I know a whole lot of things about mental health hoooo boy and I would love to share what I know with people. My knowledge is skewed toward the US because that's where I live, so I'm more educated about the DSM than the ICD, and I know more about US treatment than about anywhere else, but I also know a whole lot of things about where to look, so don't be afraid to ask no matter where you are. I have ADHD, generalized anxiety disorder, and some kind of depression thing (current diagnosis is DD-NOS but It's Complicated). I have taken a bunch of courses in psychology. I have a copy of the DSM 5 sitting on my desk in a position of honor. I have access to several academic databases at my house. I have first-hand experience with several therapists, psychiatric professionals, and mental health hospitalization. I am not any kind of psych professional (although I hope to be one day). I can't give you an official diagnosis or actual treatment for anything. If you have a question like these, I can probably answer it: What kinds of conditions might cause symptom X? Which are more common? How does medication X work? What is it like to be hospitalized for mental health reasons? Why won't my psych just refer me to a therapist instead of making me find one? Hey can you get me a pdf of this academic paper that I really want to read?
I'll also post some chunks of Stuff I Happen to Know in here, because I don't want to spam the board with threads. I'm starting off by talking about safety with nutritional supplements (vitamins, minerals, herbal remedies, etc). This is important to me partially because many people, particularly in the US, can't afford to see medical professionals and therefore can't access prescription drugs, and these may be the best choice available. It's bad enough if you can't access basic medical care. The last thing I want is for those people to be screwed over again. First, and something I really want to emphasize: Any supplement that actually does anything has potential side effects and the potential to interact with other supplements or any pharmaceuticals you're taking. No exceptions. That doesn't mean that you will get side effects, any more than you're guaranteed to get side effects from any pharmaceutical, but that you could. And as the saying goes: poison is in the dose. People have died by drinking too much water, and water is about as inert as it gets. You can overdose on almost anything. Natural is not the same as safe. I do not want to discourage people from using vitamins, minerals, or other supplements. I personally take a couple as part of my own pill regimen (vitamin D every day and zinc twice a week). But I also know someone who was admitted to the hospital with serotonin syndrome caused by taking large doses of two supplements that had the same effect (5HTP and St. John's Wort) because she was under the impression that she probably couldn't hurt herself by taking things on the supplement aisle. It's something to research and take seriously, rather than make impulse purchases at the drugstore or grocery store. Along related lines, a larger dose is not always better. Many people get better results from taking a small dose than taking a large one. If a supplement only comes in Too Much, Tons, and Metric Truckloads in the price range/brand you need, then try taking it every few days or splitting the pills. In the US, anything classed as a supplement is not regulated by the FDA. Aside from making sure all statements are based in research and emphasizing that they're not intended to prevent or cure any disease, the makers of supplements aren't really subject to oversight. Individual companies will have variable quality control. Research brand names for the supplement that you want to take; important considerations include dose consistency and contamination. It's harder to get a consistent dose on herbal items than it is for isolated chemicals. As a general rule, large brands have better quality control than small ones. Please, please, please research interactions when you're choosing your supplements. For example, St. John's Wort decreases the effectiveness of a whole lot of stuff, including birth control pills, several kinds of HIV/AIDS medications, and some kinds of antibiotics. None of those are things that you want to render less effective by accident. And please, please, please do not lie to your doctors or pharmacists about any supplements you're taking. Interactions can sometimes be managed through modifications in dose, but your health care professional needs to know what you're taking in order to make that adjustment. And if your doctor tells you that you absolutely cannot take a particular supplement with a medication they want to prescribe, there are probably really good reasons for that. You can tell the doctor that you don't want to take the prescription if you're not willing to drop the supplement.
Ok well I'm not in the US so I'm guessing the answer might be slightly different here! But I am on doctor prescribed vitamin D (because I have severely low levels of it, like I'd basically have rickets if I was a kid), and unfortunately that means 3 ostelin pills a day. Like I said in my thread though, I have MAJOR ISSUES with taking pills. Are there other options? From what I've been able to work out, besides the obvious option of sitting in the sun for X time, the only other medication-based solution is some sort of horribly painful 3? monthly butt injection or something ridiculous like that? Also I am kind of curious about the difference between psychologists and therapists. I've always been under the impression they are similar, except therapists are (possibly?) less regulated, but I'm realising that this may well not be true. Is the difference that psychologist is a catch all term for therapists alongside researchers and all that? And the difference between psychologists and psychiatrists are a medical degree and ability to write scripts?
Aren't there vit D drops? There are in the UK and where I am in, afaik. So you would be basically ingesting drops of oil.
