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So many meds, not helping


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When I got out of the hospital in January, I felt as if I were in shock (many bad things happened recently). Adding to that shock was a constant state of confusion, and I couldn't tell which end was up. I knew that I wasn't happy, but I just felt kind of dead, like I wasn't having any emotions. That seemed like a good deal, to get me through those bad times, but as the shock has been wearing off, and I am less confused (sort of), I have realized that I am doing very badly. I find no joy in anything, I don't smile anymore (I used to smile even when I was depressed sometimes, it's my natural "state of face"), and I'm going downhill. :Trigger: :Trigger: :Trigger: Yesterday I started looking into ways to kill myself-- ways that would be sure to work, regardless of how painful (I've done a lot of this sort of research over the years, but it was always couched in terms of being peaceful/not messy/etc.). I am not planning on it, because I find it unspeakably evil to do that to my children (I am absolutely pro-choice for everyone else, however), but I've been having more periods of dissociation as I've gotten older and I am getting really scared that I will kill myself without really intending to (I almost did the other night).

My therapist isn't all that helpful, though I am trying to work with him in individual sessions and a DBT group. I just don't know him or trust him well enough to really go into details (and hearing once more that "it's understandable" that I would feel badly given my current circumstances doesn't help). I will be seeing my pdoc in a couple of weeks, but when I saw him last and explained that I am still very depressed, he didn't want to increase my AD (I'm at an average dose & I have a history of being triggered into manic or mixed episodes from AD).

What do I do? I've been on the med merry-go-round for so long, and we're back to trying things I've already tried. I just want to feel better. I would even take on a manic episode at this point just to stop feeling as if I am in hell (assuming that it is a euphoric mania). I've had people tell me I should go back to the hospital, but I can't live there, and being there doesn't really help. The problems it causes (losing my income, my childrens fears being increased- I already have a 9 year old that is depressed & scared that I will go back in) far outweigh any benefits.

I am so tired of this.

(Not sure if this should go here or in the bipolar forum.)

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You must be very strong Dedoubt. I have a hard enough time with regular cycling. (Except I get tricked by the

signals now.) That part about being there for the kids is so true. And they for you.

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IMO, when you decide to have children you give up the option of ever committing suicide. Ever.

I know, my god, I know. It's the only thing that keeps me living most of the time, and trying to figure out ways to keep living. That's why I wrote that I think it is an unspeakably evil thing to do. My fear is that part of me shuts down at a certain point and I go on auto-pilot/dissociation and start thinking about methods, or find myself just about to do something that could kill me. I'm freaking out lately because it isn't a conscious choice, but like I'm sleep walking. :Trigger: A couple of months ago, I self injured without being conscious of it. That has never happened before, even though there have been instance in which I've been disconnected to some degree. The only memory I have of that instance was looking down and seeing that I had done it. (and it's in a visible area, another thing I never do)

Have you had a lithium level done? 600mg is a rather low dose.

I get regular levels done. 600 is as high as I can go. My usual blood level is about 0.6-- when it gets higher than that, I show signs of toxicity. The first night I went up to 600 mg, my blood level went to 1.2, and I ended up in the hospital. Even at 600, I have a tremor, my thyroid is enlarged & my TSH is going up-- after only about 3 months on it. All of my med doses are low because of similar issues (ie. my platelet count is going down since being on the Depakote), and my doctor is theorizing that I might be a slow metabolizer of drugs.

What about adding an AAP?

Not unless there is something brand spanking new on the market. I've had terrible results from each one I've tried. As an example, Geodon gave me dystonia & EPS & psychosis (in addition to knocking me out & not working). That was the worst, but the others weren't much better.

Thanks for the responses, you two.

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Maybe swapping out the lithium for lamictal? Have you ever been on lamictal?

Have you had a tsh level checked lately? when my tsh is high I get BAD.

The dissociation thing really makes me nervous. My most serious OD was while dissociating. I don't remember taking *ANY* pills.. and woke to feeling odd and 4 empty pill bottles in front of me.

Seriously, even though the lost income and it being hard on your children, its SCARY that this stuff is happening when you are not totally aware. You need to be somewhere where people can watch you until you get out of this. For me, my dissociation gets worse when I'm severely depressed, because eventually I just can't take feeling that shitty anymore and my mind checks out. It kinda sounds like with your bad experiences lately, and the depression, your mind is just checking you out because you can't physically take things anymore.

And if you dissociate and hurt yourself severely... you might not realize until its too late.. or you have the risk of your children finding you hurt, and hurting them even mroe than if you just had a hospitalization.

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Looking at your meds, it's not surprising that you're feeling not so stable. I'm wondering what you mean about showing signs of toxicity when your level rises above .6, as that doesn't make sense.

Gabapentin isn't much of a mood stabilizer for most people. A .6 level of lithium is barely therapeutic. 500 mg of depakote isn't much.

In the last year or so, three new AAP's have been approved. Saphris, Fanapt, and Latuda.

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Maybe swapping out the lithium for lamictal? Have you ever been on lamictal?

I was on Lamictal for 1 1/2 (close to 2) years. Other than giving me a tremor and screwing with my ability to spell, it didn't do anything.

Have you had a tsh level checked lately?

It was checked about 3 weeks ago. It is elevated, but not incredibly high.

The dissociation thing really makes me nervous.

Me too. I wonder if it is just the meds making me really out of it and forgetful, though, and I am thinking it is dissociation.

Seriously, even though the lost income and it being hard on your children, its SCARY that this stuff is happening when you are not totally aware.

