My Experience Only. YMMV.

Posts tagged ‘Abilify’

But What Happens in January?

Health insurance is a hassle, especially when you’re talking about mental health. And it’s an even bigger hassle when the government gets involved. That’s not necessarily a bad thing, but it does add a layer of complexity to the insurance process.

For quite a while I was uninsurable, or functionally so. My husband and I both had decent insurance when he worked for the county, but after he left that job, it was all downhill. We muddled through without coverage, paying for our meds out of pocket and avoiding the doctor’s office unless death seemed imminent or we had to have blood work. Mammograms, flu shots, and other preventive services fell by the wayside.

Then came the Affordable Care Act, aka Obamacare. Our pre-existing conditions were no longer a factor. My mental health coverage was guaranteed without going through the county’s EAP plan (Employee Assistance Plan, a six-week, take-the-therapist-we-give-you, cure-’em-quick affair).

The only problem (well, the major problem) was that, even with the ACA subsidy, the insurance cost us $650 per month. And my doctor started prescribing Abilify (cost: $800 per month, and wouldn’t you know, it wasn’t on the insurance plan’s formulary of preferred drugs). Fortunately, the generic came out soon after. It still wasn’t cheap, but it was somewhat lower.

The next year we switched plans. Unfortunately, the new company, a co-op, went under and we were transferred to yet another plan. It was no better than the previous one. In many ways, it was worse.

Prescriptions, for example. After getting them filled at our pharmacy for a certain number of months, we were told that almost all our meds MUST be ordered for home delivery, or the insurance company would not pay for them.

Which would be fine, as they were maintenance drugs. Except that meant paying $1100 for three months of generic Abilify, in addition to the monthly premium for the insurance. I can’t scrape together a lump sum like that, so through GoodRx coupons (https://www.goodrx.com/?c=criteo_au&utm_campaign=activeuser) and the local Kroger, I managed to get my prescription for under $200 per month.

Then the real fun started. My husband’s meds and my non-psychotropics went through the mail-order system easily. The ones my psychiatrist prescribed, not so much.

I’ve just spent the time between November 19 and now trying desperately to get the mail-order place and my doctor’s office to talk to each other, fax each other, send smoke signals or carrier pigeons to each other, to get me my drugs. As I gradually ran out of meds, which I’ve written about before (http://wp.me/p4e9Hv-kO).

I finally got a little action when I went to my doctor’s office, camped out in the waiting room, talked to one mail-order person on the phone while the receptionist talked to another one on another phone, and the nurse worked the fax machine. Then I went home, called mail order again, jumped up and down, threatened to hold my breath until I turned blue, asked for the supervisor, talked to the actual pharmacist, and almost burst out sobbing. Yesterday I got my pills.

This time when I had to pick a new insurance plan or renew my old one, I found one that was almost exactly as crappy as our previous one, but at one-third the cost. And the company representative says that all generics can be bought, at either the pharmacy or via mail order, at the same low co-pay. Including generic Abilify.

We’ll see.

The next problem is, as I’m sure you’re all aware, the president-elect and Congress have sworn to repeal Obamacare as soon as they get into office, whether or not they have a plan to replace it.

What will happen then?

Will I be able to get affordable insurance?

Will I be able to get insurance at all? (Even crappy insurance is better than none.)

Will it cover mental health services? Outpatient? Inpatient? Both psychiatrists and psychotherapists?

Will it cover psychotropic drugs at the same rates as others? Or will the meds that really work for me not be in the formulary of preferred drugs?

And how long will it be before even the crappy, but lower-cost, insurance that begins on January 1st, disappears?

I’m guessing (hoping) that our insurance won’t vanish immediately, given the pace at which the government usually moves. But repealing Obamacare (though not replacing it) has been touted as one of the first things the new administration will do. And anxiety is one of my psychiatric problems. How long will I have to wait, unknowing, to learn what those answers will be?

Generally, I have anxiety when I don’t know what’s going to happen. I catastrophize, then feel at least a little better when the answer comes. (It’s usually not as bad as I had anticipated.)

But this time, when the answer comes, will it lessen or increase my anxiety?

And will I be able to afford the medicine that keeps my anxiety in check and the psychiatrist who prescribes it?

