My Experience Only. YMMV.

Posts tagged ‘drug side effects’

Bipolar and Growing Older

I was a bipolar child. I was a bipolar college student. I was a bipolar adult. And now that I am about to be able to get the senior discount card, I am a bipolar – what? – mature adult.

First, let me say that aging sucks. Except that the alternative sucks more. The problem is, I can’t always tell whether anything that happens to me is due to my bipolar disorder or due to aging. I fear that, since my bipolar is fairly well in check at the moment, what are left of my problems may be due to something else.

My hands shake, for example. This has been true for years, though. The neurologist called it “essential tremor,” which I think means it just happens and they don’t know why. But some medications have made the tremor worse, and one of the medications I’m taking now could be increasing the shaking. And the shaking gets worse when I have anxiety. So I think we can chalk that one up to bipolar disorder, mostly.

I forget words. Sometimes, when I’m talking, I forget the word that comes next and have to pause or talk around it until it comes back to me. Sometimes my husband fills in the blank, which is helpful, but really annoying. For a writer, losing words is scary, but the memory difficulties seem to happen more when I talk than when I write.

I know I’ve had memory lapses before that can be attributed to my medication, and those memories are gone forever. I’ve written about that phenomenon: http://wp.me/p4e9Hv-6k. But these seem to be single words that escape me, and that I can usually get back within a few seconds. It doesn’t feel like anything I’ve had associated with bipolar, so I suppose this one is aging. If it’s the onset of Alzheimer’s, I’m going to be so pissed.

I isolate. This I’m pretty sure is bipolar in nature, since I’ve been doing it for years, especially when I’m depressed. I’m also reasonably sure that I am getting less isolated as my bipolar disorder has eased. I still don’t get out much, though I did go to a fabulous (and large) party last Sunday. But I am active on Facebook and Messenger, and I write these blogs, and I talk on the phone.

On the other hand, I seldom leave the house, and that I think is an effect of aging. I have mobility and balance problems because of a bad back and some nerve damage in one foot. But bipolar is involved, since weight gain from medications also affects my mobility, and an aversion to crowds and noise is likely associated with my anxiety.

Side effects of bipolar disorder and bipolar medications are to be expected. So, for that matter, are side effects of aging. Teasing out which is which may seem futile, and perhaps it is. I just want to know which I have some degree of control over and whether some, especially the cognitive symptoms, are likely to fade, stay the same, or get worse.

What I Learned About Ketamine and Depression

Trigger Warning – Meds

Note that I’m not a doctor or a pharmacist or any kind of medical personnel. Do not consider this post to be advice on what you should do. If the subject interests you, ask a licensed physician for more information.

What did I know about ketamine before I started doing some research?

Not much.

I knew that as a street and “club” drug it was known as “Special K.”

Then I heard that it was being used for treatment-resistant depression. Here’s what I found.

First, you can’t just go down to Brown Street and buy a few pills. That’s illegal. And what you get may include other substances that you didn’t intend to take.

So, you need a prescription for it. Once you get that prescription, usually after a consult with a psychiatrist, you need to find a treatment center that will administer the drug. Clinic operators may be anesthesiologists, as ketamine is primarily used as an anesthetic.

The treatment is delivered via IV or injections. No simple pills to take. It’s a course of treatments, each lasting 45 minutes to an hour, with a rest of an hour afterward. The treatment may be delivered for as many as six doses over the course of 12 days. (There may also be a nasal spray option, but the IV version seems more typical.)

You have to have someone who can drive you. The possible side effects include confusion and blurry vision. You can’t drive for 24 hours after the treatment, which basically means you can’t drive for two weeks, since the treatments are roughly every other day.

They don’t know how it works. I don’t find this surprising, since every time I’ve asked my psychiatrist how a medication works, I’ve been told, “They don’t really know, blah blah blah, neurotransmitters, blah blah blah, serotonin, blah blah blah.”

It’s expensive. The initial treatment may cost $500–$1,000, and a full course of treatments may cost as much as $3,800, which insurance won’t cover. These are estimated costs, based on treatment in various regions of the country. (The wholesale cost is approximately $.32 per dose, by the way.)

The results don’t last. They give relief for as little as a few hours to as much as nine months, after which a $600 booster shot is required.

