This is a post all psychiatric registrars should read when considering how to build rapport with new patients. I experienced a manic switch about 2 days after starting pristiq. I switched from being hysterically, suicidally depressed to bouncing off the walls. I couldn’t sit still, I couldn’t sleep, I was energised, excited, engaged, I even wrote a letter to the drug manufacturer thanking them for curing my depression. I got out of bed at 4am, ran to the supermarket, bought ingredients to make pancakes and lemon curd, cooked breakfast for the house and then washed the windows. Days before I couldn’t stop crying, planning my suicide or get out of bed.
My GP had also prescribed diazepam – she said it was a precaution because in some instances people’s energy increases before their mood on antidepressants and they’re at a higher risk of suicide because they feel low but suddenly have the energy to act on their urges. She said to take the diazepam if I felt at risk. I didn’t feel at risk but I did feel out of control on the pristiq so I started taking the diazepam. No matter how much I took it didn’t have any effect on my hypomania. It was crazy.
At that point I was seeing my GP twice a week until we got on top of my “depression” so I saw her later that same week and declared that I was cured. I remember her looking at me, intensely, asking “I can see you feel good, but do you feel too good?” I had to admit that I did. She took me off the pristiq and prescribed a low dose of sodium valproate and made an appointment for me to see a psychiatrist to get a proper diagnosis.
She continued seeing me regularly until I could see A. My mood kept cycling rapidly. It was awful, up one day and down the next. My wife and mother in law were intolerant.
The day came when I went to meet A. I was anxious. I had to open up to a complete stranger and answer all sorts of questions about my inner world. I was also concerned that I wouldn’t know what was relevant and I’d waste our time. My GP had written in her referral letter that I was living with my wife and mother in law. I didn’t know how that would go down, whether he’d judge me or not. I remember him opening his door and my chest was pounding. What he did was perfect. He shook my hand, introduced himself by his first name, and asked me where I got married. I replied and he told me not to tell his boyfriend because his boyfriend wanted to get married but he didn’t. He was in a same sex relationship too! I felt immediately at ease. I asked him how long we had (90 mins) and told him he’d need to ask all the questions because I didn’t know what was relevant and what was superfluous. He said that was fine. As he conducted the consultation he listened, provided opinion, and concluded with a diagnosis and a new, more aggressive medication regime. At no time did I feel judged or humiliated. He was warm, compassionate, respectful, non-judgemental and professional.
I continue to see A monthly and he coordinates my care across my inpatient psychiatrist, S, (A doesn’t do admissions), my GP and my psycho-sexual therapist. I feel lucky to have someone so generous to be my psychiatrist.