netsavy006 Posted March 20, 2009 Share Posted March 20, 2009 I'm having thoughts of wanting to change my meds around again and I know this is not good. I really dislike the Zyprexa but it does help me so I don't really have a good valid reason why I want to get off. I think it's because of the negative publicity it get's plus of all the negative stuff I know about it. (increased cholesterol (runs in family), increased triglycerides, higher diabetes risk than other AAPs). I'd rather work down on the Zyprexa and up on the Abilify but I don't know how my body would handle such a change. My body just went through a mess with Abilify 5mg 3x/day and we had to work the dose off for a period of time and had a re-hospitalization. My doctor said to leave everything the way it is yesterday when I saw her but I didn't have the thoughts yesterday. I'm having them today and they are really bothering me because I want to be stable and I want to listen to my doctor, but I also want to have the benefits from the medication that I know I can get when at the appropriate dosages. I remember the other times I was on 15mg/day of Abilify I had akathisia. I don't know if I could go through that again. Mom says I could be going through some of that now with the 5mg/day with the Cogentin 1mg 2x/day (though less severe) and that made me a bit upset because I like how I emotionally feel when on Abilify despite the side effects. My doctor says it's the brain chemicals that Abilify affects that gives me the good feelings I get from Abilify. What could I do to help calm myself down so that I don't have all these thoughts and plans and stuff of that nature. I know I can't be rushing here and there and everywhere trying to get what Andy wants because it doesn't work that way. But what can I do? I'd like to have the treatment that I'd like. But of course it's the doctor's choice and not mine. Zyprexa 7.5mg HS is helping me to sleep and helping with mood stabilization so I can't complain about that but what could I do about my thoughts? I feel really messed up and don't know what I should (or shouldn't) be doing. What do you recommend? Thanks for reading and thanks for your help, Andy... Link to comment Share on other sites More sharing options...
tryp Posted March 20, 2009 Share Posted March 20, 2009 Well, from reading your post, it seems like you've got quite a bit of insight this time around. This time, you've identified the thoughts as not-helpful and it sounds like you know deep down that you should just leave your meds alone and do as your pdoc tells you. I think that's a pretty good starting place. Did you ever manage to make any headway on getting your pdoc to let you have therapy? It sounds like you're having some pretty obsessive thoughts, and therapy can be good for that sort of stuff. Sometimes I have feelings like that. I'm feeling a little bit dissatisfied with my meds at the moment, in fact. All I can really suggest is distraction - when you catch yourself starting to obsess about it, just turn your thoughts somewhere else. I know it's much easier said than done, but it's what I've been doing. Maybe someone else will have something more helpful to say. Link to comment Share on other sites More sharing options...
frog Posted March 20, 2009 Share Posted March 20, 2009 Hi Andy, I think we should be able to tell our doctors what we do and don't want. You're the one in your body. You're familiar with the side effects. I had akathisia on risperidone and, although I was in the hospital, no one realized what it was until a nurse decided I might as well try cogentin - gone in twenty minutes, and we knew what was happening. I was freaking out on the inside, but I'd learned how not to freak out on the outside in hospital (for fear of being forcibly sedated), and they just chalked it up to normal anxiety and gave me benzos. If I hadn't continually told the nurse there was a problem, she would have never tried the cogentin. Then I had terrible anxiety/panic/hopelessness on sodium divalproex. It took months for me to realize what was going on, and in that whole time my doctor kept saying that valproic acid shouldn't do those things. Eventually I just said I want off, she got me off in under a week, and I felt a lot better. I had exercised my right to choose, based on how I felt on the drug. The blood sugar and cholesterol risks are definitely there with atypical antipsychotics, especially Zyprexa, and it is frightening. It sounds as if you can't push the Abilify, though, because of the akathisia. Have you talked to your doctor about your concerns about Zyprexa and what other options might be out there? Risperidone, according to my doctor, has fewer blood sugar problems than Zyprexa or Seroquel. Or there's Geodon, or the mood stabilizers: lithium, Tegretol (carbamazepine), valproic acid (Depakote etc), lamotrigine (Lamictal)... From your list of meds, it doesn't look like you're on a mood stabilizer. I have these types of thoughts about my treatment too, and I think they're okay. It just means you're dissatisfied. Whether or not to switch meds is an important decision, especially given the recent troubles you've described, so I can see you not wanting to go "here and there and everywhere", but it feels punishing to me when I read that your treatment is the doctor's choice and not