More About Meds and Tooth Decay: Brush Several Times A Day

One of my most popular posts is the one about the dental problems that can result from taking meds for your brain.  As I said in that post, tooth problems aren't something that most pdocs even know about, let alone warn us about when we start taking crazy meds.  So you start a bunch of new meds for bipolar, depression, or ADHD, and suddenly your previously cavity-free mouth looks like that of a meth user.

I was at the dentist last week and learned something interesting, and a little counterintuitive, that I thought I should share with y'all: Drinking more water doesn't help your teeth.  I'd sort of assumed that it would.  I mean, if the problems are caused by your mouth being dry, wouldn't it make sense to make your mouth wet?

The problem with my hypothesis is that tooth decay, of course, is caused by bacteria.  Your mouth fights bacteria not with water, but with saliva.  Saliva has antibacterial properties.  Water does not.  Saliva also remineralizes your teeth, filling in any tiny pits that could develop into cavities later.  Water does not.  As my dentist said, "It just means you have to pee a lot".

My dentist recommends a lot of ways of dealing with this.  There's the high-flouride prescription toothpaste.  There are the mints and gum with xylitol in them, which stimulates saliva production.  Then there's plain old brushing.  By brushing your teeth several times a day, you get rid of that bacteria, and that prevents cavities.

Lamictal Stupids, Abilify Stupids, and a Third Degree Burn

The "lamictal stupids" are a reasonably well-known side effect of that med.  As for Abilify, it's a partial dopamine antagonist, so I guess it's not surprising that it has its own stupids.  But what happens when you add them together?

You get something that a friend of mine once called "not just stupid, but STOOPID".

My crowning Abilify achievement from last year was leaving my keys in my front door.  I live in a not-great neighborhood of a major city.  Thank the gods a decent person rand my doorbell to let me know: "that could be really dangerous!" he said.  Yes, I know.  That's why I've never done it before.

Since starting Abilify this year, I don't think I've remembered to lock my car even once.  Then I left my backpack (where I keep my wallet) in my car with the door wide open as I went to put away a shopping cart. 

The crowning achievement for this year: burning myself on the inside of the oven as I was reheating some pizza  (Abilify also seems to interfere with my ability to know where my hands are).  Then I forgot about it.  Later that night a noticed a classmate looking at my forearm, where there seemed to be a bad scrape with a bruise.  "That's weird," I thought.  I went home and tried to figure out what I'd hit my forearm on.  Then I forgot about it.

Two days later, the scab came off.  And I realized that it wasn't a bruise, or a scrape.  It was a godsdamn third degree burn.  Then I remembered burning myself reaching for the pizza. 

Now, between being a Girl Scout, and then a lifeguard, and then a Girl Scout camp counselor, and then a Girl Scout troop leader, I've been certified in first aid for at least half my life.  I damn well know what a third degree burn looks like.  And yet, it took two days for it to dawn on me that I was looking at a third degree burn.  Of course, for the prior two days, I was not caring for the burn at all.  I was waiting for the "scrape" to heal.

Now I'm doing the neosporin thing, and trying to keep it protected.  But I suspect this will leave a permanent scar.

Thanks, Abilify.

Lamictal 300 mgs: Plus 2 mgs Abilify, minus 5 mgs Adderall

The short version: my mood has been all over the place for the last week and a half.  My pdoc had two options.  Number 1: Go back on 12.5 mgs of Zoloft, which would numb me out a bit, and shouldn't give me SSRI problems because they'd be tempered by the lamictal.  Or, number 2: go back on Abilify for the short term at a very low dose; I'd still feel my feelings, but I won't be reduced to tears over stupid shit.

In other words, the lamictal is helping a lot with the depression, but it's not stabilizing my mood as much as it needs to, and it needs help.

We decided to try Abilify first. We know from past experience that it will work immediately.  I also think it's important to feel my feelings; I just need not to be completely overwhelmed by them.  I feel pretty good about this.  I can start it tomorrow and stop crying like an emo kid.

We're also removing the Adderall from my cocktail.  After two weeks it's clear that while it does help my mood, it doesn't help enough.  It also wreaks havoc with my sleep.   Unless I can be sure to squeeze in some seriously vigorous exercise, and I can't always do that, and messed up sleep equals messed up mood.

A few words about my mood lately.  At some times I'm feeling really good, almost too good, and for no particular reason.  Then if I'm triggered (or sometimes when I'm not), I crash and crash hard.  I start sobbing and simply can't talk myself down, let alone stop, for several hours.  When I finally do, I last about ten minutes before I start sobbing again.

What do I mean when I say "stupid shit"?  Well, let me tell you about the day after Thanksgiving.  We like to cook our own small turkey, because we like to do things with the leftovers.  But, unbeknownst to us, the turkey was partially frozen.  It probably was up against the side of the refrigerator case or something.  Anyway, it took all afternoon to cook (way too long for a 12 lb turkey, so I was already crying about that).  Then we cut into it, half of it was raw.

The rational side of my brain, and my husband, told me that this wasn't my fault, and that we could just use the turkey for stock, so it wouldn't be a total loss.

The crazy part of my brain was in tears because I'd wasted all day and my husband was sick so he couldn't help me cook so we hadn't spent time together and he was leaving the country the next day AND I RUINED THE HOLIDAY!

Don't even ask what happened when he returned from his trip and didn't immediately give me a hug.

I can't be crying so much that it interferes with my life.  And with my husband probably also being depressed, I can't be triggering that feedback loop where does something without knowing it will upset me, and then I start crying, and then he feels bad for upsetting me ... and gets stressed ... and I feel bad for stressing him out, so I cry more ... and he withdraws from me emotionally ... so I get more upset ... and the cycle begins anew.

To wrap up: Abilify.

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?