ANOTHER round of medication roulette?

[no name no slogan]

So I go to my psychdoc for the first appointment since my hospital stay this morning, and guess what:

HE WRITES ME THREE MORE PRESCRIPTIONS :WTF:

As some of you may know, I've been detoxing off FOUR different drugs over the past couple weeks. My hospital doc then writes me a scrip for Trileptal (mood stabilizer) which I started on a week ago.

I see my regular doc today for the first time in over a month, and he proceeds to prescribe me Cytomel (thyroid replacement), Geodon AND Lamictal, (two more mood stabilizers). I've already been on Lamictal with decent results, but do I really need THREE of the damn things? Not to mention the scheduling of the Lamictal which required a calculation from NASA just to get down since I'm already taking Trileptal.

Granted, every day for the past couple weeks have been pretty up and down, which I largely blame on the absence of any drugs. Either "mixed states" or rapid cycling, which is really hard to tell in my case. Either way it sucks. But here's the REAL kicker:

He wants me to call back on Thursday so we can prescribe a (drumroll please......): AN ANTI-DEPRESSANT: which is what I thought the WHOLE POINT of this appointment was!!!!

I called my mom after the appt, and she (like me) just about shit a brick. Understandably she's a little bewildered. I was so stunned during/right after the appointment I didn't know what to do. I just got detoxed off four drugs, now they want to add them back on? HOLY FUCKING SHIT ALREADY.

I know this doc is good, too: I've had him for a couple years (thru several ups and downs), and he was recommended to me by a doc who works for the Mayo Clinic (which is where I was hospitalized and have been receiving treatment for the past month).

Is this really all the better modern medical science can do? Or am I really so damned broken it takes that many drugs to fix me?

I went out to my car and cried after my appointment. I am very near the end of my fucking rope right now. Here's me taken about ten minutes ago. For some reason this shirt seems very appropriate today.

[Droopy]

1. I've had great success with Geodon

I don't know if you need to be taking all of that, but give it a shot and see what it does. I also take lithium and bupropion (Wellbutrin generic).

[no name no slogan]

2. I suppose I should but I've taken so much lately

the last three months have totally sucked-- not able to work, not able to live alone (OR in the city I usually live in), suicidal, etc. This is the longest episode I've had in years and I just want it to end.

Before detoxing I was on lithium, lamictal, cymbalta and zoloft. Previously I've been on wellbutrin, paxil, effexor and trazodone too. I'm just sick of all these damn useless meds that don't do anything. I even had a P450 test done to see whether or not I have the enzymes that work on certain drugs and still....

[Droopy]

3. I hear you, man

I know that some drugs that work for some people don't work for others and I know you are really sick of the meds, but I think you should really give this a shot. I know that Geodon usually works within a week if it's going to work. I was put on that stuff the last time I was hospitalized and within 7 days I was ready to go back to work.

I'm sorry I don't have better advice. The only other thing I can tell you is that if you give the new meds a shot and they don't work within the amount of time that they are supposed to then get back with your doctor immediately. Don't forget that you have some say in how your treatment is implemented. As a patient you have rights. Don't be intimidated by the doctor.

[no name no slogan]

7. Seven days? DAMN

I was actually supposed to be doing an FDA study for Geodon approval for treatment of bipolar depression thru the Mayo Clinic, but I washed out because of some irregularities on my ECG. I was a pretty good candidate otherwise, I was told.

I can't believe I'm saying this but right now I would KILL to go back to work, even though I don't even like my job much lately. Living in moms basement and not working eats major ass right now.

[EFerrari]

4. Geodon made Doug's life possible.

But, is he adding them all at the same time? :wtf:

[no name no slogan]

5. Yeah that's the funny part...

I said it's a bit much for all at once isn't it? I guess we'll keep going up and down for awhile just for kicks because apparently it's really funny when I rapid cycle. Eh whattya do?

[EFerrari]

6. So, how is he going to figure out which med is working

or not working or needs to be titrated if he adds them all at the same time?

That's the part I don't get. And after wrestling to get Doug's meds straight and my own as well, I'd feel really uncomfortable about doing it that way. But, I'm an English teacher. lol

[no name no slogan]

9. Very good question indeed

I'm in the process of getting a second (possibly third) opinion from another doc or two at the Mayo Clinic. My regular psych doc isn't a Mayo guy, but my mom knows a good psych doc here, who knows an expert or two on bipolar who practice at the Clinic.

