I’m totally at a loss for words when I try to discuss this article, Critics: Don’t tie driver’s licence renewal to psychiatric history. Oh, there’s nothing wrong with the article itself. The topic, however, horrifies me. There is something really, really wrong with the Registry of Motor Vehicles in Nova Scotia.

Service Nova Scotia now requires people renewing their licences to indicate on an application form if they’ve had a “psychiatric or psychological condition.”

People who indicate yes — even if it was something such as a bout of depression — are asked to provide more specific details and then must have a doctor complete a medical, sharing what’s usually confidential information with the government.

“The contents of the medical report will be reviewed by department staff and may be referred to a committee of medical specialists who make recommendations on clients’ medical fitness to safely drive,” the province has advised affected people in writing.

The application form also asks those renewing their licences if they have had lung, heart, eye or neurological diseases, a stroke or dementia.

Doctors sometimes charge a fee for the medical and failure to comply with the request could result in drivers losing their licences.

Why, why, why would anyone ever think this is a good idea?

Paul Arsenault, the provincial registrar of motor vehicles, defended the practice, saying that his department needs to know that information for the sake of public safety.

“If somebody’s severely depressed, they probably shouldn’t be on the road,” he said.

Hiya. Manic-depressive here. Severe depression, mania, psychosis, the whole works. I’ve never had a car accident. I’m not saying that nobody ever caused an accident because they were manic and driving too fast, or that no asshole has ever committed suicide by crashing their car, but that’s got nothing to do with me. My psychiatric condition isn’t any of the provincial government’s business, and I certainly don’t see why anybody who needs to get their license renewed should have to tell the government if they’ve had a brief bout of anxiety or depression in the past.

Carol Tooton, executive director of the Nova Scotia division of the Canadian Mental Health Association… wondered why the province would require such sensitive medical information that has little to do with somebody’s ability to operate a vehicle.

“I’ve never heard of this before. It certainly doesn’t help to eliminate the stigma around someone who may have a mental illness.”

See, I’m not the only person who thinks this is screwed up.

Stephen Ayers, the executive director of the Schizophrenia Society of Nova Scotia, said he was uneasy about the requirement and found it intrusive.

“This is concerning, obviously. It’s required by law for a physician or psychiatrist to notify (the Registry of) Motor Vehicles of a medical condition a person has that would impair their ability to drive.”

David Simpson, with the Mental Health Police Records Check Coalition, an Ontario rights advocacy organization, said the practice smacks of discrimination.

“What you always have to be worried about in situations like this is if there is some sort of systemic bias in place or covert discrimination, that they believe because you have a mental illness you’re going to use your vehicle as a weapon to injure people or injure yourself.”

I would definitely not indicate yes on this form and then pay $50 to get a doctor to complete a medical.

Since that article is a week old, how about you also check out one from today’s issue of the same paper? I mentioned Howard Hyde’s death last year, and here’s the latest news:

The Nova Scotia government will appoint a fatality inquiry into the death of Howard Hyde, who died after being Tasered by Halifax police in November.

Justice Minister Cecil Clarke announced the inquiry today on the heels of a report from the province’s chief medical examiner that found that Mr. Hyde died of excited delirium, not of being zapped with a Taser.

Yeah, because you hear about so many people dying of excited delirium while they’re not in police custody, right?

When I was a bit younger, I used to have really bad PMS. It was probably bad enough to be diagnosed as PMDD, but if anybody ever did diagnose me as such, they didn’t tell me. Every time I attempted suicide, I think it was just before or during my period. The worst thing about it was that my period was also extremely irregular, so I never even knew when the PMS was coming. Although there was a good side to that, too — I’d suddenly become intensely suicidal, but when my period would come, I’d be so relieved to know that there was a concrete reason for my mood, I wasn’t “going crazy” again, and I’d be feeling better in a few days. That’s an amazing sense of relief to have.

