Outpatient Treatment Center

To make the next few posts easier to understand, I want to describe to you the treatment center that I was admitted to, the various programs they have and the types of therapies we learned about.

At this center, there are three levels of treatment; Inpatient Hospital Treatment, Partial Hospitalization Program, and Intensive Outpatient Program. There is also a residential facility for patients with eating disorders. In all of these programs, the adults are separated from the adolescents.

With inpatient treatment, there are various units to which a patient could be assigned. This includes the Special Intensity Unit for patients who are experiencing more acute symptoms of their mental illness. While in inpatient care the doctors, therapists and nurses work together to address the patient’s disorder and work towards long-term recovery. After discharge from inpatient treatment, the patient continues care with the Partial Hospitalization Program or PHP.

Partial Hospitalization Program or PHP, is considered the highest level of outpatient treatment. PHP is a full day program that consists of group, individual, family and other various therapies. PHP is the follow up to inpatient treatment but can also be the starting point for another patient. Each patient is placed within different programs where it is deemed that they will receive the most amount of beneficial therapy.

Intensive Outpatient Program or IOP, is a half day program that helps patients transition to life outside of the program. It is often a follow-up to inpatient treatment and PHP. IOP offers group, individual and family therapy along with transitioning to daily routines. It is considered the lowest level of outpatient treatment for the program and transitions patients to life outside of treatment including setting up schedules and appointments with outside therapists and psychologists.

The center also includes an after care program which is a once a week group therapy session. This allows for continued group therapy alongside your individual outside therapist and doctors.

Each day started with our morning check-ins. With these, we described how we felt at the moment, any questions or concerns we had with medications or therapies and how our previous evenings had occurred. After check in, we had our one hour group therapy session which met daily. During these sessions anyone was free to talk about anything and everyone was allowed to talk, discuss and suggest ideas and solutions. After group therapy, we would either have expressive (art) therapy, music therapy, medication education, emotional regulation, or weekend planning depending on the day. The last hour before lunch, which was also the last hour for the IOP patients, was spent learning about different therapies, issues and ideas dealing with mental health or if you were fighting an addiction, learning about co-dependence on drugs and/or alcohol Many of these classes have given me ideas and information to use for posts.

After lunch the PHP program would continue with two more class periods. During the first class period, patients would learn about distress tolerance, cognitive behavioral therapy or CBT, expressive therapy and anger management. During the second class, patients learned about mindfulness skills, healthy alternatives, communication skills, expressive therapy, and interpersonal effectiveness. Expressive therapy is taught often because it allows patients to express how they feel in a safe environment. Please read Alternative Medications & Therapies for more information on expressive therapy. During the day, we are also pulled out by our doctors, therapists and APNs for meetings and check-ups.

At the end of the day, we would fill out our daily wrap up sheets, detailing how we felt and if we felt we could stay safe during the evening. After the program, our doctors, therapists and staff would meet to discuss our continuing treatment and eventual discharge.

The program I attended is an accredited program within the nation. But if you think you need more help than a weekly therapist appointment please check within your area for a program that can teach you to manage your mental illness.

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Medication

In this post I’m going to discuss the various types of antidepressants that a doctor may prescribe. I am not a doctor and I will not claim anything other than a basic understanding of medicine. If you have questions about any of these medications please ask your doctor.

The initial group of antidepressants a doctor may prescribe are reuptake inhibitors. The first medication a doctor will generally choose will be a Selective Serotonin Reuptake Inhibitors, or SSRIs. This type of medication blocks the reuptake of serotonin to the nerve, which increases the level of serotonin in the brain. SSRIs are the most commonly prescribed, generally non-sedating and best tolerated by patients.

The second most popular medication is Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs. This medication blocks the reuptake of serotonin and norepinephrine to the nerve, which increases the level of these chemicals in the brain. SNRIs are often prescribed for severe depression and are safer if a person overdoses. SSRIs and SNRIs have fewer side effects than older antidepressants, although some people tend to experience sexual problems which may be fixed by switching medication or adjusting the dosage.

Norepinephrine and Dopamine Reuptake Inhibitors, or NDRIs, block the reuptake of dopamine and norepinephrine and increases these chemicals in the brain. This is one of the few antidepressants not associated with sexual side effects. There are various other types of reuptake inhibitors including but not limited to Serotonin Antagonist and Reuptake Inhibitors (SARIs) and Noradrenalin Reuptake Inhibitors (NARIs), which affect various brain chemicals.

Another group is cyclic antidepressants. These are generally known as the first generation of antidepressants. Tricyclics (TCAs) and Tetracyclics act in the same way as reuptake inhibitors by blocking serotonin and/or noradrenaline which increases these chemicals in the brain, elevating mood. Cyclic antidepressants are designated by tri or tetra dependant on the number of rings in their chemical structure. Cyclics are powerful but less used today because of the serious nature of their potential side effects.

The last type of antidepressant I’m going to discuss is Monoamine Oxidase Inhibitors, or MAOIs. MAOIs block the natural enzyme that breaks down serotonin, epinephrine and dopamine which increases the level of these chemicals in the brain. Using MAOIs requires a strict diet because of dangerous, even deadly, interactions with foods and other medications. MAOIs cannot be combined with SSRIs. They can also be especially effective in cases of ‘atypical’ depression.

Finding the right medication takes time and patience. You may need to try several medications before you find one that works. It can take several weeks for the medication to go into effect. Medication should only be stopped under a doctor’s supervision. Make sure to report side effects to a doctor immediately. Your doctor may recommend combining two antidepressants or adding mood stabilizers or anti-psychotics.

On some occasions, antidepressants can worsen depression or lead to unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant immediately contact your doctor or get emergency help. Remember, that antidepressants improve mood and reduce suicide risk in the long run.

Occasionally, hospitalization is needed because depression is so severe. Inpatient hospitalization is necessary is you are in danger of harming yourself or others. Psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Many hospitals have partial hospitalization or day treatment programs to help people while they get their symptoms under control.

Please remember I am not a doctor and I will not claim anything other than a basic understanding of medicine. If you have questions about any of these medications please ask your doctor.

National Institute of Mental Health

Mayo Clinic

Beyond Blue, Depression & Anxiety