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 …

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…

Fus Ro Dah!

Since writing my last post and looking at lists of Lamictal/lamotrigine side effects, I’ve done a 180 and no longer feel safe taking my medication. Part of me believes it is a lot easier than confronting the APN about her decision to have me stop taking the medication. Part of me believes that I’ve been experiencing side effects the whole time and either ignoring them, not attributing them to the medication, or acknowledging them and attributing them to the medication but refusing to admit that maybe this isn’t the right medication.

All of me is angry at the APN, psychopharmacology, and the entire “healthcare” system: all doctors, their administrative staff, and especially managed care… I want to say I know it’s irrational, but is it, really? My blood pressure and heart rate are high and that’s set off some alarms regarding the medication… but maybe it’s due to the stress of trying to access medical care!

There isn’t really anywhere for this anger and the accompanying destructive urges to go. The APN’s office is closed for the federal holiday, so the earliest I might be able to talk to her is tomorrow. I have too much other stuff on my plate to waste time trying to get in touch with someone as flaky and dismissive as her! Verbally abusing anyone else would be mean and probably backfire. Physical acts of aggression, homicide, arson, etc. would take way too much effort. I’d rather play Skyrim. Shouting at people in that game is a lot more satisfying, and if it isn’t enough I can set them on fire with my mind.

So I’m just fed up with the whole thing and the thought of swallowing their b.s. in the form lamotrigine dispersal tablets makes me sick! I checked, online sources state that stopping lamotrigine without slowly reducing the dose first is safe for people who are being treated for bipolar, but not epilepsy. (do NOT take this as medical advice! Always talk to your doctor before stopping a medication.) Given the alternatives, I’d rather say “fuck you!” to medication and harness the energy from my anger to be awesome at my classes than keep taking something that may be making me sick.

There is a quiet voice in the back of my head saying that maybe it’s the therapeutic effects of the medication that have helped me get to this point. But my symptoms haven’t been much better than before I started taking it, and I’m inclined to attribute the ups and downs to the circumstances of my life. I can’t tell if it’s making a difference, so maybe it’s not. “There’s no point in taking it just to take it.” Right?

I’ve been wasting too much time and energy on this. There are about a million better things I could be doing!

Dismissed

I had another appointment with the APN on Friday. She took my blood pressure – which was a bit high, both for me and based on the health guidelines I’m aware of – and said it was “fine.”

Then she asked how I’ve been. I told her about being tired and unmotivated to do anything; sometimes I don’t even feel motivated to play Skyrim. I tried to put it in the context of everything that’s been going on: the stress of the holidays and then everything just stopping. I told her when I’m very depressed there’s less anxiety because I don’t want to do anything so there’s nothing to be anxious about, but when I’m less depressed and starting to want to do things I feel anxious about them. (To be honest I’m not sure that’s entirely true. I experience different kinds of anxiety. But I didn’t express this to her.) I also told her about the ominous voice twisting all the imagery in the guided meditation into things I found threatening. I told her I’m both excited and anxious about my classes starting next week: excited because I’ll have some structure in my life and anxious because of the responsibilities. (Not to mention my social anxiety.)

As I was talking about this stuff, she was making notes on the computer (facing away from me). Then she looked back through her notes from past appointments and the information I’d provided in the intake paperwork before our first meeting. She weighed me and told me I’m a candidate for sleep apnea. She told me to go get blood work done so she could see if there is a problem with my thyroid or something (past blood work has ruled that out, but I haven’t been able to show her the printout to prove it). She also called a sleep center for me and handed me the phone, basically forcing me to make an appointment for a sleep study.

Okay, I’ve been dragging my heels, I can kind of understand her being a bit heavy handed. But the next thing she did utterly terrified me.

She told me to stop taking the Lamictal/lamotrigine. She said I’m “sensitive” to it and it doesn’t seem to be helping. “There’s no point in taking medication just to take it.”

That’s it. No plan for slowly reducing my dose over time to minimize withdrawal symptoms. No concern over what effects suddenly stopping Lamictal might have on me. Granted, I’m only taking 75 mg, but we’ve worked our way up to that dose very slowly. If I’m “sensitive” to it, doesn’t that increase my chances of being “sensitive” to suddenly not taking it?

