Thursday, December 1, 2011

Review and Update

The last few months have brought a long of different meds into and out of my life.  Because I haven't done a full list with update on everything I've ever taken for a very long time and I need to demonstrate something to my pyschologist I am going to post that below the current list.  The current list is in flux because I've been incredibly unstable after 2 years of stability, but  as of today this is it:
Seroquel XR 650 mg
Lithium (Eskalith) 1/2 of a 450 mg tablet (recovering from toxicity and on 1/3rd dose while stabilizing mood)
Emsam (MAOI patch) 9 mg and 12 mg alternating days
Klonopin 2 mg at bedtime, 1 mg twice daily as needed
Amitiza 24 mcg twice daily for constipation
Nexium (switching to Xanax 150 per pulmnologist this week)
Amiloride 10 mg (for diabetes insipidus)
Synthroid 88 mcg
Nuvigil 225 (on hold because I'm on disability and very sensitive to agitation right now)
Singulair 10 mg (asthma)
Alvesco (inhaler for ashtma twice daily)
Probiotic 1 daily
Latuda, new antipsychotic.  Tritrating dose up currently at 20 which is half the usual starting dose.

So, I am currently at 19 pills/patches/puffs per day.  Still way down from the record of 33 although it feels like I'm taking a lot right now.

PRNs:
Vistaril 50-150 mg as needed
Valium up to 10 mg as needed for sleep (no longer working because of tolerance)
Lunesta 3 mg for insomnia
Miralax
Colace (up to 500 mg)
Senna
Ventolin inhaler (up to 4 times daily for asthma)
Albuterol nebulalizer (up to 4 times daily for ashtma)

Should be taking but not for various reasons (mainly constipation):
multivitamin
vitamin B complex


As far as my history goes, it is this:

Thursday, May 3, 2007

The Comprehensive Master of Irony Med Experience

This list includes the meds I have taken in the years of my battle against treatment resistant bipolar I. My story is told in my blog. (Updated 8/10/09)

Xanax (fall 1997): sent to doctor by psychologist for antidepressants, given this instead. Slept for 3 solid days after one dose and refused to take it again.

Paxil (fall 1997): tremors, nausea, vomiting, diarrhea from first pill; rash by 3rd dose

Zoloft (fall 1997): no response; increased insomnia (now known as hypomania)

Remeron (winter 1998): fairly good response; new medication and doctor not sure how to dose so dose limited to 30 mg; significant sedation impaired ability to function well

Elavil (spring 1998): attempted switch due to insurance; returned to Remeron/Zoloft quickly due to increased depression and risks after being severely depressed recently

Remeron and Zoloft combined (spring 1998): good response and awake appropriate amount of time. Tolerated well until graduate school started in fall 1998. Unable to function with remaining sedation with required hours of study, labs, and lecture.

Zoloft (fall 1998): Depression not well controlled. Increased insomnia. Constant, debilitating diarrhea.

Zoloft and Trazodone (fall 1998): sleep improved somewhat but on dose of trazodone needed overly sedated.

Zoloft (fall 1998/early winter 1999): same side effects. Repeatedly asking to be allowed to taper off meds. Psychiatrist opposed due to severity of depressive episode and repeated episodes.

Nothing (winter 1999-spring 1999): Took self off meds without MD approval. Functioned well for several months until insomnia returned.

Ambien (spring 1999-fall 1999): Used as needed at a very low dose. Rarely used during the summer and early fall. Dose increased twice in October 1999.

Remeron (fall 1999-summer 2001): Taken at higher dose with almost no side effects. Very effective until winter 2001 when severe depression began; unable to see doctor or change meds due to insurance issues.

Wellbutrin (summer-early fall 2001): Unable to eat anything but chicken soup and mashed potatoes. Twenty pound weight loss in 6 weeks with constant nausea. No effect on depression even at higher doses.

Effexor (fall-winter 2001-2002): Loved this med. Sadly it cheated on me. Each dose I would get a response that seemed hopeful, then after 3 weeks it would fizzle out. Again, typical bipolar, but nobody around me knew it. On the maximum dose I was begging to die, which led to seeing the first psychiatrist who had an opening. (never do this; she was terrible)

Celexa (winter 2002-summer 2002): See Effexor. Except this time I kept trying to pretend I was all better because I thought I should be. I wound up very suicidal that time as well.

Ativan (winter 2002-Nov. 2009): Prescribed after an enormous panic attack and 3 solid days of crying this made more difference to me than anything had in years. As of June 2007 trying to switch to Atarax for increased control of anxiety without sedation/narcotics. Successful by July 2007; ativan for PRN use when extremely anxious or fast response needed or for insomnia.  Discontinued while switching to Emsam due to developing tolerance.

