Know Your Meds: Anti-Anxiety Medications

The next class of medication are anti-anxiety medicines, which reduce the emotional and physical symptoms of anxiety.  Benzodiazepines such as alprazolam (Xanax) can treat social phobia, generalized anxiety disorder and panic disorder. This information comes from NAMI and goodtherapy.org

These medicines work quickly and are very effective in the short-term. However, people prone to substance abuse may become dependent on them.

Because the body can become used to the meds, doctors may need to increase the dosage over time to get the same therapeutic effect. People who stop taking benzodiazepines suddenly may experience unpleasant withdrawal symptoms. Other potential side effects include:

  • Low blood pressure
  • Decreased sex drive
  • Nausea
  • Lack of coordination
  • Depression
  • Unusual emotional dysfunction, including anger and violence
  • Memory loss
  • Difficulty thinking

Antianxiety and antipanic medications on the market include:

Know Your Meds: Antidepressants 101

Antidepressants improve symptoms of depression by affecting the brain chemicals associated with emotion, such as serotonin, norepinephrine and dopamine. The following information comes from NAMI, goodtherapy.org and other sources.

Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are newer antidepressants with fewer side effects than older drugs, but no medication is entirely free of side effects. Potential side effects of SSRIs and SNRIs include:

  • Nausea
  • Nervousness, agitation or restlessness
  • Dizziness
  • Reduced sexual desire/difficulty reaching orgasm/inability to maintain an erection
  • Insomnia, drowsiness
  • Weight gain or loss
  • Headache
  • Dry mouth
  • Vomiting
  • Diarrhea

One antidepressant (Bupropion) affects mostly the brain chemical dopamine and is in a category of its own.

Meanwhile, older types of antidepressants, including tricyclics and monoamine oxidase inhibitors (MAOIs), may be prescribed by a mental health professional if newer medications do not seem to be effective. Common side effects of tricyclics include:

  • Dry mouth
  • Blurred vision
  • Constipation
  • Urine retention
  • Drowsiness
  • Increased appetite, leading to weight gain
  • Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
  • Increased sweating

MAOIs are the least-prescribed of all antidepressants because they can cause dangerously high blood pressure when combined with certain foods or medications. People taking MAOIs must watch their diets carefully to avoid potentially life-threatening complications. Off-limits foods typically include aged cheese, sauerkraut, cured meats, draft beer and fermented soy products such as miso, tofu or soy sauce. Some people may have to avoid wine and all forms of beer.

Some antidepressants may be useful for post-traumatic stress disorder, generalized anxiety disorder and obsessive-compulsive disorder but may require higher doses. Symptoms of depression that are part of a bipolar disorder need more careful assessment because antidepressants may worsen the risk of mania and provide little relief from depressive symptoms. As always, ask your doctor about what treatment options are right for you.

When will the medication work?

In the first few days, the person may have better sleeping and eating habits. In the first 1-3 weeks, the person may have better memory, sex drive, and self-care habits. They may also feel like they have more energy and start to have less anxiety.

After 2-4 weeks, the person may start to have a better mood, less feelings of hopelessness, and less suicidal thoughts. They may also start to feel interested in hobbies again. It may take 6-8 weeks for the medication to fully work.

What are the common side effects?
These are most common in the beginning, and usually get better within 1-2 weeks.

  • Headache
  • Upset stomach, diarrhea
  • Sleepiness or feeling more awake

Some antidepressants can cause sexual problems, such as a decrease in sex drive or problems with ejaculation.

How long do people need to take this medication?
Some people need to take medicine for up to 1 year after they feel better. Others need to take medicine long-term to prevent their symptoms of depression or anxiety from coming back. The length of time depends on how bad the depression or anxiety was, how long they had it, and how many times they have had depression or anxiety in the past.

Here are some of the medication names and their types, with some links to their descriptions in goodtherapy.org

Know the Meds: Antipsychotics 101

Note: This information came from the websites of NAMI, goodtherapy.org and other sources, as well as my own experience. 

