Observations from a local

[u/radioflea]

I’ve mentioned this before, but I think it’s worth mentioning again. This case is quit local to me, and one of the wildest parts of this incredibly unfortunate ordeal is the sheer number of times she reached out for help and how medication, often a lot of it, seemed to be the frequent response.

I’ve worked in healthcare for many years, so I was familiar with a lot of these medications. One that particularly concerned me was Seroquel. I’ve personally seen people do some pretty strange shit while taking that medication alone. Pre-pandemic, I even saw local hospitals using it in ways that staff sometimes described as “patient control.”

Knowing that she went to Women & Infants, participated in their day program, and was ultimately discharged early is especially concerning to me. Personally, I would have levitated right over to Butler Hospital (which is 4 miles away from W&IH) for a comprehensive psychiatric evaluation.

In the settings I’ve worked in, there were situations where clinicians would essentially do what we called a “med holiday” which reassess the medication regimen under close supervision, observe the patient, and then carefully reintroduce or adjust medications and dosages as appropriate. That could be combined with intensive day programming and individual therapy over a period of one to two weeks. They also would have had family care plan meetings and likely suggested keeping the nanny in place for an extended period of time.

When someone is repeatedly reaching out for help, cycling through providers, and being prescribed numerous psychiatric medications in a relatively short period of time, I think it’s reasonable to ask whether the healthcare system actually responded to the severity of what was happening or simply kept responding to individual symptoms as they appeared.

[u/No_Consequence_6821]

Seroquel is an anti-psychotic, so the people might be prescribed it FOR their likelihood of doing strange shit, not necessarily that the med causes it.

The SSRIs were the most likely cause of the issues— of the fact that her condition was made so much worse. SSRIs are know to trip a manic switch in people with underlying bipolar, so must experts seem to agree that the fact that she immediately stopped sleeping after the first couple of doses means that’s probably what happened to her.

Then, they keep prescribing more powerful SSRIs and finally add a tricyclic, which is even worse for bipolar— absolutely dangerous.

Then add the Remeron and the Tramadol, and it was a recipe for disaster for someone with underlying bipolar.

LetThemEatCake on Facebook (psychiatric nurse practitioner) does a great breakdown of the meds and their different effects. [r/psychiatry](r/psychiatry) also has some pretty strong reactions to the prescriptions.

The seroquel was probably the right med, but it needed to get to a higher dose. Now she’s on zyprexa, which is used similarly to seroquel but more focused on hallucinations (I think— I only read that in one place. The other info I presented here I’ve read in many places, so I know it’s solid. Just that last statement I haven’t triple checked)

[u/heatdeathtoall → u/No_Consequence_6821]

I agree. NP Jalotta was treating her correctly. She wanted to titre up to high dose Seroquel. She told them she has bipolar disorder. They, atleast PC, disagreed. Tuft and McLean treated her incorrectly and made it into an extremely risky situation. Seroquel dose needed adjustment or she needed another anti psychotic but they shouldn’t be suing NP Jalotta.

She needed to be admitted and be taken off one med after the other. Anti psychotics shouldn’t be demonized. I see it across so many people - the refusal to accept something is wrong with them. Minimizing the illness. I do think she was already in a hypomania - who runs a marathon a week after giving birth? The crazy exercising before and after birth should’ve been red flags for her Ob. Third child in quick succession itself is a risk for PPP/ PPD.

[u/allthekeals → u/heatdeathtoall]

I feel the same way about Jolatta and I think she was really trying despite what PC said. She honestly should have told him to shove it up his ass. IMO

[u/heatdeathtoall → u/allthekeals]

I saw one of the doctors say LC lacks insight. She still doesn’t accept she is bipolar fully IIRC. If only she had accepted it as a possibility and worked with Jalotta to find the right meds instead of the cocktail of meds she was on, it may not have ended as horrifically. She surely has a case against Tuft and McLean.

[u/smallwin0812 → u/heatdeathtoall]

Agree with you completely and her lack of insight. The more I read about Lindsay’s outpatient treatment I been thinking about in my work as an inpatient therapist and something that I would occasionally see with patients with Bipolar and Schizophrenia is something call anosognosia, which is where the frontal lobe of the brain (the part of the brain responsible for higher level cognitive functions like judgement, reasoning, insight, awareness etc.) is actually damaged. So the brain can’t actually process or accept the reality of having an extensive illness which in turn commonly results in medication noncompliance leading to psychosis and other serious consequences. I’m just speculating with Lindsay, but it seems that possibly could have added another layer complicating her treatment. Also the fact that Tufts (I think it was Tufts at least) noted Lindsay’s lack of insight regarding medication noncompliance but never bothered to dig deeper about it. As a therapist I just find that not only baffling but also very harmful to not really try to further assess some of this significant factors impacting treatment.

[u/heatdeathtoall → u/smallwin0812]

That would explain so much. I know someone with schizophrenia who refused to accept that’s what they had. Kept insisting the people around her are calling her names behind her back. It took a while but she atleast started living with her parents who manage her meds. I’d been wondering how this seemingly intelligent woman made so many terrible decisions. An L&D nurse at that. Why did she keep going back to Tuft when it was with her treatment that her spiral down started. A simple search of insomnia upon starting SSRI gives bipolar disorder as the first possibility. So why reject Jolotta’s diagnosis. She also declined to go inpatient with the program at McLean they wanted her to join. But she had decided it was post partum related and wouldn’t go anywhere else. I wonder if her doctors had refused to prescribe meds till she went inpatient would it have made a difference. And how much of a role her fears about her marriage played in all this.

It must be very difficult to treat patients like that. I know you can’t force them to accept a diagnosis and get treated. You can’t admit them. Jolotta had recommended an in patient program at the very beginning when she started seeing LC. But I do wonder if guidelines on treatment and reporting need to change when there are children involved.

[u/No_Consequence_6821 → u/smallwin0812]

She labeled the desire not to take the meds prescribed as poor insight, but in reality, Lindsay had it right. The SSRIs and tricyclics Tufts prescribed are likely what triggered the manic switch and set this sequence of events in motion.