Tag Archives: antidepressants

Back to the Basics

Things seem to have reverted back into a state of normalcy for me. Of course, when I say normalcy, I mean my normalcy. This change definitely has it’s plusses and minuses (less physical pain and vision problems, a return to a flip-flopping of psychotic mixed and depressive states, and the typical health care team issues I tend to run into every six months or so) but I wanted to address this return “back to the basics” that has occurred over the last two weeks before writing about anything else that has been on my mind.

My current psychiatric medications have returned to a regimen of  lithium only. 

I’m sure it was pretty clear that the seroquel I tried the last few months brought on some serious health problems, but it wasn’t until the issues with blurred vision, dizziness, nausea, and light and motion sensitivity that I began to suspect the wellbutrin I’d began in the last two months might be contributing to the problem. After having my eyes, ears, and stomach checked out I began a systematic stop and start of the medications I was taking at the time to see if any changed occurred. I pulled the plug on the 150 mg of wellbutrin I was still taking (after decreasing a week earlier and seeing some improvement and speaking with my psychiatrist) and about ten days later (Saturday) I was able to sit through watching a movie for the first time in five weeks without thinking I was going to vomit.

Not having been able to watch tv or movies for that long was pretty agonizing, movies are one of the few things I generally still feel passionately about and being without that sense of comfort was very jarring.

I was a little surprised (but glad I didn’t have to go see a neurologist about this) because the warnings for wellbutrin list “eye pain and vision problems” but that isn’t very specific. What really tipped me off was that I found out that wellbutrin can trigger problems with vertigo, and though I have experienced plenty of vertigo in the past and what I was dealing with this time was different, there were aspects of my symptoms that felt similar. At any rate, this issue is improving… and I wont be taking anymore wellbutrin in the foreseeable future.

The swings are back in action. 

While the seroquel seemed to keep me from swinging around the mood spectrum, it also kept me in the depressive end where I was sinking very quickly into a dangerous place. Now that I’ve stopped it, I’m back to my typical, sporadic swings lasting anywhere from thirty minutes to days or weeks at at time.

“From your perspective, which is worse?” I asked my boyfriend. “When I am depressed all day every day, or when I seem ok one second and then fly off the handle the next?”

He paused for a moment before replying, “I can’t really call one ‘worse’. They’re both equally devastating.”

I feel like I ask myself the same question a lot, because remaining in a single state (like depression) can sometimes feel better, more stable to me than rapid cycling because I can often do a better job of predicting my future mood; depressed. At the same time, everything shuts down and my mood rarely stays “somewhat depressed”, usually moving toward “earth-shatteringly depressed”.

If I’m rapid cycling, I can usually experience one or two hours a day where I feel relatively ok, and if I’m really lucky, maybe one day in a week where I feel relatively stable. Sometimes, just the fact that these moments are possible makes rapid cycling feel somewhat better to me.

I find the negatives of rapid cycling to be much worse though. It grinds on my relationships, I have no way to make any kind of predictions about how I will be feeling from one moment to the next, and switching into mixed episodes (which has become more and more common for me) becomes extremely dangerous.

Annnd health care team problems… as per usual.

I feel confident today in saying my concerns about my healthcare team the last week have had nothing to do with delusions.

Usually when I have problems with healthcare, it has been because of insurance coverage, or co-pays, or my old doctors not taking new insurance, or whatever element of the system seems broken at the time. This time, my concerns are a little different.

October has always been a fishy month to me, and I don’t consider myself superstitious but usually when something weird goes down or people are acting very strange, it is in October.

Anyway, first my general doctor started acting very strange and making me incredibly uncomfortable. He’s began giving me these long “pep talks” about how I need to look inside myself and find happiness, naturally this is one of the biggest turn-offs you can come across when you have a mood disorder. This has happened twice now, and though I understood when it happened the first time (I had a breakdown in his office) the second time it was completely unwarranted and generally had nothing to do with anything we spoke about in my appointment (regarding stomach pain). This man has always been a good doctor to me, very smart and professional for several years, and I know he is coming from a place where he is intending to help me, but for the most part while I was stuck in that little cold room with him trying to make extended eye contact it felt like if either of us is insane, it is definitely him.

