Expert: Libby Bonner - 5/29/2005

Question
Thank you in advance for volunteering on Allexperts. I understand that your advisement is not a substitute for a personal visit to a doctor's office. This is an urgent situation and I want to have as much information as possible, as I am very serious (and motivated) about managing my illness, and getting properly diagnosed.
I am a 41 year old male and have attempted to commit suicide 11 times, 5 of which required hospitalization; the most recent attempt was last Sunday the 22nd. Last February I was unconscious for 3 days in the hospital due to an attempt. I overdose on pills as a compulsion and find it my only exact means for escape of the more intense episodes of my illness. These symptoms presented themselves in my preteens, and consistently persist and worsen to present day. As a child I was physically and emotionally abused by my parents, my father died 10 years ago, my mother died 3 years ago. I am ostracized from my family and have no family support. My support base consists of my exwife and my girlfriend, the former is an infrequent support. I stopped working as a cook about a year and a half ago, and am finding it very hard to even take the first step towards new employment.  My marriage of only a year ended due to an affair (which I had) that lead to pregnancy, which was very hard on me, and a very confusing and worsening time. At the same time I lost my best friend of 10 years for the same reason. I also lost all my friends during this time and have not rebuilt a consistant social group since. I have gone through many significant relationships and have not been single longer than 3 months. I have been in many toxic relationships, and it's hard for me to form any deep bonds.
Physically, I have had at least one concussion, I have high blood pressure, I have a hard time sleeping (staying asleep, getting to sleep - I use a white noise machine to help but it doesn't always do the trick), I have migraines, sight problems (near sighted), infrequent visual hallucinations, frequent and troublesome urgent urniation (related to childhood abuse), weakness on my left side.. I am a smoker, however I do not have a street-drug or alcohol dependence. I don't drink much at all and I don't plan to. Past stressors have been (but are not limited to): frequent moves, extensive changes, loud noise, social situations, pressure, being alone, isolation, conflict, rejection, very low self-esteem, lack of routine, difficulty with authority figures, violence directed at me.. My symptoms include but are not limited to: extreme anxiety, feelings of hopelessness, worthlessness, loneliness, frustration, performance anxiety, I am very self-critcial, self doubtful - I second guess myself in panic, manic episodes, depressive episodes, frequent and dramatic mood swings, feelings of apathy and dulled reality, confusion, feeling lost, inability to concentrate, memory loss/dullness, inability to set and keep goals, I think of suicide many times daily, I have panic attacks, I isolate myself extremely and push away friends and loved ones, I either feel emotions too strongly or not at all. I am nonviolent to others, I only harm myself.
Past Diagnosis: disthymia, major depression, P.T.S.D., Bipolar, all from different professionals. I have been put on different medications: Zoloft, Celexa, Prozac, Effexor, Lithium, Zyprexa, and some I cannot remember. Zyprexa caused aggressive behavior, nothing major but uncharacteristic of my regular personality. I was on Lithium for about a month, at different dosages as guided by my doctor at the time, at which time the trial was terminated due to lack of effect. I had some general malaise during the trial. Zoloft was prescribed and taken three months, with no effect. Celexa did nothing as well. Prozac was the pill that I was on for the longest, and I
was able to function and work at a fairly high level - but after a suicide attempt these pills were taken away (however these pills were not part of the attempt). Effexor did nothing. I have also seen a psychiatrist, psychologist, several GPs, specialist (neuro), etc.
If you need more information on the situation in order to answer the questions, don't hesitate to ask.

Questions:
Given the information I have given you on myself, are there any conditions that match my case which I could get tested for?

How can I get help faster? This is very urgent but it being dismissed very quickly, or I am being put on very long waiting lists.

Are there any good doctors or anything specifically helpful for my case in Ottawa Canada?

Are there any specific tests I should be ask for, to help with my diagnosis?

Are there any online resources you can direct me to that would be helpful in my situation. I find there are many sites that are more depressing than helpful on the subject, and want to deal constructively with my rehabilitation.

I have a move coming up on the 15th of June, and I am getting more and more anxious about it. I find it paralyzing to even think of packing, but I have a limited supply of support that can help me with this move. Do you have any suggestions of how I can make this move easier (if not possible)?

It has been suggested that nutrition is playing a large role in my illness. In your experience, are there "trigger foods" that worsen moods or trigger
manic/depressive episodes? Are there foods that stabilize moods?

How long, generally, should I expect to stay on a suggested drug before I can see it's stabilizing effects?

Are there any suggestions you can give me for short term relief, as in treatments, activities, etc?

What can I do at the beginning and during an episode to stop from descending into suicidal behavior?

Is there any way I can make my home more friendly to my illness?

Is there any way I can, in the future, make my career more friendly to my illness?

