Mental Health Series: Dopamine Agonists and Compulsive Disorders – Not a Good Mix

I have several compulsive disorders: Obsessive Compulsive Disorder, Binge Eating Disorder, and Compulsive Shopping. My other disorders include Bipolar Disorder 1, Generalized Anxiety Disorder, Social Anxiety Disorder, PTSD, and more. Although, of the three compulsive disorders, Compulsive Shopping hasn’t been given an actual Mental Illness disorder designation, it is heading in that direction.

I remember back in 2008 when I realized I had a problem. I spent over $5,000.00 in one month. Most everything I bought was for my new granddaughter, but it wasn’t necessary or required. I just went in the stores, went to my happy place, and resurfaced as I left the store, wondering how I could have spent so much and why did I have so many packages and bags?

A blog post, Compulsive Shopping Symptoms and Secrets sums up the emotional aspects of why we shop:

COMPULSIVE SHOPPING SYMPTOMS

•                Compulsive shopaholics who shop when they are feeling emotional distress

•                Trophy shopaholics who are always shopping for the perfect item

•                Shopaholics who want the image of being a big spender and love flashy items

•                Bargain seekers who purchase items they don’t need because they are on sale

•                Bulimic shoppers who get caught in a vicious cycle of buying and returning

•                Collectors who don’t feel complete unless they have one item in each color or every piece of a set.

•                When they are feeling “out of sorts, shop for a ” pick-me-up.”

The blog posts goes on to identify some of the emotional symptoms identifying compulsive shopping:

•                Spending more than they can afford

•                Shopping as a reaction to feeling angry or depressed

•                Shopping as a way to feel less guilty about a previous shopping spree

•                Harming relationships due to spending or shopping too much

•                Losing control of the shopping behavior

Fast forward to this year, 2016. I have attempted to keep my compulsive shopping in check, although I still had my moments. However, this year, it went over the top out of control. My husband I moved an hour north of where we used to live in Tampa, FL, to an airport community. It was beautiful and so serene, calming, and relaxing. Everyone had the same interest; nearly every home had a hanger with a plane or three. The runway went right down the middle of the community with our roads as taxiways. I’ve developed five gardens so far in the back yard, and we have visitors such as deer, turkeys, Sand Hill Cranes, Eagles, Hawks, Falcons, rabbits, and more.

We did have to spend quite a bit of money getting the house prepared to move in as it was a foreclosure that sat empty for five years. It needed everything from air conditioning units; to appliances; to a septic tank lift station, to a hanger door. And so much more, this post could turn into a laundry list of repairs.

It took a LOT of money.

So, my husband’s idea was to put us on a budget to repay all the expenses incurred, as well as provide various categories for future spending with limits for each month.  It was something I just couldn’t grasp. I tried, every month, every week, every day, but I still was spending my budget in the first week, and moving money around to compensate for the rest of the month’s shopping sprees.

It even got to the point that one weekend, my husband wanted to Baker Act me into a psychiatric hospital to see if something seriously drastic could be done. Even if it just kept me from spending for a few days. It was a last ditch effort to stop my compulsive shopping and a way to save my husband’s own sanity.

Instead we had a very long, heart to heart talk about my feelings of being controlled by him and the budget, my feelings of not being worthy as I am a disabled Veteran and am unable to work outside of the home. What my purpose in life versus what my husband’s idea of my life purpose differed. I wanted to contribute more money to our income, but my husband felt that my mental health was more important, and I didn’t need to work, he’d rather I didn’t, and he preferred that I take care of the house, the pets, the gardens, and relax.

I just couldn’t do that.

So, he accompanied me to my next Therapist appointment and we talked to him and asked him to help. And, he has, but I got even more help from my psychiatrist today. I told him about the compulsive shopping and he immediately focused on dopamine agonists. It was first prescribed at the end of February 2016 for Restless Legs Syndrome (RLS.)

It has been discovered to have a very nasty side effect. It increases and causes compulsive activities.

Dopamine agonists were first released to the public in 1997. An ABC News article titled Strange Side Effects Surprise Patients, published July 15, 2008, stated the following:

Dopamine agonists, which mimic the brain chemical known as dopamine.

Dopamine works in the brain's movement and coordination centers, and it is also involved in the brain's pleasure response by reinforcing behaviors that provide enjoyment -- including drinking, drugs, sex and gambling.

