Wednesday, August 31, 2011

Day 50: My Mood Disorder Action Plan

Tonight is my final MCBT class.  Our homework for this week was to come up with an action plan in the event that, in spite of our best meditative efforts, our depression recurs.  We were told to make a list of our usual depression symptoms (because they're usually the same in each person), write down three things we like about ourselves that we might forget when we become depressed, and create an action plan -- if we become more depressed, what will we do to care for ourselves?

As I've written before, the symptoms I'd long ago learned to identify have changed.

Here are the symptoms I used to have when my depression was getting worse:

  • Feeling the edge of The Pit
  • Feeling of “falling”
  • Feelings of excessive sadness
  • Excessive tearfulness
  • Irrational guilt
  • Catastrophizing thoughts
  • Taking things too personally
  • Anhedonia
  • Lassitude/lack of motivation
  • Insomnia
  • Overeating
  • Oversleeping

And here is what was going on with me last fall and winter:

  • Troughs or crashes in mood between the times of 4 and 8 pm become more frequent
  • Troughs or crashes in mood between the times of 4 and 8 pm become worse (tearfulness, paranoia about relationships, pessimism running to despair)
  • Troughs or crashes in mood lengthen beyond the 4 to 8 pm range
  • Tearfulness, sadness, or anxiety due to trivial or nonexistent things (such as cheezy songs, movies, tv)
  • Excessively bizarre thoughts or anxieties (such as worrying about the balance or destruction of photons in the universe)
  • Feeling the need to act on excessively bizarre thoughts, or take action on the basis of bizarre anxieties (needing to turn all the lights in the house on to keep it "balanced")
  • Increased irritability
  • Sudden, frenzied activity, especially late at night (such as suddenly feeling the need to clean the house at 11 pm)
  • Dramatic upsurge in energy after 10 or 11 pm
Hmmm. Not only are those nothing like my previous symptoms, but they don't look much like depression at all, do they? Good thing I'm seeing my pdoc in two weeks. I will bring this to him and show him it.

For kicks, here's the rest of my Action Plan:

Three Things I Like About Myself (that I tend to forget when I get depressed):
  • My sense of humor
  • My curiosity
  • My creativity
My Action Plan for Mood Symptoms Consists of the Following Steps:
  • Breathing Space (use breathing space to check in: would meditation be helpful or harmful at this time?  What is the best self-care I can give myself right now? What steps do I need to take next?)
  • Make a choice of what practices are most helpful to me and start using them (be nice to know what these are …)
  • Take specific actions, including the following steps:
    1. Inform spouse
    2. Inform pdoc *** if spouse is traveling, this is Step 1 ***
    3. Determine what would be the best action toward self-care and do it immediately
As you can see, my "action plan" is not much of an action plan.  That last one is pretty non-specific, and might not be enough to go on in a crisis.  

Do you have an action plan?  Do you have comments about mine?  Please let me know in the comments!

What the Hell is "Normal"? And Does It Preclude "Greatness"?

If you read John McManamy's blog, you're aware of Nassir Ghaemi's recent book  A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.  You'll also be aware that McManamy thinks it's great, and raises a lot of important issues.  If you read this blog, you'll know that I think the book is highly problematic and not worth my time.

McManamy's belief is that this book starts an important conversation about the "gifts" conferred by mental illness -- gifts that "normal" people don't have.  But what exactly is "normal"?

McManamy makes a passing reference to Nazi Germany, and asks whether "normal" was part of their problem.  As it happens, I've studied this issue in some detail.  Normal ain't got nothing to do with it.  Trauma?  Now, trauma's got everything to do with it.  Is trauma "normal"?  I'd like to think not.  On the other hand, I know plenty of traumatized people, including myself, so maybe it's more "normal" than society would like to think.

But it's important to note here that "normal" may or may not mean "healthy".  When referring to a "normal" organism, the word means that the organism in question is healthy and without pathology.  This is the way the word is used in a discussion about "normal" versus "mentally ill".

Tuesday, August 30, 2011

Lamictal, Day 49, 100 mgs: A Normal Night's Sleep! For Real!

Last night I tried to go to sleep around 1.  I fell asleep, probably by 1:30.  I stayed asleep until 9 am.  I decided to doze until my alarm clock went off at 10.  Then, I woke up.


Monday, August 29, 2011

Day 48, 100 Mgs: Slept 11 Hours Last Night, but Maybe Appetite Has Returned?

Something happened today that hasn't happened in weeks.  I woke up ... almost ... hungry.

