Lamictal 300mgs: Nearing My Psychoversary

It was last year at this time that things started to get really bad.  I felt OK during the sunny days, had low energy during the cloudy days.  Once it hit 4 pm though ... then The Thoughts started coming.  They went something like this:

There's not enough light in the house.  There's not enough light in the universe! But if I turn on all the lights in the house, I can keep it from tipping into the darkness.  

So ... darkness somehow "weighs more" than light?  That doesn't make any sense; how can darkness "weigh" anything?  It doesn't; it just doesn't.  

On the other hand ... I the dark, cavernous maw in the other room is sort of bugging me. All right, I'll humor myself, I'll turn on every damn light in the house.

And then, as the weeks wore on:

Lamictal 300 mgs: Dark Thoughts

Several months ago, I wrote about why I didn't realize my depression was worsening: because I was nowhere near The Pit.  Like a lot of depressives, when I get depressed I feel like I'm falling, as if I'm circling a dark pit, as if I'm falling into it.  Or at least I used to.  Before my psychotic episode I had no such feeling, and it didn't occur to me that I was headed for trouble.

I've been at a loss to describe what did happen to me last year.  But last night I had just a brief glimpse of it.  This horrible feeling welled up for a few minutes, kind of like what happened last year but nowhere near as serious ... it felt like ... like ...

It felt like I was being engulfed by a wave of devouring darkness.  It's not falling into The Pit.  Trust me, they're totally different.  Believe me, the devouring darkness is worse.  But this being me and all, I felt better immediately when I could assign a dramatic metaphor to what I was feeling.

And yes.  If it happens again, or lasts more than five minutes, I'll be calling my shrink.

ADHD Medication and Federal Law: Why Is It Such A Hassle To Get My Medications?

A few weeks ago, Mo over at Milligrams asked me to write a post on ADHD.  I realized that responding to his comment on my post actually required a series of several more posts.

Today's post addresses is actually one in a sub-series, concerning the legal issues that pertain to ADD medication.   This post United States covers federal drug laws, which operate under the United States Federal Controlled Substances Act.  When you're having trouble finding treatment for your adult ADHD, it pretty much comes down to the Controlled Substances Act.  That's why I'm beginning my series with this topic, even though it's rather dry.


*** Today's post concerns federal law and how it affects the simple act of filling your prescription.  I will begin with a brief overview of the classification of ADD medications under the federal Controlled Substances Act.  I will define the term"Schedule II medication".  I will go on to describe what that classification means when it comes to filling prescriptions ADHD meds.

As always, this long and complicated post is broken up into sections which are named in bold.  I will recap the main points of my post at the end.


And because it makes me feel better to write it, even though I'm sure you know better, I want to make it clear that I am not a lawyer, and this post should in now way be construed as legal advice. ***

The United States Controlled Substances Act: Schedule II

By and large, medications for ADHD are psychostimulants, and they generally fall into one of two categories: amphetamines and methylphenidate.  Under the US Controlled Substances Act of 1970, these drugs were designated as Schedule II controlled substances.  Schedule II includes any medication that has a high potential for abuse and addiction.  To put this in some context, other meds in this category include cocaine and opium.  

(To put it in even more context, the only class of medications that is more restrictive is Schedule I.  Schedule I drugs have no recognized medicinal purpose in the US and can only be used for research.  An example of a Schedule I drug is heroin.)

Notice the bold font I used up there, in the section on Schedule II? I wanted to make the point that this is some serious sh*t. 

As you might imagine, Schedule II drugs are tightly regulated by the feds.  But that's not the only set of laws that regulates these meds.  The Controlled Substances Act permits states to enact whatever regulations they want to regarding a controlled substance -- as long as those state regulations are even more stringent than federal law. I'll get into that in a later post.

What Does the Schedule II Classification Mean for Filling Prescriptions of ADD Medications?

Obviously, any prescription medication needs a prescription from a practitioner order to be dispensed -- otherwise, it wouldn't be a prescription med.  Where Schedule II medications differ from other meds is how the scrip can be transmitted to the pharmacy, and how many refills are allowed.  Unlike other, less regulated medications, Schedule II drugs are subject to the following rules.  And these are just the rules that pertain to pharmacists:

• Schedule II drugs cannot be dispensed without a written prescription from a medical practitioner.  There are two exceptions to this:

• The prescribing doctor is the one giving you the meds, and is you're the end user.  In other words, your pdoc can give you free samples of Medication X  -- if you are the person who will be taking the medication -- to make sure the medication is effective, you can tolerate it, etc, before you pay for a whole month's prescription.  Basically this means that you have to be an adult patient.  Your child's pdoc can't give you free samples on behalf of your kid, because you're not the end user.  And you can't just go giving drug samples to kids.