The article went on to say that the makers of these dopamine agonists have been putting warnings in their medication documentation, but did not realize that it had gotten this out of hand, as stated in the ABC News article:

Scientists have recently begun to quantify the behavioral changes associated with dopamine agonist drugs. In a study presented in late June at the International Congress of Parkinson's Disease and Movement Disorders conference in Chicago, more than 13 percent of 3,090 Parkinson's patients had a problem with compulsive gambling, buying, sex or binge-eating.

People who were taking dopamine agonists had a two- to three-times greater chance of having one of the four impulse-control disorders.

A two to three chance? How about those who already have compulsive disorders? I can attest the chance of affliction is much higher and the effects are so much stronger.

What are dopamine agonists? 

According to the Parkinson's Disease Clinic and Research Center:

There are two commonly prescribed oral dopamine agonists in the United States:

Pramipexole

Ropinirole

• Apomorphine, a subcutaneously administered dopamine agonist, was approved for use in the United States in 2004. The dopamine agonists differ in several respects, including
• chemical structure
• duration of action
• side effects
• 
  
• Bromocriptine and the recently withdrawn pergolide are ergot derivatives and may rarely cause retroperitoneal, pulmonary, and pericardial fibrosis, and cardiac valvulopathies. Pramipexole and ropinirole have half-lives 6-12 hours and are therefore taken 2-3 times daily.
•  
• Pramipexole and ropinirole 
• Pramipexole and ropinirole are not ergot compounds. Large clinical trials comparing these medications to levodopa showed that they can be used in early Parkinson's disease and reduce the severity of symptoms. Over the years, differences in the effects of the dopamine agonists have emerged. One side effect is daytime sleepiness and "sleep attacks." Although this may occur with all of the dopamine agonists (and levodopa), it was first appreciated in people treated with pramipexole.
• 
  
• Apomorphine 
• Apomorphineis indicated in patients who experience "off states"refractory to modifications of oral medications such as increasing the dose or frequency of dopaminergic medications or introducting a COMT inhibitor. It has a rapid onset of action, usually within 10-20 minutes but the duration of action is short, lasting for only about an hour. Apomorphine is only available from specialty pharmacies. Because nausea occurs in the vast majority of patients, pretreatment with trimethobenzamide (Tygan®) is required. Initial titration and observation for side effects (syncope, hypotension) must occur in the physician's office.

In January 2014, the Addiction.com website wrote an article that provides some helpful information about what to do if you’ve been taking dopamine agonists.

If you’re a patient taking a dopamine agonist, the options are unfortunately limited. It’s worth noting that the incidence of these side effects is quite low, but there is still a chance you’ll develop them. If you’re experiencing symptoms of compulsive behavior after starting on a dopamine agonist, the best thing to do is to contact your doctor about it as soon as possible. Compulsive gambling, sex and shopping all have the potential to financially ruin patients or obliterate romantic relationships, so the importance of reducing their impact can’t be overstated. In the event of negative consequences, your physician may be able to suggest an alternative treatment. Do what you can to better your health!

As for my mental health, my psychiatrist took me off the medication immediately. I am now taking supplements to treat my Restless Leg Syndrome (RLS): Potassium and Magnesium. It will take approximately two weeks for the effects of the drug to leave my system.

I no longer have this dark cloud hovering over me, questioning every purchase or thought of purchase. I have a better future to look forward to with my husband and our plan to get out of debt.

Have a blessed and happy day.

Vicki

Mental Health Series - PTSD (Post Traumatic Stress Disorder)

Post-Traumatic Stress Disorder (PTSD) 

Recently I went through a PTSD crisis. It occurred because of a trigger that happened several weeks ago. A couple of days after that trigger, another trigger occurred. Then, a couple of days later, another trigger occurred. They weren't monumental triggers like having the same traumatic event happen. They were triggers of telling the event in various ways and talking about it to fill out some disability paperwork. Then the next trigger was a personal lesson during bible study. The third trigger was just a discussion on forgiveness.  Just a simple word and a simple non-related discussion.

However, each event built upon the other causing very serious symptoms in me. I became anxious, increasingly emotional, flashbacks, nightmares, insomnia, loss of desire to be with others, lack of ability to concentrate on activities, and eventually a series of panic attacks that escalated throughout the two weeks I attempted to cope with it on my own, until I ended up in the psychiatric ward of the hospital for intense, immediate and safe treatment. Especially, because I started having suicidal thoughts.

