Today has been unusually rough. I reached out to my psychiatrist because I wanted to change my meds. Specifically, I want to get off of the Clozapine and possibly try IV Ketamine. However, his response was not as I hoped it to be. Basically, it was an ultimatum. Either I go back on ECT or possibly try IV Ketamine, but it would be in addition to Clozapine. If I go off of Clozapine, he will no longer be my psychiatrist; he would only continue to see me for 30 days or until I find a new doctor.

I’m going to come up with a list of questions to ask him at our next appointment on January 11th. My husband will be coming with me. I don’t know what I’m going to do.

I’m off to go see a Coyotes game; hopefully that will make me feel a little better.

I'm a 32 year old married woman who has been dealing with Bipolar disorder since the age of 14. This is all about my life, diagnoses, and treatments. If you have any questions, just ask me. I hope that others with Bipolar Disorder or PTSD can relate to my blog and find it helpful.

38 thoughts on “Ultimatum From My Doctor”

  2. Do you have any idea how many medications there are out there available to treat Bipolar? Furthermore many of them can be combined with each other. So maybe you tried one by itself a few years back and it didn’t quite work and you tried this other one by itself and it didn’t quite work. Both of them almost did the job alone. What would happen if you took them together? What were the side effects? Were they tolerable? Did either of them cause weight gain for you? I’m telling I had a doctor like this who thought an ultimatum like this would work. I found another doctor. This new doctor found me a med that treats me Bipolar, PTSD, and my migraines. Because this new doctor was willing to listen to all my symptoms and was willing to do her homework. More than likely we will be adding a new med to the one I’m taking at some point here but she is still listening to me. And that is what you need. Bring in your questions. Bring in your husband. But start collecting a list of new doctors too. Do not let this ultimatum have power over you. Let your husband take care of finding the new doctors if you need to but get that list ready. Put the negotiations back on the table because what this doctor has done by giving that ultimatum is shut the conversation down. Ultimatums are ALWAYS power plays. Always. It’s never about the patient. It’s never about your health. If it was he wouldn’t threaten to leave you. He wouldn’t attempt to trigger panic and desperation in you. It’s very likely that he believes you have no where to go and that he is your only option. Or worse, he believes you have become dependent on him. It happens a lot and this is why the ultimatum works. Prove him wrong because this is bullshit. Let your husband see what I’ve just had to say. Go over your options together for other doctors. If you really don’t have another option and you really have to stay with this asshole then you’re going to have to play the game a bit differently. Sadly in mental health the unspoken consensus is that it’s completely okay to sacrifice physical health and well-being in the name of mental stability. I have a sister that is a psych nurse so I’ve heard the argument a billion times. I will NEVER agree. I just know that if your husband is fighting with you on this you will have better chances than if you are fighting this alone. So if he starts making his presence known and makes his voice heard on your behalf you may see your doctor start changing his tune. But seriously, I don’t trust doctors that make ultimatums like that. Ever.

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    1. I’ve been on just about every med possible, in many combinations. I’m currently on 13 medications (3 are for physical health, the rest are for mental health). I’m not sure what I’ll decide this time, but I will definitely research everything thoroughly and come up with a plan before I see my doctor again. I really like this doctor and I don’t want to lose him unless absolutely necessary.

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      1. Definitely get your husband to speak with your doctor then to report the behaviors and moods he is seeing. Sometimes what pdocs see in us is the attitude “I don’t need meds” which is part of our illness sadly. And quite honestly part of MY illness is paranoia. Certain things will trigger and cause it to flare hard – ultimatums are one of those for me. So for me, hearing this my first response is always going to “nope right out” and find someone else.

        However… looking at this from a calmer and more logical perspective:

        If you like this pdoc and you do trust him then my advice is that instead of focusing on changing meds, focus on making him understand what’s happening first. Make him understand how you feel, how you are doing, and how rapidly you are gaining the weight. Get your husband to help you make the pdoc see and understand this. Because until that happens the pdoc isn’t going to understand or agree than a med change is even needed. Even if he does agree, if he doesn’t know exactly what’s happening in your world then he’s flying blind with the med change. That’s not good.

        The other thing I didn’t realize was that you were taking more than one med for this. I mistakenly assumed it was the only med you were taking. It’s odd that I made this assumption. My sister is a psych nurse and she has been in the field for years. A part of me knows that polypharmacy happens all the time both in psych and in geriatric care. But for whatever reason I made mistake. I’m sorry. The moment you add another medication – of any kind – to the mix is the moment that med changes become more complex. Nothing happens in isolation when it comes to the body. Even heart meds will effect the brain. This is why we are seeing blood pressure meds being used in psych now. I have a son that has a script for one and he doesn’t have blood pressure issues.

