Depression

[sails]

Like most drugs, seroquel has a number of 'off label' uses, anxiety being a common one....

Agree GB - this is what has shown up in my internet searches and that it is often being prescribed for insomnia and anxiety.

I don't plan to respond for a while as I have a night off from caring for the girls and would really like to relax while I can and wish to thank all those who have been constructive and genuine in their posts.

I will update when we have more information and will post the progress in the event it should help someone else in the future.

 

[Julia]

Julia, you can't just rock up to a psychiatrist and demand to be seen. You need a referral - surely you know that?

Of course I know that. But in your earlier post today you gave the impression that your daughter was in the throes of a really acute illness and if this were the case, then I'm sure hospital care with the appropriate psychiatric intervention would be made available.
It now seems that the situation is not as acute as I'd perceived from your post.

Please stop jumping to conclusions and trying to sort out something about which you clearly do not have all the facts.

I'm not trying to 'sort anything out' other than to encourage you to attempt to have the situation properly managed by a competent psychiatrist. awg has said the same. You berate me and thank him. That's fine.

By email you were far more interested in whom might be to blame for her being on it in the first place. The fact is, she is on it and has to come off. I don't care who is to blame, I just want her off safely and with proficient and experienced medical help.

No, I was not more interested in who might be to blame, other than to reiterate the point already made by others on this thread, i.e. these drugs should be prescribed and managed by appropriately experienced psychiatric professionals. Mostly this does not include GPs.
And yes, I've disagreed with you that the entire blame for your daughter's distress is to be laid at the door of the manufacturer of the drug. I stand by that.

I'm glad to know you have sought advice from people experienced in dealing with the situation and, as always, wish you and your daughter a rapid resolution of the problem and a more healthy future.

 

[sptrawler]

I have only just read this post and it appears to me to be getting 'out there'.
I wouldn't think a stock forum, even in the general chat thread, is the forum to be looking for medical advice.

 

[sails]

Of course I know that. But in your earlier post today you gave the impression that your daughter was in the throes of a really acute illness and if this were the case, then I'm sure hospital care with the appropriate psychiatric intervention would be made available.
It now seems that the situation is not as acute as I'd perceived from your post.

Julia, she was not doing well two days after she dropped down 25mg, however since putting the dose back up 25mg to the last level, she has improved over the last few days. I'm sorry, but something like this can change daily and her symptoms of a few days ago have changed. This bad reaction to dropping the dose was quite unexpected and I have been advised that we did the best thing by restoring the dose to the last level until we could get qualified medical help. This is what has caused the improvement in the last few days, and although it has left her with some insomnia, the searing head pain has reduced to a dull headache.

I now have her registered with the Critical Care team here and that makes it easier to call if we need help urgently or just need to speak with a medical professional.

I'm not trying to 'sort anything out' other than to encourage you to attempt to have the situation properly managed by a competent psychiatrist. awg has said the same. You berate me and thank him. That's fine.

AWG also said many other things for which I thanked him. If I knew of a competent psychiatrist who fully understood withdrawal from this medication, I would do whatever was necessary to get there. However, reading the stories of so many people, it seems that many psychiatrists still believe this drug doesn't have withdrawal and so there is a risk of further medications being added to "treat" the apparent psychosis caused by withdrawal. I don't know how to find such a good professional. The last psychiatrist of several years ago had her on such mind bending medication that her eyes were rolling to the back of her head. This was to help her through a marriage breakdown and she had the care of her eldest child who was then around 5 years old. I phoned her GP (different one) and she agreed it was way to much of an overkill and suggested stopping the medication. We never went back to that psychiatrist. I lost a fair bit of confidence in psychiatrists so far, however, I am sure there must be some excellent ones out there.

Thankfully, the professional with whom I spoke yesterday was very aware and confirmed much of what I had learned from my internet searching was correct. I don't know how else I could learn this information and get insight as to what really happens. When people blog their withdrawal journey over several weeks, it does give a pretty good insight as to how it can affect people in different ways. I like to know to be prepared in advance for what might be thrown at us. The fact I had become quite familiar with other people's withdrawal experiences made it much easier to ask questions and have an intelligent discussion when speaking with professionals.