I'm out of the hospital now, but I'm not "cured." I'm not over the PTSD crisis. It's still there. But, I'm better able to cope because of the skills I learned while hospitalized, the addition of a mood stabilizer, and a medication to help me sleep. All of these combined, still do not make the PTSD crisis go away. I still need to work with my psychiatrist and my therapist to develop a treatment plan. Hopefully, this plan will include EMDR therapy. I've had EMDR therapy before, but it was nearly six years ago. Because the of the intensity of the triggers, I believe another session is required. 

When someone is feeling threatened, a “flight or fight” response is triggered that protects them from harm. However, in someone with PTSD, the “flight or fight” response is changed or damaged in some way. Someone with PTSD can feel stressed or frightened even when there is no threat of danger.

How does PTSD develop? 
PTSD usually develops after a terrifying, horrific ordeal that either involved physical harm or the threat of physical harm. Usually the person who develops PTSD may have been the one to be harmed, or the harm could have happened to a loved one, or the person who develops PTSD could have witnessed a harmful event that happened to a loved one or even to strangers. These result in the person developing Fear Memories.

Even though PTSD was first brought to the public’s attention by war veterans, PTSD can result from a variety of traumatic events: assault, muggings, rape, torture, kidnapped, held captive, child abuse (physical/sexual), childhood neglect, sudden death of a loved one, car accidents, train wrecks, plane crashes, terrorist attacks, bombings, or some kind of natural disaster such as flood or earthquake.

The person involved in the event can develop PTSD or other people can be affected who have to pick up the pieces of the tragic event afterwards such as: emergency workers, law enforcement officers, friends, and/ or family.

PTSD development varies from person to person. Symptoms can occur within hours or days of an event, it can sometimes take weeks, months, or even years before the symptoms actually appear.

How are Fear Memories created? 
Scientists are currently working on studying genes that play a role in creating fear memories. Like other mental disorders, it is likely many genes with small effects are at work in PTSD: (Stathmin, GRP, 5-HTTLPR)

What are the causes of PTSD? 
While scientists study the brain and fear and stress to determine the causes of PTSD, environmental factors are also considered: childhood trauma, head injury, or a history or mental illness.

How common is PTSD?
Although it’s been said that any of us can suffer from PTSD given the right circumstances, it’s estimated that approximately 5% of men and 10% of women suffer from PTSD at some point in their lives.

What are the signs or symptoms of PTSD?
PTSD can cause many symptoms. These symptoms are grouped in three categories: 

1. Re-experiencing Symptoms
2. Avoidance and Numbing Symptoms
3. Increased Anxiety and Emotional Arousal Symptoms

What symptoms do the three categories have? 
1. Re-Experiencing the Traumatic Event

• Intrusive, upsetting memories of the event 
• Flashbacks, (acting or feeling like the event is happening again) 
• Nightmares (either of the event or of other frightening things) 
• Feelings of intense distress when reminded of the event 
• Intense physical reactions to reminders of the event (such as: pounding heart, rapid breathing, nausea, muscle tension, sweating) 

 2. Avoidance and Numbing

• Avoiding activities, places, thoughts, or feelings that remind you of the trauma 
• Inability to remember important aspects of the trauma 
• Loss of interest in activities and life in general 
• Feeling detached from others and emotionally numb 
• Sense of limited future (you don’t expect to live a normal life span, get married, have a career) 

 3. Increased Anxiety and Emotional Arousal

• Difficulty falling or staying asleep 
• Irritability or outbursts of anger 
• Difficulty concentrating 
• Hyper-vigilance (on constant “red alert”) 
• Feeling jumpy and easily startled 

 Other common symptoms of PTSD include: anger and irritability, guilt, shame, or self-shame, substance abuse, feelings of mistrust and betrayal, depression and hopelessness, suicidal thoughts and feelings, feeling alienated and alone, and physical aches and pains.

Who is at risk for PTSD?
Although it’s impossible to predict who will develop PTSD in response to any trauma in their life, there are certain risk factors that can increase your vulnerability.

• Previous traumatic experiences, especially in early life 
• Family history of PTSD or depression 
• History of physical or sexual abuse 
• History of substance abuse 
• History of depression, anxiety, or another mental illness 
• High level of stress in every day life 
• Lack of support after the trauma 
• Lack of coping skills 

What are the treatments for PTSD? 
Education plays a big part of treating others for Post-Traumatic Stress Disorder (PTSD). It helps to provide information about the illness to help the person manage their symptoms. Psychological and medical help is also given to those with PTSD. When receiving education about PTSD, the person who suffers from PTSD will learn about others, their traumas, and that it is caused by stress rather than weakness in the person involved.

Cognitive Behavioral Therapy is an important part of using therapy to help those with PTSD. This many even be combined with group therapy. It helps people who suffer from PTSD to recognize and adjust their trauma-related thoughts.

