Just Lamotrigine

… yeah. I didn’t take the trazodone Wednesday night, nor Thursday, nor last night. And I’m doing better. I feel like I’ve woken up from a bad dream. And speaking of dreams, I’m back to my usual anxiety dreams – which I KNOW are dreams once I wake up. So much better.

My anxiety is kinda overwhelming tho. I’d almost forgotten what it was like to feel like this. I have a thing I need to be not only present at but act in a professional capacity. I think I can deal with it, but I’d wanted to go to a cultural event at my local library – no pressure there, just show up have fun and leave. But I was kinda freaking out about it – especially the leaving and getting to my later commitment on time part – so I guess I’m not gonna go. It’s just easier that way. There will be other opportunities … right?

*sigh*

I’m kinda doubting whether I’ll ever be able to find and maintain gainful employment.

I don’t want to stay on just lamotrigine, and either way I’ve been thinking for a while that it would be good to increase my dose slightly. I’m debating whether I should ask to go back on fluvoxamine or clonazepam. The former was a rocky start, but I got used to it and I think staying on it might’ve been good for me. The latter … I don’t think I ever had any problems with it – I don’t remember any. It helped with my anxiety. It’s not the safest med in the world but you know what, fuck it. I’d rather be functional while I’m alive than live longer.

Something tells me getting my prescriber to agree to this won’t be easy. I’m writing her a letter in hopes that will prevent me from ‘acting irrationally’ at our next appointment.

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Quit Playing Games with My Brain

Disclaimer: Anytime I write about medications, I’m sharing my own thoughts and experiences. This is NOT medical advice.

I had a rough time on the fluvoxamine maleate, at least initially. September was a stressful month anyway, though. So, it’s kinda hard to determine whether the problems I faced were a response to stress, a reaction to my meds, or some combination. All I know is I started occasionally mispronouncing words that normally I’d have no problem pronouncing correctly. I had to stop most of my Green Party activity because I was getting too overwhelmed. And I was suicidal.

I visited with Banji the first weekend in October and felt much, much better by the end of it. But I’d already told my prescriber about being unhappy with the fluvoxamine, and she’d already switched me to a new medication. Almost reluctantly, I weaned myself off fluvoxamine this past weekend and started taking trazodone.

The only things I’m happy about on trazodone are that 1) I’ve stopped mispronouncing words, and more importantly 2) I had the good sense to make sure I wouldn’t be driving for 5 hours on a new med!

Since I started taking trazodone Sunday night, I’ve had weird, vivid, disturbing dreams that it’s taken me a while to realize (once awake) were dreams. I’m having a harder time falling asleep, in part because the occasional involuntary muscle movements are becoming more frequent. I feel like I’m having trouble staying asleep, but that could be because my sleep cycle is shifted later than it should be. I feel groggy and tired. I’m anxious and having trouble concentrating and following conversations. On Monday while driving I couldn’t see the sign for the place we were going until we were practically there. When people gave me directions I heard “right” and thought “left” until the last moment. When I speak I’m too aware of my mouth movements and I feel like I’m listening to someone else.

When I told Ron about this stuff, ze said, “If you feel like your brain is broken, the trazodone is doing its job. It’s a hospital med used to shut down the brain of a patient who is psychotic and make them sleep. As an outpatient, if you are not psychotic, you have no business taking those meds.”

Ze urged me to find a new prescriber. I … I can’t. Not like this. And even if I were 100% on top of everything, I’d probably have to make my first appointment at least a couple months in advance. And that’s assuming the places I called even had mental health prescribers available – most are already overwhelmed with too many clients.

IF I remember our conversation correctly, my prescriber said I could try this med for a few days and stop taking it if I didn’t like it. I’m sure I remember her telling me I don’t have to wait a whole month, and I don’t think she said I should call before stopping. But I’ve been thinking for a while that I’d rather take just the lamotrigine if that’s what it takes. Maybe all I need is another slight increase, I’m on a pretty low dose.

Being on clonazepam wasn’t perfect, and I know there can be risks – particularly addiction. I feel like my sleep was more satisfying on the fluvoxamine. But I miss the way my brain worked on clonazepam. I rarely felt anxious – that’s probably the most important thing. I might’ve felt depressed, but I was functional. I knew I could do what I needed or wanted, and when I tried I would usually succeed. Now …

Good Bye Clonazepam

I took my last dose of Clonazepam today. I’d been thinking for a while that it might make more sense to stop taking it than to fill the new prescription and drag out another month of taking these half-doses, which don’t do the job but still run the risk of interactions and side effects. I called my prescriber to make sure that would be okay, and she gave the go-ahead. So starting tomorrow I’ll just be taking Lamotrigine, Fluvoxamine Maleate, and the supplements I’ve found helpful: omega 3, vitamin D, and a vitamin B complex.

