Sister suffering bad anxiety/depression episode

LegacyUser

Hi,

Looking for others' experience with this.

My sister is currently experiencing a very bad anxiety/depressive episode. She has been prescribed medication and we were told it would take 2/3 weeks for them to kick in.

We're wondering what the procedure is for getting her admitted to a hospital? She has a medical card but we'd pay to get her better, of course!

She says that her thoughts are all over the place and she cant "shut them up". She's in so much distress and our hearts are broken.

Big Bag of Chips

She needs to go to her GP and be referred. She could be put on a waiting list for a bed or she might be admitted immediately.

But her GP should be her first stop. Does she want to be admitted, or are you hoping to have her admitted involuntarily?

Involuntary admission to psychiatric services is complicated and only happens in very rare cases.

blatantrereg

Involuntary commitment is not as infrequent as you might think. It should only happen if the person is suffering from a mental disorder and is at risk of causing harm to themselves or others - or refuses to take medication that results in a significant deterioration of their condition (pretty much the same thing as causing harm to themselves). A medical doctor may sign off on this if they consider the conditions to be met. This could be done by a GP in his practice or a doctor in an A&E department of a general hospital. A psychiatrist needs to sign off on it as well after meeting the patient within 24 hours. The initial order can last up to three weeks. After three weeks the patient is entitled to a tribunal if they contest their committal. A renewal order can also be issued at this time.

Voluntary commitment can be almost as restrictive. Patients can be prevented from leaving, both in terms of discharging themselves and in terms of leaving the hospital. However a voluntary patient is not entitled to a tribunal.

I see psychiatric hospitals as offering very little in the way of treatment that cannot be done for people being treated as outpatients. They do enable observation of patients by staff who can recognise the severity of any side effects etc, as well as observe the patient's condition. Their primary function though is to contain people who fit the criteria listed above in my opinion. As a result the likelihood that most patients in them are inclined towards self-harm and possibly violence towards others. They do not necessarily offer anything in terms of psychotherapy or counselling. They are not ideal environments in many ways. Personally I do not tolerate physical restriction well and would probably crack up if I were ever to be admitted to such a place. I have been inside them in the capacity of a visitor a large number of times (different hospitals and different people).

If the doctor is satisfied that she does not pose a risk to herself or others, and that she knows she is ill and needs medication then they will not recommend an involuntary committal. You might ask the doctor what they can recommend and explain the situation. There is no reason to assume that the doctor's training includes anything outside diagnosing illness and prescribing medication though, so while he might recommend some short term medication such as anti-anxiety meds or sleeping pills, you might additionally seek to talk to a therapist or investigate any support groups or information from people with experience with the same condition.

You don't need to pay to be admitted to a psychiatric hospital if you have a medical card unless it is private.

SATSUMA

Bring her to the GP maybe the meds she is on are aggravating her condition and she may need an adjustment. There is lots of help out there for you and her.

Take care

banquo

Sounds like a bad episode all right. Has she a history of this, or is this new?

LegacyUser

Hi,

Thanks for replies, she has ahistory of anxiety and depression, this has hit her very bad though. She's getting severe panic attacks and her thinking is in overdrive.

Says she only has relief when she's asleep

Big Bag of Chips

She really, really needs to go back to her GP and talk to them. If she feel she needs to be admitted somewhere, she needs to discuss that with her GP.

LegacyUser

She has been to the gp, and was given medication for the anxiety attacks and they seem to work but when they wear off it's back to square one.
She's nearly on the ssri 2 weeks so maybe any day now they'll kick in, if not we'll have to consider the hospital route. She wouldnt have a problem going. The state she's in she'd go anywhere i'd imagine

Thanks again!

Big Bag of Chips

I know she's been to the GP - but she needs to go back! If she had a chest infection, was prescribed something by the GP, and was getting no better, she'd go back....

If she is able to wait another week to see if her meds kick in, then fair enough - but from what you say she is in a terrible way - so she needs to go back and tell her GP. There might be something else she can do/take while she is waiting for them to take effect.

Merkin

She needs to see her GP in the morning. As an interim measure they may be able to increase her anti anxiety medication or have her admitted if they feel she is in danger or unable to cope. Phone the GP first thing and offer to go with her.

LegacyUser

Thank you both for your very kind words, means a lot.

She says she'd like to go to bed for a few days to rest her mind. She's thinking about the same things over and over.

Going to bring her to the gp tomorrow and look into getting more xanax or some alternative. She's in bed now so at least that's something.

