Tuesday, September 11, 2012

Lamictal, Abilify, And Direct Sunlight -- They're Not Kidding

The little sheet they gave me with my Abilify scrip warns against direct sunlight.  Lamictal, as we know, can really screw with your skin.  Combine those with an outdoor baseball game and you have ... well ... screwed up skin.

I attended a baseball game three weeks ago.  In spite of the 60 SPF sunblock I put on my arms, they're still peeling.  After three weeks.  As for my shins, where I forgot to apply sunblock entirely, let's just say that they were pretty screwed up.

At first they followed the usual sunburn pattern.  They turned red and sensitive.  They started peeling.  Then, surprise!  Petechiea.  Those are those little red spots on the skin which I experienced on Day 2 after exercising.  They went away after a few days, and I am once again peeling like a mofo.

I burn pretty easily, but I've never had a burn like this that just keeps peeling.  Needless to say I broke out the aloe.  But I would have been happier if I'd applied more sunblock.

Friday, July 27, 2012

Can Haz Cat!

In a recent post, I wrote about how my husband and I were kind of stuck in a netherworld of wanting another cat, but of not feeling ready.

Last weekend we took a trip to the SPCA to test the waters.  By that point I felt I was ready, but my husband didn't.  Then, we met our cat.  It was a cat I had seen before but never visited; every time I saw her, she already had a visit tag for that day, so I needed to visit cats who hadn't been visited.  But I felt like I wanted to get to know her better.  I liked the way she looked at me -- as if she knew me.

She's still adjusting, of course, but still seems very different from our previous two cats.  She doesn't say much, for instance, even when she's hungry (our other cats would wail and complain, and when we told them they'd have to wait for dinner time, they'd start nipping our feet).  However, she's a sweet kitty and is already proving herself to be a lap cat.

I knew that cats were an important part of my self-care, but I'd forgotten how much.  Since the arrival of SC, my anxiety levels have plummeted by a factor of ten, at least.  I'm less depressed.  I'm more hopeful.  I don't just love cats, I need cats.

Monday, July 9, 2012

First Year on Lamictal: Efficacy and Persistent Side Effects

I started this blog one year ago today.  Since then I've been through a lot: marital problems and the loss of the two cats who'd been keeping me sane all these years.  And that's not even getting to the drugs.

Ah yes, the drugs.  I'm on a lot of things besides 300 mg of lamictal.  I'm also on 5 mg of Abilify, 70 mg of Vyvanse (for ADHD), 1.5 mg of Ativan, and (soon) 5 mg of Adderall (also for ADHD).  That's not even getting to my allergy meds.  I worry about my liver sometimes.

But this blog isn't really about the other drugs, it's about my experience with Lamictal -- how it's affected my mood, and what side effects I've had to put up with.

Lamictal has definitely stabilized my mood.  A year ago, my mood was more positive than not, but still unstable.  At 12.5 grams of lamictal, I started to feel better, but I definitely still experienced my 3pm to 7 pm trough.  I didn't start to feel stable until I hit 100 mgs.  I titrated up to 150 mgs, and did pretty well until the Autumn Equinox.

Since my depression is so sensitive to light, I went up to 200 mgs and broke out the sun lamp.  As the days continued to shorten my mood continued to destabilize.  After a few weeks at 300 mgs, I needed to start Abilify to smooth things out and to ease my depression.

I've been pretty stable since then, especially considering the deaths of my two cats in the space of two and a half months.  The cast have thrown me for a loop.  I'm sleeping more, and my motivation is shot to hell, but soon I'll be taking Adderall in an attempt to address that.

And now is the part where we address the side effects.

Lamictal seems to rewire your whole nervous system.  Like other brain meds, you might get headaches, dry mouth, dizziness, gut trouble, and sleep disturbances.  Unlike other brain meds, it affects your skin, muscles, sense of balance, and sometimes your bladder too.

