My Current Cocktail

Since the start of this blog I've wanted to write about the medications I take and try because it has been difficult for me to find detailed information of this sort online. The difficulty in writing about medications is that they can often change, and what works for one person probably won't work in exactly the same way for someone else, and a dose that one person might be able to tolerate might be intolerable for someone else. Still, I've wanted to share information about the medications I've taken and am currently taking. Something peculiar that I've noticed is that whenever people discuss these medications they use the brand name, but most people I know take the generics. That is how I have written this blog. I have only taken brand name medications when generics weren't yet available.

As it turns out, Latuda didn't work well for me. I took it for five months and tried to be optimistic about it, hoping that it would have miraculous effects. The biggest problem with taking it was that it made me tired shortly after taking it, so I ended up taking it at night, before going to bed (although I tried to take it with breakfast, lunch and dinner), and I took it with a 350 calorie snack as directed by my psychiatrist. I can't be sure whether the weight gain was a side effect of the medication, or happened as a result of the nighttime snack, but I ended up gaining 10 pounds in the five months that I took it. That was unacceptable to me because I had just spent two years losing 54 pounds. Also, it didn't help me with sleep at all. In fact, it made me quite restless at night. I would fall asleep and then wake up after about an hour and a half. I tried to stay still and fall back asleep, but I ended up staying awake and just tossing and turning in bed. So, I decided to discontinue it. I have now tried Latuda, Geodon, and Saphris, and they have all made me restless. They are similar medications, so this makes sense. My psychiatrist said that Haldol would probably have the same effect because it is similar to those medications. I never noticed that with Haldol because I've never taken it outside of a hospital, I took it a long time ago when I was doing extremely poorly, and I only took it for a short time, but I thought I would mention it here because someone who is sensitive to Haldol might also be sensitive to Geodon, Saphris, and Latuda.

So, my current cocktail is 200 mg. Lamictal, 1200 mg. Trileptal, and 200 mg. Seroquel. The combination of Lamictal and Trileptal has been a good alternative to lithium for me, preventing both mania and depression. I no longer experience extreme thirst and frequent urination, my hair has grown back and thickened, I no longer have a tremor, I've lost a great deal of weight, my thinking seems much clearer, and I don't have to worry about becoming dehydrated when working out. I don't miss taking lithium at all. 200 mg. of Seroquel helps me to sleep very well and my psychiatrist said that it also may be helping me with anxiety. I'm a little slow to get going in the morning, but I definitely have more energy than I have had at higher doses. Besides being a little tired from Seroquel in the morning, I'm not having any noticeable side effects, although I am possibly having metabolic side effects. (It is impossible to know whether my borderline metabolic syndrome is due to my medications or my weight gain, although I feel sure that I wouldn't have gained so much weight without the help of bipolar medications). I take the Lamictal at night, the Trileptal twice a day (one 600 mg. tablet in the morning, and one 600 mg. tablet at night), and the Seroquel at night. I've tried both lower and higher doses of Seroquel and 200 mg. is the least I can take and still sleep well. Over the past two months of taking this cocktail, I've been very productive, my symptoms are under control, I'm getting along well with my friends, boyfriend, family, and coworkers, and I'm exercising a lot, eating well, and steadily losing weight. I've lost the weight I gained while taking Latuda and am now down 55 pounds from my highest weight. I really hope that this cocktail continues to work and I won't have to change it anytime soon if at all. I've been working part time for the past five years and I still have hope that with more stable time under my belt, I will be able to get back to full time work. Of course, I will need to have a job with a flexible schedule that will allow me time off for doctors' appointments since I am being treated for quite a few health conditions now.

In my last few blood tests, my potassium level has been low. I tried eating more potassium for a few months, but that didn't raise my blood level, so my doctor prescribed a potassium supplement, and will be monitoring my potassium level. I've learned that having a healthy level of potassium should give me more energy, be good for my blood pressure, and may even help me have an easier time losing weight. Also, potassium level can affect mood, so having the correct level might also help my mental health. Having just the right blood level of potassium is important because both low and high potassium can cause serious health problems, so, besides trying to get enough potassium in your diet, any kind of supplementation should be monitored by a doctor.

Trying to stay healthy while taking psychiatric medications has been a challenge. The extreme weight gain I experienced raised my blood pressure and gave me sleep apnea. Treating my blood pressure and sleep apnea has made me feel better, this new combination of medications has made me feel better, eating right and exercising has made me feel better, and being able to steadily lose weight has made me feel better and has given me hope that I will be able to get off of my blood pressure medications and CPAP when I lose more weight. So, for a lot of reasons, I am feeling much better than I have in years, and I am very optimistic that my physical and mental health will continue to improve.