yours. If you're considered competent to make treatment decisions (i.e. not in a hospital being forced to swallow drugs), you should be allowed the same kind of choice as anyone else with a major chronic disease. My mother, who has a heart arrythmia, was recently given a choice about whether she wanted to go on a certain drug, and although it had possibly dangerous side effects, like internal bleeding, she chose to go ahead with it. The doctor couldn't and didn't force it on her. His job was to give her information and recommendations only. A while back she felt another drug wasn't helping her, and was making her weak, so she asked her doctor and was removed from it, no problem. (She still hasn't gotten the arrythmia under control, unfortunately.) I know that we with our mental illnesses can have trouble with insight and awareness of our moods, but the other side of the coin is that our experiences with doctors and hospitals can cause us to lose confidence in our own decision-making abilities. I would definitely at least talk to my doctor about the concerns and ask about the options. Between now and the next psychiatric appointment, though, I would write down my concerns and questions (so as not to forget or minimize them), and try to focus on the rest of my life. Link to comment Share on other sites More sharing options...
tryp Posted March 20, 2009 Share Posted March 20, 2009 Hey frog, Ordinarily, I'd totally agree with you - I'm not against patient involvement or anything. But having seen the OP's history unfold over the past couple months, I know he's been bouncing around a lot of meds, and I also know that he was having a bit of a tug-of-war with pdoc over compliance. That was where my hard line advice came from. Not meaning to talk about you in front of you, OP - hope things work out. Tryp Link to comment Share on other sites More sharing options...
gizmo Posted March 20, 2009 Share Posted March 20, 2009 I'm having thoughts of wanting to change my meds around again and I know this is not good. I really dislike the Zyprexa but it does help me so I don't really have a good valid reason why I want to get off. I think it's because of the negative publicity it get's plus of all the negative stuff I know about it. (increased cholesterol (runs in family), increased triglycerides, higher diabetes risk than other AAPs). I'd rather work down on the Zyprexa and up on the Abilify but I don't know how my body would handle such a change. My body just went through a mess with Abilify 5mg 3x/day and we had to work the dose off for a period of time and had a re-hospitalization. My doctor said to leave everything the way it is yesterday when I saw her but I didn't have the thoughts yesterday. I'm having them today and they are really bothering me because I want to be stable and I want to listen to my doctor, but I also want to have the benefits from the medication that I know I can get when at the appropriate dosages. I remember the other times I was on 15mg/day of Abilify I had akathisia. I don't know if I could go through that again. Mom says I could be going through some of that now with the 5mg/day with the Cogentin 1mg 2x/day (though less severe) and that made me a bit upset because I like how I emotionally feel when on Abilify despite the side effects. My doctor says it's the brain chemicals that Abilify affects that gives me the good feelings I get from Abilify. What could I do to help calm myself down so that I don't have all these thoughts and plans and stuff of that nature. I know I can't be rushing here and there and everywhere trying to get what Andy wants because it doesn't work that way. But what can I do? I'd like to have the treatment that I'd like. But of course it's the doctor's choice and not mine. Zyprexa 7.5mg HS is helping me to sleep and helping with mood stabilization so I can't complain about that but what could I do about my thoughts? I feel really messed up and don't know what I should (or shouldn't) be doing. What do you recommend? Thanks for reading and thanks for your help, Andy... If you feel you need to do something, but are conflicted, one thing you can do is a simple positive/negative chart. Write down all the positive aspects of the change on one side of the paper, and all the negative aspects of the change on the other. Then when you are finished, see which side has more "weight", more meaning to your life. However, be aware that life changes are rarely as simple as a positive/negative solution. It is one tool to use to *start* your decision. Keep in mind that you just started this medication regime, and adjusting medication doses can alter your mood status. If your mood status is stable at this time, it may be advisable to wait and make changes until the mood is unstable and the meds need adjusting. The side effects you mentioned can be monitored by blood tests. Have you discussed testing for these items with your GP to ease your mind? I personally know the diabetes weighs on my mind, however I get my blood sugar tested at every doctor visit to make sure it is normal. My GP also tested my blood or cholesterol, LDL, HDL, triglycerides, etc. when she found out I was on zyprexa. I actually dropped 41 points on my triglycerides since the last time they were tested :-) Link to comment Share on other sites More sharing options...