        This is why I’m now saying tell your pdoc everything – ALL your symptoms, ALL your concerns, ALL your side effects – everything. Even if you don’t think it’s a big deal. Your newest med might be clashing with one of your phys. health meds for all you know and it might be the reason you are having the issues you are having. You might have more options there in switching out a phys. health med that is more compatible with the newest psych med. I don’t know but it’s worth asking – especially if you like this doctor.

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      2. omg! i’m not a doctor and i never played one on tv. she was 8 meds, switch to a new doc who immediately started weaning her off of meds. some doctors forget that if a drug isn’t showing more positive effects than negative, then in the words of frozen it’s time to let it go, .

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  3. I might be wrong but I don’t think making you stay on a medication that makes you gain weight (and therefor adding to your depression) is a good idea.

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  5. Hope everything works out in your favor. I strongly support the IV ketamine as I’ve read numerous journal articles on the success rate. I do know your past with the drug but hopefully in a controlled environment the past can be combated. May I ask…have you ever discussed with your doc that perhaps you’re on too many medications? Just a thought. That was the case with me, but that doesn’t mean it is for anyone else. I just know that one drug causes numerous side effects that you need drugs to treat each of those and its a never ending cycle.

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  6. my 2¢

    your the patient and the boss. only you really know the effects of the side effects. sure you can describe them, but things get lost in translation.

    your doc is there to get you medically based opinion not deliver ultimatums. i sure hope if you had cancer that your doctor wouldn’t turn you away because you decided against chemo. there is no difference.

    as long as you don’t live in a small town and getting to another doc would be an inconvenience, switch to another doctor. the following two paragraphs are lifted from the modern day hippocratic oath;

    I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

    I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

    I’d remind of these parts of the hippocratic oath and dump him anyway since he doesn’t want to live it.

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      1. I only did three sessions and it did not produce results. It is effective in 70 percent of people while 30 percent it does not help. You basically have an acid trip during each session. My third session was scary as hell and I felt trapped. I vowed to never go back. I believe it does work for a lot of people. When you say dissociate do you mean during the session?

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  8. Anyone, doctor or not, who delivers ultimatums deserves to be left and someone who is more understanding and helpful found. Any psychiatrist worth their salt should know better than to force an ultimatum on bipolar or depressed people. This is a controlling behavior that I would consider intolerable.

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  9. I dont know if it works for you but ketamine did wonders for me after 20 meds failed (lithium worked for a bit and symbyax)… its not as scary, bring some relaxing music, chill out and disassociate, anyway the first time around they should give you .5ml/kg, which is very light trip, once you see its ok and its not insane and feel comfortable they usually up it to .8ml/kg, i currently take about 1ml/kg and it works 3-3.5 weeks for me. Im fighting to get a therapist because i was dumb enough to tell them i went to that clinic thinking they would be supportive but they immediately said i was a substance abuser, anyway check out my blog, i’ve lived the last year with 0 depression but i need help with my PTSD symptoms from a trauma clinic, but im on Medicaid and none would see me since its in my medical records now, so the battle goes on… be strong… ECT is alot scarier (and i’ll try it why not, would love if it erased my PTSD flashbacks :)), but ketamine is probably a better intermediary step. Now that im comfortable i even use the experience to explore my trauma from a disassociated state and it helps! 🙂

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    1. Thank you so much for all of the information. I will be restarting ECT again soon. I did ECT for about 18 months, so it’s not new to me, making it easier for me to handle. I will keep everything you said in mind, just incase I rethink what method I choose for my bipolar depression.

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      1. Yeah sure, no problem, im more afraid of ECT, they give you 5x more anesthesia 🙂 …. I promise you a little mental preparation it wont be scary it will be totally fine, for me it feels like Inception every time, when they wake up on the plane, I come back from the disassociation fresh, rejuvenated, i have went from inpatient ready to going to dinner with friends 3 hours later…

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  10. Also reading other posts, my doctor just injects 100mg or so in my 250ml bag, there’s no saline flush bag, your body breaks down ketamine within 2 hours into norketamine, which is the active metabolite that starts repairing your brain. The trip is not that scary, dont go into it with fear, its like flying on a plane for the first time, i’ve done acid in college its nothing like acid, if anything its important to let go (you are disassociating) and you can explore parts of yourself you never knew, it can even be beneficial once you know how to travel it, it would be good if there was some shaman or somebody guiding you through the experience, like i said, music and eyecovers help, you will have the sensation of sinking as you enter the “k-hole” as they call it, towards the end as it wears off, you can even look at things that tore you apart without judgement and total mindfulness, they call this state the emergent state. The doctor will be there to help you relax and calm down, to some people they even give a benzo if its too scary and you can ask for that, then the experience will be muted… make sure its IV, not IM.

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