Judging by the number of threads in this forum, January really does seem to be pretty rough for a lot of people.

Merkin

You sound like a very kind and supportive sibling, she is lucky to have you

If you can, maybe write down all you want to say to the GP tomorrow before going in so everything is covered. I would also give her the option whilst there to have a moment alone with the GP just in case there is stuff she wants to say but may not for fear of opening up in front of you. In any event, going back to your GP is the best course of action and I hope she finds herself happy and stable soon. Best of luck.

blatantrereg

Xanax is highly addictive. I would certainly seek a referral to a psychiatrist. The GP is not succeeding in treating her condition from what you say, so it is time to see a specialist. I would also suggest a second opinion on the diagnosis. Racing thoughts, intense anxiety and inability to get adequate sleep can be symptoms of common potentially dangerous conditions. Hospitalization is only something to do if it is necessary. Her home environment will be a lot more pleasant and peaceful than a psychiatric hospital.

Lux23

It can take up to a month for the meds to kick in so she may see a change in a couple of days, but I think in the long term she may be better off seeing a psychiatrist.

banquo

Yeah, if she's only two weeks in she has another couple of weeks to go.

It's cliched, but for a reason: if you can coax her into jogging - ironically, absolutely the last thing she probably feels like doing - it will use up a lot of the adrenaline and cortisol in her system and significantly reduce her anxiety.

Also, because then the brain isn't in overdrive as much, it doesn't get knackered and she should see some relief to her depressive symptoms.

Meds are great, but it's probably best to think of them as a cast on a broken leg - they provide the relief that's needed for the leg to heal, as opposed to being the cure.

Ham Sambo

Just as a matter of interest is it anxiety or depression that your sister was diagnosed with? I am aware that while there is a lot of similarities between them there is a difference, although some of the meds are the same. Does your sister suffer from a panic disorder too? as panic attacks can be a very very frightening experience to go through, perhaps her meds need to be adjusted.

BlueFairy

Your sister is lucky that she has such kind family looking out for her and being supportive with her care

The thing about meds is that they're not a magic cure. If she can find one that helps her then it should allow her to calm down from the overanxious state and into a place where she can begin to recover, but they may not make the anxiety/depression totally disappear. They may also take a little while to kick in, or a little adjusting to a different dosage/type before she finds something that works.

Cognitive Behavioural Therapy (CBT) is highly recommended for anxiety in particular, it will help her examine her unhealthy thought patterns and learn to think in a healthier way. It takes consistent work, but in the long term it will set her up with a better way of combating anxious thoughts for the rest of her life. She can also learn techniques to help her deal with panic attacks. This approach will teach her to deal herself with any feelings of irrational anxiety, rather than relying on medication in the long term.

If she's in a bad place then CBT may not be viable straight away, but certainly once she has found some meds that help her relax a bit then it would be a good idea to look into it.

There are two great books by Irish authors that would be good for her or you to read, they're very helpful:

- Flagging Stress by Dr Harry Barry (he's also written about depression, it's worth looking into his other titles)
- When Panic Attacks by Aine Tubridy

I also really like Control Stress by Paul McKenna which has a good recording with it for stress relief.

As for other lifestyle measures she can do along with her medication:

any form of exercise will be great benefit for raising her mood levels, making sure she's eating/drinking enough (avoid caffeine & excess sugar in particular), some form of relaxation method daily if possible like breathing exercises, meditation (there are loads of free ones on YouTube, this one is excellent http://www.youtube.com/watch?v=Jyy0ra2WcQQ), a yoga class or anything that will put her into a deep state of relaxtion (it's a really important factor of dealing with anxiety/depression).

Getting her to some form of counselling, CBT in particular, should be one of the first steps you look at together.

LegacyUser

Hello again,

You've all been very supportive. She has been to her psychiatrist this morning, he has a great way of getting stuff out of her. He told her to stick with the ssri she's on and gave her olanzapine 1 daily for 2 weeks and then she goes back.

I imagine it's going to be a long term thing, and that there may be more to it than meets the eye, but the medication seems to be working eventually so she's calm and the psych said to reassess the situation in 2 weeks when she calms down.
She has been having the panic attacks every morning for the last few weeks. She's ruminating over the same thing constantly! and i suppose that's giving her depression?

BlueFairy

Anxiety and depression commonly go hand in hand, you'll find many sufferers have both or that people with anxiety problems get depressed due to what they're going through.

Ruminating or obsessing over the same thing is also common with anxiety, this is the kind of problem that CBT can really help with.

