medication changes

Fear of Bipolar Medication Treatment Changes

→ March 23, 2015 - 52 Comments

Fear of Bipolar Medication Treatment Changes

I have a fear of bipolar medication treatment changes. I do. You’d think after 100 changes to my bipolar medication treatment plan I would be used to it, and while I supposed I’m used to it, it doesn’t destroy the fear. I’m so scared that a bipolar medication treatment change will make me worse. I also fear the hope that a bipolar medication treatment change offers.

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Meet a Neuroscientist and Get a Second Healthcare Opinion

→ September 27, 2012 - 3 Comments

Meet a Neuroscientist and Get a Second Healthcare Opinion

The Bipolar Burble is honored to introduce to you Dr. Marie Rowland, a neuroscientist helping people with brain disorders like mental illness through a new service, EmpowermentAlly.

A Special Offer for Bipolar Burble Readers

Marie is offering subsidized services to people with a mental illness and she has a special offer for Bipolar Burble readers – a thorough review of your mental health concerns, history and a 30 minute coaching session all for $15. Read on to learn more about Marie and her offer.

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Becoming an Empowered Loved One – An E-Patient’s Best Friend

→ July 26, 2012 - 4 Comments

Becoming an Empowered Loved One – An E-Patient’s Best Friend

Recently I discussed a little about what it means to be an e-patient. An e-patient is someone who is empowered, engaged, equipped and enabled (and many other things depending on who you ask). In short, an e-patient is someone who is fully engaged in making mental health treatment decisions.

Now, I am the first person to say that being an e-patient isn’t always possible for a person with mental illness. Often, dealing with the day-to-day slog that is living with a mental illness is quite enough pressure, thank-you, without having to put an “e” in front of your title.

E-Partners, E-Parents, E-Friends

However, even if becoming an uber-patient isn’t on your shortlist of things to do, your loved ones can also become empowered. They can become e-partners or e-parents or e-friends, if you like. And adding an “e” in front of their title can help them to feel less helpless in the face of a daunting illness that they cannot control.

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Personal Story of Medication Noncompliance

→ December 7, 2011 - 27 Comments

It is politically incorrect to say medication “noncompliance.” I suppose this is because it gives the idea that the person taking medication is “complying” to some authority figure and not consciously making the decision on their own.

I get that. But whether you call it medication noncompliance or medication non-adherence, the result is the same – the person is not taking their medications as prescribed by a doctor.

And medication noncompliance can lead to devastating consequences not only in the short-term but in the long-term as well. One reader shares her experience in her own words.

A Story of Medication Noncompliance

. . . I got manic in September without being aware of it. I was over productive, spent a lot of money, barely slept, very irritable . . . While manic, I thought I was normal, since I was stable since several months. I was only on a small amount of an antidepressant, mood stabilizer and a tiny amount of antipsychotic.

All this disappeared suddenly. I was out of energy. I was barely able to move, depressed and the most important: productivity disappeared. Couldn’t move or concentrate . . . for the first time of my life maybe, I started having anger crisis, uncontrollable ones. It was like I push a button and become extremely angry. I went through irritability before but never knew such anger. It was all verbal, no violence but very embarrassing.

I got so angry and stupidly stopped my medication.

Why Were You Angry?

I was mainly angry because high productivity was over. I was angry and frustrated, thought I finally became stable. I was angry for being bipolar. I didn’t want to live (by the way I always think about suicide even when I am high). I hated myself and this life and wanted to punish myself.

I wasn’t thinking logically. What I was thinking: I was taking medication and all was fine for several months and in spite of all this, I had mania so why to continue to take the medication! Plus I wanted to suffer physically, to have tangible pain.

What Happened When You Stopped Taking Your Medication?

Drug NoncomplianceI stopped taking medication although I knew from previous experience (several years ago) that withdrawal is terrible. I thought that since I was on low doses, the effects won’t be that strong. Well I discovered I was wrong.

