More to come!

And I’m back, folks!

I have been dealing with a depressive stage for about 6 months now, and I’m just now finally getting better.  I don’t feel manic (or even hypomanic), but I do feel much more motivated and productive.  I should have some real new content within the next few days.  Rejoice!

I was in a general low phase for quite some time, but it would fluctuate from functional to near suicidal.  I was working hard with my therapist on my PTSD so my depression was not be addressed too aggressively.  I was, however, seeing my psychiatrist regularly and we were tweaking my medicinal cocktail little by little.

I’ve used Lexapro along with anti-convulsants and anti-psychotic medications for years.  The Lexapro seemed to be working well until lately.  My psychiatrist is a very cautious one and stepped me back up to a normal dosage very slowly.  Here’s the kicker, when we doubled my dosage from 10mg to 20mg (which I’ve taken before), I became morbid and suicidal.  I began cutting again and thought of death everyday.  It just kept getting worse and I seriously considered hospitalization again…though I wouldn’t have been able to afford it.

We finally decided to try a new approach (thank the Lord!).  We lowered my Lexapro back down to 10mg so that I can taper off of it and added Effexor.  So far I have been feeling great…but not too great, mind you.

For those of you who don’t know, Lexapro is an selective-serotonin reuptake inhibitor (SSRI).  Effexor on the other hand is a serotonin-norepinephrin reuptake inhibitor (SNRI).  Basically it works on keeping two form of happy juice available in your brain instead of just one.  So far I have been feeling more motivated and have not thought about suicide in a week.  This could, however, be a bit of a placebo effect, but I’m doubting it only because I really did not expect this to work.

Anyway, I hope everyone is doing well, and if not that you’re seeking the help you need.  I’ll have a much more technical post in the days to follow.

-L.J.

Drug woes

This is just a short post to get some things out there. I’m having some trouble with my meds lately. I was on some great insurance a while back and I was on Abilify, Trileptal, Lexapro, and Seroquel. Nice cocktail there. I was doing really well on that and then I lost my insurance when I was forced to quit my job. I’m going to my local mental health center and they’re great, but now I’ve switched psychiatrists and guess what?…they have different ideas about what medications I should be taking. On top of that, without insurance I have to live on samples at the moment and Trileptal is damn near impossible to get as a sample.

My new doctor doesn’t like to prescribe antidepressants to people with bipolar disorder because they can cause unnecessary mood cycling. That’s all fine and well, but I tend to be depressed a LOT more than I’m manic and the meds I’m on now aren’t cutting it. I’m back on Lamictal (I took it about a year ago) and Abilify and we’re tapering off on Seroquel (only when I have a mood flux or if I really can’t sleep). Last time I was on Lamictal I was up to a 150mg dose PLUS I had Lexapro. My mood was pretty good. I had some flexibility with my drugs, too. I could lessen my dosage of Lexapro when I was feeling a manic episode coming on and I could up my Seroquel for the same reason. It helped me feel like I was more in control of what was happening to me. Now my Lexapro has been taken away and I’m only on 100mg of Lamictal and I’m just not feeling up to myself yet.

If you’ve taken Lamictal then you’re well aware of the potential rash you can get from it. There’s about a 10% chance of getting the rash and less than 1% of that can be fatal. The trick here is that the rashes all appear the same so if you get the rash you immediately must go off the medication. I’ve so far had no rashes or anything, but because of the risk one has to use a step-up process to get to a high dose. I had to step up from 25mg a day to 100mg a day over a 5-week period. This has been a LONG five weeks, let me tell you.

The short of it is, I just don’t feel happy. I’m functional to a point, but my motivation is still relatively low and my energy level is lacking. I have a med check coming up next week and I’m going to let them know how I feel about my medication and see if we can’t fix this. I’m just not feeling up to myself. I’d love to hear some of your stories about your medication mishaps. I know I’m not the only one struggling to find that perfect combination of price and effectiveness here. Any advice for me? …maybe I should quit complaining and start exercising.

Post-Traumatic Stress Disorder (PTSD)

What is PTSD?

Post-Traumatic Stress disorder is an anxiety disorder that effects approximately 7.7 million Americans. It can be caused by numerous events such as war (it was once referred to as “battle fatigue” and “shell shock”), being a victim of violent crime (rape, mugging, torture, kidnapping), accidents such as car accidents or natural disasters or a number of other traumatic events. Often times the event happens to the primary individual, but there are many cases where just witnessing an event (such as something happening to a loved one) can cause PTSD.