This was a major issue for me until I started taking the birth control pill. I wanted to start taking it a few years before I actually did, but I couldn’t find a doctor who would prescribe it for me. The reason? I was on Topamax, and Topamax can sometimes make oral contraceptives less effective. This only holds true if you’re on 200 mg or more daily, and I think I was on 100 mg at the time, but who’s counting?

How did I eventually get prescribed oral contraceptives? Well, one day I went to a clinic to get the morning after pill (yes, we’d been using protection, but we had a condom breakage issue) and when the doctor was asking me some questions, I told her that this was the third or fourth occasion that I’d taken emergency contraceptives (over a span of three years).

She said, “Polly, Polly, Polly, what are we going to do with you?”

She had never seen me before in her life.

I said, “Well, for starters, somebody could prescribe me the birth control pill!”

And so she did. Yes, she knew that I was taking Topamax and that it could make the Pill less effective. I should point out that the other doctors I’d asked about birth control had all been male.

I never took the morning after pill again. I have never been pregnant. A couple years later, I stopped taking Topamax.

I know that oral contraceptives cause really bad mood swings in some women, but they actually help prevent them for me. It’s also nice having my menstrual cycle regulated, so that I know when a possible time of PMS is coming up. On the other hand, since I now only rarely get depressed and irritable before I get my period, there’s still that element of surprise. If I’ve gone for many months without PMS, I’m not expecting it to happen.

Which is why last week, I spent a couple of days feeling like I wanted to go lie down in traffic, but was cheered up when I realized that I only felt that was because of PMS. Then I got a little too cheered up, because I had an insomnia thing going on, and I got hypomanic. I was so jumpy and hyper that I was seriously afraid that I was going to have to call in sick to work one day because of it. I had a cup of coffee the day before, like an idiot — I try not to drink coffee at all normally, and when I’m hypomanic, coffee is an incredibly bad idea. IT MAKES MY BRAIN FEEL LIKE IT IS JUMPING UP AND DOWN. AND IT MAKES ME FEEL LIKE EVERY NERVE IN MY BODY IS JUMPING UP AND DOWN INSIDE MY SKIN, TOO. And that’s actually a lot of fun, even if my pitiful, inaccurate attempts to describe it make it sound uncomfortable. The uncomfortable part comes because I. Can’t. Keep. Still. and any situation that would require me to stay still is horrible for me. If I’ve got free rein to climb on stuff and do whatever I want, then it’s tons of fun.

You see why this might be a problem when I’m at work, though.

I guess caffeine does this to a lot of people, but if you are not manic-depressive, I don’t think that ONE CUP OF COFFEE can make you feel like this for TWELVE HOURS STRAIGHT before you start to come down a little.

Anyway, I somehow started feeling a lot more subdued, and I was able to go to work, and it was all good.

Um, I have no idea where I was going with this. I’m still a wee bit on the hypomanic side, but not in a bad way. Oh, yeah. I wanted to mention that although I don’t eat as well as I should, for a long time now I’ve been doing really well at trying to make sure my sleep schedule is as regular as possible, because I know how important it is for me to sleep properly if I want to stay well.

Ha ha ha, I’m standing up at the computer again because I’m still not so awesome with the sitting still. Sit down, you.

Anyway, my sleep being messed up through no fault of my own and the subsequent consequences provided me with additional proof that I should definitely stick to a regular sleeping schedule. I’m so much more stable when I do. I know, duh, right? Although the insomnia wasn’t brought on by anything I did, for a few days I didn’t try hard enough to get my schedule back on track, and that only served to remind me that it is dumb not to try to get enough sleep. It is also dumb for me to oversleep, or to sleep at weird times, especially since I have a more-or-less nine-to-five kind of job.

I’m trying harder now, though. For really.

Although my brother finally more or less accepted that his girlfriend needed to work this summer, when she took a trip elsewhere just for fun, he freaked out because she was having a good time instead of being with him while he was miserable. He stole my parents’ car a few weeks ago so he could drive across the country to her, but came back after driving for two hours when he realized that this plan was not actually going to work. He said his mind wouldn’t stop racing, but none of the people who were supposed to be treating him considered that it might be related to the fact that he had just started taking two different antidepressants and had gone nearly three weeks without follow-up treatment. A few days after that, he wound up in the hospital for the second time. He “escaped” once (he was on an unlocked ward, so it’s not like it was hard to escape) and the police brought him back, but he’s been out again for a while now. He was on Seroquel for a while in the hospital, but even the doctors admit it probably made him worse, and took him off it.