The first week I was doing more or less fine. Then I started feeling dizziness, nausea, restlessness. I started feeling than something inside me was boiling. I was extremely tired, empty. I could feel that even my eyes were empty. I was very irritable.

I told my therapist (psychologist) about messing with my medication. He tried for several sessions to convince me to take them again. At the beginning of the third week, I couldn’t continue anymore. Told the psychiatrist, he told me to take a mood stabilizer for few days and an antipsychotic and wait. But my situation was going worse. By the end of that week, I agreed with both the therapist and the psychiatrist that I needed to be hospitalized.

I had to be hospitalized because I couldn’t continue on my own. I was about to collapse. I was crying all the time, not able to work, extremely irritable and tired. And I didn’t trust myself that I could force myself to take medication as prescribed. Any single trigger would have pushed me to stop or to take an overdose. I was very suicidal.

I took me 4 days on an IV antipsychotic to start to improve. What helped me the most is that I knew I was safe there, protected against myself.

How Do You Feel Back on Medication?

I am on more medication now. I am still angry about being bipolar but dealing with this in the therapy. But physically I am doing better and I am less suicidal. And I trust myself that I can control myself concerning taking medication.

How Do You Wish You Had Handled the Situation?

I should have told my doctor first place that I stopped the medication. I should have been more aware about the symptoms of mania. I should have set a system or informed my family about the “warning” symptoms of mania. But overall, I took a good decision by asking to be hospitalized.

Wanted to share it with other bipolars and tell them that it is very very bad and harmful to stop medication.

If You Want to Change Your Medication

As always, it is your right to change your treatment plan but as this reader has shared, if you do it the wrong way, you may end up in the hospital or worse. Whenever you make a change it needs to be overseen by a doctor.

And if you do make a mistake and stop taking your medication – be honest and tell your doctor so they can help you. This person did the right thing by admitting she needed help. She got it, and now she’s able to share this message with you. Listen to her.

How to Get Off Antidepressants Effexor/Pristiq (Venlafaxine/Desvenlafaxine)

→ September 12, 2011 - 94 Comments

How to Get Off Antidepressants Effexor/Pristiq (Venlafaxine/Desvenlafaxine)

Or other bothersome antidepressants.

Generally, following the rules I wrote about last week on how to stop antidepressants while minimizing withdrawal work, and most people can successfully withdraw from antidepressants with few side effects.

Some Antidepressants Are Hard to Get Off Of

Unfortunately, some antidepressants are not so easy to get off of no matter what you do. (You can learn more about this through http://drugabuse.com/ and other similar sites.) Some antidepressants:

  • Resist a taper strategy
  • Have intolerable withdrawal effects anyway *

People Have Trouble Withdrawing from these Antidepressants

Any antidepressant can feel impossible to withdraw from, but the antidepressants people have most trouble withdrawing from are:

But by far, venlafaxine and desvenlafaxine (Effexor and Pristiq) are the ones I hear about. In my opinion, these two drugs are a nightmare to come off of for most people. ^ (I’m not saying everyone has trouble with these antidepressants, just that many do.)

Here are tips on how to get off of horrible~ drugs like venlafaxine (Effexor) and desvenlafaxine (Pristiq).

Did I mention yet I’m not a doctor? Ah, well I’m not. None of this is to be considered medical advice; this is an informational article only. Never alter your treatment without talking to your doctor. Thanks.

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How to Stop Antidepressants While Minimizing Withdrawal

→ September 6, 2011 - 15 Comments

How to Stop Antidepressants While Minimizing Withdrawal

While antidepressants can absolutely be life-saving medications, sometimes antidepressants aren’t the right medication at the right time for you. Or sometimes, it’s just time to try to get off of antidepressants. (For simple depression, this is often done if you have been stable for 6-12 months.)

Can't Get Off Antidepressants

But the key to getting off antidepressants successfully is to minimize withdrawal symptoms because otherwise you may feel like you’re trapped on the antidepressants. Additionally, the withdrawal symptoms may get mistaken for returning illness symptoms, which you do have to watch for, but if possible, it’s best not to get withdrawal and returning symptoms confused.

