D with anxiety needs psych help in Germany

Parent Cafe
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<p>How is that for a complicated title? Our D is 23 and married to a military servicemember, and they live in Germany. She has been diagnosed with Generalized Anxiety Disorder (GAD). She has been going along pretty well with the meds she is on, Effexor and Klonopin (as needed, she takes 1 most days but not every day). </p>

<p>However, she has gone through periods where she has extreme trouble sleeping. They have tried her on all the normal prescription sleep aids and they don’t help her at all. When she first started meds, almost 2 years ago, the family practice doc put her on Seroquel, a mood stabilizer, because the dr. thought D had bipolar disorder. With Effexor and Seroquel, she was doing very well. Then, when she finally got in to see a psychiatrist, he said she did not have bipolar but has GAD, so he took her off the seroquel and gave her the Klonopin instead. That was about a year ago.</p>

<p>She has mostly been fine, though she periodically has sleep problems, but today she called and told me she has barely slept in 6 days. She isn’t manic, like people with bipolar are when they can’t sleep; she is very tired but her body just won’t sleep. </p>

<p>She can’t get in to the military clinic for another week. Whenever she has gone in the past, she has had drs. who are contractors…German, Asian, etc. She says they don’t even examine her but just type her refills into the computer even if she doesn’t need refills. Apparently, since they are not psychiatrists, they are unwilling to prescribe her something she is not already taking.</p>

<p>When she tells them about her trouble sleeping and that she needs different meds, she says they have actually rolled their eyes. She feels so humiliated, because they clearly think she’s just a drug user trying to get more stuff.</p>

<p>She is on the list to see a psychiatrist there and has been for months. Today they basically told her there is no end in sight to the wait. She can probably get a referral to a German psychiatrist, but she has heard from friends there that the German docs will only put you into counseling; they won’t prescribe meds.</p>

<p>She wants to go back on the Seroquel so she can sleep. I read up about it online and drs are prescribing it off label for resistant insomnia cases. It has some potentially serious side effects…but not sleeping for days on end is pretty serious, too. So, she’s trying to get her family doc here to either send her records showing she has been on Seroquel in the past so that they will hopefully prescribe it to her over there or get the family doc to write her a prescription, which she would be able to fill there. I can’t imagine that the family doc will do that since she hasn’t seen D in almost a year and a half.</p>

<p>So, I’m sorry for rambling on so much. I just wondered if anyone here might have experience with the military medical system overseas and would have some ideas for her.</p>

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<p>My D is dating a 2Lt in the US Army and her dad is an Air Force Vet, so I have some insight.</p>

<p>You mention she’s on a list to see a psychiatrist. Has she contacted OneSource? They’ll give her some counseling, free of charge for the first 6 visits I believe, and as far as I know they’re supposed to contact her within 24 hours. They can’t prescribe meds, as far as I know, but I know that one way to alleviate anxiety (which, in this case, is causing insomnia) is to work through the anxiety with a therapist.</p>

<p>Most on-base DRs are contractors so there’s little help that can be done there. HOWEVER. If I recall correctly, one can only safely go without sleep for 7 days. Therefore, she should go to the ER. Tricare will cover most, if not all, of her expenses. The ER doc may very well prescribe her Seroquel (or an even more potent drug, given the severity of the situation) on the spot.</p>

<p>Best wishes.</p>

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<p>Can she come home and stay with you for a few weeks while she gets treatment here in the US?</p>

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<p>Thanks for the OneSource recommendation. I am passing it on to her. They have a 24/7 hotline. Of course, I have my doubts as to the knowledge level of whoever will answer the call, but it’s worth a try!</p>

<p>nysmile, she and her H are talking about possibly coming home for Christmas, and I was just thinking the same thing. It takes 2-3 months to get an initial appointment with a psychiatrist, but I could make the appt. now and if they decide not to come, I can always cancel it. That way someone else wouldn’t have to wait 2-3 months!</p>

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<p>I don’t know anything about health care within the military or Germany, but I think she needs to go to the ER or an urgent care center.</p>

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<p>No insight … just wanted to say that I hope she is able to get the help she wants soon. My best wishes to both of you.</p>

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<p>Good news! Last night around the time I typed that message and before that, I was praying for her intermittently. (It’s 7 hours later there) I’d send her emails to tell her I was praying so that she would see them this morning. Well, when I got up, there was an email from her saying she slept ALL NIGHT and felt very good this morning!! I am so thankful.</p>

<p>Corranged, she had mentioned the ER as a possibility, and I was going to tell her today that she needed to go there. You are right; that qualifies as an emergency, especially when you can’t get in to the clinic and they won’t much help you when you do. Thankfully she won’t need to go there today.</p>