It's not just a matter of lost income-- we will lose our house (I'm the only one here now, and barely making rent as it is). The kids' dad took time off of work last time I was in the hospital so he could get the kids to school every day, but he can't do that again, especially not so soon. I have no family or friends that can stay with them. And though it seems like a good idea to go into the hospital, it didn't really help last time (any of the times I've been, actually). It might be a safe place, but considering how long I've been trying to get meds to work, it would have to be an indefinite stay.

Looking at your meds, it's not surprising that you're feeling not so stable. I'm wondering what you mean about showing signs of toxicity when your level rises above .6, as that doesn't make sense.

Gabapentin isn't much of a mood stabilizer for most people. A .6 level of lithium is barely therapeutic. 500 mg of depakote isn't much.

In the last year or so, three new AAP's have been approved. Saphris, Fanapt, and Latuda.

My pdoc is really good with meds (Dr. Edward Drummond) and has been working with me for over five years, so I trust his judgement about dosages/levels for me. We are not all created the same way, and for some people, lower doses do work. Or conversely, higher doses for some people make them sick.

When my lithium level was 1.2 (24 hours after my previous dose, so it must have been higher), I had a severe tremor, was very confused, dizzy, felt like I couldn't see straight, was nauseated, um... I can't remember all the details, but all of that was happening and I felt completely overwhelmed and made a plan to kill myself that day. Which is when I went to the hospital. While I was in the hospital, I had lith. levels drawn every day, and those symptoms would start to come back when my levels went over 0.7 or 0.8. At 0.9, it was pretty bad, so my doctor decided to back the dose down and keep me at 600 mg. We haven't figured out why my level was 1.2 when I had taken the initial 600 mg dose. Stupid body.

At any rate, on 600mg lithium, my TSH is going up, and 500mg Depakote, my platelet levels are going down, so my doctor is unwilling to raise either dose at this point. After my next level check, we may make a different decision.

The gabapentin worked all right on its own for me when I was already sort of stable, mostly by lowering my anxiety. I'm still taking it because it helps a little, and my doctor figures it's best not to break something ain't broke... (though I seriously doubt he would ever use the word "ain't")

I will ask him about the newer AAPs, though he probably won't prescribe them for me unless they are remarkably different than previous AAPs.

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Have you tried Tegretol? I swapped out Depakote for it and did much better.

If you did not experience significant depression on Lamictal, it may have been working and you just didn't recognize it. Or perhaps a higher dose would have helped. I could not do a higher dose without cognitive effects until I was on it a couple years. Then it was no problem and my depression has been noticeably improved.

Talk to your pdoc and tdoc about the dissociation. If it is anxiety driven, your Klonopin should help. If not, then when it starts, take a cold shower or do something very tactile and grounding. Doing so tends to force you into the present and so can make it stop or at least not be so bad. Also, if it started or appreciably worsened after adding a med, talk to your pdoc seriously about it because as you mentioned, it could be the meds.

Tell your tdoc that saying things are "understandable" is not helping. That's important for him to know. Also tell him that you are trying to trust but you've got a ways to go.

If you can get your Li level up to .8-.9 (750mg?), it may help a lot. Of all the bipolar meds, Lithium has the lowest suicide rate.

Geodon made me crazy and caused physical problems. Risperdal is the only AAP I can easily take at an effective dose. The rest give me akathisia pretty bad. The meds to counter that don't work for me, but maybe there is a med that would help you with whatever are your AAP issues. More importantly, there are three new AAPs as already mentioned.

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Have you tried Tegretol? I swapped out Depakote for it and did much better.

Yes, I did. I feel like a broken record saying that it was one more that didn't work-- I spent the entire time on it in a horrible lethargic rage, too muddled in the head to even verbalize the rage-- just this nasty spitting fury at everyone and everything. Which was just a lot of fun for me and everyone else.

If you did not experience significant depression on Lamictal, it may have been working and you just didn't recognize it.

That is a good point. I was up to 275mg, and was still cycling in and out of depressive periods often enough to get put on and off ADs, but maybe it kept the depression at a less severe level. But it really didn't keep me from cycling, and my mental functioning was messed with (not as badly as what I am on now).

Also, if it started or appreciably worsened after adding a med, talk to your pdoc seriously about it because as you mentioned, it could be the meds.

It's so hard to say-- I had so many new meds added around the same time. It's been something that has gotten worse over the years-- it feels like my ability to bounce back out of the pit is almost gone, and maybe that is why it is worsening. Thanks for the recommendations about how to deal with it. I've always just kind of ignored it. Klonopin helps in that I just don't think about anything

If you can get your Li level up to .8-.9 (750mg?), it may help a lot. Of all the bipolar meds, Lithium has the lowest suicide rate.

I'll ask my pdoc when I see him, because I do like that it's been studied so well & lowered suicide rates. Since I'm on levothyroxine already, maybe the problem with my enlarged thyroid won't be as big of an issue. I do have a problem with impaired cognition though-- I tend to have rage freakouts when I can't think clearly, not to mention forgetting little things like picking kids up from school. :( when I take it. Yesterday I just washed some walls and vacuumed and scrubbed my stairs clean. It was kind of great. But I am trying to back off taking it every day because I had problems with using way too much in the past (and I am a recovered druggie).

Geodon made me crazy and caused physical problems.

I am sorry that happened to you, but lordy am I glad to hear I'm not alone. I've been told by so many people that AAPs "don't do that" (EPS & dystonia) that I started feeling crazy-- ha ha. At least it is noted down in my hospital record, so I can see it in black & white. I'd had so many problems of varying sorts with other APs, that was the final straw for me. I am really freaked out at the thought of taking one, and my pdoc is extremely hesitant, though we might at some point if all else fails.

Phew. Speaking of picking up kids...

Edited because somehow I deleted part of my post...

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