Chronic Mononucleosis

In May, I was diagnosed with chronic mono due to a high Epstein-Barr virus count and constant complaints of feeling tired. (According to my doctor, there are many doctors who don’t believe that chronic mono exists.) Chronic mono is a gateway illness that can lead to chronic fatigue syndrome (CFS). (Although CFS can have other triggers unrelated to EBV.) There’s not much information about chronic mono, but here’s what I’ve found:

According to Livestrong.com, mononucleosis is caused by exposure to the Epstein-Barr Virus, or EBV. Apparently, close to 95 percent of adults between ages 35 and 40 carry an inactive form of this virus. While many people may never experience symptoms, those who do experience symptoms may see a resolution within 2 months. Those who experience symptoms for 6 months or more are likely to have chronic mono.

What are the symptoms of mono?

  • Swollen lymph nodes
  • Fever
  • Sore throat
  • Fatigue
  • Liver and/or spleen enlargement

While I haven’t had swollen lymph nodes or fever, I have had recurring sore throats (not lately since I’ve been on a supplement) and severe fatigue. As far as I know, I don’t have an enlarged liver or spleen.

There’s not much reliable information on the Internet about chronic mono so please feel free to chime in if you know anything about the illness or virus.

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20% of American children suffer from mental illness

The new SCHIP (State Children’s Health Insurance Program) law that President Obama signed significantly increases health coverage for children, which also includes mental health parity. According to Nancy Shute of U.S. News & World Report, health coverage is expanded to:

“4 million more children beyond the 6 million already covered but also brings mental-health parity to the state programs that provide insurance for children in low-income families, requiring that they get the same access to treatment for bipolar disorder, depression, anxiety, and other serious disorders as they do for physical ailments.”

Then I stumble across this:

Depressed child“Mental-health needs are nowhere near being met,” says Jay E. Berkelhamer, past president of the American Academy of Pediatrics and chief academic officer at Children’s Healthcare of Atlanta. “At least 20 percent of all visits to pediatricians’ offices are related to mental-health problems.

Normally, though, overworked pediatricians may not ask if a child has a mental-health problem—and may not know where to refer him or her if they do. About 20 percent of children and teenagers have a mental-health problem at any given time, or about 8 million to 13 million people. Two thirds of them are not getting the help they need.

That means out of roughly 40-65 million kids, we have 8-13 million who are “mentally ill.” And then about 5-8 million who aren’t getting proper mental help.

Color me cynical but I think 20 percent is a disproportionately high number to classify children as mentally ill. I think the percentage of adults being classified as mentally ill is exorbitant enough, let alone children who are going through stages in their lives where they’re simply developing, encountering mood swings, being disobedient, and perhaps, being — perish the thought! — normal children.

But let’s address something else here: I don’t think it’s impossible for children to suffer from mental illness but the incidence should be significantly lower.

According to Dr. Louis Kraus, the chief of child and adolescent psychiatry at Rush University Medical Center in Chicago, suicide ranks as the sixth-leading cause of death among ages 5-14 — “although rare.” From ages 15-24, it jumps to number three.

The key word in that last paragraph is suicide is “rare.” The rate of mental illness in children should reflect that somehow. While I’m very happy SCHIP includes widespread mental health parity for low-income families, I’m also concerned children will be overdiagnosed with a “mental illness” when they may simply be dealing with the normal challenges of a difficult life.

“I used to care, but now I take a pill for that.” — Author unknown

Philip Dawdy at Furious Seasons has some great posts on the bipolar child paradigm that further explore the murky world of psychiatry pushing psychiatric illnesses and psychotropic drugs on kids. I’d also recommend reading Soulful Sepulcher as Stephany recounts her and her daughter’s experiences in and out of the mental health system.

(pic from save.org)

Loose Screws Mental Health News (the ODD version)

I came across an article in my Google Alerts titled, “Harvard study: Under-treatment of mental illness contributes to crime.” Intrigued, I clicked on the link to read more of the article. Turns out the lede is:

Two thirds of prisoners nationwide with a mental illness were off treatment at the time of their arrest, according to a new study by Harvard researchers that suggests under-treatment of mental illness
contributes to crime and incarceration.