So, here are some tips on the best way to get off antidepressants while minimizing withdrawal.

Learn About Getting Off Antidepressants

Firstly, by reading this you are taking the first step. Learning about your antidepressant, the time it takes to get off, and what might happen, is an excellent first thing to do. Your doctor can guide you in this process.

DO NOT STOP ANTIDEPRESSANTS SUDDENLY.

DO NOT STOP THEM ON YOUR OWN.

ALWAYS TAPER ANTIDEPRESSANTS UNDER THE SUPERVISION OF A DOCTOR.

(And as always, I am not a doctor and none of this should be considered medical advice. Only your doctor can offer that.)

Taper Antidepressants More Slowly

How to Stop Antidepressants

I can’t comment on individual doctors, but I will say in studies and in the literature they take people off medication, including antidepressants, way too fast. This is likely because they don’t want to wait around to do it the right way, but still, it gives people the false sense that you can get off antidepressants quickly – you shouldn’t.

Track Your Mood During Antidepressant Decrease

I know, it seems like I’m trying to strong-arm you into tracking your mood, but during medication tapering, it’s essential. You need to track your mood every day during medication changes – this goes for all mental illness – as well as write down when you change dosages because:

  • You need to know if you’re getting worse
  • You need to know if you do better at a lower dose, but not off the drug completely
  • You’ll have those records should you try to do it again in the future (or with another medication)

Please, please, please, even if you track your mood at no other time, do it when withdrawing from medication. (More on mood tracking here.)

(If you don’t want to track every part of your mood, then at least track the global assessment of functioning (GAF).)

Wait Six-Eight Weeks between Antidepressant Dosage Decreases

Seriously.* You are waiting so long between antidepressant dosage decreases because:

  • You want to prevent withdrawal
  • You do not want to induce mania, cycling or a mixed mood which is a real danger in bipolar

Changes to the Antidepressant Taper Schedule

You may want to slightly alter the antidepressant dosage decrease schedule:

  • Increase speed if feeling better as dosage decreases
  • Decrease speed if anxiety is a factor
  • Decrease speed if feeling worse on a lower dose
  • Decrease speed if feeling good at a specific dose (that might be the right dose for you)
  • Decrease speed for any reason if you feel the need

Never try to decrease or get off an antidepressant when:

  • You’re in a time of stress
  • There is an upcoming holiday

Decrease the Antidepressant in the Lowest Dose Possible

Slow Antidepressant Taper

This does not mean cutting your current pill. Some pills cannot be cut for safety reasons. This means getting a prescription for the smallest increment available and decreasing the antidepressant dosage by that much.

When you’re closing in on getting off the antidepressant completely, slow down even more. Cut the pill if you can. If you can’t, alternate on the higher dose for one day and then the lower dose for one day.

Exceptions to the Antidepressant Withdrawal Rules Above

As with all things in life, there are exceptions:

  • If you’ve been on the antidepressant a very short time you may be able to get off of it quickly
  • Fluoxetine (Prozac) may sometimes be tapered more quickly
  • Venlafaxine (Effexor), desvenlafaxine (Pristiq) (and sometimes other antidepressants) can be too hard to get off of using this method (see next article in series)

Getting Off an Antidepressant Takes Too Long

Look, you are getting off a medication that has altered the chemicals in your brain. This is not a minor event. While this method is slow, it gives you the very best chance of successfully getting off the medication without inducing withdrawal or worsening illness symptoms.

Don’t Freak Out When Coming Off Antidepressants

Remember not to freak out. Some withdrawal symptoms and some bipolar/depression symptom fluctuation may occur and you’ll still be all right. Just maintain a close relationship with your doctor to make sure it isn’t the start of something more serious

How to Get Off of Antidepressants with Minimal Withdrawal Series

Previously we saw:

Up next is:

—————————————————————————————————————————————–

If Your Doctor Doesn’t Get This, Send Them to Psycheducation.org for Their Own Education

* This information (and other information in this article) is provided by psycheducation.org and Dr. Jim Phelps.