<p>Nevertheless, I am going to suggest she do the thing of making an appointment with a psychiatrist here in the states so that if she gets to come for Christmas, she can see someone. That way, the dr. here could prescribe meds for her if she needs any adjustments. I know this is an ongoing problem, and this is going to happen from time to time.</p>

<p>Mental health problems are so hard. It’s like diabetes, something you are going to have to deal with your whole life. And then you read such scary things about the drugs they use for these conditions, but what are you going to do? Stay in your house a nervous wreck waiting to have a panic attack?</p>

<p>In D’s case, we are pretty sure counseling would be ineffective. In fact, the psych. she saw in the states last year said that. Her symptoms are all somatic (related to the body). She doesn’t have weird or wrong thoughts…she isn’t afraid OF anything, but her body feels the same way yours and mine does when we are scared or anxious. She has not been doing everything she could to help her body, though (i.e., exercise), and I am going to really encourage her strongly to get going on that.</p>

<p>Thank you all for your concern and for sharing ideas. Sometimes when you are feeling desperate about something, it just helps to have people to listen and respond.</p>

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<p>I don’t believe a German psychiatrist is the answer. I think it would require many visits before they were able to actually reach an effective treatment. I also believe that language and cultural issues would interfere with treatment and diagnosis.</p>

<p>When we lived in Germany, we learned some interesting things about practicing medicine there (and experienced the results, too). There is a written protocol for every diagnosis and condition. If the doctor deviates from that protocol, she/he has to go before a board and justify it. Too many deviations and they get in trouble. A (male) coworker of my H was married to a doctor. He told my H she found it very frustrating, because she has to go with the simplest diagnosis even if she doesn’t believe that is what it is. And she has to follow a treatment plan that starts very mild, and might include stays at various clinics or other non-medicated treatments first, even when she fully believes it will not be effective. </p>

<p>If you can go with an American doctor, that would be better.</p>

<p>Best wishes!</p>

<p>PS - Cross-posted with you. Glad your D had a good night.</p>

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<p>If you ever want to speak to a live listener, you can reach one at 1-800-273-TALK (8255), or Google for a local crisis centers such as Contact USA. You don’t have to have a “crisis” to call, the listeners welcome all calls.</p>

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<p>My apologies if this appears to be off topic. When about 14,my daughter was “diagnosed” with bi-polar disorder. I pretty much dismissed this and took her to another doctor where she was felt to have PTSD. Much of daughter’s problems were like your D’s (somatic). She had extreme fatigue, joint pain, anxiety, sleep issues and rashes. Just this past summer when she was home from school, I got a flash that maybe we had been looking in the wrong place all these years. I went back and reviewed some blood work that she had done earlier in the year when she was diagnosed as vitamin D deficient, but did not respond to the supplements. Some thing jumped out at me; a weak positive on a blood test that could indicate celiac disease. After eliminating wheat and gluten from her diet, she is a changed person. She says that she feels like “herself” for the first time in years. All of her physical symptoms have resolved and the late night hysterical phone calls have ended. This may not be your daughter’s problem, but I sure wish that we had looked at this earlier.</p>

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<p>I am so glad to hear that she slept, Timely. Hopefully she will be able to sleep again tonight. Remember, though, that if she continues having serious sleep problems she will need to see someone sooner than Christmas.</p>

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<p>I have had life long insomnia. Unfortunately, my kids have inherited this. I don’t think of it as a mental health problem or the anxiety disorder, either. It’s probable that her body hyper produces adrenalin.</p>

<p>I have had years of therapy, and it’s been very helpful, though not a quick fix for the somatic problems.</p>

<p>I have learned, for instance to relax enough so I am not on blood pressure meds I don’t need (as I once was in my 20’s.)</p>

<p>I sleep with the help of a modest sleep aid, but that didn’t become permanent until I hit fifty.</p>

<p>I found these things helpful:</p>

<p>Lowering of lights a full two hours before sleep attempted so melatonin could be made</p>

<p>White noise (I don’t know why, but this has been very helpful)</p>

<p>No exercise or exciting (think cop shoes ) TV for at least an hour before retiring</p>

<p>Boring activity at my disposal (I use really hard Sunday Times Crossword Puzzles)</p>

<p>Hot bath before retiring.</p>

<p>The therapy has helped me feel more in control of my life and helped me be a calmer person so I think perhaps less adrenalin is produced. My medication for asthma has adrenalin though this has been a tough nut to crack.</p>

<p>Persistence will yield results.</p>

<p>PS: To a worrying mother I’d like to say that I’ve lived a very normal, successful life. I have had the same tenured college teaching job for 23 years, I haved raised two very healthy (besides occasional sleep disturbance) kids and have a stable marriage.</p>

<p>Just adding this to give hope and alleviate worry.</p>

<p>Good luck to your D.</p>