She needs a technique to help her deal with the panic attacks, have her ask her therapist about it.

LegacyUser

Thanks bluefairy for the tips, you posted at the same time so didn't see it.
She's going to a therapist who she seems to have a good click with and tells her things and she says she can be very honest with her so that's great.

We dont think she has schizophrenia or anything like that, but her worries are making her mind race, which the psych said was just because she has her mind so worked up.

BlueFairy

Yeah I've been there myself, so I have an idea of what she's going through and it can be scary. It's because she's in a state of high anxiety, her body and brain are in red alert mode due to all the stress hormones and worrying. Racing thoughts are a normal thing to experience when you're that anxious and panicky.

In time as the meds help her to relax, and as she works on the anxiety, the racing thoughts should lessen.

Exercise will help her deal with those stress hormones by releasing endorphins, and relaxation will activate her parasympathetic nervous system which will help her mind and body to remain calm. She could try taking a vitamin B complex supplement which would also help with the stress levels, but only if it's compatible with her medication so best talk to her doctor about it.

Personally I don't know much about schizophrenia, but it does sound a lot like anxiety rather than anything else. It's up to her psych to determine that stuff I guess. It sounds like she has a good thing going with her therapist, so that's definitely a good start for her.

The Calm Clinic website has a lot of good information about anxiety issues that you guys might find helpful: http://www.calmclinic.com/

blatantrereg

I would ask the psychiatrist if they think she might have bipolar disorder.

Maura74

Sister wrote: »

She has been to the gp, and was given medication for the anxiety attacks and they seem to work but when they wear off it's back to square one.
She's nearly on the ssri 2 weeks so maybe any day now they'll kick in, if not we'll have to consider the hospital route. She wouldnt have a problem going. The state she's in she'd go anywhere i'd imagine

Thanks again!

I know of a young person in his twenties that used to get anxiety attacks years ago. His GP told him to get a small brown paper bag and put it over his nose and mouth and breath in and out several times in the bag until the anxiety subsided a little and that work for him. Also perhaps yoga classes would help as well.

Hope she gets help soon, wishing her well.

FollatonWood

blatantrereg wrote: »

I would ask the psychiatrist if they think she might have bipolar disorder.

Woah, how did you get from anxiety and depression to bipolar disorder? Also, the psych would have an obligation of confidentiality to the client, so disclosing this to the family would be completely unethical. To be honest, the family should be asking the girl involved how her treatment is going - not her treatment team.

LegacyUser

Thanks again.

Her gp thought that maybe she's is bipolar but she doesn't show the typical symptoms. It's more of an anxiety problem that she has, in that shes always thinking about worrying things that others dont. I hope that makes sense.

Her medication is starting to kick in at least so we'll have to wait for things to settle down more. She has started showing an interest in things which is good, watching telly and reading magazines etc.

LegacyUser

Thanks again to everyone.

Bipolar is something that has been considered, I suppose we're going to have to wait until she's in a more relaxed frame of mind before we discuss anything more. Her medication seems to be kicking in and she's definitely more relaxed and has started eating. Would love to know what's going on in her head though

blatantrereg

FollatonWood wrote: »

Woah, how did you get from anxiety and depression to bipolar disorder? Also, the psych would have an obligation of confidentiality to the client, so disclosing this to the family would be completely unethical. To be honest, the family should be asking the girl involved how her treatment is going - not her treatment team.

I'm just saying it's a sensible question to ask someone who is qualified to answer, which I am not. Bp is typically misdiagnosed for some time as one or both of those. The meds used are different and using meds for one on the other can be damaging.

My own experience is that psychs talk to family more than patients want, sometimes contrary to what they explicitly say. Not speaking as a patient; dont know whether they are ignoring the law or if it's different for psych patients.

banquo

Re: the relationship between anxiety and depression. It's usually pretty simple.

Anxiety = brain overload. Brain gets knackered. Depression = brain shutdown. Also, anyone who gets it will tell you that anxiety is exhausting. That's why people not typically prone to depression get a bout of it when their anxiety is around.

Second thing: Your body produces more cortisol (stress) first thing in the morning than it does later on (when, theoretically, you're trying to fall asleep.) In an anxious person, this is why you've no appetite in the mornings, and part of what leads to strong morning anxiety.

LegacyUser

Thought things were improving and we know it's not going to happen overnight but things seem to be back to the same.
She says that she would love to sleep for a week so that she wont have to worry about things.
The medication has stopped the tears though but still have no idea whats going on in her head!