No, I was not more interested in who might be to blame, other than to reiterate the point already made by others on this thread, i.e. these drugs should be prescribed and managed by appropriately experienced psychiatric professionals. Mostly this does not include GPs.

I agree with you. I don't understand why GPs are allowed to prescribe drugs of this nature - surely it should be reserved for experienced psychiatric professionals AND, imo, should be a last resort medication. I do acknowledge that there are some people whose brain chemicals are through the roof and they may need something as strong as this to give them some semblence of normal life.

And yes, I've disagreed with you that the entire blame for your daughter's distress is to be laid at the door of the manufacturer of the drug. I stand by that.

No, I don't put the entire blame on the manuracturer of the drug. However, this "off label" use for anxiety and insomnia seems irresponsible - but who is fully to blame, I don't know. I understand the manufacturer reels in around $4.5 billion per year from this drug alone. Surely that suggests that it is being used far more widely than it should be. I really don't care who is to blame, but I do take objection to your statement that I place the ENTIRE blame on the drug manufacturer simply because I expressed my initial outrage and frustration.

Drug manufacturers have their place and they have developed life saving medications. I do not write them off. I am simply very disappointed that this drug is being used/sold for purposes that it might not be intended. It is not my place to do an inquiry to find out who should take responsibility for so many lives. I do know that Astra Zeneca has had some law suits over Seroquel because people have been unaware of the side effects - here's a link: http://www.aboutlawsuits.com/seroquel-951/

I'm glad to know you have sought advice from people experienced in dealing with the situation and, as always, wish you and your daughter a rapid resolution of the problem and a more healthy future.

Thanks Julia. I really don't want to argue over this as I have enough on my plate as it is.

 

[sails]

I have only just read this post and it appears to me to be getting 'out there'.
I wouldn't think a stock forum, even in the general chat thread, is the forum to be looking for medical advice.

SP, I'm not looking for medical advice. I am interested if anyone has had experience or knows of anyone who has come off this medication. We get medical advice from professionals, but it also helps to get a general understanding of what we might be in for getting her off this medication and to be able to communicate with those who understand.

I have received PMs where perhaps people feel more comfortable in sharing their experience privately rather than risk attacks from other posters. I appreciate the information from these PMs and is the reason I asked the question.

I know you think it shouldn't be on a stock market forum, but sadly, traders and their family/friends are not exempt from depression.

 

[sails]

Have just found out that this medication is available online without a prescription...

 

[Logique]

The nationally broadcast ABC radio program thought it was a good idea to play 'Tenterfield Saddler' by Peter Allen (and similar such) at 3am this morning. Do they do this deliberately?

As the new year is ushered in, and at 'suicide hour', is it too much trouble to play something appropriately cheerful? Insensitive clots. Late home and only tuned in by mistake, never again.

 

[sails]

A three-year investigation led by the attorneys general of Florida and Illinois found that AstraZeneca also failed to properly disclose possible side effects, including weight gain, hyperglycemia, diabetes and cardiovascular complications.

Under the settlement, AstraZeneca agreed to not market the drug in a misleading manner or for unapproved uses and to provide accurate responses to requests about off-label usage, Harris said. The company must also enact policies to ensure that no financial incentives are given to sales representatives for unapproved marketing, and it must post on a website any payments made to physicians.

Last April the company reached a $520-million settlement with the U.S. government, also over allegations that it marketed Seroquel for off-label uses. California received $31 million of that settlement.

Read more from the LA Times March 11, 2011|By Stephen Ceasar:
AstraZeneca to pay $68.5 million in Seroquel settlement

and

"This is very worrisome; frankly I have serious concerns about these drugs," says Dr. Steven Nissen, who is chairman of the Cleveland Clinic's cardiovascular medicine department and serves as an ad hoc advisor for FDA panels. Studies point to a "very questionable balance between efficacy and safety" for the class, he said. But that message, he said, has been lost in an apparent "marketing bonanza" for the companies that make the medications. A recent report by the consulting firm Decision Resources found the makers of the atypicals spent $993 million in 2006 to promote the drugs to doctors and patients.

Read more:
Use of atypical antipsychotics for lesser disorders is gaining ground, despite safety concerns

 

[Smurf1976]

This is the most difficult post I have ever made on ASF. Please bear with me...

