Every two months I have an appointment with my psychiatrist for "medication management." That's what they call the 20 minutes I have to meet, discuss, and make any changes to my medications.
I met with Dr. G on Friday. It was in the morning so I was sure to be groggy and miss some something.
We talked about the usual stuff: sleep, meds compliance, exercise, diet, and medication effectiveness. However, we spent most of the time going over my disability retirement application.
Disability Retirement
The disability retirement program is for federal service, not social security disability. However, as a condition of the federal program I also have to apply for social security disability. I did this last month. I am doubtful they will approve my application.
Social security disability has a higher bar or threshold for acceptance than the federal disability retirement. They require that you must not be able to perform any gainful work due to a medical condition that will last at least 12 months. However, for the federal system the applicant need only be unable to work in their current job because of a medical condition.
Anyway, Dr. G and I spent a lot of the appointment discussing how my bipolar impacts my ability to do my work. For example, during a bipolar depression I struggle with concentration and memory problems. This makes it difficult for me to effectively read and analyze technical reports, which is an essential function of my job.
Dr. G typed what we came up with in her notes. The notes will be used to document how the illness impacted my ability to do my job. When the notes are typed up in the required format along with some additional information it is called the Physician's Statement.
Medication
Dr. G and I discussed possible changes to my medications. She mentioned Seroquel and Remeron. I am reluctant to start another mood stabilizer at this point.
I am trying to reduce my psych meds. I recently got of Abilify and now I am considering stopping Cymbalta. I don't think it is doing much anymore.
However, I do want to try the supplement N-Acetyl-L-Cysteine or NAC. I recently did some research into NAC and it seems worth trying. So we agreed that I'll try the NAC and see how things go. In the meantime I will research Seroquel and Remeron although I'm not very excited about either of them.
That's about it. Won't be writing about Dr. G for a while since my next appointment isn't until May. She's overbooked.
Showing posts with label psych meds. Show all posts
Showing posts with label psych meds. Show all posts
Wednesday, January 25, 2012
Thursday, December 15, 2011
Medication Withdrawal Effects
I've been searching the web lately trying to better understand potential adverse health effects from psychiatric drug withdrawal. Why can one person get off a psych med without hardly an ill effect while another will suffer for months during the process? Hmmm, this looks interesting.
Each person's brain/body responds differently to drug withdrawal, just as each brain/body reacts differently to a new drug. In the latter the process can produce adverse reactions we call side effects. For drug withdrawal, troublesome symptoms are usually called withdrawal effects. A more fancy term being used is discontinuation syndrome.
Withdrawal Effects. Withdrawal from psychotropic medications can include flu-like symptoms such as fatigue, lethargy, aches, insomnia, diarrhea, nausea, and dizziness. Some people become hospitalized because of the withdrawal process. The experience can be horrible and last months or even years according to those who've been through a bad withdrawal.
In an online web forum one practicing M.D. was quite critical of the withdrawal effects from psych meds. He lamented that there are some patients who's experiences are so bad that they end up deciding to stay on the drug, even when they have determined it has no therapeutic value for them. They were stuck on a drug that wasn't working because withdrawal was too excruciating. What's worse, some unfortunate souls in this situation continue to experience withdrawal effects even after getting back on the drug!
From an article on antidepressant withdrawal, the writer says withdrawal effects are more likely to occur (a) if you have been on the medication for six weeks or longer and (b) if you are within the first two weeks of the tapering off process.
Drug withdrawal symptoms are reported across the psychiatric spectrum. An article in the journal Medical Hypothesis reports withdrawal effects in antidepressants, antipsychotics, lithium, and benzodiazepines such as Xanax.
I was quite concerned about withdrawal effects from the antipsychotic Abilify (aripiprazole) during my recent tapering off from it (see my last post on 12/12/11 about this). I didn't do much research before stopping. I just hoped for the best. Fortunately things worked out well for me.
Some personal websites were particularly grave about the withdrawal effect. I bet these folks are the unfortunate ones who have debilitating symtoms that can last for many years.
We certainly need more research in this area. Without more information it is difficult to compare the risks and benefits of stopping. Perhaps there are other medications or practices we can do to minimize the withdrawal effect?
One big step in the right direction comes from a new company adverseevents.com. They are making it possible to readily find information about the toxic effects of medications including psych drugs. Their process uses a propriety algorithm to extract data from the FDA's Adverse Events Reporting System (AERS) and assemble the information into a useable and understandable format for patients and healthcare professionals.
