Desperately Seeking Answers!

[Snickers]

5 weeks ago my husband of 32 years attempted suicde.

There is no doubt as to the reason why he got to that stage he was working excessively long hours in a high pressure role which included after hours emergency duty in his own business that saw him on duty constantly for over a month.

He had had difficulties with sleeping for quite some time which added to his exhaustion. There is no family history of depression & in the few weeks leading up to his overdose we thought he was looking exhausted but were not aware of any feelings of depression – although he was getting anxious about being able to cope with the work load.

After 3 days in Emergency & 2 days in a mental health unit he was discharged with mild depression & given a prescription for one the most common antidepressants at a low dose which we were told would make him feel much better in 2 weeks & really good in approximately 4 weeks.

He was also given a prescription for another drug to help him with his sleep. Sounded simple – we started planning a getaway for him to de stress, relax & recover.

Five days after starting the medication he started having anxiety attacks & a sudden thought of suicide. He was hospitalised to keep him safe & to help him re-establish a normal sleep pattern. Medications were increased. After a few days he was released but he then started having very frightening anxiety attacks during which all logical thinking disappeared his worry that sparked the attack was illogical. He was hospitalised again.

The medications were changed slightly & increased yet again.He was put on a waiting list to go into a private mental health unit. After 4 days he was transferred.

Since being in the unit his medications have been increased & changed & he has gone downhill to the stage where he seems to have lost most of his cognitive functioning (unable to complete simple tasks). He has now been classed as having deep depression! They are now recommending electroconvulsive therapy as the drugs do not seem to be having any effect.

Can anyone out there tell me if they have had a similar experience? It is possible this downward spiral is due to medications??? Or is this something that commonly happens with mental illness??? Desperately trying to come to terms with what is happening to the intelligent gentle loving husband I used to have! I feel so helpless watching him go through what appears to be torture for him!

[BeeGee]

Hi Snickers,

I posted a longer reply, hopefully it will show up soon. In the meantime, the short answer is that it's possibly adverse effects of meds, but it's equally possible that it's his illness progressing rapidly.  I think the main takeaway of my message was the importance of working collaboratively with his psychiatrist/treatment team. Now that he lacks capacity for decision making you will be his substitute decision maker; ask lots of questions and try to be as informed as you can. This is really hard for you, especially being so sudden, but you are doing really well so far. It's great that you've come here for support and I hope we can be of some help to you through this ordeal.  Love and hugs.

[BeeGee]

Dear Snickers

It seems my original post has vanished into thin air, so I'll try to reconstruct what I remember saying. First up, I'm really sorry that this has happened to your husband - and to you. Mental health crises affect everyone in the family, so please know that we are here to support you as much as the sufferers.

His rapid decline after commencing combination meds is suspicious. My guess is that he's been given the usual first line SSRI + a benzo for sleep/anxiety. It's possible that he is experiencing an adverse reaction to one or more of his meds. To rule this out, I would suggest talking to his psychiatrist about the possibility of weaning him off all meds while he is in hospital and under supervision, to see if his symptoms get worse or better. This may be traumatic particularly if he does get worse; he may need some level of sedation to be able to cope. It's also possible that his condition has rapidly declined; there may be neurophysiological reasons for this, and I expect that they have done imaging investigations (e.g. MRI) in hospital to look for major structural problems.

ECT is a very effective treatment for depression that is resistant to medical therapies. It has a good evidence base for effectiveness, and is nothing like you see in the movies - it is gentle, patients are sedated and barely move during the procedure. Most people respond well to it. A common side effect is some memory loss. Most people get memories back over time, although some don't. For those who consider ECT they are usually in a pretty bad way so the trade-off of improvement vs. the risk of some memory loss seems reasonable. Two members of my family had it, and had major improvement, although one said if she'd been aware of the memory loss problem (hers didn't come back) she wouldn't have done it. I'm not sure that's true though as she is so much better now than before.

I guess you just have to trust that the psych really is trying to achieve the best outcomes for him, but it can be a pretty inexact science at times with much trial and error. Make sure you ask the psych plenty of questions, be fully informed, and don't forget that while hubby lacks capacity you are in charge of decision making. If you really don't agree with recommended treatments there are avenues for you to pursue depending on what state you are in.

Please keep us posted on your progress!

Love, BG.