Relentless Holiday Cheer

a snowmanFor many of us with bipolar disorder, the holidays are hard to get through. There is stress caused by family, shopping, entertaining, and crowds. Or the celebrations of others can bring loneliness, isolation, immobility, and despair. Above all, there is the relentless, overwhelming, mandatory cheerfulness, and the expectation that we should feel that way.

As I write this, tomorrow is Thanksgiving. A bit over a week later is my birthday. Then comes Christmas. And, of course, New Year’s Eve and Day.

Every year these celebrations are a trial and a chore for me. I don’t know how you get through them, but this is what they usually look like for me.

Thanksgiving. We have no family in town, so it is just me and my husband. Actually, this is not bad, because it relieves us of the responsibility for massive cooking, anxiety-filled entertaining, and the always-dicey interactions with family. At most, it means we Skype with my mother-in-law while we all eat, which is taxing enough.

This year we are short on funds, so we’re having spaghetti instead of turkey. (I don’t like to do turkey anyway: http://wp.me/p4e9wS-2z.) Then we will indulge in our two traditions: the Thanksgiving episode of WKRP (“As God is my witness, I thought turkeys could fly.”) and the ceremonial playing of Arlo Guthrie’s “Alice’s Restaurant.” Then we nap. That’s it.

And what am I thankful for this year? I can’t think of much, except for my husband and cats, and that my pdoc just increased my Abilify. It hasn’t kicked in yet, except to make me sleepy, but, hey, a nap is on the schedule anyway.

Birthday. This is one of the big ones, with a zero at the end. My husband has already given me my presents (a variety of shoes and slippers). I can reliably predict that there will be a day-old baked good from where he works. No singing, no candles. That’s the way I like it. I’ll count the number of greetings I get on Facebook and feel miserable no matter what it is.

(My attitude toward birthdays is colored by the fact that a traumatic childhood event happened at a birthday party, although not my own.)

Christmas. The biggie. We exchange gifts ahead of time, without wrapping them. We go to the Chinese buffet. Dan watches a movie that I can’t stand, like Mr. Magoo’s Christmas Carol, or one I can sort of tolerate, like It’s a Wonderful Life. Or one I actually like, like Scrooged.

New Year’s Eve/Day. We used to go to a friend’s house for leftover Christmas cookies and singing “Oh, Danny Boy” on the porch (don’t ask), but she was one of the people who couldn’t put up with my bipolar isolation and tendency not to respond to invitations or to show up if I had. So that’s out now.

Dan’s family has a tradition of shaking their purses or wallets at midnight to ensure prosperity for the new year (it failed spectacularly last year). He’ll be working, so we can’t even kiss at midnight. I drink cheap champagne and go to bed early. We might have pork on New Year’s Day. Or not. But unless we have cole slaw or Dan opens a can of sauerkraut for himself, no cabbage.

If that sounds like a dreary holiday season, well, it is, but it’s all I can handle. I have tried. I really have. In years past I have bought Christmas sweaters and earrings and sent cards and entertained and done Secret Santas at work. I have had dinner with family. (Decorating is largely out, owing to the cats.) I have organized trips to fancy local buffets or restaurants. I have wrapped presents creatively (if sloppily) and even shopped off-line. I have baked spice cake and decorated sugar cookies with my friend Peggy. I have gone to community carol sings.

But no more. In many ways, like my life, my holidays have been pared down to the bare minimum. I approach them with dread and survive them with relief. They do not lift my spirits and nowadays I don’t expect them to.

It’s ironic that, though in many ways I am improving and healing and rebuilding my life, the holidays still defeat me. They are, at least for now, pieces that I can’t reclaim. I don’t think it would be much better if a bout of hypomania hit. I can just see myself buying presents for my far-flung friends, then bottoming out before I could mail them. You can’t time these things, after all.

The best I can wish for myself and for all of you is this:

Survive. Hold tight to whatever happiness you find. And please, please, get through this season any way you can.

Running Out of Drugs

Isolated Empty Pill BottlesRunning out of your medications is scary.

I know. It’s happened to me several times in the last few months.

Sometimes it was a matter of supply. My usual pharmacy ran out of Ambien and wasn’t going to get any more until after the weekend. Fortunately, they recommended a mom-an-pop pharmacy (yes, such things do still exist) just down the street and helped me transfer my prescription there.