What are symptoms of PTSD?

• Persistent and recurring painful recalling of events (can be through images, thoughts, or perceptions)
• Upsetting dreams of the event
• Reliving the experience (may be acting as though it is happening , hallucinating, or flashbacks)
• Acute  psychological distress when faced with things that remind the person of the event
• Physiological reactions to stimuli reminiscent of event
• Increased agitation
  • Difficulty falling asleep or staying asleep
  • Irritability
  • Anger outbursts
  • Lack of concentration
  • Startling easily
• Avoidance of things associated with events (not previously done before occurrence of event)
  • Avoiding thoughts, emotions, or talking about the event
  • Cutting off contact with people associated with memories of the event
  • Avoiding activities or places associated with the event
  • Inability to remember or bring up important aspects of the trauma
  • Lack of interest in activities, especially those that may have an association with the event
  • Feeling detached or unable to relate to others
  • Unable to process feelings (such as love toward others)
  • Expecting little of the future (by way of marriage, work, family, health, etc.)

What do people with PTSD experience?

• Intense distress
• Reliving of the traumatic event in a variety of ways
• Physiological reactions to stimuli associated with the event
• Nightmares
• Panic Attacks
• Depression
• Flashbacks (reliving the trauma)
• Problems with sleep
• Feeling detached
• Feeling numb
• Startling or scaring easily
• Irritability
• Anger
• Aggression (sometimes resorting in violence)
• Loss of interest in activities formerly enjoyed
• Difficulty with affection
• Avoidance of things associated with the trauma

What happens when you have PTSD?

I’ve already mentioned the basics here involving how a person with PTSD may act or issues they might encounter, but what can really happen? PTSD ranges from mild to severe and people who experience traumatic events can have many or all of the above symptoms. In many cases events brought on by another person (such as rape or kidnapping) have a more intense effect on a person than that of an outside source like a natural disaster or accident. Often times, as with many other mental illnesses, PTSD can be accompanied by other ailments such as depression, substane abuse, or anxiety (PTSD is classified as an anxiety disorder, after all). Some people with PTSD have a relatively high level of functioning and it may not even be clear to them what their anxiety stems from exactly and some people have huge difficulty socializing or even working.

What are flashbacks?

Flashbacks occur when a person relives or reenacts the trauma. This can cause a person to lose touch with reality. The feelings associated with a flashback are very distressing and may come in various forms like images or even smells.

How are you diagnosed?

As with any illness, mental or otherwise, only a qualified professional can really diagnose an individual with PTSD. A person must experience symptoms for at least a month for the diagnosis to be complete. Often times the symptoms begin within three months of the trauma, but sometimes symptoms don’t appear until several months or years have passed.

How long does PTSD last?

The degree and duration of PTSD varies from person to person. Some people never develop PTSD from a traumatic event while others develop a serious and debilitating case. In some people, symptoms go away after a few months and for others they experience symptoms for years after the trauma. Occasionally PTSD can become chronic.

I hope this brief introduction to PTSD was helpful and informative.  I’m planning to make a post about my own battles with PTSD, but as you might imagine, it’s turning out to be more difficult than I thought.  Even writing this and talking about symptoms causes triggers in me and I become upset or angry, but this is something I knew would happen from the start.  More on my own battles with PTSD and current treatment plans in the near future.

Psychiatric Medications

Medication. If you’re dealing with a mental illness not only are you probably seeking talk-therapy, but you’re also probably being prescribed medications. This is just going to be a cursory lumping together of certain types of psychiatric drugs. I’ll go over types of medication and give a brief list of the (hopefully) most common brands/types of medications in each list. I’ll go into more detail about specific varieties of drugs in subsequent posts. Sound good? Ok, let’s go!

 

Antipsychotic (neuroleptic) Medications

 

What they do: As with most medications, antipsychotics (or neuroleptics) do not cure a mental illness, but they do provide a great deal of relief of symptoms. Psychosis often manifests as hallucinations or paranoia and the antipsychotics serve as a way to keep these symptoms at bay. Also, neuroleptics can shorten the periods of psychoses in individuals. This group of medications, as with most drugs prescribed for mental illness, alter neurotransmitters in the brain which convey messages between nerve cells. Antipsychotics have been shown to help in cases of schizophrenia mainly, but may also be used for bipolar disorder and other disorders/illnesses that cause psychosis.

