Q: When to Go to the Hospital
I was dx in April. In Aug. and part of Sept. I was manic and managed
to avoid being hopitaized. Now just when I thought stablized again I have gotten
very depressed and can not even get my self to go to Commuity Allanice most days
and take of myself. I have had suicidal thoughts and thoughts of how it can be
done. I have not acted on these though.
How does a person know when they should go to the hospital and get help? Or
should I tell my Dr. and let him deside?
Dear Mary --
"Yes": you should tell the doc' and let him help you decide; and you
should try to make the decision yourself so you demonstrate you're taking
responsibility for maintaining your own safety, which really helps your
treatment team (they will worry less if they think you're monitoring safety
yourself and capable of saying "I probably better be in the hospital
now" instead of finding yourself taking action on your
In general we think about using the hospital for safety
when someone can tell they're on the verge of acting on their suicidal
thoughts. Some people are more impulsive than others, and they may need to
be hospitalized with a lower "threshold"; whereas someone who is going
to think and plan and even communicate that planning, without nearing the brink
of action, can work with her/his treatment team sometimes and avoid having to be
hospitalized. It's really up to you and your team, thinking
together. So, yes, tell your Doctor.
Note that it is almost the norm' for a depressive phase
to follow a manic phase. So the September experience almost predicts that
you would land where you are now. And just as you cycled out of the manic
phase (medications may have helped), you will almost certainly cycle out of this
depressive phase as well. Mood stabilizer medications can decrease this
cycling back and forth but sometimes it can take a while.
What to do about your depression in the meantime?
That's pretty controversial. Some psychiatrists would give you an
antidepressant on top of your mood stabilizers; others would use
"antidepressant" mood stabilizers like lithium and lamotrigine; others
would hang in there with your mood stabilizers and watch to see that the
depression is getting slowly better, only adding an antidepressant if there's no
movement, or worsening. (I'm one of the latter, usually, unless the
depression is clearly dangerous, as it sounds yours might be). Call the
doctor today; and go to the Emergency Room if you can't make contact and things
are getting worse.
Published December, 2002