What Are Our Treatment Options in Psychiatry?

choosing

I go through this almost every time I see a new patient.  I often hear that this is all they really wanted, “To know what my options are and that I’m not choosing something way out there.”

First off, most treatments for psychiatric brain illnesses are not done with intention to cure, but rather to restore health and increase quality of life.  Healthy is not the same as disease free.

This applies to all the treatments listed here.

1.  Hospitalization:

Inpatient – 24 hour locked unit, voluntary and involuntary, little psychotherapy, and daily physician care.

Partial Hospital – Day Hospital that runs during business hours such as 9AM-3PM, voluntary only, includes intensive psychotherapy, and weekly physician care.

2.  Counselling/Psychotherapy:

Talk therapy and exercises of various forms.  May be with physician or nonphysician.

3.  Stimulation Therapies, such as:

Deep Brain Stimulation (DBS) requires brain surgery to implant an electrical stimulation device in the specific brain area, controlled by a device implanted in the gut. Effective, but higher risk.  Least time consuming for maintenance care.

Transcranial Magnetic Stimulation (TMS) – The patient sits in a chair with a magnet at the head’s surface that uses magnetism to stimulate the brain for treatment, 1 hour a day, 5 days a week for various weeks, according to the patient’s need and funding.  Few side-effects.  Time consuming.  Not as effective as DBS or ECT but comparable to some medications.

Electroconvulsive Therapy – Uses electricity to stimulate the brain, inducing a short seizure for treatment.  Considered safe and of low risk.  Most effective.  Response is speedy.  Few, and mostly temporary side effects.  Does not enter into the body systems.  Less time consuming.

4.  Medications:

Chemicals for treatment in the form of pills, liquids, injections, patches, powders, vapors, gases – enter into the body systems causing physical side effects that, as with any treatment, must be weighed against the benefits.

Pills – generally taken daily, which is a challenge to treatment compliance, and activate internal conflict and personal stigmas.

Injections – generally done in a clinical setting, bimonthly or monthly.

5.  Aerobic exercise 50+ minutes, 5 days a week.

6.  Sleep hygiene.

7.  Diet

8.  Alternatives – such as over the counter herbals, naturalistic supplements, meditation, spiritual, acupuncture, acupressure, massage, or no treatment.

Questions:  What do you think of your options?  What do you choose?  And why?  Please tell us your story.

Did I miss anything?

Self-Care Tip:  Get informed about your treatment options.

Tower-of-Babel Syndrome

COMPLETION-OF-THE-TOWER-OF-BABEL-GENESIS-XI9-2-Q6503

From time to time, I hear complaints that someone’s brain illness got better with medications and/or ECT, but just came back when they stopped. This almost always happens when a patient never transitioned to maintenance ECT and/or medication therapy.

I dub this, the Tower-of-Babel Syndrome.  We all suffer from it at some point in life, trying to be like God.  Or maybe a lesser god?  During this Tower-of-Babel Syndrome, after we have paid the price, after we have complied with the many hard tasks, after we have built ourselves up into something glorious, we are cured from illness. Right? Once we stop perceiving it, illness that is, we are closer to God, more like Him/Her, perhaps more perfect, when we feel better and do not need medical care. Little gusts of wind are all it takes to fill our wings and off we go, living life free from disease laden earth.

But this is a mistaken expression of freedom.

The number one reason for relapse is…? You remember.  Treatment noncompliance. Is relapse most often due to life stressors? There are so many. No. All those reasons for why we think we feel what we feel and do what we do, all those forces acting on us from the outside in, they are not the reasons we relapse most often.

There is something like a super-bug growing amongst us who engage in treatment on and off. We do it four or five months out of seven. We skip here and there and do not “over-react” if we do. “They don’t control me, after-all.” We apperceive the situation. We think we, by not being consistent with medical treatment, demonstrate our freedom. We are free when we engage in medical treatment or when we do not. We are free because we are human.

The super-bug in brain illness is a progression of disease process heightened and sharpened by treatment noncompliance. A growing resistance to treatment and an acceleration of our falls, how long it takes for us to drop into a relapse and how hard and far we fall.

Let us work together to take away barriers to consistent treatment.  You may laugh when you hear about the Tower of Babel.  You can laugh.  A bonus.

The Tower-of-Babel Syndrome is familiar to those of us who stop any variety of medical treatments on our own, excluding our treatment team members, (such as our physician, Wink! Wink!) in our decision to end treatment.

By stopping medical treatment, many of us have this sense of eliminating the reason we started in the first place.  Take treatment.  Disease continues.  Stop treatment.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You are gone.  Turn back.  You reappear.  Turn.  And just like that, you have been eliminated.  Even now, remembering it delights me.

Not so cute however, is disease relapse.  Maintenance ECT and/or medication therapy has a protective effect on the brain, prophylactic against further insult. It does not increase the distance between Me and God.  It does not increase a mislabeled dependency on treatment.  Maintenance therapy is part of our life journey.  It is part of our ability to be present with ourselves.  It is friendly.

Questions:  What keeps you in treatment?  Do you feel more diseased when taking maintenance therapy?  How do you manage that?  Please tell us your story.

Self-Care Tip:  Stay in maintenance therapy.