• It is a medical emergency, in which case oral permission from a practitioner is sufficient.

• There can be no refills of a Schedule II medication.

In short: None of the conveniences available for other prescriptions are available in the case of a Schedule II.  You have to have a written scrip -- your doctor cannot phone it or fax it in.  And when it comes time to refill?  You have to bring in a whole, brand-new, written prescription.

(The section of the Controlled Substances Act that governs the dispensation of Schedule II drugs is

Title 21 > Chapter 13 > Subchapter I > Part C > Section 829.  It can be found at on the website at the Cornell University Law School.  Go on, click on it.  It's exciting!  Besides, all the cool kids are doing it.)

What Do Schedule II Dispensation Rules Mean For Patients With ADHD?
 
Reading the last paragraph, it might sound like federal law requires people with ADD to see their psychiatrists once a month just to keep taking their prescribed medication.  Sounds like a major inconvenience, doesn't it? Is this really the case? Well, that depends.

Prescribing Schedule II Drugs Under California State Law:

In California, the answer  -- from a legal perpective at least -- is NO.  Granted, some pdocs might prefer to check in with their patients on a monthly basis, sometimes for good reasons, and sometimes for bad ones (more on that later).  But as far as the law in concerned, psychiatrists can write multiple prescriptions for a Schedule II medication and post-date them.

This is what my pdoc does.  By this point he knows me and trusts me, so I see him once every three months for a med check/depression check, and he then he writes three scrips with an "OK to fill after [this date]" notation.  That being said, he saw me once a month at the beginning; partly this was to check in with the meds, and (though he didn't say this outright) to make sure I wasn't tweaking. 

Other doctors like to see their patients once a month regardless.  It's not their legal obligation; they just feel more comfortable checking in more often.  Or, in some cases, they might prefer to bill the insurance company a monthly fee, and make more money than they would by seeing the patient every three months.

Again, this is the case in California, and if you live in another state the situation might be completely different.  Even so, when it comes to prescribing Schedule II's, doctors can impose all kinds of restrictions on their patients.  But that's a topic for another post.

To recap for my ADHD readers who just skimmed this post (and if I hadn't written it, believe me that's what I would have done):

• ADD meds are placed in Schedule II under the Controlled Substances Act, along with drugs like opium and cocaine.
• Schedule II substances require a written prescription, with a few exceptions (such as emergencies)
• Schedule II substances cannot be refilled
• Some doctors require monthly visits from their ADHD patients in order to give them the written scrip
• In some states, this is the law; in others, it's the doctor's personal preference

The next post in this series discusses drug laws and the impact they have on prescribing doctors.  The third post is about what it's like to live under these laws.

Lamictal 300 mgs: Depression and Some Thanksgiving Gratitude

I complain a lot in this blog.  Its intended purpose was to be a mood diary, and while it is that, it's also become a place for me to vent about my life.  I write here to clarify my thoughts and feelings -- but also to bitch about -- my meds, my mental illness, my learning disabilities, and the impact they have on every single area of my life.

Today I've decided to do something else.  In honor of Thanksgiving weekend, I've decided to list the things I'm grateful for.  I've also decided to make this a weekly feature of my blog.  I whine a lot.  In fairness, the last year of my life has really sucked.  But there are also plenty of good things about my life that I should acknowledge more often. 

Besides, gratitude has been shown to protect against stress and depression, so it will even do me some good.  Ironically, given a post I wrote a few days ago, I'd like to express gratitude for my medications.  For all my issues with Big Pharma, for all my concerns about the long-term side effects they might have, the simple fact is that my meds dramatically improve the quality of my life. 

My Pharmacoepia

Just for fun the other day, I decided to compile a list of all the medications I take.  Here they are in all their scary, scary glory.

