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Script Shrink

@scriptshrink / scriptshrink.tumblr.com

Writing about mental illness? Ask ScriptShrink!
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BIOFEEDBACK AND EMDR!

I’ve been lowkey annoyed, as a therapist, with all this “Booker should go to therapy” comments because if he can’t tell the truth, psychotherapy won’t be any fucking good for him.

A huge part of talk therapy’s effectiveness is having an experience of being truly seen, of being able to be authentic and real with another human being and feeling their honest empathy and acceptance. If Booker has to lie and hide 90% of his life, the benefit is very limited.

So I’ve been thinking about what’s actually his issue, what’s actually wrong with him, what could be treated.

There’s a little bit of a gimme the Old Guard get, where if a normal human being encountered that much pain and stress—I’m talking physical pain and physiological stress—they would be a burned-out wreck. Their nervous system would just spend all its time pumping out pain signals. So already, their neural healing is as advanced as their other healing.

But if we’re assuming Booker’s incredible history of trauma and years of nihilism has still managed to etch itself onto his brain the way it might a mortal’s... I mean, one therapy is medication, and beyond your usual antidepressants there are experimental PTSD medications with promise, like MDMA (yes, the party drug). He could also try transcranial magnetic stimulation, which is administered over 20-30 treatments over a year (every two or three weeks).

But as for things Booker would consciously work at, there are two well-proven process therapies that don’t rely on talk because they target the physiological and emotional mechanisms of PTSD more than the cognitive ones.

One is biofeedback—here’s an informative video and an informative article. It basically means training your brain and body to react in a different and more controlled way, so that, for example, you’re able to calm down in response to an incipient panic attack, or able to focus on the positive in a stressful situation.

The other is EMDR—here’s an informative video and an informative article. In EMDR the therapist provides sensory stimuli that basically puts your brain into “debug” mode, and you practice going from a feeling of peace and stability, to accessing your traumatic memories, to finding new ways to deal with them, to going back to being okay enough to go back to your life. EMDR is rather unique because the client needs to talk very little; most of the work is done internally.

So those might be of use to Booker. And Quỳnh, if she ends up going too.

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scriptshrink

This is a great example of how to use psychology with your fictional characters! 

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My MC's best friend has just confessed that she's been purging due to an eating disorder. She's pregnant and it triggered a relapse. They can't seek professional help because she lied about her mental health to get there and could be in big trouble if the truth gets out. The plan they came up with is for the MC to stay with her for an hour after each meal and keep her distracted until she's digested her meal. Does that sound effective? What could go wrong?

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CW: eating disorders (bulimia) extensively discussed, pregnancy, suicide and miscarriage mentions. Skip if you’re not sure.

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Anonymous asked:

I have a character that has fairly severe PTSD. She happens to have a friend that is one of the best scientists in the world and does know enough about psychology to give proper therapy. The character suffering from PTSD knows she has it and wants to get better but at the same time is also afraid to face everything that happened and to stop blaming herself for things that aren't her fault, and to forgive herself for things that were her fault. What is a realistic way the doctor would help?

There are a couple of things that need to be addressed here. 

  • It’s not considered ethical for a therapist to treat someone they have a pre-existing relationship with (even if it’s platonic).
  • There are legal requirements that your character would have to fulfill in order to practice psychotherapy. Your character would need to have a specific degree (either masters’ or doctorate) and a license.
  • Being “one of the best scientists in the world” would not translate into being good at therapy. Your character could have a good theoretical knowledge of the topic, but being a good therapist requires a lot of practice and face to face experience with clients. 
  • Think of it as learning how to juggle. You could know all the physics governing how the balls move and the kinesiology of the human body, but that doesn’t mean that you’ll be able to juggle 7 balls and then catch one of the balls on the back of your neck without practice (see video - warning, it starts a little loud).
  • Something to note is that even if your scientist character has a doctorate in psychology, there are subdivisions and some parts of psychology are much more scientific than others. Some of my professors are indeed brilliant scientists in their respective fields (psychopharmacology, physiological psychology, psychophysiology, etc.) but have stated that they would not be comfortable treating clients, even though they’re psychologists.
  • Treating PTSD in particular is not something that should be undertaken by anyone who is not qualified to do so. It is fairly easy to fuck up, with severe consequences.