The article is poorly titled. The headline was designed to be alarming: “Watch out for those crazy people! They’re violent!” It’s not “under-treatment of mental illness” that “contributes to crime” so much as it is “two-thirds of inmates with mental illness are off medication.” There’s nothing in the article that asserts people with mental illness contribute to the crime rate in America. An interesting read but an inaccurate head.


shoppingThe New York Times had an article a few weeks ago on compulsive shopping eventually becoming a legitimate disorder. I’d been wanting to write about this for a while but Gianna at Beyond Meds beat me to it. She aptly titles her post, “It’s called poor impulse control, people .” She writes:

It’s a psychological problem. But let’s relegate out of control shopping to a brain disorder too, so people can have one less thing to take responsibility for. This is really getting ridiculous. Pretty soon we won’t be responsible for any of our bad behavior as it all becomes pathologized and out of our hands. And you can be sure they’ll be a drug for it, too. Since their calling it OCD related it’s a good bet they’ll try out SSRIs.

The DSM-V is currently being crafted in secret but everyone in the medical field fully expects new disorders (such as subthreshold bipolar disorder and Internet addiction) to pop up. Don’t be surprised if CSD (compulsive shopping disorder) pops up in it too. (pic via pro.corbis.com)


In related let’s-give-everything-a-diagnosis news, some mental health experts are assigning a new label to women obsessed with having children: baby addiction.

baby…Sometimes the desire to keep having children can be rooted in complex psychological issues dating as far back as one’s childhood. In certain cases, experts say, it can become a compulsion, an obsession or even a “baby addiction.”

While the current book of psychiatric diagnoses, the “Diagnostic and Statistical Manual of Mental Disorders,” has no entry on baby addiction, mental-health professionals say they see patients, mostly women, who desperately want to keep having newborns, even when they already have several children and aren’t managing their family situation well. That, they say, is a big red flag, no matter what term is used to describe it.

“It can be an addiction,” says Gayle Peterson, a family therapist in the San Francisco area and author of “Making Healthy Families.”

Peterson has seen several women in her practice who’ve been overwhelmed with four or five children, including those with special needs. Some of the women were suffering with depression or panic attacks and yet when their youngest child became a toddler, they wanted another baby. These women can be driven to have more children in an effort to make up for some sort of void or loss, usually from their own unhappy childhood, explains Peterson.

“If you’re just having babies to complete something in yourself that never got completed, you really are talking about an addiction,” she says.

While it might be an addiction, it’s not DSM-V diagnosis-worthy and it definitely doesn’t need medicinal treatment. Get some psychotherapy and call it a day. An addiction like this is behavioral more than anything else. (pic via sodahead.com)


And last but not least, we’ve also got a new case of “climate change delusion.” (Ha!)

Last year, an anxious, depressed 17-year-old boy was admitted to the psychiatric unit at the Royal Children’s Hospital in Melbourne. He was refusing to drink water. Worried about drought related to climate change, the young man was convinced that if he drank, millions of people would die. The Australian doctors wrote the case up as the first known instance of “climate change delusion.”Robert Salo, the psychiatrist who runs the inpatient unit where the boy was treated, has now seen several more patients with psychosis or anxiety disorders focused on climate change, as well as children who are having nightmares about global-warming-related natural disasters.

–snip–

Of course, no one can predict what effect warming will have on our psyches. The links between mental illness and the weather can be tenuous or even downright contradictory. Depending on which studies you read, suicide is more common, less common, or equally common in hot weather. Ditto dry weather.

It looks like my post just turned into an ODD (OverDiagnosis Disorder) case. I’ll get back to you once I’m free of my concern for the environment, my desire for multiple children, and my penchant for window shopping.

Coming off of Lamictal (lamotrigine)

Medication

I am officially joining the ranks of those who are facing the challenge of Lamictal withdrawal.

On Wednesday, I went to see my psychiatrist with a plan to come off of Lamictal:

  • 150 mg for 3 months
  • 100 mg for 3 months
  • 75 mg for 3 months
  • 50 mg for 3 months
  • 25 mg for 3 months
  • 12.5 mg (depending on whether my side effects on the 25 mg are bad)

I told him that my husband and I were looking to have a child sometime next year and that I’d like to taper off of Lamictal but was open to the possibility of getting back on it should I encounter severe suicidal ideation and mixed episodes. He warned me against it and thought it was a bad idea.

He proceeded to say that it’s a maintenance medication, I have a lifelong disorder, it won’t just go away, my symptoms would probably return, I have a higher risk of attempting suicide, blah blah blah — am I aware of all these risks?

He explained people with bipolar depression after coming off of meds can actually be worse, undergo severe depressive episodes, have more suicide attempts, and yadda yadda yadda. To sum it all up, I was risking my life just to get off of Lamictal.

