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. 

Goodbye, ECT, and Good Riddance

Wednesday was my tenth and last ECT (electroconvulsive therapy) appointment.  I am so very excited to be done with these treatments, I can barely contain myself.

Oh, the things I won't miss...not having to drive 45 minutes each way for every treatment...not having to wait in the inevitible backlogged queue for it to be my turn when I'm finally there and ready...not having that "lost time" feeling every time I wake up...not wanting to sleep for two entire days after the treatment.  (Well, if I'm honest, I'll still probably want to sleep, because that's just the way I work.  But at least it won't be a drug-induced, fall-into-bed-and-pass-out sleep.)

I also won't miss the random aches and pains I have after each treatment, especially in my right shoulder and back.  What is that about, anyway?  I think the pains are a result of my muscles clenching up during the seizure, but I get muscle relaxers, so that shouldn't be it. It's a mystery.

The only thing I'm concerned about is feeling worse.  For all the irritating parts of ECT, I really think it did help.  And I notice that the further I get from my last treatment, the more depressed and irritable I get.  This mood change could also be due to the fact that I have to stop taking my lithium 48 hours before each treatment.  For right now, I'm going to assume that the lack of lithium is the culprit, and not the lack of ECT.  I'm not sure what I'm going to do if it turns out I need ECT regularly to feel okay -- that would, frankly, suck.  I don't even know how or if that would work.  Hopefully I won't need to find out.

For now, I'm just going to bask in the glory of "graduating" from my treatments, and hope for the best.

This is Me...This is My Brain on Psychiatric Drugs...Any Questions?

I think a big question that plagues many people who take antidepressants, antipsychotics, and other types of psychiatric drugs is, how much do these drugs change your personality?  And, how much does that matter?

Obviously, if you're taking some sort of mood-altering drug, it's because your mood is interfering with your life, presumably in a negative way.  You're depressed, psychotic, anxious, or have some other undesirable problem that you've sought treatment for.  The only problem is, often times, the drugs you get to help you through the original issue cause other undesirable issues that may or may not be worse than the original problem.  For example, I wrote a few weeks ago about the mountains of Seroquel I'm taking and how they make me blunted and tired.  Add that to my ECT treatment from yesterday, and I've slept the better part of the last day and a half.  I'm lucky I have a babysitter so that I can sleep as much as I need, but I still feel like the world's laziest person.

Another issue I've noticed being on a higher dose of Seroquel in addition to ECT treatments is that I just kind of feel stupid.  My reaction times are slower, I can't think of words or phrases as quickly as I usually do; I can't flesh out ideas like I usually can.  While I don't think I'm a particularly great artist or crafter, I feel like my normal pool of creativity is definitely shallower than it used to be.  When it comes down to it, those things are small prices to pay to be a functioning member of my family and society.  It's more irritating than anything, to have a half-formed idea hanging in your brain and lack the ability to give it structure and substance, but it's irritating, nonetheless.

One last complaint (let's face it, this is just one big rant) I have is that I just don't care about most things.  My weight, cleaning the house, getting out and doing stuff, setting up fun, structured activities for the kids -- I just can't be bothered.  It's as if my mantra is, "Whatever." I did manage to get my girls signed up for ballet and theater classes, and I made the giant step in managing my weight of buying a bunch of Lean Cuisines.  Maybe just the fact that they're in my freezer will rub off on my other food and make all of it low-cal, tasteless and cardboardlike.  I can only hope, because that's about as far as I've got.

Even entertainment-type stuff has less appeal.  I can hardly sit through a whole television show anymore; I just don't care.  I've been reading the same book for three weeks.  And it's a good book!  I just can't get that interested.  Even knitting and crocheting hold less appeal for me; I feel like just about everything I do turns out crappy and I just can't get excited about anything.  I flip through lists of projects in my head and nothing grabs me.  It's so frustrating.