His ex-girlfriend, if that’s what she is, has cut off some forms of communication with him, but they’re still emailing each other, and every time he gets an email from her, he gets upset. A few days ago he smashed the glass door of a cabinet. I know this girl has problems with depression, but she’s always seemed much more stable than my brother throughout their relationship, even though they’ve always fought a lot. Now, though, she’s seeming nearly as unstable as he is. She keeps telling him that she loves him but can’t be with him, and mixed messages are the last thing he needs right now. He’d prefer if she were supportive, of course, but I think he could even handle a breakup better than he can handle what’s going on right now. Not that I’m saying this is her fault — I know he’s not easy to deal with, but she’s really making things worse, even though she’s not doing it on purpose. Apparently she has also been sending weird emails to my parents.

Previously, my brother had planned to attend a day programme soon. Now he says he doesn’t want to bother trying to get better unless his ex(?)-girlfriend is supportive of him. That’s just him being completely pigheaded. His shrink, though, did say that nobody can help him “until he gets over that girl.” Um, his main problem is that he doesn’t know how to get over “that girl,” and if he knew how to do that on his own, he probably wouldn’t need a shrink.

My younger brother is like the poster boy for borderline personality disorder, but since mental health professionals seem to be looking only for BPD poster girls, none of them had ever considered this diagnosis for him. No, I’m not sure whether I think BPD is a useful construct, but he does fit the criteria to a T (except, as far as I know, the last one, “transient, stress-related paranoid ideation or severe dissociative symptoms”).

Last week, I kept mentally writing a blog post in which I would describe all the ways he fit the criteria for BPD, but refer to him as “she” until the end of the post, where I would say that there was one major lie in the post and to switch all the pronouns, I’m actually talking about a guy, not a girl. My brother can be awfully exasperating, but what really bugs me, and what that post would have really been about, is sexism in the mental health profession. About how I, a girl, have been called personality-disordered simply because I used to cut myself or because sometimes I’ve disagreed with doctors’ opinions about something, but someone who very obviously fits eight of the nine criteria for BPD isn’t diagnosed with it because he’s a guy. I’m not really interested in amateur diagnosis of anybody other than myself, but it seemed appalling that behaviour that would get a female slapped with the BPD label was ignored in a male. I never did write that post, because 1) it would have wound up being awfully long and I’m lazy, and 2) it seemed malicious to write a post delineating all of my brother’s very worst qualities when he is one of my favourite people in the world and one of my best friends.

Now there is another reason to never write that post, which is that a doctor has finally considered that he might have BPD. Until the other day, my brother’s official diagnosis was generalized anxiety disorder, but he’s been in the hospital for a couple of days because of suicidality. One doctor is saying bipolar spectrum disorder and another is saying borderline personality disorder.

As for how he is doing in there, it varies. He went voluntarily, but then when he said he wanted to leave and it was stupid and he should have just killed himself instead of going to the hospital, of course they changed his status to involuntary. For a while he was really mad that he’s stuck there because he wants to go online and see if his girlfriend is terribly worried about him, as he wants her to be. He was doing a countdown online to the day he planned to kill himself and dramatically telling his friends that it would be his “last day on Earth.” His girlfriend has a good summer job on the other side of the country and he is upset about that because he would prefer that she come home to her apartment and work at the part time waitress job that she had before she found the better job. He thinks that her wanting to make money to pay the rent for her apartment, where he sometimes lives with her for free as he has no job, means that she doesn’t really love him. My mother said today, though, that he is feeling less angry about being in the hospital now because he thinks he should stay until he feels safe.

