Prescription by Dr. Ziya

WARNING: This is a (potentially risky) decision I have made for myself. It does not take the place of medical advice by a qualified mental health professional.

Today I had a conversation with 2 friends that confirmed a few thoughts I’ve been having:

  1. I will not go back to Psychiatrist B under any circumstances.
  2. I need to stop taking my current medications.
  3. Listening to music daily will improve my mood and possibly also my brain’s functioning.
  4. I need to be honest and talk about my disorder more often.

Psychiatrist B didn’t take my thoughts about harming myself and even committing suicide seriously, despite the fact that the drug he was prescribing me can cause such thoughts. He also needed assurance from me that it was worth gaining weight to have the possibility of recovering from a disabling disorder; that my mental health is more important than my appearance! (He also made the typical assumption that fat = ugly, which I have no desire to perpetuate.) As one of my friends put it, there’s a significant risk that if I keep going to this doctor, his problems will have a negative impact on my well-being. It also certainly doesn’t bode well that the “clinic” hasn’t made any attempts to contact me about rescheduling the follow-up appointment I canceled nearly a month ago.

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long-white-pillsRegarding my medications, the bottom line is: they’re not providing the relief I need. Regardless of whether they’re helping “somewhat,” the fact remains that they are not helping enough. And there’s the possibility that they are causing or contributing to some of my more disturbing symptoms. I haven’t been taking them for the past few days and to be honest it’s been a very rocky road. At this point I’m unsure whether I should hold my ground until they’re completely out of my system – or start taking them again in smaller and smaller doses until it’s safer to stop completely (or I run out). Everyone seems to think it’s better to wean myself off them slowly, but I’m concerned about what might happen if my levels spike again after being so low for the past couple days. It’s also a lot easier to just not take them than to try to figure out what doses would be appropriate and remember to take them regularly.

It’s recently come to my attention that I’ve been doing my readers and the companies that make certain brand-name drugs a disservice. I’ve been taking generic “equivalents” of Zoloft and BuSpar (sertraline HCl and buspirone HCl, respectively); prior to beginning this blog I was taking bupropion in place of Wellbutrin. Anyone reading my blog would think I was taking the brand-name drugs and that they were causing or contributing to the undesirable effects I’ve described. This is most certainly not the case. In Generic Versus Brand: What’s In That Pill? Part 1, Disorderly Chickadee sheds light on how generic formulations of brand-name drugs often are not as effective as the brand-name version; in some cases the difference in functioning one experiences can be “like a brain transplant.”

Most notably, there is a huge difference between Wellbutrin and generic bupropion, enough so that one generic formulation was recalled. It’s not the one I was taking, but it still raises some suspicion that I might have done a lot better if I’d taken actual Wellbutrin instead. I’m also wondering whether brand-name Zoloft and BuSpar would be more effective (and safer!) than the generic sertraline HCl and buspirone HCl I’ve been taking.

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bob marleyI don’t usually listen to music, unless you count the background stuff in Oblivion – which either alerts me to the presence of enemies or puts me to sleep. Yesterday I had the very pleasant experience of listening to some of the more upbeat tracks on a CD of instrumental Celtic music. The bass and percussion were very grounding and calming, helping me to feel safe … while the foregound instruments were lively and played complex melodies in compound meter.

MeterI had a lot of fun listening to the music, felt calmer and happier, and thought it was having a desirable effect on my brain. It required enough of my attention that there was little to no room left for disturbing thoughts, and it seemed to help organize my brain. My hypothesis is that the regular firing of neurons involved in listening to the music (which are located throughout the brain) may have provided the stimulation, serotonin, dopamine, and information pathways my brain needed to function more effectively. I might need to experiment a bit to figure out how many times per day and for how long I should listen to music, as well as what types of music will provide the best effects … but overall I’m optimistic that listening to music regularly will help – a lot!

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meep-and-lolz-cropFinally, it felt really good to be honest about what I’ve been struggling with and have my friends accept my reality. They listened and shared their own related experiences, which helped me feel less alone in my struggles. They offered advice – some of which I found helpful – but more importantly demonstrated that they support me in my efforts to take care of myself. “You know you can call any of us any time you need to talk, right?” Yeah, I do; I just need a reminder that there are people who want me to reach out to them in my times of greatest need, when I feel like I’d be doing everyone a favor if I just ceased to exist.

Finding the Right Medication – Part Three

(Part One | Part Two)

I have been feeling much, much better since I stopped taking the Wellbutrin. I feel calmer, infinitely less angry. I even feel happy at times for no reason! Part of it is that I was able to do something extremely simple to alleviate my symptoms – all I had to do was not do something I had found difficult, anyway! Part of it is that, while the initial energy boost from the Wellbutrin felt good, the medication was making me irritable.