Bipolar Disorder – When to Get Off Antidepressants

→ August 31, 2011 - 18 Comments

I try not to give medical advice here because I am not a doctor. But so many people ask me about this I felt I had to address getting off antidepressants without withdrawal. So many people with bipolar disorder (depression and others) need information about getting off psych meds and they are not getting it from their doctors.

This is the first in a three-part series:

  1. When to Stop Antidepressants in Bipolar Disorder
  2. How to Stop Antidepressants in Bipolar Disorder While Minimizing Withdrawal
  3. How to Stop Taking venlafaxine (Effexor) and Desvenlafaxine (Pristiq) – as they are particularly nasty to get off

This is an informational article only and should not be considered a recommendation. Talk to your doctor before any and all changes to your treatment. I’m not kidding about this.

These recommendations are primarily from PsychEducation.org and Dr. Jim Phelps with some commentary by me.

Bipolars Shouldn’t Take Antidepressants

Some doctors are on the fence about this, but more and more bipolar specialists are recommending people with bipolar disorder not take antidepressants. There are lots of reasons for this, and I have to tell you, they are compelling.

Why Shouldn’t People with Bipolar Disorder Take Antidepressants?

Some reasons people with bipolar shouldn’t take antidepressants:

  • Antidepressants may not work in bipolar disorder – believe it or not, the literature is mixed on how well antidepressants even work for bipolar depression.
  • Antidepressants can induce mania or hypomania (known as switching) – most of us have seen this and it happens all the time to bipolars who are prescribe antidepressants by non-psychiatrists because they just don’t understand the danger. And it is very dangerous because once switched, this type of mania or hypomania can be treatment resistant.
  • Antidepressants can induce rapid-cycling or mixed moods – same as above, this cycling can be treatment-resistant.
  • Antidepressants can worsen a bipolar’s illness overall – this is more controversial and I suspect varies case by case.

Bipolar Disorder and No AntidepressantsTo be clear some people with bipolar disorder will always need antidepressants temporarily, or long term, for their mood, but more and more, doctors are saying to avoid them whenever possible. (Alternatives will be presented in a future article.)

When to Stop Taking Antidepressants

Here are some guidelines from Dr. Phelps about when to stop taking antidepressants in bipolar disorder:

  1. If they have been on antidepressants a short time, I stop them.
  2. Less than a week, stop; two weeks, cut in ½, a week later stop.
  3. Likewise, if they just increased their antidepressants dose I will do the above, decreasing to their previous dose and get rid of the rest later.
  4. If manic or severely hypomanic, get rid of antidepressants now.  Usually can stop abruptly.
  5. If cycling or mixed get rid of the antidepressants.
  6. If they are not getting better after several add-on meds then slowly decrease.
  7. There are more exceptions to the above rules than there are rules.

When to Stay On an Antidepressant if You’re Bipolar

More guidelines from Dr. Phelps: When a bipolar should stay on an antidepressant:

  • If the patient is doing well, no mixed state symptoms or cycling, leave it.
  • I usually wait until the patient is doing better to much betterto stop an antidepressant; why:
  • Trust is an issue.  If the first thing we do is make them suffer more they will be unlikely to stay around long and may not even go to another psychiatrist.
  • Even though we know the antidepressant is causing harm often time the patient thinks either the antidepressant is helping or every time they try to go off they feel much worse.
  • Waiting until they are better is usually a good thing.
  • Also waiting longer usually means that the patient is going to be more educated about bipolar in general.

When to Get Off an Antidepressant Recommendations

I think Dr. Phelps’ recommendations are good ones, otherwise I wouldn’t have them here, but note where he says there are more exceptions than he has listed, so keep in mind, you might fall into one of the unlisted exceptions.

And I think the part above where Dr. Phelps talks about trust and making sure the patient is better before messing around with their cocktail is key. It shows he’s respecting the patient and their health, not to mention the doctor-patient relationship which is very important.

