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How Do You Know When You Need Iop (an intensive outpatient program)?


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#1 lavender

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Posted 29 October 2011 - 12:45 PM

I recently started seeing a P-Doc after years of therapy for PTSD and basically failing to improve from some pretty major, life changing health conditions. Oh, and not getting off the couch for 6 months, which I thought was caused by my thyroid disorder, but wasn't improving with the thyroid meds.

P-doc put me on Lexapro, but I just slept all day. Then I tried Prozac and that made me suicidal. I was looking up ways people had committed suicide, getting in the bathtub then wondering if I could drown myself, so irritable I couldn't stand myself, and terrified. Suicidal thoughts stopped as soon as I stopped the prozac, and p-doc had me try Abilify. 3 weeks later, and I am better than I have been in a long time.

But the p-doc did a referral for IOP when I reported being suicidal on the prozac, and is still pushing for me to do a program. My T-doc (who has known me for years) thinks it's unnecessary because I have gotten so much better since stopping the Prozac. And I ended up refusing the program I was referred to after I found out I would have to take a leave of absence from school. It took a month to get an intake because of the waiting list, and I'm feeling better now.

I did find another program that fits my schedule better, but they don't have any openings. So, it's another wait. Meanwhile, I'm stuck between a P-doc and T-doc who don't agree. I don't want to do a program really, but I want to feel better, if that makes sense. And I don't want my P-Doc to think I'm totally uncooperative. I'm just not sure it will help me, and I don't want to waste my time since I'm already struggling with chronic fatigue that makes managing my daily tasks pretty hard.

I'm just wondering how to know when a program might be helpful?

Thanks

Edited by Blue Heron, 29 October 2011 - 12:56 PM.
changed the topic title to make it clearer

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DX: Major Depressive Disorder, PTSD, Alcoholism-sober for 9 years
Other Medical Conditions: Hypothyroid, Graves Disease, Fibromyalgia, Sleep Apnea, Migraines, Heart Palpitations
Current Meds: Abilify 7.5 mg, Effexor 225 mg, Neurontin 1500 mg, Provigil 200 mg, Armour Thyroid 150 mg, Metoprolol 25 mg am&pm
Supplements: Calcium, Magnesium, Vitamin B Complex, Vitamin D, Iron, Fish Oil
Failed Meds: Prozac, Lexapro, Zoloft, Cymbalta, Trileptal, Wellbutrin





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#2 martasi2

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Posted 30 October 2011 - 11:06 AM

You can always talk to the program director to get more information. What therapies and/or skills are taught? How are groups structured? How often do you meet w/a PDoc or therapist? It's a treatment option like any other, and you're entitled to know how it works before you sign up. Very few people do this, but it is your right.

I think it's important to know how your PDoc thinks you'd benefit from the program - what skills does he think it will give you, how will it help you cope better with your illness and life situation. There's a good reason he recommended the program, and it's worth hearing his views about it.

Your TDoc might be thinking only in the short-term. Sure, you're better since you're off one med and on another, but what about your overall skills level and life skills? What does your TDoc think about partial programs and is she biased against them. Some TDocs can be possessive and resent the influence of other clinicians. I'm not saying this is happening, I'm playing Devil's Advocate here based on my own experience.

Edited by martasi2, 30 October 2011 - 11:09 AM.

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#3 lavender

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Posted 30 October 2011 - 09:07 PM

P doc says I need CBT and DBT (which I would get in IOP) because those are the only therapies that are proven to work with depression. I had to stop myself from laughing at the guy because I'm in school to become a therapist, and I know that while CBT has a high success rate, no one therapy is for everyone, and CBT is not the only thing that works.

P doc also said because I don't have a good support system, which is funny because he never asked me about my support system, just knows that my abusive family is not in my life (which is a good thing) and that my girlfriend lives far away. I have a pretty solid support system of friends (family of choice) who I talk to daily. They know what's going on with me, and have been checking on me regularly since the whole Prozac suicidal episode. I told people after it happened because I was terrified and wanted a plan in case it happened again. I really don't want to have to call some strangers at a suicide hotline, and I'm really scared of hospitalization.

