The Unending Chain of Side Effects

I saw my psychiatrist today, as I have the last three Wednesdays.  Let me first say, that despite the fact I have to drive over an hour down and back for my twenty minute appointment, I really do like my doctor.  She seems really on top of things, and also seems to be interested in continually expanding her knowledge.  To a teacher, that's pretty much the best personality trait anyone can have.
The reason I'm seeing her so frequently is that I'm trying to change meds.  I was on a ton of Seroquel plus lithium, and we're trying to phase out the Seroquel and get me on another atypical antipsychotic.  Last week, she cut my Seroquel almost in half and prescribed Abilify, something I was on a long time ago but don't remember a lot about.

Turns out, the Abilify (like Geodon before it, another atypical antipsychotic) gives me akathasia.  Akathasia, in lay terms, is when you get really antsy and jittery and feel like you can't sit still.  It was worse on the Geodon, but it seems to be getting steadily more irritating the longer I'm on Abilify.  So to combat the akathasia, my doctor prescribed a drug called Propranalol that works by lowering your blood pressure and making you less antsy.

To make a long story shorter, it ends up I can't take the Propranalol because it gave me chest pains, made me a little shaky, and I have a level 1 AV block (a very minor heart condition) that isn't a big deal by itself, but could be an issue on the medication.  So now we have to change directions and move towards Depakote rather than Abilify.

The problem with Depakote?  It causes weight gain, which is one of the reasons I was trying to get off Seroquel in the first place.  So now I have to go to my primary care doctor and see about taking a drug for diabetes 2 called Metformin, which helps with weight loss. 

I talked a few days ago about the idea of getting off of meds completely; this whole side effect debacle makes me even more interested in the idea of getting off drugs.  I feel like we're getting to the point where we're managing side effects more than we're managing the underlying problems, my bipolar disorder.

Does anyone with chronic problems have this same issue?  The daunting task of managing side effects?  Of taking drugs to offest the drugs you're taking?  It's frustrating, and if I didn't have anxiety problems already, I'd definitely have them now. 

ECT Update, and Why I Hate Seroquel

No, I haven't fallen off the face of the earth.  Like most people, I got distracted by Christmas and haven't updated in a little while.  Here's hoping you and yours had a lovely holiday and are getting some much needed rest and relaxation.

I am now in the "maintenance" phase of my ECT treatments.  I finished up my "acute" phase last week on Friday, with my sixth treatment.  Now I'm on to one treatment a week for a month, which is much less of a hassle, especially considering the treatment facility is 40 minutes away.  The bad news, though, is that while I was pretty sure the treatments were helping the first week or two, now I'm not so sure -- I seem to have slipped back into a funk and am generally intolerable to be around.  I'm trying to tell myself that maybe it's just the stress of the holiday (like I wrote last week, it's hard to determine what ups and downs are due to having bipolar disorder and what are due to general life stress).  I hate the thought that I may have to go back to 3 ECT treatments a week for another few weeks to try to stave off a heavier depression, but if I do, so be it.

I'm also tired -- very, very tired.  And I'm not sure if it's a side effect of the ECT, or the increased dosage of Seroquel I'm on.  When I was hospitalized in early December, the doctor increased my Seroquel and decreased my lithium in anticipation of starting ECT treatments, because lithium and ECT don't play well together.  I went from 50 - 75 mgs of Seroquel daily to 450+ mgs daily.  I think it does what it's supposed to do, which is even out my moods and make me a little less irritable and raw -- but it also makes me really sluggish.  Add the ECT treatments (and anesthesia) I'm undergoing, and I'm pretty worthless. 

It's so irritating to me that I have to make a choice between being an ugly-acting, depressed witch and being an exhausted, useless sloth.  I guess I should just be grateful that there are drugs that do help depression (more or less), and just look at the side effects as a small price to pay for the benefits they provide.  But it's still frustrating.  Ultimately, though, there's not much I can do about it -- just hope for a speedy end to the ECT treatments so I can get back up on a therapeutic level of lithium and leave the Seroquel behind.  Here's to hoping!

Hello, Mania, my old Friend....

...and since it's 3:30 a.m. and I'm writing a blog post, it's obvious I've come to talk with you again.

(and if you don't get the above cultural reference, you're too freaking young.  Go get Simon & Garfunkel's Concert in Central Park and report back later).

So while I was in the Lindner Center, the doctor there put me on a new, fun drug called Geodon (generic name:  ziprazidone).  It's an atypical anti-psychotic (AAP), much like Seroquel or Zyprexa, but it's a little bit newer and the side effects don't seem to be as bad.  For example, Seroquel and Zyprexa both cause insane weight gain, Zyprexa worse than Seroquel, and I've gained like, 50 lbs on Seroquel over the past five years.  Yeah, okay, I also had four pregnancies and three kids in those five years, but I'm gonna blame it on the Seroquel anyway.

