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Treatment Challenges: Overcoming Short-term Obstacles for Long-Term Success

Getting the Right Diagnosis and the Best Treatment

“Once begun; half done.” If you’re at this website, you’ve begun. Discovery of your own form of a mood disorder can be daunting, but you’ve embarked on a healing journey. Congratulate yourself. You’ve begun; you’re half done.

The next important step is getting the right diagnosis. Avoid any setbacks in your care by being as honest as you can with your healthcare providers. You can help them determine the exact form of your mood disorder by listing all of the symptoms you currently exhibit as well as those you’ve had in the past. Since mood disorders commonly run in families, your healthcare providers will also want a list of those in your family who’ve been diagnosed, as well as those who exhibit the symptoms delineated above. Discuss and list family members treated for (or exhibiting symptoms of) “nervous breakdown,” alcohol or narcotic abuse.

Common Pitfalls to Avoid During Treatment

Despite the extensive treatments and therapies available, treating a mood disorder sometimes aggravates patients. In fact, it’s often because of the extent of treatments available that progress can take time. It’s important that, through trial and error, you invest the time and energy trying medications, meeting different therapists to find a good fit, checking out support groups and making lifestyle changes. You’re not the only one juggling your ingredients for the best outcome.

Below are some common obstacles those seeking treatment encounter. Preparing for these potential pitfalls, along with determination on your part and reinforcement from your support system, will help you succeed.

Having Inappropriately High Expectations: The bad news: three typical treatment approaches ALL take weeks and even months to work. When working through issues with family and past behaviors in talk therapy for instance, you will experience pain. You may even need to exert effort to change long-held behaviors. Applaud yourself for this work, because work it is. The result of all of this work, however, is peace of mind and improved daily life. Give yourself credit for any small progress you make. Remember: Baby Steps.

Similarly, medication may not take full effect for two to six weeks. Sometimes, it can take even eight weeks before levels have built up enough in your body for the medication to be fully effective. Don’t let a two month lag time discourage you. By investing two months now, you will reap lifetime rewards.

Adjusting or Abandoning Treatment: Your treatment will not work effectively if you do not stick with it. Most likely, you’ve received a diagnosis from a healthcare professional who’s seen many cases like yours. He or she has also seen what works best. Promise your doctor, your family and yourself that you will comply with your treatment. If you’ve researched your diagnosis and been careful to come up with solutions with your healthcare team, you will probably be more invested in following all treatments thoroughly.

Depending on Only One Treatment Approach: Research has proven definitively that mood disorders improve when individuals utilize more than one treatment. Those who only pursue talk therapy sometimes cannot get into a clear enough frame of mind to benefit from it. Those using only medication ignore life issues that they cannot manage alone, thereby adding to their stress and dysfunction. The effects of talk therapy and medication are buoyed by emotional and educational reinforcement offered by support groups. Finally, a body has its best chances of performing optimally when healthy. Boost your medication’s effectiveness by eating well and exercising.

Ignoring Medical or Physical Conditions that Exacerbate Mood Disorders: Menopause, aging and the use of medications treating unrelated physical issues can affect both the mood disorder and its treatments. Make sure you have a complete physical examination when starting treatment and once each year after that. Discuss your medical history with your doctor.

Abusing Alcohol or Narcotics: Using alcohol or drugs while taking medication can be dangerous. It can interfere with the medication, rendering it less effective or it can effect your physical systems negatively. Using alcohol or drugs while attempting talk therapy interferes with clear communication. Many effective approaches to alcohol and narcotic abuse exist; Alcoholics Anonymous isn’t the only one. You may need to embark on these in concert with or even before you begin treatment for your mood disorder. Do not hesitate to talk with your healthcare providers about your struggles with alcohol or drugs. Those with mood disorders are prone to dependency on these substances. The doctors have seen it before; they know how to help you.

What Can I Do to Get the Most from Treatment?

Be Informed: We’ve mentioned it before and we’ll mention it again: become the expert in your own care, a partner with your doctor. This proactive approach helps you feel empowered and hopeful, reducing confusion and frustration. You can turn to books, healthcare providers and reliable internet sites (usually those affiliated with major universities or reliable non-profits like the California Bipolar Foundation) to get basic information, cutting edge news and even different opinions. Having a notebook with pocket dividers and lined paper can help you organize articles and information under different topics.