In Canada - I believe you can get Vitamin D in a liquid? It might be in the baby care section, because that's a thing that babies need more of and obviously they can't swallow pills. I'm not sure if it has any additives, or if you'd need shit-tons more, or anything like that. :/ worth looking at though? Also, from my understanding, "psychotherapist" can mean pretty much anything. I am not sure if "therapist" is a regulated term, but I believe "psychologist" is, and I am 99.99% certain "psychiatrist" is (since yes, that one needs an MD, if I recall). It may be that psychologists have degrees in psych, but do not have the medical training and therefore cannot prescribe. Therapists are more about methods of therapy that don't involve meds, though they should usually know about meds (at the very least, they should know when a med is probably needed). but hey, this is just life experience, no research. @Aya may know more precisely.
As to your vitamin D question: I don't know what your dosage looks like, but I do know that here in the US you can get vitamin D in a whole lot of forms because it's often used for kids and they tend to be bad at swallowing pills and very picky. I looked up ostelin and they seem to have liquid and chewable forms, but that also looks like it's an OTC-oriented site. Still, if the same people are making the OTC stuff that make the prescription variety, I'm sure they have prescription-level doses of liquids and chewables. Talk to your doctor about it. If you can't get a mass-produced liquid or chewable, you might be able to find a local compounding pharmacy that will make one for you. It's likely to cost more if you have to do it that way, but it's an option on the list. Various psychology-related people: Psychologist is not a regulated term in the US. In practice, it's usually used to refer to people in academia or research. Usually they don't have particular training in biology or medicine and aren't allowed to prescribe medication--though typically they're not working in positions where that would be a concern anyway. (There are a few places where people with a PhD in Psychology can take a special training class to be able to prescribe psychiatric medications, resulting in a PsyD, but that's pretty rare and it's kind of iffy as to safety.) Depending on your jurisdiction, therapist may or may not be a regulated term. Therapists are educated in a lot of different ways. I think the most common are four-year degrees in social work or master's degrees in counseling. These days therapist is used more or less interchangeably with counselor. Therapists don't do medication therapy, just talk therapy. A psychiatrist is a medical doctor that has taken extra years of study in psychology. It used to be common for psychiatrists to handle both medication and talk therapy for a particular patient, but in the last few decades things have shifted such that psychiatrists pretty much never do talk therapy anymore and they only handle the medication side of things. Psychiatrists are not the only professionals in mental health who might see a patient and prescribe medications. I saw a psychiatric nurse practitioner for awhile, for example.
Hi, this post is actually kind of what got me into this forum. I have been kind of pointed in the direction of looking into a possible thyroid condition because I have/might have Social Anxiety-I know I have this, I went to the university counseling center about it. I also have a family history of it, in that no one else has been officially diagnosed by all the women on my mom's side of the family have the exact same symptoms. Generalized Anxiety-This one hasn't been officially diagnosed, but I definitely have anxiety that is about more than just social stuff. Dysthymia-Again, this is not actually diagnosed and am I less sure that it is even a thing in my life, but my social anxiety is making it a little weird to go back to the counseling center. But anyway, I distinctly remember not really having actual emotions past the age of like 11, soooooo... Asexuality/Low Libido-I currently identify as asexual, but my roommate has pointed out that this might actually just be low libido and part of a larger issue. Are these actually markers of a thyroid condition? What else might it be? How do I tell a real, live therapist that I think I might have dysthymia because my roommate told me so, cause that just sounds stupid? If I do actually have any of these things what do I do then?
@theoffensivegayfriend - re: dysthymia. "Hi. I've been doing some research and self-observation, and I've noticed that my emotions run low to neutral at almost all times. I'm concerned about dysthymia or depression. Can you help me?" (This is how my research started. What I have is probably closer to dysthymia than to major depressive disorder, because it is all-the-time and not so severe as someone having major depressive episodes (though it can be) - not to mention one of my episodes can start in seconds instead of being a slow spiral, and it can end just as quickly. I frequently describe it as having a lower emotional baseline than most people. I call it depression more often than dysthymia because most people haven't got a clue what dysthymia is, but may have some experience with depression.) Also, I have zero experience with thyroid issues, so it wouldn't hurt to talk to a doctor and get that checked out (I believe those are relatively easy tests? I could be wrong), but it's worth noting that social/generalized anxiety, dysthymia, and depression can all contribute to a lower libido. (not necessarily to a lower mental desire for sex, just lacking the physical chemicals/arousal readiness.) So yeah, you could be asexual, you could have a physical issue, but it's totally not out of the realm of possibility that the brainweirds are messing with the sexytimes.
It's been too long since I've had the side effects talk. I'm on a low dose of mirtazepine, a Remeron generic, right before bed. I also have a tendency to pick at myself (pluck hairs) to excess after taking, but before sleep. I don't mean just my usual picking, I mean chunks of hair, yes that feels good picking. Is this a side effect? I know some psychoactives cut down on picking impulses but I don't think I'm on any, but I didn't know if there were some that could make it worse.
hm. some quick looking reveals increased sensitivity to touch as a less common side effect. Maybe that's it?