I suspect the P-doc was evaluating if I needed to go in-patient when he referred me to the IOP program. I refused in-patient and told him I wasn't going to kill myself, despite the thoughts, that I wanted help. So he really didn't have any grounds to admit me. But he said he was concerned because I had a past suicide attempt when I was 13, which was over 20 years ago. I get his concern, but I'm not chronically suicidal. Granted, I was pretty friggin depressed before the Prozac, but the suicidal thoughts really felt like they were triggered by the med and have subsided since I have been off it.

My T Doc knows me well, knows that I have tried to see other T docs in the past and have always come back to her in worse shape. She says I don't do so well with "standard treatment." She's pretty unique in that she does Existential Psychodynamic therapy, and what she does works for me. I got sober and out of an abusive relationship and have basically turned my life around in the 7 years since I have been seeing her. And I trust her, which is pretty huge for someone who survived the abuse I lived through.

I was doing really well until I got so sick 18 months ago. The longer I have been sick, the more my depression has spiraled down. I think one of the other things that led to my depression being so bad was that I was trying to see a different T doc for several months (insurance reasons), it wasn't working and that T-doc suggested I go elsewhere. That was right before I started the prozac and went back to my old T-doc.

I have been a lot better since I've been off the prozac and seeing my T-doc regularly, even before starting the abilify, I wasn't having any more suicidal thoughts, and my T-doc says I'm not in crisis anymore. I'm doing a whole lot better on the Abilify and have been able to do things I haven't done in 6 months.

So, I get the concern that my T-doc might be possessive, but she's right, that other therapies have failed me, that I always leave or get fired by other T-docs. I have tried individual and group therapy in the past, and nothing has been helpful besides my current T-doc. So, I'm pretty hesitant to spend the time and money to try one more thing, even though I really want to get better. I have pretty limited student insurance, and I don't want to use up all my mental health benefits now, when I need them to last me until next August.

The person who was supposed to evaluate me for the IOP program at the hospital my p-doc works at basically wasted my time telling me I needed to take a leave of absence from school, and that my professors would have to comply (my understanding from the school is that a leave of absence means forfeiting the semester). I had a class one day a week that conflicted with the program, and she said I couldn't miss IOP for it. Then she just kept saying it wasn't her job to sell the program to me. She couldn't tell me what the cost to me would be or if there was even financial aide to help with my costs. And the info she had on my insurance was wrong. So, it was a really bad fit.

I don't know much about the other program I am looking in to, except that it works with my school schedule (3 days a week 8-12) and there's financial aide to cover what my insurance doesn't pay. But I will ask more questions if I end up calling back, which I'm thinking is unlikely at this point. I really don't want to do a program.

Edited by lavender, 30 October 2011 - 09:12 PM.

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DX: Major Depressive Disorder, PTSD, Alcoholism-sober for 9 years
Other Medical Conditions: Hypothyroid, Graves Disease, Fibromyalgia, Sleep Apnea, Migraines, Heart Palpitations
Current Meds: Abilify 7.5 mg, Effexor 225 mg, Neurontin 1500 mg, Provigil 200 mg, Armour Thyroid 150 mg, Metoprolol 25 mg am&pm
Supplements: Calcium, Magnesium, Vitamin B Complex, Vitamin D, Iron, Fish Oil
Failed Meds: Prozac, Lexapro, Zoloft, Cymbalta, Trileptal, Wellbutrin


#4 bergsonisme

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Posted 31 October 2011 - 03:04 AM

Short answer is:

1) You're unwell enough that you're willing to invest time that you could spend doing so many things to see and do.
2) The financial aspect works out: you can afford it, or there's family support, or there's government/VA/uni money for that.

There are some alternatives to explore: occupational therapy, group therapy. I was terminally shy as a teenager and snapped out of it with theater lessons and a presentation in front of a large audience. But again, only you can tell how unwell you are.