Lithium (spring 2002-winter 2006, spring 2007-now): Initially prescribed to boost the effects of antidepressants, the main result was to make it more obvious that I was cycling. Caused major (38% of body weight) weight gain. Required high dose and high levels but worked well after I got used to the side effects. Developed toxicity in winter/spring 2006. Unable to find effective dose that did not include symptoms of toxicity after that time so use discontinued. Resumed use when it became apparent that cycling is mostly controlled by this agent. Currently taking very low dose and trying to inch up as needed, with blood level just below what is considered low therapeutic. Side effects include thirst, constant need to pee, possible kidney stones, heat sensitivity, fatigue, very dry skin, and initially some pants wetting until timing was figured out. Side effects of toxicity much worse; see main blog in spring 2006.  Second toxicity in Nov. 2011 requiring hospitalization due to hallucinations and need for fluids.

Prozac (several horrible weeks in the summer of 2002): Placed on this by horrible psychiatrist who was basically giving up on me when I did not respond to celexa/lithium combination. At this point she'd admitted I was probably bipolar, then gave me something likely to make me manic. It made me terribly manic and so unable to think it took several weeks to be able to decide to stop the med and get help elsewhere.

Depakote (fall 2002-present): Began as first step in clinical trial determining efficacy of depakote/lithium/lamictal cocktail for rapid-cyclers. Initially on CR version with no success achieving therapeutic levels until switched to high dose ER version as a last resort. Side effects include serious fatigue, constantly dilated pupils with light sensitivity, heat sensivity that limits summer activities, constipation, weight gain, sweating, increased suspectibility to respiratory infections, and more thirst. Summer 2007 began taking very high dose (3000 mg; frequent labs indicate levels do not stay normalized). January of 2009 began tapering. Last dose taken in July 2009.

Placebo (winter 2003): This one isn't for sure but my reaction indicated probably placebo. I had no side effects for one thing. Easiest drug ever. I had an initial reaction that seemed good but after a week or so was determined to probably be cycling. I became suicidal and was nearly hospitalized during this time.

Lamictal (winter 2003-spring 2004; spring 2007-current): At first seemed great. Some headaches at first. Eventually I was on a very high dose. And then the daily vomiting started. After trying many things to stop the vomiting, including several months to taking 8 chewables instead of 1 or 2 adult pills it had to be stopped. The guidelines for use with Depakote now suggest limiting the dose to much lower than I took. I am currently re-trying it and have thrown up (only?) twice in 5 weeks. I am staying at a much, much lower dose this time and have noticed it can easily make me swing into mania. )6/04/07: I have been dealing with a very itchy, ugly rash all over my face for the last week. Lamictal is on hold and will re-start at half the initial dose and hopefully work back to where I have been. Unless I'm allergic in which case life just isn't fair, again. I've gotten 2 new side effect meds out of this. 06/16/07 Officially declared allergic and will not be given Lamictal again due to high risk.

Keppra (summer 2003): trialed as an additional mood stabilizer for several days. I don't remember specifically how but I felt "funny" on it and wanted off. No response noted in that time although I didn't give it much chance; I didn't realize yet how unlikely it was for anything to work for me.

Geodon (winter 2004-summer 2004): initiated with rapid dose increases due to very sudden and severe depression. Initially caused sedation and blurry vision. Also caused what I called the "zombie look" as I had no visible affect, ever. Patient's families inquired whether I was on drugs. After a few months began having strange, uncontrolled oral movements (tongue thrusting in and out of lips). That hurt because if I tried to control it my tongue rubbed on the inside of my teeth. Due to this and the onset of incontinence at night and then at work med was discontinued. It was effective while I took it, but not worth the side effects I developed.

Abilify (winter 2004):  It was added to Geodon to hopefully replace it when it didn't work quickly enough. My doctor suspected I would be sensitive and started me at something like 1/8th of the normal dose. Within a few days I was having episodes of falling. I would be standing still and then fall over. After seriously bruising/nearly fracturing my arm, having my vision become even more blurry and causing me to see double, I spent a fun night in the ER only to learn it would take weeks to clear from my body. In the meantime I developed akasthesia, a constant need to be in motion. Not needed on top of a mixed episode. It took 6 weeks for my vision to be functional enough to work and about a month before I could safely drive. A few days of this medication was enough to last forever.

Remeron(summer 2003-summer 2004): Resumed treatment with old favorite antidepressant at higher dose and with mood stabilizers. Very effective. Ultimately had to stop because it contributed to hypertension and edema (see Risperdal).