Personally, I've experienced everything but the headaches (and the dreaded Stevens-Johnson syndrome) at one time or another.  Here's the breakdown:

Urinary Problems

I occasionally have trouble peeing, and this has been especially true since starting Abilify.

GI Problems

I've had occasional diarrhea and loose stools, but by far the worst thing was the severe constipation I experienced at 200 mgs.  The weird thing about this is that I had no constipation at any other dosage.

Sleep Disturbances

In the beginning, I also had severe sleep disturbances (this is by far the biggest side-effect tag on this blog). The meds gave me delayed sleep phase -- I could sleep a normal eight hours, but only between 3 am and 11 am.  Since I had been sleeping much more normal hours, this was incredibly frustrating.  This problem went away when I started using my sunlamp in the Fall, and it hasn't returned since I stopped using my sunlamp in the Spring.

Balance Problems

Before I injured my shoulder, I was lifting weights a lot.  As I recover from my injury, I'm doing yoga.  Both exercises require pretty good balance, and I notice that I sometimes have more trouble with this than I used to.  However, it's gotten better the longer I've been on my meds.

Muscle Tension

This is actually a positive side effect.  Whereas some folks notice that they're muscles are tight and sore, my muscles have loosened up significantly.  I'm much more flexible, and I don't get delayed onset muscle stiffness anywhere near what I used to get.  (Delayed onset muscle stiffness is that thing where you get stiff and sore hours to days after exercising).  Since I was lifting weights, and plan to return to lifting weights, this is pretty sweet.

Skin Problems

Aside from the Dreaded Rash of Deadly Doom, aka Stevens Johnson Syndrome, lamictal can mess with your skin in all kinds of ways.  And indeed, I've had skin issues since Day 2.  Anything that happens to my skin seems to be amplified, whether it's heat rash, sunburn, or insect bites.  This is another side effect augmented by Abilify (which actually warns you away from direct sunlight).  

To give you an example, a month ago I wrote about a sunburn that I had gotten three weeks previously.  It was still messing with my skin.  It has now been eight weeks since that sunburn, and my skin is still a weird texture, and it only stopped peeling a few weeks to.

The moral of the story is, SUNBLOCK.

The Most Important Thing I Have Learned About Lamictal

One of the posts that makes the consistent top five on this blog is the one about where to find Teva lamotrigine.  Why does this matter?

For whatever reason, lamotrigine's bioavailability can vary by something like 20%.  Isn't it great that we regulate drugs in this country?  Anyway.  If you want the same bioavailability as the brand name, you need the Teva generic.  I personally had a disastrous experience on the NorthStar version, and I know I'm not the only one.  I got the NorthStar version at the Costco Pharmacy.  As for Teva, Walgreens always carries it.  To be safe, I fill my scrips at Walgreens. 

And that pretty much wraps up my first year on lamictal.  This blog has gotten 11,538 page views since its inception a year ago.  I hope it's helped a few people along the way.

Sunday, July 8, 2012

Overcoming My Fear of My Own Mind

The other night, as I was falling asleep, I realized that I was actually thinking about myself.  Boring stuff mostly, where I'm going, how to get there, my complete lack of confidence in my ability to do so.  The odd part is that it wasn't scary.

Since my psychotic episode, I've been terrified to delve too deeply into myself.  I've had a creative block.  My meta-cognition has sucked.  I've been put so much effort into hanging on by my fingernails that I haven't had time to think about myself ... but it's also something I've studiously avoided.  I've been afraid of my own mind.

My psychotic episode, and the subsequent mood issues, makes me feel like my mind completely betrayed me.  I'm a person who has always prided herself on being rational, on being able to think straight, of only holding well-reasoned opinions.  The belief that the universe is devouring light particles is neither rational nor well-reasoned.  The fact that I could believe such a thing, even while knowing it was false, is deeply frightening.

The belief came from such a deep part of my mind that I've been afraid to go back, so to speak.  I've been afraid to look into my own depths.  What if I'm overwhelmed again?  What if my mind starts lying to me again?