So, to sum up, I'm going through that unavoidable existential crisis that most people who are on mood-altering drugs go through at some point.  If I think, therefore I am, what am I if I think slower, or less sharply?   If I think differently, or less?  If I think, but I just don't care?

Antidepressants and anger

About a month or six weeks ago, I had the opportunity to join a DBT (Dialectical Behavioral Therapy) session at a nearby hospital.  I went in for the initial assessment, but ultimately decided not to do it.

There were a few reasons why I decided not to participate, not the least of which is that I'm lazy and have commitment issues and couldn't see myself hauling across town every single Tuesday for the next six months.  There was another, more specific reason, though, that doesn't have anything to do with my personal shortcomings.

During the assessment, the therapist was asking about anger, and what happened when I got angry, and how I coped.  One of the most significant and consistent benefits I've noticed about antidepressants and mood stabilizers, essentially since I started taking them almost ten years ago, is that my anger episodes have all but disappeared.  I still get angry, but it's more mild irritation than blinding rage (except when we're talking about the people putting the new roof on my house, but that's another story).

I used to get so mad, it would be hard to see; I'd stammer and get all shaky.  I'd throw things (shoes were my favorite thing to throw, I don't know why) and slam doors.  It was ugly.  And, seriously, when I started on medication, those episodes sort of floated away.

This brings me back to the DBT assessment.  The therapist asked what happened when I got really angry, and I told her I used to have serious anger problems, but since I started antidepressants and mood stabalizers, those episodes went away.  She looked at me in a kind of condescending manner and said, "Well, I can tell you, medication rarely helps manage anger.  But therapy can."  She then moved on to the next part of the interview.

Now, I'm sure she's much more well-versed in all this kind of stuff than I am, but I know for a fact that my anger has lessened a lot since I started my meds. I guess it could be a coincidence, or maybe just mellowing out with age, but it seems awful odd that the two would coincide so completely and not be related. 

That's about the point I lost a lot of confidence in the DBT program.  I got the feeling it was going to be a "meds are bad, therapy is good" kind of situation, which isn't totally a bad thing; but what's more, I got the impression that I was going to be told my perceptions of my situations were "wrong," and that the therapists and facilitators are "right."  And let's be honest; if I wasn't wrong about a lot of my perceptions, I probably wouldn't need DBT.  But I'd like the facilitators to at least listen to me and not dismiss my ideas out of hand because they didn't fit with their notions of therapy or treatment.

In retrospect, maybe I was too quick to judge the situation.  I have learned, however, if I get a certain "vibe" or feeling about something, it's often right -- no matter how quickly I get that feeling. 

I think I made the right decision.

Or maybe I am just really lazy and didn't want to haul all the way across town every week.  Whatever.  At least I'm not going to get mad about it.

Lithium: Edgy cultural reference or psych drug?

I was excited last week to find out that I had a free trial of Sirius XM radio, which my car is enabled for but I don't subscribe to.  One of my favorite stations on XM is called "Lithium," which claims to play edgy 90's alternative/grunge rock (I say "claims" because one day I heard Creed, so I think it's questionable how "edgy" they are).

One day as I was driving around, I started thinking about the name of the station.  Since Lyddie (girl #3) was born, I've been on lithium as a mood stabilizer.  It's the first time I've been on lithium, personally, but it's one of the oldest and most-tested psych meds around, and is widely acknowledged to be the "gold standard" (per CrazyMeds) for bipolar disorder.  And I know it seems to be working for me.

But what, exactly, does it mean that an "edgy, hardcore" radio station has taken "Lithium" as its name?  Is the use of the word, and, undeniably, the associations with it, giving a negative or incorrect image to a drug that otherwise has helped millions of people?  Is it casting the wrong kind of light on mental illness?  According to Wikipedia (which, of course, is the God's honest truth and we can believe everything it says), the name "Lithium" is a nod to the Nirvana song of the same name.  I know the song, and, as with most Nirvana songs, have no idea what the hell it means.  So, I again turn to Wikipedia, where it says the song is about religion and it being a sort of "opiate" for the person in the song.  Frankly, I have no idea what lithium has to do with that, either.

