Tag Archives: mood stabilizers

Wrapping Up the Week

This was a bit of a down and out week. My mood chart’s numbers have been lower than they’ve been in months, and I’ve taken an antipsychotic four times within the last week (I take them as needed). That number is ridiculous, considering the last time I took one was a random occurrence, and the time before that being at least a couple months ago.

I feel justified in saying that something isn’t right, and I was already suspicious of the medication I just started (trileptal) before this morning’s 3 am slightly psychotic episode. After that I feel like my hunch has grown into something larger, and I’m not sure what to name it. Perhaps I am having a mega-hunch.

Yes, I have still been taking the trileptal. Funny story, I emailed my doctor as described in Looking into the Trileptal Mineshaft earlier this week, but what I didn’t really mention after that is that he wasn’t there. I received a response from  another doctor (whom I don’t know and doesn’t know me) who said mine was out for the week and it would just be best if I keep taking my current dosage of trileptal until he gets back.

Frankly, this email made me stomp my feet, cry, and gnash my teeth a bit. I disrupted my boyfriend at work with an impulsive phone call because I was so upset about receiving this advice.

What frustrated me the most was that this doctor, who knows nothing about my situation and intense sensitivity to most psychiatric medications, also added non-chelantly in the email that he didn’t think mood stabilizers ever had any negative effect on people’s mood, which is why I should just keep taking the medication I was given.

On my end, that sort of remark easily gets interpreted as,

“honey, you just cray-cray. That’s why you really oughta just keep taking these pills!”

As a consumer, I can see this as a possible side effect printed clearly on the leaflet I was given. Not to mention, I’ve had these sorts of rare side effects before from other medications.

I really wasn’t sure what to do, and I went back and forth about whether or not I would comply at least three times each day since then. It may be easy to say, “just stop taking it,” but as with the Lamictal situation -I am really trying to take this on as seriously as possible. I need to evaluate every move I make with caution and thought, because the decisions I make about taking something or not taking something could literally change my life. 

Isn’t that terrifying? It is a large burden to bear.

I really hoped that seeing my therapist on wednesday would help clarify things for me, but I got a call before my appointment to find out that she too was out of the office.

I don’t know that I’ve ever felt so abandoned by my mental support team before, and it seems as if the planets had to of aligned just right in order for both my psychiatrist and therapist to be out of their respective offices the entire week unexpectedly and at the same time. At that point, all I can say is thank goodness I have a sense of humor or I might’ve taken it a tad personally.

I mentioned earlier in the week that I believed trileptal was causing me to feel desperation, which I found to be quite upsetting and a good reason to stop taking it. Many days later, that desperation has begun to morph into something much larger and darker, suicidality and self-harm ideation have began popping up at unexpected times in unexpected places. Agitation that is accompanied by surges of energy that leave me feeling like my chest is about to explode. Garnishes of intense paranoia that render me feeling entirely powerless. Completely distressing nightmares.

The way in which these symptoms are happening are almost identical to the first time I had an adverse reaction to fluvoxamine (the first medication I was ever given, pre-bipolar diagnosis). The waves of psychosis began getting worse and worse (I don’t experience psychosis much on a regular basis, usually) and the cycling became so fast that things became unintelligible. became unintelligible. And the idea of that happening again scares the bajeezus out of me.

I genuinely wondered if I kept taking trileptal if I would start to follow the same sort of path of when my moods were so destabilized by a medication before. I realize trileptal is supposed to be for mood stabilization (and my past medication sinkhole was with an antidepressant) but my body acts in mysterious ways. The only time I took Klonapin (for anxiety) I had an enormous, un-provoked panic attack. It is as if my body works with these chemicals totally backwards. 

After taking trileptal several days after I would have liked to have stopped, I can very clearly see things heading in that direction. There are all the signs of awfulness there, and there is no way in my mind continuing in this direction is a good idea.

I’ll email my doctor on Monday, but I’m stopping trileptal today. And I’ll fade into the woods tonight, the trees will cocoon me, and perhaps by the time I come home from camping on Sunday some little portion of this will be undone.

Looking Into a Trileptal Mineshaft

I am pretty glad my psychiatrist’s office now has email capability (though I was getting to know the women who worked at the front desk pretty well over the phone). I just sent my psychiatrist an email about Trileptal, and unless he is able to pull a magic rabbit out of his hat, I am not expecting to continue taking it.

