Pills vs Intravenous

When someone is having an episode (mania,hypo or depression), they call their pdoc. The pdoc writes them a script. The person then has to wait a few weeks to see if the med works.

I've never been inpatient but have read many posts of ppl that have. It seems as though their inpatient for abt two weeks. And say they feel totally refreshed upon discharge. Does the hospital administer meds intravenously? Why do meds from the hospital work faster?

They give you higher does faster for some stuff. I also think there is less daily stress because everything is done for you and all you really need to do is go to groups. You don't have to worry about your outside relationships (besides visits) either. It's supposed to be a time to focus on yourself.

I don't know of any IV meds given to psych inpatient. Being inpatient the meds can be started and quickly increase since you are being watched 24/7.

Yeah like instead of eight weeks of lamictal titration you can do it in a few days because they can immediately notice side effects or the rash.

Also I agree, there is really no stress to deal with. I used to go inpatient frequently just because I didn't want to deal with my real life.

I'd like to know that, too, Coco.

I think some patients are admitted to increase medications more quickly as one has suggested. But I think, too, that many patients who are hospitalized are there because they have a toxic chemistry that must be
alleviated.

Somehow, I suspect that the fluids are relieved of the loads of meds currently in place and then a strong sedative is given intravenously to maintain a calm for the patient to undergo healing. It would surprise me if patients came out of the hospital with the same prescriptions for medications that they entered the hospital taking.

Does anyone have any information about how this is all treated? I have a feeling that BipolaRNurse might be able to give you information on this if she'd come on the thread and let us all know.

I'm going through the titration w/ Lamictal and its been 6 weeks of hell. I still have 2 more weeks.

You can't do a fast increase of Lamictal, it would increase the risk of SJS. That one has to be titrated up.

I can't speak to hospitalization (but in my job I've worked in in-pt psych and haven't seen people on IV meds, I think they keep you until you're stable, however long that takes), but one good thing I can say about Seroquel is that it works in about 40 mins. Maybe other AP's are that way too, but you don't have to wait like you do with AD's and mood stabilizers.

And this is how I avoided the hospital with my last manic episode. I took a few days off from work while my Seroquel was increased on a daily basis until I was some semblance of normal (although not normal, more like sedated by a sledgehammer). The thing is, with the first pill (this is when I was started on it) I was quickly very sedated and soon fell asleep.

I guess what I'm saying is, if you need a very quick fix to calm you down (if it's mania, not depression) then having Seroquel around (PRN for example) can help you quickly, without the need for IV meds (if that's even an option). So an option is having it (even if you don't take it regularly, and especially if you don't it will probably have more of an effect) just in case to knock you off your a ** if you're really losing it...

Well maybe my doctor was dumb lol because he put me up to 150mg in two weeks....but then I don't know what the max dose is, maybe he stopped me at a low dose.

They only give you a shot of haldol or the one that starts with T if you are out of control and a danger to yourself or others. Otherwise you get pills most of the time. At least in my experience.

I do not think they give you IV fluids in-pt unless you're physically sick in some way. I suspect it may well be dangerous, in fact, to attempt to get whatever meds are in you out of your system. Unless you OD'd.

But I think, too, that many patients who are hospitalized are there because they have a toxic chemistry that must be
alleviated.

Nope. People are not hospitalized for this reason, as the psychiatric community does not believe that people need to be hospitalized due to a 'toxic chemistry.'

Not anti-depressants or anti-psychotics. Downers (aka depressant, or central depressant) can be administered intravenously (and get into the bloodstream quicker than taken orally). In emergency situations if a person is agitated or in pain they might be given a depressant intravenously to calm them down asap.

Psychotropic meds like anti-depressants and other meds that work in the brain take longer to have an effect because it takes longer for them to get into the brain. These meds have to get through the blood-brain barrier which can take a long time (weeks, etc.)

The combination of psychotropic meds and alcohol often make for a serious toxic condition, I've read. And I assume that can be considered by physicians as a "toxic" state, as use of caffeine for those sensitive to it can cause "toxic" symptoms and even brain damage in patients with or without bipolar illness.

I believe that hospitalization is called for in such cases, and I believe that based on all that I've read about uses of those two things in bipolar patients who attempt to self-medicate and are sensitive to alcohol and caffeine and (likely) possibly prescribed medications.

I've tried to find the treatment techniques, including iv use at psychiatric hospitals for in-patient treatment, but haven't been able to gather any information pertinent to it. I'd really like to know from someone who has served beside doctors when ordering procedures for use in in-patient treatment and, more especially, if patients are often put back on the same medications they were taking before entering the hospital. (I rather doubt it, personally, knowing what I know about side effects of psychotropic meds.) The fact that one psychiatrist gave up a career in psychiatry (and then wrote a book about his experiences) because of side effects of medications and how they affected his patients has long ago stirred me to be so alert to these meds.