Antipsychotics come in two major categories: typical and atypical. Occasionally they are called first and second generation.

The antipsychotics developed in the mid-20th century are the typical and first generation class.  Atypical or second generation were developed more recently. These medications reduce or eliminate the symptoms of psychosis, such as delusions and hallucinations, by affecting the brain chemical dopamine.

Both types of antipsychotics are used to treat schizophrenia and schizoaffective disorder.  The atypical also are used to treat acute mania, bipolar disorder and treatment-resistant depression.  Both kinds work, but they have different side effects.

What are the names of these medications? 

What are the side effects?

Side effects are most common at the beginning, and most get better over time.  The most common are:

  • Sleepiness
  • Dizziness
  • Upset stomach
  • Increased appetite

First generation antipsychotics are more likely to cause movement issues, such as tardive dyskinesia (a condition in which the brain misfires resulting in random, uncontrollable muscle movements and tics.)

The second generation can cause weight gain.

How long does it take to produce results? 

It often takes four to six weeks for the medication to fully work.  However, in the first three days, the person may feel less upset and angry.

After one or two weeks, the person may have a better mood and improved self care habits.  You may see clearer thinking, with fewer hallucinations and delusions.

How long do people take this medication? 

It depends on the situation: how bad the problems were, how long the illness lasted before treatment, and how many times they have had episodes.  Some people only need it for one or two years, while others need it for a lifetime.

 

 

Know the Meds, Part 1

The treatments for mental illness conditions vary from person to person, which doesn’t make things any easier.  People with the same diagnosis can have vastly different experiences with treatments and medications.

Of course, your loved one’s mental health provider is the best source for information about treatment.  Getting a HIPPA release so you can discuss the situation with them is very useful.  The articles in this series, based on information from NAMI and my experience, are general information to help you understand the treatment options when they are discussed.

Psychotropic, or psychiatric, medications influence the chemicals in the brain that regulate thinking and emotions.  While they can be more effective when combined with therapy, often a person needs the medication first to reduce symptoms to allow them to participate in the therapy.

Predicting what works is a challenge.  One field of research called pharmacogenetics does genetic testing to help determine how medications will interact with a person’s genes.  Some people I know have taken these tests, so it’s worth discussing it with the doctor. It’s also helpful to tell the doctor if a medication has worked well for someone else in the immediate family.

Another major challenge is that the medications rarely work instantly.  A person may need to take medication for as long as a few months to see a difference, which becomes even more irritating if side effects are causing issues.

To try to stop that, physicians usually start with small doses and build up to get to the point where the symptoms are better.  It’s important that your loved one does not stop medicine at once.  Usually, it’s better to taper off to avoid unpleasant effects.

The main categories of psychotropic medicine are:

  • Antipsychotics
  • Antidepressants
  • Anti-anxiety medicine
  • Mood stabilizers

We will look at each in this series.

15 Ways to Abide With Jesus

Want to enjoy the presence of Jesus in your life as a caregiver?  Here’s 15 steps to help you get there.

