How paranoid is too paranoid?
February 10, 2007 9:26 AM   Subscribe

I feel like I'm losing my mind but I'm too worried about my medical records to do anything about it.

Something changed about 6 months ago and now I'm anxious and depressed nearly all the time. These are two emotions that had previously been mutually exclusive. And previously I was rarely anxious, except before an exam or something. I WAS often depressed, but in a can't get out of bed way. Not a jittery and irritable way like now. In university I took Zoloft and had to quit it because of anxiety attacks and serious indigestion. (Both of which my University psychiatrist told couldn't possibly be because of the Zoloft, but when I quit it, they went away.)

I can't focus. My menstrual cycle has changed- it's heavier and more frequent. My heart feels like it's beating irregularly (just once in a while, usually the day after I've exercised particularly hard).

I went to my doctor, got lots of tests and she gave me an ECG. Everything seems normal, except my resting heart rate's really slow (45 bpm). She didn't think it was anything to worry about, though. I've lost about 10 kg so far- due to exercise, probably. I was overweight before, and still am but not by much. Though I still get hungry, I'm not the slave to my stomach I used to be.

The only things that bring relief are running on a treadmill and being outdoors in wide open spaces. Did I mention I'm getting more claustrophobic, too? These are both new and bizarre behaviours for me)

I've had a lot of anxiety-producing changes in my life over the last 6 months, which is why I didn't take any of this seriously at first. But my life has calmed down and my symptoms are still making me miserable.

I feel I should go to some other doctor or psychiatrist. I am in the United States and I have a huge fear of the medical system here. Things go on your record and stay there forever. And affect you forever.

My family and friends are nearly all therapists and nurses, which has really undermined any trust I might have had in the medical profession's ability to keep confidentiality. My family and friends are pretty good about it, at least as far as I've been able to see, but their collegues seem to have no concept of what kind of damage they can do by not taking care of their patients' information. Confidentiality to them is a sort of courtesy, that can be dispensed with if it seems appropriate, which is often.

The new HIPAA regulations have made things worse- my family can't get to my records (fine by me). Other doctors can't get to them. (well, okay). But the local idiot sheriff can, if he gets a search warrant, or a number of other documents that allow it.

I also have a terrible fear of people doing things for my own good. Breaking confidentiality. Committing me, God forbid. Which is part of the reason I am reluctant to talk to my friends and family. They're friends and family but they're also professionals. What if they feel obliged to DO something?

If I do manage to find someone out of my official insurance system, what am I allowed to tell them without them feeling obliged to turn me in? Can I tell them if I'm feeling suicidal? If I have to keep 10 feet away from anything that smacks of self destruction- well, I may as well not show up. And finally, I have a terrible, unreasonable fear of being committed. It's not that I think it's likely, but it would be the worst thing I can ever think of happening. There go all open spaces (God, the claustrophobia) and any control over my own mind (the drugs).

I'm not against drugs in theory, but I have just watched my father's doctor drug him into delusions, paranoia, and memory loss. And when we told the doctor what was happening, he said he couldn't be talking to us about his patient. A failed marriage, two arrests and the loss of his driver's license later, my father got another doctor. But you can see where my mistrust comes in.

This is turning out very long. My questions are: Am I right to be this paranoid about my medical record? (And has anyone had any experiences with off-the-record psychiatrists?) What do you use as a baseline for normal? If I start taking drugs, what will my end goal be? How will I know when they're working correctly? I am not interested in taking my doctor's word for it, given my experiences with doctors. How will I know when and if I can quit taking them?

Any help you can give me I would appreciate. I've always been the stable person around here, so this is scary.

Anonymous email account gngcrzy@yahoo.com
posted by anonymous to Health & Fitness (31 answers total) 6 users marked this as a favorite
 
What was the something that changed 6 months ago? if it's too private, then please don't feel obliged to reveal it, but if you know what it is, you might be able to start finding some way to deal with it.
posted by Solomon at 9:38 AM on February 10, 2007


First of all, I have to assure you that [really huge number] of people suffer from exactly the kind of problem you're having right now. You are not alone -- in fact, if you asked ten friends, you'd probably be surprised how many of them have felt the way you do right now. Maybe it would help to talk to some people about their own experiences. By hearing other people open up, maybe you will begin to feel that your secret is not worth keeping. If you are going to get better, you will want the support of your loved ones. I don't know how to help you trust, so maybe you will just have to take that leap of faith and start somewhere.