Geodon is actually not a new drug, but apparently it seems to be used more often when other AAPs haven't worked.  I'd never heard of it when the doctor put me on it, and I feel like I'm pretty well-versed in this stuff. The nurse had me sign a release for it with the rest of my meds when I first got there, and she told me that it was a drug that they usually inject you with when you get really psychotic and they can't control you, and they almost certainly wouldn't have to give it to me.  Two days later, the doctor calmly informed me it was goinng to be part of my regular routine (in a capsule form, not an injection).

Apparently, it's marketed by Pfizer, and they were involved in a federal case a few years back that included being fined by the FDA  for marketing Geodon and three other meds for "off-brand uses."  To the tune of $2.3 billion.  That's with a "b," not an "m."  Here's an article from a medical fraud advocacy group that says that Pfizer got what they deserved, and here's another article from Forbes saying the whole thing was ridiculous.  I'll let you decide.  But the point it, maybe the drug is sort of unpopular due to public opinion reasons, I don't know.

Essentially, though, the doctor at the clinic took me off my virtual pharmacopeia of drugs I was on when I went in (lithium, Zoloft, Seroquel, Lamictal, Buspar, and an occasional Ambien and Ativan) and wanted me just on lithium and Geodon.  In fact, she said that a sort of "perfect storm" of occurrences led up to me being hospitalized, with the icing on the cake being the Zoloft, causing an agitated mixed-mania state, that was causing hallucinations, delusions, and suicidal thinking.  I'd been on Zoloft for six years, so Zoloft and mania or Zoloft and mixed-states was never on my radar.  I was taking all of my normal drugs in relatively low dosages, except the Zoloft.  I mean, I'm depressed -- give me an antidepressant, right?   Seems logical.  But it turns out that none of the meds were really helping, and some of them were actually hurting. Antidepressants can actually be pretty bad for bipolar people, but I've never had any obvious problems with them before, so I've stayed on one after another after another (you name it, I've been on it) for years.  This is actually a pretty major problem for some people, but I'll talk about that another time.

So when the pdoc sent me home on Wednesday, I was on Geodon, lithium, and Xanax as needed (with the idea that eventually I'd get off of everything except the Geodon).   Three drugs seem like nothing, compared to my previous med cocktail.

The only trouble is...well, it's 3:30, and I'm writing this blog post.  Yep, seems like something is sending me into some sort of (at least hypo-)manic state.  I'm pretty sure it's not the Xanax, since Xanax usually knocks me on my ass.  But I've had three of them since 7:00 p.m. tonight, and other than the fact I can't see straight and I feel like my brain is rattling around in my head, I'm not at all tired.

I did do some web searching, and that shining bastion of research, Wikipedia, mentions that "Ziprasidone is known to cause activation into mania in some bipolar patients."  Thanks, Wikipedia, for that thorough explanation.  At least they list references; here's a link to one of the studies that supports this claim (there are a couple). I also found a couple of discussions online about "Geodon mania" that were asking the same questions.  Here's one; here's another.  God, I seriously love the internet.  You could do a search for just about anything and find a discussion about it.  Anyway, irrelevant.

Maybe it's the Geodon, maybe it's something else causing the mania, I don't know.  I've actually cut way back on my caffeine, so it can't be that, and the Zoloft is gone, so it can't be that, and I've been on the lithium for about six months...so I'm kind of at a loss.  I will mention, though, that the sleeplessness isn't the only manic symptom I'm experiencing, so this isn't just a case of insomnia. I won't elaborate, in case my husband reads this, but he'll know what I'm talking about when he gets my next credit card bill (sorry, sweetie). 

For now, I think some of the Xanax has kicked in and, while I'm not tired, I definitely can't see straight.  So I think my rant is at an end for the moment.  I hope you're sleeping, cozy in your bed, and not doing random research on anti-psychotic meds that you feel like a crazy person for needing to take. 

Oh, wait, I AM a crazy person. Oh well. Least I'm a crazy person with a credit card.  For now.

Hobo bag blues and the stomach flu

So last week I was going like gangbusters on my Noni hobo bag, until I realized I misread the pattern and was only decreasing by two stitches every three rounds instead of four. I did this for probably 60 rounds of the bag body. Talk about frustrating. I am eternally indebted to my mother, who actually went ahead and tore out the rounds for me and re-balled my yarn. I'm sure she did this because she loves me, but also because she knew how much money I spent on the kit and couldn't bear the thought of me not finishing it.

In addition to my knitting woes, the entire household came down with the stomach flu last week -- the two-year-old on Tuesday, the rest of us on Thursday. It was that awful stuff where you projectile vomit till you think you going to see your shoes coming out; at least it only lasted about 24 hours for all of us -- except me, of course, probably because of being pregnant and generally down in immunities.

My mood, knock on wood, is slowly improving. I think the medication changes made while I was at the hospital were a step in the right direction. I even managed to take the kids to story time today at the library, and that's the first time I've taken the kids out by myself in quite a while. I'm still not good, but I'm much better than I was, and any improvement is welcome.