  1. Try a daily prayer of surrender. “Today, this is Your day… Today, I am Yours… May Your Spirit lead, guide and prompt me throughout my day… May I be sensitive to Your prompting and respond accordingly… Today, I surrender my life to You…
  2. Read a short section of Scripture or a devotional book as often as you eat.
  3. Pray Bible verses. Even if it’s just a few verses, pray the Bible back to God.  This is easier if you put up Bible verses around the house. That can be in framed calligraphy, a perpetual calendar of Biblical thoughts or simple Post-it notes.
  4. Be in the day with a plan and the willingness to disregard the plan to respond to what God allows.
  5. Keep focused on what you are doing. When you walk with Jesus, everything you do can be a prayer. This is where the practice of Christian mindfulness comes in.
  6. Listen to yourself and be compassionate. Overcoming restlessness and the need to focus on the trivial to avoid the pain of grief is a problem that I have, and I think many others who are caregivers of people with mental illness have as well. The Three Things exercise can help you to focus your attention, reduce restlessness and add calm: Stretch or drink some water. Note three things you see, three thinks you hear and three feelings you have. 
  7. Refocus during transitions. Try to center yourself as you move from place to place, from event to event. You can say:  I am calm, peaceful and aware of the presence of God as I enter this home/door/time/event.
  8. Carry on a conversation with God and try to make it continual.
  9. When you run out of words, say the Jesus prayer. Using a “Jesus” prayer when you need to calm down or you are in a situation in which you would just look at your phone helps. You can pray “Jesus, Jesus, Jesus” over and over.  I use “Come Holy Spirit.”  It’s also a nice way to go to sleep at night.
  10. Stop to praise God
  11. Be a “yes” to all that is in God and to each circumstance and person who comes into our lives. Have faith that God is at work even in horrible circumstances. We should look at all circumstances, environments, and even all persons as coming through God’s hands so we can serve Him. This is the “good” that all things work for as mentioned in Romans 8:28: 28 And we know that in all things God works for the good of those who love him, who have been called according to his purpose. Acceptance of this kind makes caregiving less depleting and exhausting.It’s so challenging, but you can accept the reality of the circumstance and not argue in your mind that it should be different.  Second, you also need listen to yourself rather than taking a treat (food, a drink or a nap). Acceptance is not the same as being happy in sad circumstances. You cannot pretend everything is fine, because your mind knows it’s not. Accepting that everything is not fine, but it is impossible for you to change allows you to offer more empathy without draining excessive energy. We are not in heaven yet, and bad things happen in a fallen world.  God is still present and wants to abide in you.  The joy of the Lord is your strength.  Follow an energy draining situation with an energy builder such as reading, meditation, pray, eating something healthy and tasty.
  12. In everything give thanks
  13. Think on these things. Philippians 4:8:Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy – think about such things. I made up a phrase to help me remember this: The normal real person likes an excellent pizza. (true, noble, right, pure, lovely, admirable, excellent, praiseworthy).  This helps me to do a thought check when I seem to be on the wrong track.
  14. Give yourself a GIFT list.The GIFT list idea originated with Pam Young and Peggy Jones, and I adapted it to give myself something else to think about. I keep the daily list with my to-dos. GIFT stands for: Grace, Imagination, Focus and Thanksgiving.  I ask for a Grace from the list of the fruits of the Holy Spirit (love, joy, peace, patients, kindness, goodness, righteousness, gentleness and self-control). For Imagination, I pick a virtue and image how I could incorporate that virtue into my day.  Focus is the day’s predominate activities.  (Attending meetings, writing, planning, cleaning, making things, running errands, enjoying the family, taking a Sabbath, etc.)  And Thanksgiving is a gratitude list I fill out as the day goes on.  When my mind goes on a tear, I deliberately turn it back to the Grace, Imagination or Focus of the day.
  15. Summon up your courage and pray the welcoming prayer. This is the scariest prayer I’ve ever prayed: Welcome, welcome, welcome. I welcome everything that comes to me today because I know it’s for my healing. I welcome all thoughts, feelings, emotions, persons, situations and conditions. I let go of my desire for power and control.  I let go of my desire for affection, esteem, approval and pleasure. I let go of my desire for survival and security. I let go of my desire to change any situation, condition, person or myself.  I open t the love and presence of God and God’s action within. 

This practice of the presence of God, somewhat difficult in the beginning, when practiced faithfully, secretly brings about marvelous effects in the soul, draws down the abundance of God’s grace upon it, and leads it imperceptibly to this simple awareness, to this loving view of God present everywhere, which is the holiest, the surest, the easiest, and the most efficacious form of prayer. People who lean on Jesus know things that other people don’t know.

 

The Aim of Christian Meditation and Mindfulness

The prayer of the presence of Jesus and Christian mindfulness are two parts of a whole:  the experience of abiding in Jesus.