Sleep Study

I've been having trouble sleeping for years. I'm 42 now and my insomnia started when I was about 14. The diagnosis of bipolar disorder at 19 explained my sleeplessness at the time. About 10 years ago, I started having sleep problems again. I had gained a lot of weight because of bipolar medications, and my psychiatrist suspected that I had sleep apnea. He referred me to a sleep specialist and I had a sleep study. It was determined that I had mild sleep apnea (too mild to treat) and I was told that I would get better sleep if I slept on my side, so that is what I did.

This past summer, I started to suspect that my sleep apnea had gotten worse. I was waking up about 6 or 7 times each night, that I remembered, and I didn't feel rested. Part of the problem was that I was taking lithium, and it was causing extreme thirst, which was compelling me to drink huge amounts of water, and I was in the bathroom all day and all night. I was so thirsty that I would drink more water each time I woke up at night. Whether because of my extreme thirst, or suspected sleep apnea, I wasn't getting good sleep, so I asked my general practitioner to refer me to a sleep specialist, and I let my psychiatrist know about it. My psychiatrist was very interested in learning the results of my sleep study.

My sleep study in October was disastrous. I got out of bed 7 times to go to the bathroom and drank 6 cups of water throughout the night. I only slept for 1 hour, although it seemed like I didn't sleep at all. During that hour, I stopped breathing 16 times because of sleep apnea. That qualifies as moderate sleep apnea and is considered serious enough to treat. I went back for another sleep study in November, and this time I wore a CPAP, a device that blows a gentle stream of air into the nose during sleep to keep the airway open so that you can breathe properly. I slept 7.5 hours and was getting at least 90% oxygen all night, which is in the healthy range of oxygen. It was determined that I would get my own CPAP, and I did.

In December, I met with a respiratory therapist and was fitted with a mask and learned how to use and care for the CPAP. At first, I was given a full face mask. After three weeks of sleeping with it, I decided that it was too uncomfortable, so I went back for another mask. This time I got nasal pillows and they are proving to be much more comfortable.

I was not really excited about using the CPAP at first, but now, at the end of January, I feel so much healthier and more energetic since I've been using it, that I believe it is worth the expense and awkwardness. Also, it is thought that if you have sleep apnea and bipolar disorder, using a CPAP can lessen your experiences of both mania and depression. As an added bonus, I even look better. My eyes look much more rested and my skin looks radiant. Now, in addition to considering it necessary for good mental and physical health, I consider it to be a beauty treatment, and that makes me feel more excited about wearing it.

Unfortunately, many people with bipolar disorder gain weight from the medications, and that causes other health problems, like sleep apnea. There is a possibility that if I lose weight, I will be able to sleep well without the CPAP. Getting to my ideal weight is my next quest. When you get good sleep, you have fewer stress hormones in your body, so it is easier to lose weight.

Since I've been using the CPAP, I've lost 23 pounds. This is probably also the result of a medication change. When my psychiatrist learned, from the sleep study, that I was waking up and drinking water all night, she substituted Trileptal for lithium. I've been asking psychiatrists to take me off of lithium for years, but this was the straw that finally broke the camel's back. I'm also taking Lamictal and Saphris to control my bipolar disorder and I'm doing very well. I'm stable and alert and feeling much more optimistic about the future than I've felt in years.

The Right Dose

"All substances are poisons: there is none which is not a poison. The right dose differentiates a poison and a remedy." Paracelsus (1493-1541)

I was depressed for the month between my last appointment with my psychiatrist and my most recent one. I didn't reach the lowest depths of depression, but it was interfering with my daily activities. I was the happiest when I was at work, but I wasn't socializing as much as usual, and I was having trouble unpacking after closing a storage space I had rented when my boyfriend (now my ex-boyfriend) moved in with me.

When I was describing my depression to my psychiatrist, I didn't use the word depression, I told her that I thought I had a more realistic view of life after switching out Seroquel for Saphris in my bipolar cocktail. I am now taking Saphris, lithium, Lamictal, and temazepam as needed. There were problems I hadn't noticed, when I was taking Seroquel, that were worrying me, but I thought I would be able to keep moving forward.

About a week later, I called my psychiatrist and asked for another appointment. I told her that I don't like to use the word depression because it is the last state I like to be in, but I was worried that Saphris was causing me to be depressed, and I wanted to quit taking it. I had quit taking it many months before, because I felt like it had caused depression.

My psychiatrist said that she thinks Saphris is probably the best antipsychotic for me because it is less likely to cause weight gain than other atypical antipsychotics. She said, "I was probably blocking too much dopamine," and changed my dose from 5 mg., morning and night, to 5mg. at night only. I was skeptical that this change would help, but it did.

I felt good the next day and have felt good ever since. I really wanted to quit taking Saphris, but during the discussion with my psychiatrist, about the dose, I was reminded of the quote above, something I was exposed to in a college biology class, and it gave me the will to try a new dose. I'm really glad I did. Maybe Saphris will turn out to be the wonder drug for me that it has been for some others. I'm going to keep giving it a try.