So far I haven’t noticed any ill effects from the Fluvaxamine, so I guess that’s a good sign. I don’t really feel like it’s kicked in yet; I hope it does soon because I’ve been … well … I’ve spent the last 3 days inside playing Skyrim all day. Today I kept getting interrupted and feeling too overwhelmed to do anything useful, so more Skyrim. Mostly because of politics, drama, and financial issues that I don’t really feel like getting into right now … though … I dunno, other folks are venting to me, and I don’t know who I can talk to about it so … whatever.

New Prescriber, New Meds

I had my second appointment with my new prescriber last week. At our first appointment, she told me she’s not a fan of one of my medications, Clonazepam, and said she wants to start weaning me off it so I can start taking something else. She wanted to put me on a SSRI (selective serotonin reuptake inhibitor) “to help with both depression and anxiety.” I resisted because I’ve had bad experiences with two different ones. There were no changes to my meds last month.

But this month she reiterated the need to get me off Clonazepam and told me to start cutting the pills in half. She also said there are medications that help with hording and prescribed me one, Fluvoxamine Maleate. It’s a SSRI. I’m torn between not wanting to take it because I’m scared of how it might affect my brain and the rest of my body – and wanting to take it because I can use all the help I can get to deal with this hording.

I talked to Wakana about it and she seemed very concerned about the change in meds, especially since I only just started seeing this prescriber. I’ve been taking half doses of Clonazepam since September 1st; so far I’ve already had two days (Monday and today) when I felt ill enough that it affected my functioning, and almost kept me from following through on important plans. I’ve been feeling down, slightly queasy, less sure of myself, tired, anxious, freezing (as in fight, flight, or freeze), and sometimes twitching – in other words, like crap. I suspected on Monday that I was having withdrawal symptoms; Wakana confirmed it today. I have an important meeting tomorrow at noon, and another Friday evening; I don’t have time to malfunction because of changes to my meds.

I’d say “especially changes that are based on the prescriber’s philosophy rather than the medication’s effects on me,” but it’s a little more complicated than that. Clonazepam can be addictive, it has interactions with a lot of things, and I was questioning how much it’s been helping me. I feel like I need more support vs the depressive symptoms than I’ve been getting from Lamotrigine. (There’s no way I’m going off that, though. It keeps my brain from trying to kill me.) To this prescriber, at least, all signs seem to point to SSRIs. I don’t quite get why she’s so obsessed with them.

I’m starting a new bottle of Lamotrigine tomorrow, so I figure it’s a good time to start taking the Fluvoxamine. But I’m really not sure whether it’s the right choice – especially since Wakana pointed out that I’m already addressing the hording without this med, and we agreed that many of the problems I’m facing can only be addressed by getting Fox to take responsibility as well. What will this stuff do to me?

I don’t know, but Wakana suggested tracking my mood and I think it’s a good idea. I’m not sure exactly how I want to do it though – I’ll probably find an app – and I’m annoyed that I don’t have a way to get a baseline. I’d rather not do one retroactively, I’m already having issues because of one change in meds, and I was having issues before that due to interpersonal drama – in short, there are too many variables to determine whether whatever I’m experiencing has anything to do with a particular medication.

I’m just feeling more and more like I want to be done with everything. That’s not a good sign…

The Epic Quest for a New Prescriber

At my last psychiatric appointment, my prescriber of nearly 3 years (an awesome advanced practice nurse) informed me that she’s retiring – and the community mental health clinic where I’ve been receiving care isn’t hiring a replacement. There wasn’t any offer to help me find a new prescriber or set me up with one. She just gave me a list of numbers to call, and sent me on my way.

I knew I should’ve started the search immediately, but I was stressed out by the idea so I did what I do best: I procrastinated. I got distracted. I focused on just about everything else. To be fair, “the incident” happened soon afterward; I needed time and energy to recover from that. (Things are going well, by the way, update pending.)

Two months have passed.

Somehow my lamotrigine & clonazepam prescription refill cycles got de-synchronized, so I’m in a kind of weird situation. I used the last lamotrigine refill a few days ago; “additional refills require authorization.” I have 26 full doses left, including today’s. There’s still one more refill on the clonazepam.

So it’s crunch time. I need to find some way to refill these medications – preferably before I run out or resort to cutting pills in half. I honestly fear for my life if I have a disruption in access to my meds – if not my physical life, my ability to continue my activism and maintain healthy relationships. Perhaps more importantly, I fear losing the ability to do the things I need to improve my life – such as completing my degree, finding a job that pays a living wage, consistently functioning well in that job, and learning how to keep my home from becoming an unlivable nightmare. Even more importantly, I fear losing the ability to take care of myself, which includes the ironically (read: cruelly) daunting task of accessing and engaging in treatment.