netsavy006 Posted March 20, 2009 Author Share Posted March 20, 2009 That's the problem. With the medication my pdoc says the diabetes test is done once every 6 months and I don't know if that will include the test for the lipids or cholesterol or triglycerides, etc... That could be too late with Zyprexa, even Abilify but I feel more comfortable with Abilify because it's more "weight neutral" (and according to the Abilify website, it doesn't affect cholesterol) and Zyprexa I know has a higher association with diabetes. But Zyprexa does have it's 2 benefits (mood stability and sleeping). Link to comment Share on other sites More sharing options...
sorrel Posted March 20, 2009 Share Posted March 20, 2009 There are 2 issues here: your obsessiveness your meds and they are different issues. You obviously realize you are being obsessive. You just saw your psychiatrist and accepted her plan, but now are suddenly overcome with an urge to mess with the plan and change everything. That's good that you recognize it. Now you have to make an active effort to discourage that kind of obsessive thinking. For example. instead of continually thinking about it, write down a list of your questions and concerns about your meds. Then bring the list the next time you see your doc. On the subject of your meds, you seem conflicted. You like Abilify but don't like the akathisia it causes. You like Zyprexa but don't like the risks. You need to make some firm decisions, like: -Is Abilify worth the akathisia? yes or no -Is Zyprexa worth the metabolic risks? yes or no -Am I willing to consider other meds? (from reading your posts one might get the idea that Abilify and Zyprexa are the only 2 drugs for bipolar disorder out there) (gizmo's pro/con chart is a good idea for this) Once you are able to answer those questions, I would suggest sharing those answers with your psychiatrist. Then let her make the decisions -- offer your input, but let her make the decisions and you follow instructions. Link to comment Share on other sites More sharing options...
netsavy006 Posted March 20, 2009 Author Share Posted March 20, 2009 Well I tried 2 mood stabilizers. I tried Depakote 250mg BID and we couldn't stabilize the blood levels. The blood levels had actually dropped as I was taking the medication and it made me feel depressed. I didn't even want to get out of bed to do anything. I tried Tegratol 100mg BID this past hospitalization but it made my suicidality worse so it had to be stopped right away so there goes that choice. - Is Abilify worth the akathisia? If it could be handled, yes (Cogentin does help). - Is Zyprexa worth the metabolic risks? In the short term yes, but I don't want to be on it long term for those reasons. - Am I willing to consider other meds? What are the other meds? Lamictal my inpatient pdoc didn't even want to try with me for several reasons: 1. Rash risk 2. takes to long to get to a "stable" level 3. interacts with lots of other medications At least that's how he explained it to me, so I guess Lamictal is out. What other choices are there? It seems like my choices are being exhausted. If you can give me some good medication choices that would be great. Thanks... Link to comment Share on other sites More sharing options...
