Lamictal Was Immediately Stopped For No Reason

[Maychild]

Four weeks ago, my pdoc decided that I was no longer Bipolar (after a 16 month old diagnosis). That I was Unipolar with Bipolar tendencies or Bipolar NOS. He said that I no longer needed Lamictal and cut me down to 150 mg's from 375 mg's in one day. Two weeks later he had me stop it all together.

A week later I was a mess. I didn't feel right, I was moody, irratable and irate. My husband called him because he was so concerned about me. He put my pdoc on the phone and he said, "I just don't know what to do with you anymore. I think you need to come into the hospital to be observed. I'm not changing your meds, I just want to see how you are really reacting." He is the department head of the Psychiatric Unit at my area's hospital.

I asked him if I could start taking the Lamictal again at 75 mg's and he said, "I don't think that it's going to do anything. You don't need it."

Well, I took it and an hour later I was feeling better. Each day I was feeling better. His statement of "I just don't know what to do with you anymore" really bothered me. I thought back through the 16 months of treatment and the 22 medications that he had me try. How he ordered me to fire my psychotherapist a week ago because he didn't think she was doing her job. I felt completely alone and abandoned.

So, on Wednesday I went to see him. He asked how I was doing and I answered that I felt great (I had been depressed since September so he was suprised. It also correlates to when he upped my dosage from 250 to 375). I had made an appointment with a nurse practicioner earlier in the week and wasn't sure what I was going to do during the appointment with my pdoc. He asked how the seperation went with my tdoc and I said fine. I also stated that it was my right as a patient to end the treatment with my provider at anytime. He agreed. I brought up that I had concerns with the way he had me stop the Lamictal. How he had treated me on the phone that afternoon. He didn't seem too conerned that I was upset with him. Then, it just popped out of my mouth. "I'm not going to be seeing you anymore."

He looked dumbfounded. He asked who I was going to see for therapy and if I had a clinician lined up. I did of course and he wrote down their names. I left the office. I felt great.

Later that day, I went to see my new therapist. She immediately started off with, "I'm not going to work with you if you are going to constantly question me. I know that you fired both of your doctors in the past week and I don't want to deal with difficult patients."

He had called her without my knowledge. Now I'm scared that he's called the NP and told her the same thing. I am proactive in my treatment and I do ask questions. I feel that I have a right to do so when I'm putting serious medications in my body. According to the therapist, this is disrespectful to do to your pdoc and going behind his back.

Sorry for the long rant but I'm still upset and shaken by this. I'm still on a low dose of Lamictal and feeling really edgy today. I'm also paranoid about my appointment on Monday.

Did I do the right thing? How do I approach my new clinician if she's gotten a call? Isn't it illegal for him to contact other doctor's without my permission?

Any input would be appreciated.

[Soundtrack_by_Rush]

In your shoes I would have done the same thing and fired the pdoc.

You did a great job explaining things here and I think what I would do is ask your new clinician if she was contacted (it may be a non-issue if she wasn't) and go from there. If she was, I would politely tell her you would like to give her details of the last 2 weeks and get her feedback. If you come across as "seeking her opinion" rather than trying to defend yourself and/or come across as adversarial you stand a better chance of getting off on the right foot and making her an ally.

I am not sure if your doc broke any laws or not since you may have signed a release way back when that basically lets him share your info with your insurance company and/or other medical professionals, but it was still a very asshat thing to do IMO. You have every reason to be shaken up and upset by his behavior.

[tryp]

I would be really upset if that happened to me as well.

With the therapist - even though I think it was wrong for him to contact her and say that, her response was equally bad, I think.

I don't think I'd be comfortable working with a therapist who started off our relationship on such a confrontational foot.

She doesn't want you to question her? Who does she think she is, the supreme overlord? My therapist lets me question her. In fact, she likes it when I ask questions, because it means I'm engaged in my treatment.

If I went to see a therapist and the first thing she did was accuse me of being difficult, without having met me or evaluated me for herself, it would probably also be the last thing she did.

[nalgas]

Unless you had a life-threatening rash or something, your doctor is crazier than anyone on here for stopping your Lamictal that suddenly like that. That's way faster than is reasonable or safe. No wonder you felt like crap. Also, 22 meds in 16 months is also absolutely insane. That's not long enough on average to give a fair trial to anything, and it's even more of a mess to sort stuff out if he was changing multiple things at a time. If that's a direct quote (or at least accurate paraphrase) of what the therapist said, she sounds kind of like a jerk, too. Yuck. Hopefully something good comes out of not seeing that guy anymore, at least.

[Silver]

Maychild: this is the same psychiatrist who was returning your calls on Labor Day? who helped you get off the polypharmacy you were unhappy about? who worked with you to get you off of drugs that were destabilizing? Reading the actual med history that you outlined, that psychiatrist was actually pretty rational from all the changes you described, and he was willing to read information that you brought him. And he was very good at changing one thing at a time, and he was doing it in what struck me as a very rational order.

