Tag Archives: side effects

Now With Even More Damage Control!

My ability to write right now is severely limited, but I’ll come back to that in a minute.

First I want to note that my stomach pain and problems seem to be stable-ish at the moment. Granted, I am not eating anything acidic, dairy, beef, or caffeine (so pretty much carbs, carbs, some peas, and more carbs) but my stomach seems to be coming around. I’m hoping that over the next few weeks I can introduce some small bits of more exciting food to it (condiments! flavors!) and see what will happen, but as it is now it appears that stopping the Seroquel has also put an end to my stomach’s apparent suicidality.

There are several symptoms I have been experiencing however that have not improved.

Though the reduction of wellbutrin from 300 mg to 150 mg earlier this week did reduce the amount of blurry vision and inability to focus I was having, it did not seem to touch the dizziness, nausea, eye pain, and (what I have now pinpointed to be) sensitivity to light and sound. The sensitivity to light has become severe enough that I can’t use the TV, computer, or even my iphone without turning the brightness all the way down, wearing sunglasses, and then only using it for a few minutes at a time before stopping again. Failing to do this results in intense dizziness, eye pain, and increasing nausea.

Having to wear sunglasses indoors makes me feel like a doofus. Strangers keep accusing me of trying to look cool, which (believe me) is pretty much the opposite of how I feel right now.

Even now I am writing a paragraph of this post at a time, hanging out in the kitchen for several minutes, and then coming back to write more. Needless to say, unless things change drastically soon my posts will probably be fairly few and far between for a while.

Since both my regular doctor, my GI specialist, and I thought these symptoms were also associated with the Seroquel (which I have been off for two weeks now with no improvement, and actual worsening the last few days) there are several theories floating around.

One theory (from my GI specialist) is that I might have some kind of bowel disease. I will probably be subjected to the pleasure of receiving a colonoscopy in the next two weeks to check for that.

After seeing the ear doctor (to check up on the theory of some kind of inner ear problem and finding nothing) his theory was that it might have to do with an eye problem.

After seeing the eye doctor (who found no evidence of any abnormalities) his theory is that it is a neurological problem -or- a side effect of one of the other medications I’m taking.

Going back to my GI doctor she agreed seeing a neurologist is also a good idea, since I have a history of weird headaches and headache symptoms and this could potentially be all of the symptoms of a migraine without the actual headache part. Apparently that can happen, albeit rarely.

In the meantime, my theory is that it has to do with one of the drugs I’m taking, so I am systematically phasing all drugs out and then back in individually to rule them out as culprits for this issue. The ones I have left to scrutinize are lithium (which I’m not particularly worried about because I’ve been taking it several years now), the wellbutrin, and ranitidine (an acid reflux medication). Both the wellbutrin and ranitidine have potential side effects involving dizziness, vision problems, and vertigo, and these weird symptoms came on right around the time I increased the wellbutrin and started the ranitidine.

Though the side effect thing really gets my goat, if these symptoms are a side effect I think I would be grateful at this point. Really the alternative would involve something potentially being seriously wrong with my brain or bowels which (let’s face it) doesn’t sound like a good time.

Plus I think it is the responsible thing to do to really scrutinize my medications at this point because I have a long history of getting weird side effects and it is much easier (and financially viable) to stop taking something for a week or two (with my doctor’s consent) than to move forward with brain scans and swallowing radioactive bullets and whatnot. Obviously, I will do those things if I need to, but why go there if it isn’t actually necessary?

In conclusion; things are better and worse. Thankfully I’ve switched back to depression this week because I couldn’t go to all of these appointments half deranged (let alone fully deranged). As usual, I am trying to do the best I can… and though “best” in this situation involves a lot of panic attacks and crying, I at least have sunglasses to hide my tears behind.

Advertisements

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.

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.

A Bittersweet Return to Psychiatry

As you may remember, the healthcare reform required that I find a new psychiatrist… only to have that one present itself as unreliable. After a few desperate phone calls and a miracle (the fact that my old psychiatrst is now taking my new insurance) I made an appointment with him a few weeks ago.

The appointment was yesterday, and though I’ve only been without a psychiatrist for three months it has felt like forever. While I waltzed into his office feeling quite chipper and very glad to see him, the appointment was rather bittersweet.

At this point it seems like my mood swings have developed something of a pattern, something that hasn’t happened in the three years I’ve been mood charting and tracking my symptoms. I could be jumping to conclusions here, after all the pattern might have been spurred by the pain and/or medication from when my ovarian cysts have been rupturing (now two for two, two months, two cysts). While I would be thrilled to be able to expect some level of predictability with what I’m dealing with, I’m not holding my breath for at least another month so I can see what happens next.