Next it was my GI specialist. I needed a prescription refill order and she failed to return any of my calls, messages, or emails for three days. When she finally did send the order, she sent the wrong order to the pharmacy and never called me back. After calling the office again (to make another appointment) all of the notes from our last appointment have mysteriously vanished and there is no record of it. Needless to say, this (even more than the above problem) makes me extremely nervous. I realize she is a busy woman, but I feel like my experiences last week are definitely bordering on (if not already) unprofessionalism. I ran out of medication saturday, I still haven’t heard from her or her office.

Finally, my therapist quit unexpectedly two weeks ago. He had scheduled a follow up appointment with me last week, but the receptionist called me that day and said he never showed up. By the time this happened I couldn’t help but laugh.

I don’t have much of a plan of action for the first two doctors (maybe they’ll get their sheezy together?) but as far as therapy is concerned, I’m ready to switch clinics. The one I have been going to the last three years I’ve had a lot of problems with, and the people who work there are very inexperienced. Instead I’ve began pursuing a community clinic specializing in patients on medicaid with more significant mental health problems (me!), at this point I’m just hoping to get in before next month when things become extremely (more) stressful.

Tonight I have an appointment with my psychiatrist and I am keeping my fingers crossed he hasn’t completely fallen off the deep end too.

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Well, Well, …Wellbutrin?

Today I have been on Bupropion (Wellbutrin) for two weeks. I took 150 mg for the first week and then I was bumped up to 300 mg a week ago. I was a little nervous about going up to 300 mg as my notes (from my first hospitalization around 10 years ago) recorded my maximum dose of Wellbutrin at the time as being 150 mg.

As usual, my psychiatrist had been very specific about keeping tabs on any mania that might be triggered by this medication but (as I suspected) nothing even remotely akin to mania has taken place so far. In fact, the only changes I have detected are:

  • increased volume in the (already present) ringing in my ears
  • dry mouth surpassing anything Lithium every threw at me -to the point where I have been experimenting with different dry-mouth remedies and medications
  • greatly increased tremor action (increasing what was already present due to Lithium)

While I don’t particularly enjoy clanging glasses of water against my teeth while trying to drink or being almost entirely unable to apply eyeliner on myself because I’m shaking so much, honestly I’d rather experience that over, say, a headache lasting two full weeks (ahem, you  know who you are seroquel).

I understand that I have not been taking this antidepressant long enough to realistically expect any improvement in my (still sinking) depression, but the few inconvenient side effects I’ve had have been extremely preferable to pretty much medications 1-14.

Having said that, my psychiatrist was insistent that I increase my seroquel/quetiapine dosage to 50 mg before starting the wellbutrin. I realize this is considered a tiny amount to most people, but even so I’ve been having a very hard time on it. Beyond the two week headache I had when I increased the dosage (which seems to have abated now) I’ve also been having a host of gastrointestinal problems involving a lot of pain, more than a little discomfort, and enough bloating to make me look like a pregnant woman by the time I go to bed.

If I need to keep taking quetiapine, a trip to my gastroenterologist is imminent. None of my previous stomach medications are working anymore, and while this is something that is probably number one on my list of concerns there is an extremely close tie for number one, namely;

hair loss.

Yeah. Nobody likes to have chunks of hair falling out, and right now I am losing at least 3-4 times the amount I would normally lose in a day. My hair is very thick (so I am sure it is not noticeable yet) but I don’t particularly want to use the fact that I have a lot of hair as an excuse to lose more. I know this is not a side effect listed for Seroquel, but  when I did a quick search online it seems I am not the only one experiencing this (by far). Also, I wouldn’t peg this on the wellbutrin because it started before I began taking it.

Thankfully, today I get to address these issues (and more) with my psychiatrist. I am not exactly looking forward to going out in public but I have definitely been experiencing some things that need to be addressed. Hopefully I can find some relief from the physical discomfort, even if I’m still waiting on relief for the emotional.

Long Game: Depression

There are times when my rapid cycling gives way to a long, drawn out affair. Though I sometimes experience other moods “popping in” during these episodes I can usually distinguish an episode up for the long-game because my symptoms begin like a snowball rolling down a hill. By the time it reaches the bottom it can easily knock me off my skis.