Lack of appetite in the morning has been a problem for me since Week One of lamictal.  It's always been noticeable, but usually I've been able to overcome it.  As I've titrated up, I've gotten worse, until last week it was a four-hour struggle to choke down my breakfast.  At managed to eat just enough to keep exercising, and I lost the couple of pounds that I'd gained on the NorthStar version of lamotrigine.  So that's something to be grateful for.

Last week, a bunch of relationship stress hit the fan, adding to my sleep problems.  I got a couple decent nights' sleep, but by no means enough.  The night before last, I woke up about five times, and I had the following dreams:

  1. My husband was angry with me.  Yeah, well ...
  2. We were living in our car.
  3. We were living in the backseat of our car.  The front seat was occupied by a woman and her baby.
  4. We were living in the backseat a car belonging to the narcissistic, verbally abusive mother of a friend of mine.  She was living in the front seat.
  5. We were looking at a rental apartment that was in back of a truck stop.  It was fairly nice and spacious, and connected to the truckstop by a corridor with a lovely parquet floor.  It was separated from the truck stop by a pair of flimsy sliding doors.
So, no anxiety about my living situation.  Nope.

Last night was different though.  I felt tired by 11, and went to sleep.  I woke up a few times to pee, but slept really deeply otherwise.  I was actually awake before my alarm went off at 10 am.  I enjoyed 11 hours of fairly good sleep.  I feel well-rested for the first time in recent memory.

Although ... I have to wonder about waking up as often as I do.  Lamictal causes dry mouth, which has me drinking a ton of water.  Am I waking up because I'm drinking all this water, and therefore needing to pee a lot?  Or am I only needing to pee because I wake up and realize that I have to go?  I would so love to get a normal eight or nine hours worth of sleep.

Lamictal, Sleep, and the Marriage Bed

I've been writing a lot lately about my relationship problems.  In a nutshell: the living situation that my husband said was working, wasn't.  The money situation that my husband said was working, wasn't.  Also, it turned out, my husband resents the fact that I don't get out of bed until 10 at the earliest.  Of course, I can't really control this, and he knows that, which means that he feels bad about resenting it -- but he still resents it.  So now, in addition to having physical difficulty sleeping, I feel guilty about it too.

Learning that he'd been hiding all of this from me really hurt.  That being said, I can also understand it.  He was trying (albiet in a wrong-headed way) to protect me and give me a bit more time to get stable.  What hurts much more, and is far less understandable to me, was to learn (during the course of our first couples therapist visit) that he's been so frustrated for so long that he basically can't remember what he ever saw in me in the first place.

Now, I thought we were doing OK until a week ago.  The only indication that something was wrong had to do with the way my husband slept -- when I got into bed, he would roll away from me, shifting until he was on the far edge of the bed.  I even asked him if he was mad at me.  No, I'm not mad at you.  Why do you ask?  he said.  I told him that he was rolling away from me, avoiding me, from the minute I got into bed.  I can't help that, he said, I'm doing that in my sleep.  It has nothing to do with you. 

Yeah.  About that ...

Sunday, August 28, 2011

Day 47, 100 mgs: Treating Mental Illness Like An Illness

I've mentioned before that I'm taking a class in mindfulness-based cognitive therapy (MCBT) for depression.  We're taught various meditation techniques, which teaches us mindfulness skills, which allows us to be aware of our thoughts, which in turn allows us to recognize thoughts that are depressive, and finally, allows us to release those thoughts.

Last week we talked about caring for ourselves if we relapse.  The hope is that the meditative practice will help to prevent this, but also that it will allow us to notice a relapse before it gets too bad.   It's important to be mindful of the physical and mental symptoms that herald a depressive episode.  Depression, the facilitators explained, tends to follow a pattern in a given individual.  Our homework for the week is to write down what these symptoms are and write up a plan in the event that depression strikes.

This was slightly depressing to me, because in my case, the "usual symptoms" have changed.  Wah!

But a more interesting thought occurred to me: in all my years and years of therapy, none of my mental health care providers ever thought of doing this.  WTF?

Saturday, August 27, 2011

Day 46, 100 mgs: Craving Salt on Lamictal?

One thing I've noticed this past week is the tension between symptoms and side effects.  I'm talking about side effects like reduced appetite and sleep problems -- which are both symptoms of depression, and which both contribute to making depression worse.

I've really struggled with eating for most of the week.  I'm usually hungry by dinner time, but by that point I've had at least eight hours with (usually) insufficient food.  Not good for my mood.  Not good for my ability to exercise, which is not good for my mood.  Not exercising keeps me from sleeping; not eating means that when I do fall asleep, I'm so tired I tend to sleep for much longer than I otherwise would.