Paxil. One drug that kept coming up was the SSRI antidepressant Paxil (paroxetine). According to a the Mayo Clinics Medical Edge Newspaper Column, Paxil is in a group of SSRIs that are the most difficult to quit. This is because certain SSRIs are metabolized (removed from the body) more rapidly than other SSRIs.
In one blog post the author explains her experience with Paxil withdrawal effects. Her reaction was so severe that they had to allow seven months for her to taper off. Withdrawal effects included headaches, lethargy, depression, dizziness, the "zaps" (whatever those are) and nausea. At the same time she says a close friend withdrew from Paxil with only headaches.
Adverseeffects.com reports withdrawal effect information about Paxil. Data they have from consumers between 1/1/2004 to 6/30/2011 that shows withdrawal from Paxil has a hospitalization rate between 5 and 7 percent! Wow, who knew?
I don't remember any withdrawal effects when I got off Paxil about 10 years ago. Maybe I was too depressed to notice. I remember I didn't respond well to the drug therapeutically.
Takeaway message. The symptoms from tapering off vary a lot from person to person and drug to drug. Trying to determine who will experience withdrawal effects and how severe those effects will be is really anybody's guess at this point.
We need to explore whether the long-term recommendation for bipolar disorder treatment should be indefinite use of psych meds? Should medication for life really be the presumptive remedy?
Finally, when stopping a medication it is critical to work with your psychiatrist so that the tapering off period is as gradual as necessary to control the withdrawal effects. You need to start low and go slow.
Each person's brain/body responds differently to drug withdrawal, just as each brain/body reacts differently to a new drug. In the latter the process can produce adverse reactions we call side effects. For drug withdrawal, troublesome symptoms are usually called withdrawal effects. A more fancy term being used is discontinuation syndrome.
Withdrawal Effects. Withdrawal from psychotropic medications can include flu-like symptoms such as fatigue, lethargy, aches, insomnia, diarrhea, nausea, and dizziness. Some people become hospitalized because of the withdrawal process. The experience can be horrible and last months or even years according to those who've been through a bad withdrawal.
From an article on antidepressant withdrawal, the writer says withdrawal effects are more likely to occur (a) if you have been on the medication for six weeks or longer and (b) if you are within the first two weeks of the tapering off process.
Drug withdrawal symptoms are reported across the psychiatric spectrum. An article in the journal Medical Hypothesis reports withdrawal effects in antidepressants, antipsychotics, lithium, and benzodiazepines such as Xanax.
I was quite concerned about withdrawal effects from the antipsychotic Abilify (aripiprazole) during my recent tapering off from it (see my last post on 12/12/11 about this). I didn't do much research before stopping. I just hoped for the best. Fortunately things worked out well for me.
Some personal websites were particularly grave about the withdrawal effect. I bet these folks are the unfortunate ones who have debilitating symtoms that can last for many years.
We certainly need more research in this area. Without more information it is difficult to compare the risks and benefits of stopping. Perhaps there are other medications or practices we can do to minimize the withdrawal effect?
One big step in the right direction comes from a new company adverseevents.com. They are making it possible to readily find information about the toxic effects of medications including psych drugs. Their process uses a propriety algorithm to extract data from the FDA's Adverse Events Reporting System (AERS) and assemble the information into a useable and understandable format for patients and healthcare professionals.
Paxil. One drug that kept coming up was the SSRI antidepressant Paxil (paroxetine). According to a the Mayo Clinics Medical Edge Newspaper Column, Paxil is in a group of SSRIs that are the most difficult to quit. This is because certain SSRIs are metabolized (removed from the body) more rapidly than other SSRIs.
In one blog post the author explains her experience with Paxil withdrawal effects. Her reaction was so severe that they had to allow seven months for her to taper off. Withdrawal effects included headaches, lethargy, depression, dizziness, the "zaps" (whatever those are) and nausea. At the same time she says a close friend withdrew from Paxil with only headaches.
Adverseeffects.com reports withdrawal effect information about Paxil. Data they have from consumers between 1/1/2004 to 6/30/2011 that shows withdrawal from Paxil has a hospitalization rate between 5 and 7 percent! Wow, who knew?
I don't remember any withdrawal effects when I got off Paxil about 10 years ago. Maybe I was too depressed to notice. I remember I didn't respond well to the drug therapeutically.
We need to explore whether the long-term recommendation for bipolar disorder treatment should be indefinite use of psych meds? Should medication for life really be the presumptive remedy?