For now I'll wait and see I guess :shrug:

[Larissa238]

8. Crazy adding in all those meds at once

Be on the lookout for major side effects. I was on Lamictal, but my doctor tripled my dose in 2 weeks (you are supposed to go up slowly) and I got the rash, so they took me off. I don't know why they would throw so many meds at you. Like someone else said, how are you supposed to know what's working if they start so many at once? And on the flip side, if one gives you bad side effects, how will they know which one is causing that? Is there a way you can call the doctor and ask to go on them slowly, and have the most important one started first? Like, have the mood stabilizers first, then the antidepressant just so you know you are stable and not going to go manic.

:hug: And even though you feel how your shirt says, there are still people out here on DU that care :)

[no name no slogan]

10. Yeah, I'm going back on Lamictal from scratch

Doing the whole into kit again because I washed out of it two weeks ago. I don't quite understand why I'm doing three mood stabilizers and no anti-ds right now, considering the depression is the biggest worry right now.

I've got TWO separate Lamictal kits, as I can ramp up on it quicker because I'm already taking Trileptal, which is related to Tegretol, which became the Jefferson Airplane, which begat the Jefferson Starship, which paved the way for the Alan Parsons Project, which I believe is some sort of a hovercraft (bad obscure Homerpalooza Simpsons reference I know, but somehow it makes more sense than my doc does). I had to sit down with my mother tonight to figure out what to take on which days and for how long because it's so damned confusing. yech.

I'm beginning to think that all doctors are quacks. I will now have taken one dozen psych meds in 13 years with this current round of new meds. It seems they don't know much more than I do.

Thanks for your ongoing concern. You're one of the good ones! :hug:

[Tandalayo_Scheisskopf]

11. You know...

Back when I had "The Job", I was listening to NPR and they did a story about a new wonder drug for schizophrenia: Seroquel. Now, I had heard of it and the news was good, real good, like no agranulocytoma and real positive results with increased cognition and learning skills, abatement of symptoms and re-integration of the schizophrenic consumer into the community. But the interesting thing was this story highlighted the differences between psych care in Europe and the US. Seems in Europe, they only put people on atypical anti-psychotics for six months, tops, as opposed to the US, where you get on them and tend to stay there or ride the medication roundabout.

Why?

Well, they found, in Europe, that keeping people on the atypicals and other medications for longer periods would cause real and lasting problems with neurotransmitter production, especially L-Dopa. This would create a set of symptoms that were indistinguishable from schizophrenia. So, they would wean them off and monitor the patients and then act again if they started becoming symptomatic. They were having great success with this mode of care, too.

I just thought I would bring that up. It stuck with me, and who knows what bearing it might have on anyone's own situation?

[no name no slogan]

14. In Europe, they also never prescribe SSRIs and anti-deps to bipolars

...because they risk triggering a manic episode.

They do all the time here :scared:

[fed-up]

24. thanks for your post-do you have links to the European studies on Seroquel?

I'm a newly diagnosed BP (w/anxiety & PTSD) and the pdoc wants me to take Seroquel, but after me doing my own research I think I would prefer Lamictal. The pdoc did not tell me how long she expected me to be on the Seroquel. I have to wait til next Sunday to make my case to her.

[Larissa238]

19. Yeah, I know the medication roulette.

Been there done that. Right now I'm on a good mix - some decent meds and some good support. I don't know how much of it is the meds and how much of it is the support, but I'm doing okay.

I think one of the most important things that no doctor can do for you is get you in a loving, stable environment. They can get you into a stable one (hospital) but they are missing the caring part. I have been making tons of improvement in a caring and stable environment, much more so than when I was just in a stable place.

We need more places like that one town where the mentally ill are totally accepted and just live their lives in peace, and not hounded bu doctors to take mind-altering drugs (no, not the illegal kind lol)

:hug:

And no more cannonballs to the stomach for you! :)

[no name no slogan]

20. Can't help but love Grand Funk Railroad

Mark Farner's wild, shirtless lyrics, the bong-rattling bass of Mel Schacher, and the competent drum work of Don Brewer.

Heh. Glad somebody caught the reference! That's one of my favorite episodes.

I'm going back for a follup with the Mayo doctor in another couple hours. She's mostly on the same page as my regular doc, and this appointment is mostly for reassurance (especially for my mom).

I totally agree about the supportive atmosphere. I think part of the reason for the severity of this episode was because I was with someone who 1) didn't understand this disease, 2) didn't want to understand this disease and 3) didn't want to be there for me.