Eye-Movement Desensitization and Reprocessing (EMDR), a form of cognitive therapy, has been found to be extremely successful in helping those with PTSD. It works by the person with PTSD talking about the trauma they suffered and the negative feelings they associate with the event, while focusing on a rapidly moving object or a tone while wearing headphones.

Medications are also helpful. They help the various environmental and/or physical symptoms demonstrated by the person with PTSD, such as serotonergic antidepressants. Other medications such as mood stabilizers and antipsychotics have also been found to be helpful.

Those with PTSD who maintain their medical regime are less likely to experience a relapse of their illness if the antidepressant treatment is continued for at least a year.

When should someone who suspects PTSD see a doctor? 
If symptoms occur for more than a month, it may mean the person is suffering from PTSD. It doesn’t necessarily mean you have PTSD if you’ve experienced a traumatic event and suffered some occasional fear and anxiety, lack of concentration, sadness or changes in sleeping or eating habits, or even bouts of crying. However, if the symptoms are severe enough to impede the person’s ability to get back to a normal life he / she should see a medical professional. If the symptoms are so strong that someone in the person’s life such as a friend or family member feel that they may harm themselves, seek medical attention immediately.

I should have let my psychiatrist and therapist know immediately how severely affected I was due to the PTSD triggers. It's possible, the right treatment could have been started immediately, thus, avoiding an Emergency trip to the hospital resulting in hospitalization.

I beg you. If you or someone you know experiences anything like what I've described here in this article, please seek professional help immediately. Don't wait. It only makes the situation worse.



 Image Copyright: unkreatives / 123RF Stock Photo

Mental Health Series - Top Five Healthy/Unhealthy Ways to Cope with Anxiety

The Five Unhealthy and Five Best Ways to Cope With Anxiety

Anxiety is something we’ve all probably experienced in our life. We’ve lived through a life-threatening moment where our heart races or we’ve felt anxious about a test or before a hospital procedure.  We may have had to cope with an emergency. This is normal anxiety and it goes away once the situation does.

However, for those who suffer from anxiety, symptoms can continue while the situation doesn’t. These symptoms can frighten a person into an ongoing cycle of worry and anxiety that perpetuates more symptoms.

Anxiety affects us in four distinct ways:

• ·      How we feel
• ·      How our body works
• ·      How we think
• ·      How we behave

How We Feel?

1      Are you anxious? Nervous? Worried? Frightened
  Do you feel like something horrible is going to happen?
  Are you tense, stressed? Uptight? On edge? Unsettled?
  Do you feel unreal? Strange? Woozy? Detached?
  Are you panicky?

How Our Body Works?

1     1.     Heart pounds, races, skips a beat?
2.     Chest feels tight or painful?
3.     Tingling or numbness in toes or fingers?
4.     Stomach churning or butterflies?
5.     Having to use toilet?
6.     Jumpy or restless?
7.     Tense muscles?
8.     Body aching?
9.     Sweating?
10. Breathing changes?
11. Dizzy, light-headed?

How We Think?

1    1.     Constant Worrying?
2.     Can’t Concentrate?
3.     Thoughts Racing?
4.     Mind jumping from one thing to another?
5.     Imagining the worse and constantly thinking about it?

How We Behave?

1    1.     Pace Up and Down
2.     Start jobs and not finish
3.     Can’t sit and relax
4.     On the go all the tie
5.     Talking quickly or more than usual
6.     Snappy and irritable behavior
7.     Drinking alcohol more
8.     Smoking more
9.     Eating more or less
10. Avoiding fearful situations

Anxiety is an illness that cannot be cured. But with careful management, it can be reduced and treated. You must learn to work on your anxiety by:

·      Understanding your anxiety better

·      Reducing the physical symptoms

·      Altering your thoughts related to anxiety

·      Changing your behaviors related to anxiety

If you do not do these things, the following can occur if you tend to treat your anxiety by following the advice of the worst ways to cope with your anxiety. If you see yourself in any of these situations, please contact a mental health professional or your primary care physician and seek medical attention immediately.

Top Five Unhealthy Ways to Cope with Anxiety

Unhealthy Thinking– Worry, Obsessive thinking, Rumination – all of these can trap your mind in an endless loop and spiral into more advanced mood disorders such as Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, and other psychological conditions.  Obsessive thinking exaggerates and extends upsetting feelings. Rumination focuses on future outcomes of events that haven’t occurred or gives the person something to worry about by having an uncontrollable preoccupation of the past.