When I can choke down some food, I notice that my mood improves immediately.  Of course it does.  One of the things I've learned early on about this illness is that if my mood is unaccountably low, I need to think about when I ate last.  Sometimes, for me, the first indication that I'm hungry is a low mood.

Friday, August 26, 2011

Lamictal 100 mgs: Appetite and Stress

Since I went up to 100 mgs of lamictal my morning appetite has been even worse than it was.  It's just such a chore to choke anything down.  So why bother trying?  Well, not eating will make my mood worse, and that makes the lamictal rather pointless.

Yesterday was harder than most days.  My partner and I had our first session with the marriage counselor to try and deal with our difficulties.  The appointment was at 11, so given the way my appetite has been, I didn't bother to try and eat anything more than a handful of trail mix.  As for the session itself, it was as hard as I expected it to be.  The therapist asked us both to tell the story of how we met, why we were attracted to each other, why we decided to get married.  I can answer each of these questions.  My husband cannot.

WTF?  My partner in life basically has no idea why he wants to be with me, or even why he ever did?

Wednesday, August 24, 2011

Day 41, 100 mgs of Lamictal: Feeling Better About Life

I think I may be hitting a sweet spot where the lamictal dosage is concerned.  It's been tough to track my moods in some ways because I've had a fair bit of stress since I started the titration.  The situation with my grandmother is stressful, and my mood definitely took a hit from that.  Then there's the whole deal with my marriage.

I'm feeling more optimistic about that today.  The last few days have been pretty hard.  At many points I found myself obsessing over the difficult times my husband and I have had.  I wondered if we've ever been truly happy together.  I wondered why my husband even wants to be with me, when my learning disabilities, my ADHD, and my mood disorder clearly cause him so many problems.  It's been nearly ten years since I've done this sort of thing.

I guess the mindfulness training must be paying off, because at some point I realized that I was basically thinking "depressive thoughts" about my husband and me.  My depression was causing me to undervalue the good times we've had and the good things about our relationship.  Basically, instead of thinking depressive thoughts about myself -- I'm no good, I'll never be successful, etc. -- I was thinking those thoughts about my marriage.

Tuesday, August 23, 2011

ADHD and Mood Disorders: Fun With Relationships

Last week, I thought my relationship was doing OK.

That was before Sunday happened.

On Sunday, what I had hoped would be a simple conversation about budgeting turned into a complete fiasco.  First, it turns out that Dear Husband is frustrated that I need so much scaffolding to deal with our budget (never mind that he keeps changing the scaffolding on me).  Then, it turned out that what's "really" frustrating him is that living where we are just isn't working for him, and he doesn't know how much longer he can "keep doing this".  We need to move closer to his workplace.

I've been aware that living where we are is not workable in the long run.  I also thought we were in a workable holding pattern, one that would allow me to get my head together, and maybe even start bringing in some income.  I thought this because my husband told me it was workable.

But it turns out that it's not.  His reason for hiding this from me?  That I get upset whenever he brings it up, and that he didn't think I was "strong enough" to deal with it.

100 mgs of Lamictal: Sleep, Appetite, Exercise

I titrated up to 100 mgs of lamictal yesterday, and not a moment too soon.

I've been sleeping better than I have been for the last several days.  I've been falling asleep by 2 am, sleeping through the night, and waking up (with my alarm) around 10:00.  Waking up seems harder than it has been.  My body wants to sleep until 11.  I don't know if this is fatigue from getting back into my weight lifting routine, or if I'm not sleeping as well as I think I am, or if the med is just making me sleep longer.

My appetite in the mornings is even worse than it's been.  This morning I got up at ten, fell asleep on the couch, woke up again at 11, and have been trying to finish breakfast off and on ever since.  It's now 3 pm.  Eating in the morning just feels like a chore.

The appetite thing is impacting my exercise (and probably my sleep too).  When you're doing strength training, you need to eat in order to build your muscles.  If you don't eat, you make yourself vulnerable to injury, and you also feel tired.  And in my case, if I don't exercise enough, my sleep phase gets even farther out of whack.

I've also been feeling dizzy and out of it today.  Could be the lamictal -- both of those are potential side effects -- or it could be the lack of food.

Sunday, August 21, 2011

Lamictal Day 43: To Sleep, Perchance to Dream

It's not on the list of side effects the pharmacist gives you, but brain meds are known for giving you weird or unusually vivid dreams.  It took me by a bit of a surprise back in the day, when I was first dx'd with depression and put on Zoloft, but then I decided it made a certain amount of sense.  I mentioned it to my therapist to make sure it didn't portend some latent psychosis (ha!) and she assured me that a change in dreaming was pretty normal.

