I'm pretty depressed right now. My life has been a bit like a bad country song lately: my cat died, my marriage is in trouble, I'm unemployed ... all I need is a midnight train out of town and the narrative would be complete.
Earlier in the week I was damn miserable. I'm not suicidal or anything; I don't have "a plan", and I really don't want to die ... except that I felt like I wanted to die. I didn't say this to my pdoc, but described my mood and motivation, and how they had suffered incredibly since the death of my dear kitty.
I figured that he'd up my abilify because it seems to be a very effective antidepressant for me. Instead he recommended that I try taking .5 mgs of ativan during the day as needed. At that dosage, he said, it shouldn't make me sleepy.
So yesterday I tried it. Within half an hour I needed a nap -- pretty amazing, given that I'm also on 70 mgs of amphetamine for my ADHD.
So much for that idea.
Showing posts with label meds. Show all posts
Showing posts with label meds. Show all posts
Friday, April 13, 2012
Friday, March 16, 2012
Does Lithium Work by Resetting the Body's Clock?
Biplolar Blog featured a really interesting story about a recent study of lithium. Lithium, of course, is one of the go-to meds for bipolar disorder. Scientists at Manchester University have discovered that the drug inhibits a "clock protein" called GSK3 (damn that GSK3!) which inhibits the the body's circadian rhythms.
This finding is interesting for a couple of reasons. First, it suggests that bipolar disorder is due in part to a dysfunction in the body's natural wake-sleep cycle. Second, it provides a refined target for possible new medications. Potentially, these medications may lack the side-effects of lithium -- side effects that often cause people to give up on the drug entirely, triggering another bipolar cycle. Finally, it sheds light on why so many people find light therapy, which also affects the body's rhythms, to be so effective at treating mood disorders.
Given all the problems I've had with my internal clock, and all the crazy shit I've had to do to regulate it, I gotta say this makes a hell of a lot of sense to me. You can read the whole article here.
This finding is interesting for a couple of reasons. First, it suggests that bipolar disorder is due in part to a dysfunction in the body's natural wake-sleep cycle. Second, it provides a refined target for possible new medications. Potentially, these medications may lack the side-effects of lithium -- side effects that often cause people to give up on the drug entirely, triggering another bipolar cycle. Finally, it sheds light on why so many people find light therapy, which also affects the body's rhythms, to be so effective at treating mood disorders.
Given all the problems I've had with my internal clock, and all the crazy shit I've had to do to regulate it, I gotta say this makes a hell of a lot of sense to me. You can read the whole article here.
Friday, December 23, 2011
Lamictal 300 mgs: Side Effect #2 -- Decreased Appetite, Weird Cravings
Lamictal and Appetite:
Continuing my series of the most noticeable side effects of lamictal, today's topic is loss of appetite. I've written 15 posts about this. I've found it to be less disruptive than the sleep issues, but at least those could be addressed with my blue light. Loss of appetite is far more persistent.
I started having problems with my appetite on July 19th. It's come and gone over the months, but mostly they've come and stayed. Right now, thanks to the Abilify, they've camped out on my lawn.
The appetite problems manifest primarily as difficulty eating breakfast. Not only am I not hungry,but food seems completely unappealing. My usual breakfast, which I've enjoyed for a few years now -- yogurt with dark cocoa stirred into it, a gluten-free carb (either bread or a waffle), and some salad greens -- often seems yucky to me. Breakfast often sits there for four or five hours as I slowly pick at it.
When I do eat breakfast in a somewhat normal fashion, it's because I'm eating dinner foods. Specifically, salty, fatty dinner foods. Green chile and cheese tamales from the farmers market. Weird omelets.
By 3:30 or 4, I'm ravenous. Unfortunately, this is my depressive time, and my breakfast problems haven't helped my mood any. On the other hand, I'm hungry enough that I to make up my calories in the afternoon and evening, so at least I'm getting enough of them.
Since this problem was beginning to abate after I'd been on 150 mgs for a month, I suspect it will disappear again once I stop taking Abilify.