It is one thing to deal with headaches, nausea, dizziness, and fatigue, but I have definitely seen a severe and sudden change in my mood after starting Trileptal.

As a reminder, most people have an improvement in mood stability while taking Trileptal (oxcarbazepine), but I have seen an almost immediate downward shift into depression with cycling 2 or 3 times per day into an irritable/agitated mixed state and back into depression again. By yesterday it was bad enough that I had to take an antipsychotic before bed, and if I had the attention span to write the email out to my psychiatrist last night, I would have.

Obviously the major threat from this sort of mood change is suicidality, but the game changer for me is desperation.

Desperation is like suicidal thinking wrapped in a big bow made of justification.

If I am under a large amount of stress, or in a large amount of pain, desperation can make any form of escape feel justified, and all forms of escape feel welcome. That can mean anything from playing video games for days at a time, to being inebriated for long periods (or more frequently), or even fantasies of self-harm or suicide to escape the immediate situation. With depression it is easier for those fantasies to remain fantasies, but when I cross over into an irritable/agitated place where the negativity of depression lives hand-in-hand with the energy and impulsivity of hypomania (as I have the last few days),

shit gets tricky.

This moment of desperation is the only time I can think of where antipsychotics feel like a good idea, because I find being a zombie preferable to the agony of a mixed episode.

Personally, I find desperation to be one of the most dangerous places a person can be in, because someone who is cornered (in any part of life) is almost always more likely to do something irrational because they believe they have very few options. A wide view narrows to a small tunnel of vision, and a picture with 100 options becomes a picture with 5.

With depression I usually feel lethargic enough to withstand desperation, because giving in would mean doing something and I never quite feel like doing anything while depressed (at least, up to a certain point). I think this is kind of a nice fail-safe, though it really doesn’t feel like it when I’m there. This is something I can feel a bit good about, because I know desperation’s tactics; choose a course of action and take it immediately. 

When it is present, desperation chants repeatedly in my ear, “you have to do something! Do something, do something, do something!”

In the last few days this chant has come and gone like the tide rolling in and out again. This feeling works as something of a clear sign, and it says,

“This stared with the Trileptal…

…do the math.”

So there you have it.

I hope that my doctor will respond quickly and agrees with my reading of this sign, but I do also have a series of mood charts showing the change in behavior/activity and the overview, showing that this is the lowest point of depression I’ve had in three months. How unfortunate.

Three Strikes, You’re Out

It was about time I’ve been put into the awkward position of trying to conclude what to do about some horrible side effects.

Many of you know I have been making a third attempt to increase (ever so slowly) Lamictal (generically called lamotrigine, it is an anti-seizure medication used also as a mood stabilizer for bipolar disorder), and I don’t want to drag you through the entire story but the first two attempts went a little something like this:

  1. I began taking 25 mg of Lamictal about a year and a half ago, after a week I developed a large rash, which is the most common side effect. The rash can be deadly, so I had to stop taking it.
  2. About 6 months later I begged my psychiatrist to let me try taking it again, until he caved. I started at 6.25 mg (yes, a teeny, tiny sliver)  and slowly increased a sliver every two weeks until I reached 25 mg. I did not get a rash (hooray!) but I lost access to my doctor, and my dosage could not be increased without one. To save money, I stopped taking the medication (and as 25 mg is the smallest form it comes in, that was allowed).

And here we are now, I began trying this whole shabang over again about a month and a half ago. Teeny slivers, bigger slivers, and then an entire 25 mgs. No rash, some skin irritation, but nothing huge.

Then, last monday I started my first dose above 25 mg, 37.5 mg. Doesn’t seem like a big leap, does it? Especially when a “theraputic dose” (where it begins working) is usually around 200 mg.

I counted out on my fingers, at the rate I was going it would be seven months until I was near 200 mg, eight if you count from the start.

The trouble I’ve had with bipolar medications is that I am extremely sensitive to them. I either react very badly at the lowest dose available, or -like in the case of Lithium, can take up to and beyond the maximum amount for me without ever reaching a dosage that effects my mood swings.

The same is true for other sorts of medications too. I am sensitive, so I try to take only one thing at a time.