My pdoc was trying to scare me into staying medicated.

He then added if I really wanted to come off of my meds, I could “just stop.”

WHAT?! My eyes flew open.

He stated he’d had patients who had stopped cold turkey without a problem. According to him, anticonvulsants don’t have severe withdrawal effects.

WHAT?! His advice just flies in the face of what most doctors recommend. In fact, quitting Lamictal immediately increases the risk of seizures, which is exactly what I’m afraid of.

Philip’s experience and Gianna’s experience along with the comments on each blog are proof that many people have experienced tremendous withdrawal effects from decreasing Lamictal’s dosage. In the past, I’ve quit Paxil and Lexapro cold turkey — both with not-so-good results to put it mildly.

I insisted that I wanted to come off of it slowly so he said I could just cut my 200 mg pills in half and jump down to 100 mg and stop after 2 weeks.

For real? Two weeks, doc? I had a plan that would take me over a year and you’re reducing it to a mere two weeks? On 100 mg dosage?

Again, I insisted that I wanted to take more time. He reluctantly wrote me a 30-day prescription for 100 mg and said since I was off the medication, I had no need to see him anymore. “Good luck,” he flatly told me.

When I came home after the appointment (and a bitching session to my husband), I remembered that I’d stashed a few 150 mg pills away sometime ago after I jumped back up to 200. So as of Wednesday, my arsenal included:

  • A bottle of six 150 mg pills
  • A bottle twenty-five 200 mg pills
  • A prescription for thirty 100 mg pills

I dropped down to the 150 mg on Wednesday and have been doing all right so far. I intend to keep myself at 150 mg (cutting the 200 mg and the 100 mg in half) for at least 2 weeks, then drop down to 75 mg for 2 weeks and then 50 mg for 2 weeks. I’m most worried about coming off of the 25 mg. This is a way more accelerated plan that I hoped for but I’ve got to work with the cards that I’m dealt.

We’ll see what happens.

More Famous People With Mental Illness

The local NAMI chapter has literature all over a counter at my local library. One of the pieces of literature actually was a 5×7 index card with a list of famous people who struggled with mental illness. It was kind of interesting so I figured I’d share it. Some I’d already known about; others were a bit of a surprise. How did they figure out who had bipolar disorder back in the 1800s?

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Diagnosing myself

Thoughts on Bipolar Overawareness Week: Part III

In all seriousness, I have wondered about the BPD diagnosis but in my mind, have somewhat fallen short. I don’t think my symptoms are strong enough to be plastered with a BPD label.

To conclude my several-post rambling, I should answer the question that I initially posed. Do I think bipolar disorder is overdiagnosed?

No.

Many of my fellow bloggers will likely disagree with me. Zimmerman’s study at Rhode Island Hospital took into account whether those “diagnosed” with bipolar disorder had a family history of the diagnosis in the family. Maybe I’ve turned to the dark side. Just because I don’t have a family history of bipolar doesn’t mean that I can’t suffer
from the disorder. However, I have a family history of schizophrenia: one father and two aunts. Does this put me at a higher risk for schizophrenia? Definitely. Does this mean I could suffer from bp and have the schizo gene pass me by? You bet. I don’t think that I need a first-degree relative to suffer from bp to make me a classic diagnosis for bp.

For instance, when it comes to my physical appearance, I’m the only one on both sides of the family who suffers from severe eczema to the point where my dermatologist suggested a punch biopsy. Does that mean that I need to have a family history of eczema to obtain the malady? Not necessarily. Why is bipolar disorder any different?

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Thoughts on Bipolar Overawareness Week: Part II

Here are some things that have occurred in my life:

  • racing thoughts
  • spending sprees when I have no money
  • cleaning at odd hours of the night
  • thinking that I’m the most amazing job interviewer ever
  • worrying that people are watching me through video cameras or the wall in public bathroom stalls
  • afraid that a video camera exists in our bedroom (I know it doesn’t. I think?)
  • talking to "friends" who don’t really exist
  • disobeyed parents
  • talked back to authority
  • suicide attempts
  • rage/anger/hostility/irritability
  • temper tantrums
  • violent outbursts
  • socially awkward
  • extreme mood swings (happy to sad or angry in the same day)
  • doing things and barely remembering them
  • memory loss/forgetfulness
  • chronic fatigue
  • indecisiveness
  • no interest in sleep
  • inability to focus on one thing for an extended period of time/lack of concentration
  • anxious about being around people I don’t know/don’t like
  • anxious to go out and spend time with friends and/or family
  • impulsiveness
  • overeating
  • persistent, negative thoughts

All right. So those are some things that have occurred over the course of my life. Let’s see what I diagnoses I can pigeonhole myself into.