You may still need regular antidepressants and psychotherapy. Ketamine may get you “over the hump” until your regular antidepressant kicks in, but is not a stand-alone treatment.

There are side effects. Confusion, hallucinations, and high blood pressure are among them, along with something called “lucid daydreaming.”

More research is needed. Duh.

The FDA has also approved trials of MDMA (Ecstasy) for treating PTSD. It is also being researched for effects on OCD, depression, and other conditions.

So, assuming that I could afford it, would I try ketamine? There’s not one easy answer to that.

Back in the days when my depression was drug-resistant, when I had spent years trying different combinations of psychotropics, when I was considering electroshock, I might well have seen ketamine as something to consider before I took that step. It should be noted that, at the time, my psychiatrist did not recommend or even mention it, so it might not have been appropriate for me whether I wanted to try it or not. And anyway, a combination of meds and therapy finally kicked in and made the subject moot.

Nowadays, I would not try ketamine (or MDMA, for that matter). My bipolar depression has moved from drug-resistant to drug-alleviated, at least for the most part. And that “most part” is enough for me. I have no need to be driven 45 minutes to the nearest clinic or to try to find a psychiatrist and anesthesiologist willing to go off-label. I am satisfied as I am.

As always, Your Mileage May Vary.

Sources

http://www.webmd.com/depression/news/20140923/ketamine-depression#1

http://www.ketaminetherapy.com/Depression.html

http://uchealth.com/intranasal-ketamine-infusion/

https://psychcentral.com/blog/archives/2012/12/01/should-you-try-ketamine-for-depression/

https://en.wikipedia.org/wiki/Ketamine

http://www.webmd.com/depression/news/20161130/fda-ecstasy-ptsd-treatment#1

To Sleep or Not to Sleep – That Is the Question

According to WebMD (which I find a pretty reliable source), “An inability to sleep is one of the key signs of clinical depression. Another sign of clinical depression is sleeping too much or oversleeping.” http://www.webmd.com/depression/guide/depression-sleep-disorder#1

So, apparently, with either unipolar or bipolar depression, either way you’re screwed when it comes to sleeping.

Most of what I could find online about depression and sleep talked about depression and insomnia. WebMD says:

An inability to sleep, or insomnia, can be one of the signs of depression…. Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep caused by another medical illness or by personal problems can make depression worse. An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed. http://www.webmd.com/depression/sleep-depression#1

But, they add, “a small percentage of depressed people, approximately 15%, oversleep or sleep too much.”

I seem to be in the 15% that sleep too much. I usually wake up around 7:00 or 8:00, take my morning meds, and go back to sleep until 9:30 or 10:00. Sometimes I have a little nap in the afternoon. (For me, a “little nap” is about two hours.) I take my nighttime meds at 11:00 and am asleep by 12:00.

That’s a lot of sleeping.

Of course, those are just averages, just when I’m depressed, and just when I have no deadline-dependent work to do. Many days lately, I have been getting out of bed when I first wake up and skipping the afternoon nap. But then I go to bed even earlier, though I usually read for a couple of hours.

On the other hand, I’m subject to mixed states, when depression and anxiety coexist. When that happens, I want desperately to sleep, but can’t turn off my idiot bipolar brain. I’ll lie awake thinking about my writing, or my finances, or any damn thing. I’ll wake up at 5:00 and do the same. Those are often the days when I try to work in a nap.

Back to WebMD. They note:

Doctors may sometimes treat depression and insomnia by prescribing an SSRI along with a sedating antidepressant or with a hypnotic medication. However, hypnotic drugs usually should be taken for a short period of time. http://www.webmd.com/depression/sleep-depression#

Part of my nighttime meds are an anti-anxiety drug and a sleeping aid, plus an SSRI and an atypical. So, am I overmedicated?

It’s possible. But I trust my psychiatrist, and I’ve been on this regimen for a number of years now. My bipolar symptoms are now fairly well controlled, I’m able to work, and with the help of my husband, I manage to get through most days with level moods, only mild depression, and only occasional hypomania. I’ve been on other drugs and other combinations of drugs that did not work as well, or gave me horrible and vivid nightmares or other side effects.