Feelings can shift so rapidly in the hospital sometimes, can’t they? Most of the time, it’s very boring, so when anything at all happens, sometime it seems monumental and you can overreact.

This is not an anti-BPD post. My brother behaves like a stereotypical, worst-case-scenario borderline, and of course I’m going to vent about that. I realize that most people diagnosed with BPD aren’t actually like him, and I’m hopeful that whatever the hell is wrong with him, whether it’s BPD or something else or BPD and something else, he will soon get some appropriate help and will feel better and not be such a pain in the ass. Even if he is bipolar without BPD, I’m glad that somebody has finally noticed that something other than GAD is going on.

thememoryartist recently made an excellent post, A new proposal for the DSM, which “outlines and categorizes the features of Mental Health Professional Personality Disorders.” It’s funny because it’s true. Which also, of course, makes it sad. I’ve seen plenty of mental health professionals whose behaviours and attitudes are outlined very well by those criteria.

In a comment, Gianna mentioned that the post might be educational for mental health professionals. I’ve met some MHPs who would appreciate it very much… but they’re not the ones who tend to exhibit any of the listed behaviours. I think the ones who actually exhibit the “symptoms” would see that piece of writing as an example of a patient being narcissistic and overly hostile, and would never recognize themselves in the criteria.

There are also a lot of interesting comments on this post about PTSD misdiagnosed as BPD.

I am doing okay physically with the Zoloft and Epival withdrawal. I didn’t even have any of the brief dizzy spells yesterday. I was, however, staring at a word on a computer screen when I saw it suddenly jump several inches to the left, even though this did not really happen. I am hoping that this is just a regular hazard of the twenty-first century, as opposed to a withdrawal thing.

As I mentioned in a comment on my last post, medication withdrawal has made me kind of stupid lately, though. I can’t remember anything, my attention span is even worse than usual, and… um, I already forgot what I was going to write in the last part of this sentence. Oh, yeah, I’m constantly almost late for stuff. Since none of this has been interfering with my work performance, it’s not really all that important. It just bugs me.

Tomorrow I get to see my GP and I hope I’ll get my prescriptions. I have to pay forty freaking dollars for the cab ride there and back, because there’s a shortage of family doctors here, no bus service to the neighbouring town where my doctor is, and I don’t have a car.

Everybody has already read about this study and its claims that there is something called “subthreshold bipolar disorder,” and as far as most of us can tell, SBD equates to “simply being human, but big pharma thinks you need antipsychotics for it anyway.” I’m lazy, though, so I haven’t commented upon it until now.

CL Psych posts about the incredibly loose criteria for SBD and the media’s claims that there is “appropriate” medication for it in Subthreshold Bipolar: The Giant Sucking Sound and Subthreshold Bipolar: Media Blitz and Lilly.

Philip Dawdy has also written several posts about subthreshold bipolar disorder, including Name The New Bipolar Disorder, in which he urges people to come up with a better name for SBD. I haven’t come up with anything yet, or rather, I haven’t come up with anything that no one else hadn’t thought of and posted already!

I am vastly confused by the stats from the article in the Archives of General Psychiatry. No, they’re not too complex for me to understand; they’re too stupid for me to understand. Only a 2.4% prevalence of Americans who, twice in their lives, meet half of the criteria for hypomania? I would expect it to be more like 99% than the 4.5% it winds up as in this study once you add the 2.4% to the 1% prevalence for bipolar I and the 1.1% for bipolar II.

I am more of a fan of the bipolar spectrum than some people in the blogosphere are, but this subthreshold nonsense is taking things way, way too far. Honestly, sometimes I like the things that Akiskal has to say, and he’s one of the authors of this study. Some doctors overdiagnose bipolar disorder, and most people who diagnose it overmedicate their patients. But there are still plenty of health care professionals who don’t recognize bipolar disorder. Sometimes, it’s not their fault — they don’t see the patient when he or she is hypomanic, and even if they do ask him or her about past symptoms of hypomania, the patient, in the middle of a depression, is pretty much unable to remember ever feeling okay, let alone hypomanic, and doesn’t — can’t — answer accurately.