On Tuesday, December 11th I had my first appointment with a new psychiatrist, Psychiatrist B. He accepts my insurance, so that appointment only cost me $25 – a tenth of what I’d paid Psychiatrist A!

As we talked, I felt like Psychiatrist B was listening to me and really understood why I had decided to change doctors. He said that, from what I was telling him, Wellbutrin might not be the right medication for me. He theorized that, if nothing else, cutting the slow-release pills in half caused too much of the medication to enter my system too quickly, so I kept oscillating between overdose and withdrawal. That is what caused the intense feelings of rage.

Psychiatrist B gave me a prescription to get my thyroid checked. He said it was up to me whether I wanted to try a different antidepressant medication, or wait until I knew whether my thyroid was involved in my symptoms before determining a course of treatment.

Based on the assumption that I am still getting some benefit from the Wellbutrin, even though the side effects have basically ceased, I decided I would rather not risk “sobering up” to find myself with severe depression and no medication in my system to keep me from hitting rock bottom. That could literally be fatal.

So Psychiatrist B wrote me a prescription for Zoloft, a selective serotonin reuptake inhibitor (SSRI) which he called his “favorite.” I probably should have asked him why it was his favorite, but I didn’t. And he gave me very specific instructions: I’m supposed to take half a pill each morning for six days, and then start taking a whole pill once a day, in the morning. If a whole pill is too much I should go back to taking half, but stay with it consistently for at least a month.

You can’t get much clearer than that!

I decided to create this blog late Tuesday night, so I was not able to wake up early enough Wednesday morning to feel comfortable starting with the Zoloft. I’ve spent Wednesday largely focused on setting up the blog, including the About Me and Breaking the Silence pages, as well as this very long, 3-part post. Thursday will be my first time taking the new medication and I’ll admit I’m a bit wary of it. There’s really no way to know what effect it will have on my brain, the rest of my body, and my ability to function in society – until I take it!

Finding the Right Medication – Part Two

(continued from Part One)

I called Psychiatrist A near the end of October intending to increase my dose to 250 mg per day. Instead, he prescribed Lexapro “to give [me] a boost.” He asked what my Wellbutrin dose was so I said 200 mg; he did not ask me whether that was in one or two doses. So, when I picked up my new prescription, I had Lexapro in 10 mg pills and Wellbutrin in 200 mg pills.

I had no idea when to take what, so I looked online and found out that people tend to take Lexapro at night because it makes them feel drowsy. I followed suit that night and, thinking it was what Psychiatrist A intended, took 200 mg of Wellbutrin the next morning. My pupils dilated and I developed a headache and muscle twitches.

By that night I thought I was doing okay, though, so I took a second dose of the Lexapro. When I turned off the light and lay down to sleep I had the most awesome visual hallucinations. There were beautiful designs in vivid colors, some of which were more abstract and some that looked like vines and leaves, in a kind of stained glass style with white outlines. They filled my entire range of vision and moved slowly as one unit like the surface of a lake. I joyfully went to my mom – the hallucinations stopped as soon as I turned on the light – and told her what was happening. She said I was high on LSD and to go back to bed. I followed her advice and happily enjoyed the show until I fell asleep.

The next few days were not nearly as fun. My muscles kept jerking – to the point where a spasm might cause me to sit up in bed! – and my ears were ringing loudly and constantly and I had a horrible headache that would not go away no matter what I did! I felt cold and hot at the same time. I was terrified. I couldn’t get in touch with Psychiatrist A and when he finally called me back he said my symptoms were due to anxiety. He said if I was really so concerned I could stop taking the Lexapro. He instructed me to cut the Wellbutrin pills in half so I could take 100 mg twice a day again. I followed his instructions but was very upset by his attitude because I felt like he wasn’t taking me or my symptoms seriously.

Over time my drug-induced symptoms ceased, though a month and a half later I still have occasional muscle twitches that did not occur before the Lexapro and Wellbutrin overdose. I continued taking the Wellbutrin, 100 mg twice a day, by cutting the 200 mg pills in half. But I found it very hard to take the doses at the same times every day, and I found I often would forget to take the second dose. I was also becoming more and more angry. When I made a mistake I would act on the compulsion to hurt myself – the physical pain helped me calm down. I thought, “I should just kill myself.” I knew I was overreacting to my frustrations and others’ reasonable expressions of annoyance, but that did not reduce the intensity of my emotions at all! Actually, sometimes the knowledge made me feel worse because I beat myself up for being “so immature.”