Talking to Your Doctor about Getting off Antidepressants is Scary

I know it’s scary to think about going off antidepressants, even if you do think they are causing problems. But think about it, discuss it with your doctor and make the right decision for you. And don’t do anything until you read the next part about how to get off antidepressants without withdrawal.

Bipolar Disorder – Getting off Antidepressant Series

  • Bipolar Disorder – When Not to Take Antidepressants

Coming up:

Polypharmacy Treatment Requires As Much Faith As Science

→ August 18, 2011 - 24 Comments

As I’ve said, mental illness treatments often don’t work. And you have to keep trying treatment anyway. Because without doing anything new, you are condemned to being stuck in the same mental illness mire you are currently in.

But in all honesty, mental illness treatment requires faith. Trying psych med after failed psych med requires a belief that something will work in spite of the evidence to the contrary. It requires a belief that is not based on personal experience.

I hate that.

Why Does Mental Illness Treatment Require Faith?

Faith has several definitions, one is:

A strong or unshakeable belief in something, especially without proof or evidence.

And let’s face it, that describes a lot of what we do in mental health treatment. Don’t get me wrong, that doesn’t mean it isn’t going to work, but it does mean that trying treatment after failed treatment requires more faith than logic.

Faith in Polypharmacy (Multiple Medications)

Bipolar Disorder and Polypharmacy

Seriously-ill folks, often with bipolar, schizophrenia and treatment-resistant depression, are typically on lots of medication: One or two antipsychotics plus one or two mood stabilizers plus an antidepressant. Some of us get by with less medication, but many don’t.

And there is little evidence about the efficacy of polypharmacy, or indeed, how to go about applying it.

And yet, many people are on multiple psych meds.

[push]For bipolar, there was a recent recommendation against antipsychotic polypharmacy stating multiple antipsychotics are not more than effective than one, and they pose greater side effect risks.[/push]

Sure, you could blame an evil drug company conspiracy, but I suspect the answer is much simpler: it just works better for some individuals. But those people need faith to believe that. These people need faith that using these medications provides their best treatment outcome.

And all those people on antipsychotics plus anticonvulsants plus antidepressants are really going it alone. These just are no studies in these situations.

Studies on Polypharmacy

But of course there are few studies on polypharmacy. There are innumerable combinations and trying to find funding for this kind of research is extremely difficult. And even if you could, the outcome would be extremely hard to interpret due to the number of variables involved.

(There are a few exceptions. For example, fluoxetine (antidepressant) and olanzapine (antipsychotic) have been tested and approved together under the name Symbyax. Of course that is only two medications and not the many on which many of us find ourselves.)

You Gotta Have Faith

Taking Multiple Psych Meds Requires Faith

(Feel free to hum George Michael at this point. I can’t seem to stop doing it.)

My personal cocktail is on the ridiculous side of treatment. It’s that kind of cocktail doctors despise. And my doctor, being responsible, would like to reduce the number of meds.

I get it. I do.

But I really, really don’t want to get worse. Or, you know, dead.

So I have to have faith. I have to have faith that making an alteration to this cocktail will be beneficial in the long run.

But I Hate Faith

But I’m not big on faith. I’m not big on anything that isn’t logical and evidence-based. Unfortunately, that just isn’t an option here.

Faking Faith

I have to fake faith. The idea of which make me smile.

I suspect if George had written that oxymornic statement, his song wouldn’t have been such a hit.

(Of course, he was faking heterosexuality, so maybe he’d appreciate the irony.)

Control Over Bipolar Treatment – Learned Helplessness

→ May 6, 2011 - 14 Comments

One of the crazy things that will happen to you when you seek treatment for being crazy, is doctors will ask you what treatment you want. Usually your psychiatrist/doctor will give you two options: Would you like to try psych med A or psych med B? This provides the mirage of control over your mental illness and your mental illness treatment.

Frustration, thy name is bipolar.