Another time the problem was the prescription. I ran out of Ativan, but when I called in for a refill, I was told that it wasn’t time for one. When I looked at the bottle more closely, I discovered that they had given me 60 pills, as if I were taking two a day, instead of the three a day actually prescribed. (I was changing doctors about that time and there was miscommunication.)

Yet another time, it was money. I ran out of Abilify (actually aripiprazole – all my scrips are generic) and was told that even with insurance, it would cost me $800 because of the out-of-pocket required minimum. I spent a couple of days arguing with the insurance company, researching solutions online, and making sure a local pharmacy would take the coupon I found, which lowered the price to under $200. (I also had to stand in line while they called the coupon people and the insurance company to see how to enter it all in their system.)

And of course there are the everyday screw-ups. My husband forgot to pick up my scrips, or forgot which pharmacy they were at, or didn’t hear me say that I was completely out, or the pharmacy didn’t open until 10:00, or they had my pills in two different bags and they only gave us one. There are lots of ways it can happen.

Once I even took my entire supply on a weekend getaway and left them in a drawer in the bed-and-breakfast. I know. Stupid.

Most of the time running out of drugs isn’t a crisis. It just feels like one.

Of course, there are exceptions. It is a crisis if you run out of certain anti-anxiety drugs and you don’t get any for several days. You can have withdrawal – actual, physical as well as psychological withdrawal. I’ve heard that benzo withdrawal can be as bad as opiates. That’s one reason it’s important to replace your meds as soon as possible.

A lot of psychotropic medications build up to a therapeutic level in your bloodstream, so a day or two without them probably won’t even be noticeable. When you start taking them again, your levels will even out.

But even if the med you run out of is one that you can easily tolerate a day or two without, you may have some psychological effects. When I run out of a prescription, even for a short time, I become twitchy and agitated – my hypomania kicks in and comes out as anxiety, the way it usually does for me. I fear crashing back into that deadly unmedicated space where all is misery and despair. Intellectually, I know that likely won’t happen. But it sure feels like it will. This is one way my none-too-stable mind plays tricks on me.

It’s like the opposite of the placebo effect – believing that a medication will help you and experiencing gains even if the pill is fake. In this version, I believe that not taking the pill will cause relapse, even though it actually won’t.

Whatever else you feel or do, DO NOT use missing a couple of pills as an opportunity to go off your meds entirely. This is another lie your brain can tell: “You’re doing fine without it. Why keep taking it?” It may not be right away, but you will feel the effects of not taking your meds, and then there you are, back in the Pit of Despair or rocketing to the skies. It won’t be pretty.

For me and a lot of others like me, the key to effective medication is consistency. Once you find the right “cocktail,” stick with it. But if you run out, don’t panic. Keep Calm & Get a Refill.

What Bipolar Disorder Has Cost Me

We lose a lot when we live with bipolar disorder – function, memory, friends and even family.

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But we also lose something more tangible – money. Or at least I did, and I know that a number of others have experienced this as well. Here’s how it went for me.

Work. I quit my full-time office job (possibly in a fit of hypomania). I had a new boss and had told her about my disorder. Her only question was, “What will that mean?” My answer was, “Sometimes I’ll have good days and bad days.” (It caught me by surprise.) Immediately after that, I began receiving bad evaluations, which I never had before. Was my performance really declining? It probably was, as I was heading into a major depressive episode.

But I wasn’t out of work quite yet. For a while I worked freelance, and pretty successfully. Then my brain broke, and there I was – unemployed. I had savings in a 401K, and we ran through all of that. Then my husband had a depressive episode and we ran through his 401K as well. And the money we got from refinancing our house.

Disability. Sometime in that stretch of time, my husband realized that our money was going to run out. He asked me to file for disability. Many of you know that story. I was denied. I got a disability lawyer. By this time – years later – I was able to work freelance again a bit, and my lawyer told me shortly before my appeal hearing was scheduled that the hearing officer’s head would explode when he learned what my hourly rate was.

Never mind that I could work only a few hours a week – maybe five, in a good week.

Insurance. Then there was insurance. As a freelancer, of course, I didn’t have any. My husband’s good county job had covered us, until he became unemployed too. I’m sure a lot of you know that story as well. No insurance. Huge pharmacy bills, and psychiatrist and psychotherapist, and doctor visits and the odd trip to Urgent Care.