Are you with a different psychiatrist than you were?

I just went through your post history. Last time we 'saw' you, you were at 150 of Lamictal, 25 mg of Topamax (gone), 10mg of Haldol (looks like that's now gone), 40mg total daily dose of propranolol (for multi reasons, not just psych - but that went away), 10mg of diazepam (that went up), were going to try a bit of Thorazine at bedtime (that appears to have stayed), and you were taking a bit of Cytomel (that stayed.) Looks like you now have Adderall as well.

Looking at your history, at least some of those 22 (I'm only up to 20, I missed 2, I think) meds were from prior providers.

My review of post history and your new sig shows Zoloft, Paxil, Wellbutrin (don't know who made the treatment changes with the ADs; your post says that for years you'd just stop taking ADs and then would become manic; I don't know if that's a pattern you had grown out of or not), trazodone, Xanax (stopped due to tolerance), Valium (became tolerant), Klonopin (you d/c'ed, if I read the history correctly, and one post says you felt suicidal on it, which seems like an excellent reason to d/c it to me), Seroquel (don't know who stopped), Lithium (tapered off at your request), Depakote, Abilify (you only were able to tolerate one dose), Neurontin, Haldol, Thorazine, propranolol (which you've said you don't consider to be a psychiatric medication in your case, and you were quite passionate about it), Lamictal, Cytomel (for ?thyroid disorder, not for psych; unclear by posts), Topamax (for migraine), Geodon (stopped because it was inducing mixed states), and now Adderall.

I'll respectfully disagree a bit with Nalgas - the count isn't so much important as whether or not they were of utility and whether the prescribers made reasonable efforts to work with you on side effects, etc., to give the drug a fair shake/trial. You were on several drugs at once, for one thing. Abilify was a flash in the pan. Some of these weren't the prescribers' decision to d/c, so I won't put those ones on the docs' sheet-o-shame; it's easy to say they should hold the line, but they also try to maintain a therapeutic alliance with the patient, so they have to find a balance. I mean... 22 isn't a GREAT number, but you've been on so many damn drugs at a single time that I can see how it got there.

I am in 100% agreement that the radical dose reduction you describe in Lamictal doesn't make sense, unless you were reporting symptoms of concern for an immune reaction / drug reaction or altered mental state that could possibly be secondary to the Lamictal, or something that could have sounded like one of those symptoms.

I'm also confused as to why propranolol - which addressed your anxiety, your migraines, your PTSD, and your tachycardia - was stopped... and Adderall, a sympathomimetic, was started. I'm sure there's a great explanation, I'm just confused.

Medical staff/therapy staff can communicate as necessary in order to coordinate care. (ETA: in fact, if they think your judgment is impaired, they'd better.) If you have concerns about it, you can talk to them if you feel that bias has been introduced - in fact, I'd encourage you to do that - and you can also leave a letter in your chart.

I saw that spring/March had been a rough time for you last year, as it is for a lot of people with mood disorders. Did anyone address that seasonal component with you? (Or with your psychiatrist?) If not, is there a possibility you're still having that process going on?

Oh - before I forget. Restarting Lamictal at 75 mg is not any safer than starting at 75 mg - you are at the same risk of adverse reaction as someone who is starting it for the first time. So the same titration rules apply, whether it's a restart, a start, or a re-re-restart.

Anyway, nice to see you back, Maychild! Sorry about the circumstances.

[Maychild]

Maychild: this is the same psychiatrist who was returning your calls on Labor Day? who helped you get off the polypharmacy you were unhappy about? who worked with you to get you off of drugs that were destabilizing? Reading the actual med history that you outlined, that psychiatrist was actually pretty rational from all the changes you described, and he was willing to read information that you brought him. And he was very good at changing one thing at a time, and he was doing it in what struck me as a very rational order.

Are you with a different psychiatrist than you were?

I just went through your post history. Last time we 'saw' you, you were at 150 of Lamictal, 25 mg of Topamax (gone), 10mg of Haldol (looks like that's now gone), 40mg total daily dose of propranolol (for multi reasons, not just psych - but that went away), 10mg of diazepam (that went up), were going to try a bit of Thorazine at bedtime (that appears to have stayed), and you were taking a bit of Cytomel (that stayed.) Looks like you now have Adderall as well.

Looking at your history, at least some of those 22 (I'm only up to 20, I missed 2, I think) meds were from prior providers.

My review of post history and your new sig shows Zoloft, Paxil, Wellbutrin (don't know who made the treatment changes with the ADs; your post says that for years you'd just stop taking ADs and then would become manic; I don't know if that's a pattern you had grown out of or not), trazodone, Xanax (stopped due to tolerance), Valium (became tolerant), Klonopin (you d/c'ed, if I read the history correctly, and one post says you felt suicidal on it, which seems like an excellent reason to d/c it to me), Seroquel (don't know who stopped), Lithium (tapered off at your request), Depakote, Abilify (you only were able to tolerate one dose), Neurontin, Haldol, Thorazine, propranolol (which you've said you don't consider to be a psychiatric medication in your case, and you were quite passionate about it), Lamictal, Cytomel (for ?thyroid disorder, not for psych; unclear by posts), Topamax (for migraine), Geodon (stopped because it was inducing mixed states), and now Adderall.

