Wednesday, October 19, 2011

Lamictal, Constipation, and Electrolytes

I promise, I'll stop writing about constipation soon.  Because I think it's finally going away. 

In a post last week, I wondered whether my GI problems might be caused by a minor electrolyte imbalance.  Electrolyte imbalance isn't a common cause of constipation.  Usually the culprit is a low-fiber diet.  My diet includes enough fruits and veggies that this shouldn't be a problem.  I tried eating prunes, and Cheerios, and and anything else that might have a laxative effect, but no luck.

I thought that perhaps the lamictal dry mouth is causing me to drink so much water that I'm pissing away electrolytes.  Over the weekend, I started drinking Emergen-C, which in addition to crazy amounts of vitamin C (which I don't really care about) serves as an electrolyte replacement drink.

And I can report that it helped enormously.  Can't say that I'm back to normal, but I'm feeling so much better.  So if you're having GI issues with lamictal, try drinking gatorade or any other electrolyte replacement beverage.  It might really help.

Cognitive Distortions and Mood. OR: I Have A Job? Meh.

I have a job now.

After a year and a half of unemployment.  After nearly a year of bad, serious crazy.  After learning that my partner is so angry about my crappy work history, my lack of contribution to the household finances, that he can't remember why he loves me.

A job.

It fell into my lap out of the sky.  An acquaintance of ours has decided that he needs his business to have a better web presence.  He's of the pre-internet generation, and he's aware that things like blogging and FaceBook and search engines are important; he's just damned if he knows why or how.  My partner mentioned to him that I had experience in these areas, thinking that this fellow would call me to ask for advice.  Instead, he offered me a job.

The gig is part time, I get to use my brain, I get to work from home, AND I get to create my own schedule.  If I need to sit in front of my sun lamp, I can do that.  If I need to take a meditation break, I can do that.  If I need to listen to Bach, I can do that.  It's not just a job, it's my ideal job.

So why can't I get psyched up about it?

Tuesday, October 18, 2011

Lamictal 200 mgs: Two Weeks, and Still Not Stable

I realized today that it's been awhile since this, my mood diary, has included writings about my actual mood.  Mostly I've been bitching about side effects.  Because they've really sucked.

It's been two weeks since I've titrated up to 200 mgs of lamictal.  My mood was higher, and more even, for the first few days ... and then it rained for a few days.  The days got shorter.  My mood started slipping, and my late-afternoon troughs returned.  I'm still at a point where waking up to a cloudy day, or hearing something that's only a little sad, can leave me depressed for the rest of the day.  I'm seeing my shrink today, and planning to ask him if we can raise my dose.

But.  The last two days have been pretty good.  I think.  Maybe.  Too good?  Maybe.

A few nights ago, I stayed up until 4 am reading Tina Fey's book, Bossypants, after staying up until 2 am watching Voltron.  It was hilarious.  So was Bossypants.

Monday, October 17, 2011

In Which I Ponder My Eccentric Family, and the Nature of Existential Boredom

I'm taking a trip during the last week of October to visit my grandmother.  I've been anxious about the trip for a lot of reasons.  I don't know how much my grandmother's cognition has declined.  I don't know what it will feel like to see such a strong personality reduced to confusion.  Then there's the whole daylight issue; the days are a bit shorter in PA than they are here in Norcal, and she lives in the mountains, so they may feel even shorter than they are.  I'm concerned about my sleep.  On the one hand, it's normalized somewhat; on the other hand, I know that the three hour time change will probably mess it up.  Even so, it's settled in at 2 am to 9 or 10 in the morning.  And Grandma gets up early.

I've been trying to calm myself by reminding myself that my sister will be with me, and we can support each other when we need it.  It will be fun to see my grandmother and my aunts and uncles.  We'll also be able to give compassionate, concrete help to a family member in need.  I'm on medication and I'm bringing a portable sunlamp with me.  My pdoc has given me the OK to travel.  Everything will be fine.

Yesterday I realized that the underlying cause of my anxiety was actually none of these things.  It's the fact that there's no internet at my grandmother's house.  How pathetic am I, right?

I started to laugh at myself, and my anxiety evaporated.  I can survive without the internet.  I've done it before.  So why does it feel like such an existential threat right now?  Well, like so many answers, this one lies in the past.  It also has much to do with the eccentricities of my late grandfather.

Sunday, October 16, 2011

Exploding Head Syndrome: D00d srsly, it's a thing

Last time I visited my pdoc, he was on about cortisol levels as a possible cause of my mood problems.  I'm what's called a "night owl" -- I'm one of those people whose natural circadian rhythm has me falling asleep between 2 or 3 am, and waking up around 10 or 11 am.  Apparently night owls experience some sort of cortisol trough between 4 pm and 8 pm (which is the time my own mood likes to burn down, fall over, and sink into the swamp).  My doctor theorizes that I'm somehow more sensitive to this trough than other people.  Unlike most people, who feel a little sleepy and have a cup of coffee, I spend the hours between 4 pm and 8 pm sobbing my heart out because my cats are going to die someday.