Last night, something shifted in me.  It was as if I'd been hanging on to a branch for dear life.  If I let go of the branch, I'd go over Niagra Falls.  I had to put all of my energy into hanging onto that damn branch, or else.  Then, a channel opened up in front of me, a peaceful stream, and I can start making my way toward it.

I still find myself hoping that the stream isn't too deep.  I'm afraid of what else might be in the water with me ... giant sturgeons, ichthyosaurs, anglerfish ... but at least I don't hear a thundering waterfall in the distance.

Friday, July 6, 2012

So Much for Inner Peace

In a recent post I wrote about feeling a sense of acceptance for my lot in life.  My dead cat, my troubled relationship.  That sense of acceptance has come and gone since then, but mostly gone.

I've been really moody this week.  OK, one day it was because I forgot to take my meds, but still ... someone asked how I was doing and I started crying about my cat.  They didn't even ask about my cat.  Yet, I was in tears, and could barely speak.  Yesterday I felt tearful as well.

I wasn't quite this bad after Piglet died.  I suspect it was because I still had CC there to comfort me.  I'm stuck in a crappy place where my partner and I aren't ready for another cat, but not having one is driving me crazy.  I'm afraid I'll meet the perfect cat before we're ready, and also terrified that I'll never bond with another cat as long as I live.  

Thursday, June 14, 2012

Anxiety and an Empty House

After my volunteer shift at the animal shelter yesterday I started feeling anxious.  My gig involves socializing with cats, which I love ... and yesterday, also gauging my comfort level with the idea of getting a new cat.

Yes, my kitty has only been gone for five days.  It's too soon for me, and my poor husband was out of town when CC was euthanized, so he still needs to process the fact that she's really gone.  Nonetheless, I want to start thinking having cats in our family once again.  The house is just so fucking empty right now.

What I can't tell is whether I'm anxious because I started imagining myself with other cats, or because of the empty house.  Every time I hear a noise, I think "Oh, that's CC".  Only it's not CC, and it never will be.  That's one of the things about grief though; always thinking you see the deceased out of the corner of your eye, or hearing them in the other room, or thinking that they're on the couch or upstairs or wherever.

This experience made me realize that I've never been alone in my own house before.  I've always had cats, ever since I moved into my own place at the age of 20.  For that matter, I got Piglet and CC at that time.  They've never not been here.  One or the other was always on my lap, or sitting on the couch with me, or hanging out in the next chair.  One or the other was usually talking to me.  It's never been this quiet before, and I'm really having a hard time with it.  Of course, I could take the Xanax my pdoc prescribed me, but I'm already on so many goddam drugs, and for some reason Xanax scares me.

So until we're ready for another cat, I may just have to live with anxiety.

Wednesday, June 13, 2012

Acceptance, Actually

The path to healing is supposed to involve "acceptance".  Sometimes this is called "surrender", a word which I hate for its connotations of cheesy romance novels.  So I'll talk about "acceptance".

Since my psychotic episode I have struggled mightily against my illness.  I felt like I had to; I couldn't afford to go back there, I couldn't afford for my mood to get any worse, I couldn't afford another mistake with my meds.  I've struggled against everything that's gone wrong with my life over the last two years.  The jobs I've lost.  My relationship problems.  The loss of my cats.

Then, the day before my cat CC died, I was overcome with a sense of calm.  The universe is kicking my ass right now, for whatever reason.  There's nothing I can do about my illness except what I'm already doing -- taking care of myself as best I can.  The job stuff, my cats -- those situations are both out of my control.  My relationship -- well, that needs work, no question, but we're finally ready to start that work after healing from the trauma of our previous, fraudulent couples counselor.  So there, at least, there is something I can do, and I am damn well going to do it.

I don't know why or how I attained my sudden sense of calm.  I just know that for the first time in two years I feel like I know what I can and can't control, and I feel deeply that things will get better.  It's a damn good place to be.