I'll respectfully disagree a bit with Nalgas - the count isn't so much important as whether or not they were of utility and whether the prescribers made reasonable efforts to work with you on side effects, etc., to give the drug a fair shake/trial. You were on several drugs at once, for one thing. Abilify was a flash in the pan. Some of these weren't the prescribers' decision to d/c, so I won't put those ones on the docs' sheet-o-shame; it's easy to say they should hold the line, but they also try to maintain a therapeutic alliance with the patient, so they have to find a balance. I mean... 22 isn't a GREAT number, but you've been on so many damn drugs at a single time that I can see how it got there.

I am in 100% agreement that the radical dose reduction you describe in Lamictal doesn't make sense, unless you were reporting symptoms of concern for an immune reaction / drug reaction or altered mental state that could possibly be secondary to the Lamictal, or something that could have sounded like one of those symptoms.

I'm also confused as to why propranolol - which addressed your anxiety, your migraines, your PTSD, and your tachycardia - was stopped... and Adderall, a sympathomimetic, was started. I'm sure there's a great explanation, I'm just confused.

Medical staff/therapy staff can communicate as necessary in order to coordinate care. (ETA: in fact, if they think your judgment is impaired, they'd better.) If you have concerns about it, you can talk to them if you feel that bias has been introduced - in fact, I'd encourage you to do that - and you can also leave a letter in your chart.

I saw that spring/March had been a rough time for you last year, as it is for a lot of people with mood disorders. Did anyone address that seasonal component with you? (Or with your psychiatrist?) If not, is there a possibility you're still having that process going on?

Oh - before I forget. Restarting Lamictal at 75 mg is not any safer than starting at 75 mg - you are at the same risk of adverse reaction as someone who is starting it for the first time. So the same titration rules apply, whether it's a restart, a start, or a re-re-restart.

Anyway, nice to see you back, Maychild! Sorry about the circumstances.

Silver thanks for replying. I don't know where you saw Zoloft and Paxil in my sig, but I am not on those. He also tried Ritalin and some antihistamine for sleep that didn't work. I am on 100 mg's of Thorazine and 20 mg's of Valium (actually it used to be 50). The Propranolol was stopped because it was giving me dizzy spells and vertigo.

There was no psychiatric reason that I was given for stopping the Lamictal. He decided that I was a different diagnosis and I simply didn't need it because it wasn't doing anything for my depression (interesting that my depression started when he upped my dosage to 375).

Yes, this is the same pdoc that returned phone calls. This is also the pdoc that as of our parting was frustrated and was at a loss as to how to treat me. A medicine would work for a month and then peter out on me, hence the 22 meds. I do not blame him for that, I was just stating a fact. I decided that a new set of eyes might be a good option since he didn't know what else to do. He blamed my psychotherapy and ordered me, literally, to fire my therapist. He was also appauled by the statement that she made to me last April: I will never be independent. All of the traits that I loved in myself are actually the disease. And, I can't make rational decisions on my own. I've been trying to process that b.s. since then. I finally told him about it. He also ordered me to enter a DBT trauma therapy program, which I have.

His call to my interim therapist, whom I have known for a year and a half, was convoluded in my opinion. He obviously complained about me because certain points were made when the session started. Half of the session was spent on how I interact with my doctors. There were more important things that I had to talk about than my pdoc's complaints.

I also had a visit with my MD earlier that day and discussed my concerns. I asked him if I was being reasonable about discharging my pdoc and he said yes. I had lost confidence and trust in him, two very important things. Regardless of the reckless cessation of Lamictal, I didn't trust him anymore.

So now I'm starting with two new medical professionals on Monday. My nurse practioner will have a list of the meds that I've tried and that I am currently on. Yes, the Adderall is interesting. It's supposed to help with the depression. As for the Wellbutrin, because it isn't a SSRI, there was no concern about mania. I couldn't feel either of the meds when my Lamictal level was at it's highest. As of now, the depression is gone (as I stated) and I have my motivation back.

So, to answer your questions, I have fired that wonderful pdoc. I have been on 22 different meds the last year and a 1/2. I took back control of my health care on Wednesday because there was no progress being made with either doctor. I am making all efforts on my part to do the work, now I just have to find the right docs to fit my bill.

[Silver]

You had lifted Zoloft and Paxil among your past meds in a prior post; your history stated that you'd been on 50mg of Valium, tapered down to 10mg, had only been on 10mg for the sleepwalking (thought to be associated with lithium) and had desired to taper off altogether and thought it would probably happen, as the propranolol was so helpful with anxiety, etc., but apparently it's gone back up to 20mg per sig. Anyway, I didn't intend to convey that they were in your current meds, but I see the juxtaposition there of sentences on re-read. Sorry for any confusion.