Communicate Accurately with Your Healthcare Providers: Beyond the research suggested above, you should have a place where you write down your questions. Know that doctors these days are accustomed to patients asking hard questions and even taking notes during examinations. Further, it’s growing more common these days for patients to bring another person with them—a friend or a family member—who can serve as an “extra pair of ears.” The days when doctors were considered second only to God are over. They’re now used to challenges and questions from patients, so if you think your care could be better, don’t be shy about expressing yourself. Try to be as specific as possible about your issues—stick to the facts—and avoid becoming too aggressive. A doctor on the defense may be distracted form the medical issues at hand. If you’ve aired your grievances and nothing improves, know that your insurance plan or your state benefits most likely include several other clinics. Getting a second opinion is a common practice now.

Set Goals: It’s not only annoying yuppies that set achievement goals. Strivers in every arena measure the progress of any new endeavor by whether goals are met. A medical endeavor is not different.. Knowing what you want to achieve in your treatment before you embark on a treatment plan will help you measure that plan’s effectiveness. First, you need to be aware of the typical results so you can form reasonable expectations. You can get this information from your healthcare providers or from the internet. Once you establish your goals, track your progress. This exercise will not only help you determine how effective your treatment is, it will confirm your hope for a different future.

Track Your Treatment, Lifestyle and Moods: Specifically, at the end of each day, record a sentence or two about the three facets of typical treatment: medication, talk therapy and support groups. Writing down your exercise and eating habits, too, will, in the long run, help you coordinate your mood and medication with your lifestyle choices. Which leads us to journaling your mood! For those with mood disorders, the levels can vary from: stable, manic, depressed and mixed. Organize the aspects—treatment, lifestyle, mood— so that you can most easily discover patterns among the three variables. This effort will help you anticipate mood changes and make treatment decisions with your doctors.

Connect with Others and Know You’re Not Alone: Great doctors have written many books about the connection between hope, happiness and medical outcomes (see Bernie Siegel’s Love, Medicine & Miracles and Dean Ornish’s). Great researchers have concluded that social connection impacts longevity more than many other health factors. Social connection is within your reach. Not only will others in a support group help you, but you most likely can help others. Give and receive. Accept and contribute. Know that according to the National Institutes of Mental Health (www.nimh.gov), 19 million American adults have a depressive disorder. Nearly 2.5 million adults have a bipolar disorder. Because bipolar disorder, however, can go unrecognized and untreated, researchers estimate that the number is much higher. Today, more than 1,000 support groups—both for patients and those helping another—exist to help those impacted by mood disorders.

How Can I Improve the Effectiveness of My Medication?

The most important individual on your treatment team is YOU. As mentioned above, getting support, complying with your treatment plan and maintaining a healthy lifestyle increases the effects of the medication you receive. Several additional steps will help ensure your body and brain get the full benefits.

Pay Close Attention to Prescribed and Changing Dosages: Doctors usually start patients on low dosages of medications so that the body has time to adjust. At the beginning of treatment, the doctor will explain the beginning dose and how the amount will rise or “step up” gradually over the coming months. During this period, your doctor will require that you meet with him regularly so that he can monitor your dosage, mood and any side effects. While there are some “typical” dosage standards, interestingly, some people respond well to low dosages; others require much higher dosages. While this period can be frustrating, take heart in the fact that the tinkering going on now will most likely set you up for a lifetime of the effective treatment.

Research Different Medications Available: Several different classes of drugs exist to address mood disorders. Anti-depressents work to help the brain feel more pleasure. Companies have also developed effective mood stabilizers (anti-convulsants) and antpsychotics (also called neuroleptics). Your doctor may prescribe one or more of these to address your specific symptoms. Researching how each drug targets the neural synapses not only helps you feel more in control of your treatment, it encourages you to remain compliant (and it’s interesting)! None of these medications are addictive and they will not change your personality. In fact, some doctors believe that they control problematic symptoms so that your true personality can come to the fore. Each medication will come with instructions about whether to take them with food or on an empty stomach, in the morning or evening. The instructions will also indicate whether the medication interact with certain foods in a negative way. You may need to avoid some foods, beverages (particularly alcohol) and natural/herbal supplements.

Take Medication According to Instructions: At first, it may seem like a chore to remember to take your medication at the right times and with the right foods. Tools like alarms, watch alarms, computer alerts, pager alerts, mobile phone alarms or a pre-fillable medication container can make staying compliant easier. Some take their medication at the same time as another daily activity (e.g. while making breakfast or brushing teeth). Others have a family member remind them.

