When is it time for inpatient treatment?

February 21, 2012 5:25 PM

I think I'm having a nervous breakdown. Should I pursue inpatient treatment? Any recommendations in Austin, TX?

I'm a fit, physically healthy woman in my early 30s. My life is good. I have a stable marriage and a great job. But I've suffered major depressive episodes every few years since I was a teenager. I started taking antidepressants under my regular internist's care about six months ago.

I took 10mg Lexapro for about a month before I moved up to 20mg. To treat anorgasmia, I also started taking 150mg Wellbutrin. It worked for a while -- then, I think I had something like a manic episode. I was coming on to coworkers in front of my spouse, I was trying to go out partying every night -- just a long litany of really inappropriate behavior. I was drinking a lot too.

It's now two months later, after another totally out of character affair (that just ended poorly). I feel more depressed than ever. I've taken the breakup really badly. I can hardly function. I'm calling in sick and overeating. It feels like my heart is racing and I can't relax. I feel like I'm spiraling out of control and I'm scared. This has been going on for a couple of days. It's not the first time -- I've been able to ride it out before -- but this time, I want to treat it, not ignore it. And I'm worried about it finally having an effect on my job, and getting even worse for my marriage.

I asked my doctor for help with the anxiety. He gave me beta blockers. I found them completely ineffectual.

Obviously, I need to find a real psychiatric professional. But I haven't seen one since I was a teenager.

I'm tempted to look into an inpatient program, to get a clean start -- get out if my house, devote myself fully to getting better. I'm pretty sure I can get a week or two off work (I'm very well respected and I feel comfortable discussing the topic with my manager). Does that sound like a good idea?

Would I be able to bring my Kindle and some knitting? (I know, sounds funny, but my knitting is important to me -- and I'm not suicidal or violent ...)

Do you have any recommendations for programs in or near Austin?

Thanks. It feels like a big step to just type this out.

posted by anonymous to Health & Fitness (19 answers total)

Would I be able to bring my Kindle and some knitting?

When I was in for a 3-day, I wasn't allowed my things for a day or two. I'm not sure that, depending on the facility, they'd want sharp objects around. Not for you, but for the other patients (if it's that kind of place, where there are a number of patients together) who may be in danger of self-harm.
posted by xingcat at 5:32 PM on February 21, 2012

You say you have a stable marriage and then, two paragraphs later, admit to having "another" affair that ended poorly (how did you expect it would end?).

I'm not a doctor but your thought processes here seem extremely disjointed irrational. I mean, you're talking about sabotaging your marriage in one breath and asking about knitting in the next. Have you had a full medical workup lately that included blood tests and neurological examinations?

St . David's Medical Center
919 E 32nd Street
Austin, TX 78705
Telephone: [phone]
posted by Avenger at 5:38 PM on February 21, 2012 [6 favorites]

I am not a doctor, but I've got lots of personal experience with all this. It really sounds like you may be bipolar. But, please, again, I'm not a doctor and don't know you at all. But I think it might be a good idea to explore this possibility with a professional.

Regarding hospitalization, unfortunately, insurance is what mostly determines the care you can receive. My experience (personal and otherwise) is that you won't be hospitalized if you are not suicidal or violent. But that may be different in your area or with your caretakers. Also, generally speaking, hospitalization is usually very brief, not longer than a week, often less. The reason for hospitalization is to get you stabilized until you feel safe; you would be evaluated by several professionals, then a care plan would be devised. Usually you would be released after just a few days, once the plan is settled on. Even if they prescribe new antidepressants or tweak the ones you're on, it takes several weeks for them to take effect; but you will not be allowed to stay in the hospital until then.

But, whether you seek and gain hospitalization or not, you must seek treatment--now. Tonight. Don't wait 'til you feel suicidal or violent. Call your local ER and talk to someone there. They will be able to tell you if they think you should come in or they will recommend you make some phone calls tomorrow to psych professionals. And if you can't, ask your husband or some other loved one to help you. It also sounds like you might need to try some different meds. This can be a real pain, as it takes several weeks to see if the med is effective. But try to be patient.

By the way, you almost certainly would not be allowed knitting needles in a hospital, not only for your own safety but for others'; maybe a crochet hook would be allowed. A Kindle would probably be OK, though.

In the meantime, please try to be good to yourself (even if you feel you don't deserve it--you do), and ask for help and support from your friends and/or family. Good luck to you.
posted by primate moon at 5:54 PM on February 21, 2012 [4 favorites]

Get screened asap. The behaviour you describe fits the description of mania ....if so taking unopposed antidepressants is not good.
Being screened for type two bipolar would be smart at the very least.

Please take this seriously .
posted by St. Alia of the Bunnies at 5:55 PM on February 21, 2012 [8 favorites]

You definitely sound like you could use a really serious evaluation by a psychiatric professional. Inpatient is one option - they might also let you start in a partial program, since you're not currently at risk of hurting yourself (from what I read here, anyway.)