For that matter, you don't list Wellbutrin in your current sig... but if I read your post, you ARE taking it. Which is nice, because it actually is on-label for depression.

I can see a clinician being appalled by a therapist making the statement that you would never be independent; the context, of course, would be very important. Uh, I'm still impressed that you had a psychiatrist who was taking the time to interact with your therapists, actually, and to follow up on what was happening in sessions. Even if you weren't happy with the clinical course. And that you have a DBT trauma course in your area. Nice.

So what would happen once a medication stopped working after a month (they started working within a month?) and would peter out on you? Your psychiatrist would then d/c the med and just switch you? Jeepers, that would indeed suck.

You wouldn't be the first, second, or fiftieth person around here to have noted that Lamictal can change effects significantly depending on the dose. I agree, the lower doses can be a lot better for some people.

I hope it works out well with your new folks. A tip: keep your timeline very precise when interacting with medical/psych staff. It will enhance your credibility with them (being positive and motivated will already help a lot, of course), and it will allow them to help you much better.

In your prior post in 8/08, the ones I pulled the meds from, you listed all the earlier meds (this was before the Haldol, Thorazine, Ritalin, Adderall) as being in the past two years.

Now it's 22 meds in the last 16 months or 18 months. Obviously "within the past two years" would include that, but it's imprecise, and although it doesn't seem like a big deal in casual conversation, it's frustrating in a clinical venue, not least because that doesn't let the new prescriber go back through chart notes, etc., to see what happened with those particular meds.

I'd suggest that you do a "Gantt chart"-type layout of your medications, if you can. (Google "Gantt chart" for the visual.)

You can mark dose changes on the 'bars' for each medication.

Mark things like hospitalizations on there as well. Mark down the positives/negatives and reason for discontinuation - not a big huge essay, just a few words is enough.

Keep a copy. Update it.

That can make your life so much better and save everyone hours of screwing around with this stuff.

You can pull from your posts here, or wherever; you can get fill records from pharmacies; whatever. It's worth doing before you see your new provider, if it's possible. Do it on graph paper if need be, by hand, and expect it'll take a couple drafts.

Start incorporating that sucker (once you get the basic history done) with an ongoing mood chart and you have a really interesting document...

Good luck on Monday!

[Maychild]

Just wanted to clarify about these meds. Yes, they were all administered (aside from Zoloft, Paxil and Klonopin). I also forgot another three: Ativan, Visteral and Moban.

I just went through your post history. Last time we 'saw' you, you were at 150 of Lamictal was upped in September to 375, 25 mg of Topamax (gone), 10mg of Haldol (looks like that's now gone), 40mg total daily dose of propranolol (for multi reasons, not just psych - but that went away), 10mg of diazepam (that went up) it was actually at 50, were going to try a bit of Thorazine at bedtime (that appears to have stayed), and you were taking a bit of Cytomel (that stayed.) Looks like you now have Adderall as well.

Looking at your history, at least some of those 22 (I'm only up to 20, I missed 2, I think) meds were from prior providers.

My review of post history and your new sig shows Zoloft not on, Paxil not on, Wellbutrin (don't know who made the treatment changes with the ADs; I've had the same pdoc for a year and a half. He has administered all of these meds. your post says that for years you'd just stop taking ADs and then would become manic I would not stop taking the meds and become manic, it was the other way around and I never stopped without consulting the physician; I don't know if that's a pattern you had grown out of or not), trazodone (my MD when I was 18), Xanax (stopped due to tolerance) (stopped because the pdoc doesn't like it, actually emphatically hates it), Valium (became tolerant) (still on Valium. I have not become tolerant), Klonopin (you d/c'ed, if I read the history correctly, and one post says you felt suicidal on it, which seems like an excellent reason to d/c it to me), Seroquel (don't know who stopped) (prescribed by an old pdoc and taken off by until recently pdoc, not me), Lithium (tapered off at your request) (it was decided by my pdoc that I am Lithium intolerant, no request), Depakote, Abilify (you only were able to tolerate one dose), Neurontin, Haldol, Thorazine, propranolol (which you've said you don't consider to be a psychiatric medication in your case, and you were quite passionate about it) (I've actually stated on several occassions that it was for anxiety and panic attacks, I don't know where you read anything differently), Lamictal, Cytomel (for ?thyroid disorder, not for psych; unclear by posts) (I have hypothyroidism), Topamax (for migraine) (was used as an antipsychotic not for migraines. It did help with them though), Geodon (stopped because it was inducing mixed states), and now Adderall.

I hope that clarifies things. I don't just up and stop taking my meds. I always talk to my doctor about any concerns or reactions that I may have to things.

[Silver]

Just wanted to clarify about these meds. Yes, they were all administered (aside from Zoloft, Paxil and Klonopin). I also forgot another one: Ativan.