Finally, when stopping a medication it is critical to work with your psychiatrist so that the tapering off period is as gradual as necessary to control the withdrawal effects. You need to start low and go slow.
Monday, December 12, 2011
UPDATE: Meds Change Successful!!
This post is an update to my ALERT: Meds Change post from the 11/16/11. At that time I had just seen my psychiatrist the Friday before on 11/11/11. I could of made it an 11 a.m. appointment and arrived 11 minutes late, but that would be silly.
My appointment was from 2 to 2:20 p.m. I hate those 20 minute "medication management" type visits. I feel I don't have enough time to process all the information and make good decisions on how to move my treatment program forward.
Anyway, I have been working with my pdoc since 11/11/11 to reduce and eliminate Abilify (Aripiprazole) from my medication regime. The good news is that I was successful, yay. I'm now Abilify free!
The dose reduction went like this:
My appointment was from 2 to 2:20 p.m. I hate those 20 minute "medication management" type visits. I feel I don't have enough time to process all the information and make good decisions on how to move my treatment program forward.
 |
| 30 mg Abilify Tablets |
Anyway, I have been working with my pdoc since 11/11/11 to reduce and eliminate Abilify (Aripiprazole) from my medication regime. The good news is that I was successful, yay. I'm now Abilify free!
The dose reduction went like this:
- On 11/11 reduced Aripiprazole from 30 mg to 15 mg each evening. Just break that tablet in half and swallow.
- On 11/23 reduced from 15 mg to 7.5 mg each evening. You should of seen those pills as I broke them into four pieces using my fingernails. I don't think they were meant to be broken up like that. They wanted to stay whole and complete. But the good doctor said do it so I did.
- On 12/7 I stopped taking Abilify completely.
I've been off the drug now for five days and things are going okay. I still have my moderate depression which can range from mild to severe depending on the brain biochemistry flavor of the day. I notice that I'm less tired in the morning and find it easier to get out of the darn bed each day. This is an important daily ritual for me. If I'm not out of bed by 9 a.m. then it's likely the whole day will be shot.
Most importantly I experienced no withdrawal symptoms. I am very pleased with my divorce to Abilify. It's going to save several hundred dollars over the year and I don't have to put up with its whiny, sleepy side effects.
Now I'm stable with moderate depression taking my three psychotropic meds, including Xanax as needed, up to 2 mg per day. I'm taking 60 mg Cymbalta, 450 mg Wellbutrin, and 300 mg Lamictal daily. Each day I also take 300 mg of Omega-3, a multivitamin, and 325 mg of aspirin.
I've been taking the aspirin for the last couple weeks after reading an article by James M. Greenbelt on how inflamation in the brain can make you insane in the membrane. He says, "It appears that inflammation and the complicated collection of immune system chemical messengers called cytokines play and important role in brain function and may cause psychological symptoms."
Not really a raving review for addressing brain inflammation but the article makes sense.
Another study was more promising, especially for people like me that have treatment resistant depression. He states, "A study involving depressed patients classified as non-responders supplemented each patients standard antidepressant treatment with the addition of aspirin, an anti-inflammatory. More than 50% of these patients responded to this combination treatment. At the end of the study more than 80% of the group responsive to the anti-inflammatory went into remission."
Now that's what I'm talking about. Remission. Wouldn't that be awesome. It's too bad there's not a similar study/trial evaluating aspirin as an add-on med for bipolar depression.
I think I'll keep taking the aspirin each day and see if it makes my brain feels less inflammatory, whatever that feels like.
I'm not sure what to do next. I can try and reduce or eliminate another pharmaceuticals. I'd go after Cymbalta next. I know I'd be a fool to get off the Lamictal and I respond well to Wellbutrin. I can not attest to the effectiveness of the Omega-3 and multivitamin. I think they make such a small difference in my mood that I can't tell if they are doing anything.
I also want to try the supplement NAC (N-acytelcholine). I wrote about it here. I am okay with the unidentified but likely low risks it poses. Yes, that's it. I'm going to stay with my current meds mix until my next pdoc appointment in January. We'll discuss taking NAC at that time. I think she'll go for it.
In the meantime I will enjoy my new found alertness and wakefulness. I hope it lasts for awhile.
Bye bye Abilify. That's one less box car of meds riding on this precarious, crazy train called me.
Most importantly I experienced no withdrawal symptoms. I am very pleased with my divorce to Abilify. It's going to save several hundred dollars over the year and I don't have to put up with its whiny, sleepy side effects.
 |
| Dopamine Receptors Impacted by Abilify |
Now I'm stable with moderate depression taking my three psychotropic meds, including Xanax as needed, up to 2 mg per day. I'm taking 60 mg Cymbalta, 450 mg Wellbutrin, and 300 mg Lamictal daily. Each day I also take 300 mg of Omega-3, a multivitamin, and 325 mg of aspirin.