In their book “Practicing the Prayer of Presence,”  Adrian van Kaan and Susan Muto wrote:  “The best way to cope with suffering is not stoic indifference or pessimistic complaints, but constant conversation with God in all matters, great or small, at all times and in all places.

“A deeper way of learning to pray is to try to live in the presence of God. This is the beginning of always praying as the Gospels and St. Paul recommend. We try in a relaxed way to become aware of His Presence all the time we are awake. We need the grace of quiet concentration and perseverance to develop this habit.

“If we practice the prayer of Presence, we will be better able to check our speech.  Is it agitated, restless, disquieted?  Or is it calm, deliberate and quietly rooted in Christ, who is our Way, Truth and Life?”

What they are talking about has similarities to secular meditation and mindfulness.  But it is quite different.  What the world calls meditation is just a preliminary step that Christians call “recollection” exercises.  It is necessary to bring our spirit together again in inner stillness if we want to be fully present to the Lord.

The aim of Christian mindfulness meditation is:

  • To make our minds familiar with the truths of God.
  • To dwell on those truths.
  • To apply the insights we receive to our lives.

One of the reasons that mindfulness is a popular today is that research shows that it helps to reduce stress and even pain.  Mindfulness can release the mind from an overgeneralized state.  It relieves the automatic brooding, avoidant mind.  Loving kindness meditation and kindness to one’s self also help to decrease the fears that come from feeling responsible when anything goes wrong.  Being overly responsible is an issue I have.

Abiding in the Lord has elements of this mindfulness: seeking to concentrate on the present moment.  “The day’s own trouble is sufficient for the day,” as Jesus said. But it goes beyond that to recognize that God is present in the here and now.  God is here.  God is now.

The condition to receive the presence of God is emptiness.  We must empty ourselves inwardly of all that is not God, including distraction, agitation, fear and nervous tension.  All must give way to the flow of quiet presence.

The person who is experienced with this kind of effort is not a person whose mind does not wander.  Everyone’s mind wanders.  The experienced person is someone who gets very used to beginning again and again and again.

A Caregiver’s Secret Weapon: Abiding in God

Loving someone who has a mental illness often means struggling with despair.  You may live with unpredictable and frightening events.  You may struggle with a different kind of grief … the loss of a person who is still alive.

People who have a relationship with Jesus have a great advantage in dealing with this situation.  Jesus invites His own not only to trust him, but to abide in Him.  He invites us to stop looking for the light at the end of the tunnel and find His light instead.

As caregivers for the mentally ill, we frequently feel powerless.  This is the condition needed to feel the presence of God: to be empty and powerless, as powerless as the crucified Christ appeared on the cross.  So in some ways, this situation does allow us to more easily abide in the Lord.

This summer I went to a monastery for a silent retreat to see what God had for me in increasing my relationship with Him.  In the monastery library, I found an old book called “Practicing the Prayer of Presence” by Adrian van Kaan and Susan Muto.

They wrote: “For it is in the misery of our powerlessness that we call down upon ourselves and others the Infinite Glory and Mercy of God.”

Jesus invites us to abide in Him while He abides in us. Jesus spoke about this in John 17: 25-26 in his prayer for believers at the Last Supper.

“Righteous Father, though the world does not know you, I know you, and they know that you have sent me. 26 I have made you known to them, and will continue to make you known in order that the love you have for me may be in them and that I myself may be in them.”

Then again in John 15:4-5:

Remain in me, as I also remain in you. No branch can bear fruit by itself; it must remain in the vine. Neither can you bear fruit unless you remain in me.

“I am the vine; you are the branches. If you remain in me and I in you, you will bear much fruit; apart from me you can do nothing.

John 14:2020 On that day you will realize that I am in my Father, and you are in me, and I am in you.

God dwells within us.  But we also dwell with our own thoughts, fears, emotions and concerns.

Here’s some good news:  Your mind is not all there is to you. Your thoughts are just thoughts. No matter how loud, they are not masters, giving orders that have to be obeyed.

