The Drug Talk

No, not those kinds of drugs!  But as a very quick note on THEM, they are (mostly) bad for us and should never take the place of the ones I’m actually going to write about.

Psych-prescribed meds.  Everyone has the same disclaimer when addressing this which should be painfully obvious to us all by now.  Everyone’s body and brain chemistry are (for the most part) different, and what works or doesn’t for one person won’t necessarily have the same effect for another.

Sure, prior to my correct diagnosis, I had taken other types of meds.  Other than anti-depressants that would have the opposite of their intended effect, only one is worth noting.  I was prescribed Xanax, not by a psychiatrist, but by a general practitioner.  That particular drug in my system, with a few other key factors, lead to the most major psychotic episode I’ve had.  Since I could’ve easily died, that’s not good.  Good, though, I guess, that such dramatic impacts eventually lead me to the right person and the right diagnosis.

So I know an anti-depressant of some kind was added to the mix during that first year and eventually scrapped.  But, other than that, my memory is that I’m one of the lucky ones that found the right mix with my doctor either early on or right from the start.

For me, that was Saphris as a mood stabilizer and Klonopin for anxiety.  But I’ll describe how even those were not the same for me as others on them.

You see, I have an inability to swallow pills.  Hospitals and the like sometimes opt to put me through so-called “swallow studies” to have this proven to them.  So, I don’t know and will never know, how much of a factor that was in the choice of drugs for me.

The Saphris, as far as I know, only comes in a sublingual (under the tongue dissolved) form.  The Klonopin, I took as ODT (Orally Disintegrating Tablets).  So that seemed to allow even someone like me an ability to use the assistance of medication.

Yet, it is clear that both drugs, while effective, did not work within me the way they do with others.  The Saphris was originally intended as 10mg at night and another 10mg in the morning.  I know that almost every drug (prescription, over the counter, etc.) seems to warn about “drowsy” effects.  But, for me, even 10mg essentially knocks me out no matter what time of the day or night it is.  We tried 15mg at night and 5mg in the morning and even that I could not do.  So it moved to 20mg at night and remained so for many years.  I’m hopeful that the drugs main desired effect on mood worked.  I’m certain though that the “added benefit” of being a sleep aid worked like a charm.

The other drug, the Klonopin, I am not fully sure the dose had been what it had been from the very beginning.  But at some point, it became a 1mg tab before each meal and 1mg at night before bed.  The thing is, along with other interesting additions to the already discussed lineup (Bipolar II Disorder with Anxiety and Depression) I also suffer from IBSD (Irritable Bowel Syndrome with Diarrhea).  (For some reason, I didn’t even like typing that last word out, but oh well).  Based on what the drug is supposed to do, it doesn’t seem that out of left field to me that it has aided me in my ability to digest food more comfortably.

Those that know about this drug might be thinking DAMN 4mg a day EVERY DAY?  Yep.  Many in the field consider this to be pretty much a maximum allowable dosage.  Others that know even more about this drug will note a couple of other key things to consider.

1st – it is a Schedule IV drug.  But so what?  So is Ativan, Xanax, Valium, etc.  But, yes, it is considered a Narcotic and highly addictive, particularly in the higher dosage I was taking.  Most psychiatrists in today’s environment would opt to only prescribe this drug (especially at those levels) as a short-term solution.  (We’ll get to that).

Whether it was more because the drug is addictive or because I have an addictive personality, I became addicted.  And, frankly, I don’t care.  I don’t need to know the cause or whatever.

That is because taking so much for so long I developed a tolerance for it.  Sure, that likely means that its efficacy has been reduced over time.  But, more importantly, in my opinion, it also means that the long-term “concerns” that a healthcare professional may have about dose levels, frequency and duration are moot.

I have moved beyond such concerns and even dealt with the pure nastiness of withdrawal.  Frankly, even if they could somehow know with certainty (because they really can’t) that it doesn’t quell my anxiety anymore but still counteracts the IBSD, I’d still want to take it.  I don’t think that is the case, though.

So I took 20mg of Saphris at night as a mood stabilizer and Klonopin 1mg 4 times daily from 2010-2015.  Almost.  Someone else whom I may write about later cut the Saphris dose in half to 10mg a day at night.  I’m not exactly sure when that started.

Then about a year ago, a single event in my life had an impact on many aspects of it to this day.  Again, perhaps details for a later blog post.  Suffice it to say, eventually, I had to adjust my meds not by choice.

Now, I no longer have standard insurance, I am on Medicaid.  For obvious financial reasons, Medicaid does not cover either of the prescriptions I had for so many years.  The Saphris is gone completely.  To replace it, Seroquel was added.  The Klonopin technically remained.  Both are only acceptable to Medicaid in generic pill form, though.  So they have to be crushed as finely as possible and taken with something, usually apple sauce.  Unfortunately for me, the main doctor overseeing my psych care opted to cut my Clonazepam dose in half.  I have noticed an impact on my anxiety levels as well as my digestive issues.