On Monday December 3rd I was so angry a cold calm clarity was starting to come over me, to the point where I almost felt I could commit horrible violence and not feel bad about it at all. I decided what I wanted more than anything was to have an entire room full of things I could completely and utterly destroy. I wanted to feel my whole body moving through that space, have the satisfaction of watching objects shatter, make the most atrocious mess humanly possible … and when I was done, just walk away. No consequences, not even concerned, frightened, or angry looks from other people. I felt like it was a metaphor for what people have gotten away with doing to me.

On Tuesday December 4th my professor was talking about people with depression and suicidal ideation. I was half tempted to raise my hand and give an insider’s perspective – that’s actually part of what inspired me to create this blog. After class I talked to her and she offered me a lot of encouragement. She got me talking about music and the next thing I knew I was smiling, laughing, and thinking about my future.

On Wednesday December 5th I completely ignored my music therapy session and my music therapist. I shut out the whole world.

I finally returned my music therapist’s calls on Thursday December 6th. My music therapist suggested that the intense rage I was feeling might be a side effect of the Wellbutrin. I had not taken any of the Wellbutrin since my first dose on Wednesday, so I decided to just stop taking it altogether. Sure enough, on Friday, Psychiatrist A confirmed that I should stop taking the Wellbutrin!

(to be continued)

Finding the Right Medication – Part One

It is hard to say how long I have been severely depressed: sad, with very low frustration tolerance, and lethargic most of the time. But by mid-late July 2012, I was frightened enough by my suicidal thoughts and compulsion to hurt myself that I decided it was time to start taking medication for my depression. My music therapist agreed with me and recommended Psychiatrist A.

Psychiatrist A does not accept insurance, so I had to pay him $250 in cash – and that was a discounted rate! Based on our conversation, he suggested that I try Wellbutrin. He gave me a one-week supply of 150 mg extended-release pills and a one-week supply of 300 mg extended-release pills.

During the first week, taking 150 mg of Wellbutrin each day, I felt as though nearly all of my symptoms were significantly improved! At times it almost felt like I had too much energy! – but it was a very welcome change from what I had become accustomed to. After a while, I started to settle down. I still felt much better, but I was no longer bouncing off the walls.

During the second week, I started taking 300 mg of Wellbutrin each day. I had a panic attack on the first day, but attributed it to the fact that I had taken that day’s dose a few hours less than 24 hours after the previous day’s dose, so I probably had too much of the medication in my system. Sure enough, I responded better to the medication in following days when I took the doses about 24 hours apart. I felt more motivated, had the energy to do what I wanted, and was in a better mood.

Except that each night I had horrible chest pains. I tried to keep calm and tell myself I was okay, but I couldn’t sleep. I tried to find information about what it might be online, but the more I read the more convinced I became that there was something wrong with my heart. I was having a heart attack. There was a blood clot in one of my essential arteries. The medication was causing the blood vessels in my chest to constrict and spasm. Whatever! Each night I was taking my life into my hands; I had finally decided not to kill myself but I was convinced I would probably still die.

Finally, after nearly a week of this, I had a night were I could not sleep, so I decided to call my mom. She picked me up and, since it was the middle of the night, took me to the emergency room – despite her conviction that I should wait until morning to go to a regular medical facility. Sure enough, by the time we actually got to the hospital, I was starting to feel better. All the tests they did came out completely normal; I discovered my heart and I are actually in excellent health! So healthy, in fact, that I managed not to have a real heart attack when I received the hospital bill …

I called Psychiatrist A about reducing my dose and we agreed that it would be safest to take me back to 200 mg per day. He told me to take a 100 mg slow-release pill twice each day. Without more specific instructions, I decided to take the pills 12 hours apart – which, due to my sleep cycle, tended to mean taking the second dose at midnight or later. It took about four hours for me to wind down after the second dose, so I basically became nocturnal.

A friend who also takes two doses of Wellbutrin each day told me that he takes them about 6 hours apart, and I should never take the second dose after 8pm. I tried following his advice, but it wasn’t always easy.

Over the next couple of months I often found myself angry, and while my depression wasn’t as bad as it had been I was unsatisfied with the effects of the medication. The depression was still interfering significantly with my ability to enjoy myself and take advantage of career-related opportunities that involved interacting with people. My self-esteem was too low for me to feel comfortable trying to make a good first impression, and my energy level and mood were also too low. I didn’t want a potential employer to see me on the verge of tears!

(to be continued)