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#5 lavender

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Posted 31 October 2011 - 12:59 PM

Short answer is:

1) You're unwell enough that you're willing to invest time that you could spend doing so many things to see and do.
2) The financial aspect works out: you can afford it, or there's family support, or there's government/VA/uni money for that.

There are some alternatives to explore: occupational therapy, group therapy. I was terminally shy as a teenager and snapped out of it with theater lessons and a presentation in front of a large audience. But again, only you can tell how unwell you are.

Here's a song: http://www.youtube.c...h?v=c3Q_MSbmhA4

thanks.
Maybe I'm just not ready/open to IOP right now, and my time (and money) would be better spent elsewhere until I am.
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DX: Major Depressive Disorder, PTSD, Alcoholism-sober for 9 years
Other Medical Conditions: Hypothyroid, Graves Disease, Fibromyalgia, Sleep Apnea, Migraines, Heart Palpitations
Current Meds: Abilify 7.5 mg, Effexor 225 mg, Neurontin 1500 mg, Provigil 200 mg, Armour Thyroid 150 mg, Metoprolol 25 mg am&pm
Supplements: Calcium, Magnesium, Vitamin B Complex, Vitamin D, Iron, Fish Oil
Failed Meds: Prozac, Lexapro, Zoloft, Cymbalta, Trileptal, Wellbutrin


#6 lavender

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Posted 31 October 2011 - 01:19 PM

If you decide that partial care is right for you, the nuts and bolts of establishing a routine and fulfilling your commitment to be there everyday could do wonders for your depression. Partial Care is like a job, but different from one in the fact that you'll be in a low-stress, non-competitive environment. If making friends is difficult for you as it is for me, you might find it easier to bond to one or two people--although you probably won't associate with them on the outside because most people protect their anonymity in programs like this. Think about, and discuss with your doctor about what groups would benefit you most. Groups fill up fast, and many of them are closed. Focusing on what you want may help you snare a group that your case manager might not select for you otherwise. I wish you the best of luck. :mad:

I appreciate your description of what it's like for you. I m pretty much back on a routine now. Going to bed and getting up at the same time each day, and at normal times (not 4 am) And I feel like one of my big stressors is having too much to do with the level of my fatigue, like not having enough time to get to my schoolwork with limited hours that I am capable of focusing (although that seems to be getting better too).

I didn't get the impression that I got to choose groups, for the programs I looked into, but I will ask. I really have no interest in CBT or DBT, even though that's what my doc thinks I need to do. I've had too much counselor education for my own good! My experiences studying both treatments haven't left me with a good feeling. But if I knew there were other types of groups, I might be more open.

I'm still not convinced IOP will be helpful. What I want is more energy to do the things I need to do, to be able to think more clearly, remember what I do from day to day, and to not feel like my brain is going too slow to keep up with the world around me. Oh, and to not feel overwhelmed by simple things like driving and making phone calls. And I'd really like someone to sit down with me and help me go through all my bills/medical bills to help me sort it all out and send in financial aide stuff instead of letting everything go to collections because I'm too overwhelmed to face it all (which is what my T-doc says I need). More of a case manager to help me out than me having to attend more groups.

I'm nervous because I go back to see the p-doc tomorrow, and have to face the fact that I already refused the program he recommended. I hate standing up to authority figures. I hate feeling caught between what he wants for me and what my T-doc wants for me. But I think maybe having written this all out and what I think will help me might actually help me get through tomorrow.
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DX: Major Depressive Disorder, PTSD, Alcoholism-sober for 9 years
Other Medical Conditions: Hypothyroid, Graves Disease, Fibromyalgia, Sleep Apnea, Migraines, Heart Palpitations
Current Meds: Abilify 7.5 mg, Effexor 225 mg, Neurontin 1500 mg, Provigil 200 mg, Armour Thyroid 150 mg, Metoprolol 25 mg am&pm
Supplements: Calcium, Magnesium, Vitamin B Complex, Vitamin D, Iron, Fish Oil
Failed Meds: Prozac, Lexapro, Zoloft, Cymbalta, Trileptal, Wellbutrin



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