I can't speak to the situation in the US, because I'm not from there. But I can tell you that in my mind, your well-being is more important than any piece of paper that might tell someone that you're not as strong as they think you are. It's okay. It's okay not to be completely together. It's okay to have a condition that needs treatment. Would you rather live your life suffering from depression and anxiety in private, or be well and happy but risk that some people might find out that you've needed help to get there?

About medication. You'll know when it's working. You won't need a doctor to tell you. You'll probably notice one day that you don't feel like garbage. Then you'll notice that more often. It takes some time but it is possible for you.

Don't worry about when you'll come off medication. I have looked at it like insulin. If I need to take this I will take it, period. But, you may find there's a time when the idea of living without medication isn't scary. That might be when you can try decreasing and eventually going off completely. If the idea of stopping medication terrifies you, listen to that. You don't have to do anything until you're ready. There is no normal except what you feel is good for you, and there's no schedule or chart to go by, you just have to listen to and observe yourself.

I know how you feel. I have my own history and I feel for where you're coming from. Please just put your well-being first! At least take the first step of telling someone (anyone, even just a friend) what you're experiencing.
posted by loiseau at 9:48 AM on February 10, 2007 [3 favorites]


I realize you had a bad experience with you father, it had to be hard to watch.

You need help. I understand your concern for your medical record. But you need to see your physician. If your psychiatrist at college didn't work out, there are others. Ask your private physician for a name.

Yes, they may (and should) ask if you are suicidal. Tell them the truth. If you are, they will go on to ask if you have a plan, or the means to carry it out.

Please, please get help today. As far as medications, whomever prescribes should go over with you what the goal is of the medication and side-effects. Don't worry about going off them now, wait until you are better and are in a better state of mind to talk with your physician about it.

I'm worried about you. I can't tell by reading your post if you are suicidal or not. Please, know that there is help available. You don't have to feel this way.

www.suicidehotline.com has phone numbers for you to call if you need someone to talk to. Please don't hesitate to contact them.

Don't be afraid to reach out to family members YOU TRUST. They can guide you to the appropriate resources you need.

< virtual hug>>>
posted by 6:1 at 9:58 AM on February 10, 2007


Hmm, sounds like a lot's going on. There's no way to fully answer every question/concern here, I'm sure you know.

You might consider going to a support group such as DBSA to start thinking some of this stuff through -- it's "anonymous" in the sense that it doesn't create any kind of medical record.

In the US, often people go to psychologists and pay "outside" of their insurance plans, either because their plan doesn't cover the service or because they don't want to use their insurance because it creates a centralized record of services. So, there's a "record" in that the psychologist has a file on each patient, maybe sends out invoices, but there isn't a record in the sense that if you don't disclose the name of the psychologist there's no way to track down the record. Psychologists can't write prescriptions, though.

The standards for involuntary treatment (getting committed) vary from state to state, but often the standard is something like: the person has to pose a threat to themselves or others, or the person has to be so disabled that they can't house, clothe, and feed themselves.

If you do decide to try another psychiatric medication, just do what you did before -- try to figure out if the benefits to your mood and anxiety outweigh the side effects. You'll have to see a medical doctor for a prescription, of course. Which tends to create more of a "record" because doctors tend to be part of bigger systems than psychologists (who are often just under their own shingle). But millions of Americans do take psychiatric drugs, so it's becoming less and less of a big deal in this country.

Employers are increasingly regulated as to the extent that they can intrude into an employee or applicant's psychiatric history. And millions of people with psychiatric records apply for jobs and work without any issue.

However, there are other areas that are less regulated, where such a record may come up: licensing (e.g. getting licensed as a doctor, as a lawyer, as a foster parent, as a child care provider, as a pilot, etc.); certain federal employers (military, US State Department, Peace Corps); security clearances; international adoptions. I'm sure I'm forgetting some. The license or adoption or whatever may still be granted depending on the situation, but it does suck to have to answer intimate questions and worry about the outcome.
posted by ClaudiaCenter at 10:02 AM on February 10, 2007


IANAD. But...
You have already adopted the most healthy approach to cutting anxiety. That said, it isn't working as a general anxiety reducer, and your anxiety is situational and not dissipating after the anxiety-producing events. Therefore you may be experiencing anxiety disorder. I can personally recommend CBT (and I've praised EMDR before, in cases of psychological trauma), possibly with an SSRI and/or a benzodizapene (Xanax, Klonipin, etc) that could assist with working through the anxiety. Careful, though, benzos are problematic in that you could easily develop a tolerance and habit for them in long-term use.
I have felt better going off the insurance grid for counseling and prescriptions (used to work for an insurance company). Feel free to contact via email, in profile. Good luck!
posted by nj_subgenius at 10:14 AM on February 10, 2007


From how you explain your experience on Zoloft, I am wondering if you might (like me) have undiagnosed Bipolar type 2.