netsavy006 Posted March 21, 2009 Author Share Posted March 21, 2009 I do think therapy will help you. Talk to your pdoc more about exploring that option. My pdoc said I can't have therapy because I have too many goals and they mainly relate to meds... She told me that before I went into the hospital last time... Link to comment Share on other sites More sharing options...
tryp Posted March 21, 2009 Share Posted March 21, 2009 I would seriously bring this up with her again. If you're going to focus your energy on pushing for any one thing, I would push for therapy. I remember a while ago, you were asking for advice about how to bring it up again, and you got lots of good comments there. Did you ever try to approach her again about therapy using any of those approaches? Admittedly, I'm a bit of a therapy-head myself, but I really think it's a great tool for managing all kinds of things. Link to comment Share on other sites More sharing options...
netsavy006 Posted March 21, 2009 Author Share Posted March 21, 2009 Does a case manager count? Because I just recently got one of those. She comes 2x/month to help me out with things that I may need. Link to comment Share on other sites More sharing options...
netsavy006 Posted March 21, 2009 Author Share Posted March 21, 2009 But then she just comes back to me later on (next appt) saying that I can't go to therapy because I set goals and the goals relate too much to the medications. That's why I get denied therapy. Another time it was because I didn't speak up to the therapist (and that was in family therapy (Mom and I)). (I feel like I have an answer for everything...) Link to comment Share on other sites More sharing options...
sorrel Posted March 21, 2009 Share Posted March 21, 2009 On the subject of meds: The negatives you listed for Lamictal are not specific to you -- they are risks/problems for everyone equally. Yet, people still take it. Many people. So I would say that IS, indeed, still on the table for you. Lithium is another option. Trileptal is another (maybe -- some people do respond differently from Tegretol.) If you like AAPs or respond well to them, Risperdal is a possibility that does not have the akathisia issue as badly as Abilify, nor the metabolic risks quite as bad as Zyprexa. Also, there are the old APs (eg Stelazine, Trilafon.) Also Geodon. Neurontin is way off-label but is often helpful for bipolar particularly when there's a lot of anxiety. On the subject of therapy: If she thinks your goals are too med-focused, come up with some goals not related to meds -- things you could accomplish in therapy. I think was discussed in your other thread. Really, I just cannot imagine a situation where a patient really wants therapy and is motivated and demonstrates objectives for it, and the provider says, "Nope, sorry, can't have it." Link to comment Share on other sites More sharing options...
netsavy006 Posted March 21, 2009 Author Share Posted March 21, 2009 Risperdal is a possibility that does not have the akathisia issue as badly as Abilify, nor the metabolic risks quite as bad as Zyprexa... Only comment I have about Risperdal, I've been on it (.5mg/day). 6 weeks into treatment I started developing motor tics so I had to be taken off of it. Link to comment Share on other sites More sharing options...
SashaSue Posted March 21, 2009 Share Posted March 21, 2009 I can't help wondering if a little more zyprexa might not help all this obsessive thinking about meds. Because, as someone else suggested, you can't really make good decisions about meds until you're something like stable, but as long as you've got all this going on, you don't necessarily seem all that stable. As far as therapy goes, are you sure your pdoc didn't mean something more like, therapy wouldn't be all that helpful right now, until you're more stable on your meds? Whatever she meant, I don't understand why your getting therapy is her decision? I mean, what's she going to do if you just call a therapist & start going? Call him or her and somehow forbid them to see you? As for the bloodwork stuff you're worried about, why not just go to your GP & get any tests your pdoc isn't doing done there? Link to comment Share on other sites More sharing options...
netsavy006 Posted March 21, 2009 Author Share Posted March 21, 2009 I can't help wondering if a little more zyprexa might not help all this obsessive thinking about meds... I can't take 10+mg of Zyprexa because I end up getting the similar akathisia from Zyprexa when at a higher dosage. I know it seems strange that I will take it from Abilify and not Zyprexa, but that's the way my mind is @ this particular moment... Link to comment Share on other sites More sharing options...
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