While I have experienced four solid weeks of depression now I wasn’t ready to call the “big episode” until I felt certain the depression wasn’t going anywhere.

This week it became clear the depression is here to stay for a while. That is, unless the dosage of bupropion (Wellbutrin) I doubled on monday begins to work some magic.

The signpost I passed during my current descent was clear enough, and I felt pretty proud of myself for noticing. My thought process seems to have become overwhelmed by depression now, and I found myself wondering why my boyfriend cared about me so much when I really didn’t deserve it.

Errr…

There is this realm of guilt and self-loathing that I only really experience during depression (though sometimes it can occur during my mixed episodes), and it is something that tends to take a firm hold on me when the depression lingers long enough to convince me these thoughts and feelings must be true.

At this point, I think I’ve played this game long enough to be able to see where this is going. When I have episodes like this they often last for months at a time and in the past have been known to result in hospitalization… that is, unless something can pop me out of it.

Right now it seems clear that my next course of action is to batten down the hatches, and frankly since I am already in the process of pursuing ECT (electroconvulsive therapy) there is a chance I could get lucky and I can line it up by the time (or even before) I truly hit rock bottom.

For me it feels like the real bummer is that pretty much everything I own is still in boxes after moving, I’ve been extremely unmotivated (thanks depression!) and given this current situation, I’m not really sure when that might change.

Really, let’s be honest though. I have access to a tea kettle, some dvd’s, and a barrage of pillows, and I consider those all to be highly prized items when experiencing a depressive descent. I want to be prepared but, fingers crossed… maybe I wont reach that point.

Feeling Worse Before Feeling Better

During my last two visits with my psychiatrist we concluded to move forward with the idea of pursuing electroconvulsive therapy (ECT) as the next treatment option for my treatment-resistant bipolar symptoms.

While saying, “let’s do it!” has set a series of actions in motion (mostly on his side), I have yet to see any of the fruits of that action. At this point he is trying to get me a consultation with the staff at one of the two hospitals in the area that perform ECT, but the situation is tricky. Of the two hospitals, the closest one severely gives me the creeps, and the other involves a commute through a busy area (and we don’t have a car). Naturally I’m assuming that after urging my brain into a state of convulsion, I probably shouldn’t be riding the bus, so figuring out a system to even get to the hospital for these treatments is another thing to work on.

Having said that, after some research it appears that there will probably be a significant wait time (no surprise there) to even see these leading doctors to have a consultation. I am not expecting any of this to happen any time soon, but I am a little thankful to have some time to allow my head to wrap itself around the idea of taking such a step in such a (scary?) direction. I know my fear probably isn’t overwhelmingly warranted, seeing as I was just as nervous about the idea of taking lithium and now, even after having overdosed on it, I find it no more terrifying (and possibly even less so) than any other drug I’ve tried thus far.

In the meantime my depression is significant. In the month of June I experienced eight days of “stability”, and in July I experienced three. Keep in mind, “stability” is simply a word here that means the majority of the day was spent feeling well, which can mean an entire day -but more often for me means something like experiencing 8 hours of feeling well and 5 hours of total chaos. Even when it doesn’t account for the entire day, a significant mood swing lasting even 1/4 of the day is enough to cause major issues with my plans and ability to get things done.

The most frustrating part of seeing these numbers is knowing that it is summer, and that this is the time of year I typically the best. That means even though I am feeling my “best”, I am still experiencing episodes lasting between 3/4 of the month to the entire month.

For that reason my psychiatrist has opted to allow me to try an antidepressant again while we wait for a word on the ECT situation. Wellbutrin/Bupropion has been the only medication that has ever (presumably) had a positive effect on me, however I took it over ten years ago and the psychiatrist I was seeing was definitely… sub-par. At this point I can’t say if it truly did anything for me, but it appears that in conjunction with whatever else I was taking, it didn’t cause psychotic mania (the way other antidepressants have for me).