It's hard to diagnose (you don't get as manic as a classic Bipolar) but antidepressants can screw you up big time if you do have it. AND fwiw the (not totally unwarranted) paranoia you are describing can definitely be part of it.

My email is in my profile if you wanna talk about it.

Meanwhile, keep running on the treadmill, and go buy some fish oil capsules-plus some B complex vitamins. All that might help long enough for you to decide what your plan of action needs to be.
posted by konolia at 10:22 AM on February 10, 2007


(oh, I am a DIAGNOSED bipolar type two. Sorry for any confusion there.)


.
posted by konolia at 10:23 AM on February 10, 2007


Hey anonymous -

You've a lot on your plate. Good advice here thus far; this is a great community.

I'll add this - find someone you trust to talk to. I think this ought to be number one. Talking it out can get it outside the confines of your head, where it is spinning around and around, very difficult to get perspective upon it. Find someone to trust, and then trust them; many people rise to the occasion.

Some clergy understand the need for privacy, it's part of the tradition of many religions. I'm not religious but I have found many extraordinarily helpful, and kind, and caring people serving there. Get away from people who are not on the front lines; people on the front lines, who see people in trouble, are often much less enamored of dogma and willing to help without making you sing a hymn or whatever. And they can (maybe) help you find some other professionals who would help you 'off the books'; I'd think you'd have to explain a lot less than to the average man on the street.

If you tell any professional at any time that you are suicidal, you run the risk of getting 'helped'. I think that many are bound by law to tell others if you are deemed 'danger to yourself, or danger to others'.

Pray if you believe in it. Rest as much as you can. Be aware that you're scaring the shit out of yourself, and calm yourself when you can see that; when you notice that you're juking yourself around, have a cup of tea, read a calming passage, nap if you can, whatever. Ease up on yourself. A cup of tea is healing, sometimes. Isn't that lame? But it's also true.

We're all with you here. Good luck.

I wish you peace.
posted by dancestoblue at 10:31 AM on February 10, 2007


You probably won't be committed just for feeling suicidal. However, if you have a method picked out, the means to execute the method, and a serious plan to carry it out, then you will be committed (as you should be if you're that far along, as you're an imminent threat to yourself). Seriously, there's not enough room to commit everybody, and caring professionals know that the hospital is terrible and is only to be used as an absolute last resort.

Given your family history, you shouldn't expect to come off medication once you start it. If you get off the drugs, it's a bonus; but don't expect that off the bat.

You will know when you've got the right drugs when your mosts troublesome symptoms have significantly lessened with side effects you can live with. You should probably have a short course of talk therapy to help you off the ledge, too.

Personally, I use my insurance. The drugs and shrinks are pricy. My insurance pays out $4k/yr in treatment costs, and I don't do talk therapy. That's enough to buy me a new car every 5 years. To me, it's worth the paper trail to save the cash.

You have failed SSRI treatment, which means you're probably headed for frequent office visits, drug cocktails, and/or pricy patented drugs. Round 2 is harder than round 1.

The downside to using insurance is that you must have continuous group coverage. That means you'll be paying through the nose for COBRA if the policyholder loses his/her job.

Good luck with whatever you decide. Please seek treatment however you can.
posted by crazycanuck at 10:43 AM on February 10, 2007


I think going off the insurance grid isn't a bad idea, but otherwise, I think your paranoia about records, confidentiality, getting committed, etc., is likely a symptom of what you're experiencing. As was already stated, huge numbers of people get help for these sorts of problems. If getting help for this kind of thing resulted in being committed, psychiatric institutions would be absolutely overflowing with patients.

I have a number of anxiety disorders including panic disorder, and one rule of thumb I've developed to help me see through my own paranoia is this: whatever my WORST fear is -- the one I'm really freaking out about -- is almost always guaranteed to be incredibly unlikely. It's just that when I'm panicking, it's hard to look at the fear objectively enough to realize it.