 

Some Typical Antipsychotics

• Largactil, Thorazine (Chlorpromazine)

• Prolixin (Fluphenazine)

• Haldol, Serenace (Haloperidol)

• Molindone

• Navane (Thiothixene)

• Mellaril (Thioridazane)

• Stelazine (Trifluoperazine)

• Loxapac, Loxitane (Loxapine)

• Perphanazine

• Compazine, Buccastem, Stemetil (Prochlorperazine)

• Orap (Pimozide)

• Clopixol (Zuclopenthixol)

Common Side Effects

• Dry mouth

• Muscle stiffness

• Muscle cramping

• Tremors

• EPS (movement disorders)

• Weight Gain

• Tardive dyskinesia

Atypical (2^nd Generation) Antipsychotics: All of these medications are FDA approved for the treatment of schizophrenia and many are also used for acute mania, bipolar mania, psychotic agitation, bipolar maintenance, etc. Though the first atypical antipsychotic (Clozapine) was discovered in the 1950s, this group of medications did not begin to gain headway until the 1990s. Atypical antipsychotics are now often used by doctors as a first-line treatment for psychosis due to the fact that the side effects tend to be less severe than that of typical antipsychotics. This type of drug is now quickly replacing these first-generation neuroleptics. Though the neurotransmitter dopamine must be modified in some way to have an antipsychotic effect, the way most atypicals work is relatively unknown.

Some Antipsychotic Medications:

• Clozaril (Clozapine)
• Risperdal (Risperidone)
• Zyprexa (Olanzapine)
• Seroquel (Quetiapine)
• Geodon (Ziprasidone)
• Abilify (Aripiprazole)
• Invega (Paliperidone)
• Serlect (Sertindole)*
• Zotepine*
• Amisulpride*
• Melperone*
• Olanzapine combined with Fluoxetine (Zyprexa or Symbyax with Prozac)*Not FDA approved for use in USA

Anti-manic Medications (at least some of them) Including Anticonvulsants

Background Info: There are 4 major types of anti-manic medication; they are tricyclics, monoamine oxidase inhibitors (MAOIs), lithium, and anticonvulsants (yes, for epilepsy). For a long time, Lithium was the medication of choice for doctors for mania and also depression, but as of late anticonvulsants are used. I think this mostly has to do with the liver problems that can be associated with Lithium, and the maintenance for taking Lithium is somewhat higher than in anticonvulsants (taking blood tests at least every 6 months). The idea behind the use of anticonvulsants is the lower risk of dangerous side effects and the relatively hassle-free (i.e. no blood tests) prescription. It is currently unclear how these medications work, exactly, but I’m sure that day will come.

 

Some Anti-manic/Anticonvulsant Medications

• Cibalith -S (lithium citrate)

• Depakote (valproic acid, divalproex sodium)

• Eskalith (lithium carbonate)

• Lamictal (lamotrigine)

• Lithane (lithium carbonate)

• Lithobid (lithium carbonate)

• Neurontin (gabapentin)

• Tegretol (carbamazepine)

• Topamax (topiramate)

 

 

 

Now we get into antidepressants. Seems like doctors dole these out like candy these days, but they are effective for people who need them. This is probably the broadest (and thus longest) section of psychiatric medications that I’ll cover. Note that I won’t be able to cover every single antidepressant every made (just like I couldn’t cover all the antipsychotics or anti-mania medicines), so if you don’t see your particular prescribed drug on my lists, DON’T PANIC. (Who here doesn’t love Douglas Adams?…I mean, really). It’s very easy to find out what category of drug your prescription is and from there it’s much easier to understand how it works and why you should or should not be taking it. Anyway, bear with me on this one because it is looooooong.

 

Antidepressants

How they Work: Drugs in this umbrella-ed category are used to treat serious depression, though sometimes doctors will prescribe them for milder cases of depression as well. A common misconception is that antidepressants are uppers or stimulants due to the uplifting effect they have, but chemically they act very different from stimulants. The idea is not to make anyone hyper or act coked-out (forgive the slang, but there just isn’t a better description), but to treat the symptoms of depression and hopefully help the person with depression feel how they did before the onset of their depression. Physicians prescribe antidepressants based upon the individual’s symptoms and often more than one medication is needed. To feel the full effects of these medications, the patient must remain on them for at least 6-8 weeks. Some people feel better right away and others gradually, and sometimes it simply isn’t the right medication for said person and you have to try again or augment with something such as lithium or another antidepressant. Ok, now onto the varying types of antidepressants.