Even better, if we acknowledge our negative thoughts, feelings and body sensations, we prevent the mind from spiraling into an aversion. Fighting and flaying about in our own mind does not make an environment where the Prince of Peace can abide.

Brooding about why things happen and worrying about what’s likely to happen next … focusing on anxiety, tiredness, etc., actually strengthens the negative as it keeps you focused on fear rather than the reality of God’s desire to be present with you.

Next time:  How Christian meditation and mindfulness can help.

Why Low Expectations Are a Good Thing

How do you feel when you expect a $100 tax refund and the IRS finds a mistake in your favor, so you get $1,000 instead?

How about when you expect to wait for 10 minutes and you end up waiting an hour?

The way that things turn out compared to how we expected them to turn has a lot to do with how we feel.  Understanding the impact of our expectations can help us deal with the pain and frustration of loving someone with a brain-based (mental) illness.

For example, living with a person who has clinical depression is hard.  We want to help, but we don’t know how. Sometimes our efforts make things worse.  The same is true when you live with a person who suffers from anxiety disorders, bipolar disorder or the spectrum that is schizophrenia.

All of them have an intense need for love, but they often have trouble being loving in return.

What would an expert in the psychological community expect from a person with clinical depression?  Low energy, for one thing.  The depressed have so little energy that they rarely can think about other people.  So they seem self-centered.  The depressed person can feel an inner anger that life isn’t fair.  Yet, getting in arguments to try to talk them out of their hopelessness doesn’t work.

A person with bipolar disorder is expected to show signs of the illness.  The mood swings between mania and depression, with long or short periods in between, may seem as if they don’t have a rhyme or reason.  The reason is chemical, and it needs treatment.

Living alongside someone with borderline personality disorder is a true roller coaster ride.  One minute you are the best, and the next you are seen as a monster. “Walking around on eggshells” is a common description of daily life in that household.  People with this illness are in emotional pain almost all the time, and they project issues on others.

In short, people with mental illness are expected to behave in ways you don’t like.  They can no longer meet many simple expectations that we had for them before the illness.  One of the toughest issues family members have is deciding what the new expectations should be:  Can he work?  Can she do chores?  Can he join us for family dinner?  Can she take a shower without prompting?

This change has more impact on us that we want it to have.  We experience deep pain as we try to adjust,  as one thing after another becomes too much for them to do.  Grieving this loss is tough at the beginning, and it’s just as tough as time goes on.

You can measure stress by the difference between what is happening and what you think should be happening.  So your stress will be intense, unless you change your thinking about “what should be.”

At the beginning of a loved one’s mental illness, a psychologist suggested to us, “Why don’t you try not having any expectations at all?”  Easier said than done, and hard to hear.

But we learned to keep our expectations as low as possible.  To fill in the gap,  it’s wise to turn to God’s promises.  God is both sufficient and faithful,  walking with us through this valley of the shadow of death.  Abiding with the Lord can give you expectations of peace and comfort.

 

 

 

 

 

It Gets Better: The Emotional Stages of Mental Health Caregiving

Just as Elizabeth Kubler-Ross developed a stage-of-grief model, several sociologists have created a model for the emotional stages of loving someone with mental illness.

Dr. Joyce Burland, a psychologist, spent two decades of helping her mother and her daughter deal with schizophrenia.  She found no model for the experience, so she created the family education curriculum Family to Family for NAMI.  (My husband and I have taken this course and recommend it to many families in our support group.)

The Burland model has three stages:

  1. Heads Out of the Sand – The family knows their loved one has a mental illness.  They may still be in denial about how severe the illness is. The family needs education (especially about the prognosis for the illness), crisis intervention and emotional support.
  2. Learning To Cope – The family accepts the illness while still experiencing emotions like grief, anger and guilt. They need education about self-care and coping skills for their loved one, as well as peer support.
  3. Moving Into Advocacy – Some families eventually become advocates to help others struggling with these issues.