These fears are among the most potent triggers for my worst depressive symptoms.

Oh, and by the way, my state just cut funding to community mental health. Clinics are closing or cutting whatever (whomever) they must to try and stay afloat. My current clinic no longer serves clients with private insurance, and it had to let go of its front desk staff.

jiFfM

Star Trek: Next Generation characters Picard and Riker both facepalming. The text reads: “Double Faceplam. For when one facepalm doesn’t cut it.”

So, yesterday, I began The Search. My counselor (who helps me with behavioral approaches to wellness) had suggested that my primary care doctor could possibly authorize refills, so I called his office. They said he “might” be able to, “depending on [my] situation,” so I made an appointment. I’m hoping he can authorize a one month supply of the lamotrigine, and if necessary I can return to him for a three month supply of both medications. (Clonazepam is a controlled substance, so any ‘new’ prescriptions not filled within 30 days expire and need to be reauthorized – at least in my state.)

Even if my primary care doctor can help me, seeing him for psychiatric consultations is not sustainable. I don’t have, nor do I anticipate developing, the rapport I’d need to literally trust him with my brain. I need a specialist who really knows what they’re doing, especially if and when it becomes necessary to make adjustments to my medications. (Which may be soon, I’m still trying to figure out to what degree my current problems can be addressed through music therapy and changes in behavior, vs meds.)

Ideally I’d like to switch to the other prescriber at my current clinic, whom Fox has been seeing and seems to like. If not her, perhaps someone at another location in the same agency – surely that would provide some consistency of care, right? I called the intake office; the person who answered seemed surprised I hadn’t been referred to another prescriber. “Well, you might want to call the other numbers on your list, because we’re currently scheduling for September.” “September?” “Yes.” I hung up on them.

I started making some additional calls. Bad number. We don’t do that. We’re not accepting new clients. We’re currently at capacity, but may be hiring someone, you can check back.

newprescriber1

My to-do list item on Habitica.com with several steps checked, reflecting the efforts I put in yesterday.

There are several additional numbers on my list, but most of the clinics are in urban areas that may be … inconvenient … to access. Middle class suburban snobbery aside, I anticipate that these locations are even more likely to be “at capacity” or otherwise struggling to serve clients for whom they’re the only choice.

So I’m gonna try calling intake for my current clinic/agency back, see what they can do for me. (I realized later that September is only about a month and a half away.) Hopefully my doctor can set me up through August, maybe September as well; if there’s any interruption in my access to meds it will hopefully be short enough that I’ll be okay. And I’d rather have this set as a backup in case my doctor can’t help me and/or I can’t find a prescriber elsewhere; the longer I wait to make the appointment, the later it will be and the more likely this is to become devastating.

I forgot to refill my prescriptions until I ran out – of course on the day I was running late and had to rush out the door. I tried to put in the refill request for the clonazepam first, but was unsuccessful; somehow my prescriptions got de-synchronized so I was out of refills with that Rx number and I didn’t have the new one to put in. I was in crazy anxiety rush mode, so I didn’t try refilling the lamotrigine – even though it had 2 more refills with that Rx number.

I asked Fox to go to the pharmacy for me and he did, because he’s wonderful. He said (they said) they didn’t have anything in the system for me. I was tabling at a pride event and he had to leave for work and it was Sunday, so there wasn’t really any opportunity to follow through on anything.

On Monday I realized I should’ve tried to refill the lamotrigine, better to have one of my meds than neither, right? That was no problem, but I had to speak to a pharmacy representative to deal with the clonazepam. The person I talked to at the pharmacy had an irritating tone to her voice and was too nonchalant, like there was no problem with them not having the information necessary to make sure I have access to a medication that keeps me alive. She didn’t even try to be polite like saying ‘sorry’ – but she did offer to fax my prescriber. And she explained that the clonazepam prescription had expired because it’s a controlled substance, so it has to be filled within 30 days.

I walked to the pharmacy with my inner voices screaming, an irritable mess, barely holding myself together. By the time I got the lamotrigine my ears were ringing and my eyes were so full of static everything was in a darkened haze and I couldn’t think straight and everything felt completely WRONG. That was after missing one dose – and it’s not even that high a dose. I took the dose – better to at least take one of my meds, right? and everything cleared within minutes. The difference was noticeable to Ron over the phone.

I had to play phone tag with my prescriber for a couple days, but I was able to refill the clonazepam today. I didn’t notice as much as an effect when I took it, except that maybe I’m a bit calmer? And I was rather sleepy, I attributed it to waking early from a bad dream, but the medication is known to make people drowsy. Ron seemed surprised I’m able to function at all taking [my dose] of it every day.