Being completely honest, the best way that your scientist character can help her friend is to provide a referral and pay for their friend to see an actual qualified therapist. 

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Living in a Group Home Pt. 1/2: General Situation

(I’m going to do a Part 2 later, on actually working with the staff on recovery goals, but right now I have to do my chore (see below))

Let me start by saying a little about myself, for perspective: I’m 28, cis female, asexual and aromantic. I was diagnosed with depression at a young enough age that I can’t actually remember if if was before or after starting elementary school, and with ADHD a few years later, and I’ve been on meds for them (immensely helpful) ever since. I was diagnosed with Aspergers in high school. For almost three years, I’ve lived in a group home run by a local non-profit. I haven’t lived in a facility of this sort run by anyone else, so I can’t tell you anything about the spectrum of experiences different facilities afford.

The organization that runs my group home has three levels of care:

  1. staff onsite 24/7
  2. staff onsite most of the day (7am-10pm weekdays, 9am-7pm weekends)
  3. staff come by in the morning and evening to give out meds and check in

(I started in level three but moved to level two because I couldn’t handle keeping things clean by myself, to a degree that it could have caused trouble for the organization if there had been an inspection.)

I know a lot of people don’t like labels like ‘high functioning,’ but these levels of care do roughly correspond to those kind of descriptions. The people in the 24-hour house are often those most clearly unable to take care of themselves.

To be in the program I’m in, you have to be on disability, and like most of the others, the organization is my Representative Payee, meaning they receive my checks and give me an allowance. I usually have about $150 to work with a month, plus a little over $100 in food stamps. This has to cover food and other expenses like most toiletries. I have yet to figure out how the people who smoke (not allowed in the house, but so common on the side porch that the neighbors once complained) afford it.

Everyone pays for their own lunch and dinner, but most people participate in the group meal for dinner, paying for food for everyone one night a week. I don’t, because I’m a vegetarian and they always have some sort of meat. I think the requirements are that there be a protein, a vegetable, and a starch. People tend to make the same few low-effort things over and over, like chicken nuggets or spaghetti with meat sauce. Vegetables are usually boiled. Staff may help people cook depending on their ability to handle it on their own.

There are three staff members, though on most days only one or two are there at a time. They’re usually quite young, with bachelor’s degrees only. I don’t know how much they make, but from discussions with my therapist (employed by the same non-profit) I know it’s basically peanuts. House staff don’t often stick around for more than a year in my experience. Of the three who worked here when I arrived, one left to take a supervisory position with another organization, one went back to school, and one finished additional schooling and switched to working for tech support, which apparently pays better. There’s also a supervisor, who is in charge of several different houses and comes by at least once a week to coordinate things with the house staff and check in with residents. One of the house staff is kind of in charge of the others, but not by much. This person also takes care of logistical stuff like office and cleaning supplies and doesn’t work weekends.

As part of the program, everyone is required to get out of the house and do a “meaningful activity” on at least three days every week. What that means may vary according to the person. For example, spending time at the library would count for most of my housemates, but not for me, since I’d be doing the exact same thing I would at home (reading, browsing and writing), only without the occasional video games. Most people make use of the classes and activities offered by the non-profit at the same building where the therapist’s and psychiatrist’s offices are.

Activities include cooking class (more focused on producing “dollar lunch” for people who are around that day than actual teaching), gardening in the greenhouse (plants are sometimes sold at the annual craft fair to raise money for the organization), yoga and a group that goes to various events and locations of interest in the community. We have several good museums nearby that they visit sometimes. Counselors in the “life skills” area that runs most of these classes have a lot of turnover too, though not as much as group home counselors, and the available classes sometimes change depending on the skills of the current batch. I’m very lucky that we have a guy with a creative writing background who runs a writing group. It’s just a prompt and then sharing and commenting at the end, but he gives good feedback. I just worry that he’s being gentle with me the way I know he does with other clients (not untruthful, mind you, just careful).