Continuing my series of the most noticeable side effects of lamictal, today's topic is loss of appetite. I've written 15 posts about this. I've found it to be less disruptive than the sleep issues, but at least those could be addressed with my blue light. Loss of appetite is far more persistent.
I started having problems with my appetite on July 19th. It's come and gone over the months, but mostly they've come and stayed. Right now, thanks to the Abilify, they've camped out on my lawn.
The appetite problems manifest primarily as difficulty eating breakfast. Not only am I not hungry,but food seems completely unappealing. My usual breakfast, which I've enjoyed for a few years now -- yogurt with dark cocoa stirred into it, a gluten-free carb (either bread or a waffle), and some salad greens -- often seems yucky to me. Breakfast often sits there for four or five hours as I slowly pick at it.
When I do eat breakfast in a somewhat normal fashion, it's because I'm eating dinner foods. Specifically, salty, fatty dinner foods. Green chile and cheese tamales from the farmers market. Weird omelets.
By 3:30 or 4, I'm ravenous. Unfortunately, this is my depressive time, and my breakfast problems haven't helped my mood any. On the other hand, I'm hungry enough that I to make up my calories in the afternoon and evening, so at least I'm getting enough of them.
Since this problem was beginning to abate after I'd been on 150 mgs for a month, I suspect it will disappear again once I stop taking Abilify.
Thursday, December 22, 2011
Clonopin .25 mgs: This Med Is No Joke
I was having trouble sleeping a few weeks ago, so my pdoc wanted to try me on something that actually makes you sleep. Ativan (lorazepam is the generic) doesn't actually put you to sleep as such; it just makes your brain stop chattering or ruminating, so you're more relaxed, making it possible for your body to fall asleep.
So I tried it. My scrip was for .5 mgs, but since I didn't know its effects I cut the 1 mg pill in half, and then in half again (have I mentioned how much I love having a pill cutter?) and took .25. The next day I was a bit groggy. "Well", I thought to myself, "sometimes these things go away after the second day. I'll try it again tonight."
The next day I was exhausted, dizzy, and generally felt ill. When I made my weekly farmers' market run I felt like I had to put all my mental effort into driving safely, and even then I think was taking a risk. I had to bail on a friend's party, and we had to put off getting our Yule tree until the next day.
There are people who can take Clonopin (clonazepam) with no ill effects whatsoever. Mo at milligrams takes it for anxiety. A friend of mine also took it for anxiety, but only when she absolutely had to, because it put her down for a nap every time. I learned that I am not one of these people.
So I tried it. My scrip was for .5 mgs, but since I didn't know its effects I cut the 1 mg pill in half, and then in half again (have I mentioned how much I love having a pill cutter?) and took .25. The next day I was a bit groggy. "Well", I thought to myself, "sometimes these things go away after the second day. I'll try it again tonight."
The next day I was exhausted, dizzy, and generally felt ill. When I made my weekly farmers' market run I felt like I had to put all my mental effort into driving safely, and even then I think was taking a risk. I had to bail on a friend's party, and we had to put off getting our Yule tree until the next day.
There are people who can take Clonopin (clonazepam) with no ill effects whatsoever. Mo at milligrams takes it for anxiety. A friend of mine also took it for anxiety, but only when she absolutely had to, because it put her down for a nap every time. I learned that I am not one of these people.
Monday, December 19, 2011
Weekly Gratitude: Rats. Yes, really.
This week I'm expressing my gratitude for rats.
Yup. Rats.
Not the rats that ate my car a five years ago.* Not the rats that tried to live in my walls two years ago. Nor do I refer to the kind of rats that carry the plague and grow to the size of small racoons.
(At this point I feel compelled to remark that my rat problems are not a result of living in squalor. I don't. I live in a major city in CA, which has no winters to that would kill some of them. They like my yard because my neighbor has an apple tree that feeds them.)
No, I am not talking about vermin. I'm talking about lab rats.
I'm talking about the rats who run mazes and endure water tests to teach us about mammalian (and thus human) cognition. The ones whose bodies are used to test our psych drugs for animal safety. The ones whose lives are sacrificed, and their brains sliced up and examined, so that researchers can see first-hand the physical and chemical changes wrought by meds or other stimuli.