Meds. Then my doctor put me on Abilify – $800 a month. I got a couple of months free from the drug company – just enough to discover that it really worked for me and I didn’t want to give it up.

Then, with remarkable timing, the Affordable Care Act (aka Obamacare) came along and we were able to get insurance again. It wasn’t really affordable, though, costing only slightly less per month than the Abilify. But it covered all our other prescriptions, too, so we came out a little ahead.

Budget. Since then, that’s the way it’s been going – month to month and disaster to disaster. My work is irregular and I never know how much I’ll get in any given month. My husband’s pay is steady, but meager – minimum wage. We have managed to make our mortgage payments and keep the house, which my husband doubted we’d be able to do when I couldn’t work. I know in that respect, we’re way luckier than many families struggling with bipolar disorder.

Our latest disaster came this week, when our only remaining partially working vehicle (no reverse gear) blew out second gear as well. The money we had borrowed and put aside for major dental work that the insurance wouldn’t cover disappeared with a poof – and still wasn’t enough. We had to borrow more from an already fed-up relative. I don’t blame her. She never expected to have to keep bailing out her grown son and his wife when she herself was past retirement age.

Our Future. I don’t see anything changing. My mental disorder is under much better control, but I know I’ll never be able to work in a full-time 9–5 job again. Job opportunities are few for people our age anyway, despite anti-age-discrimination laws. And I’ve never tried applying for a job where I must ask for accommodations to offset my illness, but I’m sure employers find lots of reasons not to hire people who need those. Again, despite the laws.

So why am I telling you all this? Am I just whining and feeling sorry for myself? Well, yes, I am, but that’s not the point, really. Bipolar disorder takes a brutal toll on our emotional lives, our families, our relationships, and more. It can also put us on the brink of poverty, or in our case, one paycheck and one more disaster away from desperate straits. I know that there are bipolar sufferers, including some of my friends, in much worse straits.

It’s stressful.

And we all know how stress affects a person with bipolar disorder.

Badly.

P.S. Aaand the well pump just gave out.

Abilify: The Next Chapter

I’ve been taking Abilify as an add-on to my other psychotropics for about six months now, and I have some pieces of good news to share.

Good news #1: The generic (aripiprazole) is now available! There was a slight delay between the time the FDA gave approval for the generic (April) and the time it went on sale. But now it has arrived in drugstores. (I understand that the same company makes both the brand name and the generic, which strikes me as goofy, but then what do I know about drug marketing?)

Good news #2: Between my insurance and my pharmacy, I now have to pay only $15/month for the generic. The brand-name Abilify was $800 without insurance and $125 with. My insurance is not cheap, though it is still less than the cost of brand-name Abilify. When you add in all my other prescriptions and doctor visits and tests and such – plus all my husband’s drugs and other medical expenses, the insurance suddenly doesn’t seem so pricey. (I got this insurance through the Affordable Care Act, and I hope the Supreme Court doesn’t screw it up for me.)

Good news #3: Despite my tiny dosage (2 mg.) I have noticed significant effects. After six months on the drug, I have more energy, better focus and concentration, and fewer down/useless days (unless I overdo and run out of spoons). (See http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/ if you don’t know what I mean by that.)

I’ve been doing major housecleaning/sorting, going out – actually outside the house – to run errands other than my shrink appointments, and I even went to a party – a reunion of people I used to work with. I wore my new skirt, navigated the social milieu successfully, and stayed an hour and a half. (The next day was one of my no-spoons days, though.)

This is only the third time in my life that I’ve noticed a significant effect from taking a new prescription. The first was Prozac (fluoxetine), which felt like looking at a color television after years of black-and-white. With static. Showing only commercials. The second was Lamictal (lamotrigine), which felt like a switch flipping and turning on my ability to think rationally. And now there’s Abilify.

Whatever side effects I may have, I’m willing to live with. (Unless I get the tardive dyskinesia. That would be a deal-breaker.) This feels like real living and I’m happy about it. I don’t think this is hypomania, either. I think I’m supposed to feel this way. I’m going to run with it.

Of course this isn’t the end of bipolar disorder for me, or the end of this blog. I still have plenty to say about my experiences with bipolar depression, mental health in general, and particularly mental health in the media and society.