Dr. David Karp, a sociologist at Boston College, proposed a second model with four stages:

  1. Emotional Anomie – This stage comes before a firm diagnosis.  It can include fear, confusion, bewilderment and questioning of one’s possible “guilt” in the situation.  (“What did I do wrong to cause this?”) It also contain the fervent hope that the problem will “just go away.”
  2. Hope and Compassion – This occurs when the diagnosis is provided.  Fear and confusion directed at the loved one turn to compassion.  The family starts to learn about the illness and to understand they need to be caregivers.  While still hoping that the illness will be resolved quickly, some caregivers may feel that they are willing to do anything to make things better for their loved one.
  3. Loss of Dreams and Resentment –  Now the family understands that the illness may be a permanent condition.  Some experience anger and resentment because it is a problem that they cannot fix.  The resentments also arise from realizing that the illness will have a long-term impact on their own plans.  Some, such as adult children dealing with an ill parent, find themselves in a role reversal situation.  Many rethink their expectations for the ill loved one, struggling to understand what is realistic.  The struggle to decide what behaviors the loved one can control and what they can’t becomes a daily reality.  Families begin the process of trying to love the person and hate the illness. As the demands of caregiving continue, some families become isolated from friends and other family members.
  4. Acceptance –  The family realizes that it can’t control the loved one’s illness.  They feel somewhat relieved that they are not responsible for fixing the issue.  Karp was the person who created the “4 Cs”:  “I did not cause it. I cannot control it. I cannot cure it.  All I can do it cope with it.”   At the same time, the family more easily sees their loved one’s strength and courage in the struggle.  This may led to more respect and even admiration for that person.

Where you do think you fall in these scales?  Have you experiences the differences between having a loved one with a “physical” illness, such as cancer or heart disease, and having a loved one with a brain-based disease?

When the Worst Happens

Help Wanted

Needed immediately: a person to work 24 hours a day, 7 days a week, 365 days a year. Work gets tougher on holidays and trips. No salary.  No benefits. You may spend significant amounts of your own money out-of-pocket. No training. Learn by trial and error, although  what works one day might not work the next.  Be prepared for days that break your heart and times when you will be mistreated on the job.

If you are a caregiver for a person with mental illness, this is your job description. The shock and horror of getting this job has a seismic impact on the family.  Having a family member with any kind of serious illness is devastating.  Dealing with a mental illness … so often a brain-based physical illness … has extra components that make it even more grueling.

Factors Influencing the Family’s Response

A training put together by Michelle D. Sherman, Ph.D, for the Department of Veteran Affairs to help families impacted by post-traumatic stress disorder, clinical depression and other illnesses common to veterans noted that some families have an easier time responding to this situation than others.

The factors that impact the situation in any health crisis include:

  • The family’s support system.
  • Previous experience with or knowledge of the illness.
  • The family’s coping pattern in times of great stress.
  • Access to health care and the quality of that care.
  • Financial status.
  • Type of onset of the illness (sudden vs. gradual, public vs. private).
  • Nature of the symptoms.
  • Other demands on the family.
  • The loved one’s compliance or refusal to participate in care.
  • Prognosis of the illness.

Other factors are specific to mental illness:

  • Reactions by others are unpredictable and even hurtful.
  • Family members feel guilt that they somehow caused the illness, could have prevented the illness or did not detect it early enough. It’s typical to feel guilty about your reaction to previous behavior caused by the illness that you felt were intentional actions.
  • The prognosis and course of treatment are less concrete than with other physical illnesses.
  • The loved one can have embarrassing behaviors that could even result in arrest.
  • The loved one (as well as some family members) can refuse to accept the diagnosis.  This can result in failure to comply with treatment, lying about that, anger toward the family and total lack of appreciation for the family’s efforts.

As a result, families feel isolated. When they turn to their social and religious support, some get no help. Many fear telling others about the illness and do not ask for help.  Tension within the family can get very tough, especially when one or more family members refuse to believe that the loved one has a mental illness.

Families do tend to go through stages as they deal with the situation.  Next time, we will look at the patterns involved in this.