I've been taking the aspirin for the last couple weeks after reading an article by James M. Greenbelt on how inflamation in the brain can make you insane in the membrane. He says, "It appears that inflammation and the complicated collection of immune system chemical messengers called cytokines play and important role in brain function and may cause psychological symptoms."
Not really a raving review for addressing brain inflammation but the article makes sense.
Another study was more promising, especially for people like me that have treatment resistant depression. He states, "A study involving depressed patients classified as non-responders supplemented each patients standard antidepressant treatment with the addition of aspirin, an anti-inflammatory. More than 50% of these patients responded to this combination treatment. At the end of the study more than 80% of the group responsive to the anti-inflammatory went into remission."
Now that's what I'm talking about. Remission. Wouldn't that be awesome. It's too bad there's not a similar study/trial evaluating aspirin as an add-on med for bipolar depression.
I think I'll keep taking the aspirin each day and see if it makes my brain feels less inflammatory, whatever that feels like.
 |
| N-acytelcholine (NAC) molecule |
I also want to try the supplement NAC (N-acytelcholine). I wrote about it here. I am okay with the unidentified but likely low risks it poses. Yes, that's it. I'm going to stay with my current meds mix until my next pdoc appointment in January. We'll discuss taking NAC at that time. I think she'll go for it.
In the meantime I will enjoy my new found alertness and wakefulness. I hope it lasts for awhile.
Bye bye Abilify. That's one less box car of meds riding on this precarious, crazy train called me.
Wednesday, November 23, 2011
Bipolar for life! Really?
The vast majority of folks with bipolar disorder have been told there is no cure and they'll be on medication indefinitely. I know I've been told this more than once by well meaning psychiatrists and mental health professionals.
I happen to agree with them, mostly. I don't consider myself well enough to even begin to think of getting off my meds these days. I wish I was better off. I want to say to people that I'm in a full remission.
But that is not the case. These days I'm either depressed or sleeping. I experience times with mild depression and other days I find myself entrenched in the dark mood. Most of the time I live with moderate depression.
Nevertheless, I persist with the hope that someday I will be able to be completely free of psych meds while holding the bipolar in remission. By remission I mean the disease is still there but it's not expressing itself in any significant way.
What are my chances of being symptom free without psychiatric medication? I don't know. But I do know that there are bipolar sufferers out there that have made it to a non-medicated state. So there is some chance. The possibility exists!
I'm not even sure of the steps I would take to get off meds. Would I start decreasing all my meds (abilify, cymbalta, lamictal, wellbutrin) at the same time or one by one? How fast should I get off each drug? The psychiatrist knows this information.
This is a delicate area. Nobody should attempt to go natural (off psych meds completely) without the supervision of a qualified mental health practitioner, usually a psychiatrist. Hopefully friends and family understand but that is not guaranteed.
Please note I am not a mental health professional and I am not giving medical advice here. I am just putting down my thoughts on the matter of being medicated for life.
 |
| photo by Salvatore Vuono |
I happen to agree with them, mostly. I don't consider myself well enough to even begin to think of getting off my meds these days. I wish I was better off. I want to say to people that I'm in a full remission.
But that is not the case. These days I'm either depressed or sleeping. I experience times with mild depression and other days I find myself entrenched in the dark mood. Most of the time I live with moderate depression.
Nevertheless, I persist with the hope that someday I will be able to be completely free of psych meds while holding the bipolar in remission. By remission I mean the disease is still there but it's not expressing itself in any significant way.
What are my chances of being symptom free without psychiatric medication? I don't know. But I do know that there are bipolar sufferers out there that have made it to a non-medicated state. So there is some chance. The possibility exists!
I'm not even sure of the steps I would take to get off meds. Would I start decreasing all my meds (abilify, cymbalta, lamictal, wellbutrin) at the same time or one by one? How fast should I get off each drug? The psychiatrist knows this information.
This is a delicate area. Nobody should attempt to go natural (off psych meds completely) without the supervision of a qualified mental health practitioner, usually a psychiatrist. Hopefully friends and family understand but that is not guaranteed.
Please note I am not a mental health professional and I am not giving medical advice here. I am just putting down my thoughts on the matter of being medicated for life.
Subscribe to:
Posts (Atom)