In order to even allow me to try wellbutrin/bupropion again, my doctor is requiring me to go up to 50 mg of seroquel/quetiapine. I increased my dosage from 37.5 mg to 50 mg on Sunday night, and the last 52 hours I have been a mess. I’ve had hot flashes and profuse sweating, overwhelming nausea, constant upset stomach and stomach pain, lethargy, lack of appetite, etc. Not a fun time, but this morning I can already tell is a slight leg up after yesterday, so hopefully I can get over this hump soon to test out wellbutrin again.

So there’s an update, this is really the best I can muster in my given state. What I can say is that I am actively doing everything in my power to try to guide (or wrench, whatever works) myself into a better place… even if that means feeling significantly worse because of side effects before I can feel better.

SSDI Prep – My Medications

I’ve been working my way down the list of objectives given to me by my attorney for my SSDI hearing. Here’s where we’re at:

1. Keep a diary
2. Make a list of things you used to do but can no longer do
3. Make a list of medications
4. Write out a description of your job duties of your former jobs
5. Meet with your lawyer

Next up is to prepare a list of my medications.

Keeping track of my medications has been fairly difficult. My diagnosis is bipolar type 1, but recently my psychiatrist has moved me into the category of “treatment resistant” bipolar disorder since I have tried numerous medications that haven’t had any (positive) effect on my symptoms.

Basically what this means is that I have been trying every new medication my psychiatrist throws my way, usually every couple months. I’m constantly ramping up on a dosage or ramping down, so even trying to predict what I’ll be taking in three weeks (at my hearing) is sketchy at best.

I’ve talked a bit about this before, but the way I go about handling all of the information that comes with trying so many new medications is that I have a spreadsheet where I list:

  • the medication I tried
  • when I began taking it and when I stopped taking it
  • the maximum dosage achieved
  • the side effects that ultimately caused me to stop taking it

I keep a separate section for medications I am currently taking, with similar information.

I also keep a list of hospitalizations at the bottom of the spreadsheet for a very important reason.

Let’s say I am going to the emergency room, or entering an inpatient hospitalization, or even going to see a new psychiatrist – this sheet has my entire medication history on it. All I have to do is hand it to the nurse or doctor when I arrive instead of trying to prod a brain that is thoroughly out of whack for this information. And, hey, if you want to have your prescribing doctor’s information on the sheet, that never hurts either.

I keep all this information in a spreadsheet on a cloud (through gmail) so I can access it from any computer with internet in an emergency. So far, it has really helped me.

Ok, so side note, I am preparing my medication list to include all of the medications I’ve tried so that I can demonstrate (if it comes up) that my symptoms have been treatment resistant at my hearing. Again, it is always better to have more information than not, so I want to consider my entire history, as well as my current medications.

If you are compiling a list of your medications, it is perfectly reasonable to start with your current ones. Open up the medicine cabinet, grab your bottles, and start your list.

You want to list all medications, so consider things like herbal supplements you might take (I take fish oil), over the counter daily medications (I take pepcid AC daily for an abundance of stomach acid), or things like prescription face creams (which I use for acne). You also want to consider medications you take as needed. 

These things may not seem important, but they might be addressing issues that are side effects of the psychiatric medications you’re taking. I have stomach issues and acne from taking lithium, so I use two medications to address those side effects.

My current medication list looks like this:

  1. 1200 mg Lithium Carbonate (once daily)
  2. 20 mg Latuda (once daily)
  3. 50 mg Tegretol (once daily)
  4. 5 mg Risperidone (as needed)
  5. 10 mg Ambien (as needed)
  6. .01% Tretinoin Gel (once daily)
  7. 20 mg Pepcid AC (twice daily)
  8. 1000 mg Fish Oil (once daily)

From what I understand, this is all that is required for the social security hearing. I know from experience, however, that if asked to recall information about my previous medications I will have a bit of trouble, which is why I want to be ready with the full history list.

If you are interested in making a list of your full medication history, there are a few things you can do to help in the process.

  • You can ask your prescribing doctor to give you a list of what they’ve prescribed. Most doctors I’ve met are happy to share this information.
  • Look at old medication bottles. I have a bit of an OCD thing where I can’t throw mine away, so I have every psychiatric medication bottle I’ve been prescribed since 2003. This was extremely helpful in piecing together which medications I took and when.
  • Look through a blog or journal. You may have written something about trying a new medication, or stopping an old one.
  • Ask a family member or friend if they remember any details.