Of special note is the art program. This isn’t art therapy, as the woman who runs it makes very clear. It’s actual art classes. The teacher has a degree in (I think) fine arts. There’s a more basic class, where there are specific projects assigned, and a more self-directed studio class you have to be invited to. Even in the more basic one, you can pursue your own interests if the project isn’t doing it for you. Until recently, a small local gallery donated wall space for us to display and sell our art, but now that the owner is retiring the teacher is looking for someplace new. And people do sell art, and for amounts of money that really make a difference when you’re on disability. One of my pieces sold for $120, which was a very nice cushion for the grocery bill. I kept only about two thirds of that, because I used the studio’s materials. It would have been 85% if had used only my own materials.

Socially, the house is pretty dead. There’s no conversation over dinner, though there sometimes is in front of the TV.

Entertainment-wise, it’s pretty much just that TV. It has a very basic cable package, and is on nearly constantly. There are some books around, but I’ve never seen anyone else reading. I think the books may have been left behind by people who moved out. We still have VHS that no one has gotten rid of, too. There’s also a Wii, but I’ve never seen that used either. One other person says he has a laptop, but I’ve never actually seen it. An older woman has an iPad, which she likes to watch videos on. We have one person whose English is quite poor, so her main entertainment is music from her home region. The staff and both used to play youtube videos for her, but now she has an iPod. I gather that she had a lot of money left over after a year or so of not doing anything with it but buying groceries.

The house itself is pretty big, and I gather that it’s one of the newer ones the organization owns. It’s a coed arrangement, with the guys having three rooms upstairs and two of them having to share, while the women on the main floor and the basement all have their own rooms. I’ve got the basement room at the moment, having switched with someone who was having more difficulty that usual and who the staff wanted closer to them. Bathrooms are shared except for the basement one, which I have to myself. There are two other bathrooms on the main floor, one for two clients and one for the remaining female client and the staff. There’s also one upstairs for the guys. The guys aren’t supposed to use any of the women’s bathrooms on pain of cleaning the whole thing, but it happens anyway because it’s more convenient to the living room.

There’s free internet but it’s not exactly great. The bandwidth on the guest network that clients have access to is terrible (250kps downloads per device, throttled) and about a year ago they started turning it off from 10pm to 6am. This is the same at every house, apparently, and apparently done because people somewhere were staying up all night online.

A few other tidbits:

  • They regulate the temperature in the showers so people can’t burn themselves, which means you can’t really get a good, hot shower, just a warm one.
  • I don’t think this is normal, but meds are dispensed from a machine in your room, though only staff have access to them and they have to be taken in the office.
  • The fire alarm, which is hella loud, automatically contacts the local fire department. Everyone has to leave the house when it goes off and can’t go back in until the fire department clears things – regardless of weather or state of shoelessness.
  • Everyone has an evening chore, like cleaning the dining or living room or the hallways, and chores change every month.
  • The furniture is serviceable and boring, and there’s no decoration other than the Game of Thrones poster I put up and reminders like “please do not put feet on or lay on furniture.”
  • They take the pillows off the furniture and lock them in the office at night too keep people from sleeping in the living room.

[Thank you for sharing your personal experiences! -Shrink]

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Anonymous asked:

How long is the average inpatient stay, and what is the longest a character could realistically be hospitalised in the US? I live in the UK, and I've known people to be hospitalised for several years, but I get the impression that US inpatient stays are much shorter?

You are indeed correct. Because of deinstitutionalization* (the movement to close mental hospitals and instead treat people in the community), bed space in inpatient wards is in extremely high demand, and as such the duration of inpatient treatment is extremely time-limited. 

The average inpatient stay at the psych hospital the Shrink works at is 3-5 days. The longest I’ve personally seen was around 50 days, and the longest stay I’ve heard of within the last five years or so was around 200 days.

State hospitals (see my post here) have a much longer average duration of stay, but there are pretty stringent requirements to be admitted into one. Even if a patient qualifies, the waiting list for admission can be months long. Out of the literal hundreds of patients that have come through my psych hospital’s doors in the time I’ve been here, less than 10 patients have been successfully transferred to a state hospital for long-term care.

* Don’t even get the Shrink started on deinstutionalization. I have many very strong words to say about it.

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Treating mental illness in fantasy settings

CW: self harm mention

I recently received an ask that included the phrase “[it’s a] fantasy-type setting, so there isn't really any medication for treatment [for mental illness].” This is absolutely one of my worst pet peeves when writing about mental illness.