I don’t want to hear opinions on the drugs I take from people who are not M.D.s and have never met me, or as Jenny Lawson said recently, “something that every person who deals with mental illness dreads…well-meaning advice from others.” Believe me, whatever it is, I’ve tried it. That’s not why I’m writing this.

What I do have to say: Whether you sleep too much or not enough, bipolar disorder may be the cause. There are treatments, some involving meds, and others not. Meditation, for example, helps many people sleep. (My mother used to sing herself to sleep with hymns when she had insomnia.) It’s a thing to discuss with your psychiatrist and/or your psychotherapist. He or she may be able to help. You don’t have to go through sleep disruptions without treatment. Even with all the problems that sleep causes me, I’ve got a system that works well enough for me.

And … now my insurance company thinks it knows better than my psychiatrist and only allows me a sleeping aid every other day. Apparently my choices are pay for it myself or take Benadryl. Again, I’m not asking for advice. Just restful, restorative sleep.

When Bipolar Disorder Wrecks Your Sex Life (NSFW)

I had a hot sex dream last night. That’s fortunate, as it’s the only hot sex likely for me these days. I have bipolar disorder 2 and tend toward the depressed.

I have only once experienced the hypomanic rush that leads one to the desire for uninhibited, crazy, insistent, steamy motel sex. So I can’t really tell you much about that, except to make sure it’s safe sex, even if it is spontaneous, wild, and compelling. Coping with the aftermath is also something I can’t help with.

So. Bipolar depression and sex. (I am writing from the point of view of a cis-gender heterosexual female, so YMMV.)

It will likely come as no surprise to you to learn that bipolar disorder has an effect on your sex life. And, aside from mania, that effect is to lessen or completely kill it. And there are varying levels: low libido, lack of desire, difficulty ejaculating, etc. The question is what to do about it. Here are some examples of advice:

[S]ex is a part of life and it’s a part you don’t want, or need, to hang up just because you have a mental illness…There are therapeutic techniques that can deal with hypersexuality or low sex drive, and, of course, there are always medical options as well.

http://www.healthyplace.com/blogs/breakingbipolar/2013/01/normal-sex-bipolar/

And this:

Getting bipolar disorder under control is the first step to improving your sex life. It’s easier to address these issues when your moods are stable. Many people with bipolar disorder have healthy relationships and satisfying sex lives. The key is working with your doctor to find the right treatment and talking with your partner about any sexual issues.

http://www.healthline.com/health/bipolar-disorder/sexual-health#outlook5

And that’s all well and wonderful, but how much does it actually help?

Not that I’m an expert, but here’s what I can say about the subject.

Realize that most of sex happens in the brain. The body goes along for the ride. If you’re bipolar, you’re already having trouble with your brain. It makes sense that you’d have trouble with sex too. Don’t beat yourself up. It can be a nuisance or a sorrow or a loss, but it doesn’t have to be a tragedy.

Decide how much sex you actually need in your life. Some people have naturally low sex drives and are quite satisfied with long gaps between sexual encounters or occasional masturbation. If this is the case for you, dandy. The real problem comes when you and your partner(s) have a mismatch in your sex drive. That’s where the talking comes in.

Ask for what you need and encourage your partner to do the same. And accept and/or give what you can. If you need a hug or a cuddle, ask for it. If your partner asks for one, give it. Don’t push for more right then. Even if you have no desire for “the act” yourself, you may be able to give your partner some of what she/he needs. Or vice versa. Of course, if you’re at the very depths, you may not even be able to ask for a hug. But if one is offered, don’t turn it down. Keeping that bond going may improve your connection when the depression has eased.

You can try different medications or see an endocrinologist, but don’t expect quick results. Or any, necessarily. The one drug that peps up your libido may also be the one that gives you side effects you can’t handle. And after years of trying different combinations of pills, you may decide, like I did, that having a reasonably functioning brain is more important to you than having regular sex. In other words, you may face a trade-off.

Listen to your body as well as your brain. I already know that my brain is not performing up to specs. Occasionally, when I’m reading a book or watching a movie or remembering a dream or thinking about an old friend, I feel something that reminds me of what it is to feel desire. If that happens, enjoy and encourage it. It’s a signal that you may not be totally numb from the neck down.

