleep without prescribing a medication that has risk of habit formation, which is why you shouldn’t feel limited to only working with medications advertised in the latest television commercials.

References:

¹ Angarita, G. A., Emadi, N., Hodges, S., and Morgan P. T. (2016) Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addiction Science & Clinical Practice, 11(9). Retrieved February 11, 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845302/pdf/13722_2016_Article_56.pdf

^{² Colrain, I. M., Nicholas, C. L., and Baker, F. C. (2014). Alcohol and the sleeping brain In E. V. Sullivan & A Pfefferbaum (Eds), Handbook of Clinical Neurology. (Vol. 125, pp. 415-431). Online: Elsevier. Retrieved February 9, 2018 from}^{https://www.sciencedirect.com/science/article/pii/B9780444626196000240?via%3Dihub}

³ Lewis, J. G. (2013, October 28). Alcohol, Sleep, and Why You Might Re-think that Nightcap [Web log post]. Retrieved February 11, 2018 from https://www.nature.com/scitable/blog/mind-read/alcohol_sleep_and_why_you

⁴ (2014, June 1). Marijuana use is associated with impaired sleep quality. Retrieved February 11, 2018 from https://aasm.org/marijuana-use-is-associated-with-impaired-sleep-quality/

⁵ (2014, June 2). Penn Medicine Study Finds Marijuana Use May Impair Sleep Quality. Retrieved February 11, 2018 from https://www.pennmedicine.org/news/news-releases/2014/june/penn-medicine-study-finds-mari

⁶ Sleep and sleep disorders. Retrieved February 9, 2018 from https://www.cdc.gov/sleep/data_statistics.html

⁷ Sleep and sleep disorder statistics. Retrieved February 9, 2018 from https://www.sleepassociation.org/sleep/sleep-statistics/

⁸ Why lack of sleep is bad for your health. Retrieved February 9, 2018 from https://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/lack-of-sleep-health-risks.aspx

Psychotropic Side Effect Burden

Here’s A New Side Effect Screening Tool, The PADRS-10!

January 30, 2018June 11, 2020 Web Manager

Medication side effects can have significant and lasting negative impacts on a person’s mental function and daily quality of life. In an attempt to help individuals identify whether or not they are experiencing an unsafe reaction to their mental health medication(s), we present the Psychotropic Adverse Drug Reaction Screen – 10 (PADRS-10). Designed by Dr. D’Loreyn Walker MD, this screening tool is intended to help individuals identify some of the more severe side effects of mental health medications and facilitate a conversation between the individual and their psychiatrist or general medical doctor of choice. Having been submitted for the review of general and behavioral health doctors as well as psychotherapists, the PADRS-10 is intended for use by both individuals concerned for medication side effects and medical providers for preliminary office screening of psychotropic medication side effects. To purchase the latest revision of the PADRS-10, click here.

For individuals looking to reduce their mental health care costs, we also offer 33 Ways To Stretch Your Mental Health Dollars, a resource to help people get more from their mental health payments.