 

Tricyclics

During the 1960s through the 1980s, tricyclics were prescribed as a first treatment for major depression. As with other medications, tricyclics affect neurotransmitters in the brain. This first group of tricyclics targeted norepinephrine and serotonin. First generation tricyclic medications are just as effective as newer treatments for depression, however, like the typical antipsychotics, the side effects are often worse.

 

Some Tricyclics

• Elavil, Endep (amitriptyline)

• Anafranil (clomipramine)

• Norpramin, Pertofrane (desipramine)

• Prothiaden (dosulepin, dothiepin)

• Adapin, Sinequan (doxepin)

• Tofranil (imipramine)

• Pamelor (nortriptyline)

• Vivactil (protriptyline)

• Lofepramine

 

Side Effects of Tricyclics

• Arrhythmias

• EKG changes (increased hear rate, etc)

• Very lethal in overdose

• Dry mouth

• Constipation

• Bladder problems

• Sexual problems

• Blurred vision

• Dizziness

• Daytime drowsiness

 

MAOIs (monoamine oxidase inhibitors)

Around the same time that tricyclics came into use, MAOIs made their appearance. MAOIs are usually prescribed when people with severe depression do not respond to other medications. Often times MAOIs are used as a last-ditch effort due to the fact that they can have adverse reactions with certain foods, beverages, and other medications. For this reason, when they are prescribed, the patient must stick to a strict diet to avoid such negative reactions.

 

Some MAOIs

• Marpan (isocarboxazid)

• Manerix (moclobemide)

• Nardil (phenelzine)

• Parnate (tranylcypromine)

• EMSAM (selegiline transdermal system)

 

Side Effects of MAOIs

• Serious or fatal reactions with many other antidepressants including SSRIs

• Similar reactions with foods/beverages containing tyramine (includes cheese and beer)

• Moclobemide works differently and has fewer reactions

 

SSRIs (selective serotonin reuptake inhibitors)

Trying to explain how an SSRI works is a little daunting. There’s a lot of heavy jargon and I don’t want to bog anyone down with that right now, so I’m going to give you the dusted-over version. Serotonin is a neurotransmitter like norepenephrine or dopamine. Depression is linked to the lack of stimulation of a receiving neuron in the brain (i.e. the neuron that receives the neurotransmitter). SSRIs inhibit the reuptake of serotonin which stimulates the neuron resulting in the serotonin remaining in the synaptic gap (the space between nerve cells) longer than is normal. This allows for the recipient cells to recognize the serotonin over and over to result in full stimulation. Whew…so the basics are that SSRIs keep the happy juice around longer than normal. Get it?

 

Some SSRIs

• Celexa (citalopram)

• Lexapro (escitalopram oxalate)

• Paxil (paroxetine)

• Prozac (fluoxetine)

• Luvox (fluvoxamine maleate)

• Zoloft (sertraline)

 

Side effects of SSRIs

• Sever drug interactions

• Sexual problems

• Headache

• Nausea

• Nervousness

• Insomnia

• Agitation (the jitters)

 

Other Antidepressants

These drugs seem to work similarly to the tricyclics in that they affect norepenephrine and serotonin. However, these newer medications appear to have fewer side effects. Since each drug works a little differently, I won’t go into the details right now. Some effect neurotransmitters differently and others are chemically unrelated to other antidepressants.

 

Some Other Antidepressants

• Wellbutrin (bupropion)

• Cymbalta (duloxetine)

• Serzone (nefazodone)

• Edronax (reboxetine)

• Desyrel (trazodone)

• Effexor (venlafaxine)

 

Side effects for most newer antidepressants are similar to those of the SSRIs.

 

 

Antianxiety Medications

What they do: Antianxiety medications do just what they say; they ease or eliminate anxiety. Though some antidepressants are used for anxiety, there are also medications expressly for anxiety disorders such as generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorders, phobias and post-traumatic stress disorder (PTSD). The most common type of antianxiety medication are the benzodiazepines. These relieve symptoms in a short amount of time and can be taken in daily doses or as needed. Patients using benzodiazepines can sometimes develop a tolerance for or dependence on these drugs. The only other medication specifically for anxiety is buspirone which requires 2 weeks of consistent use to build up to optimal results. Beta-blockers are often used for “performance anxiety” as well.