So far, the pattern looks a little something like this:

16 days hypomanic level euphoria dominant mixed episode
6 days with multiple depressive mood swings per day
5 days of stable mood
6 days with multiple depressive mood swings per day
17 days hypomanic-manic level dysphoria dominant mixed episode
6 days severe depression

I realize this is like… barely a pattern, but it is more like a pattern than anything I’ve experienced before.

Anyway, bittersweet. Great to see my old psychiatrist, but somewhat alarming to realize he has given me every medication (save the newest one, Saphris) that is available or reasonable for me to try. Three months ago I knew this, so why did it feel like such a shock to hear again yesterday?

It seems like I’ve exhausted nearly every possibility when it comes to psychiatric medications without any luck. I say nearly because, again, I can try Saphris (though I want to make sure I can get it for free before consenting to that, it currently has no generic and is terribly expensive) and I’ve agreed to try Seroquel. Again.

The thing is, I was first given Seroquel (quetiapine) while hospitalized, and they gave me a massive dosage first thing in the morning. Within an hour I couldn’t stand or walk because I was so dizzy, and because of that I told them I wouldn’t take it again. 

I think things might be different if I can take a little bit at a time at bedtime and get my body used to the effects (as long as they aren’t as horrible as they were taking a massive dose). You see, I have a very sensitive body chemistry and I tend to feel side effects somewhat exponentially, in conjunction with most medications having little positive effect for me (treatment resistant symptoms!). I’m more than willing to try this again, because frankly I have few (two?) options left in this realm of medicine.

By 2 pm yesterday I was feeling completely despondent and suicidal. I mean, nobody likes to hear that they feel like shit but there are no medications left to treat me. Talk about hopelessness!

That is, until I started thinking about the other options out there. I know there are still many other types of treatments I can try, it just gets my goat how often people (patients, doctors, pharmaceutical companies) promise guaranteed relief from pharmaceuticals when that hasn’t been my experience at all.

At this point, though I’ve tried acupuncture, there are other alternative treatments out there I can try. The trouble is that the ones my insurance covers are the ones I can afford at this point. I went into a terrible amount of credit card debt when I was trying acupuncture as a treatment method and unfortunately it didn’t do much to help me at the time.

My mind circled back to the idea of ECT. I don’t think my psychiatrist has brought it up lately because I really freaked out on him the first time he did. My reaction was the same as the first time I was suggested lithium, namely;

“Seriously? My symptoms can’t be THAT bad, right?”

Here, three years later, I can’t hold down a job. I’ve given up doing most of the things I love to do. I’ve tried every medication available to me (well, nearly) with no improvement. I yell at people in public uncontrollably while manic, I deconstruct my relationships while depressed, and I can’t tell the difference between reality and delusions while in mixed episodes. Are my symptoms bad enough to warrant ECT? Yes, I dare say I think so.

So… there. That’s an option. And just feeling like I have an option (albeit a bit of a scary one) makes me feel slightly better. After my last hospitalization I’ve always said that if it came to being hospitalized vs. trying ECT, I would rather try ECT.

I’ll try the Seroquel thing first and see how that goes, and I’ve got Saphris to try as well. Having said that, I’m planning on putting the option of ECT back on the table next month when I see my psychiatrist and see what he says.

I know I’m not the only one out there who has had trouble finding treatment options that work for them. I know it is simply the sickly, syrupy voice of depression when I feel singled out of a group that has already been singled out. The truth is not that I’m an “outcast’s outcast”… but so much of our lives involves comparing ourselves to the people around us that the things that make us unique often feel like pitfalls. I have to (and I will) find a way to make life work for me… and given my tenacity I can’t imagine anyone better suited for the job.

Mixed Themes and Risperidone Dreams

Day 17 of the mixed episode I’ve been residing in, longer than most mixed episodes I’ve tracked at this point. Mixed episodes are generally the biggest time for concern in the day-to-day of my bipolar life because each one brings something new to the table (a new concoction of depressive and manic symptoms) while adhering to an underlying theme of cynicism, anger, and hostility.

To top that off, mixed episodes are also the time I most often (though I do, at times, during mania as well) experience psychosis. Delusions, hallucinations, paranoia, and unbridled fear aren’t always present at these times, but they can pop in at a moment’s notice, rearing their ugly snake-covered heads and bringing down everything around me.

I often consider mixed episodes to be the trifecta of evil. My symptoms of rage and hostility put all of my relationships at risk, the unbearable agitation and confusing physical symptoms leave me desperate, and therefore put my own life at risk (via impulsive suicidally), and the ever-present chatter of what seems to be thousands of thoughts all being read aloud by different voices talking over each other in my mind (well, that and the psychosis) is a recipe for mental falling-down-the-rabbit-hole risk well outside the realm of what depression or mania seem to press on their own.