I think you do need help. There's no shame in needing help. If you can't bring yourself to seek professional help yet, I'd suggest reaching out to family or friends. There are also some online support groups, which can at least help you feel less alone. One I've found helpful is Find the Light (not religious, despite the name).

Again, please know that you're not alone. Very best of luck to you.
posted by treepour at 10:59 AM on February 10, 2007


Close your eyes and take a long, slow, deep breath.

Take another.

And take several more.

Okay. You are a million miles ahead of yourself, worrying about several hypothetical worst-case scenarios (the local sherrif getting your medical records to have you commited, limits on future employment, etc.). I used to do this sort of thing, too, before I got my own levels of anxiety and depression under control -- I called it "storytelling," and it was a way for me to check out (both emotionally and intellectually) of the present, because there was something in the present that I didn't want deal with, or a decision I didn't want to make, or an action I didn't want to carry through on -- or, sometimes, simply an emotion (sadness, fear, anger) I didn't want to have to feel.

I saw the future as some elaborate chess game, in which I had to frantically strategize to take care of every single possible move and countermove in order to win the game. But the thing is, even the greatest chess player can't see every move down the road every time, and -- more to the point -- life isn't actually a chess game. There is no such way, to make the one big decision to put all uncertainty into check. Life is full of uncertainties: that is one of the most essential facts the nature of being alive. We cannot control our lives so that nothing "bad" happens; the best we can do, I believe, is to learn that we can handle whatever happens to us, good or bad.

And what's the trick to that? Staying present. "Take care of the present," goes the saying, "and the future will take care of itself." Stay with your breath. Stay with your feelings. Stay with your body.

And right now, in this present moment, your feelings and body are telling you to go see another doctor. That's all you need to do. Step out of the chess game and simply take care of yourself. That is all you need to do.

Yes, the health insurance system in this country is deeply fucked-up -- I could tell you stories about my own 20-year medical/insurance dramas, but A) there isn't enough room on the entire series of tubes that is the internet to tell it, and B) the real point is that it all turned out fine -- I have insurance and I have my physical and mental health, after years of struggling for all of those things. You can have them too.

As for the medical side of things, a few specific things stood out to me:

- I can't focus.
- My menstrual cycle has changed- it's heavier and more frequent.
- My heart feels like it's beating irregularly [...] my resting heart rate's really slow


These (as well as the depression) could be symptoms of thyroid problems. Did your doctor check your thyroid function? If not (or if you don't know), ask to have your thyroid checked when you go to the next doctor. Thryoid problems are quite common (especially in women) and generally pretty easy to control. It might not explain everything that's going on for you right now, but it could explain some of it -- and getting help will mean real relief (believe me, I speak from experience).

Good luck. Stay present. Be good to yourself.
posted by scody at 11:22 AM on February 10, 2007 [4 favorites]


Did the doctor check your thyroid levels? I had a similar experience when my thyroid started flaking out on me -- there were underlying depression/anxiety issues, but they came on strong, suddenly, in conjunction with fluctuating levels of thyroid hormone. My T3 and T4 were okay (low normal) but my thyroid stimulating hormone (TSH) was very high. That meant sometimes I was hyperthyroid, sometimes hypo, so I got symptoms for both (weight loss, heavy periods, panic attacks, agoraphobia, etc). Thyroid hormone is important and subtle, and can muddy the waters pretty significantly. Once I got my thyroid problems cleared up, my psych issues were clearer. I didn't even end up getting on any psych meds at that point, although I did several years later.

For a long time, I was afraid the meds would make me not-me. I had to get bad enough that the illness was making me not-me before I would consider medication; once I did, I found that the meds were allowing me to be me again. Or, me-but-better. Sometimes, when I'm particularly happy, I'll look around and think, "So this is what normal's like!" It took me a little while to realize that not everyone walks around every day waiting for people to betray them, or being angry with the world. In my (very limited) experience with psychiatric meds, the end goal is to feel like they're doing nothing -- to feel normal, healthy, and alert, and as if that state of being is totally natural. I wish you the absolute best of luck in getting there. I hope you can find someone you can trust to talk to; you shouldn't have to deal with this on your own.
posted by katemonster at 11:27 AM on February 10, 2007 [2 favorites]


Just to reinforce what katemonster said, consider this from heartdiseaseabout.com:

The heart rate is modulated by thyroid hormone, so that in hypothyroidism the heart rate is typically 10 - 20 beats per minute slower than normal. Especially in patients who also have heart disease, however, hypothyroidism may worsen the tendency for premature beats (such as PVCs) and even tachycardias such as atrial fibrillation.