We have also recently added a small dose (I’m not even really sure – I think just 50mg) of Trazodone to the mix.  While listed as a sedative and anti-depressant, I think the current small dose at night is being used mostly as a sleep aid.  If it also has other positive impacts such as lessening my depression then great.  But I was having trouble with sleep with just the Seroquel, so it is what it is.

This post is already longer than most people’s attention spans at 1100 words and counting.  I did not even address things I could, such as certain issues I had with the Saphris like subconscious actions taken by me similar to “sleep-walking.”  But, truth be told, while maybe not as dramatic, I experienced this in the past with Ambien and other things and had issues sleep-walking as a child.

The length of this post I felt was necessary because while drugs are not the ONLY answer, they ARE part of the necessary discussion.  I get the sense that if Psychiatrists did not have such obvious financial incentives to keep patients on drugs and coming back for visits that they may wish for a future for us where drugs are no longer needed.  Such a blissful utopian vision of our future seems to come more often from those not prescribing the drugs – such as psychologists, therapists, social workers, etc.  All I know is it has not been a full 7 years for me, yet, and I don’t think I am anywhere near that point now.

So the last part of this I feel I need to address is those of us going off our meds and/or never taking them in the first place.  We all got a pretty good version of our mental kinship in Bradley Cooper’s portrayal in “Silver Linings’ Playbook.”  But some important distinctions.  First, his character has Bipolar I and not II like me.  So, you are not likely to see me throw a book through the window of my parent’s attic just because I’m pissed at Ernest Hemingway’s decision on how to end the book.  Also, more importantly, it is JUST a movie and it is JUST a character.  I give credit to David O. Russell and team for a good narrative, though.

But one of the things addressed but almost as an aside is the character’s personal decision that he no longer needs to take medication.  This is a horrible decision, even for a fictional character.  However, it is helped, albeit slightly, that he wishes to supplant it with things like exercise and healthy eating, supposedly.  We see him running sometimes, so there’s that.  The only real meal we see him eat (because did he eat any of what his friend and friend’s wife made?) is a bowl of cereal.  Other than that are his mom’s Sunday football snacks, which likely aren’t part of a healthy diet.  Point is, diet and exercise can be great SUPPLEMENTS to a path to a brighter future for us.  But they are NOT a substitute for it.

I knew someone like us who was under the misguided notion that they didn’t need medication.  They also felt like they didn’t need therapy or anything else, really, and it is sad.  It is certainly true that bipolar is a spectrum disorder and those on polar opposite ends of the spectrum are likely drastically different.  I probably should have stated that sooner, but most of us dealing with this already know this.

So, this should also be abundantly clear.  I am not a doctor or other type of health professional.  In fact, truth be told, I’ll be the first to say that science, in general, has always been one of the weakest parts of my intellect and understanding.  I am merely a patient.  But now I am choosing to also be a more public advocate for positive change and awareness.  I am not now, and will not ever, be giving out medical advice as if I am in a position to do so.

That being said, though, it is clear to me that if not everyone, mostly everyone who suffers in this way ought to have medication management as part of their plan for progress.  We hear the term “getting the formula/mix right” all the time.  Sometimes initial attempts either don’t work and need to be altered or do work at the time and then don’t seem to anymore for whatever reason.

1775 words later, I’ll step down from my soapbox now.  Anyone that knew me prior to 2010 who lost touch and then saw this post would be confused, to say the least.  I was always pretty adamant about not wanting to take drugs, especially not long-term mind-altering psych drugs.  I really didn’t even want to take Tylenol unless I felt it was ultimately necessary.  I guess that changed for me following my correct diagnosis and my pure faith and trust I put in the man who gave it to me and laid out a plan that included medication.  I don’t know now if this means I am destined to be “on something” for the rest of my life or not.  I’ve learned better than to think I have any ability to plan that far into the future, though.

So although maybe not the main point made in this post, but hopefully seen in it is the importance of medication management.  That point, while directed at fellow patients like me should really be hammered home to everyone else that may be in our lives in some way.  If someone you know like me has either chosen to never take anything or used to have medication management and now chooses to go without, be very watchful if you can.  I can’t and won’t give you medical or perhaps any legal advice of what to do in such a case.  However, for your sake, theirs and anyone else around them, I hope they can be lead to a path that uses all tools available to them.  This does not, however, mean just shove a pill down our throats and call it a day.  As previously stated, the right mix is essential for future progress and finding such a delicate balance is such a precise science and art that I will not ever claim to be able to properly explain it.

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