(Off the subject: Just today I read that Celexa has been given warnings for its use by the appropriate government agencies. It should not be used for dosages higher than 40 mg. because it can cause serious heart arythmias. It's these side effects that get to us so badly for some of us.)

I have read that orthomolecular treatment for psychiatric conditions often involves so much chemistry analysis long before initiating corrective measures that, before doctors can really treat the illness, they must get the diet straightened out; and that after doing so, they find that the patient may need drastically reduced medication or may even be considered safe (in some instances) without psychotropic meds. I wonder if psychiatrists undergo that kind of analysis when in-patients are given treatment. It seems to me that it would be called for in this day and age.

I hope that BipolaRNurse also sees your thread, Coco.

The question you ask, Coco, is one that is of tremendous value in helping to make people aware of the need for more up-to-date treatment choices for in-patient care. Orthomolecular psychiatrists have the edge on treatment in hospital care, in my view. Question is can everyone afford that?

In your average Psych ward isn't doing the whole detox (unless you are coming off addictions) Typically they just want to mess with your medications get you stable and tell you to follow up with your Pdoc. ECT patients are usally kept inpatient longer, but typically most people are in and out with in 7-10 days.

They don't do much blood work besides your normal stuff.

I think if anyone wants to really dig deep and look at diets and allergic reaction they will have to seek out that stuff as an out patient and find a doctor that offers that treatment. Maybe private fancy rehabs would offer that type of care, but I would not know.

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Thank you, Christina. That's about what I expected to be the case
in most instances. It's no doubt helpful, but a little sad, in my view,
that more isn't offered.

The patient really needs to take a pro-active role in his care considering the parameters described here for in-patient routine treatment , I think.

Once I was inpatient to go thro monitored Klonopin withdrawal. I could never have done this at home. I was also a nervous wreck and needed to rest. I was given a Geodon injection for the first 3 days to sedate and let me sleep.
The second time I was feeling very suicidal, so my meds weren't working. This is when Seroquel was introduced. It was also much easier for them to do this under supervision. However, I seem to have reacted very differently to it in hospital than at home - at home I could definitely not handle the same doses.

Being inpatient also meant I could see my T daily. Group therapy was optional, and I wasn't interested. I basically slept.

I don't know of any drugs being given IV.

Antipsychotics can be injected.

Most people cannot afford orthomolecular treatment and it may not necessarily be covered through insurance.

You can go in to increase meds, decrease meds, switch meds or re-stabilize on a medication dose. When I was hospitalized, someone went in because she stopped taking her meds for a week or two and needed time away to restart her meds and stabilize. I think she stayed 3-4 days. If you voluntarily go to inpatient you have more rights then being state-ordered. You can ask to leave (they will discharge you after 72 hrs), and you have more say in what you will take.

A lot, if not most of the time it takes for AP's and AD's to work is because the actual effects are caused by structural changes in the nervous tissue, and not by increased levels of any neurotransmitter. The medications sometimes need to be "in the brain" for weeks before these changes occur, but it does not take the psychotropic substances weeks to reach the brain.

AP injections are sometimes used for acute psychosis in in-patient care here where I live, and the patient is generally involuntarily committed.

Coming to the party late, but here I am.

TBH, I've never been inpatient (yet) or worked inpatient psych, but I know that many drugs are given IM (injected into a large muscle), not IV. The IM route is used when fast-acting medication is needed in the case of severe agitation, threatening behaviors etc. and/or the patient refuses or spits out oral medications.

IM meds are also used to bring blood levels of certain drugs up to therapeutic levels, thus stabilizing the patient more quickly. Most antipsychotics and anxiolytics come in injectable form (years ago when I worked in a nursing home, we used to line up the psych residents and swack 'em up with a shot of Haldol IM every night). They're usually more effective because of the route of administration, which gets the drug into the bloodstream faster since it bypasses the stomach.

I've not heard much about IV psychiatric meds; personally I've never seen it---it's so much faster and easier to slam 5 mg of Haldol into an arm muscle than try to start an IV and then push the medication verrrrrrry.......slooooooowly to avoid speed shock.

Nice explanations, everybody. Enjoyed this thread.

Has this helped, Coco? I'm a little "enlightened" by it.

eek! shots!

Unfortunately inpatient places quickly find out that they could ask.me.to jump through a flaming hoop and I would.if the possibility of a shot is discussed. I feel so used whenever this happens. I always behave, but I was at one place where they'd keep you longer if you had questions about your meds and gave you shots of sedatives and then left you in front of everyone as an example if you pissed off a nurse. So naturally I didn't ask about my meds or why I felt like I was gonna pass out after the tiniest bit of activity.

One of the few times I had meds (depakote) drastically increased in the hospital left me totally annihilated (muscles didn't work, legs were like rubber). And after 2.5 mths inpatient ECT I was crushed. I've never felt close to being "refreshed" after leaving a psych ward (and most of the stays at a highly prestigious Psych Hospital on East Coast).

I agree! If I feel relieved it's because I'm relieved to be out!

This has really helped, feel enlightened too.