I have found out a few hours ago that a work colleague has had some sort of mental breakdown. According to family, verbal comments are along the lines that they hate their job / workplace / employer, hate life, have nothing to live for and hate pretty much everything. I'm not sure if they have specifically mentioned friends / family in that context or named any specific individuals.

I really only know them through work, and in that context a few points are very clear. They are absolutely the standout performer amongst those employed in that job. Easily the most productive, the most professional and reliable etc. He's the type of person where you think that if a promotion opportunity came along, well then he's the obvious first choice to offer it to. And the thing is, most of the other staff would actually agree on that point.

As his immediate supervisor, we do have formal performance reviews etc as well as casual conversations and I have frequently mentioned this aspect of his work and expressed concern that it may be unreasonable, expecting too much etc. Such concerns are promptly, usually quite bluntly, dismissed with the usual words being "not at all".

Other notable points about his behaviour that I;ve noticed are as follows. I really don't know how much if any of this is relevant but I thought I'd post it.

Seems to be unusually well balanced personally. Highly intelligent, good with computers etc at one end, but also seems to be good with the ladies and likes sport and partying at the other end. Couldn't really be pigeon holed in the stereotypical nerd vs sportsman type way.

Is forever a "yo-yo" dieter. Lose weight then gain it again. Rinse and repeat.

Periodically decides to go on some sort of "detox" and give up alcohol, unhealthy foods etc. A few weeks later will go out on the town and get very drunk.

Seems unable to save money. Earns $80K a year and has no significant savings or assets that I know of. I suspect he'd have trouble finding $1000 cash in a hurry if it were needed without borrowing.

Has a number of "plans" which are frequently revived but never acted upon and then abandoned again. The primary one is buying land and being an owner builder - has been talking about it for years but never goes beyond talk.

Always seems excessively tired, including when working only normal hours. Also gets regular headaches.

Seems to always be doing things for others on the weekend. Building work, moving houses, fixing cars etc. That sort of thing.

He used to have a major interest in cars. Modifying them, tinkering, increasing the power output of the engine etc. This sort of thing pretty much was his life for quite some time. But at the moment doesn't actually have any running, registered car at all so far as I know and it's been like that for a while now.

Makes comments about health risks etc which seem rather odd. Eg if someone casually raises the controversial issue about radiation from mobile phones being a health hazard, he will respond by saying he sleeps with it under the pillow. Things like that - it doesn't seem a rational response.

Constantly buying new things. Mobile phones (we're talking about a new one every few months), cars, household items etc. Rapidly loses interest in the new item and wants another new one - eg bought a new phone roughly 3 months ago and within a few weeks had decided it was "crap" and wanted a different one.

Had a recent health scare (heart related) and resolved to eat healthy food, not drink alcohol, exercise etc. Stuck to it religiously at first but has since returned to eating junk food (corn chips etc) and very heavy drinking over the Christmas - New Year period. Surely their doctor would have advised to not do these things?

Personal details: 26 years old, male, single, no kids.

All the above examples are just things that I can think of in hindsight. I never paid much attention at the time, but now that he's had a breakdown and thinking back there would seem to be some behaviour - related alarm bells that have been ringing for quite a while. Or at least that's how it looks to me, bearing in mind that I know nothing about this sort of thing beyond what I've read on the 'net over the past few hours.

Anyone have any thoughts on this? I have no idea what to do now. Do I call? Go around and knock on the door? Keep well away? Am I partly to blame for allowing someone to perform well above average at work? Should I have prevented this from occurring? So many questions and I'm way out of my depth here...

 

[cynic]

This is the most difficult post I have ever made on ASF. Please bear with me...

Anyone have any thoughts on this? I have no idea what to do now. Do I call? Go around and knock on the door? Keep well away? Am I partly to blame for allowing someone to perform well above average at work? Should I have prevented this from occurring? So many questions and I'm way out of my depth here...

Also a very difficult post to answer.

I'd like to share a few of my thoughts just the same. (Disclaimer: I have no tertiary qualifications whatsoever, but have experience of a few things that just might relate to the situation you've described. These are my opinions only and need to be considered within that context).

Firstly, you are not to blame for what has happened. Your colleague whilst unfortunate to be in the midst of such a life challenging crisis has at least one thing working in his favour, namely, he has a compassionate supervisor who's sincerely interested in assisting in any way he's reasonably able.