Patients Choosing Psych Meds Has an Air of Hilarity to It

This choice, of course, is ridiculous.* How should you know which medication to pick? They’re the doctor, the fancy psychiatrist, aren’t they supposed to know?[push]Do you pick the one that’s your favorite colour or matches your hair?[/push]

What criterion could you possibly use to pick a psychotropic medication that would conceivably compare to an actual doctor? Most patients, bipolar or otherwise, don’t even know the chemical name of their psychotropic medication. And why should they? All the di’s, tri’s, methyl’s and dride’s don’t really come in handy on a day to day basis.

The Doctor Is Fighting Learned Helplessness

Control over Mental Illness Treatment

What the doctor is doing here, is using basic psychology similar to the type parents use on their children.

Your child won’t go to bed. You say to little Billy, “which pajamas would you like to wear, the Spiderman or the Superman ones?” The child then focuses on the fact they get to make a decision, they feel empowered and are less likely to refuse to go to bed. The adult, of course, has given the child a choice the parent doesn’t care about. Superman or Spiderman, the kid is still getting into bed.

This is what doctors are doing. They are giving the person with a mental illness a choice that doesn’t matter. Sure, it seems like it matters because they’re drugs, and your life is on the line, but either way, you’re agreeing to a treatment, and that is all the doctor cares about. (It is why you are there, after all.)

Psychiatrists are Trained to Prevent Learned Helplessness

Doctors have been trained to do this because of the concept of learned helplessness. Learned helplessness is seen in lots of areas of life, but the basic principle is: the person comes to believe they are helpless, whether or not they truly are. A common example of this would be a battered spouse. Because they have been repeatedly abused and controlled, they start to think they don’t have control over anything in their life, even when they do. (Abusing people programs them this way and is one of the reasons an abused person doesn’t leave an abusive relationship.)

As Wikipedia puts it:

[a person] has learned to behave helplessly, even when the opportunity is restored for it to help itself . . . Learned helplessness theory is the view that clinical depression and related mental illnesses may result from a perceived absence of control over the outcome of a situation.

Learned Helplessness is Dangerous in Mental Illness

And this is a very real concern for the mentally ill because not only are you controlled by your disease, but then you’re controlled by the drugs put on top of that. If you then add the layer whereby you doctor is in complete control over your care, the patient begins to feel helpless in increasing areas of their life. This is problematic, particularly for the crazy, because that kind of helplessness, leads to hopelessness, which leads to suicide. When you can’t control anything, there is just no reason to stick around.

Choice of Psychotropic Medication Treatment Feels like a Game Show

But choosing between psychotropic pill A and pill B is akin to choosing to be hit on the head by a baseball bat or a two-by-four. I’m pretty sure there is no good option there. But it gets worse. Choosing a psych med is really more like choosing the blunt object behind curtain A or the blunt object between curtain B. You don’t know the ramifications of the decision. You don’t even have a shaded outline of what to expect. It’s like choosing a car based on how far apart the headlights are. It’s ridiculous. It’s laughable.

Control of Mental Illness, Control Over Treatment

[push]You can choose whether to get treatment or which pill to take, whatever that’s worth, but often these things feel surprisingly similar. Even a person who doesn’t exhibit learned helplessness can reasonably feel completely out of control.[/push]

And you can feel as empowered as you like, but the truth is, you really don’t have control. You didn’t have control over your brain when you got sick, you don’t have control over getting worse and you don’t have control over how your treatment goes, no matter the window dressing provided by the doctor.

You can pick doctors, therapists and pills, but feel helpless in all the ways that matter. It feels like you can’t get better, can’t have a normal life and can’t even figure out why you should want to be on this planet. It feels like picking Spiderman or Superman pjs, but either way, it’s bed time.^

Notes:

* Choice of medication is, in fact, critically important. And if you haven’t been treated for long, there are many objective ways to select a treatment. However, for cases of treatment-resistant bipolar or major depressive disorder,  the choice becomes more and more random as the objectively correct choices have already been tried.
^ I’m not suggesting that you shouldn’t choose, or that choice isn’t important, I’m simply the frustration inherent in the choice.