I honestly don't know how I feel about the name of the radio station (and the name of the song, now that I think about it).  Maybe I'm being overly sensitive -- I tend to over-think things like words and their connotations, I guess it's a hazard of being an English teacher.  But in a world where "crazy" and "mentally ill" and "psych ward" and "looney bin" are all words and phrases thrown around way too carelessly and with negative stigma, maybe I really can't be too sensitive.

Back to the point, part 2

In my last post I started detailing the issues I've had during pregnancy with getting mental health care, which is the whole reason I started this blog in the first place.  I will continue the story with this post.

In late October/early November, I went to my general practitioner because my mood had started getting really bad since going off my meds (Seroquel and Lamictal) in August.  After talking to me, -- which involved a lot of crying on my part-- looking at my medical history, and looking at the cuts I had made on my arms, he put me back on a low dose of Seroquel.  For about a week, I felt not great, but functional, but then things continued back on their downhill spiral.  I was crying all the time, just wanting to sleep, having anxiety attacks, and doing a lot of cutting.  I called my GP back and talked to a nurse, who in turn talked to the doctor, who increased my Seroquel dosage. 

The increase in Seroquel didn't seem to make much difference, other than to make me more tired (something not particularly desirable when you're trying to chase a four-year-old and a two-year-old).  I called my ob/gyn's office to see if she could help out at all.  She put me on Vistaril as needed, which is pretty much just an antihistamine but can kind of mellow you out at the same time. Both my ob/gyn and my GP suggested strongly that I see a psychiatrist, but not wanting to go back to my prior psychiatrist, and with nobody recommending a new one, I was sort of at a loss for who to see.  If you've ever tried to get psychiatric help in Dayton, Ohio, you understand what I'm talking about.  There aren't too many psychiatrists, and those that there are often have a 3-6 month waiting list just to schedule an initial appointment.

In early December, after a few more weeks of generally decreasing mood and functionality, I called my family doctor again and the nurse recommended I go to Kettering Behavioral Health Center, a facility located in Centerville (I think) that has both inpatient and outpatient care.  They also offer walk-in assessments.  I drove myself over there and talked to the admitting nurse for about a half hour.  I explained I was about 21 weeks pregnant (in case she couldn't tell), was cutting myself daily, crying all the time, and generally feeling like utter crap.  I was worried that my mood was hurting the baby, and I needed psychiatric help to look over and manage my medications. She asked the $64,000 question:  "Are you suicidal?  Do you have specific plans?"  I told her that I frequently thought about suicide, but didn't have a specific plan to follow.  I thought about taking pills or slitting my wrists, but hadn't written a suicide note or anything.

At this point she assured me that the facility had an ethical responsibility to help me out, since I was a danger to myself and my baby, based on my suicidal thoughts and cutting behavior.  They wouldn't just send me home and tell me good luck.  She asked me to step out while she called the psychiatrist on duty and talked to him about what to do next.  My sense of relief was tangible -- finally, someone was going to help me.

She came out to the waiting room a few minutes later and told me that the psychiatrist wanted to admit me to try to regulate my medications.  I didn't particularly want to be admitted -- it was close to Christmas, and I wanted to be home.  But, I knew I needed help, so I agreed.  She went back to her office to talk to the admissions people to get the process started.

About 15 minutes later, she called me back in to her office.  As it turns out, they couldn't admit me to their facility, because I was more than 20 weeks pregnant, and they didn't have the medical facilities to help me in out in case of a problem (they are not on the same grounds as the actual hospital).  What they could do is prescribe Klonopin for me, a powerful anti-anxiety drug, increase my Seroquel again, and suggest if I was still having problems to either call my old psychiatrist or go to Miami Valley Hospital's ER.

And with that, despite their "ethical obligations," they sent me on my way.

Next post:  a new psychiatrist and the ER.