@theoffensivegayfriend The thyroid produces hormones that affect how you react to other hormones. I am honestly not sure what the precise biological mechanism is, but I do know that it can cause depression and anxiety. Often it's associated with some other physical symptoms as well, but not always. If you have any kind of depression or anxiety problem, whether you have any particular reason to suspect thyroid involvement or not, it's absolutely worth getting your thyroid checked. Medical science knows what to do for over and underactive thyroids. For people whose mental health issues are being caused by thyroid issues, the effect tends to be pretty astounding, unlike with the rest of us "regular" crazy folk where medical science still isn't sure that antidepressants are better than placebo. You already have an anxiety diagnosis, so for getting your thyroid checked, you don't even have to bring the depressive symptoms into it unless you want to. You can just say that you've heard that sometimes anxiety is related to thyroid problems and you want to rule that out, or find out if that's involved. You get some blood drawn and a few days later they have your results. (As someone with an anxiety disorder myself: the very hardest part was scheduling the appointment. Everything else was easy.) I can't tell you exactly how likely it is that your thyroid is involved in your issues. It might be more likely if you have some of the symptoms on one of these lists. But it's absolutely definitely 100% worth investigating for anyone with a chronic mood disorder. Since you've already made contact with your university's counseling center, it might be easier to use them as a resource when talking about potential dysthymia or chronic depression or other anxiety stuff. You've already met them and you have at least that much experience on whether they're nice people. When I first got diagnosed with anxiety, the university's counseling center actually set up an appointment with the psych that showed up once a week at the student health center rather than making me dance around trying to figure out what I was supposed to do. For some people, when talking to doctors, it feels more comfortable to talk about particular symptoms they're experiencing instead of what they think it might or might not be. You can say something about not having strong feelings or being disconnected from your feelings from puberty, and move on from there. You don't have to make guesses about what's going on in your brain, even if that's what brought you there, if the idea of saying "I think I might have This Thing" is what's stressing you out. You can just talk about what you've experienced. Feeling distant from your emotions is a strong enough symptom to be worth investigating even if you have no idea why it might be happening. Finally, as to low libido/asexuality: I would try not to spend a lot of time worrying if you're ace or "just" depressed. Even if six months into antidepressants, you start wanting to have sex with every human over 18 that you encounter, that doesn't change anything about what you're experiencing right now. If a doctor asks you about low libido specifically, then feel free to mention that, but I don't know of any medical or mental health condition where a lack of sex drive is going to tip the scales as to whether you have it. Feel free to ask me follow-up questions if you have any. I have no idea how clear or useful any of this has been and it is kind of a huge wall of text...
Okay, what I'm reading here is that you have a problem with hair picking that predates taking this medication. Correct me if I'm wrong because that's sort of the basis of my thinking here. I Am Not A Biochemist so my understanding here may be incomplete. If you're seriously worried you should talk to your doctor and not me. My reading says that mirtazapine is broken down by the body "quickly" (grrr internet "quickly" is not a number), reaches maximum blood concentration after two hours, and has a half-life of 20-40 hours (that's a long time!). So when you take each night's dose, you get a spike in the amount in your bloodstream, but you also have a whole lot of yesterday's dose floating around in your system (and possibly some from the day before yesterday as well). The timing between taking the pill and when you end up with picking impulses kind of matters here. If you're doing this five or ten minutes after you take the pill, it's much less likely than if it's an hour later. My reading of the package insert doesn't mention worsening picking impulses in particular. That being said, skin picking and hair pulling are currently thought of as being in the same "group" as OCD, and I know that for some people, one class or another of antidepressants might have a side effect of increasing obsessive/intrusive thoughts in OCD. As we all know, psych medication is a crapshoot and affects everyone differently; it's certainly possible. It's also possible that your brain has just decided that picking is a good way to help you wind before bed. The impulse/release cycle can end in a deep relaxation for some people, and the part of your brain that wants to do these things does not really understand that some behaviors are healthy and some are not. So that'd be a big fat maybe.
Alright, I'm going to copy/paste one of your suggested questions: What kinds of conditions might cause skin-picking / hair-plucking? Which are more common? For context, I've been picking at the skin on my fingers (usually around fingernails) for years, possibly since I was 5 or 6. (I also pick at the nails themselves, but that generally doesn't cause me pain or harm.) However, in recent years (probably just in the last year or so) I've begun picking at my eyelashes and eyebrows as well (the latter of which kind of makes me sad since I love my eyebrows.) There's also... Spoiler: kinda gross (regards feet) For several years - not sure how many, probably somewhere around 6 - I have also occasionally picked at and peeled the tough skin on my big toes, despite this sometimes causing bleeding, and often causing moderate to high pain. I would usually walk funny for a day or two afterwards. This would often occur in the summer, since it gets super hot here in Texas and I would thus be barefoot a lot. After I made that connection, I basically determined I should wear socks pretty much any time I wasn't in the water, and that's pretty much solved that problem.
