Can mental health issues be serious even if you're not suicidal?

February 1, 2015 4:48 PM

This question in September was me, and months later I am still really struggling, even after a medication change. My quality of life is definitely being impacted, but I just cannot get past the thought that since I'm not suicidal, I'm not psychotic, I've never been hospitalized, I have a job, I maintain a home and hygiene, I have great relationships - all of this means that my mental illness must be pretty minor, all things considered.

Right after I wrote the last question, I called my shrink, and after some further questioning, he said that he believed it could be bipolar disorder, and started me on a mood stabilizer (Lamictal). As I've been reading more and more, it's made a lot of stuff in my past make sense. This article sounds so much like my lifelong experience - the depression starting at 20, multiple anti-depressants that pooped out, difficulty sleeping but not at all feeling rested on little sleep, fatigue and exhaustion - just years and years of some relief but never really resolving anything. But all this time, I never thought it could be bipolar because I'm a pretty risk adverse person and have never had those really extreme highs before, and have all the markers of functionality I mentioned above.

And now I also realize that I had my first hypomanic episode in my 20s, after being put on Prozac. I would walk for miles and miles and not eat anything and organized everything and it just felt good - since I wasn't spending thousands of dollars or going 3 nights without sleep or having delusions, it never occurred to me that it could be mania. I felt just like wow, I'm doing so well. Until I crashed when the Prozac stopped working. And it's been like that for 20 years, over and over again, anti-depressant after anti-depressant.

So now I've been on the mood stabilizer since September, and at first, I was feeling really good and stable, not hyper, not depressed, and I was cautiously optimistic that this would be the drug for me. I'm still at the smallest therapeutic dose, and we've been working up to a higher dose slowly. But this past month or so I've been slipping into hypomania and then crashing - that's why we're increasing the dose.

But even still, I'm just not in a great mental state. This week in particular, I've been crying daily, and feeling brittle and fragile and shaky, and my appetite has been switching from not being able to eat a thing to compulsive overeating. My body is so fatigued but I can't sleep because my brain just keeps going a mile a minute. I want to run out of my skin but I can't muster the energy to physically move. I can't concentrate and I flit from topic to topic in conversation or in reading (I have 25 tabs open right now) and I'll have short bursts of hyperventilating and trembling and panicked thoughts - I'll think of one thing that is bothering me or I'm worried about and within 30 seconds flat I've worked myself up in to a frenzy over all the potential pitfalls and worst outcomes and I can't sort through what is a legitimate concern and what is just misperception.

And since these moods cycle so quickly, I can feel calm and fine just an hour after I've been sobbing and frantic - and then the hysteria feels like a really fuzzy memory, hard to really recall at all. So it doesn't really seem all that serious, since it goes away so quickly. And then I get hit with the frantic feelings again, and it seems like new all over again, and I just can't really grasp or keep straight just what is going on with me - I can't put it into perspective. I keep perseverating over whether I'm really sick or just a whiny baby who can't tough it out, and it really just keeps coming back to it really only seems like things are serious when someone is suicidal, and since I'm not, end of story, stop your complaining. As soon as I'm not feeling bad, I feel like I've been making it all up, it is so distant. Until it comes again. But it's also hard to give a full picture of what is going on and what I'm feeling to my shrink - it really all depends on how I've been feeling right before my appointment.

I haven't been able to keep my thoughts straight at work and my uncompleted work has been growing and growing and I've been having to hide in the bathroom to cry multiple times a day and was having a harder and harder time keeping it together, so I finally spoke to my manager Friday about needing help, and she couldn't have been more supportive - they're going to work with me to get things in a better place for me at work, and stressed what a valuable employee they find me and just want me to be well.

And I felt so relieved about that, felt a huge weight off my chest, but still all weekend I've been bouncing around all over the place mentally, I just feel so hyperstimulated and agitated and up and down - the relief is always so short lived.

I keep thinking that maybe I do need something more intensive that bi-weekly or even weekly less-than-an-hour sessions with my shrink. I really just want to take some time off to heal, to stabilize and relax and recharge and make plans for how to deal with a chronic mental illness. (It's been so painful to accept that.) I am sure my office would work with me to arrange time off, but how do I really make that healing? I've been self medicating with marijuana a ton, so if I am home with time off I will just stay stoned the whole time to try to keep the edge off everything.