By saying “there’s no treatment for mental illnesses” simply because of the setting, you miss a huge opportunity for imaginative and creative world-building.

Let’s look at a tangentially related example from one of my favorite authors.

Years ago, I remember reading one of @tamorapierce ‘s books (I forget exactly which book it was), and a single tiny detail really left a lasting impression on me. 

The female main character was able to obtain an enchanted charm to prevent pregnancy. 

Honestly, that blew my fucking mind. Despite being an avid reader of fantasy, I’d never seen magic used in that way. It seems like birth control is such a modern invention, but this charm was integrated so seamlessly into the world that it just felt right. It was such a clever, creative detail that in retrospect makes perfect sense. 

So back to my point: if magic can recreate (or even surpass) the effects of modern medicine to treat physical problems, there’s no reason you can’t also creatively apply it to treat mental illnesses.

  • Does your setting have potions? Then you can make a potion of euthymia to treat depression.
  • Does your setting have enchanted objects? Then you can have a bracelet of grounding to ward off dissociation and flashbacks.
  • Does your setting have spells that can affect people’s minds? Then you can have a mood stabilizing spell to treat bipolar disorder.
  • Dungeons and Dragons already has spells and objects that let you see through things that aren’t actually there! That’d be really helpful to a character who has visual hallucinations.
  • Also, St. John’s Wort (which is a naturally growing herb) has been used as an antidepressant since medieval times. See my post about it here.

I collaborated with the Scriptshrink consultants to come up some more examples:

  • Hypnosis-like magic could help characters work through mental blocks in therapy, through unraveling the thought patterns that lead up to destructive loops, or dissecting the elements of a panic attack to sort of unpack it and make it more manageable. (Elizafaraday)
  • A spell or charm to see through the eyes of others could help with body dysmorphia and social anxiety, or that could give a visual or audio cue as to how others perceive the character (ex not even noticing-favorable-neutral-unfavorable) (Elizafaraday, Anon32)
  • Magic items like bracelets that can provide any sensory input desired when touched to allow different stims. (Anon32)
  • Magic spells or elixirs than can block stimuli when over stimulated. (Anon32)
  • A magic ring that could treat self-harm, trichotillomania, or excoriation disorder by making the wearer’s skin unbreakable and their hair impossible to pull out. Alternately, it could give the illusion that the wearer has already done that activity (including all the neurochemical stuff that implies), without actually having themselves come to harm. (Anon32)
  • If you decide to go with the idea that schizophrenia is caused by spirits / possession, there could be a spirit repelling potion or wards to prevent it. (barc0de)

I would also recommend that these treatments have some kind of drawback, so they don’t end up falling into the “perfect instant magical cure” trope. 

  • Spells may wear off with time, or can only be cast by certain people. They may also have side effects if cast constantly (headaches, dizziness, etc.) 
  • Potions can be expensive or require gathering certain rare ingredients. They could also have side effects.
  • Maybe the enchanted item is fragile, and could break if directly hit while its wearer is in combat (for maximum drama).

Also, feel free to hit up @scriptwitchcraft for ideas on potion crafting and stuff in a magical setting!

Disclaimer -  The Shrink would like to emphasize that this is advice meant to apply to writing fantasy settings only. Do not apply this post to treat mental illness in real life.

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Anonymous asked:

Hi, I'm trying to write a character who had BPD traits as a kid and went in the foster system at 13. I've tried to read up on it but I couldn't really find any concrete info (or I missed it) but is a psych eval mendatory for those kids and what's the % of chances his BPD traits might be missed ?

Following the BPD ask : my character ends up seeing a different therapist by the time he’s 17, is he old enough to be diagnose w/ BPD ? Are there specific treatments for that ? most of what I could find was Behavioral Therapy which seems to not be considered to have good results in helping people who/ BPD get better (I don’t think it’s possible to “cure” PDs right?). He also sees a nutritionist ‘cause he was homeless for a few years d'you think it’s possible to link treatments and diet?

The Shrink is not familiar with the foster care system, and thus does not know if psych evals are mandatory.

I can’t give you a percentage chance that your character’s BPD would be missed, but it’s actually fairly probable given that your character is male (presuming based on the he/him pronouns). A lot of therapists unfortunately are rather sexist in applying a diagnosis of borderline, and rarely diagnose male-presenting people with it.