Sorry if I sound sappy, but it’s good to be alive and functioning!

The Universe vs. Me

I set out Friday to drive from Ohio to Michigan – about a 3-4 hour drive, depending on traffic.

Five miles out, the Saturn stopped working. Called husband and AAA. Towed to local mechanic. Probably bad clutch.

So we switched my luggage to my husband’s Blazer. About 30-40 miles away from home, car stopped working. Called cell phone emergency road service. Towed to nearest garage. No idea what’s wrong with it, or if the random mechanic is any good.

So my husband picked me up and put my luggage in the back of his ’84 pickup. Halfway home, the radiator blew. I had a meltdown. Called AAA. Towed home. Had pizza delivered.

That’s it on the vehicles. Not even a bicycle left.

Also, there is No Money, except maybe enough to pay the mortgage and health insurance for February.

I have my Abilify, but it hasn’t kicked in yet.

A couple of friends suggested that this was the universe’s way of telling me not to go to Michigan, thereby avoiding something even more heinous that would happen there.

My questions regarding this theory are:

Did the universe really want us both stranded at home, with no way to get to the store or pharmacy, or for that matter, to the other cars?

Did the universe really want Dan to miss more work and lose more pay, especially since he lost nearly a month’s pay going to stay with his mother while she recovered from surgery?

Did the universe really want us to invest yet more money in the cars, when we just bought two of them new wheel bearings?

My answer: No.

The universe is not conspiring against us. This is not divine retribution for a life of sin. This is not bad karma because I was a cannibalistic serial killer in a past life. This was not caused by some higher power that knew I shouldn’t go to Michigan because the place where I was going to stay would spontaneously burst into flames in the middle of the night.

But sometimes it sure feels like it.

I believe there is no larger “because.” Just the fact that we have crappy vehicles and can’t afford the upkeep.

I have no idea what to do, except go to bed, finish having my meltdown, and stay there till the Abilify revs up.

The Abilify Saga Continues

It turns out, Abilify works for me. Except now I have to work for Abilify. To afford it, I mean.

I now wake up around 7:30 or 8:00 instead of 10:00. I can concentrate long enough to read whole chapters of books, and am enjoying that immensely. I am able to get showered and dressed and go out to run a few errands. I can decide what to eat and even recognize when it’s time for me to eat.

And I can work. I have taken on a mega-project, which has required my attention up to eight hours a day, researching, writing, editing, and proofreading. I don’t know how well I’m doing (there are some differences of opinion about that), but I’m doing it, goddammit.

I may be pushing myself a little too hard, despite the new energy and focus. The other day I had to force myself, one pitiful step at a time, to address a dozen Christmas cards. “You have the list, you can put the addresses on the envelopes. You’ve got enough stamps, you can surely put them on the envelopes. (Don’t call me Shirley.) Better put return addresses on. You can do that much, then stop. You can slip the cards into the envelopes. How hard can that be? You had them printed with your names, so you don’t really have to sign them if you don’t want to and won’t have to fake your husband’s signature because he’s not here. That would be too much. Now lick the envelopes. All you have to do is stick out your tongue. Might as well take them to the mailbox. You need to get cat food out of the car anyway. Okay, now you can crash. Egg sauce, Ted.”

Many’s the year when all that was Just Too Much. According to the Mystic Law of Reciprocal Cards, we get about four nowadays, and are very grateful for those.

And grateful for the Abilify. Except it’s $800 a bottle, even for the tiny dose I’m taking. I got one free month and one discounted month ($650) from the manufacturer and have spent a lot of time since worrying and seeking solutions.

There will (we hope) be a generic in April. Yay.

I know someone who was taking it and has some left over.

I know someone in Canada.

Will my doctor prescribe a higher dosage so I can break them in half and stretch them (and the cost) out?

I may have at last solved the problem. After hours on the phone and hours more on hold, we finally have new insurance. It costs about as much per month as a bottle of Abilify, but the drug benefit kicks in before we’ve paid the deductible (which is way lower than previously). So our many, many other drugs will magically shrink to $15 per – or less with mail-away – and we’ll come out ahead. A little. Probably. If I can keep up the pace on work.

Plus, now we have dental, and oh lord do I need that. But that’s another story for another time.

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