Having a history of your medications can be helpful, but it isn’t absolutely imperative. After all, you could always begin your list with what you’re taking currently, and if things change, update it. Realistically, I only really care about having a history list so I don’t wind up taking the same medication twice, when I’ve already had a bad reaction to it in the past.

Here’s a chopped down version of my list:

  • Latuda 40 mg (12/10/13-) – back and neck muscle agitation, mood destabilization
  • Geodon 120 mg (10/28/12-8/2/13) – developed muscle spasm in jaw, intense dizziness, fainting, no appetite
  • Lorazepam 1 mg (10/1/12-10/25/12) – worsened mood (hostility)
  • Trileptal 150 mg (6/12/12-6/21/12) – worsened mood swings
  • Zyprexa 5 mg (4/3/11-6/6/11) – 40lb weight gain in two months
  • Zoloft 100 mg (4/7/11-4/13/11) – triggered mania
  • Abilify 5 mg (4/13/11-4/20/11) – extreme nausea and dizziness
  • Clonazepam (4/3/11) – severe mood swings, panic attacks
  • Seroquel (4/2/11-4/3/11) – extreme dizziness, trouble focusing, intense drowsiness
  • Prednisone (2/04/11-2/6/11) – severe mood swings with uncontrolled crying spells, unprovoked panic attacks
  • Lamictal 25 mg (2/23/11-2/26/11) – rash, discontinued
  • Wellbutrin 150 mg – (no memory)
  • Neurontin 300 mg – (no memory)
  • Fluvoxamine 150 mg (12/02-2/03) – worsened depression, mania, psychosis, and homicidal/suicidal ideation
 There we have it!

The Medication List

With things burning out so quickly with the Geodon I’ve been working on updating my medication list.

This list is primarily listing all of the medications I’ve taken and what side effects I’ve had/why I’ve stopped taking them.

Keeping a list like this has been incredibly helpful for a number of reasons.

First off, any time I want to see a doctor who doesn’t know my immediate psychiatric history I can bring the list to help them get an idea of what I’ve already tried.

Next it helps when my own memory farts out and I can’t quite recall why I didn’t keep taking drug X, looking at the list can remind me very quickly and easily why trying that medication again would be a bad idea.

Finally, the most useful situation I’ve found for this list is when I was hospitalized and I knew I wouldn’t be able to remember all of the medications I’ve tried, etc. I simply brought the list with me to the hospital, and made things easier on myself, the nurses, and the doctors there.

The real tricky part of a list like this is remembering to update it as soon after switching medications as possible, and keeping it updated regularly. I find it is best to work on it in periods of feeling well, but I realize sometimes that isn’t an option.

I really try to be as organized as possible about my psychiatric care because I don’t want to try the same step twice. It is important to me that my medication search is as objective as possible, and tools like the medication list have helped me along the way.

Recommendations for Use of Antidepressants with Bipolar Disorder

Antidepressants and bipolar disorder, should they mix? My own experience with antidepressants has helped fuel the controversial antidepressant fire in my own life, but I was curious to see what the “professionals” had to say about it.

The International Society for Bipolar Disorders (ISBD) Task Force has just released a new set of recommendations for the use of antidepressants with bipolar patients in the American Journal of Psychiatry. The final recommendations are the result of 173 studies, and urge caution. Dr. Eduard Vieta states,

First, they shouldn’t be used in mania or in mixed episodes, they should only be used in bipolar depression in patients with a history of a good response in the past to antidepressants and no history of rapid cycling or switches into mania right away.

(Mixed episodes as well as rapid cycling and switches make me a poor candidate.)

In addition, antidepressant monotherapy (meaning taking an antidepressant alone with bipolar disorder) is not advised, neither is taking an antidepressant if you have predominantly mixed states.

Of course, I could say “tell me something I don’t already know”, but at least these people are putting it on the record and hopefully others will benefit from being spared antidepressants when they are prone to having a bad reaction.

For the entire article, go here.