I keep wondering if an inpatient program would help, but again, I'm not THAT bad. I have always been under the impression that inpatient programs were for people with the inability to take care of major tasks of daily living and who were actively wanting to harm themselves. My mother's entire family has been hospitalized multiple times for psych reasons, and it was also for self-harm or florid delusions. I'm not like any of those, so wouldn't I just be a faker who's looking for an excuse for time off from work? But I just want to be somewhere quiet where my brain can be quiet and my body can be quiet and I am not just so constantly frazzled and frayed and on the edge.

So I guess my questions are, does this sound serious? Should I be taking it seriously? What does taking it seriously entail? What do I do, what actions can I take? Am I overreacting? Do I investigate inpatient? (I at least have good health coverage.) If I did, would they just think I was being dramatic and making a big deal over nothing and wasting resources for the people who are really sick and can't work or maintain families? Have you been someone "high functioning" who has felt like I have? What did you do? I just feel like I have to do something different and I don't know how to start.

posted by Neely O'Hara to Health & Fitness (27 answers total)

But even still, I'm just not in a great mental state. This week in particular, I've been crying daily, and feeling brittle and fragile and shaky, and my appetite has been switching from not being able to eat a thing to compulsive overeating. My body is so fatigued but I can't sleep because my brain just keeps going a mile a minute.

None of this is normal, none of this is sustainable (especially the lack of sleep, which will make things worse and worse), and yes yes yes YES you deserve more help. Waiting until one hits rock bottom just makes for a longer, more difficult climb out.

Email this to your p-doc. Please make this a priority.
posted by rtha at 4:52 PM on February 1, 2015 [8 favorites]

Yes. Mental health issues can be serious even if you are not suicidal. There are many forms of mental illness that do not cause one to want to commit suicide that are still devastating, just devastating.

You sound like you know that you want more care than you're getting right now. It's OK to ask for it. I would get in touch with my therapist ASAP if I were you and I would share this all with them.

I keep wondering if an inpatient program would help, but again, I'm not THAT bad.
You think you know something that might help you solve things here. Do it. Don't let it get THAT bad before you try to get help, because it's often much more difficult to actually figure out how to get help when one is really, really, really, really, really in a bad way (e.g. suicidal, delusional, etc.) Take advantage of the fact that you are lucid and that you are telling yourself what you need, and go after it.

If inpatient is not for you, it's not for you, and you and your doctor can figure that out together.

You deserve to get help. You need it and you know that you need it. You deserve it.

Take care.
posted by sockermom at 5:04 PM on February 1, 2015 [2 favorites]

Yes, it sounds serious and worth taking seriously. (And not like bipolar II, which is the type that tends to be depression-and-hypomania-and-mixed-states without the mania.) I'd recommend you talk with your psychiatrist about what you can do to step up your treatment for a while.

There are some options in between "weekly therapy" and "full inpatient." You may want to ask about or investigate "intensive outpatient" or "partial hospitalization" programs in your area. These can vary wildly but at a very high level, are basically that middle ground - something where you spend a few hours a week, or maybe a few hours every day, at an intensive treatment program but you aren't there 24 hours a day.

I think you might also really benefit from a peer support group to get a sense for what is typical of people with bipolar disorder - you'll find it's quite a range, and I bet you'll find some people who have been through what you're going through and may be able to tell you specifically in your area what supports are avialable to you. Depression and Bipolar Support Alliance's website has listings and I've found their support groups around here to be really great, although of course your local options may vary in frequency or quality.

You're doing the right thing to take this seriously before it becomes a crisis. I hope you get some good support lined up soon and start feeling a bit less fragile.
posted by Stacey at 5:34 PM on February 1, 2015 [3 favorites]

I keep perseverating over whether I'm really sick or just a whiny baby who can't tough it out

No, stop right there. It's not the case that everyone around you is experiencing the kinds of difficulties you describe, but that they are just tougher and can suck them up and function. You're describing being pretty badly distressed by moods and this is a real affliction.
posted by thelonius at 5:58 PM on February 1, 2015 [5 favorites]