I would guess that your anxiety is your body's way of compensating for the effects of your low thyroid, by jacking up your heart rate and various other things.
posted by jamjam at 12:08 PM on February 10, 2007


The one time I went to a psychiatrist it was completely out of my own pocket (fine by me, no way would I get ANY kind of insurance involved) and did not put my Social Security number on any documents. I was prepared to walk out if I was prompted for it, but I left the line blank and no one asked. I leave my SSN off all documents and it has never been an issue.

Hope that helps.
posted by rolypolyman at 12:19 PM on February 10, 2007


Nthing the thyroid. It can cause a host of crazy problems that seem completely unrelated and make you feel nuts. Please get your levels checked ASAP. Also, i am too much of an idiot to know how to link past threads, but if you search the green, there is a host of info in here that might help convince you.

FWIW, a pal of mine just had her thyroid removed. Her symptoms, when she finally went to the doctor included: period every two weeks, rapid heart rate, weight loss, hunger, anxiety, paranoia and what others have called the "bitch from hell" syndrome.

Now that it's out, she can see that she has actually been feeling badly for years. She often says something like, "So this is how everyone else ALWAYS feels? Wow."

Good luck to you.
posted by metasav at 12:30 PM on February 10, 2007


Which gives you a better quality of life - keeping yourself in the same condition you are now, or seeking help? What could possibly feel worse than being suicidal? If you're thinking of killing yourself, then someone maybe looking at your medical records sounds a lot better than death. If you truly want to live, then you will do whatever it takes to live. If you truly don't want to live, then what difference does it make if people know that you have problems? Extremely common problems, to boot.

Trust me. Unless you're signing up for NASA, almost NO ONE cares if you're in therapy or on psychiatric meds. No one that matters, at least. If anyone has ever looked down on me, I haven't been aware of it, nor would I give a rat's ass.

My end goal has been to be in control of my emotions and my reactions to events. I don't feel jerked around by anxiety and sadness. I'm capable of taking care of my business without undue discomfort. I interact with others in a healthy, assertive way. With drugs and therapy, I'm about 90% of the way there.

You have to believe you're worth it, and you have to take a leap of faith that you are capable of handling any situation. Take a look at someone who's really in a bad situation - say, a refugee from Darfur - and realize that if they can still survive that, then you can handle your own situation.
posted by desjardins at 12:44 PM on February 10, 2007


I wish I had access to AskMe when I was dealing with anxiety and depression problems. Questions very similar to yours come along once a month or so (do a search for anxiety, etc and you'll find many questions and comments). There was one just a few weeks ago, as I recall.

Your concerns about medical records seem a bit overblown. Although, given the negative stereotypes about mental illness and depression, your feelings are entirely understandable.

It's possible that your fears are being driven by the anxiety symptoms you're experiencing rather than anything rational. When I went in for help, the doctor asked me point blank: Do you have thoughts of suicide? It was really difficult for me to admit, but I answered that I had. I was not institutionalized and my privacy was not violated.

I'm no doctor, of course, but I think there's a vast difference between thoughts of suicide and attempted suicide. The latter requires hospitalization - just as if you had a serious infection that was threatening your life - where the former is generally just a symptom of other issues.

The good news is that what you're experiencing is very common and generally treatable. In my case Paxil made me feel normal - I was able to get my life back again. Just over a month ago, I finished weaning myself off medication and haven't experienced any negative consequences. Sometimes I notice a certain anxiety, but having been through it all before I'm in a much better position to deal with it. Maybe similar medication will help you. Maybe it's your thyroid.

The solution lies in seeing your doctor, a therapist or both. You've got to work up the courage to take those first steps. Good luck!
posted by aladfar at 1:01 PM on February 10, 2007


You really, really need to be in therapy. I really wouldn't worry about your medical records. It's a small matter compared to, well, losing your mind. Besides, unless you're planning on running for president in the next 4 years, who's going to access your records and then hold you accountable? All that they will say is that you go to therapy and receive medication for depression and anxiety--- two ridiculously common maladies in this day and age.
posted by sneakin at 1:21 PM on February 10, 2007


From what you say, the chances of being "committed" are extremely low. Even with immediate suicide risk where there may be an involuntary hospital stay the length of time is generally in days not weeks or more.