I recommend you call these people.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:56 PM on February 21, 2012

Oh, and yeah - no knitting needles were allowed at the inpatient facility that my partial program was adjacent to. But practically everyone was crocheting; a longer-term patient in that facility was teaching everyone who was willing to learn. Probably a fourth of the people in the partial program were doing it, because they'd been stabilized there first.

And this sounds like bipolar to me, too. But I am bipolar, and I worry that it might be a bit like how you see red Ford Fiestas everywhere, once you buy one.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:00 PM on February 21, 2012 [1 favorite]

The doctor who is giving you the meds, is he a psychiatrist or a family doc? It just seems like a psychiatrist would work more closely with you on this.

Anyway, if you are bipolar and you take only antidepressants without a mood stabilizer, it can send you into mania. IANAD but it sounds like that might be what's going on. You need to seek help right now. If you don't want to go to the hospital now then stay home from work tomorrow and start calling psychiatrists until you get an appt for later in the day.

Please don't wait and see or anything like that. Get help now.
posted by dawkins_7 at 6:17 PM on February 21, 2012

I'm not bipolar, and the behaviors you're describing sound like a manic phase to me. Get to a psychiatrist ASAP, because if you are bipolar, those antidepressants are just cranking up your mania.
posted by Sidhedevil at 6:18 PM on February 21, 2012

Psychiatrist! Not your GP! A good psychiatrist wouldn't have let things get this far--if you'd told her about the sexual acting-out, mental confusion, etc.
posted by Sidhedevil at 6:19 PM on February 21, 2012 [4 favorites]

As mentioned by others above, a partial program is an alternative to inpatient treatment that might be a good fit for you right now. Inpatient is usually for crisis intervention and something they try to move you out of as soon as you're more stable (not a danger to yourself or others). After you're out of inpatient they generally move you into partial. Partial can be a good option because it allows you to check in every day with professionals who know what you're going through and also allows for a lot of group therapy while you're stabilizing any medication changes and regaining confidence in yourself. I am not a doctor, though, and you should speak to a psychiatrist as soon as possible. They can help you figure out what's right for you.

Though I don't know what immediate treatment plan is right for you, I can share my experience with antidepressants making me manic and the solution that worked for me. The first time I took Welbutrin - just the very first pill I took - sent me into a manic episode and I couldn't sleep at all for 24 hours. The main effect for me was severe agitation. I spent a lot of that time walking in circles around the kitchen because I couldn't sit still. I refused to take any more Wellbutrin after that, but several years later a psychiatrist suggested that I add a mood stabilizer to my antidepressant after hearing about my previous experiences. (Wellbutrin was by far the worst, but no other antidepressant had been very helpful for me and they all made me agitated and uncharacteristically argumentative.) Adding a mood stabilizer (Lamictal, in my case) made all the difference in the world for me. Antidepressants started helping without making me feel crazy. I even eventually added Wellbutrin into the mix at a time when I'd been on Lamictal for a while and it was very effective without making me manic.

I'm sorry you're going through this, but it is not that uncommon for antidepressants to have this effect on people. Getting past this might only require a change to your medication.
posted by psoch at 6:41 PM on February 21, 2012

Several years ago, I spent about a week in inpatient psych care at Shoal Creek here in Austin. It wasn't really my idea of a good time, if you know what I mean, but it got the job done — they kept an eye on me, tweaked my prescriptions, set me up with an outpatient psychiatrist, and sent me home. I'd definitely recommend it to someone who was feeling unsafe or out-of-control.

Really, though, I agree with the other suggestions upthread: go to the ER or call Psych Emergency Services now, and see what they recommend. They will either steer you towards an inpatient facility if they think it's necessary, or will help you find some sort of outpatient care if that seems more appropriate. You don't need to make up your own mind ahead of time on which kind of treatment you want.
posted by nebulawindphone at 6:51 PM on February 21, 2012

Psychiatric Emergency Services
56 East Avenue Austin, TX 78701
[phone]

If you must go inpatient, I had a good experience on the depression ward at Shoal Creek. Don't know if that's what you need, but if you'd like more details, MeMail, email or IM me (all info in profile).
posted by MuChao at 7:46 PM on February 21, 2012 [3 favorites]

Another recommendation for contacting Psychiatric Emergency Services. They are there 24 hours a day and will help you navigate your way through the options available. There are several options in town, and insurance will be a factor, but shouldn't stop you from getting the help you need.
posted by goggie at 7:51 PM on February 21, 2012

I've done inpatient before and though I am not bipolar, the circumstances of my life at the time I went to the ER for help sound very much like yours, with the calling out of work and disordered eating and inability to focus on anything for very long because of racing thoughts/heart. You go to an inpatient facility when you are in an acute crisis. The point of treatment there, for most people, is not to be long-term, but to stabilize you in the immediate future so you can focus on establishing a long-term outpatient plan. I am obviously not a professional, but it sounds like "acute crisis" certainly describes what you are experiencing. Like others have said, I really think you should call and at least talk it out with people in the ER.