I want to note quickly that this is rather unusual. Most people don’t have this problem, and in fact most people I’ve talked to have had great improvement with Lamictal. That is one of the reasons I wanted to try it again, I was hoping I could tap into that helpfulness, even if it took me 8 months total to get there.

After stepping through the threshold my body created around the 25 mg last Monday, things quickly went south. As the days were progressing through the week, the side effects were becoming more severe and intolerable.

I couldn’t sleep because my muscles felt like I had worked out all day and hurt like the dickens, but I had done little more than sit on the couch. The pain was waking me up several times in the middle of the night.

Nausea crept up on me until it was so severe I was having trouble eating. I didn’t want food, I wanted to be as far away from food as possible. I force-fed myself (and always felt slightly better after), but then I’d have sharp stomach cramps for hours.

Honestly, I didn’t even read the side effects page this time around. I wanted to walk into this without having to ask myself if I’d just “conjured” these side effects up, but by Thursday my muscles hurt so bad and I was so fatigued the only thing I could do all day was lay on the couch.

By Friday I suddenly realized that what I was experiencing could be side effects from the drug. It took me that long to realize because I had been a bit hypomanic earlier on in the week, and though I felt terrible I honestly didn’t think about why. I was in the moment where there is only observation, so a thought that went, “huh, I feel odd, that’s weird…” and trailed off was the best I could do at the time.

When I came a bit more to my senses, it was Friday at 4:30 pm. My doctor’s office closes at 5, and I was running around trying to find the insert that given to me with the Lamictal.

I sat down on the couch and circled 8 of the side effects on the insert I was experiencing, and 4 more under seek medical attention right away if you are experiencing these side effects.

Now it is 4:45 pm and I either need to call immediately or try to last through the weekend without and emergency room visit.

I found myself in that awkward position of not knowing if I should quit. Yes, I was in a horrible amount of pain. Yes, it was very unpleasant. But by all accounts I’m told it will pass, right? The side effects of most medications pass after a time, maybe I just needed to wait them out?

And, I tried to fool myself for a bit, maybe I have the flu? Maybe I forgot to wash my hands after riding the bus and I contracted the flu. Maybe that is why I feel so crummy.

Two days, I decided. I would give myself the weekend to see if any of the symptoms I was having passed. I had an appointment on Monday to see my doctor anyway, so I could walk right into his office and let him know one way or the other.

But… things got worse. By the time Sunday rolled around I had been experiencing a constant headache for four days. I was thrown into an irritable, angry mixed state (my body really doesn’t respond well to prolonged pain) and I burst into tears while walking down the street downtown with Corey. It wasn’t long before I was laughing and crying at the same time (which is always a weird phenomenon when it happens) and my mood imploded.

I was a black hole experiencing all moods at once, at which point I said something about wanting to punch a cake.

As awful as the experience was, I felt like the decision was beginning to be made for me. I could not endure something like this for eight months. I would be so unstable by the time the medication would be trying to stabilize things it would be like working backwards. 

Defeat is difficult to accept. If this one doesn’t work, how many more drugs are there for me to try? Not many. Is there still hope?

A little bird perched on my shoulder and said,

“And what if none of them work?”

I know it meant well, that little bird, but for a moment my mind was entirely wreaked. I hadn’t thought of it, I always just figured that if I kept trying and didn’t give up, something would help eventually. That my persistence through desperation would pay off in the end. It never occurred to me that it might not.

And then what?

My mind flashed through images of pain, of suffering, of nothingness, of frolicking, of anger, of elation, of… what?

Yesterday my therapy appointment was scheduled back to back with my psychiatry appointment.

When I walked into my therapist’s office, I asked her the same question the bird had asked me. She was knocked back in her chair, like an invisible wave had hit her, and she blinked a few times. I don’t think she knows the answer either.

By the time I reached my psychiatry appointment I had cried 4 times on the way there, all for no apparent reason. That, and the 5 day long headache were the only proof I needed to justify that I was doing the right thing. I couldn’t take anymore.

This third try with Lamictal is the final try. The third strike. My doctor is concerned it might have been starting to make my muscles degrade, some rather ridiculously rare side effect that I will have to have some lab work done for in order to make sure things are ok.

This morning I had my final moment of justification, because when I woke up my 120 hour headache was gone.