Having said that:

You need some help. If you are not in immediate danger no one is going o throw you in the hospital against your will. Some of the things you describe are exactly the things that keep so many people from receiving the assistance they need. There is a stigma attached to mental health issues that isn't present in other physical aliments. If you had a broken leg you wouldn't think twice about going to the doctor to have it fixed. Something in your system is not working correctly. perhaps it is the thyroid, perhaps it is the chemistry being not in balance, which causes these feelings. Get help, be persistent, establish a support network. Do what needs to be done. There is no shame in your condition, whatever it may be.
Perhaps medications would help, perhaps therapy, or a combination. The fact is you don't know now, and even if it is frustrating it is important.

good luck
posted by edgeways at 1:28 PM on February 10, 2007 [1 favorite]


You probably won't be committed just for feeling suicidal. However, if you have a method picked out, the means to execute the method, and a serious plan to carry it out, then you will be committed

This is, likewise, my understanding of the situation. I've heard the same formula from a number of people, including health care professionals and patients.

I have a friend who showed up for a scheduled shrink appointment. The doc asked her if she was suicidal. My friend said yes. I can't remember whether she, the shrink, asked about a plan, but she did ask some more questions before reaching the conclusion that my friend was serious about it. Next thing you know, she was in a mental institution. She only had to stay a few days, fortunately.

When this happened, I called a friend of mine who's a doctor and asked him a bunch of questions about what was going on and what would happen next. The bottom line, as I recall, was that they could only hold her for thirty days. After that, they could only keep her if she either decided to stay voluntarily or they went to court to have her declared mentally incompetent. We didn't see much chance of the former happening. As for the latter, my friend assured me that it happened very rarely. Apparently, it's a really big deal, requiring lots of lawyering and so forth. My doctor friend was pretty confident that my psychiatric patient friend didn't have to worry about it.

Also, I should point out that "...[a]pproximately half of all current insurance plans limit mental health hospitalization to 30 to 60 days per year." In other words, if they keep you too long, your insurance will stop paying the tab. If it's a private facility, I'm pretty sure that means they'll release you. I'm not sure how it works with a state run institution.

I remember reading one account, a long time ago, about a guy who was committed and wasn't happy about it. He called his insurance company from the institution and got them to stop paying the bill. When the funds were cut off, he was released.

But as far as finding treatment options that won't compromise your security... you could consider driving to another city to see a doctor. Or, you might be able to find a doctor locally who's an outsider of sorts. If your town is solidly Christian, talk to the Hindu immigrant psychiatrist or the dykey LPC. They're a lot less likely to buddy up with the other shrinks in town.

Also, you might consider announcing as soon as you walk in the door that you have concerns about your privacy being maintained, that you know a lot of the local doctors break the rules in this area, and that you're prepared to sue if your confidentiality is breached.
posted by Clay201 at 1:41 PM on February 10, 2007


If fear of involuntary committment is keeping you away from psychiatric care, here are some details to consider that might lessen your fear:

1-Involuntary commitment is a legal action. There are legal standards that must be met, which is not only the whole "threat to self or others" standard, but also that there is not a less restrictive way to get you treatment. A doctor would vastly prefer you to accept voluntary treatment than to force you into a hospital. If you're thinking about suicide, it's a very good idea to tell your doc about it--their primary goal is to help you through it, not to lock you away, really.

2-You are female; for various reasons, more men are involuntarily committed than women.

3-Your socioeconomic status. You had the $ to go to university and to consider out-of-pocket treatment. You've got insurance, so maybe you're holding down a job right now. There is a positive correlation with low $ status & involuntary commitment rates. (Also, if you don't have a substance abuse problem, you're also less likely to be committed.)

4-This seems drastic (and only recognized in certain states as of yet), but maybe consider a psychiatric advance directive if it'll make you feel more protected.


You're smart, you're critically evaluating the health care system, you're taking care of your health as best you can. This won't change--you will still have agency and autonomy even if you see a psychiatrist. You are more likely to lose your sense of control & Self to an untreated mental illness than to some guy you talk to an hour each a week. Therapy is treatment, not a sentence; why not give it a shot--you're the one deciding to get it, you're paying for it, and you can always quit. It's more likely to help you gain control than to put you in a position where you don't have control (which seems to be of concern to you).
posted by neda at 2:00 PM on February 10, 2007


scody and others above have good advice.