Morning cocktail:

• Lamictal, 300 mgs (mood stabilizer)
• Vyvanse, 70 mgs (long-release amphetamine to treat ADD)
• Claritin, 10 mgs (anti-histamine)
• Nasacort, 2 puffs each nostril (corticosteroid to keep my sinuses and ears from inflaming)
• Singulair (leukotriene inhibitor to prevent asthma symptoms

Midday:

• Adderall, 5 mgs  (used as an amphetamine "booster" to treat late-afternoon mood slump)

Bedtime: 

• Ativan, 1.25 mgs.  

Monthly:

• My good and dear friend, the Nuvaring (birth control)

As Needed:

• Q-var (corticosteroid for wheezy asthma -- I pretty much have this for emergencies)
  
• Abuterol (corticosteroid for acute asthma attack -- I need this even less often than the Q-var)
• Phenlyephrine (decongestant that is MY BEST FRIEND, because I can't tolerate Sudafed; for the longest time there were no other decongestant options out there, but phenylephrine was released because you can't cook meth from it.  Thanks, crystal meth epidemic!)
• Advil (If you don't know what this is, you live under a rock and probably don't have internet anyway)
• Booze (for fun.)

My poor liver.  My poor, poor liver.

 

Lamictal! Adderall! Ativan! The Musical!

In yesterdays post I wrote about feeling tied to my sunlamp for most of the day.  This is particularly bad during the late afternoon during my usual 4pm to 8 pm slump.  It's seriously cramping my style.

I saw my pdoc recently, and he was concerned about the slump.  He wants to try other things before raising the dose of lamictal.  It which seems fair enough. 300 mgs of lamictal is as high as they usually go to treat mood disorders; 400 mgs and upwards puts you into anti-convulsant territory.

So his suggestion is to take 5 mgs of Adderall XR in the afternoon.  Great.  Another drug.  I wasn't already feeling like my pee could be sold as a street drug that "will really make you trip, man!  This stuff is primo!"

Hmmm.  Maybe there's a profit to be had there ...

Yesterday was the first time I tried the Adderall booster.  It definitely helped my mood, but I slept like crap last night.  I was exhausted, and hope to sleep like a baby.  As I sometimes (OK, all too frequently) do these days, I had two drinks to make damn sure I would sleep well.

Your Recommended Dose of Irony: My Sunlamp is Depressing Me

In case you haven't read any other post on this blog, I have severe seasonal affective disorder.  Now, you're asking yourself, how "severe" can seasonal affective disorder really be?

It can be SO SEVERE, that's right folks, SO SEVERE that one can become actually psychotic due to lack of sunlight.  (I've written about it here, here, here, and here.  Also, on a lighter note, here.

Since I don't want to wind up psychotically depressed again, I sit in front of a sunlamp.  A lot.  My sunlamp is in my brightly-lit art studio, which also has full-spectrum lighting.  It's very bright in here.  Which is good.  It helps me.  But it's also getting kind of old.

I need to sit by the sunlamp in the morning, so I do that while checking my email and blogging.  Then I get distracted by checking my email and blogging ... and besides, I just feel so much better when I'm by the lamp.  So I'm here at 9:30 or 10 every morning, eating breakfast and messing around on my computer.  I do that for a couple of hours.

Then, I have to be back in front of the sunlamp when it starts to get dark.  My mood slumps, sometimes severely, between the hours of 4 and 7 pm.  Now that it's getting noticeably dim by 3:30, I have to be here by that point, or the dreaded slump begins.  On days when it's rainy and dark I just park myself here and stay all day.

The problem is that it gives me no flexibility in my afternoon schedule.  Having lunch with a friend from 1 to 3?  Can't stay an extra hour.  Can't run errands afterward.  Can't come home and exercise -- nope, need to sit in front of the damn lamp.  And it's not like I can move the lamp; I need to be in my studio, where it's generally bright, or I start to slump.  Anyway, having a light that emits 10,000 lux seriously strains your eyes if it's all up in your face in an otherwise not-brightly-lit room.

The Gottman Method of Marriage Counseling: It Might Not Be What You Expect

UPDATE:  Thanks to a google alert (presumably), an employee at the Gottman institute got in touch with me regarding this post.  This individual was able to ascertain that my couples therapist is not, as we were led to believe, Gottman Certified, and they've kindly offered to help my partner and me find someone who is. 


I hope to learn how to verify Gottman Certification, at which point I will write a post about that.  As for this post, I will be leaving it up for the sake of informing others how misrepresentation in marriage counseling can go horribly wrong.  I may revise it or remove it in the future depending on how events play out.