Stacey's mention of a level of treatment in between weekly therapy and inpatient is a very good one. I have had life-long severe problems with depression (not bipolar) and have had a few stints of inpatient care. They were appropriate at the time and helped in some ways. Then I was in a period of less severe depression which didn't seem to warrant inpatient treatment, but my brand new therapist took it very seriously and suggested I needed more intensive help. Despite my skepticism I entered a 3-week "partial hospitalization" session. To my amazement this treatment was the most affective and long-lasting help I have ever gotten. In fact, my depression has been in complete remission since then, 3 years ago. I thought this form of treatment sounded useless; it sounded like just days full of classes in issues that I already knew all about (cognitive behavior techniques, sleep hygeine, group sessions, planning for weekends and beyond, social support, etc.). And it was. But for some reason, it really worked. I would urge you to look into this option. It might help you, too.
posted by primate moon at 6:02 PM on February 1, 2015 [4 favorites]

Yes, mental health issues can be serious even if you're not suicidal - and it's SO much easier to get help and have it work BEFORE it gets that bad.

You are allowed to get help. You are not taking resources from somebody who is worse off than you - you're taking resources that you NEED to take. And if somebody has the gall to say something like that? F THEM.

I agree with Stacey's point about the IOP or PHP programs - I've been in one twice and have gotten a lot of help there. The support was immensely useful - it wasn't just me who felt this way, other people do too, and it's going to be ok.

FMLA could be helpful, too, or short-term time off work. I'd caution against doing so without a plan. Your doctor's help is sometimes necessary to protect your job, and you don't want to just sit around and not get anywhere while off work.

You are allowed to feel better than this.
posted by Ms Vegetable at 6:05 PM on February 1, 2015 [1 favorite]

You are not a whiner. I think it is a great thing to discuss all your treatment options with your care team. They are not there to judge you worthy or not worthy of help, but to help you.
posted by warriorqueen at 6:07 PM on February 1, 2015

Can you imagine a person with awful diarrhea, constant stomach pain, hadn't eaten in three days saying "I'm not actually dying, I don't think I should go to the hospital"? It is OK to take sick leave because you are having a health crisis that needs your attention. Doesn't mean life will be like this forever - but it is going to take some work and some experimentation to figure out how to get better.

The crazy fast mood swings sound like rapid cycling. (This happens with both bipolar I or bipolar II). I know one person who takes her medication three times a day - not evenly spaced but at specific times to match her cycles. She functions great - I was very surprised when she told me - but apparently she went through some awful stuff before she figured it out. So, get into see your psychiatrist asap to talk about what is happening. In the meanwhile, if you can manage it, try to keep a record of your symptoms and especially writing down the time of day so you can see if there is a pattern.

Also, there are definitely options that let you focus on your recovery short of hospital level in-patient treatment. There are residential programs which give you a break from your life and 24 hour support but not the intense supervision or level of nursing care of a hospital. There are also intensive outpatient programs where you go all day or part day but go home at night.

You need to be talking to your doctor to figure out the options but frankly, it doesn't hurt to do some research to know what you need and be willing to advocate for yourself. Doctors don't always know the options - if you have some ideas, they can let you know if they think it is appropriate. Also, don't worry that you aren't sick enough or are taking a bed away from someone else - if there is a shortage of beds, the facility will do its own triage - you don't have to do it for them. Let us know what you decide to do. I may be a stranger on the Internet but I sending you my best wishes.
posted by metahawk at 6:08 PM on February 1, 2015 [1 favorite]

I am a therapist who works with private clients who are highly functional professionals with mild anxiety as well as (in a second job) with Medicaid clients who are almost all on disability due to their psychotic disorders. I regularly (generally several times a month) go out to put clients on involuntary psychiatric holds. I know what that looks like.

While it sounds like you do not need an involuntary psych hold (which is a good thing!), you absolutely deserve help! Voluntary programs may make total sense: Your symptoms are interfering with your occupational functioning, your sleep, your decision-making, and your concentration. Those are major things. You do not have to be at the absolute bottom to deserve intensive help.

As others have said, there are options between "weekly therapy" and "inpatient treatment." IOPs (Intensive Outpatient Programs) might be perfect for you for right now, or inpatient treatment might be appropriate. Your insurance might be able to give you names of programs you could call for an assessment, or your doctor could.