Unhealthy Eating

Stress and anxiety increases your appetite along with triggering the release of a number of chemicals in the brain including adrenaline and cortisol. These make you feel alert to help you handle any threat and make you ready for action. However, whenever you’re overly stimulated with anxiety, your body begins to crave comfort foods for biological and psychological reasons. Your body craves foods associated with memories from childhood and comfort.

Unhealthy Drinking/Drugs/Illicit (Illegal) Activities

One way to avoid your anxiety is to self-medicate with alcohol, drugs or illegal drugs, or other types of illicit activity such as self-harm, like cutting. These activities do not reduce the anxiety, replace the anxiety, or remove the anxiety. They only delay or magnify the symptoms.

Unhealthy Sleeping

One way the body deals with an anxiety attack is to shut down all bodily functions, and sleep. You may think that if you sleep away your anxiety, you will awaken with the anxiety gone and you can then go on with your life. It doesn’t work that way. You’ll only have slept away most of your days and nights and not accomplished anything but worry your family and friends, and possibly lost your job or gotten behind on paying your bills. The anxiety will still be there.

Unhealthy Withdrawal from Social Functions/Friends/Family

When you withdraw from friends, you may begin watching too much television, or do too much of one activity alone. This is not healthy for you. You cannot avoid your issues my avoiding your friends and family. 

Top Five Best Ways to Cope with Anxiety

Physical/Relaxation Exercise

Try some physical exercise to get the heart beating at a regular beat that stretches your muscles, but also try some relaxation methods such  as aerobics, walking, yoga, or massage as well.  By keeping up with healthy exercise, you will automatically assume a healthy sleep cycle.

Social Activities

Keep up with activities in your age group or neighborhood. Go to a senior center if need be, or other group in your appropriate age group. Find out what activities are taking place and join. Talk to your family and friends and form a regular weekly game night. Do whatever makes you happy and joyful.

Maintain a Support System

Reach out and connect with others who you trust and can stay in contact with on a regular basis. Make sure that you include your mental health physician or therapist, your primary doctor, a neighbor, your life partner or closest friend, and anyone else you can trust. These are people who you will be able to go to if you ever need to when an anxiety episode strikes or if you feel the need to use emergency services someone there can call one of these people for you.

Prayer/Meditation

If it so moves you, join a local church of your affiliation. There are many functions among the church family. You can always ask for prayer or find someone to pray with you. Listening to self-guided hypnosis or meditation is another way to help you relax and cope with your anxiety.

Healthy Eating

Maintain a healthy balanced diet, as much as possible. Eat lean protein, green vegetables and drink plenty of water to keep your body hydrated and avoid sugar and processed foods.

When you become aware of how you handle anxiety, you make healthier choices. Studies suggest that highlighting social ties can deliver certain health benefits.

Remember, you are only one defining decision from a totally different life.

image courtesy of incredible joy.com 

Mental Health Series - TIPS FOR YOUR APPOINTMENT WITH YOUR PSYCHIATRIST

The following recommendations can make the experience with your psychiatrist more helpful and satisfying:

1.- Remember to verify with your insurance that your provider is in network or if you need a referral from your PCP, before you schedule your appointment.

2.- The day of your first appointment make sure you have directions and try to get there 15 to 20 minutes early to fill out new patient paperwork.

3.- Be always on time for your appointments. Your therapy time is very important, and every minute counts.

4.- Remember to take with your photo ID and health insurance card with you the day of your appointment.

5.- Write a list including all the prescriptions or over the counter medications, herbs, vitamins or  supplements that you are currently taking and any medication allergies.

6.- Make sure your records from previous providers are sent before your appointment, that way your Psychiatrist can review them beforehand and have a better idea of your history.

7.- If you need to cancel or reschedule your appointment call 24-48 hours in advance. Same as your time, your provider time is also important.

8.- Write down all your symptoms and for how long you have had them. And all the questions you want to ask your doctor as well.

9.- If you don’t understand something, ASK. Your provider will clarify the information for you.

10.- Remember to make your follow up appointments at the end of your visit and get an appointment card with the date and time, as well as the recommendations provided during the current visit all  written so you won’t forget.

11.- Don't worry. Your provider is there for you. Use your time wisely by asking important questions and paying attention. If you don't understand ask your provider to repeat or explain in a way that helps you understand. It might be helpful to bring along a notebook and pen to write down everything said so that you don't have to try and recall from memory.

Do you have tips that can help others? Please list them in the comments below. Thanks!