Curing personality disorders is indeed not really possible. However, there are treatments and therapy that can help people with personality disorders learn coping skills and such so that they can alleviate the distress they can experience.

There is indeed a specific treatment for BPD called dialectical behavior therapy (aka DBT) that has been found to be pretty effective!

As for the treatments and diet…eating healthily definitely doesn’t hurt, but it’s not sufficient on its own to cure mental illness. We do have a dietitian that we consult with at my internship site, but their involvement in treatment is fairly limited. 

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Anonymous asked:

Hi! My character has Panic Disorder and Generalized Anxiety Disorder (undiagnosed at the time) and is under a ton of stress, to the point where he basically has a mental breakdown (he starts having a panic attack but the symptoms are worse than usual and it doesn't stop, even after like 3 or 4 hours) and ends up checking himself into a mental hospital, which he spends 3 weeks in. Would that be realistic?

CW: suicidal ideation mention

It’s unlikely that your character would have a continuous panic attack for 3-4 hours straight, but your character could definitely have a series of them in quick succession.

The second part of your ask, I’m afraid to say, is not realistic at all.

Firstly, a character would not be checked into psych hospitals if their sole presenting problem is anxiety / panic attacks, unless their anxiety has driven them to the point of being suicidal. (Soon I’ll be making a post on specific inpatient admission criteria! Stay tuned!)

The whole idea nowadays is to treat patients in whatever environment is the least restrictive one possible. Anxiety is treatable on an outpatient basis; there’s no need for the intensity and restrictiveness of inpatient treatment. 

Secondly, even if your character was suicidal from the anxiety he’s experiencing, he wouldn’t be kept there for three weeks. The average stay at my hospital for a suicidal patient is 3-5 days

There are more long-term facilities run by the state - this is more the kind of thing people think of when they hear the words “psych ward.” However, these places are always full, with a waiting list that can last months. Because of the high demand, state hospitals (in my state at least) only accept transfers from psych hospitals like the one I work at, and do not accept any voluntary patients whatsoever.

There are also private inpatient programs that focus on treating a specific kind of disorder, but I’ve never heard of one that only treats panic attacks / GAD.

What would likely happen instead is that your character would present at an ER, get a dose of an anxiolytic if they’re actively having a panic attack, and get a referral to an outpatient psychiatrist.

Note - The Shrink is basing her response on the policies of the American psych hospital that I am currently interning at. Policies my vary. 

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Anonymous asked:

I have a mid-30's female character in my story who suffers from depression. Reader doesn't get much in-depth backstory for her, but she's one of 5 main characters. Fantasy-type setting, so there isn't really any medication for treatment. She is outwardly confident and outgoing, seeming like nothing bothers her and she's just out for a good time. But I want to *show* that she struggles with this without outright saying it. How would you recommend I might do that? Or should I just say it somehow?

I’m a big fan of naming the diagnosis. I’ve got a whole bunch of different ways you can incorporate a diagnosis into a non-modern setting - check out that post here: http://scriptshrink.tumblr.com/post/158545336703/what-level-of-specificity-would-you-recommend-in

If you decide not to state the diagnosis, at the very least check out the criteria here. There are a lot of ways you can incorporate those symptoms into a character’s behavior.

As a side note - the concept that fantasy settings don’t have any possible treatments for mental illness is a pet peeve for me. I’m going to make a post shortly about creative ways to treat mental illness in that kind of setting pretty soon! 

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My character has PTSD, but doesn't have access to a therapist. All they have is a reluctant adult, so what kind of therapy could they do?

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They could listen to and be supportive of your character, but you can’t call what they’re doing “therapy”. Therapy actually requires a lot of training and a license to perform. When dealing with severe mental illnesses like PTSD, it is hard to make progress, and very, very easy to make things worse. This is akin to asking how someone without access to a dentist could treat cavities.

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I'm writing about a character suffering from Major Depressive Disorder and I had a question about medication combinations. In the story her psychiatrist and her therapist by proxy become worried that the combination of medications she's on might be causing an increase to her anxiety or desire to self harm and want to change what she's taking. Is this a realistic situation? What medications could she be on? Thank you!!