I honestly don’t know if it’s helping. Maybe it isn’t. Maybe it’s wreaking havoc on my central nervous system and I should stop taking it immediately. She didn’t explain why she thinks I’m sensitive to it, and gave a very simplistic explanation of why I should stop (which suggested she views me as medication-seeking). Her tone sounded dismissive to me, so I didn’t feel comfortable asking questions. I couldn’t think quickly enough to formulate them and felt like she wouldn’t listen anyway.

Maybe it is helping and my depression would be a lot worse without it. I feel like she’s not taking my life circumstances into account. I was doing great up to the wedding, then suddenly all my loved ones had gone back to their own lives, nothing meaningful had changed, and I no longer had something important to work on. I couldn’t sleep for a week or so while Mom was having work done on the roof. Then the holidays were a blur of excitement, socializing, not getting enough sleep, and thinking my godmother was going to die. Then, once more, everyone left and everything stopped – except worrying about my godmother. The floor dropped out from under me – and my pending courses for the Spring semester are looming over me.

The courses are the thing that has me the most concerned about stopping my medication. I’d like to have a bit of stability going into such a big lifestyle change; the last thing I need is unpredictable changes in my body chemistry and mood at the same time I’m going into a frightening and challenging situation. The last time I took these courses I had to drop them because they were triggering self harm and suicidal urges. I don’t feel safe trying to take them again without some kind of safety net. (I should probably talk to my instructors about this.) At least taking medication is something I’ve been able to do with some consistency; I feel like I’m doing something to help myself!

I suppose I could possibly enjoy the same effect from continuing to take my supplements (omega-3, vitamin d, and a vitamin b complex with folic acid and vitamin c), but I really don’t want to give up on the Lamictal just yet. Wakana has been urging me to take medication for so long (since before I started this blog), I hate the idea of finding that yet another one doesn’t work. I don’t want to start from scratch again…

During the meeting with the APN, my mood went from 1) low energy, depressed and a bit anxious, to 2) slightly higher energy and a bit irritable, to 3) more depressed, frustrated, and wanting to cut myself. She ended the appointment after telling me to stop taking the Lamictal; she didn’t even ask if I had any questions or concerns or anything else I wanted to talk about. I feel like she thinks I’m not really depressed or only mildly depressed and that I’m being lazy.

(Much of our conversation was her giving me advice: to make healthier food choices, move around more, make a schedule for myself, and give myself a to-do list with simple tasks that help me feel good. Some of these are lifestyle changes I want to make anyway and think would be helpful, but in general it sounds like stuff laypeople say to people with depression because they don’t understand it.)

I left and made sure I have future appointments pre-booked, but thought about not coming back. In an ideal world I would find a better psychiatrist, but with my insurance that would be a nightmare. And I’d have to start the whole medication dance all over again! When I was halfway across the parking lot I thought about going back to ask about reducing my dose slowly, but decided I wanted to consult with someone before trying to advocate for myself. I had just utterly failed at advocating for myself and was in no state to do so successfully.

I talked to someone I know who works with adult psych patients and has bipolar himself, and with his wife who has a good amount of medical knowledge – including potential effects of different drugs and what various symptoms might indicate. Together they helped me decide to continue taking my current dose of the Lamictal until I’m able to talk to the APN again. They encouraged me to talk to Wakana about it and have her talk to the APN as well. My friend with bipolar also made an important point: my insurance might not approve the sleep study right away, or in time for our next appointment, or ever. I can’t wait, untreated, while they bathe in red tape (as I have been for my tooth – brief update: I have an appointment for a periodontal consultation and another to get a root canal).

At the very least, I want a better understanding of her thought process. I want her to sit down and look me in the eye and answer my questions until I feel confident in whatever course of action she prescribes. Is that so much to ask? If I have to go off Lamictal, I feel much safer reducing my dose slowly with a plan we’ve come up with together. If possible, I intend to have Fox there with me. He’ll be there for my future scheduled appointments, at least!