I just went through your post history. Last time we 'saw' you, you were at 150 of Lamictal was upped in September to 375, 25 mg of Topamax (gone), 10mg of Haldol (looks like that's now gone), 40mg total daily dose of propranolol (for multi reasons, not just psych - but that went away), 10mg of diazepam (that went up) it was actually at 50, were going to try a bit of Thorazine at bedtime (that appears to have stayed), and you were taking a bit of Cytomel (that stayed.) Looks like you now have Adderall as well.

Looking at your history, at least some of those 22 (I'm only up to 20, I missed 2, I think) meds were from prior providers.

My review of post history and your new sig shows Zoloft not on, Paxil not on, Wellbutrin (don't know who made the treatment changes with the ADs; I've had the same pdoc for a year and a half. He has administered all of these meds. your post says that for years you'd just stop taking ADs and then would become manic I would not stop taking the meds and become manic, it was the other way around and I never stopped without consulting the physician; I don't know if that's a pattern you had grown out of or not), trazodone (my MD when I was 18), Xanax (stopped due to tolerance) (stopped because the pdoc doesn't like it, actually emphatically hates it), Valium (became tolerant) (still on Valium. I have not become tolerant), Klonopin (you d/c'ed, if I read the history correctly, and one post says you felt suicidal on it, which seems like an excellent reason to d/c it to me), Seroquel (don't know who stopped) (prescribed by an old pdoc and taken off by until recently pdoc, not me), Lithium (tapered off at your request) (it was decided by my pdoc that I am Lithium intolerant, no request), Depakote, Abilify (you only were able to tolerate one dose), Neurontin, Haldol, Thorazine, propranolol (which you've said you don't consider to be a psychiatric medication in your case, and you were quite passionate about it) (I've actually stated on several occassions that it was for anxiety and panic attacks, I don't know where you read anything differently), Lamictal, Cytomel (for ?thyroid disorder, not for psych; unclear by posts) (I have hypothyroidism), Topamax (for migraine) (was used as an antipsychotic not for migraines. It did help with them though), Geodon (stopped because it was inducing mixed states), and now Adderall.

I hope that clarifies things. I don't just up and stop taking my meds. I always talk to my doctor about any concerns or reactions that I may have to things.

You're dead right, I completely misread that post about antidepressants/mania, and I apologize. I'm a complete ass on that one. Kick me. (Why don't we have a jackass emoticon for these moments?)

As you know, Topamax isn't an antipsychotic. It's used for anti-headache effects and anti-seizure effects. And I had thought from this post that you were using it for headache (prn, unusually, but hey) and that you had a fortuitous calming effect. Probably not having an anti-epileptic effect in that little time at that low a dose... Sounds like it turned on you at higher doses?

Thanks for clearing up the ambiguity re: hypothyroid. You talk about a "chronically imbalanced metabolism." That's kind of nonspecific, as some people will use Cytomel for weight loss (this is high up in the Not A Good Idea category.) That same post discusses tolerance to benzodiazepines, as well as plans to d/c the Valium in the imminent future.

You were actually saying lots of things re propranolol, including that you "do not count [it] as a psychiatric drug." But it clearly had a beneficial anxiolytic effect for you by report.

Your posts talk about d/cing lithium "with the approval of" your psychiatrist, not "at the insistence of" your psychiatrist. The water-retention and feeling of lack of creativity were really rough for you, as cited in multiple posts. You also recognized it was helpful to you in the winter months and you really had a good grip on the idea of vanity versus sanity. The somnambulism, etc., are all totally understandable reasons - but you took the literature in to him and advocated on your own behalf, which is not a BAD thing.

You'd gained 45 lbs on the Seroquel and it wasn't working. I just lost the link on the suckiness of Seroquel for you, but you meant it. But you were really clear about those things. It sounds like a fair trial of the rx and a fair set of reasons to d/c.

So, again - this is when the number of drugs isn't so much the issue. If drugs are ineffective, lead to your admission to the unit, etc... those probably really aren't ideal drugs for you, eh?

Anyway - this is why that Gantt-chart type list can be super handy. It saves re-inventing this kind of list. And it has 2 additional important functions, Maychild: it keeps you looking rational and coherent, rather than flaky (and they don't think, "Man, this gal just goes through the meds, eh?"; and it allows other prescribers to rapidly and fairly effectively evaluate prior prescribers' work.

This is part of what a specialty consult service would do at a big regional center - recreate the medication history, and then integrate it with the timeline/life history / functional history.

I have one of these. It's invaluable. I keep it in its little folder (which should be platinum plated!) and I update it faithfully as needed. On the rare occasions I need to see someone new, I give it to them, and they almost cry when they open it up... that means we can spend the majority of the first or second visit focusing on useful stuff. Heh.

Not busting your chops here, just trying to make sure you're in good shape for this meeting with the new folks on Monday, because you are clearly trying to do stuff right!

[Maychild]

Just wanted to clarify about these meds. Yes, they were all administered (aside from Zoloft, Paxil and Klonopin). I also forgot another one: Ativan.