In an effort to be a good, self-educated crazy person, I decided to do some research about cortisol, night owls, and all that jazz.  In the course of this, Wikipedia suggested that a related article concerned Exploding Head Syndrome.  Honestly.  It's a thing.  Not just a metaphor that describes my sinus-and-ear infections, but a thing that's somehow related to night owls and cortisol.  I'm sure it's extremely unpleasant for people who suffer from it, but still ... BWAAAAAAAAAAAAAAAHAHAHAHAHA! Exploding Head!

Saturday, October 15, 2011

Lamictal 200 mgs: Electrolyte Imbalance Causing Constipation?

I've been bitching for several weeks about the sudden constipation that accompanied my titration up to 150 mgs of lamictal, and that seems only to have gotten worse when I went up to 200 mgs.  This side effect has been particularly distressing because I basically can't do anything about it.  When you're constipated, it's usually because you're not getting enough fiber, right?  So add fiber to your diet and you'll be fine.

Problem is, I was already eating a high-fiber diet, with plenty of greens, fruit, and whole grains.  I tried adding prunes, water soluble fiber, and laxative tea (the last one doesn't help much, since you aren't supposed to take laxatives for more than a week at a time).  Then I tried adding Cheerios, which I really can't stand, but decided to try because they've always been my personal Laxative of Last Resort.

Each of these interventions has helped ... sometimes.  And only slightly.

Friday, October 14, 2011

Lamictal 200 mgs: Bruxism is Back?

In a previous post, I wrote about how lamictal has affected my muscle tone.  I'm no longer stiff after working out, and my muscles in general are looser.  In the same post I wrote that my bruxism had improved a lot on lamictal -- I no longer seemed to grind my teeth at night, and my jaw wasn't clenched when I woke up in the morning.  This was pretty great, since I've ground my teeth my whole life.

In recent days, it seems like the bruxism is returning.  My jaw isn't clenched when I wake up, but the muscles there are a bit sore.  I'm not sure whether this is a side effect wearing off or not.  I certainly hope not.

So I'm currently testing a theory: that the jaw pain is actually related to stiffness in my neck.  I've been noticing for a few weeks now that my neck has been stiff in a way that once landed me in physical therapy, where I got a lecture about proper sitting posture while working at a computer (or playing a keyboard instrument, which was the real issue at the time).

Ironically, I think this problem arose because I was trying to be more ergonomically correct.  Generally, I'd been working on the couch with my laptop.  A few weeks ago, when I started using my sun lamp in the mornings, it was easier to set it up on my studio table than to prop it up next to me on the couch.  And anyway, using an ergonomically designed external keyboard should be better for me, right?

I now think I was wrong.

Tuesday, October 11, 2011

By Request: What Adult ADHD Feels Like

Today's post is is by request, by Mo over at Milligrams blog.  I had left a comment on a post he had written called "Depression Without Sadness".  He described having a week off work, feeling like he should get off the couch and go do something, but lacking the motivation to do it -- even though his mood was pretty good.  I commented that this sounded a lot like me, before I was medicated for my ADHD.  Mo emailed me to ask me to write about ADD.  Could I write a post about my experiences with it?  What does it feel like to have it?  What meds do I take?  What's my experience on those meds?

Some of these questions are hard to answer.  It would be easier for me to describe how it "feels" to have ADHD if I had any idea how it felt not to have ADHD.  As for my experiences with ADD ... well, that would be my life story.  I decided to tackle this by considering my subjective experience of the world -- how I perceive it, internalize it, interact with it.

What I wrote is still pretty long, so I apologize if you have ADHD and find it overwhelming.  To help with that, I've broken it into sections, which are titled in bold face.  The sections describe my unmedicated brain on those rare "good" days, and then my unmedicated brain on "bad" days (which was most of them).  This is followed by an attempt to put the ADD experience into an analogy that a non-ADDer might understand.  Finally, there is a section about my experience with my ADD medication.

Friday, October 7, 2011

Lamictal 200 mgs: Cheerios, the Laxative of Last Resort

After experiencing some relief from bloating and gas (but not the constipation) that emerged when I titrated up to 150 mgs, I landed right back there when I hit 200.  My stomach hurts, my pants don't fit, and -- I'm sorry if I'm being gross here -- I just want to take a godsdamn shit.

This has brought me to my Laxative of Last Resort: Cheerios.

Since I was a teenager, Cheerios have gone right through me.  This is one reason I hate them.  The other reason is that they were the only cereal deemed to be "healthy enough" by my parents, so I ate them every effing morning until I was eight years old.  My friends, of course, got to eat Fruit Loops or Frosted Flakes or Lucky Charms.

My parents told me that my suffering was due to the fact that they loved me enough to make sure that my teeth didn't rot and I developed healthy eating habits.  Like most young children, I didn't believe them.  They made me eat Cheerios because they were mean!