So skin-picking and hair-plucking are actually both listed as disorders in themselves in the DSM. Skin-picking is called excoriation disorder. (It was called dermatillomania in the DSM-IV and the 5th edition only came out a couple years ago, so most informal resources will be under that name.) Hair-pulling is known as trichotrillomania (and why its name didn't get changed is kinda beyond me). They're so highly comorbid that some researchers believe they're different manifestations of the same disorder. OCD and major depression are both commonly found in people with these disorders, but cause and effect are unknown here. Officially, they're in the "Obsessive-Compulsive and Related Disorders" group, and they occur more often in people with OCD and their first-degree relatives (parents, siblings, children) than in the general population. Spoiler: Discussion of mental state when picking/pulling Most people who experience one of these disorders do not have obsessive thoughts involving their skin or hair, though some do. Often the behaviors are accompanied by rituals. Some people report entering a state of altered or diminished consciousness when they pick or pluck. There tends to be a cycle of tension prior to the behavior followed by a sense of release afterward. Some researchers argue that these conditions are better understood as addictions than as obsessive-compulsive disorders. I've seen many people describe their experience as more like self-harm than OCD-related impulses. Both conditions respond pretty well to behavioral therapies such as CBT or something called habit reversal training that I'd never heard of before writing this up. When medication is prescribed, SSRIs are usually the first choice.
Huh, I hadn't realized they were basically their own conditions. As far as I know, I do not have OCD (this is the most OCD-like symptom I've ever had) and neither do any of my family members. I do suspect I have depression, however. In my experience, it's kind of like... there's a rough bit or irritated bit of skin, and at first it feels more right that I should pick that part off, but then the rest of it is also kind of uneven, so if I continue it can get mildly painful (or majorly painful, in the case of toes - of course, that was more like peeling). As for whether it's more like an addiction vs. OCD... well, the only connection I've felt to OCD is the skin-picking I just described, but it can definitely feel like an addiction when I can't seem to stop, even though I hate the idea of thinning out my eyebrows. @pixels Solidarity! The scary thing is how long I did it without really realizing that it was a problem, or at least that it was a Problem. It was only when I started worrying that I might cause visible thinning/gaps in eyebrows that I started thinking, wait a minute...
Oh hey skinpicking I don't pluck my hair but I sure do pick my skin. I have a lot of wee tiny spots all over my arms, and I pop them obsessively, and then pick at the resulting scabs. Happens on my face too, which has previously led to horrible enormous oozing scabs on my chin, heh. The arm ones sometimes get infected, but it's only blown up into something that wouldn't clear up without antibiotics once, thankfully. It definitely appears to be a soothing mechanism for me. I think it started as a 'I hate how I look with spots, I have learned from somewhere that getting all the ooze out will make them heal up, I'm going to pop them', and then that led to scabs, and I picked scabs before I popped spots. I don't know where the scab-picking started but since I've been doing that since I was a wee babling I think it was just childhood scab-picking that simply never fucking stopped. But by now it's. Well it's kind of still that, but it's also definitely something I do when stressed or distressed, because it sort of comes in waves- if I'm in a decent place I won't do it unless there's a huge obvious spot on my face, but I've been in a worse place recently and I'm back to spending like half an hour quietly looking for tiny little spots to pop. And it's definitely self-soothing, I go quiet and don't think at all while I'm doing it. This is all very gross and I don't know quite what my point in recounting it was, but here it is.
wait, picking the skin around your nails until you bleed is something to be concerned about? ugh fml fwiw I pick aforementioned nail skin, I pick at scabs until the wound scars, I pick at blisters, I pick at uneven patches of hardened skin on feet, and sometimes I scratch myself in my sleep randomly? ... Seeing it listed like that looks far more scary than it actually is though, it doesn't even really hurt usually and it only happens when I'm really bored or really irritated, so uh....
Skin- and scab-picking, now that's a symptom I haven't relayed to my therapist yet. I don't know how I missed it, I picked my fingers bloody when I was 7... (And I only started popping spots because my dad would pop them for me when he saw one (without warning or consent), and that hurt. (Honey & cinnamon might be sticky af, but much less painful in getting rid of them)) Symptom question: What could cause a disconnect between emotions and brainspace? As in, my body runs an emotion script, and my brain either doesn't notice (or notices late because of the feedback I get from my body via my other senses), or the script interferes with what my brain tells my body to do (eg, crying makes speaking difficult, there is suddenly a tone modulation that I did not intend and that is counterproductive to the conversation), and then I am confused, because a) where the fuck did that come from, b) why the fuck is my body feeling something my brain isn't, and c) why the fuck do I not get a say in this.