In my experience, one of the universal symptoms of depression is making up excuses why you can't get treatment, in fact why you can't even make that first appointment to ask somebody about getting treatment.

I don't mean to pick on you -- you do clearly have some legit reasons to be cautious. But I've seen this pattern many many times: people make helpful, sensible suggestions about how to get help, and it's like a game to shoot down those suggestions with increasingly elaborate reasons. Recognize that this pattern is irrational. Try to look at yourself, and see if you are falling into this irrational thought pattern. Reasonable caution should not mean paralysis -- if you're paralyzed, you are being too cautious. You see that you need some help. I hope you will take (reasonable, cautious) steps to get it.
posted by LobsterMitten at 2:38 PM on February 10, 2007 [2 favorites]


I don't want to scare you, but I was in a mental health ward once (for feeling suicidal) where my dad's ex-wife works. She broke confidentiality and told my half-sister. When I went to the hospital and reported her, they said because I couldn't prove it, there was nothing that could be done.

BUT - when I was first admitted, she wasn't working that shift, and if I had known to ask, I could have asked to be transferred to a different hospital. Now, if you have insurance and there are no other hospitals in the area that take your insurance, it could be a problem.

I don't think you can be "committed" by another person unless you are an immediate danger to yourself or others. I voluntarily signed myself in and was in for just a little bit less than 72 hours - involuntary commitment in my state (Indiana) is 72 hours. (But if you are still viewed as a threat to yourself or others, I think they can re-commit you, not sure.) It was better to be there because it was a safe place and I knew I couldn't hurt myself... therefore, it accelerated my recovery. (This was about 3 months after I began therapy, and it was my only hospital stay. I was in therapy total for 2 1/2 years.)

I recommend the psychiatric advance directives Neda mentioned, if for nothing else than peace of mind. I have also personally had EMDR therapy, and it greatly helped my recovery.
posted by IndigoRain at 3:15 PM on February 10, 2007


Am I right to be this paranoid about my medical record?

It depends. If you ever expect to need a security clearance then a medical history of depression will be a problem.

Other than that, no.

(And has anyone had any experiences with off-the-record psychiatrists?)

"off the record" is more a matter of trust than anything else. My psychiatrist is not on any insurance sheet, and assures me that my treatment records in his office stay in his office. When I first started taking anti-depressants I had very much the same worries as you, so I made sure to have that discussion with him.

What do you use as a baseline for normal?

"Normal" is overrated, but consistently thinking about suicide or other self-harm is not healthy. Consider it that hearty chest cough that let's you know it's time to think about taking your illness a little more seriously.

If I start taking drugs, what will my end goal be?

That's up to you. Relief (either temporary or permanent) from your anxiety and depression seems like a good thing to aim for.

How will I know when they're working correctly? I am not interested in taking my doctor's word for it, given my experiences with doctors.

Commit to taking them for two months, and keep a diary during that time. Every night write down your experience of the day and your thoughts of what you might be doing in the future.

At the end of two months, read your diary.

How will I know when and if I can quit taking them?

There's no way to know for sure. If you taper off of them and still feel okay, it's time to stop.


Last but not least, I realize that your situation is sticky but anti-depressants combined with talk therapy have a much much higher success rate than just anti-depressants.
posted by tkolar at 6:06 PM on February 10, 2007


Baseline for normal: being able to function.

Not liking elevators is pretty common and is a normal variant. Not being able to use elevators, or not being able to go to the gym, or an office, or anything that has a door... that's when it interferes with your functioning and that's when it's a problem.

And of course normal has gradients. There are all these super-effective people out there who have terrific time-management skills, great focus, good listening skills, make good decisions quickly, are always optimistic and focussed on the solution and so on. For them, being a normal person would be abnormal. But most of us are just happy to get by.

If you enjoy your friends and have an active social network; if your physical health is good; if you're enjoying whatever sex life you have right now; if you eat well and with pleasure; if you have rewarding work at which you are competent... you're probably normal enough.

But it doesn't sound like you're getting much out of life right now. That's crappy, which is reason enough to try to change things.

I second the bipolar II (I have it) and thyroid suspicions. Follow up with an MD. A good psychotherapist will help too, but don't stick around any psychotherapist who doesn't make you feel better about yourself.