 

Some Antianxiety Medications

• Xanax (alprazolam)

• BuSpar (buspirone)

• Librax, Libritabs, Librium (chlordiazepoxide)

• Klonopin (clonazepam)

• Azene, Tranxene (clorazepate)

• Valium (diazepam)

• Paxipam (halazepam)

• Ativan (lorazepam)

• Serax (oxazepam)

• Centrax (prazepam)

 

Side Effects of Antianxiety Medications

• Drowsiness

• Loss of coordination

• Fatigue

• Mental slowing

• Confusion

 

Finally! Ok, so there’s a basic run-down of the most common medications used for various mental illnesses and their symptoms. I hope this was useful and I’ll do more in-depth features on specific drugs and/or categories of drugs in later posts.

Intro to Hallucinations

The National Institute of Mental Health describes hallucinations as, “something a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel…Many people with [schizophrenia] hear voices that may comment on their behavior, order them to do things, warn them of impending danger, or talk to each other (usually about the patient)…Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects…and feeling things like invisible fingers touching their bodies when no one is near.”

 

 

I should probably take a moment to talk about schizophrenia and other disorders associated with hallucinations since it would only be topical. The lovely brochure at NIMH (thank you again!) states that schizophrenia is, “a chronic, severe, and disabling brain disorder…it affects about 1 percent of Americans.” From there, depressive disorders (including Bipolar disorder) affect another 9.5 percent of the American population. I include depressive disorders because of certain psychoses that may develop during severe mood swings, such as my hallucinations. That’s over 10 percent of the population that could conceivably have an hallucination at some point in their adult lives. To me, that’s quite a lot, and therefore worth taking the time to become educated on the subject.

 

 

The first hallucination I ever had was during late summer of 2006. It was a chilling moment. Not only because I thought there were people standing in my living room who were very uninvited, but also because I realized I was seeing something that was not there. I thought, “Only crazy people have visions like this. I must be crazy.” Maybe I was. Hell, maybe I am. The important thing is that I was able to understand that this was a red flag for me. I had been hypo-manic for several days and I had been sleeping less and less. One morning I had been up the entire night and was supposed to work at my job at a gas station at 7 in the morning. It was 4:30am and I was only just beginning to get to the point where I might be able to sleep. Then I saw them. A small group of people standing in my living room, huddled together and in deep conversation. I nearly you-know-what-ed in my pants.

 

 

At the time I was staying in a friend’s living room. My bed was set up on the floor right in the middle of the room and I would be moving in a few weeks into my new apartment. As I laid in my bed, trying to force myself to sleep I was suddenly aware that these people were talking about me. I couldn’t hear what they said in their hushed voices, but I knew it wasn’t good. What had I done to them? My internal fear and lack of self-esteem manifested themselves as a group of individuals who were talking about me behind my back. Thankfully I was coherent enough to immediately call work and tell them I was ill. I didn’t know what else to do. You can’t just tell your employer, “Hey, I’m seeing people, probably not safe to be around customers today. See you tomorrow!” No, out of the question.

 

 

For me (at least thus far), hallucinations are a warning sign. This usually means things like I haven’t slept enough (during mania, for example) or I am getting depressed to the point of needing a meds adjustment. The last time I was in the hospital I nearly drank facial astringent as a way to kill myself before the intruders could get to me. There were no intruders. I knew then that I needed help, and I called my parents faster than you can guess. This may seem gruesome and utterly insane to some people, but I want to be as honest as possible. No one really told me that I could have hallucinations. I thought only schizophrenics had them, and that I was in the clear, so to speak. It’s important for people with mental illnesses to keep themselves informed about their disorders. Now I take the time to read up on lots of aspects of Bipolar disorder and PTSD (yes, I will get into that, just not today) and I also read up on any medication prescribed to me. It is imperative to take the time to become educated about something that has such a huge impact on your life.

 

 

Ok, ok, I’ll get off my soap box now. You can clearly tell that I’m a proponent of education. The point here is that hallucinations are something everyone should learn about if they deal with mental illness. To wrap up for today (rest assured I’ll talk about this again sometime) here are some great resources for information:

National Institute of Mental Health

National Mental Health Information Center