Any sleep researched can tell you that everybody dreams.  People who think they don't dream simply don't remember them.  I found that during my years of Jungian analysis, I usually remembered one or two dreams per week.

Modern Jungian therapists -- at least the competent ones that I had -- don't simply rely on orthodox psychoanalysis to treat their patients.  They also draw on family systems theory, behavioral and cognitive behavioral approaches, and psychoeducation (educating the patient about their illness) in order to treat their patients.  Dreams, nonetheless, are still considered to be very important.  They relate to the patient's inner life, to the symbols the patient finds meaningful, and provide clues for how the patient might act more authentically in waking life.

Friday, August 19, 2011

Mindfulness CBT: ADHD, Anxiety, Mood, and a Helpful Hack

I've mentioned before that in addition to my crazy, I have ADHD (predominantly inattentive type).  Like a lot of ADD-ers, I've been scared to death of trying meditation.  I've done other spiritual practices, like guided visualizations, or trance work, but meditation "just didn't work for me".

A lot of this has to do with past trauma related to growing up with ADHD.  When you've been shamed your whole life for your failures in attention, anything that sounds like paying attention will raise your defenses.  I'm bad at paying attention.  Everybody always said so, and then I got a diagnosis to prove it.

Since I started taking a class in Mindfulness CBT, I've come to realize something very important -- the only thing required for meditation is that you know how to breathe.

I wish I'd learned this years ago, because I can already tell that meditation is helping me a lot.  It helps even though I don't do it every day like I'm "supposed" to.  I've discovered that I'm calmer after meditation, whether or not I was aware of feeling anxious before.  It lifts my mood if I'm in one of my late-afternoon slumps.  I can't say that it's made me more mindful overall (the goal of the class is to teach us to be mindful in general, so we can recognize our depressive thoughts before they really seize hold of us) but it's definitely helpful in the moment.  And "in the moment" is where you're supposed to be when you meditate anyway.

So how can you possibly meditate when you have ADHD?

Wednesday, August 17, 2011

Day 40: Lamictal, dizziness, and exercise

Last week I noticed something odd when I was working out.  Every time I went to do lunges of any sort, I had an unusually hard time keeping my balance.  This was true of both my dominant and non-dominant legs (I'm right handed, therefore my left leg is also dominant, and stronger).  I was wobbling all over the place, and all of the stabilizing muscles in my working leg were working overtime.

When I started doing lunges three years ago, I was about 50 lbs heavier and recovering from a knee injury, and I could still keep my balance better than this.

I'm noticing balance issues even when I'm not working out.  It's not like dizziness or vertigo.  I get that with ear infections, and it's kind of like the floor is moving up and down.  This is more like a milder and more prolonged version of standing up too quickly.  I notice it when I'm standing or walking, but I have less of an issue remaining upright when I can use both legs.

This seems to be related to the dose increase.  Last week I was ready to blame it on the inferior generic lamotrigine, but this week I'm back on the Teva, and it's still happening.  I hope to gods it goes away soon, because my adductor muscles are getting overworked.  My knee is also annoyed, and none of this is helping my left hamstring.

So although I am experiencing more muscle pain than I have been, it's related to straining to keep my balance.  Delayed-onset muscle stiffness is still blissfully mild, when it's there at all.  The only other change in side effects I've noticed is some dermatitis on my upper arms that seems particularly bad around bedtime.  Here's hoping the balance issues improve soon.

Tuesday, August 16, 2011

Crazy Meds, Dry Mouth, Bruxism, and Tooth Decay: What Your Doctor Didn't Tell You

Today at The Lamictal Diaries, we're going to talk about one of those things your doctor probably didn't tell you when you started taking your brain medicine.  We're going to talk about the massive dental problems that can result from taking SSRIs, stimulants, mood stabilizers, or antipsychotics.

Yup.  Dental problems. Your doctor probably knew to tell you that some of the most common side effects of your medication are dry mouth and teeth grinding.  Most med students, however, don't spend that much time learning about teeth in med school, which means that most doctors don't think of side effects in terms of how they'll impact your dental health.  Most doctors simply don't know that dry mouth and teeth grinding (also called "xerostomia" and "bruxism" respectively) are not trivial annoyances, but potentially serious conditions that can have a serious impact on your quality of life.   Over time, these conditions can lead to tooth decay, receding gums, tooth fracture, and ultimately, tooth loss.