Life doesn't seem do-able right now. But you're going to be ok.
posted by kika at 5:44 AM on February 11, 2007


Nthing thyroid problems. Furthermore, impress on your GP that you have these symptoms, regardless of what bloodtests say (the "normal" range for thyroid hormones is totally out of whack for a small percentage of the population. Better yet, ask to see an endocrinologist... there are many chemical disorders that have almost entirely psychological-seeming symptoms, especially for some people. Example: poly-cystic ovarian syndrome can present as severe/chronic PMS symptoms (which for me mean depression + anxiety) and heavy/painful periods.

Another thing to consider is if you have a sleep disorder, or some other fatigue-inducing problem. How does that cause anxiety? Because the only way your body can keep itself awake is by running on "emergency systems" e.g. nervous energy and adrenaline. I know that sounds backwards, but I had the same problem about two years ago (either semi-conscious or vibrating out of my skin with anxiety) and once I fixed the sleep problem, the anxiety decreased markedly.

Remember, medicine is more an art than a science, so you may have to look into or try many things before you find a solution that works for you... but that doesn't mean there's no solution.
posted by sarahkeebs at 6:42 AM on February 11, 2007


Follow up from the OP

Thank you for the advice. I felt better just after posting it, but I know this craziness will be back, so I'm trying to formulate a plan of action before that happens.

A few things I should have said- I am 35, and the Zoloft experience was when I was about 22, so it may not apply any more. And it was treating my (until recently) usual depression, which is the can't get out of bed, don't care about anything sort.

There wasn't any THING that happened 6 months ago- that's just when my body started behaving badly. I was doing a lot of travelling and work was stressful so I originally wrote it off as just stress, but then it didn't go away.

I did get my thyroid tested in early December- that was my first thought, too. But the tests came back normal. This really feels like some basic chemical's off, and the craziness is just a symptom. But since the tests she ran seem normal I don't know where else to look.

Last night I emailed my MD with all my symptoms except the paranoia and claustrophobia, which seem too crazy to admit to when I know it will go into my charts. I told her nothing had improved since I saw her in December and now what?

I AM functional- but I feel like I'm having to fake it a lot, and hiding what I'm going through seems like crazy behavior in and of itself, a la my step-grandma when she started getting an alzheimer's-like thing.

Anyway, thank you all again for your answers and your compassion.
posted by jessamyn at 9:27 AM on February 11, 2007


Sure, ask your regular doctor to check thyroid levels, citing the heart and menstrual symptoms. If your weight has suddenly done strange things in the last 6 months, another argument. Make sure he/she does the full test and not just T3 or T4. Wouldn't it be reassuring to find there is a perfectly good medical reason for what's going on?

A couple points about confidentiality. I agree with those who suggest an off-insurance or even next-town-over psychiatrist. As far as HIPAA goes, remember your doctors can share information if you sign a bit of paper that permits it. The sherriff can only get your records if there is an emergency (eg, you have been seen climbing to the top of a bridge), or if he gets a warrant, but only if he knows where your records are in the first place.

One last thing. If any of the medical professionals in your life decide you are a clear and present danger to yourself or others, they do indeed have ethical obligations to prevent that. This includes the ones you know personally and the ones you pay to listen to your problems. This is such a drastic and complicated step that they will think about it at least 3 times before picking up a phone. It is very difficult to lock someone up for their own good. It often involves multiple court hearings and tesimony from multiple mental health professionals who really need to be getting back to the paying patients in their offices. This is very frustrating to the people who love someone who is mentally ill, but very important for you.

Please get help. Tomorrow is Monday. I've never met you, but I care.
posted by ilsa at 10:19 AM on February 11, 2007


If you are at all feeling suicidal, please read How not to commit suicide. Dpression is so debilitating, but there's treatment, and you deserve to feel better. Good luck.
posted by theora55 at 8:17 PM on February 11, 2007


Let me chime in here to ask if you had your calcium levels checked during your last doctor's appointment. I suffer from parathyroid disease, which causes hypercalcemia, which can cause psychiatric symptoms of the kind you describe.

It's called hyperparathyroidism and it has nothing to do with the thyroids and it is much rarer than thyroid disease but you definitely ought to rule it out.

Best wishes to you, and yes, I think you should trust your doctor.
posted by macinchik at 8:45 PM on February 12, 2007


Um, that's the "thyroid" (no S). I believe we only come with one of them.
posted by macinchik at 8:46 PM on February 12, 2007


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