I just went through your post history. Last time we 'saw' you, you were at 150 of Lamictal was upped in September to 375, 25 mg of Topamax (gone), 10mg of Haldol (looks like that's now gone), 40mg total daily dose of propranolol (for multi reasons, not just psych - but that went away), 10mg of diazepam (that went up) it was actually at 50, were going to try a bit of Thorazine at bedtime (that appears to have stayed), and you were taking a bit of Cytomel (that stayed.) Looks like you now have Adderall as well.

Looking at your history, at least some of those 22 (I'm only up to 20, I missed 2, I think) meds were from prior providers.

My review of post history and your new sig shows Zoloft not on, Paxil not on, Wellbutrin (don't know who made the treatment changes with the ADs; I've had the same pdoc for a year and a half. He has administered all of these meds. your post says that for years you'd just stop taking ADs and then would become manic I would not stop taking the meds and become manic, it was the other way around and I never stopped without consulting the physician; I don't know if that's a pattern you had grown out of or not), trazodone (my MD when I was 18), Xanax (stopped due to tolerance) (stopped because the pdoc doesn't like it, actually emphatically hates it), Valium (became tolerant) (still on Valium. I have not become tolerant), Klonopin (you d/c'ed, if I read the history correctly, and one post says you felt suicidal on it, which seems like an excellent reason to d/c it to me), Seroquel (don't know who stopped) (prescribed by an old pdoc and taken off by until recently pdoc, not me), Lithium (tapered off at your request) (it was decided by my pdoc that I am Lithium intolerant, no request), Depakote, Abilify (you only were able to tolerate one dose), Neurontin, Haldol, Thorazine, propranolol (which you've said you don't consider to be a psychiatric medication in your case, and you were quite passionate about it) (I've actually stated on several occassions that it was for anxiety and panic attacks, I don't know where you read anything differently), Lamictal, Cytomel (for ?thyroid disorder, not for psych; unclear by posts) (I have hypothyroidism), Topamax (for migraine) (was used as an antipsychotic not for migraines. It did help with them though), Geodon (stopped because it was inducing mixed states), and now Adderall.

I hope that clarifies things. I don't just up and stop taking my meds. I always talk to my doctor about any concerns or reactions that I may have to things.

You're dead right, I completely misread that [link=http://www.crazyboards.org/forums/index.php?s=&showtopic=23761&view=findpost&p=292160" target="_blank]post[/link] about antidepressants/mania, and I apologize. I'm a complete ass on that one. Kick me. (Why don't we have a jackass emoticon for these moments?)

As you know, Topamax isn't an antipsychotic. It's used for anti-headache effects and anti-seizure effects. And I had thought from [link=http://www.crazyboards.org/forums/index.php?s=&showtopic=24667&view=findpost&p=296190" target="_blank]this post[/link] that you were using it for headache (prn, unusually, but hey) and that you had a fortuitous calming effect. Probably not having an anti-epileptic effect in that little time at that low a dose... Sounds like it [link=http://www.crazyboards.org/forums/index.php?s=&showtopic=24862&view=findpost&p=297503" target="_blank]turned on you[/link] at higher doses?

Thanks for clearing up the ambiguity re: hypothyroid. You talk about a "[link=http://www.crazyboards.org/forums/index.php?s=&showtopic=23926&view=findpost&p=292185"'>http://www.crazyboards.org/forums/index.php?s=&showtopic=23926&view=findpost&p=292185" target="_blank]chronically imbalanced metabolism[/link]." That's kind of nonspecific, as some people will use Cytomel for weight loss (this is high up in the Not A Good Idea category.) That same post discusses tolerance to benzodiazepines, as well as plans to d/c the Valium in the imminent future.

You were actually saying lots of things re propranolol, including that you "[link=http://www.crazyboards.org/forums/index.php?s=&showtopic=23715&view=findpost&p=292191" target="_blank]do not count [it] as a psychiatric drug[/link]." But it clearly had a [link=http://www.crazyboards.org/forums/index.php?s=&showtopic=23926&view=findpost&p=292185"'>http://www.crazyboards.org/forums/index.php?s=&showtopic=23926&view=findpost&p=292185" target="_blank]beneficial[/link] anxiolytic effect for you by report.

Your posts talk about d/cing lithium "[link=http://www.crazyboards.org/forums/index.php?s=&showtopic=24158&view=findpost&p=292987" target="_blank]with the approval of[/link]" your psychiatrist, not "at the insistence of" your psychiatrist. The water-retention and feeling of lack of creativity were really rough for you, as cited in multiple posts. You also recognized it was helpful to you in the winter months and you really had a good grip on the idea of vanity versus sanity. The somnambulism, etc., are all totally understandable reasons - but you took the literature in to him and advocated on your own behalf, which is not a BAD thing.

