Akathisia is a psychiatric medication side effect that revolves around psychological and psychical restlessness which causes distress. People with bipolar disorder report more akathisia with psych med treatment than do those with schizophrenia. And I am now reporting the horrible restlessness, agitation and distress of akathisia is happening to me.
I have experienced so many bipolar medication side effects that I can’t remember them all. They have ranged from the common that many people experience like weight gain and dry mouth to the more unusual such as falling out hair and me falling over. When I started taking bipolar medication and started experiencing side effects, I tended to just grit my teeth, bear it and suffer. And I see this all the time in people. People constantly contact me and ask what to do about bipolar medication side effects because they are currently suffering.
I don’t believe in needless suffering. I believe there are things you can do about many, if not most, of the bipolar medication side effects.
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.
Apparently I’m the only one that understands the concept and usage of healthcare statistics.
Recently a commenter got angry at me for saying this:
“. . . Are there people who have had a bad experience with ECT [electroconvulsive therapy]? Yes. Are there people who have had very bad experiences with ECT? Yes. But then, I was hit by a car, so things happen. It’s not really the car’s fault. . . ”
My point, of course, is that there are people who have bad experiences, I would never deny that. But there are people who have bad experiences with everything. That doesn’t mean it’s the typical experience. We work hard to reduce traffic deaths and injuries in North America and doctors work hard to try to implement ECT in the best way too.
A Commenter on Statistics
But the commenter felt,
“. . . And you wonder why are people anti-psychiatry? Because they had horrible horrible experience and are consider “oooops” and downplayed number in statistic . . .”
Well, um, yes. That’s what statistics are.
I’m on Twitter. Not a surprise there. And I have a pretty active following there. Most of the people are fans, but a few aren’t. A few quite disagree with me and what I have to say. Which is fine. People can have their views.
And recently, I was tweeting along, minding my own business when someone said this to me:
and have you been on antidepressant, mind altering drugs all these years. Making choices while under the influence
My first reflex was to reply,
and have you been making choices all this time while being an ignorant, sanctimonious ass?
But I’ve heard through the grapevine that wouldn’t be professional. So I said nothing. If Mr. Twitter wants to judge me for taking medically prescribed medication, that’s his right. Even if it is a small-minded, uncompassionate, hateful thing to do.
And really, I have snarky answers for many of the asinine comments people make to me. However, I don’t tend to share them as it makes people all pissy. That being said, this particular comment hit a sore spot – being under the influence of brain-bending medications.
It’s a bit of a short week what with the holiday and all, but still, there is time for three new things about mental health. Today’s three new things are:
- A safety warning on the atypical antipsychotic drug asenapine maleate (Saphris)
- Saffron and depression
- Multi-drug (polypharmacy) treatment of mental illness
Serious Allergic Reactions Reported with Asenapine Maleate (Saphris)
Asenapine maleate (Saphris) is an atypical antipsychotic drug recently approved for use in the treatment of bipolar type 1 mania and mixed episodes (as well as schizophrenia).
In slightly less than two years of approval, about 87,000 people have been prescribed asenapine maleate. The FDA’s Adverse Event Reporting System (AERS) has had a significant number of serious allergic (hypersensitivity) reactions reported. These serious allergic reactions were reported in 52 cases and are considered Type 1 hypersensitivity. From the FDA:
“Signs and symptoms of Type I hypersensitivity reactions may include anaphylaxis (a life-threatening allergic reaction), angioedema (swelling of the deeper layers of the skin), low blood pressure, rapid heart rate, swollen tongue, difficulty breathing, wheezing, or rash . . . Several cases reported multiple hypersensitivity reactions occurring at the same time, with some of these reactions occurring after the first dose of Saphris.”
Any such reactions require immediate medical attention.
You can report serious allergic reactions to the FDA’s MedWatch program here.
FYI, asenapine maleate’s label has been changed and updated with this new information.
Saffron (crocus sativus) is the most expensive spice by weight and is integral in French bouillabaisse. And someone asked me this week, “Can saffron help with depression?” Initially, I did a search on the Alternative Medicine Index at the University of Maryland Medical Center and turned up nothing. This alternative index lists most everything so my immediate answer to “can saffron help with depression,” was no.
However, I may have spoken slightly too soon.
Upon closer inspection I did find one study that asserts, in treating mild-to-moderate depression:
“Saffron petal was significantly more effective than placebo and was found to be equally efficacious compared to fluoxetine and saffron stigma.”
Now, hold on a minute. This is not a good, particularly scientific, study. This is just a review of studies, some of which are very questionable in nature. The above statement is premature at best. All that can really be said (in my opinion) is that saffron deserves further study and that some formulation of it might work.