You probably already know that a key part of managing your mood disorder is to reduce stress and anxiety in your life.  Getting cavities, cracking a tooth, or going to the dentist for painful procedures are sort of the opposite of that.  So what can you do to prevent your mental health from destroying your dental health?  And why am I on about this anyway?

Lamictal Day 39: 125 mgs? Oops.

I'm supposed to be taking 75 mgs of lamictal.  Today I accidentally took 125.  For a drug which can have serious consequences if too much is taken too soon, this could have been a serious mistake.  So far though, the only side effect seems to be some mild tachycardia, which went away after I meditated.

How did I manage to screw this up?  Well, in order to replace the disastrous NorthStar lamotrigine, a prescription which my psychiatrist had written for 25 mg pills, I needed a different denomination of pills in order for my scrip to be covered by insurance.  Lamictal and lamotrigine apparently don't come in a 50 mg denomination (no, that would be easy).  My pdoc had to write the scrip for 100 mgs, and then I was supposed to break them in half, and cut the remaining piece in half, and thus achieve 75 mgs.  Kind of confusing.  To help explain, here's a picture of Teva lamotrigine:

As you can see, they're scored down the middle, so it's pretty easy to break them in half and get 50 mgs. To break one of those halves in half takes a sharp knife, but it's doable.  I know this because I did it yesterday.  Then I put the half of a half tablet back into the medicine bottle.

Monday, August 15, 2011

Lamictal Day 38: First Day on 75 mgs (for real this time)

When I switched from the crappy NorthStar lamotrigine back to the Teva formulation, my psychiatrist told me to go back to 50 mgs for a couple of days.  I've decided that two days constitutes "a couple".  I want to get back on track here.

My mood was slightly variable yesterday, possibly because I'd read something that really pissed me off (long story, won't go into it here).  I found myself freaking out about my mood, afraid that I wouldn't get it under control by the time the days start getting shorter, and fretting about my "lost week" on the NorthStar crap ... and then fretting about all the time I've lost to this illness, and fearing the loss of still more time if I have another bad winter.

Hence the decision to kick it up to 75 mgs.

Sunday, August 14, 2011

Day 37: NorthStar Lamotrigine Side Effects

I spent all last week bitching about it, but in case you missed all that, my lamictal titration was interrupted by a change in generic brands, from Teva to NorthStar.  Back when I first started lamictal, my pdoc told me that generic lamotrigine  can vary significantly in bioavailability.  Teva lamotrigine, he explained, is the only generic that's remotely equivalent to brand-name lamotrigine.  The pills made by other manufacturers can have up to 20% less of the medication in them.

I spent all last week on NorthStar lamotrigine.  Allegedly, I was taking 75 mgs a day.  My psychiatrist wonders if my body was getting any of the med at all.  It was doing bugger-all for my mood, but there still seemed to be side effects.  Here's what I noticed:

Saturday, August 13, 2011

Day 36: Back on Teva Lamotrigine, Thank the Gods

As I related yesterday, my pdoc called in a new lamotrigine scrip, this time at my local Walgreens, which carries the pills manufactured by Teva.  The NorthStar crap I'd been on just wasn't cutting it.  I'm taking 50 mgs for a few days, and then I get to try to cut half of a 100 mg pill in half to get 75 ... my psychiatrist seemed to think this is possible, so I hope he's right.

I'm already feeling better, though my inner monologue points out that it's bright and sunny for the first time in a week.  Confound those confounding factors!  I spent my weekly visit to the local Farmers' Market ruminating on the number of things that can impact my mood disorder.  Things like sunlight, which is beyond my control.  Or the micronutrients in my diet, which are sort of within my control, except that I can't afford to buy a lot of organic produce these days.

I told myself that my rumination was probably not helping me.  Yeah? said my ruminating voice.  Who else is going to take care of these things?  I'm the only one who knows how I'm feeling, who can track that with what I'm eating or how much music I listen to or any of these other factors.  It's not like there's anybody else living in my head!

I realized that this was something to be grateful for.  And thus I was enlightened.

Friday, August 12, 2011

Day 35 on Lamictal: Changing Back to Teva Tomorrow

I got in touch with my pdoc and told him I wanted to go back onto the Teva lamotrigine as soon as was physically possible.  He's calling in the scrip right now.  By tomorrow I hope to be approaching normal again.

Yesterday wound up going hellishly bad.  By early afternoon I felt like I wanted to die.  My mood picked up a bit after that, but I still felt low and sad about some pretty ridiculous things, like the imagined suffering of the beans I was cooking for dinner.  Until 8 pm or so, when, like clockwork, my mood picked up.