Adventures with Psychiatry pt2

So it’s been a few days since I began taking the full 300mg dose of the bupropion. And so far, the patterns that seemed to be emerging before are consistent:

  • Increased irritability. It’s stuck around, but I think I’m starting to get the hang of handling it.
  • Much lower scores on the Burns check list: the highest this week has been a 12, with four different instances of a 9 representing the low. In fact, my weekly average dropped from a 14 to a 10 (technically a 9.8, but close enough).
  • An easier time actually getting going. Four days in a row of paid work (all successfully done) is a good testament to that.

The only difference I have noticed is something I was warned about: if I take the second dose too late, the 6 hour jolt of energy is enough to make it difficult for me to get to sleep. Mostly, this is a problem when I wake up late (ie, 1 or 2pm), rather than the drug acting in some weird way. The other thing I have noticed has been an increase in headaches; but that could simply be attributed to general lack of sleep. In fact, that’s probably what it is; headaches are a fairly common result when I get less than four hours of sleep in a night.

All told, I’m mostly liking the bupropion so far. I’m thinking of doing one more part to this series after a few weeks on the full dose when I’ve gotten a better picture of how it’s affecting me.

Adventures with Psychiatry pt1

Following in Ziya’s lead, I also recently had a psychiatric appointment. I made it the same date as zir appointment, and it was supposed to be for the day after zir appointment. But of course, things happen, and five days later (the 5th), I had an appointment with the same psychiatrist that Ziya had so many problems with the last time.

My appointment thankfully went much smoother, and since I’ve been doing the Burns depression checklist every night for the past three weeks or so, I had a pretty good sense of what my symptoms really are. This made his choice of medication easy: the generic of Wellbutrin (bupropion). This post (and the next few parts) will consequently track how I’m feeling on the medicine as I ramp up to the full dose and beyond.

So far, I’m a little more than halfway through the ramp up period; I have two more days of just one 150mg pill a day, then I progress onto two. And so far, it seems to be helping with my main symptom: the incredibly low energy (as well as the motivational problems that follow from that). Prior to starting it on Wednesday, my typical score on the Burns was in the 17-26 range; basically, the upper end of mild with the occasional break into low moderate. Since I’ve been taking the bupropion, the highest I’ve gone is a 13, and I’ve seen my second 9 in several weeks. So while I may still hit the low end of mild, I’m seeming to stay more towards normal but unhappy.

I feel significantly more energized and capable of actually getting things done. This is a huge improvement.

But I’m also finding myself more susceptible to distractions (for example, people talking near me or Ziya humming a song or thinking aloud). And those distractions are definitely hurting my ability to focus. I’m also finding that, so far, I’ve been becoming more prone to irritability. Little things that didn’t use to bother me are starting to and with an ease I haven’t felt in awhile. It is possible that the latter issue is (at least in part) due to having the energy to actually feel those emotions again. But I’m not sure if the bupropion is the cause of the former, and I’m hesitant to look at the side-effects; I don’t want my brain to get any ideas. I’m hoping that the former will become easier to deal with; I like this new energy far too much to want to try some other random drug.

Maybe things will shift when I start taking the full dose next Tuesday. Part two will probably go up after a few days on that dose.

Into Darkness

Today I brought Mom to outpatient physical therapy (PT) for the first time. She kept asking me to go in with her, but was able to operate the handicapped person’s elevator by herself. Other people opened doors for her. As soon as she entered the place proper, she seemed to forget I was there, trying to figure out whether I should help her, and if so what I should do.

Once Mom was happily at PT, Fox and I went to a relatively nearby movie theater to see Star Trek: Into Darkness. I’m going to try not to give spoilers but I will say there were a lot of explosions. Overall, it was an excellent movie and I’m really looking forward to seeing it again. If I do so in theaters, I’m bringing earplugs.