[Snickers]

Thank you BeeGee for your reply. I am currently in a state of disbelief in that 2 nights ago he started displaying paranoid behaviour that was completely illogical (people were going to get him) he started to refuse medication (believed it was going to explode inside him) I had to help the nurse force the meds into his mouth to get him to take them he was also refusing to eat or drink. I left after getting the meds into his with the hope he would settle & go to sleep. I received a phone call after midnight saying he had become uncontrollable, had to be given injections & as such was being transferred to a public hospital psychiatric unit under a section 1.

By 10am next morning he was much better -occasional illogical thought - but these disappeared as the day wore on. He was once again the hubby I know as we sat talking & making plans for the future. The psych believed the episode was caused by the ceasing of the calming drugs necessary before ect but he went spiralling up on a high due to the antidepressants! These have now been stopped!

He was seen by another psych today alone & apparently informed that they would be applying to some tribunal to force him to have the course of ect. I was expecting to also be spoken to as I have so many questions that need to be answered - but no! I was told very busy & the nurses could not tell me how to get in contact with him or when he would be reviewed again!

I really believe the meds are causing issues - I believe there is a type of ombudsman? for mental health patients but will have to do some research. I cannot believe that as his wife I have not been involved in the treatment plan!  I didn't think things could get any worse but now I have to contend with this tribunal as well!

[BeeGee]

Hmmm, things are a little different if he is under an involuntary treatment order. The finer points of how things work differ from state to state and I'm really only familiar with Qld law. Here, once a patient is on an ITO your role as substitute decision maker doesn't stand any more, although I would have thought it only decent for the team to discuss their decisions with you. If you aren't convinced that the proposed treatment is in his best interests, the Office of the Adult Guardian can override the treatment orders, and the Qld Civil and Administrative Tribunal has the final word. If you are in another state then arrangements may vary, but I would imagine that there would be comparable bodies and a similar process.

This is a tough time for you both. I understand your anxiety, but looking back at your original post (if I understand you correctly) he was beginning to display problems well before starting on ADs - it seems he was not medicated when he made the attempt on his life. Although I agree that it sounds like the ADs have made things worse rather than better, I suspect that is just masking the fact that there is still a severe underlying illness that really does need treatment. I think if I were in your shoes I'd be jumping up and down trying to get the psych to talk to me about what's happening, what they believe is wrong, why they are making the decisions they are and what outcomes they expect from the proposed treatment. It's not too much to ask that they discuss these issues fully and frankly with you. If you understand their reasoning you may even come to agree with their approach. If you just can't get them to talk you could try making a noise with the hospital admin to force a consultation process.

It's unfair and unreasonable to be keeping you in the dark - you deserve better treatment than that. All the best to you, and please keep us up to date.

[j3nn]

Hi 

I was reading your story and a few things stuck out to me. 

I found myself in a caring role too. 

Firstly it is important for you to have some support. I found that carers assist is awesome if there is such a group in your area. Also ARAFMI are fantastic for knowledge and support for you, while you support your loved one.

These organisations can also help advocate on your behalf with doctors. They would be an invaluable asset to ask about the tribunal, and about your rights and about electronic therapy. They are dealing with carers every day and know how to navigate the mental health system. I can't stress enough how important it is for you to give them a call.

In my experience, medication has always taken a good 8-9 weeks to kick in properly. 

Maybe you could ask for a family conference with the doctor to get him to address your concerns. (bring your support with you) 

It seems odd to go straight in for the electronic therapy rather than try some other medication. (purely my opinion)

So I have had a similar experience with my loved one(s). it is important to understand  that it is my experience and yours will be different of course although there are some similarities, this is just my story. 

It started with trouble sleeping, (we thought depression), illogical thoughts (delusions, hallucinations) it then got worse, he was hospitalised and taken off anti-depressants and put onto anti-psychotics. They took a long time to kick in (8-9 weeks), in which time he seemed to get worse. He too was paranoid about food, medication, everything really. There were ups and downs, times when we thought he was getting better only to see him get worse the next day. It was exhausting and he even got catatonic, they were considering putting him in a ward with a drip because he wouldnt eat. Then they tried something. And it worked right before my eyes!! Then it wore off!! It was a fast acting short lasting trial. When that worked, they knew what to use with the anti-psychotic to encourage it to kick in. And it did work. He was in psychosis. 

He has had two more episodes since. He now has an injection once every 30 days and it is working well for him. This has been over a few years.

I guess the point of my story is to please get some support.

Take one day at a time.

You might have to become 'politely pushy' with his doctor. It is good practice to include the loved ones in all aspects of treatment. Get involved. Explore all options. Ask questions. 

🙂