I could tell you that everything will be okay and you’ll soon be back to romping between the sheets with wild abandon. I haven’t seen statistics on it, but it seems unlikely. If you want to get your sex life started again, you’re going to have to work at it, just like you work at taming your bipolar disorder.

 

Bipolar Basics for the Newly Diagnosed

If you have recently been diagnosed as bipolar, there are a few basics you should know. You’ll likely find them out on your own, but it might take a while.

So, here are some tips.

    1. Being bipolar isn’t necessarily a tragedy. It’s a chronic illness. At times it’s better, at others, worse. It’s not a death sentence and it’s treatable. You can still live a reasonably full and satisfying life.
    2. You need help. To live with bipolar disorder, you need a support system. Unfortunately, your friends and family may not be all that supportive. Fortunately, there are online support groups. But the most important parts of your support system, at least at first, are your psychiatrist and your psychotherapist. I recommend having one of each – psychiatrist for medication, therapist for talk or cognitive behavioral therapy, or whatever works for you.
    3. You will most likely need medication. And the odds are good that you will need it for the rest of your life. Don’t panic. After all, diabetics need insulin, usually for life. You may hate taking pills, you may hate the idea that you are dependent on them, you may hate the fact that they remind you of your brain’s difficulty functioning. But realize that meds will make your brain’s functioning less difficult. They are worth the hassle.
    4. Everyone is different. Everyone’s symptoms are slightly different. Everyone’s medications are slightly different. Everyone’s reactions to their medications are slightly different. A support group can help you with general information, but they cannot tell you what is ultimately best for you. Your particular symptoms and your unique version of bipolar disorder may well require different medications, in different amounts, than your friends. And you may have different reactions to them. Some pills have no effect at all on one person and are life-savers for another.
    5. Getting better takes time. Once you have your diagnosis and your medication, don’t expect to feel better quickly. Most medications for bipolar disorder take a while to build up in the body. Six weeks is not unheard of. Then your doctor may assess how well the medication is working, and change the dose or even the medication itself. Then you may go through another six weeks of waiting for the new dose or drug to take effect. Each case of bipolar disorder requires a medication regimen tailored specifically to the individual, and that often takes some doing.
    6. There are several different types of bipolar disorder. The two main types are called type 1 and type 2. Type 1 is the classical bipolar disorder, which used to be called manic-depressive illness. Type 2, a more recently identified version of the disorder, often manifests as mostly depression, possibly with hypomania, a less severe version of the ups that accompany bipolar 1. Other forms of bipolar disorder are rapid cycling, in which one’s mood states alter quickly, even within a few hours. Another version of bipolar disorder is called mixed states. Mixed states occur when a person experiences both extremes of emotion at the same time – for instance, depression and irritability, or fatigue despite racing thoughts.
    7. The odds are that you already know someone with bipolar disorder, or at least some kind of mood disorder. One in four Americans will have a psychiatric or emotional illness at some time during their lives. Because we don’t talk about it, though, no one may ever know. Especially when the disorder is treated properly, a person with bipolar illness can maintain function in society and choose whether or not to share the diagnosis with friends and coworkers. Many people choose not to because of the stigma surrounding mental illness. It’s a valid choice, but it cuts the bipolar person off from possible support and understanding from others who may share the disorder.
    8. Relationships can be difficult but not impossible. Relationships are difficult for everyone. People with bipolar disorder have relationships that are difficult too. The disorder may make the relationships even more difficult, especially when the family member or loved one or even close friend does not understand the symptoms, the medication, the mood swings, the anxiety or fatigue, or all the other facets of bipolar. The best cure for this is education. However, it may not be possible for a relationship to survive bipolar disorder, just as a relationship may not survive trauma, grief, addiction, infertility, incompatibility, meddling relatives, infidelity, parenting, or a host of other conditions. It may be better to look at all the circumstances surrounding a troubled relationship rather than automatically blaming bipolar disorder for difficulties.
    9. Learn all you can. Because bipolar disorder is so little understood by the public, because it manifests differently in nearly every case, because a person can be actively suffering or in remission, because a person may have any of the different types of bipolar disorder, because everyone is different – the need to educate yourself and probably those around you is essential. The more you know, the less you’ll panic when a symptom you haven’t experienced before suddenly hits. Rely on reputable sources. Medical, psychiatric, or psychological websites are usually the best. Support groups can offer much information, but the people in a support group may not be any more well-informed than you are. And there are lots of people selling “miracle cures” that can lure a person away from needed medication and other services.
    10. Keep trying. It’s hard. It’s frustrating. It’s difficult. It’s painful. It’s confusing. But bipolar disorder is something you can live with, and even something you can rise above. The secret is to keep trying. Keep seeking out therapy and friends who support you. Keep taking your medication, even if you don’t want to. (Stopping your medication without advice from your doctor can be dangerous, so don’t try that.) Be stubborn. When you feel like giving up, tell yourself that maybe things will get a little better in the morning. Hang in there. You may not realize it, but there are people who need you in the world, who need you to be functioning and happy, who need you to keep fighting the disorder.