As someone who sees people with serious mental illness on a daily basis: Your issues are serious and you deserve to take them seriously. Not because they're incurable and not because you're screwed up, but just because the symptoms of your mental illness are significantly impairing multiple areas of your life and your current level of treatment is not reducing those symptoms. It is smart and responsible, not overreacting, to seek additional treatment in such a situation.
posted by jaguar at 6:09 PM on February 1, 2015 [7 favorites]

(Also, I would really caution against spending several unstructured weeks at home medicating with marijuana. I am not your therapist, this is not therapeutic advice, but I think you may want, at the very least, to discuss that plan with your mental-health professionals and listen to their advice before doing that.)
posted by jaguar at 6:11 PM on February 1, 2015 [3 favorites]

Please do try and find a hospital that will take you. You will need to let all the drugs, both legal and illegal, clear your system before you can get an accurate diagnoses and then figure out what medication cocktail will work for you. While the drugs are leaving your system and during the time that new medication is being introduced, you really need someone outside of yourself to evaluate you and help you to remain safe and reasonably comfortable.

First things first:

Set up a camera. The next time that you feel an episode coming on or find yourself in an episode, record yourself. And then watch that every time that you try to talk yourself out of getting the help that you desperately need. Life isn't supposed to be the way it is for you right now.
posted by myselfasme at 6:57 PM on February 1, 2015

Oh, crap, I misspoke badly above. I meant to say that this DOES sound like BP2, not, you know, the exact opposite. Sorry for any confusion.
posted by Stacey at 7:01 PM on February 1, 2015

I wonder if it would be helpful to separate "emergency" from "serious" in your head. A heart attack is an emergency, but cancer is serious even if it's not a "NEED TO DO SURGERY RIGHT NOW!!!" emergency. Planning to commit suicide is an emergency, but anxiety and depression and possible hypomania that are interfering with multiple areas of one's life are serious even if they're not such an emergency that someone could put you in the hospital without your consent. You don't have to wait until your serious problem has become an emergency to seek more help.
posted by jaguar at 7:26 PM on February 1, 2015 [2 favorites]

You said before that DBT skills were helpful. Have you seen this site?
posted by feckless fecal fear mongering at 9:20 PM on February 1, 2015

I might be missing it, but have you tried an atypical antipsychotic? I was having constant rapid mixed-state-type panic similar to what you described, and risperdal nearly stopped it within 48 hours. It was like magic. I had to go off the risperdal due to side effects but I'm now on a combination of Zyprexa and Zoloft (after much trial and error) which is working amazingly. Yes, it's definitely serious even if you aren't suicidal or completely falling apart. Getting serious intensive help before it gets to that point is WISE.
posted by celtalitha at 11:03 PM on February 1, 2015

Response by poster: Thank you everyone, this is really just so helpful and so kind and I appreciate it so much. Please don't mind my disjointed responses.

I am definitely going to call my shrink in the morning and tell him how I've been doing. And the intensive outpatient programs really sound like something to investigate. I absolutely do not want to take time off and just self-medicate - not being able to manage my marijuana consumption is something I am very distressed by but I'm also very distressed at the idea of stopping and having to deal with the heightened anxiety and insomnia.

I am having so much difficulty keeping structure in my life in general and finding motivation and my self-care is just slipping beyond the basics. So I really want some kind of immersive environment that will provide structure and help me get back on my feet to be able to do it myself again. I loved the DBT program I did outpatient years ago but I can't seem to bring myself to initiate the skills myself without a program.

I've never taken an atypical anti-psychotic because I guess they sound so serious. And I worry about possible metabolic side effects. I'm fat but my weight has been steady for over a decade, so I don't want to gain weight. And diabetes runs in my family anyway. Then again, I can barely bring myself to move, let alone exercise like I used to and want to again, so that's not great metabolically either.

My problem is that after I wrote this question I took a Xanax and smoked a lot and then slept for hours and now I feel rested and not shaky and not like I'm going to cry and now it feels like I've been making a big deal out of nothing. And I worry that my shrink will hear me all composed in the morning and think the same thing. My partner keeps reminding me that I've been unsteady and unstable and just one patch of relief doesn't mean it's permanent. And you've all helped me see that too. So I'm going to call. Thank you again for all the encouragement, you MeFites are such a great source of support and kindness.
posted by Neely O'Hara at 11:37 PM on February 1, 2015

Shrinks have seen this, too. Patients who feel better when they finally come. Don't worry about that bit. Just go.
posted by Namlit at 12:10 AM on February 2, 2015

Can your partner go with you to see your psychiatrist, or talk to them on the phone? That kind of collateral information is usually very helpful to mental healthcare providers.
posted by jaguar at 6:38 AM on February 2, 2015 [2 favorites]

Yeah, keep your question here handy when talking with your psych so that you can detail the problems you've been having. When you're feeling composed and well-rested is a great time to address this, but if you list your recent symptoms they should know that this is serious and requires more treatment. I agree that having your boyfriend join in to advocate for you can help if you feel like you might try to downplay your symptoms.