You'd gained [link=http://www.crazyboards.org/forums/index.php?s=&showtopic=13342&view=findpost&p=293572" target="_blank]45 lbs[/link] on the Seroquel and it wasn't working. I just lost the link on the suckiness of Seroquel for you, but you meant it. But you were really clear about those things. It sounds like a fair trial of the rx and a fair set of reasons to d/c.

So, again - this is when the number of drugs isn't so much the issue. If drugs are ineffective, lead to your admission to the unit, etc... those probably really aren't ideal drugs for you, eh?

Anyway - this is why that Gantt-chart type list can be super handy. It saves re-inventing this kind of list. And it has 2 additional important functions, Maychild: it keeps you looking rational and coherent, rather than flaky (and they don't think, "Man, this gal just goes through the meds, eh?"; and it allows other prescribers to rapidly and fairly effectively evaluate prior prescribers' work.

This is part of what a specialty consult service would do at a big regional center - recreate the medication history, and then integrate it with the timeline/life history / functional history.

I have one of these. It's invaluable. I keep it in its little folder (which should be platinum plated!) and I update it faithfully as needed. On the rare occasions I need to see someone new, I give it to them, and they almost cry when they open it up... that means we can spend the majority of the first or second visit focusing on useful stuff. Heh.

Not busting your chops here, just trying to make sure you're in good shape for this meeting with the new folks on Monday, because you are clearly trying to do stuff right!

I went through the med history through my pharmacy (thank you Walgreens for having that online!). I made a list and dosages. One or two I couldn't remember, but it's pretty thorough. Thanks for suggesting that. Most of them had no effect on me that could be noted.

As for the Lithium, the lack of motivation and depression that it caused gave my pdoc enough pause to take me off of it and rule it out. I made it through the winter without it, so I guess I didn't need it that bad.

Thanks for all of the advice.

[nalgas]

Looking at this again now, I'm pretty much all in agreement with what Silver said, since she obviously knows a lot more about what was going on before than I did until seeing all this stuff. I've had good luck with making lists/charts of stuff when seeing new doctors, too, since it helps them figure out what's been going on more easily and helps you keep track of everything you want/need to tell them better. Hopefully that'll help getting off to a good start with the new people, and you and they will be able to figure something out to get you feeling better.

[N&P]

About sharing info with other docs...

I don't know about all states and countries but in my state, a psychiatrist (that meets certain criteria) may NOT share information with another provider unless given express consent to do so. I had concerns about my medical doctor accessing my psych info so I revoked the permission I had once given. Luckily, my records are all computerized so any breach of my psych info is detectable.

[Silver]

Written psych information can't be shared; verbal information can between providers in order to coordinate care, and written psych info can in case of emergency situations with written justification/ documentation. (As in: this person received a rx for 90 tablets of lithium 300 mg on this date - you can see how the ER would want to know that.)

At least in my Western state.

It really opened up a lot under coordination of care.

On the other hand, it's hard as hell for other parties to get it, which is nice.

[N&P]

I know that when I am admitting a patient, I have to get written permission to disclose psych info (verbal/written) TO facilities and to obtain info (written/verbal) FROM psych providers. If I don't have permission to release info, I have to refuse to speak with primary docs about their own patients' psych care...except in emergency situations.

From what I can see, it appears as though most states have their own laws that expand on HIPPA.

Susan is right...it should be posted in pdoc offices.

[Maychild]

To clarify-

he was already terminated as my psychiatrist. There was no release of information granted for this therapist. He did not state any medical problems that I was having. He was complaining about being fired and how I was a "difficult" patient because I asked too many questions and was proactive in my wellness. Period. He violated HIPPA, I've already checked.

[Silver]

Hey, Maychild, how did your meeting go with your new NP today?

Also, all med/psych offices (in all states I'm aware of) hand patients a written info of the HIPAA outline and that state's additional frills. I've had to sign for one at every clinic/office I go to - every year, in most of the offices, although the dermatologist is pretty laissez-faire about updating it annually. Apparently he's not getting a lot of turnover.

And one is available at the desk. At every office. I was collecting them for a while to compare them for a project (why - what do YOU do in YOUR free time? sure, I used to knit... now I read HIPAA updates...)

Again, HIPAA is very interesting when one reads it line by line as to when specific consent is required. This little mini-spiel covered it briefly, a while back, and not much has changed, I think.

It does require that your office tell you, in writing, when they're going to disclose your information.

My psychiatrist's office says, in essence and on a quick read, about what this dude's says (but my doc can spell HIPAA correctly.) Except my doc doesn't post it in her office because, as she points out, some of her patients need large type and some of her patients are very short, so she has it in a binder on the coffee table... Note that the example includes people the clinician see in the future.

Here are another example and another. You will note that "health care operations" includes coordination of care.... a very broadly defined phrase.

Anyway, so, how'd it go, Maychild?

[Maychild]

Hey, Maychild, how did your meeting go with your new NP today?

Also, all med/psych offices (in all states I'm aware of) hand patients a written info of the HIPAA outline and that state's additional frills. I've had to sign for one at every clinic/office I go to - every year, in most of the offices, although the dermatologist is pretty laissez-faire about updating it annually. Apparently he's not getting a lot of turnover.