Do you have any other tips for the newly diagnosed? Please share them in the Comments section.

I Chose Fat Over Misery

I was a skinny kid who grew a lot less skinny.

Do my bipolar meds have something to do with that?

Probably.

Do I care?

No.

I’ve noticed a lot of people with bipolar disorder panicking over the topic of weight gain. “I know I need meds, but I’m afraid of weight gain.” “What meds can I take that don’t cause weight gain?” “I tried X med but I quit because of the weight gain.”

It’s true that mental health and physical health are linked – what affects one may affect the other. And it’s true that medications have side effects, among which may be weight gain.

What I don’t get is why some people are so afraid of weight gain that they would sacrifice their mental health to avoid it.

Actually, I do sort of get it. There are ads everywhere that promote thinness – even to the point of illness – as the ideal for both feminine and masculine. There is a “War on Obesity” and plenty of people who will tell you that your body mass index is the most important number that identifies you. There are fat people jokes and gags that could not be told about any other group, be it race, sex, ethnicity, or religion. Plenty of comedians have made a good living making fun of fat – even their own. On TV, the fat character is never the hero.

Now back to the skinny, scrawny, bony kid I was. Undiagnosed and untreated. Aware that there was something wrong with me, but no idea what.

I had mini-meltdowns and major meltdowns. I had anxious twitches. I burst into tears when certain songs came on the radio – and not necessarily sad ones. “Take Me Home, Country Roads” tore me up. “I Am a Rock” could leave me sobbing. I took walks in the rain till I was soaked to the skin. I would laugh out loud for no reason that anyone else could see.

I was a mess. But a thin one.

It’s relatively recently that doctors and scientists have explored the connection between psychotropic medications and weight gain. Some have speculated that people who are depressed don’t eat much. Then, when their meds kick in and they feel better, their appetites return. In my case, I ate more when depressed and less when anxious. By the end of my undergraduate years, I was drinking banana milkshakes so my parents wouldn’t worry about how thin I was when they saw me at graduation.

Slowly, I got better with therapy and meds. Slowly, I gained weight. At first I didn’t notice. Then I did. I tried prescription diet pills and Lean Cuisine, which worked – for a while. But eventually, as is true of most dieters, I started piling the pounds back on. If one of my psychotropics was to blame, I couldn’t pinpoint which one, what with going on and off so many different ones and the cocktail of several I ended up with.

But as I got better and gained weight, I also started making friends, going on dates, finding lovers, and eventually meeting the man I would marry. Some of them were overweight, too. But that wasn’t what mattered most to them – or to me. Oh, I suppose there were people who were turned off by my well-padded physique. Maybe some of them were marvelous people, and maybe I would have enjoyed their company if they could have seen past the weight.

But the fact is, I now have plenty of close friends who just don’t give a damn about weight. Sometimes one of us will need to lose weight for a specific health reason like diabetes, and the rest of us will offer encouragement. But for the most part, we are who we are and love each other that way.

Given the choice – and I do have the choice – I will take the psychotropics that keep me reasonably stable and happy and productive. And yes, overweight. I remember the misery, the despair and pain, and no matter how I look, I don’t ever want to go back there. Self-esteem, for me at least, is better if it comes from the inside out, not the other way around.

The bottom line?

I’ve been skinny. I’ve been fat. Either way, I’m still me.

 

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!

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