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Question
Posted by: Rob28 | 2010/07/22

Prof, please help.

Hello again Prof, I hope you are well?

I''ll launch right into the problem.

Without going into the desperate detail about why, long story short, I''ve lost everything. The fact that I can send this is because someone else is paying for the internet access.

I used to be able to afford tons or psychiatric meds and regular consults with the psychiatrist. However, I''ve been referred to the state hospital. I have never actually seen a doctor - the nurse prescribes medication (which I''m pretty sure is illegal) without consulting with me for any great length of time. When I was scheduled to see the state psychiatrist for the third time in a row and he/she just didn''t bother to show up hours after I was told to be there - i decided to give up.

It has been months and I have not taken any psychiatric medication. And yes, I have bouts of depression (sometimes that it is difficult to get out of bed) but I don''t seem to be manic or even hypomanic. The depression doesn''t last long, maybe eight hours if it''s really bad. I still function - I mean, it''s not like I''ve stopped washing or something..

I have trouble sustaining sleep. And it doesn''t help that I''m harassed (really, as in abused over the phone) by debt collectors and banks and god knows who else.. and when I do sleep I don''t feel rested.. also, at times during the day I experience a sudden intense fatigue.

I''m also seriously suicidal, although I don''t know that I would actually do it, as I can''t even afford to be buried. I think I have R1.50 in my wallet.

I have over 100 pages of employer rejection letters from Sept last year. I am trying to get a job, but despite my best efforts I''m going nowhere quickly.

I am probably more trained than the nurse prescribing the medications so i object to her diagnosis.

The pressure''s mounting, and I don''t know I can sustain this incredible pressure for much longer (for instance, I have lots of friends that want to go out for a cup of coffee - but I can''t even afford that.. so I keep lying my way out of it and isolate myself in the process involuntarily)

Prof, any advice you can give I would appreciate.

Last Dx: F31.7
Last Rx: Epilim CR 500mg bid, Lithium Carbonate 400mg ii nocte

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Our expert says:
Expert ImageCyberShrink

Not as well as I might be, not as ill as I could be. Thanks for kindly asking, Rob
Private practise is more unpredictable in quality than one might expect, but at least as a more directly paying customer you have some leverage in being mildly assertive. The State sector is also even more unpredictable in quality, but there are still some good people working within it, and where there are students in training, you might find someone more ready to take an interest and to get other advice to guide your treatment.
It is indeed illegal for a nurse to actually prescribe medicines, unless they've sneaked in some legal change without letting me know. In some hospitals or clinics they have more autonomy once a doctor has authorized the prescription, to vary doses, etc.
And nobody should be on treatment without having at least been seen and initially assessed by a doctor, and wihout a doctor supervising whatever others do within the treatment plan.
Doctors who simply don't bother to trn up for clinics they are supposed to attend ( and paid to attend ) should simply be sacked - they're a waste of public money. I wonder if there is some way to approach the Superintendent or senior hospital administrator to ask about why this has been happening, as they may be unaware and really need to look into it. At first my rapid typing produced a typo, that they should :"loom into it" which would probably be a good idea, too
I have no financial expertise at al;l, but it may be worth disussing with your bank and creditors, as its better for them to get at leasty SOME of the money owed, eventually, than simply harrassing you ( which costs then money ) in ways that make it even harder for you to eventually repay.
As regards the friends, tell them frankly that you would love to see them and chat with them, but sadly can't afford a cup of coffee. Real friends wouldn't be bothered and can surely afford a couple of cups.
A fresh assessment of your condition is really necessary. You are not describing major bipolar symptoms, even if not taking meds at present, but the persistent suicidal thoughts must be taken seriously, as well as the incomnia - and yet the medications apparently recommended contain no antidepressants, merely mood stabilizers suitable for marked bipolar problems.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

3
Our users say:
Posted by: Renata | 2010/07/22

All i can say is Pray!

Reply to Renata
Posted by: anon | 2010/07/22

gosh, i feel so sorry for you, i know it doesnt help to say that...

i know you say the depression doesnt last long, but isnt extreme fatigue and ''un-rested'' sleep signs of depression as well?

cant you perhaps get a job as a waiter in the meantime?
or something, i dont know...

what are you qualified as? maybe an internship to cover the basics? perhaps youve tried that already, hey.?

man i wish i can help but i cant even if i knew you.

Reply to anon
Posted by: cybershrink | 2010/07/22

Not as well as I might be, not as ill as I could be. Thanks for kindly asking, Rob
Private practise is more unpredictable in quality than one might expect, but at least as a more directly paying customer you have some leverage in being mildly assertive. The State sector is also even more unpredictable in quality, but there are still some good people working within it, and where there are students in training, you might find someone more ready to take an interest and to get other advice to guide your treatment.
It is indeed illegal for a nurse to actually prescribe medicines, unless they've sneaked in some legal change without letting me know. In some hospitals or clinics they have more autonomy once a doctor has authorized the prescription, to vary doses, etc.
And nobody should be on treatment without having at least been seen and initially assessed by a doctor, and wihout a doctor supervising whatever others do within the treatment plan.
Doctors who simply don't bother to trn up for clinics they are supposed to attend ( and paid to attend ) should simply be sacked - they're a waste of public money. I wonder if there is some way to approach the Superintendent or senior hospital administrator to ask about why this has been happening, as they may be unaware and really need to look into it. At first my rapid typing produced a typo, that they should :"loom into it" which would probably be a good idea, too
I have no financial expertise at al;l, but it may be worth disussing with your bank and creditors, as its better for them to get at leasty SOME of the money owed, eventually, than simply harrassing you ( which costs then money ) in ways that make it even harder for you to eventually repay.
As regards the friends, tell them frankly that you would love to see them and chat with them, but sadly can't afford a cup of coffee. Real friends wouldn't be bothered and can surely afford a couple of cups.
A fresh assessment of your condition is really necessary. You are not describing major bipolar symptoms, even if not taking meds at present, but the persistent suicidal thoughts must be taken seriously, as well as the incomnia - and yet the medications apparently recommended contain no antidepressants, merely mood stabilizers suitable for marked bipolar problems.

Reply to cybershrink

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