During my last hospitalization (April, 2011) where I was jumping between suicidal depression and psychotic mixed symptoms the house psychiatrist prescribed me Zyprexa. That was the first time I had ever taken an antipsychotic drug before, and though it seemed to help something at the time, I couldn’t convey to my psychiatrist upon leaving the facility exactly what that was. 

I’m not particularly surprised by this, after all… I was pretty familiar with symptoms of depression at the time, and though less familiar with symptoms of mania I could identify them. Mixed episodes were, however, something I did not understand yet. All I knew was that I felt horrible at times, the most horrible I’d ever felt, and I couldn’t quite nail down exactly where that terrible feeling was coming from.

I continued taking the Zyprexa for two months and rapidly gained 40 pounds. Long red stretch marks began to appear across my entire body, and it seemed that any benefit the drug was giving me was being quickly outweighed (heh) by incredible weight gain.

Together, my doctor and I began testing other antipsychotics on my system. We landed on Risperidone, and though I had the least side effects from taking it I still had to deal with intense drowsiness (often knocking me unconscious within 30 minutes of taking it and elongating my sleeping habits to 12, 14, sometimes 16 hours after having taken it) and severe brain fog that made it difficult to put thoughts and words together.

Because of how sleepy it made me, both my psychiatrist and I concluded I couldn’t take it all the time (as I still had a job at the time). Instead he decided to give me a prescription and allow me to take the drug as needed. 

As needed. Yes. The last couple years I have taken .5 mg of Risperidone as needed for symptoms like psychosis or… you know… violent hostility. Honestly, I’ve often opted to take Ambien instead because it put me to sleep immediately in a similar manner but didn’t leave me feeling like a total train-wreck the next day. Since most of my mixed episodes have been fairly short and sweet, it didn’t seem necessary to really bombard myself with drugs. I’ve been somewhat wary of taking more Risperidone because I was nervous about not being “on the ball” for plans the next day, and because I haven’t take it much, I often forget about it entirely.

It can be easy to fall into a place where I feel overwhelmingly awful and not be able to see the things around me that might normally help me feel better. I think this is part of the reason why I am on day 17 of my current mixed episode and only began taking the Risperidone on day 15.

And I found it. That thing, the elusive thing that I couldn’t discern when I was taking Zyprexa a few years ago. I knew that when I took it, something was different. Some symptom was gone, but my mind was just too foggy to be able to point it out.

Yesterday morning I woke up after a 14 hour Risperidone nap and there was the brain fog I was expecting. However, there was something else I wasn’t expecting.

Silence.

My mind, so loud and chattery and unruly the night before, seemed to keep sleeping even after I opened my eyes. Yes, I felt a little stunted and perhaps a little dull, but this was a dullness I was thankful for. That brain fog that I had wrestled with so much a few years ago was now the thing that seemed to be making taking this drug worthwhile!

I feel like treating bipolar disorder is a constant game of “which is worse?” While some side effects from medications or other treatments might seem unbearable in times of stability (or during less severe episodes), there may be times where certain symptoms or types of episodes feel far worse than those effects. The biggest trouble is that ever-changing-symptoms make it incredibly difficult to discern when “worse” might become “worth it”.

Between a Rock and a Pill That May Cause Hair Loss

With the fairly recent mixed manic episode I had at work, my psychiatrist is pretty concerned.

I’m not surprised, -or, well, actually I was a little surprised when he prescribed me Lorazepam (especially after having such a terrible reaction to Klonapin), and when he swiveled his char around and said,

“ok, we seriously need to get you on something to deal with the mania now that you’re having it. The choices are these:

  • Depakote, which can cause weight gain and may potentially make your hair fall out, or
  • Tegretol, which will lower your sodium level and render your hormonal birth control useless.”

Well doc, don’t make them look so appealing! You’ll make it too difficult to decide!

Yep. So these are the last two drugs left, as far as I know, that I haven’t tried. At least, the ones I haven’t tried that my doctor thinks have minutely more than a snowball’s chance in hell of working for me, and are readily available.

I told him I wanted to wait until he comes back from his vacation to decide, which puts me in the middle of October. I can’t discern whether that is a good plan or a bad one, because October is usually significantly more elevated than the summer months.

At this point, I can’t quite decide whether the idea of self-inflicted misery due to ridiculous side effects is better or worse than the notion of potentially losing my job in a fit of fiery manic passion in the unforeseen future.

(Actually, I am much more likely to just become so agitated and paranoid that I crack under the stress and quit. At least, that is what my track record has proven to look like so far.)

I know. I jest, albeit cynically, but I do expect to go through with trying at least one more drug.

Who knows? Maybe I’d look cute slightly balder.