Secondly, the over achieving champion of the workplace wanted to be so because doing for others was his way of making himself feel worthwhile and important in life. He wanted to mean something to others in order to compensate for a deeper sense of worthlessness/failure and/or insecurity, hence his constant desire to continually overachieve. This was his way of trying to prove his worth to himself and the world in general.

Thirdly, this purportedly healthy diet (I'm guessing that he consumed little or no salt throughout) and exercise regime that he underwent (whilst good in some respects ) may have exacerbated an undiagnosed chronic illness. Frequent headaches, depression, sleep disorders and temperature sensitivity, are several common symptoms of a range of serious physical health disorders/diseases. I believe that a thorough medical examination would reveal (amongst other things) thyroid dysfunction.On this note please bear in mind that the more popular pathology tests in use today are renowned for failing to detect thyroid dysfunction/irregularities.
You might want to acquaint yourself with the Canadian definition of Myalgic Encephalomyelitis & CFS the reason being that I strongly suspect that your colleague is displaying a number of classic symptoms of this (or similar) illness.

Fourthly, the fact that he's a young single adult with no children, might have contributed to his sense of being less than complete in his life. Christmas/New Year festivities etcetera often rub salt into this emotional wound. Witnessing people celebrating these events in the arms of their beloved partners and/or children can often give rise to feelings such as isolation,not belonging and not counting for anything (in the game of life). I've often heard questions of self doubt like "am I not good enough" or "what's wrong with me" from single adults during the festive season. On top of all this when one takes into account the custom of making new years resolutions and the contemplation of one's life (past/present/ and future) that ensues, one can readily understand how easily a deep sense of despair can arise in anyone whose life feels less than complete.


Finally, how does one approach this precarious situation? I would recommend that you establish a rapport with a family member through whom you can carefully convey a simple message of good will rather than using the direct approach. (If you suspect ME/CFS or that some other health related illness might be a factor, then tactfully broaching the subject with a trustworthy family member might also be worth considering.)
His self esteem is almost certainly at an extreme low. He's probably grappling with a sense of failure in life in general and probably feels that all that he is and all that he can ever do is insufficient to achieve acceptance and belonging in this world. Any statement about his importance to the workplace might be misconstrued as further demands - demands that he no longer feels capable of meeting. Conversely any statement about sharing the workload more fairly in future may also be misinterpreted as a judgement of inefficacy (even though you don't see it or express it that way, he'll still be his own harshest critic.).Maybe consider mentioning how impressed you are by the extraordinary levels of determination that he's demonstrated in the time you've known him.
I would recommend obtaining some guidance from a reputable psychologist prior to attempting contact (whether direct or via his family) as such guidance may save you from making an innocent (and regrettable) mistake in the conveyance of your good intentions.


Your colleague, his family and yourself have my utmot sympathy as I believe I can readily imagine just how emotionally demanding this situation is.

 

[Julia]

Smurf, I'm very sorry to hear about your colleague. Such a situation is distressing and bewildering to the person concerned and all around him.

You don't say whether he is hospitalised, or indeed receiving medical/psychiatric care.
On the assumption that he is, or that his family if he has one, is arranging this, my suggestion would be that you essentially stay away from involving yourself in the details of exactly what's wrong with him. That's for his medical advisers to sort out.


If it's feasible to reassure him that his job will be there for him when he feels able to work, whilst - as Cynic says - ensuring there's not a sense of pressure for him to do this, that would probably help him. You're obviously concerned and will naturally show him the sort of basic kindness and support someone in such a situation so needs.

He'll probably be embarrassed also, so if you're able to just reassure him about matters like sick leave, etc without getting too much into the whole psychological falling apart, that's probably going to be more comfortable for someone who obviously places a great deal of importance on being a top achiever.

Most importantly, Smurf, what has happened to this young man has probably been fomenting for some time and is certainly not your fault.

Possibly your other responsibility might be (after you've clarified the situation yourself re how long he might be off work etc) to talk to the rest of the staff, not in any detail about the person's illness but just a brief explanation as to his absence, and encouragement for any of them who are friends to be as calm and supportive as they feel able.

Good luck. You're a very sensible person. You'll handle it better than many.