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CW: self-harm, suicide

Yes, totally possible. While antidepressants are often used to treat anxiety disorders, they can also cause symptoms related to anxiety too. It’s most frequently described as jitteriness, but there are more symptoms associated with it as well (scroll down to table one here).

 Two drugs are especially associated with causing anxiety: imipramine (Tofranil) and fluoxetine (Prozac). Of those two, I would lean towards Prozac, as it’s considered a first-line treatment and is extremely common. Tofranil is a bit outdated and rarely used anymore.

Note - Typically the anxiety occurs within the first few weeks of treatment, and it actually does go away fairly quickly. A psychiatrist may try to see if the anxiety symptoms go away before switching to a different drug. 

Now, the self-harm is a bit of a different story. All antidepressants may potentially increase the risk of suicidal tendencies in children, adolescents, and young adults (ie under the age of 25 or so). 

Because this question was sent off anon, the Shrink asked how old this character is, and she’s 17. A psychiatrist could easily see an increased desire to self-harm as a warning sign that this specific antidepressant may be making your character suicidal. That’s definitely enough to merit changing what medication she’s on!

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scriptshrink
Anonymous asked:

Why might one antidepressant be prescribed over another? For example, why might a patient take Prozac over Wellbutrin or vice versa? Thank you love your blog!!

There are a lot of factors!

  1. What specific symptoms are being treated (certain drugs treat certain symptoms more effectively)
  2. What side effects the drugs have / what the character is willing to put up with
  3. What medications the prescribing doctor is the most familiar with.
  4. Patient factors (how old they are, what they’ve taken in the past, what they’re currently taking, their medical history / comorbid disorders, if they are or want to become pregnant, etc.)

Three random examples of things a psychiatrist could consider, off the top of my head:

If someone has insomnia as part of their depression, they might be prescribed Remeron / Mirtazapine (to be taken at night) because it is likely to help them sleep.

If a character also has ADHD, Strattera / Atomoxetine might be an option.

One class of antidepressants, MAO inhibitors, are almost never prescribed without the patient trying a lot of other antidepressants first. This is because you have to follow an extremely strict diet or risk death. And by “strict diet” I mean that you can’t eat cheese, cured or processed meats, anything with soy, or drink beer (among many other things). If the character is willing to put up with that diet, and nothing else has worked for them so far, MAOIs might be an option; otherwise, they’re not going to be prescribed.

There are literally hundreds, if not thousands, of little things like that to consider when prescribing psychotropic medications. That’s why they pay psychiatrists the big bucks.

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An anon pointed out that the qualities of the drug itself matter! For instance, some drugs need to be taken at the exact same time of day to be effective; some drugs also need to be taken multiple times a day!

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Anonymous asked:

Why might one antidepressant be prescribed over another? For example, why might a patient take Prozac over Wellbutrin or vice versa? Thank you love your blog!!

There are a lot of factors!

  1. What specific symptoms are being treated (certain drugs treat certain symptoms more effectively)
  2. What side effects the drugs have / what the character is willing to put up with
  3. What medications the prescribing doctor is the most familiar with.
  4. Patient factors (how old they are, what they’ve taken in the past, what they’re currently taking, their medical history / comorbid disorders, if they are or want to become pregnant, etc.)

Three random examples of things a psychiatrist could consider, off the top of my head:

If someone has insomnia as part of their depression, they might be prescribed Remeron / Mirtazapine (to be taken at night) because it is likely to help them sleep.

If a character also has ADHD, Strattera / Atomoxetine might be an option.

One class of antidepressants, MAO inhibitors, are almost never prescribed without the patient trying a lot of other antidepressants first. This is because you have to follow an extremely strict diet or risk death. And by “strict diet” I mean that you can’t eat cheese, cured or processed meats, anything with soy, or drink beer (among many other things). If the character is willing to put up with that diet, and nothing else has worked for them so far, MAOIs might be an option; otherwise, they’re not going to be prescribed.

There are literally hundreds, if not thousands, of little things like that to consider when prescribing psychotropic medications. That’s why they pay psychiatrists the big bucks.