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Diagnosing Myself

I've been away from this journal for a while for a number of reasons. I'll be candid:

1. Work has become busy. The yearly schedule at work is in line with tax season (even though I don't work in anything related to accounting) so I'm usually busy from January through May. Expect tons of blogging in June and July — there is NOTHING to do.

2. My personal life has become quite busy too. I don't really have a free night except for Sundays and I'm left exhausted from doing something every single night of the week. Free Friday nights tend to be a rare commodity.

3. I feel awful that I can't keep up on anyone's blog at the moment. There are so many wonderful blogs that I'm addicted to reading and it's much too time-consuming at the moment. (I have this tendency to read the first post and then read back entries all the way to January. Before I know it, I've spent 2 hours at work wasting time.)

4. I'm a perfectionist who meticulously reads over most of my previously written posts and corrects grammar, spelling, etc.

There's probably more that I can't remember at the moment, but you get the picture. Now, on to diagnosing myself…

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Conduct disorder

Eagles fanOh yeah, there are more than a few Eagles fans that are suffering from conduct disorder right now:

“In psychiatry, conduct disorder is a pattern of repetitive behavior where the rights of others or the social norms are violated. Possible symptoms are over-aggressive behavior, bullying, physical aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism, and stealing.”

(Just in case you didn’t know, I’m kidding about the conduct disorder thing.)

(Picture of the PO’ed lady at the right is courtesy of philadelphiaeagles.com.)

Patient Responsibility

“An article on brain shocks from about.com linked to a statement at socialaudit.org.uk on venlafaxine withdrawal. It seems that when coming off of venlafaxine, it is best to use fluoxetine (Prozac) in conjunction with it. Somehow, Prozac’s effects can minimize or negate the side effects of Effexor allowing for an uneventful withdrawal. I’m seeing my psychiatrist later today and I might bring up the idea with him. He might think one of two things: a) I’m crazy (pun not intended) or b) I don’t know what I’m talking about. My guess is he’ll choose the latter of the two.

Unlike most patients, I know more about meds than ‘the average bear.’”

UPDATE: I asked my doctor about going on fluoxetine to offset the effect of venlafaxine withdrawal. He looked up, somewhat shocked, and said, “Yeah.” So then I pushed and said, “Well, I’d like 10 mg then.” lol. He wrote out a prescription for 10 mg of Prozac in addition to bumping me up from 150 mg to 200 mg of Lamictal. I took the fluoxetine (Prozac is now a generic drug) last night and it has offset the intensity of the brain shocks. I experience them but they are much more mild compared to yesterday when they were moderate to severe. Yesterday, I was barely able to drive; today, I drove nearly an hour to work on a somewhat urban road with good reflexes and almost normal cognitive functioning. I can only hope that the Prozac continues to aid my withdrawal issues. And I was happy to wake up this morning without wondering why I dreamt that I was in a department store with parrots singing Gwen Stefani’s “Wind It Up” and swinging like moneys instead of flying.

You get the idea: Effexor causes some strange dreams.

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Antidepressants

Anti-depressants are a touchy subject for people who suffer from depression. Anti-depressants help some people, cause no change in others or, in some instances, can even harm. I went through Paxil and Lexapro before my doctor recommended Zoloft. None of those medications helped me with depression. Paxil didn’t hesitate to add weight, jittery nerves and increased anxiety; Lexapro helped to spin me deeper into depression and suicide — to a point where I couldn’t get out of bed. Once my doctor handed me a prescription for Zoloft, I realized that my end-all-be-all cure for depression could not depend on medicines. I received the argument, “Try all you can before stopping medication,” but I had done all I could on medication. My life was spinning out of control and it nearly cost me— I almost failed to graduate college and nearly lost my summer job at a prestigious magazine. While preparing for a wedding — one of the most stressful events in a person’s life — I quit taking the medication. Some people are better with anti-depressants than without them, but for others, anti-depressant just can’t and won’t do the trick.

UPDATE: Because of a recent bipolar diagnosis, I am currently on Lamictal (lamotrigine) and have been doing well on the medication. I recently came off of Effexor XR after having taken the medication and experience terrible withdrawal effects. More on that here.