My psychiatrist said, and I quote, "God knows what's going on", but that there's a good chance that 75 mgs of the NorthStar med is effectively less medication than 50 mgs of the Teva (at least in my particular instance).  It's even possible, he said, that I'm not accessing any of the medication at all for whatever reason.  He wants me to stay at 50 mgs of Teva lamotrigine for a few days, just in case, before going up to 75 mgs.

Today has been better than yesterday, though still not good.  I've felt low, sad, and simultaneously anxious and dull.  On the other hand, knowing that I'm getting off this NorthStar crap gives me something to look forward to.  I can't wait for tomorrow.

Thursday, August 11, 2011

What Is It Like To Have A Mood Disorder?

Have you ever wondered what it's like to have a mood disorder?  Especially when you already have a twisted sense of humor?  I present for your consideration the following conversation I just had with my husband:

Me: I should have called my doctor instead of emailing him.  It's not just that things have gotten worse, they've also gotten weird.

Husband: Weird?

Me:  Yeah.  When I was cooking dinner I heard a noise, sort of a plaintive sound, like a small child crying or one of the cats wanting to be let in.  At first I thought it was coming from outside, because it was so quiet ... then I realized it was actually the beans cooking on the stove.

Husband: And ...

Me: And I had the thought that I was hearing them scream as I was boiling them to death.  Which, for me, is actually a normal thought.  Only normally I would think it was funny.  But this time, it made me really, incredibly sad as I reflected on their suffering.  And that's not normal for me at all.

Husband (pauses, puts an arm around my shoulders):  ... You know, I wish I could hear you explain that particular concept of "normal" to your shrink ...


Lamictal Day 34: Mood Instability and Depression Due to Variance in Lamotrigine Generics?

Last Friday, day 28, was my first bad day since I started lamictal.  Saturday was my first day at 75 mgs, but I filled my scrip at a different pharmacy, and that meant a different generic manufacturer.  I'd been taking lamotrigine made by Teva for the first four weeks, and now I'm taking NorthStar.  Since then, I feel like I've had many more bad days than good. 

This really feels like a different, less effective medication.  My mood, cognition, and motivation are all suffering.  There have been some days where I've bee unable to get important things done, like cooking dinner or getting scrips filled.  Looking back over the last several days, I'm clearly much less stable than I had been (and I'm not remembering this accurately, which makes me glad I'm keeping this damn blog).  I'm back to my 4 pm crash.

Today, I feel better than I have most days since starting at 75 mgs, but I still feel way lower than I did last week, or any day of the previous 4 weeks.  This sucks incredibly.  I'm trying to just sit with it, let it be what it is, and not get caught up in depressive thoughts. 

Tuesday, August 9, 2011

Lamictal Day 32: Thoughts on NorthStar Lamotrigine

This is Day 4 on NorthStar lamotrigine, and so far I'm not impressed.

As I've mentioned previously, I switched pharmacies to fill my latest lamictal scrip, and my current pharmacy (Costco) sells a generic made by NorthStar.  This means that there is less available medication in the pill, possibly as little as 80% of what Teva's lamotrigine has (Teva's bioavailability is equivalent to Lamictal the brand name med).

In theory, I should still be getting more medication than I was last week.  Last week I was taking 50 mgs of Teva lamotrigine.  This week I'm taking at least 60 mgs of NorthStar lamotrigine.

If that's the case, why do I feel like crap in real life?

Why I Probably Won't Read Dr. Nassir Ghaemi's New Book, "A First Rate Madness"

A couple of my blog feeds popped up today with reviews of Dr. Nassir Ghaemi's book A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.  His thesis is that many great leaders of the world have suffered from mood disorders, ranging from major depression to bipolar disorder.  John McManamy posits that President Obama may be "too normal" to be an effective president for these trying times.  Tom Wooten, author of The Bipolar Advantage, wrote a review of the book entitled at PsychCentral entitled "We Need A Bipolar President".

According to Dr Ghaemi, many "great figures in history" have had mood disorders.  Ghandi, Churchill, John F. Kennedy, Martin Luther King, Jr., General Sherman are but some of the examples.  Neville Chamberlain and General McClellan were excellent peacetime leaders, but were basically too normal to meet the challenges of a crisis.  Mood disorders, you see, give a person experience with crisis situations and how to handle them.

I have not read Dr. Ghaemi's book.  I probably won't bother, because I consider its methodology to be critically flawed in numerous ways.