Because of these rats, neuropsychiatry is learning more and more about the physical differences that lead to brain dysfunction. Because of these rats, I have medications that enable me to be a functional person. Mad gratitude to the rats!
*OK, they only chewed the rubber insulation off the wiring, but saying that "they ate my car" is way funnier.
Yup. Rats.
Not the rats that ate my car a five years ago.* Not the rats that tried to live in my walls two years ago. Nor do I refer to the kind of rats that carry the plague and grow to the size of small racoons.
(At this point I feel compelled to remark that my rat problems are not a result of living in squalor. I don't. I live in a major city in CA, which has no winters to that would kill some of them. They like my yard because my neighbor has an apple tree that feeds them.)
No, I am not talking about vermin. I'm talking about lab rats.
I'm talking about the rats who run mazes and endure water tests to teach us about mammalian (and thus human) cognition. The ones whose bodies are used to test our psych drugs for animal safety. The ones whose lives are sacrificed, and their brains sliced up and examined, so that researchers can see first-hand the physical and chemical changes wrought by meds or other stimuli.
Because of these rats, neuropsychiatry is learning more and more about the physical differences that lead to brain dysfunction. Because of these rats, I have medications that enable me to be a functional person. Mad gratitude to the rats!
*OK, they only chewed the rubber insulation off the wiring, but saying that "they ate my car" is way funnier.
Wednesday, December 14, 2011
Abilify 2 mgs: Holy Clumsiness, Batman
I've written about the Lamictal Stupids before, and how Abilify seems to make them that much worse. Did I also mention that Abilify makes me really damn clumsy?
Yesterday I broke the last of our entry-level Reidel bordeaux glasses. We used to have two. Now we have none.
Care to guess when I broke the other one? It was last year. Shortly after starting my winter course of Abilify.
The glasses were a gift. They were our favorite wine glasses. They suited our shared taste for red wines, and they're suited well to a lot of California reds. Before you go thinking that we're affluent wine snobs, we're not -- our "house red" is a five dollar bottle of cabernet or shiraz or whatever else Trader Joe's has for five dollars. We loved those glasses so much because they made cheap wines taste like NOT cheap wine.
Of course, you may have guessed that if you read last week's post about how I gave myself a third degree burn on my forearm while taking pizza out of the oven. I've burned myself with the oven before; occasionally I graze my hand or arm on the oven rack, resulting in a small, minor burn. Never before have I actually made contact with the metal that lines the oven. Never before have I gotten a burn that's an inch long. Let alone one that's scabbed over, and that doesn't even hurt -- that last bit indicates nerve damage. Yay!
Yesterday I broke the last of our entry-level Reidel bordeaux glasses. We used to have two. Now we have none.
Care to guess when I broke the other one? It was last year. Shortly after starting my winter course of Abilify.
The glasses were a gift. They were our favorite wine glasses. They suited our shared taste for red wines, and they're suited well to a lot of California reds. Before you go thinking that we're affluent wine snobs, we're not -- our "house red" is a five dollar bottle of cabernet or shiraz or whatever else Trader Joe's has for five dollars. We loved those glasses so much because they made cheap wines taste like NOT cheap wine.
Of course, you may have guessed that if you read last week's post about how I gave myself a third degree burn on my forearm while taking pizza out of the oven. I've burned myself with the oven before; occasionally I graze my hand or arm on the oven rack, resulting in a small, minor burn. Never before have I actually made contact with the metal that lines the oven. Never before have I gotten a burn that's an inch long. Let alone one that's scabbed over, and that doesn't even hurt -- that last bit indicates nerve damage. Yay!
Monday, November 28, 2011
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:
(The section of the Controlled Substances Act that governs the dispensation of Schedule II drugs is
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):
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.
(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.
Friday, November 25, 2011
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:
Monthly:
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
- Adderall, 5 mgs (used as an amphetamine "booster" to treat late-afternoon mood slump)
Monthly:
- My good and dear friend, the Nuvaring (birth control)
- 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.)
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