Then sometimes there are shrinks who think you’re not manic-depressive if you haven’t, like, married someone you’ve just met and then bought five cars. Doctors who think mania equals euphoria and if you’re having a dysphoric mania, you’re just an asshole. Who think that mixed states or rapid cycling must always be borderline personality disorder instead, and even, believe it or not, doctors who are always going to assume that if you’re psychotic, you’re schizophrenic.

Yes, this “subthreshold” stuff is ridiculous, but within limits, I like the idea of the bipolar spectrum because it makes people aware of things that actually are bipolar symptoms but aren’t necessarily the most classic ones. It’s when you start pathologizing mild things that occur infrequently that it gets to be harmful.

No, I don’t know where the line should be drawn. But I’d say somewhere way before “subthreshold bipolar disorder” as defined in that journal article, anyway.

Nearly two weeks ago, there was a post at intueri, Suicide by Overdose Is Not Painless, that I’ve been meaning to link to, but kept forgetting. It’s a good overview of what overdosing can do to a person, since so many people assume that taking an overdose of nearly any drug will make you unconscious instantly and dead soon afterward, which is of course not the case.

It is also nice for someone to recognize that many people who overdose haven’t done their research and think that overdosing on pretty much anything has a good chance of killing them. There are plenty of health care professionals who assume that since they know that a particular dosage of a particular drug has no chance of being lethal, the general public must know this as well. This leads them to believe that all suicide attempts with low chances of lethality can’t possibly be “real” suicide attempts, that they’re all “cries for help,” manipulation, or pleas for attention, and that these people don’t really intend to die. Some people who take what seem to be obviously non-lethal overdoses truly do intend to die, though, and the only thing saving them is their own ignorance. If they were taken seriously and provided with proper help, maybe it would lessen the chances that they would attempt suicide again.

On the other hand, there are also doctors who have no idea that the amount of drugs a patient overdosed on is likely to be lethal. Or at least there is one doctor like this, because I saw him. That’s a story for another day, though, when I have time to tell it. Since I often seem so down on mental health professionals (and I have seen some good ones, although I’ve seen more bad ones), I’d like to be an equal-opportunity whiner and mention that he was not a mental health specialist, but an emergency room doctor.

I have to take my Zoloft with food. If I don’t have enough food with it, I get this horrible feeling in my throat, like choking to death, only I can breathe okay. I realize that this description makes no sense unless you’ve had the same feeling yourself, but that’s what it’s like. It’s not exactly pain, but it’s extreme discomfort. This particular discomfort feels a lot worse than some things that cause actual pain, and when I experience it, it’s all I can think about until it goes away, which usually takes about two or three hours.

The first time this happened to me, which was over eight years ago, I didn’t know what was going on and I was terrified that I was going to stop breathing and die. Luckily, when it happened again the next night, I quickly figured out that I should probably eat more food when I take my Zoloft. This was a completely random guess, a shot in the dark, but it turned out to be correct.

Occasionally, the amount of food that is generally enough to prevent the choking feeling will not work, and I will still be in extreme discomfort, despite having eaten the same amount that I usually do before I take my Zoloft. Tonight, I ate more than I usually eat before taking my Zoloft. I ate more today than I’ve eaten on any other day in the past two months, without throwing any of it up, and I was all proud of myself for my progress with the eating disorder thing. I ate lunch. I ate supper. I ate a good-sized snack and then took my Zoloft and Epival. And I still feel kind of like I’m choking. It’s not as bad as it usually is when it happens, thank goodness. Moderate discomfort as opposed to extreme discomfort — if it was the extreme choking feeling, there is no way I would be able to type this right now.

When I have a really bad night with the choking feeling, then I really don’t want to take my meds the next day. Or any time in the near future, really. There’s all this trepidation and uncertainty. Usually, I eat something and take my Zoloft and I feel fine, but other times, I eat something and take my Zoloft and feel like there’s a giant hand closing around my throat.