Good question. This is called polypharmacy and most doctors agree it’s a bad thing. The reason polypharmacy is bad is because it greatly increases the chance, and severity, of side effects. (There are other reasons too.) People who have been through rounds of polypharmacy will tell you this is true.
However, doctors continue to prescribe many drugs simultaneously for a condition. This article explores why polypharmacy is so common.
The article may make you take a look at your drug regimen and talk to your doctor about reducing some of your medication. This isn’t always possible, but a good idea if you can get away with it.
Note on Polypharmacy
It’s worth noting some conditions do warrant polypharmacy.
According to the Psychiatric Times article, the best indications for polypharmacy are few and well established:
- Bipolar depression
- Psychotic or agitated depression
- Co-morbid conditions that require independent medications (e.g., ADD and major depression)
- When partial response to the first medication requires adding another adjunctively
- When there is a combination of psychiatric and pain problems
OK all. Until next week when I will learn more and try to do better.
Not infrequently, at the Bipolar Burble I get comments about how if famous artists with mental illnesses had of been medicated, we would have no art today. For some odd reason their go-to example is always Vincent Van Gogh. Without his untreated mental illness, they argue, Van Gogh wouldn’t have been the great artist we know him to be today.
Right then. Let’s all go off our meds and paint. And chop off our ears.
Creativity and Mental Illness
There is no doubt that being crazy makes you see things in a new way. I know I can see things in ways that others can’t. It’s both a benefit and a dramatic hindrance. I’m constantly dealing with people looking at me in odd ways as they try to wrap their head around whatever-the-heck logic my thoughts are trying to make. It’s no mean feat.
But that’s not necessarily all the bipolar. That’s creativity. I was creative before I was crazy, before I was medicated. And I’m creative now, on psych medication.
Creativity and Hypomania
I have had hypomanic times where I have written and written and written and written. Thousands and thousands of words pour out of my skull. And they are brilliant.
Or at least, so I think at the time.
Hypomanic (and manic) people think they are brilliant. Think they are unbelievably talented and creative. Think they are genius. It doesn’t mean they actually are.
Creativity and Psychiatric Medication
Since being on psych meds I have written thousands of pages. Thousands. Some professionally, some not, but many fairly laudable and creative. Believe it or not folks, I do have talent and that talent hasn’t magically been removed because of the medication.
Of course, if I’m too depressed because of the bipolar to get off the couch, that has a rather adverse effect on producing anything, talented or not.*
Artists, Psychiatric Medication and Death
But so you don’t agree with me. You have personally found you’re brilliant off meds and not on. OK. Fine. And maybe you think you’d be willing to part with your ear to be Van Gogh. OK. Fine.
But you might want to keep in mind some truly brilliant people who killed themselves due to mental illness, including Van Gogh whose depression worsened over the course of his lifetime, making him unable to paint, leading to his suicide at the age of 37.
And then there are other famous artists dead from suicide:
- Sylvia Plath, suicide at 30
- Kurt Cobain, suicide at 27
- Ernest Hemingway, suicide at 62 (and just in case you’re doubting genetics, his father, brother and sister also committed suicide)
- Diane Arbus, suicide at 48 (both a drug overdose and slashed wrists)
- Arshile Gorky, suicide at 44
- Alexander McQueen, diagnosed anxiety and depressive disorders, suicide at 41
- Virginia Woolf, suicide at 59, part of her suicide note to her husband:
I feel certain that I am going mad again. I feel we can’t go through another of those terrible times. And I shan’t recover this time. I begin to hear voices, and I can’t concentrate. So I am doing what seems the best thing to do. . . I don’t think two people could have been happier ’til this terrible disease came. I can’t fight any longer. . . I can’t read.
And a whole bunch of other talented people both known and unknown who had their lives cut short by suicide.
And my guess is the loved ones of every single one of those people wish treatment had of been available for /used by their loved ones.
Psych Medication Destroys Creativity and Art
So don’t give me the bullshit argument that medications are “bad” because they hamper creativity. Because you know what really kills your creativity?
A Little Bit More
* There’s a study showing this but I seem to have misplaced it.
I’m not saying it’s never the case that medication inhibits creativity, just that it’s a poor argument and misses some of the fundamental reasons why people get treatment in the first please.
Creative people who have publically stated they are in treatment for a mental illness. Including Patty Duke, “She says that she’s more creative now because she can organize a thought.”
Long (long) time readers will recall that once-upon-a-time I took the atypical antipsychotic Geodon. I found this to be an unbearably painful and side effect laden psych med. I hated Geodon. I wouldn’t wish Geodon on my worst enemy. I lost touch with reality on Geodon. I passed out at work on Geodon. I got sick constantly on Geodon.