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

When it became clear that my husband and I needed marriage counseling, we found an outfit that used the Gottman Method.  We signed up with a local counseling clinic that offers a series of 12 sessions designed to Improve Your Relationship by Building Intimacy and Communication Skills.  Counselors who work with the Gottman method are certified by the Gottman research institute.

Six sessions into our twelve week session, I thought I'd evaluate my experience with the Gottman method and its effectiveness so far.  It's a big topic so it's going to be a series of posts.  This, the first post, will discuss the assumptions and expectations I had going into it and how they've played out.

First, a few words about the Gottman method and why we chose it.  The method is based on two things:  Dr. John Gottman's years and years of psychological research, and Dr Julie Gottman's years and years of clinical experience.  We chose this method because of its research and evidence-based foundation. Based on Gottman's own website, we thought that

Gottman Method Couples Therapy is a structured, goal-oriented, scientifically-based therapy. Intervention strategies are based upon empirical data from Dr. Gottman’s three decades of research with more than 3,000 couples.

I have ADHD.  We have some serious issues gnawing away at the foundations of our marriage.  We're kind of floundering right now.  In other words, structure sounded pretty good.

Testing for ADHD: Simple Psych Evaluation? Or Complete Pysch Battery?

This post is long, so out of kindness to readers with ADD, I've summarized it at the end with nice bold bullet points.  Also, I'm not a doctor and I'm not a psychologist, so you know this isn't medical advice, right?  

Good.

I'm glad to be in correspondence with Mo over at Milligrams Blog.  We've been through a lot of the same shit.  And lately he's been raising some very good questions about ADHD -- what it's like, how it's treated, and the latest question, how it's diagnosed.

He thinks that a lot of his symptoms could be explained by ADHD, and recently asked his doctor about getting an evaluation and medication for the condition.  In a comment to my earlier post, he said that his doctor, who's an addiction specialist among other things, wants him to get a full neuropsychological evaluation before putting him on potentially addictive meds for ADD.  The psych eval will take several hours.  His insurance company won't cover it.  And he's never heard of this one before.

I'd always read that ADD is diagnosed by a psychiatrist carefully interviewing the patient, their family members, and looking at records like old report cards in order to establish that the symptoms have been present since childhood.  Symptoms must also be present in all areas of a patient's life -- education, work, home, leisure, interpersonal relationships ... you name it.

I'd also read that neuropsych evals were considered problematic for diagnosing adult ADHD, and were not often done.  Certainly there are plenty of folks on ADD Forums who were diagnosed through psychiatrist interviews alone.

I was surprised to learn that (according to Wikipedia and WebMD anyway) neuropsych batteries are supposed to be part of the adult ADD diagnosis. 

Lamictal 300, Ativan 1.25 mgs

Last week I wrote that I'd been feeling tired and lethargic.  I thought it might be titrating up to 300 mgs of lamictal.  Or maybe the time change.  Or maybe that I'd let my exercise routine slide.

A few days later I had another thought.  Maybe it was a hangover effect from the Ativan I take for sleep?  My pdoc had recently increased my dose, from 1.0 mg to 1.5 mgs.  When I first started taking it, he warned me that there could be a hangover effect.  Maybe Ativan was my problem.

The problem is that 1 mg of Ativan isn't enough to help me sleep.  1.5 mgs might be too much.  Maybe 1.25 was the answer -- but pills are 1 mg, with scoring down the middle so they can easily be broken in half.  Would it even be possible to break one half of a pill into equal halves?

The answer, I am here to tell you, is yes.  I used a pill cutter, but a sufficiently sharp knife would work.  1.25 mgs works just dandy.  I can fall asleep, and I'm not lethargic and logy the next day.  It's a good thing. 

In case you've never seen a pill cutter, here's what one looks like:

A standard pill cutter. 

 

If you take a lot of meds, you will probably need a pill cutter someday.  I got mine at Walgreens.  The one above links to Amazon.com, because I figured since I'm using the image without permission I should link it. 

LEGAL DISCLAIMER: If you buy this from my link, I will not earn any sort of royalty or commission -- I used to have an Amazon affiliate account, but last summer they shut down their program in CA over some tax dispute with the legislature.  So, no more Amazon commissions for me.