Monday, August 8, 2011

Day 30, 75 mgs: Generic Lamotrigine Is Not Created Equal

When my pdoc first prescribed lamotrigine to me, he warned me that it was not all created equal.  The pills manufactured by Teva, he explained, have the same bioavailability as Lamictal, the brand name version.  The effective dose in a pill made by other manufacturers can vary dramatically.  If my generic got changed up on me, he said, I need to let him know.

This weekend, I titrated up to 75 mgs of lamotrigine.  I felt calmer, after having experienced some agitation toward the end of last week.  My mood was a bit lower.  Is this the "mood stabilizing" effect of lamictal? I wondered.  A few weeks ago I was feeling cheerful.  Is the higher dose bringing me down?

Yesterday I had my first late-afternoon mood dip in a few weeks; I felt vulnerable and slightly unbalanced, as if I was standing on the middle of a seesaw.  If the lamictal were really stabilizing me, I should be ... well, stable.  No mood swings.

Then it hit me -- I'd gotten my scrip filled at Costco, which uses generic lamotrigine made by NorthStar.  Walgreens, where I'd gotten my first scrip filled, used Teva.  Teva's got the highest effective dose of any of the generics.  Who the hell knows what dose NorthStar has?

Saturday, August 6, 2011

Lamictal Day 28: My First Really Bad Day, and Some Observations About Coffee

Those of you who have been avidly following my extended family drama may remember that my father is catastrophising about my grandmother's situation, but that my uncle doesn't think it's that bad.  So I thought that maybe talking to my uncle would be good self-care.  It might do me good to get the opinion of someone who isn't neurotic.

The problem is, we're not really in touch, and I didn't have his phone number.  To get it I had to drop an email to my mother.  Mom wrote back that it would be a bad idea to talk to my uncle, because it would "enflame the situation when it really needed to settle down", that she only told us kids what was happening with Grandma so we would know what was going on, and that she "should have done a better job managing her own stress levels."  If I wanted to talk about the grandma situation, I could give her a call.

In other words, I'm an errant twelve-year-old who needs to be told how to behave.  I'm not mature enough to navigate an adult relationship with my uncle.  My relationships with other family members need to be mediated by my mother, and by the way, my stress is causing her to feel stressed out.  Maybe I'm not mature enough to be party to family difficulties.  Also, my feelings are dangerous and need to be contained, like hantavirus.

Thursday, August 4, 2011

Running, Coping Skills, and Family Pain

My father and I have both worked hard to have the relationship we have now.  I don't want to go into details here.  If you want to know what it was like for me growing up, read Ashley's post about her own relationship with her father.  The details differ.  The terror was the same.

Dad probably has, or at least has had, an undiagnosed mood disorder of some kind.  John McManamy writes that depression may be under-diagnosed in men because it can manifest in anger or rage -- symptoms that don't appear on the DSM list.  My father raged.  Holy crap, did he rage.  Then, for no apparent reason, he would be in a good mood, and he'd laugh off my latest transgression.  Then he'd start raging again.

Day 27: Lamictal, Vyvanse, or Zoloft: Which Is Causing My Insomnia?

I've been writing a lot lately about the insomnia/delayed sleep phase that's been brought on by the lamictal.  Actually, I naturally have a delayed sleep phase; if my body does what it wants, I would sleep from roughly 3:30 to roughly 11:30.  We've reached a compromise with the rest of the world in which I sleep from roughly 2 to roughly 10.  For some reason, the lamictal seems to be reasserting my inherent biological clock.

But is lamictal the real culprit?  After all, I'm on two other drugs for my brain.  One of them, Vyvanse, is a dextroamphetamine to treat my ADHD.  Amphetamines are sold on the street as "speed".  I'm also on Zoloft, an SSRI, which has a paradoxical effect on me -- it is simultaneously agitating and sedating.  I'm only on 12.5 mgs at the moment, but back when I used to take it at 100 mgs, I could never fall asleep before 2 am, and my usual bedtime was more like 3 ... and waking up, even at noon, was excruciatingly difficult.

Wednesday, August 3, 2011

Psychotic Depression (Again): What is "Mood Congruent Psychosis"?

If it seems like I spend a lot of time writing about psychotic depression, it's because I do.  Before it happened to me, I had no idea such a thing was even possible.  In the months since it's happened to me, I've learned that there's not a ton of information out there, and some of what's out there isn't accurate (for instance, the assertion in the WebMD article that the condition requires hospitalization).  Furthermore, a lot of the information out there simply doesn't apply to my situation.

For starters, as my doctor told me, most depressed people who become psychotic are in pretty bad shape.  In his experience, they've already reached the point where they're struggling to take care of themselves.  I was actually functioning well, my mood wasn't even depressed for most of the day.