Temazepam

Since my 10-day hospitalization for mania, which ended in April, my psychiatrist has made adjustments to my combination of medications. I am now taking 1350 mg. lithium carbonate ER at night, 5 mg. of Saphris in the morning and 5 mg. of Saphris at night, 200 mg. of Lamictal in the morning, and 15 to 30 mg. of temazepam at bedtime, as needed, for sleep.

I just took my first dose of temazepam for sleep last night and I feel good today. I slept well, I did not have a medication hangover when I woke up, and I have been calm and productive all day. I'm thankful that my psychiatrist prescribed it, and I'm hoping that this will complete the perfect combination of medications for me. If it works, it will be the combination I have been hoping for for the past 23 years - one that lets me feel and act like my best self.

My former psychiatrist switched me from temazepam to Ambien about 7 years ago because, he said, Ambien was less likely to be habit forming. That didn't make sense to me, as I hadn't formed a habit, but he insisted that I needed to make the change, so I did, and I haven't experienced as much stability since then as I did before he made the switch.

I told my current psychiatrist what happened when I was switched from temazepam to Ambien, and she wrote a prescription for temazepam right away. Anyone who has bipolar disorder knows how important sleep is to managing the health condition. Some doctors avoid prescribing sleep medications, because they may be habit forming, and instead use other medications, like the antipsychotic Seroquel, for example. I tried to use Seroquel for sleep, but I felt very much impaired and overly sedated during the day. I made many more mistakes than usual, and always felt like I was ready for a nap. I'm happy that my current psychiatrist sees me as a unique individual and prescribes the medications that work best for me.

Many mental health bloggers shy away from writing about the medications that they take, but I don't. I've always been told, and I've learned through life experience, that medication is necessary for managing bipolar disorder, especially Bipolar Disorder I, the most severe form, and the one that I happen to have. Since I'm sharing everything else I do to maintain balance, and since medication is so important for that, I'm describing the medication that I take, and how my psychiatrist decides to prescribe it. She only likes to change one medication at a time, so she can evaluate how each one works in combination with my other medications. This can be a laborious process, but I feel that it is helping me to experience more wellness.

Every person who takes medication is a different person with a different lifestyle. There is no one size fits all in psychiatry - at least there shouldn't be. I'm not suggesting my exact cocktail of medications to anyone else, I'm just writing that it is what's currently working for me. Reading stories of recovery, including stories of people finding medications that work, has always given me hope. More than anything else, in writing this blog, I want to encourage anyone with a mental illness, as well as their friends and relatives, to hang on to hope.

Soccer, Swimming, Saphris, and Summer!

Things are looking up for me since my hospitalization last month. I've been back to work for almost a month, and I'm enjoying my days both at work and outside of work. I started playing soccer again, after a ten year hiatus, and I'm delighting in it. I look forward to the once-a-week game all week, and it inspires me to exercise every day.

Taking less lithium, as my psychiatrist has directed me to do, makes it much easier to play soccer, and also to stay hydrated. I started taking Seroquel in the hospital to stop my mania. I've taken it before, and it caused a lot of weight gain. However, this time, I snacked on low calorie foods whenever I had the munchies and ended up losing 7 pounds also probably, in part, to playing soccer again.

Last week, when I went to see my psychiatrist, she suggested that I replace Seroquel with Saphris. The last time I tried Saphris, I was depressed, and I felt that it made my depression worse. However, I wasn't taking Lamictal, at the time, which I am now. So, I started Saphris about a week ago, and I feel great. Last night, I played better soccer than I've played so far this season, and I felt more coordinated. Also, I'm more alert and have not needed as much sleep as I did when I took Seroquel. I'm back to sleeping 7 or 8 hours instead of my usual 10 hours when I was taking Seroquel. I've heard that Saphris is a "wonder drug" for some people, and I'm hoping that will be the case for me.

Every year, I look forward to the beginning of swimming season, and this year was no different. I had a great time swimming at my condo pool for the first time this year. My conditioning for soccer consists of walking in hilly places, swimming, and taking a spinning class. I'm still going to the YMCA for swimming workouts, but my condo pool is so nice for a peaceful dip after a long, hot day, and sometimes, if I'm inspired, I swim some extra laps. This happens more often as the water warms up. I absolutely love to swim in a warm pool with the sun shining down on me!

It's definitely summer in Kentucky. The temperatures have already reached the mid nineties. I don't have any big plans for the season. It's hard to save money for a vacation, as I'm collecting Social Security Disability, and only allowed to work part-time. So, I'm working on being patient and appreciating the simple things in life, such as spending time with friends and family, and enjoying the sunny weather and lazier days.

Luckily, in my town, there are lots of  inexpensive things to do--art festivals, neighborhood fairs, free and cheap musical performances, etc. I have a lot to be thankful and grateful for, and I'm happy that I'm getting back on track. Someday, I hope that I'll be stable enough to start working full-time again. But, for now, I'm going to take advantage of the extra time that I have each day, and work on strengthening myself, both mentally and physically.