Does this happen to anybody else? I once had a doctor tell me that this side effect that I was experiencing did not exist. If he traded esophagi with me and took some Zoloft without food, he would never say that again.

Philip Dawdy’s post Texas Teen Commits Suicide After Taking Lexapro contains a link to a streaming video of a newscast. At one point in the news story, the dead girl’s father talks about how Kayla was going from highs to lows, typical of most teenagers. Then the newscaster’s voiceover says, “But when the highs became higher and the lows lower, a doctor placed Kayla on Lexapro.”

Now, it’s very likely he could have gotten this wrong. The media gets quite a lot of things wrong. But if he’s right, and Kayla was vacillating between abnormally low lows and abnormally high highs, then it’s not just Forest that her parents should be thinking of suing. Prescribing an antidepressant alone for someone who shows signs of being manic-depressive is criminally stupid, especially if you don’t provide them with adequate information and follow-up care.

I am tired of tragedies happening to families all because of people who should know better, or who should care, and don’t.

I’ve taken Zoloft on and off (but mostly on) for over eight years. If you’ve read the posts Philip Dawdy made last month or last week about an article in The New England Journal of Medicine, “Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression,” or read this news article about it, you know that this study shows that antidepressants aren’t effective in treating bipolar depression.

Okay, so you probably could have figured that out anyway.

At this point, I am taking Zoloft for two reasons:

1. I’ve mostly been feeling good since I started taking meds again, so I don’t want to screw with my medications in case Zoloft is helping me avoid depression.
2. Some medications have made me extremely tired. Since Zoloft does the opposite, I assume it is helping me wake up in the morning. I have trouble falling asleep, but I wake up and I can function. I think it’s balancing out any drowsiness that my Epival might cause.

I don’t know if either of these are valid long-term reasons to be taking Zoloft, but they’re good enough reasons for me in the short term.

Zoloft is the only SSRI I’ve ever taken, but I took Effexor in January and February of 2006. Three weeks starting on it, and then three weeks coming off it. See, I was taking it all by itself without a mood stabilizer or an antipsychotic. I had gone off all of my medications in the fall, felt fine, then got really suicidal really quickly and wound up in the hospital. The psychiatrist on the unit discharged me with a prescription for Effexor although I told him I didn’t think it was a good idea for me to take an antidepressant without a mood stabilizer.

He told me it would be fine, and I figured I might as well listen to the doctor, because stopping all my meds all by myself hadn’t worked out too well for me. I was also not thinking very clearly and it didn’t occur to me that this could have more dire consequences than a mild hypomania followed eventually by another depression.

So what happened? Well, I once read the phrase “rapid cycling/mixed state hell” on an online forum, and that describes it perfectly. I don’t feel like going into any detail today, but suffice it to say that I wound up back in the hospital exactly three weeks later. It wasn’t pretty. It was, in fact, really ugly. I mean the situation, but come to think of it, the hospital was ugly, too.

I’m sure my being bipolar rather than unipolar had a lot to do with that in my particular case, but we all know that you don’t have to be manic-depressive for antidepressants to make you flip out. So it’s nice that the FDA has finally ordered updated black box warnings on antidepressants “to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment (generally the first one to two months),” whereas the warning only applied to those under 18 before that.

Health Canada had already issued a warning about this:

Health Canada is advising Canadians that Selective Serotonin Re-uptake Inhibitors (SSRIs) and other newer anti-depressants, now carry stronger warnings. These new warnings indicate that patients of all ages taking these drugs may experience behavioural and/or emotional changes that may put them at increased risk of self-harm or harm to others.

The new warning for each of these drugs, which are listed below, appears in the information package received by patients and in the prescribing information available to health professionals.

Patients, their families and caregivers should note that a small number of patients taking drugs of this type may feel worse instead of better, particularly within the first few weeks of treatment or when doses are adjusted. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or harm to others…

That’s from a press release issued June 3, 2004.

It’s a bit different, though — it applies to all ages, not just people under 25; it includes harm to others as well as self-harm; and it doesn’t include all antidepressants, just newer ones.