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Anonymous asked:

I have a few questions I was hoping you could answer! :) What do you feel is one of the most common misconceptions you see in writing about therapists/psychologists/psychiatrists? Also, in a character with severe C-PTSD who would be best for them to see out of the three? Is it possible to see more than one? How often would one of the above see someone with severe C-PTSD? Would twice a week be excessive? Not enough? etc. Thank you for your time and providing us all with so much info!

I’d say one of the misconceptions that really pisses me off is the idea that all therapists are Freudian. I really hate Freud.

For intense trauma work, meeting with a psychologist twice a week is pretty reasonable.

With severe mental illnesses, it’s typically recommended to see a psychiatrist in addition to a psychologist in order to be prescribed medications. A character would typically see a psychiatrist roughly once a month or so (less often if the character has remained stable on their medications). CPTSD and PTSD are a little squidgy because there aren’t really medications that deal specifically with those disorders, but sometimes SSRIs or a drug like Prazosin would be prescribed.

For the rest of your questions, I’ve got a few posts in my archives that I think you should check out!

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Personal Experience: Medication “Experiments”

Randomly thought of this because of recent events in my life, and if this has been said/is too much of a rant please delete and ignore, but I just remembered that doctors are weird about “experimenting”.

I took Zoloft for my bipolar for roughly five years. It gradually started to lessen in effect, even as we upped my dosage. So we switched to a different medication, can’t remember the name, that completely muffled my mania. It either made me depressed, or my depression finally had a chance to shine, but either way, it wasn’t right. I hated it, I wanted off, I wanted a different medication. My doctor decided to add an antidepressant instead, because I was a minor and had no say over what I took. The antidepressant helped a little, but it made me so “blah” that everyone noticed. Even the kids at school, who usually avoided me, started to notice something was different. And according to the doctor, that was what normal people felt like (yes, she said normal, which is a great thing to say to a depressed, suicidal child who feels alienated from his peers already). Normal was blah. Normal was empty. Normal was wanting to die but being too afraid to do it.

We switched psychiatrists. The new doctor took me straight off the meds I was on (no weaning, just told me to stop taking them) and said “we’ll have to experiment”. That’s also around the time I learned that I was always being put on new things. Nothing tried and true, just the newest drugs they could get their hands on. Stuff they didn’t know what the effects would be. And all adverse effects were met with “We’ll wait and see if it gets sorted out.”

This all came to the front of my mind because we changed my meds again just this month. My doctor is taking me off Abilify (finally a drug that didn’t give side effects, but still stopped working), which I’ve only been on for a few months, and putting me on Latuda. We’re also increasing my anxiety medication. He’s the only psychiatrist I’ve had who’s been careful about choosing my meds, but it’s still scary to hear the word “experiment” coming from a doctor.

So to anyone looking to write someone who’s been on and off a lot of meds, please remember that it’s just. So exhausting. So scary. So infuriating. And the words doctors choose affect the way you view medication your whole life.

[[It’s been a while since I got a submission! Thank you for sharing your personal experiences - Shrink]]

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Anonymous asked:

How do doctors prescribe depression medication? Say, for instance, a young male, mid-20s, develops resistance or gets used to medication fairly quickly. Would the doctor prescribe a higher dosage each time, or would they wean him under supervision and then continue the same dosage?

When a psychotropic medication isn’t working, there are a couple of different options. 

  • Increase the dosage and see if it starts working.
  • Taper off of the drug and try a different one.
  • Add another drug in addition to the current prescription.

Which is chosen depends on the doctor; there’s benefits and drawbacks for each option.

Typically, if a character developed tolerance to a medication quickly, and increasing the dosage did not work, they would not be tapered off and put back on it. There are a lot of other antidepressants out there (~30 FDA approved medications for treating depression, and god knows how many other drugs that are prescribed off-label for it), so it doesn’t make sense to waste time putting your character back on a medication that they already know won’t work for very long.

And as an FYI, when someone has severe depression that’s resistant to many different medications, ECT might be recommended as a treatment.

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Hi! Thanks for everything you do :) If a guy with bipolar is put on medication that sends him towards mania, would his doctor keep him on the meds to see if he even out, or would he immediately be taken off them? Thanks in advance!

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From the Shrink’s impression, mania’s pretty much considered an emergency. The symptoms of a full manic episode are severe enough that they wouldn’t be kept on the medication.

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