Anyone watching me during the movie might have thought I hated it, though, and seriously wondered why I didn’t just get up and leave. I spent significant portions of the movie clinging to Fox for dear life – much the same way I clung to a previous significant other when we went to see Silent Hill, a horror movie that quite thoroughly terrified (and traumatized) me. Especially during fight scenes (in Star Trek), I was shaking, looks of panic on my face, holding my head in my hands, my body very tense, insisting that Fox hold me. It was, in short, a very strong anxiety reaction. Even afterward, when I went to the bathroom, I started shaking again and felt like I was on the verge of tears.

Don’t get me wrong, I was very immersed in the movie. The acting, the music, the effects, and an engaging plot all came together to really pull me into the overall experience. I could relate to and empathize with the characters; I cared about their well-being. So my physical responses do make sense with what I was thinking and feeling in response to the movie. They were just taken to what I perceive as an extreme that does not reflect my actual degree of emotional response. Nothing in the movie was particularly terrifying or anxiety provoking; I haven’t been traumatized by it; intellectually I knew I was perfectly safe, sitting in a movie theater being entertained. But the way my body responded, you’d think I was convinced my life was in serious danger.

It was extremely loud in the movie theater and I think (hope) that was a significant contributing factor. That said, I think the metallic timbre of the explosion and especially gunshot sounds was the main trigger for my anxiety response. It’s possible the motion (visual input) might have also played a role. It’s hard to say what role the music played because I wasn’t focusing on it during the most anxiety-provoking scenes, but I did notice that at times it was very intense, with loud rapid high-pitched passages played by the string section of the orchestra (e.g. violins). Again, I think my response was “normal” in terms of its quality, but not its intensity.

I’m pretty sure it’s a side effect of the medications I’m on. One of the “infrequent” side effects listed for Zoloft is hyperesthesia – increased sensitivity in one or more senses. Now that I know that, I can save a lot of time trying to explain my experiences to my next psychiatrist and simply tell zir I have “auditory hyperesthesia.” Additionally, an “infrequent” side effect of BuSpar is noise intolerance. I’m not sure whether that’s the same thing / similar / related, or something completely different. But it’s definitely been affecting me in my daily life. Among other things, it’s harder for me to shop for items I need and make decisions because I can’t tolerate the noise (especially music and advertisements) in a lot of stores.

We went back to the PT place to pick Mom up, getting slightly lost in the process. Fox was geekgasming about the movie and its relationship to classic Star Trek. It’s the kind of thing I love to watch and listen to, but find distracting and irritating when I need to concentrate on driving. Then his mom called; I asked him to put her on speaker phone so he could help set up my GPS and I could be part of the conversation. We stayed on the phone with her for a little while after picking up my mom, who quietly complained to me that she had been waiting for us for over an hour. I think she should have been the one to do this, but I stepped up and politely told Fox’s mom I was enjoying talking to her, but let’s continue this conversation later.

Then there was driving around in circles in traffic, shopping, eating at a somewhat noisy establishment, listening to Mom, trying to express some of my needs to her – such as my need for a day (or two) to myself every week – feeling like she didn’t quite catch my meaning, and trying to cope with a splitting headache. By the time we got home I was furious! I think it’s because here I am struggling with all this shit and she just keeps asking more and more of me and no matter how hard she tries to be nice and considerate and show her support I feel like she just sees me as someone to do shit for her. A servant. Is it my hangup or something about her? I don’t even know! It drives me crazy.

But the point is when we got home I was furious. Rat therapy helped me calm down. Fox ended up doing laundry for all three of us while I took a nap; I’m torn between being very grateful and feeling guilty about “making” him do my mother’s laundry. That just seems to be breaking some kind of unspoken taboo.

Wakana had to cancel both our meetings this week because she’s been sick so I can’t even take my frustrations out on the cymbal receive the support and therapeutic experiences I need from her. (I’ll admit I’m a bit annoyed about that, but I can’t believe she’d take a week off from work unless she had a really good reason to do so. It’s not like you can get paid sick days in private practice.) So I get to drive Mom to and from PT tomorrow (and possibly other errands), but I don’t get to have the professional help I desperately need! It’s not fair!

Please help support my blogging habit by buying products related to Star Trek on Amazon.com; you can even pre-order Star Trek: Into Darkness.