To be honest, between what ze’s been telling me about it and what I’ve read online, I’m a bit wary about staying on the clonazepam. Apparently it’s habit forming and it’s better not to take it for extended periods of time. But my prescriber added it for a reason – I think because even with my mood stabilized I was still struggling with anxiety. And I don’t know if I wrote about this yet, but my prescriber is retiring, so I need to find a new one within the next month or two. I’d rather not change my meds until I’ve developed a good rapport with the new prescriber.

So, yay, I’m back on my meds! I anticipate that going a day without lamotrigine and two days without clonazepam will have thrown my levels off; it might take a while for them to get back to normal. And I’m a bit shaken by how profound my (withdrawal?) symptoms were before I took the lamotrigine. I’d come to accept that I’ll probably be taking these medications for the rest of my life, and I’d rather do so consistently than risk going back to how things were before I started taking them. Still, this was a rough reminder of how dependent I am.

The Power of Music and Metaphor

I had one of my most intense and effective sessions ever with Wakana last week. She supported me by alternating between A Major and A minor chords on the piano, adjusting her style & chords to complement the emotions I was expressing. I sang, nonverbal melodies at first and words as they came to me – statements and images and raw expressions of anger, grief, triumph… She sang too, reflecting and supporting and occasionally making suggestions. It was very intense; we peeled back most of my defenses as I became more and more relaxed.

It’s one thing to know, cognitively, that one’s self-judgment is the result of early, most likely pre-verbal, experiences of being judged and found lacking. Of not having one’s emotional needs meet sufficiently, and so on. It’s relatively easy (now, after studying psychology for over a decade) for me to connect my current emotional difficulties and insecurities to past experiences. (And yet I’m still surprised how often certain ones come up in therapy.) I’ve built this narrative about my life that organizes the chaos, giving it purpose and meaning; I can reflect on it and pat myself on the back for all the things I’ve overcome.

Yet, time and time again, Wakana tells me the same thing: “You’re too hard on yourself.” She asks what it is I dislike so much about myself. And other than this nonverbal sense of being Wrong, I can’t really answer her. Not in straightforward prose, anyway.

It’s another thing entirely to go through the process of seeking the cause of my self-judgment as it exists deep within my psyche, much as one might search a room for an item one has lost. Several years ago I moved into the other apartment in my mom’s 2-family house; she had been using its closet and cabinets for storage but was happy to have me move back in with her. As Banji helped me clean and re-organize, we identified items that were not mine. Then we moved the items to a space where Mom could sort through them without entering my apartment. We called the items “someone else’s problem,” which made it easier to remove them from my space.

I felt like I was doing that again as I searched for what could possibly be so “wrong” about me. What did I find? The Single Thing I most want to change about myself is this feeling like there’s something inherently wrong with me, which makes me depressed and anxious and keeps me from fully living my life. It keeps me from loving myself. I judge myself for judging myself for judging myself.

… Or so I thought during the session last week. The judgment is definitely what I want and need to change, but I’m still judging something about myself… Perhaps something that doesn’t need to change after all. As I wrote and re-read the above, I realized that I judge myself for having intense emotions – especially when they come up at inconvenient times. The sadness, grief, anger, fear, anxiety, etc. take over my body all too often, usually at times when my “rational side” considers them to be utterly inappropriate.

Today I tried to acknowledge and accept how I was feeling without judging or fighting it. I felt anxious while getting ready to leave the house and considered taking the medication my nurse practitioner prescribed, but decided instead to accept that I felt anxious and continue getting ready. I felt tears welling up in my eyes during conversations and let them flow, inwardly acknowledging why they were there while continuing to share my ideas and experiences.

The problem isn’t my emotions. The problem is that it is risky to allow one’s emotions to show in most social situations. It’s that I have been judged and punished from a young age whenever I expressed strong emotions – especially if my doing so inconvenienced the adults in my life. It’s that, until recently, I haven’t had the support and tools I need to express and manage my emotions in healthy ways, instead of suppressing them.

My emotions are inextricable parts of me that serve vital functions, even if they’re often not what I want or (think I) need at the time. The judgment isn’t mine. It belongs to cultural norms that should be obsolete and caregivers who internalized those norms. As humans we both create and adapt to our environment (society)… and we have an uncanny knack for creating unhealthy environments for ourselves and our children. Self-judgement and internalized stigma are two related ways in which we adapt to some of the most toxic elements in our environment.

(I feel the need to include that not everything in Western society is toxic; some aspects are actually quite awesome. Also, just as we create our environment, we can change it for the better.)

The thing is, it’s one thing to know that cognitively, to think it and talk about it with other people. It’s something else entirely to, as in the movie Inception, delve deep into one’s own mind and find something that was placed there by someone else. Wakana helped me do that last week; now I’m looking for the “someone else’s problem” box.