Provigil (winter 2004-2009? whenever Nuvigil came out): Added to decrease morning sedation so that work was a bit easier. Had to learn to alter dosing according to manic symptoms (can't take when manic) or depression. Dosing also changes with time of year (more in winter). I love and rely upon this medication. It is very frustrating though because I use it for something it is not approved for and my insurance pays only a smart portion, and it only pays that after my doctor has an annual "discussion" with my case manager. This year I was fortunate enough to have a psychiatrist reviewing my case. Once it took 5 appeals to get it covered. Stopped in 09/07 due to manic episode. Dec. 2007 trialing very low dose to prepare for return to work.

Nuvigil (2000?-present) same purpose as Provigil but with extended release so that it is much more effective with concentration issues.  Seems to work better at helping me wake up easily and early enough to work full-time.

Risperdal (spring 2004): trialed at low dose. Good response. Several days after increasing to bare minimal effective dose and really liking results noticed both legs were hugely swollen. The next day my blood pressure went up to as high as 194/100. I wound up in the ER again. Over the next few days with diuretics I lost 20 some pounds of fluid. It took several months to figure out that Remeron was further adding to the edema. I then had to take blood pressure medication for about a year to control that.

Effexor (summer 2004): trialed with mood stabilizers. I don't remember details, just that it didn't last long. Possibly we tried to replace remeron with this?

Imipramine (Oct. 2005-Nov. 2009): given as last resort antidepressant and worked better than all others had before. Dose has needed adjustments from time to time secondary to mania and depressive sx. Trialed d/c in Oct. 2007 which was unsuccessful. By 08/09 had increased to 90 mgs and unable to tolerate more but still have depression sx.

Risperdal (spring 2006): trialed again hoping it would not cause edema and hypertension. Unfortunately hope only lasted about 4 days.

Sonata (summer 2006): worked well but insurance refused to cover

Lunesta (summer 2006): see Sonata.  However, began using in 2011 as a PRN sleep medication.1/4 people has a genetic ability to taste this stuff.  I am one of them.  I do not like to take it because it leaves a bitter taste for hours.  However, it is relatively effective.

Rozeram (summer 2006): supposedly would cause gentle sleep with few side effects. I woke up extraordinarily groggy and unable to see. This was because my whole face was swollen and I had a huge rash. Cross that one off.

Ambien CR (summer 2006): Improved my life immensely because at a high dose I finally got some sleep after about 2 months. Eventually was too sedating as my episode dissipated. High on my life of things I'd take again though if an episode is totally out of control.

Trileptal (winter 2006-2007): attempted to replace lithium. Unable to tolerate constant sedation even at very low doses. Did not control cycling.

Atarax (June 2007-June 2008): using low dose three times daily to attempt to better control anxiety. Stopped use when discovered that the zyrtec needed for seasonal allergies is a derivative of atarax and I was experienceing serious fatigue as a result. Ativan is back in. Atarax used when PRN need is not as severe.

Risperdal (Sept. 2007): attempted to use low dose for short period to stop mania. Did not control mania and by day 10 started to have leg edema. Unable to increase dose safely so stopped.

Seroquel (Sept. 2007-August 2008): tolerated well at 650 mg and able to reduce to 600 mg in spring of 2008. Stopped to change to new version of Seroquel.

Seroquel XR (August 2008-present): able to tolerate at varied doses with far fewer side effects and less sedation than standard Seroquel. Has provided pretty solid stability since starting it, with a few milder depressive episodes. Dose was 300 mg until starting Emsam which is activating.  At that time dose increased to 600 mg and has varied from 600-900 mg depending on needs.  Typically between 650-750 as tolerated.

Fish Oil (August 2009): Trialing to hopefully boost antidepressant.  Some effects but nothing huge.

Emsam (Nov. 2009-current) MAOI patch for depression.  Requires some dietary restrictions especially with current dose being very high.  After learning simple care strategies including rotating sites, avoiding hot baths with patch on because it increases the release and removing any patch that starts to itch my skin issues disappeared.  If I break out slightly a tiny dab of diaper ointment (Balmex) works well.  I kept a notebook for the first 6-12 months to track sites and alternated left side of body to right, arms to trunk.  Now I use only arms and chest in different locations and with a sequence only i can follow.

Klonopin (Nov. 2009-current) Began using this in the hospital while acclimating to Emsam.  Much more effective than ativan.  2 mg used at night, 1 mg used most days in the morning, 1 mg PRN and not used often.  At times PRNs are used in combination such as severe insomnia or panic attacks.  More of this is used when more asthma meds are needed as they are activating.

Vistaril (Nov. 2009-current): 50-150 mgs PRN for anxiety.  If anxiety is severe alternate half doses of klonopin with 50 mgs of Vistaril every 2 hours.  Rarely need this but it does help.