Thankfully I've got good friends around me who help a lot. This place helps too.

[hunter]

12. Oh, my! Give yourself time.

You're on the roller coaster now. You don't want to get out when you are upside down at the top of a loop.

:grr: hate it, hate it, hate it...

take a deep breath or two or three.

:hug:

[no name no slogan]

15. Thanks

you know after all this, I'm beginning to see what turns mr. hand into mr. fist...

I'm having another consultation w/ a Mayo Clinic doc tomorrow afternoon. She was the one who recruited me for the Geodon study I washed out of, plus she's really good and will give me an oversight on my treatment plan too. Even better, my insurance said they'd cover it because it's considered a followup appointment from my hospital visit.

*fingers crossed*

[no name no slogan]

13. Just got an email from my mom's friend

he's a psychiatrist and talked to one of my docs and looked at my file, with my permission.

He said both docs are of the same opinion and want me to get to the same destination but have slightly different ways of getting there. Hearing from him set my mind at ease somewhat so I guess maybe this all does make sense after all.

All I know is that I have to sit down this afternoon and MAKE A FUCKING CHART of all my meds because I've already accidentally taken one of them at the wrong time-- nothing serious, just took it at bed instead of in the morning and consequently slept kind of crappy last night. Ah well.

Time to get out the spreadsheet.

[Droopy]

16. I'm glad you are giving it a go

I'm also glad that you got a second opinion and that it put your mind at ease. Remember, if you have any problems with the meds (bad side affects, not working, etc.) call the doctor immediately. Don't be like me and stop using them and quit seeing your doctor. I was having really bad side affects with the meds that they initially put me on so I quit using them and stopped seeing the doctor. It cost me another hospitalization and almost cost me my life. Relapse city.

[EFerrari]

17. A chart is a good idea! We used to have one on the frig.

And, I asked Doug and his doc to write out changes before he left the doc's office.

I'm glad your mom's friend looked at this. It's good to have friends in high places. :)

[no name no slogan]

18. Apparently when I was in the hospital this last time...

... one of the docs that was on my team is some sort of expert in the treatment of bipolar disorder.

I made the med chart yesterday, and will improve it today with pictures of the various pills (you'd be surprised how much Trileptal looks like Zoloft). Gotta love that series of tubes :D

Things seem to be looking better already. The mood has been a bit elevated but it's still hard to concentrate on anything longer than ten minutes. Doc on Monday said it could be a mixed state or just a tad bit hypomanic because of the lack of meds in my system.

We shall see.......

[hashibabba]

21. I've been reading a lot about thyroid problems and mental

illness lately. The Cytomel could really help you if you only need T3 (does he have you on Synthroid or something for T4, or is he prescribing by your symptoms?).

I'm just starting to self-medicate for hypothyroidism. Even though I was diagnosed a couple of times in the 70s, nobody ever mentioned actually TREATING it! I'm hoping that getting my thyroid straightened out will enable me to go off at least a couple of my five meds. I'd rather take Armour Thyroid (has both T3 and T4) and get my thyroid normalized(I'm also working on my adrenals, too).

Maybe the cytomel will really work for you!

[no name no slogan]

23. The Cytomel fucked me up bad

I went into this insane rage last Thursday which almost ended with a trip to the emergency room. I had labs done on Saturday and go the results today. My T3 was a little high but within normal range. My T4, OTOH, is low, and now I have to wait FOUR MONTHS to see an endocrinologist. More than likely they were depressed by the high dosage of Lithium I was on.

I also have issues with my pituitary gland, and I really need to see an endo to sort it out as it's beyond the scope of my GP to handle it. But there's no way I can wait until January to see one. :grr:

[stillcool]

22. I took geodon..

to replace seroquel because the seroquel knocks me out...I don't want to spend my life asleep, if I can help it. The geodon made me very weird...so they then replaced the Geodon with Lamictal, without touching the dosage of the seroquel. I also take Zoloft. After a few weeks when I was up to the correct dosage of lamictal, I started tapering down on the zoloft. So...the drug that was supposed to be replaced is still at full dosage..they've just added another drug. However, I can't bitch, because I am more awake, and I feel better. Go figure. I think for everyone involved it's a case of hit or miss. What I really dislike is when I see commercials on the television from a lawyer that say "If you took this drug, call this number. You may have blah, blah, blah...as a result of taking this drug".