Keep in mind that I am in PA, but a couple of things of note from my experience:

1.) When I went to the ER and the mental health professional there agreed with me that I should try an inpatient facility for acute crisis, I was told that I was not allowed to leave the ER to go home and get anything before going. Be aware that this might happen. They take it very seriously if you tell them you are in crisis; they don't want you driving a car or doing anything that could be of harm to yourself after you have brought your crisis to their attention. I worked out a deal where I could go home for an hour to feed my cats, make arrangements for pet care, and get a change of clothes, but my intake coordinator was reluctant to even let me do that and said that if I was not back in an hour, she would send the ambulance out for me and have me involuntarily committed. She stressed to me over and over that she was very serious about this. You don't want to be involuntarily committed, so I would suggest that if there is even a possibility in going to the ER that you will be entering inpatient, you bring a change of clothes and anything you might need along with you.

2.) I doubt they will let you have a Kindle. They definitely will not let you have knitting needles. I also highly, highly doubt they would let you have yarn at all. It seems like a liability on a ward of people in crisis, to me. My facility confiscated our shoelaces and removed all of the ties from our hooded sweatshirts. I would suggest bringing a paperback or two to pass the time you're not in group.

3.) Expect to spend at least three days there, but more like 5-7 days. They need to make sure you are stabilized in the short term.

4.) Regardless of what you think after reading this, I strongly encourage you to go to the ER and get the conversation with mental health professionals started. The experience of being hospitalized was not what I expected at all, but it is very helpful for getting you back on your feet in the short term. The most basics of your self-care -- feeding yourself and daily maintenance of your responsibilities -- are taken out of your hands, so that your whole focus for a few days is getting better and establishing a treatment plan for when you're back out in the world and do have those other responsibilities, in addition to coping with your disorder.

I have been diagnosed with anxiety/major depression for 12 years. It was last year that I was in the hospital and I can tell you that my year after being out has been the healthiest, most stable year I've had in those 12.

If you (or anyone else) are interested in knowing more about the experience, please don't hesitate to MeMail me. I wish you the very best of luck. There are people who can help you get through this.
posted by houndsoflove at 11:23 PM on February 21, 2012 [2 favorites]

Two thoughts:
First, let me chime in on the importance of getting yourself a psychiatrist asap. You need specialist - it is unlikely that an internist would completely up to date on all the options, side-effects etc.

Second, just because you aren't admitted to a hospital doesn't mean that you don't need to take time off from work to deal with this. Once you see a doctor, if you get out-patient treatment you may find that you will be spending most of the day at the hospital/clinic anyway. If not, still talk to your doctor about taking time off from work to get things better under control.
posted by metahawk at 11:27 PM on February 21, 2012 [3 favorites]

Chiming in on: see a psychiatrist, not your GP. Antidepressants if improperly prescribed can have bad effects.

They will probably not let you have a Kindle, or books, or your knitting needles. Unscreened books could risk having depressive messages in them, which is why if you are visiting someone, you can't just bring them books. Bring a change of clothes, but make sure they don't include laces or ties.

That said, I don't think it seems like you need inpatient right now. If you are not actively suicidal or homicidal, you would be taking up the slot of someone who is.

However, a week or two of mental health retreat, especially supervised, would probably be a great idea, if you or your insurance can afford it. Get somewhere with professionals to talk to you, but it doesn't have to be inpatient at a hospital.

My familiarity is with helping people get into PTSD clinics, but it is possible that there are also bipolar clinics or generalized clinics that might be really helpful.
posted by corb at 4:36 AM on February 22, 2012

Mod note: From the OP:

Thanks for the advice, everyone. I'm sitting in the lobby at Psychiatric Emergency Services (which my Google searches never found -- so especially thanks for that tip). I'm scared -- I mean, I'm surrounded by crazy people! -- but I'm glad I'm here. Wish me luck. Thanks again.

posted by jessamyn (staff) at 9:17 AM on February 22, 2012 [4 favorites]

I'm pretty much repeating what's above but if, IF you have bipolar disorder (and note that there are two 'forms' of it, referred to as I and II), you need a mood stabilizer. Antidepressants can push you into hypomania or mania. I take an antidepressant along with my mood stabilizer, but my doctor monitors this closely. I wonder too if it could just be the wellbutrin. My doctor has said that it can make some people feel like they're jumping out of their skin. It's more 'activating' than other antidepressants and is often tried to help with a libido lessened by SSRIs. You really do need a psychiatrist to do a proper assessment. Good for you for looking after your mental health. It's extremely important.

They may be resistant to taking you into the hospital, especially if they are overburdened and you are not suicidal. Be prepared for that, and grant yourself a stay at home for a week if you can't get in.

Try not to worry. You are going to be ok. You are catching this early and that's wonderful. Best wishes.
posted by kitcat at 9:18 AM on February 22, 2012

Good luck to you, OP. You should be so proud of yourself for getting the care you need. Things will get better.
posted by goggie at 1:05 PM on February 22, 2012