Second, most psychosis in people with mood disorders is "mood congruent".  That is, a depressed person will have "depressed" delusions, such as feelings of guilt -- that they're deserve to be punished for something that couldn't possibly be their responsibility, or that people treat them "differently" because those people "know" about the horrible things they've done.  Another common delusion is for a depressed patient to believe, without any rational cause, that they are gravely physically ill.

Not me. I had delusions of physics.

Tuesday, August 2, 2011

Lamictal Day 24: Sleep, Exercise, Stress, and Family

I was able to get a decent night's sleep last night.  There are two things that I think contributed to this: I went running, and my husband went to bed around 11:00 instead of falling asleep with his head on my lap while watching TV. Actually, make that three things -- I drank about three cups of Traditional Medicinals' "Easy Now" herbal tea.

Since I had exercised and meditated like a good girl, I felt relaxed throughout the afternoon and evening, and even tired by 11.  I went to bed just after my husband did, and even though I read for awhile (which is bad sleep hygiene) I felt sleepy by 11:45.  Since I'd drunk all that tea, I had to get up and pee a few times; the last such time was 12:20.  Then I fell asleep.  I woke briefly around 8, and then was up for good when my alarm went off.  Waking up went pretty easily.

Monday, August 1, 2011

Lamictal Week 3: GI Stuff, Sleep, Alcohol, Skin, and Cognition

Week 3, my first week at 50 mgs of lamictal, continued to improve my mood, but also brought increased side effects.

Gastro-intestinal stuff:  For much of the week I've been slightly bloated, gassy, and constipated.  This has been mildly annoying but livable.

Skin stuff:  Still no sign of The Rash.  My initial pin-prick rash has not reappeared, but I took last week off from working out, so I might not have seen it anyway.  I continue to experience simultaneous dry skin and acne, but this could be worsening because my period is due.

My skin is definitely more sensitive than it used to be.  If I open the oven door to remove something, I really feel the heat -- and as it subsides, it itches quite a bit.  Then it's gone.  I've also noticed that it hurts more than it used to when my cat decides to wash my face.  That sandpaper tongue is murder!  My skin is also somewhat red afterward.

Alcohol: Yesterday I drank most of a bottle of wine in the evening.

As I was falling asleep, I realized that I've gone through 3 bottles of wine this week -- some of that was cooking, granted, but that accounts for maybe 80% of one of those bottles.

I probably went through three bottles of wine in the entire previous month before last week.

As I wrote at the end of last week, one side effect of the lamictal seems to be that alcohol doesn't give me as much in the way of tipsy-euphoric feelings as it used to, but I still get the slowed-down feelings.  I thought last week that this would continue to influence me not to drink. And yet, here I am, drinking.  Why?  Well, that brings us to ...

Sleep:  The insomnia I wrote about last week has continued.  I still sleep better, once I fall asleep, but I feel more and more as if this med is trying to give me a delayed sleep phase.

Only yesterday I was writing about my brain's tendency to race at night, and the need to find a way to wind down at night.  It would seem that 3 bottles of wine was attempt to do exactly this.  The scary thing is that I was not exactly aware that I was doing this while I was doing it.

The improved nightly routine I wrote about yesterday is looking more and more imperative.  I'm not sure what to do yet, but I need to do something.

Cognition:  In spite of consuming rather a lot of alcohol last night, I woke up this morning and was immediately able to hold a coherent conversation with my husband.

I am not a morning person.

Morning people are weirdos.  Everyone else will know that the brain is not meant to be functioning immediately after waking.  It requires at least fifteen minutes to communicate in monosyllables, and then a good breakfast, in order to be merely sluggish.  People who wake up ready to discuss the debt crisis are just ... abnormal.

Still More About Psychotic Depression: Why I Didn't See It Coming

My psychotic depressive episode happened after several fairly stressful months.  When it happened, and in the months since, I've been blaming myself -- I knew I was getting stressed!  Why didn't I take better care of myself!

The stress involved money and employment.  Early in the year, my husband had taken a job at a startup that entailed a significant pay cut.  To make a long story short, I had believed that I would be able to make up at least some of the lost income, and it turned out that I couldn't.  My husband's job is far from where we live, and he was trying to make a go on public transit, but the time this took was truly ridiculous.  He was getting stressed and snappish.

I was also getting stressed.  I could see my thoughts heading into depressive territory: I'm just unemployable.  I'll never find work.  How did I think I could find work, with my spotty work record and 10% local unemployment?  Who in their right minds would hire me? Et cetera.