And one is available at the desk. At every office. I was collecting them for a while to compare them for a project (why - what do YOU do in YOUR free time? sure, I used to knit... now I read HIPAA updates...)

Again, HIPAA is very interesting when one reads it line by line as to when specific consent is required. [link=http://www.mdpsych.org/HIPAA-briefing.htm" target="_blank]This[/link] little mini-spiel covered it briefly, a while back, and not much has changed, I think.

It does require that your office tell you, in writing, when they're going to disclose your information.

My psychiatrist's office says, in essence and on a quick read, about what [link=http://www.scribd.com/doc/11530997/HIPAA-and-Health-History" target="_blank]this dude's[/link] says (but my doc can spell HIPAA correctly.) Except my doc doesn't post it in her office because, as she points out, some of her patients need large type and some of her patients are very short, so she has it in a binder on the coffee table... Note that the example includes people the clinician see in the future.

Here are another [link=http://www.northlandcounseling.us/uploads/HIPAA_Form_revised.pdf" target="_blank]example[/link] and [link=http://www.strisik.com/_practice_forms/ss_privacy_notice.pdf" target="_blank]another[/link]. You will note that "health care operations" includes coordination of care.... a very broadly defined phrase.

Anyway, so, how'd it go, Maychild?

I was so nervous yesterday morning, meeting a new NP and a new therapist in one day.

The NP was wonderful. She was like this 60 year old grandmother with long silver hair. Her office was all in Asian decor (which I find very soothing). She talked with me for about an hour and fifteen minutes and then told me what she thought. I did tell her about the Lamictal incident but left out the stuff about talking to the other therapist. I didn't think that it was necessary information for her. She was so bewildered by why he would do such a thing and why he would change my diagnosis so quickly. So, she diagnosed me definitively Bipolar 1 with PTSD, Social Anxiety Disorder and General Anxiety Disorder. She upped my Lamictal to 200 mg's a day. She left everything else alone although she wants me off of Thorazine as quickly as possible (she admittedly titrates very slowly off of medications because of withdrawal effects). She didn't understand why I was on an antipsychotic if I wasn't manic or hallucinating. I'll see her again in two weeks and then after that once a month.

I was freaking out about the Lamotrogine Rx because we are low on money (end of the pay period). I asked her if she could write a script accordingly to purchasing it via the Canadian pharmacy (100 tabs, it's $77) and she said she would after I was a more established patient. So, I went home and started calling around to different pharmacies. They were all pricing them between $142- 147 for my script of 30- 200mg tabs. Then I called Costco. $16.77. Before insurance. I almost cried. I never thought of them for some reason, but they are wholesale, duh. They don't mark up meds. So I got all of my meds for the month (normally around $150 with insurance) for $24.00 with insurance. It made my month.

Then I went and met with my new therapist. We are working exclusively on trauma but she also wants to work seperately on my agoraphobia if it's not related. It's a 16 week intensive program but it's all stuff that is residual from 15- 30 years ago. I'm pretty excited. I did share with her what happened with the pdoc and therapist and she said that it was illegal because the therapist was not an official provider for me. I was only seeing her once or twice. And I had fired my doctor before he made that phone call, so he had no official position for making that call. Anyway, mute point, what's done is done. I'm over it. I'm in such a better place than I was a week ago.

Thanks for being so supportive (again, you always are here for me). I posted a seperate post on Costco pharmacy prices. I think everyone should know that there is a really great option out there. Especially for Lamictal and Lamotrogine being so expensive.

[Silver]

Very cool!

I like that your therapist is breaking out the issues and holding the limits. That's also kind of a nice model for life.

Anyway, that's good that it's working out.

I keep meaning to write a post on how to research drug prices and on how much drug prices can vary, just within the US retail system, and I'll get to it, but since I just last night finished my 2007 taxes... Anyway, yes, now that Lamictal's out of Hatch-Waxman it's cheap cheap cheap. Wonder how long it'll be til it starts showing up on the $4 lists...

[Maychild]

Just a quick side note about my former pdoc. I was at DBSA group last night and I actually said his name when I was talking about what happened. Six people said, "Oh no" as soon as I said it. They had all been former patients of his, including our facilitator (he described him as an arrogant bastard). They all had the same problems with him, putting them on drugs that weren't necessary, treating them like they were a problem, ect. I felt very validated in my decision. The other thing that I failed to mention when I saw the NP was she asked if I was currently manic or hallucinating. I said no and she said then there was no reason why I should be on an antipsychotic. I've been on five since last July and even on two at times. I was never manic or hallucinating (except I had hallucinations from Geodon). It was just more information for me and confirmation that I made the right decision.

[nalgas]

Well, that's good news and pretty exciting that you get along with the new people you're seeing and have a plan for what to work on with them. And I knew generic Lamictal had lowered the price a bit compared to before, but under $20 is crazy. In a good way. Heh.