 

[Logique]

I don't have any qualifications, but the two posts above cover it for me. Smurf if you're on the guy's side then stay there, but I wouldn't intrude any further, unless requested. Reassuring him to take his time and there's a job waiting for him, would mean a lot.

His psychological state could be from childhood issues or any number of unknown causes, or even private drug use. Hopefully his consulting physicians will track it all down.

 

[johenmo]

Smurf - I suspect part of the issue is he's trying to achieve so much to please others (expectations, etc). This is very complicated and family will play an important part. One of the biggest challenges will be convincing him it's ok to achieve less and, importantly, to say no. A great way to get out of doing things for others came from "Don't Sweat the Small Stuff" is by saying "sorry, I already have another commitment" - and the commitment is to yourself. Lots of stuff from the others echoes what i would have said but reducing the pleasing others is key - you mention he's always doing things for others.

Burnout/overload/stress can give all/most of what you have listed & when one learns to shed some of the excesses and not worry, then one makes great strides forward. Trust me on this one!!

If your relationship is good enough that you can listen to him, then do so. Use the family to gauge how to approach him. It may be best done via his best mate - each person is different.

For the future, always be aware of just how many hours people are putting in - I have had to curb the hours of some of my direct reports on a number of occasions.

Good luck to you and him.

 

[Gringotts Bank]

Smurf, firstly it's not your fault, and secondly it's actually not a big deal!! Even if he tried to harm himself... even if he's lying catatonic in a psychiatric ward dosed up to his eyeballs, he will actually be fine once he gets a bit of treatment. You'll be surprised to see how quickly he bounces back to his old self. Then it's just a matter of letting him do his treatment and working on finding a way to let go of old negative beliefs. Perfectionist workaholic behaviour is just a cover for a subconscious script which says: "I'm not lovable as I am, but if I perform exceptionally well, and if I fix your car for free, perhaps you will like me". The gadget addiction is simply a coping mechanism. The short term pleasure of having a new toy distracts him from painful thoughts and feelings. Again this is not a big deal. Everyone has hidden anxieties similar to this, in varying degrees, and similar ways of coping. His anxiety is just a souped up version of common garden insecurities.

The only mistake you can make is to be overly serious and concerned about it. Be respectful and caring and present, but forget about the "serious concern" part. It will just aggravate his condition.

 

[Smurf1976]

A huge thank you to everyone for your comments. We often have disagreements on ASF about the markets, politics etc but there are a lot of very genuine and knowledgeable people on this forum. Thank you.

Last time I knew (yesterday afternoon) he was at home with family and they were going to arrange some sort of professional help. But of course that hasn't stopped me worrying about it - I went to bed thinking about it and woke up this morning already doing the same.

After reading everyone's comments, I am going to talk to his family (on the phone) this afternoon and point them in the direction of ASF and this thread as there is a lot of good advice here. I don't expect to talk to the affected person directly, as I think this may not be helpful, but I will make the offer via his family to do anything and everything I can to help and let them decide what that should involve.

With regards to work, I went in this morning and checked leave balances etc. In the short term he has sick leave on full pay, after that there is a longer period of sick leave available at half pay. So for the foreseeable future there is a job there when he returns. I will inform his family of the actual figures once I verify them with the HR section.

In terms of working hours etc, obviously I have a tendency to ask myself if I've caused this in some way but the comments of people here suggest otherwise. Virtually all of the overtime we do is voluntary (but paid) in that it is not time critical. That is, the job can be done this week, next week or the week after that and it doesn't really matter as long as it does get done (but must be after hours for operational reasons). In short, it's electrical maintenance type work.

I've always pushed the point that nobody is being forced, feeling confident that sooner or later enough people will put their hands up voluntarily and the job will get done so there's no reason to push anyone. This has always worked in the past - some people do more than others by choice but it's never really been an issue.

Perhaps I need to make this point a little more clearly, but it's something I've said practically every time I ask if anyone wants to work after hours this week. There's one person who never says yes, and it hasn't harmed his career in any way so I think the message ought to be out there - there isn't a gun being held to anyone's head forcing them to work nights or weekends.

Realistically though, given the chronic tiredness etc I think the weekend things he does are likely to be a much bigger issue than paid working hours. Thinking about it, Mondays are clearly his worst day which does point toward doing too much on the weekend - and by that I mean with friends etc not paid work.