Then, O glorious day!  Special K made the cut!  It was so exciting compared to those effing Cheerios!  I swore I would never eat Cheerios again.  And for the most part, I stuck by this promise to myself.  The exception was if I went to Girl Scout camp.  Cheerios got put in our gorp for some reason.  I noticed that not only did they made me run for the latrine, but they gave me mild heartburn.  I started eating around them.

Wednesday, October 5, 2011

Lamictal 150 mgs: An Overview of Mood and Side Effects

Today is my last day on 150 mgs of lamictal.  I've been at this dosage for a month, and tomorrow I'll be going up to 200 mgs.  This month has been difficult for several reasons -- life stress, mood stress, and side effect stress.  I guess I hit the trifecta.  Lucky me.

Being on 150 mgs has definitely improved my mood, but my mood suffered with the shift into autumn, so I started using my sunlamp.  In spite of this, during my third week on this dosage, I experienced more 4 to 8 pm troughs than I had in the previous two weeks.  The fourth week was much better.  What was different during the fourth week?  I had my period.

Yeah, I know that's not the stereotypical way for things to go.  And strictly speaking I don't have periods because I'm on hormonal birth control.  But this past week has been my "off week".  For some reason, hormonal birth control (this includes both The Pill and the NuvaRing, which is awesome) interferes with lamictal.  When you take your "off" week you have more of the med in your system.

Anyhoo.  My mood has not been high enough or stable enough for me to stay at 150 mgs.  It suffered with the waning light, it suffers when it's cloudy, and today, gods help me, it's raining.  The light will continue to wane, and my mood along with it.  When daylight savings time ends, it will suddenly be getting dark an hour earlier, and that's the point at which I started to crash last year.  In light of that (haha!), I'll be asking my doctor if I can ultimately go up to 300 mgs.  I just don't want to take any chances.

But the most remarkable thing about titrating up to 150 mgs has been the side effects.  Whooboy, the side effects.

Lamictal 200 mgs: Day 1

Today is my first day on 200 mgs of lamictal.  I only took it an hour ago, but one thing of note is that I'm already feeling pretty anxious.

Of course, I have external reasons to feel anxious.  My relationship is going through a very rough patch, our first counseling session went very poorly, and I'm honestly afraid to go back.  In addition to that, I'll be visiting my grandmother in a few weeks, and that's bound to be emotionally challenging.  It doesn't help that, since I'm using frequent flyer points to get out there, I have limited availability regarding flight times.  I was supposed to coordinate with my sister about arrival times, but I can't get ahold of her.  I'm afraid that if I wait too long, I won't be able to get the tickets at all, but if I go ahead and book the flights, I'll be inconveniencing everyone by arriving at a weird time.

Hmmm.  Having written that, I think maybe I'm over-thinking this.  Arriving at an inconvenient time would hardly be a disaster.  It's not like I'll miss a wedding or something.

I'm also worried about going crazy again as the days grow ever shorter.

It's not helping that the weather is being damned weird today.  It went from lovely and sunny to dark and raining to lovely and sunny again.  This would be typical weather in the upper Midwest, where I grew up, but for my part of NorCal, it's really not.  I don't know why, but I've always been uneasy when the weather does weird things.  What with climate change and everything, I guess I'll be dealing with a lot of that.

Tuesday, October 4, 2011

The Innermost Circle of Hell: Relationship Counseling

My partner and I started seeing a couples counselor last month.  What with my partner's travel schedule, and the counselor's travel schedule, our second visit wasn't until a few days ago.  And it was awful.

The therapist we're seeing uses the Gottman Method.  We chose this method because it's evidence based, and we're both big fans of that sort of thing.

Another thing that appealed to me about the method is that you start with exercises that help you build positive feelings your relationship.  This is supposed to give you a strong foundation of love and affection from which to work on conflict management.  Conflict management, by the way, is supposed to be one of the later steps in the process.

For some reason, our therapist chose to bypass this step.  My partner mentioned one of his frustrations, and the therapist asked me if I was OK with using the session to address it.  I wasn't, really; but I figured, hey, this process isn't always going to be comfortable for me, right?  Besides, our therapist was there to help us if things got bad, and maybe he could teach us some new skills to keep it from getting bad in the first place.


Monday, October 3, 2011

Walgreens: It's Where to Get Decent (Teva) Lamotrigine

As I mentioned here, since I wrote about my experiences with the horrible NorthStar version of lamotrigine (generic lamictal), I've noticed that the top google phrases that lead to my blog are things like "NorthStar lamotrigine" and "NorthStar lamotrigine side effects".

Lamictal is a very unusual drug in that its generic versions can vary widely, not just in the side effects produced, or even in efficacy, but the actual bioavailability of the drug itself.  Officially, some generics only have 80% of the bioavailable medication that brand name Lamictal does.  In fact, the only generic that is identical to brand name Lamictal is produced by the drug company Teva.

Most health plans ding you for buying a brand name drug when a generic is available.  In fact, many will refuse to pay for a brand name drug at all, unless your doctor specifies it on your prescription.  Obviously, then, the thing to do is get your hands on Teva lamotrigine.  But not all pharmacies carry it.  So where do you find it?