Don’t Let Side Effects Dissuade You from Using Medication: Patients can get frustrated in the early weeks of a medication regimen when side-effects make them feel worse than they did before beginning. This is understandable. Dry mouth, constipation, grogginess and blurred vision can interfere with your daily activities and overall well-being. First, know that many side-effects go away after the first few weeks. Taking your medication according to instructions increases the odds that your side effects will be minimized. Secondly, discuss your side effects with your doctor. He or she may be able to prescribe a different medication that doesn’t cause your body to react in the same way. If, however, you become very ill quickly, you need to go to your doctor or an emergency room right away.

List All Medications You Take: List all medications and herbal supplements you take for your doctor. You never know which substances interact negatively or render another medication ineffective.

What Are Mood Disorders?

Marked by sometimes dramatic shifts in energy, behavior, mood and thought, mood disorders effect and even warp an individual’s outlook and perception of reality. Like other physical diseases, these disorders can be treated with medications, lifestyle changes, psychotherapy and other therapies. Healthcare professionals and patient advocates have been working hard to help the general public understand that mood disorders have nothing to do with character flaws or weaknesses. Rather, they are treatable chemical and biological anomalies that respond to many safe and affordable therapies.

Starting at the most mild end of the spectrum, dysthymia generally emerges as a low mood that depresses an individual’s frame of mind over a consistent and extended period of time. The dysthymic individual can usually carry out home and work duties sufficiently, but not optimally. More severe, clinical depression often does interrupt one’s job, family and lifestyle when an individual no longer finds pleasure in activities and people he or she once enjoyed.

You May Have Dysthymia or Clinical Depression if . . .

  • You have periods of sadness, irritability or crying spells most of the time for a period of two weeks or longer.

  • Activities and social opportunities you once enjoyed no longer give you much pleasure.

  • You feel either perpetually restless or as if you’re moving in slow-motion.

  • You don’t have the energy you once did. You often tell people that you’re “exhausted.”

  • You are plagued by intense feelings of low self-esteem.
 
  • You feel incredibly guilty about events or comments you are not wholly responsible for.

  • You struggle to concentrate and make decisions.

  • You fantasize about suicide. You think about death often.

Could It Be Hypomania or Bipolar Disorder?

Sometimes, individuals cannot completely relate to the symptoms of depression above because their low periods are interrupted by days or weeks of excessive energy, a strong sense of self and a string of accomplishments. These folks may attribute their up and down periods to the normal stresses and joys of life. When the ups and downs are extreme, however, bipolar disorder (also known as manic depression) or cyclothymia (also known as hypomania) could be at work behind the scenes. A person with full-blown bipolar disorder experiences incredible up periods, but crashes soon after. One with cyclothymia may feel energized for a period and then a bit blue thereafter, but the swings are less severe.

You May Have Hypomania or Bipolar Disorder if . . .

  • You feel incredibly powerful and/or talented. In other words, you’re experiencing very high self-esteem.

  • You feel incredibly energetic, as if you can accomplish many tasks/projects.

  • You monopolize conversations, talking too much or you feel pressure to keep talking.

  • You feel unusually irritable, often snapping with little cause.

  • You experience a decreased desire to sleep. There are so many projects tocomplete, after all.

  • Your thoughts race and collide. Many great ideas crowd your mind.

  • You get distracted easily or jump from topic to topic. 

  •  You behave recklessly, either by talking too much, spending too much or engaging in casual, even unprotected sex.
  •  You focus on goal-directed activity.Will I Ever Feel Better?

Sometimes a mood disorder has been going on for so long, individuals consider it just a part of life that cannot be changed. Writers and philosophers alike write about how life is simply a struggle. Further, we hear of those in other countries or other social classes who have so much less than we do, we assume we must put our chins up and gut through our difficult moods and the behaviors that stem from them.

For a few decades now, millions of people have found significant relief from persistent mood disorders. You can, too. Typically, healthcare providers and social workers recommend three ways a client’s mood issues: talk therapy, medication and support groups. The individual can also use self-directed therapies to alleviate mood disorders. Research has proven conclusively that healthy lifestyle choices such as maintaining a balanced diet, exercising regularly, meditating and journaling has benefitted many. First and foremost, it’s important to discover which mix of treatments, therapies and lifestyle choices you respond to best. Experiment and even jot down what you’re doing so that you can become the expert in your own care, discovering what works best for you. Not only will you get better faster, the feeling of empowerment will contribute to the healing process.