Zyprexa (Sept. 2011)-taken as first a 5 mg pulse, then 10 mg pulse in an attempt to decrease agitation from akasthesia believed to be related to medications given during surgery in 8/2011.  Ineffective and discontinued while hospitalized at about 1 week.  Tolerated well.

Neurontin (Sept. 2011-October 2011)-used to treat akasthesia and agitation from this.  Had many side effects including double vision, paranoia, sedation, agitation, and was sensitive to doses, requiring very low dose to prevent sending people emails that said xhlkdjfsodifjs or that were not for them, or to let me drive safely.  The was paired with Cogentin (Sept. 2011-Nov. 2011) which helps decrease the motor activity of akasthesia.  While these sort of were for side effects akasthesia is too severe to qualify as a side effect in my book.   Cogentin was harmless.

Latuda (started 11/11)-new antipsychotic that after less than a week is improving my sleep and seems to have mood stabilizing abilities.  Will be adjusting to this for a while.

*************************************************************************************




Meds Taken Due to Side Effects
Inderal: used to decrease hand tremors from lithium. I initially resisted this drug because at the time I naively thought I could limit how much medication I could take. When the doctor insisted I try it because my tremors were so bad I was very glad to have it. I think I took this for about 3 years and then weaned myself off for some reason. By then I was so used to tremors they were not an issue.
Lasix: used to get off the extra fluid from the Risperdal experience. Not a good mix with lithium so originally given as one pill, then after several months of serious swelling my psychiatrist gave me several more to use at my discretion.
Toprol XL: I took it about a year and my blood pressure problems went away. I discovered this during the time I was off meds in 2006 and just never started it again (with the doctor's ok of course)
Hydrochlorothiazide: A diuretic that never worked very well but which was safer for my kidneys than Lasix. I took this routinely for a few months trying to get the fluid off as my blood pressure came down.
Scopolamine: A patch stuck behind the ear to help with the nausea I experienced with the undiagnosed lithium toxicity. I think it helped some. If my memory, which is hazy for that period, is correct, it allowed me to eat certain foods (tuna, baked potatoes, certain vegetables, fish). It also made my mouth as dry as I can imagine is possible, so I lived with a sour sucker in my mouth.
Prevacid Dissolvable: Another attempted treatment for my "ulcers" which may or may not have co-existed with the lithium mess
Prevacid Ulcer Pack: Combination of Prevacid and very high doses of amoxicillan and another antibiotic (Biaxin), which tasted terrible. It was 8 extra pills per day, and it may have helped the ulcers, assuming I had some, but it was quite hard on the rest of the digestive tract. They really should add Immodium to those packs. I believe that was supposed to be a month long treatment but I only lasted about 3 weeks.
Phenergan: I've had to take this twice thanks to psychotropics. Once to stop the vomiting from Wellbutrin, and once to stop the vomiting during the lithium toxicity. I can't ever take it again though because it apparently made me hallucinate. I kept having weird experiences on it, and days later discovered a sentence in it's description "May cause hallucinations". I'm sure I'm more susceptible to this given the bipolar thing, and hallucations turn out to be scary.
Synthroid: Lithium is hard on the thyroid. Months of overdosing on lithium is really hard on the thyroid. They used to give me hope that I would maybe regain thyroid function but it has been a year and nobody says that anymore so I guess I simply have hypothyroidism now forever. That's ok though in a way because thyroid hormone sometimes helps treat bipolar. Added Dec. 2007: I learned the hard way that thyroid levels being off can cause major symptoms for me. After only a few days of increased meds I felt a world better.
Atarax: Antihistamine used to treat the Lamictal rash. Essentially knocked out a week of my life. Potentially useful as a calming agent/sleep med during my next major mixed episode.  This is related to the Vistaril that I've been using since 2009.
Steroid Cream: The thing that finally made my face quit itching and breaking out.
Colace and Miralax: I've tried natural treatments for constipation as long as possible but finally am taking too many psychotropics.  Now that Amitiza exists these are PRN.
Senna: see colace and miralax
Probiotics: attempt to maintain bowel health and activity
Amelioride: diuretic that controls the loss of electrolytes as my body rapidly pushes fluids through thanks to the diabetes insipidus I have from lithium use.
Flaxseed Oil: to help with constipation and possibly depression.
Nexium: used to treat reflux which became significantly worse after beginning Seroquel and again with dose increase.  Changing to Xantac 150 in 2011 per pulmonologist.
Benadryl: used while inpatient psych Sept. 2011 as an attempt to decrease agitation.  Worked for a while and then caused increased agitation.
Mirena IUD: inserted in 8/2011 to help regulate cycles which were out of control due to lack of ovulation, probably from too many years of medications that are harmful to female hormones.

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