Not Bridget Jones

I'm not sad. I'm not desperate. I'm not Bridget Jones.

Saturday, September 23, 2006

Issues with the Mental Health Care System

There are some serious problems with our health care system, as relates to mental health.

Case in point one:
My boyfriend had a very good friend. I never met her, but knew of her through him. She was incredibly intelligent and driven, well-educated. She also had bi-polar disorder. Because she did not have health insurance, she was not able to afford the medication that would have controlled it. On May 31, she killed herself.

My recent trials:
My anxiety slowly rose during the late spring, and then, at the end of June I had a 10 out of 10 panic attack. After that my anxiety kept rising. Finally, in mid-July, I left work early, then called in sick the next two days. I knew that I was relasping into Panic Disorder with Agoraphobia. I also knew that I needed help. Immediately. My mother said she would come down the next day, and bring me to the doctor.

Now, I did not health insurance. I would start my health insurance on August 1st, but I couldn't wait. I needed help then.
So, I called the local community health center. Community health centers are for those who cannot afford health insurance. I was told that I needed to do an intake process, which mainly consisted of verifying income. I could get an intake appoint in about two weeks. After the intake, I would be able to start seeing a doctor or counselor in two weeks. Basically, I could get help in a month. "What if I need help now? What should I do?" They told me to go to the emergency room.

By the time my mother got to my apartment that day, my anxiety and panic was so bad that I was visibly shaking. The first thing she did was give me half an Ativan-equal to .25 mg. Ativan is an "as needed" anti-anxiety drug. It helps alleviate the physical symptoms of a panic attack. The last time I had a round of treatment for Panic Disorder, this was one of the drugs I was precribed. Of course, I am afraid of drugs, so was very reluctant to take it.

So, I took the Ativan ,which did help. Then we worked on a plan. I needed two things: some short term treatment so i could go back to work on Monday, and a long-term treatment plan.

It seemed like getting a precription for Ativan would be a good short-term fix, and getting into therapy was a good long term plan. Now, where to go? The health center told me to go to the emergency room, so we decided to go to the hospital nearest to me.

When we first got there, the intake nurse was wonderful. Kind, sypathetic, understanding. They pulled me out of the waiting area very quickly, assuming that I would be more comfortable in a bed. I then waited a really long time for a consultation with an MD. She did a pretty basic workup, listening to my heart, etc., then told me that the psychaitrist on duty would come see me.

Finally, that doctor came in and introduced herself as the psychiatrist on duty. She asked me a bunch of questions-clearly a basic screening for suicide and psychosis. Then she asked me to explain why I was there. I explained my history of Panic Disorder, and told hger that I had started having panic attacks again, and that I had missed the last two days of work, and that I felt that I was becoming Agoraphobic again and that I had to get back to work on Monday.
She said: "Agoraphobic? What's that? I don't know what that means."

Uh-oh.

I explained.

I said that I wanted to accomplish two things: get an "as needed" so that I could get to work on Monday, and get into therapy.
She left, and said she would be back soon.

She came back and first said: "I don't think you need to be hosptialized." What?????? Of course I don't need to be hospitalized!
She told me that, since I did not have health insurance, I would be able to get free therapy at the hospital's mental health center. Well, that's good. Then she gave me a precription. For Prozac, starting at 20 mg daily.
Now, SSRI's such as Prozac can be of great help for anxiety and panic disorders. However, they a.) take at least a few weeks to start working and b.) need to be started at extremely low doses, as a too high dose can actually cause more anxiety and trigger even worse panic attacks. High doses-such as 20 mg. I expressed my concern about this, and she said "No, this is the dose you should start on." I then asked her about an as needed, and she said, "we don't like to prescribe those." I asked her how I was supposed to go to work on Monday. She said, if you take your first dose of Prozac on Sunday, you will feel better by Monday morning.

This is a flat out lie.

From WebMD: "It may take 4 weeks or longer before the full benefit of this drug takes effect. Inform your doctor if your condition persists or worsens."

From Prozac.com: "The first several weeks are the toughest because many (but not all) people are getting used to antidepressant medication and suffering the symptoms of depression at the same time. Until the patient feels the full effects of the antidepressant (this usually takes 4 or more weeks), even mild and temporary side effects may cause them to feel discouraged and stop taking their medication."

From MedlinePlus: It may take 4 to 5 weeks or longer before you feel the full benefit of fluoxetine.

Any medical professional should know better than to claim that one dose will make you feel better.

After crying and making a fuss, I left with a script for Ativan as well. I did not take the Prozac.

On Monday, I called the mental health clinic, and explained my trip to the ER, and that they said I could get free care.
I was told that they never offer free care. If I wanted, I could pay out of pocket. I would need to start with an intake appointment. That would be $500. She also asked if I was taking the Prozac. I explained that I wished to be under consistant care beofre taking it, since i felt that the dosage was too high, and that I was concerned about the side effects of more panic and anxiety at that dosage level. I was told that if I did not take my medication, they wouldn't see me.

At this point, I was really skeptical about the whole experience. I looked up the psychiatrist from the emergency room. She's not a psychaitrist. She's an internist.

So, in seeking help, this hospital staff:

-misrepresented their qualifications
-lied about the availibilty of continuing care
-prescribed a drug at an inappropriate dosage*
-lied about the action of the drug

What does this say about our health care system? I had the support of my family, and enough knowledge of my disorder to know that what was offered to me as care was dubious at best. What if a person with a mental illness sought help and was lied to and did not have the resources to seek alternatives?


*I have since been told my my psychologist who specializes in anxiety disorders; my psychiatrist who specializes in anxiety disorders; and the BU Center for Anxiety and Related Disorders, one of the most well-respected research faclities for anxiety in the country, that had I taken the Prozac at that dose, I most likely would have ended up in the ER with uncontrollable panic.

2 Comments:

  • At 8:06 PM, Blogger magnetbabe said…

    I read the post and couldn't believe the ineptitude of the "psychiatrist". I suffer from chronic anxiety and depression (not something I talk about on my not-so-anonymous blog) and I couldn't imagine being treated that way. Not to mention the fact that SSRIs are very hard to come OFF of once you are "better." I applaud you, not bridget jones for not following this terrible advice despite her panic attack. I can't say I would have done the same, but you are absolutely right.

     
  • At 10:40 AM, Blogger Lauren Mitchell said…

    Hi,

    I just found your blog, but wanted to express my sympathy and understanding. People with anxiety or depression aren't the only one's who are poorly treated/grossly mishandled by the medical system. I have a neurological/cardiovascular disease and have had similar experiences with doctors prescribing heart medication that would have made me horribly sick had I taken it.

    I guess the lesson is that we have to be our own advocates. I'm so glad you didn't take the prozac, and that you're trying to find someone competent to help you with your anxiety.

    Best wishes,

    Lauren

     

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