As someone whose watched a loved one go through hospitalization, partial hospitalization, and a bunch of other treatments and programs lately, know that there are a bunch of options open to you and your doctor. Let them know your problems and they can help you find the right treatments for you.
posted by ldthomps at 6:44 AM on February 2, 2015

A broken leg is serious, even though it probably won't kill you.
posted by spindrifter at 6:50 AM on February 2, 2015 [1 favorite]

Response by poster: So I just called my psychiatrist and told him how my thoughts were racing and I can't stop crying (and was crying on the phone) and that I can't sleep and feel like I want to jump out of my skin and I need more help than I'm getting, that I don't feel that functional. But the conversation was basically him telling me that the anxiety is making me think things are worse than they are and to take a Xanax and rest and he'll see me at my regular appointment on Wednesday. And now I feel worse than ever (though I took the Xanax and hope it'll kick in soon) because I know I feel awful and I really do feel like I need more help but I also feel like he's the professional so I guess I've been wrong all this time? And if I'm not wrong and I do need help how do I do it if my shrink doesn't agree with me? I feel even more lost and confused than before.
posted by Neely O'Hara at 9:03 AM on February 2, 2015

What the what? Get a new psychiatrist.
posted by joeyjoejoejr at 9:26 AM on February 2, 2015 [2 favorites]

Your doctor is absolutely not automatically right just because he is the so-called 'professional'. He is capable of making big mistakes and misjudgements just like everyone. He could be wildly misogynistic and assume women are naturally overly-dramatic and needy and manipulative, and still be a doctor. Or whatever his particular absurd thought process is. I don't know how best to move forward, but I would definitely recommend changing doctors as soon as the situation allows, and finding someone who will take you seriously. His response sounds unbelievably and frighteningly unprofessional and dangerous. I wish you luck, and think you are doing everything right in trying to get more help, and you may have to fight for it.
posted by thegreatfleecircus at 9:27 AM on February 2, 2015 [1 favorite]

Psychiatrists aren't perfect and they aren't omniscient. Call your insurance and ask about their treatment options. Bring your partner in for your Wednesday appointment.

Again, you may not be having an emergency in which someone needs to see you immediately, but that doesn't mean your problems are not important. Your psychiatrist is not the only gatekeeper to your getting more care -- you (or your boyfriend, if that's something you're ok with) can research other treatment options and decide what you think makes sense, and proceed from there. Those programs will likely have their own screening processes, but your psychiatrist is not actually the screener (usually) for outside programs.
posted by jaguar at 9:42 AM on February 2, 2015

Do you have a friend or family member who could be your advocate and assistant here? I know it is scary to expose how fragile you're feeling right now, but it sounds like you could use an advocate to help you extract help from your psychiatrist and perhaps to figure out what other resources there may be. I'm so sorry you feel brushed off. Your psychiatrist may be flat-out wrong, may have misunderstood something you said, I don't know, but maybe having someone else to help you out here would take some of the pressure of you.

If you don't have someone in your life who you can ask to assist you, is there perhaps a mental health helpline in your area? These are sometimes called crisis lines but it's okay to use them even though you're not in full crisis - part of why they exist is to help things from escalating to real crises. If so, if you gave someone there a call, they might be able to help you figure out what local options exist for you.
posted by Stacey at 10:12 AM on February 2, 2015

I thought an IOP sounded weird and awful and it was the best. thing. I. ever. did.
posted by raspberrE at 7:41 PM on February 2, 2015

You may feel lost, OP, but you are not confused. You need more help than you are getting and you need a shrink who does not tell you "that the anxiety is making me think things are worse than they are." That's BS, that's unacceptable, and yes, please, follow the advice upthread to have someone (your partner, a friend, a relative) act as your advocate and help you get this sorted. You know what you need. And if your shrink cannot hear what you are saying it's time to ask for help from your partner or advocate to find a new shrink who can hear you. Good luck!
posted by Bella Donna at 11:55 PM on February 2, 2015