Thank you very much for your time, it is very much appreciated.
(This letter was dictated/guided by Pierre to me, his girlfriend, as he found it too difficult to write such a long and detailed letter on his own. I can
vouch for the severity of his condition, the urgency, and that he seriously wants to get better. I am working with him and will be sending this email
out to as many helpful people as we can, any help you can give us is appreciated, and we understand that he cannot be diagnosed online - however we want to arm ourselves with as much information and suggestions as possible. )

Pierre S. and Evelyn R.

Answer
This is a PS.  If you contact the World Fed and after you have maybe some sense of how helpful they are, what kind of help you receive, I would appreciate it so much if you could give me your impression of them.  It would help me in answering future questions.  Just use the Ask a Question thing at allexperts.

Also, a clarification re my answer to you:  behavioral/cognitive therapy would be a service NOT provided by a psychiatrist....probably be a psychologist or a social worker of some sort.
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Evelyn - we need you to stick w/ this situation until we have a Plan that is working.....Pierre needs a friend much more than he needs a girfriend, so pls don't get so involved - think of his history w/ women - that you cannot stick around for awhile.

Help is at hand:  World Feollowship for Schizophrenia and Allied Didsorders [definitely includes all], based in - CANADA.  +1.416.961.2855 or info@world-schizophrenia.org
I would suspect they have a chapter/affiliate in Ottowa.

Since I know NOTHING of Canadian private and public medicine - except for the waiting lists - your best help will come from them.   --- My only other Q would be whether Pierre has been in military service and has any benefits available from that [or whether there are perhaps veterans' hospitals us as the US has.]

Here is my best general advice:  you only want diagnosis and treatment from psychiatrists.  ONLY.

Except for lithium and Zyprexa, you have been treated exclusively w/ anti-depressants....which, should you be bipolar, could have worsened things.  [Bipolar depression is treated differently from 'regular' depression.]  -- And, regardles of diagnosis, the anti-depressants weren't doing the job; someone should have noticed and augmented them with another/other med/s.

Changing the doses of lithium within a month is ludicrous and abandoning lithium within a month is ludicrous.  But I do suspect that you need a mood stabilizer [lithium is one], possibly in combination w/ a second mood stabilizer.  Only time would tell about the need for a second.  It is a little tricky to get the dose of lithium right and you do need regular, simple blood tests to make sure that you are staying within its very narrow therapeutic range.

The doc who tried the Zyprexa has my confidence.  If you had to make a blind choice, s/he's it. On the right track, anyway.  And if Prozac worked well in the past, and some time has intervened, you might get a good result from it again.  W/ mental ilness, the whole medical management thing is getting the right med/s at the right doses [a matter of trial and error, unfortunately], and being alert for when things are getting out of whack again and then tinkering again w/ meds/doses.....something you will be doing forever.

When I speak of trial and error, I don't mean that you are going to spend 2-3 years on drug trials, willy nilly.  You are going to start, one hopes, with a [correct] diagnosis of a disorder that CAN be treated w/ meds.  Then your expert psychiatrist is going to use logic, experience and your particular symptoms at the time to make choices about meds - starting obviously w/ that [or those] likeliest to help YOU and then changing a dose, adding a drug....the tinkering that I mentioned, but tinkering that one hopes eventually leaves you in better shape.

The PSTD and dysthymia could be trickier....could involve the need for "cognitive therapy" or behavioral therapy....attempts to change how you view yourself and your problems so that some of the problems become non-problems.

That Canadian group will know the answer to this: whether there is a comprehensive system of mental health care in Canada, centers for mental illness care that are staffed by docs, but also w/ psychiatric social workers and other sorts of helpers.  We have them here, usually called community mental health centers.

The Canadian group also has a raft of exellent publications that will be helpful to you in learning about your illness/es and in giving you the confidence to work helpfully and assertively with clinicians.  [Evelyn: go w/ him to appts if you can.  Always a help to the pt and the doc, to have a third person.]  Other sources I can recommend are www.nami.org or www.mentalhealth.com    If you can get any of Jack Gorman's books, do so.  He writes on mental illnesses and on psych meds....the books are EXCELLENT but slightly out of date; there are some newer drugs not mentioned that are fabulous.

Evelyn - a book for you so that you can stick around and be even more helpful than you have been.  Author is Woolis.  Title is When someone you love has a mental illness. It will help you in good times and bad --- and there WILL be bad times.  [There are 2 edtions.  Get either, as long as you are also getting Gorman.  No Gorman?  Then get the 2d ed Woolis.]

Sorry the move is coming up.  The less Pierre is directly involved the better.  Scare up as many warm bodies as you can, E, so that Pierre will be less upset by it. He needs to spend moving day int he park or at the movies.  AND - send my note to the ex-friend, along w/ a copy of the Woolis book and/or ask him to write me.  We need him back.

Oh - last question - how to get Pierre onto short or long-term disability.  World Fellowship could answer.

Hope the answers that you are soliciting will lead to some stability for Pierre.  Stay w/ him if you can.