Thanks everyone. Any further comments are certainly welcome.

 

[Smurf1976]

I have contacted his family a short time ago. Apparently there has been a modest improvement but he will be seeing a professional tomorrow.

I have pointed family in the direction of this thread.

Now that I know a bit more about it, I'm thinking that some of the things which seemed "unusual" to me (in hindsight) may not be relevant but that some probably are. I mean, there's plenty of people who don't regularly save money and there's no law saying you have to. That one might reflect a personal bias on my part more than anything else since I've always been a saver by nature. But some of the others may be relevant as others have commented in following posts.

Let's hope for the best.

 

[Chris45]

Cheek Tweaks can help with depression.

Smiling releases antidepressant hormones such as serotonin. Serotonin is a brain chemical that activates nerve cells in the brain and plays a major role in regulating our mood. Many researchers believe that an imbalance in serotonin levels in the brain may influence mood in a way that leads to depression. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant medicines and researchers believe that the SSRI medications relieve depression by making more serotonin available to activate nerve cells.

A few years ago, some researchers at U.Q. discovered that contracting the right-hand cheek muscles stimulates the release of serotonin in the left brain hemisphere and improves mood. They found that the best technique for stimulating the release of serotonin was to start with a big wide smile then let the left side cheek muscles relax so that your mouth is twisted across to your right side. Hold this position for at least thirty seconds while thinking some happy thoughts, or simply counting happy images in your head to block the negative thoughts and allow the serotonin to do its thing. I call this a "Cheek Tweak".

The effect is subtle, so don't expect a rush like a drug hit, but do it regularly, and initially twice a day for at least a week, and you should start to feel a significant improvement in your mood which will help you avoid depression. Do it in front of a mirror and you'll probably get a good laugh from how stupid you look so it's probably best done in private.

Every time I feel myself starting to spiral down into a bad mood, I do a quick Cheek Tweak and the bad mood vanishes. I recommend you give it a try.

 

[Julia]

Smurf, glad to hear that the family seem to have things under control.

I think it's wise of you to remain at arm's length, whilst of course being as helpful and informative as you suggest re advice on sick leave and reassurance of his job continuing to be there.

As his supervisor, to get too personally involved in the emotional aspect could make it difficult for the working relationship when he returns to work imo.

Hopefully friends and family will leave the psychological counselling to those properly qualified to provide this.

He's fortunate in having a supportive and sensible boss. Goodonya.

 

[awg]

Hi Smurf, here are my opinions

your description is similar to what I have seen in people suffering bi-polar disorder, especially prior to diagnosis.

I have come across some that are VERY high functioning.

It has been my observation that shiftwork is a trigger for this condition.
(u didnt say if shiftwork is involved)

Nothwithstanding the serious nature of this illness, many can be rehabilitated to their former work positions, once they are diagnosed and treated.

He is fortunate indeed to have an understanding supervisor.

Despite some peoples reluctance, I always stress the need for an experienced psychiatrist to make a full evaluation. Do you get your auto transmission rebuilt by the local garage mechanic...no, you take it to an auto tranny specialist.

Medication for bi-polar and unipolar depression are different, incorrect medication will often exarcebate the condition

I adamantly do not believe that such illness should be diagnosed by GP alone, which is not to say he may not have bad experience or mis-diagnosis by psychiatrist..he should try and find one that has been trained in the Australian Mental Health sytem.
They may be hard to find, and have a months long waiting list. He needs a referal from a GP

A very experienced psychologist is the best adjunct to a GP, if no psychaitrist is engaged, a Medicare rebate is in place.

The average time of symptom onset to diagnosis is about 10 years for bi-polar.

You seem to be a kind fellow, and I am certain that he will remember that, but there is only so much you can do, I doubt he would favor you diagnosing him, if your organistation has a HR section, they take over long-term health cases ( which can be bad, as the care you showed may be lost)

Although it can be "dangerous" to look at, markers of all mental conditions detailed in DSMIV are outlined on the internet

 

[johenmo]

...if your organistation has a HR section, they take over long-term health cases ( which can be bad, as the care you showed may be lost)...

Interesting comment. In all my years in all the companies the number of HR people I have met who truly have a soul I can count on one hand. Maybe a form of self-protection??