You know, that being said, Geodon works for a lot of people.
I gather my reaction to this antipsychotic was fairly atypical. And if I had known what to eat when taking Geodon that might have helped.
Geodon (generic ziprasidone, also marketed as Zeldox by Pfizer) was the fifth atypical antipsychotic to receive FDA approval, in 2001. Geodon is approved to treat schizophrenia, bipolar disorder mixed-states and bipolar mania. And, of course, Geodon is prescribed off label in other cases of bipolar disorder or for depression.
Facts about the Atypical Antipsychotic Geodon
Interesting facts about atypical antipsychotic Geodon:
- Has a very short half-life – a mean of 2-5 hours
- Geodon should always be taken with food (see below)
- It slightly increases the QTc interval (heart rhythm)
- Geodon can occasionally cause mania in people with bipolar disorder
It has all the other nasty effects that atypical antipsychotics do like weight gain, diabetes, tardive dyskinesia and the like.
Geodon Must be Taken with Food
One of the nasty problems I had with Geodon is that I found unless I ate exactly the right thing (red meat, I found, but results were variable) I would get really sick after taking the drug. I would feel nauseated, dizzy, crazy and basically so sick I had to go to sleep. And it was really hard to predict exactly when this would happen. It was a bitch.
Food with Geodon Affects Bioavailability
What I didn’t know is what really matters is the number of calories consumed with Geodon.
I had thought taking the Geodon was making me sick but actually it was the withdrawal from Geodon making me sick. Due to the short half-life, if I didn’t get the correct dose of Geodon, I went through withdrawal. (I took it once a day, increasing the problem.)
And as it turns out, if you don’t eat the right food, Geodon isn’t properly absorbed into your bloodstream. This is known as bioavailability. If you take Geodon without food its bioavailability may only be 50%. So 200mg becomes 100mg.
What to Eat with Geodon
While psychiatrists generally tell people to take Geodon with food, I doubt anyone mentions that if you don’t, it is only half as useful.
Luckily, there’s a study. According to The impact of calories and fat content of meals on oral Ziprasidone [Geodon] absorption: a randomized, open-label, crossover trial:
- Maximum Geodon absorption was seen with meals of 1000 calories
- Low-calorie meals of 250 calories had only a 60% – 90% absorption rate, highly variable
- Meals of 500 calories were close to the absorption rate of the 1000 calorie meals
- Meals of 500 – 1000 calories had much less variable Geodon absorption rates
- Fat content of the meal had no bearing on outcome
So, in short, if you’re taking Geodon, you should eat a meal of 500 calories or more when you take your Geodon.
Isn’t That a Lot of Calories?
I’d say so, yes. Seeing as dosage instructions for Geodon are to take Geodon twice daily with food, that’s at least 1000 calories right there. Kind of nutty, but there it is.
Do Doctors Know about Calories, Diet and Geodon?
Honestly, I have no idea. I wouldn’t be surprised if they didn’t know the magic formula was 500 calorie meals with Geodon. You might want to ask your doctor about it.
 In case you’re curious, Geodon is one of four drugs Pfizer plead guilty to illegally promoting for disorders for which it was not FDA approved.
 By the way, you could get around this problem with intramuscular injections. If, you know, that were an option for you.
 And by “should” I mean according to the study and after talking to your doctor. Of course.
When you look up the side effects for any psychotropic, say bipolar, (or really any) medication, you will find a list of side effects a mile long, many of which are rare side effects. In fact, even good, old, non-psych med, pain killer ibuprofen has oodles of side effects and drug interactions; people pop those without a thought.
And that’s OK. No one really worries about tinnitus when taking ibuprofen in spite of the fact between 1% – 5% of people may experience it.
- You won’t be able to remember them all (duh, not even doctors can)
- You won’t worry about them because if you did, there wouldn’t be enough worry time in the day
Frequent Side Effects, Infrequent Side Effects and Rare Side Effects
I’ve always been the kind of person to get common side effects, just perhaps to a greater degree or duration. Occasionally I’ve seen an infrequent psych med side effect now and then, but pretty much never anything a doctor would consider to be rare.
The Mood Stabilizer Lamictal and Side Effects
The mood stabilizer (anticonvulsant) Lamictal is a tough drug to ferret out in terms of side effects. That’s because it’s been around for quite a while and tested in many populations. Lamictal side effects are known for epileptics and people with bipolar I (although it’s used for other mood disorders too). There are further defined populations of:
- Monotherapy in adults with epilepsy
- Adjunctive therapy in adults with epilepsy
- Adjunctive therapy in pediatrics with epilepsy
- Monotherapy in adults with partial seizures
And, scientifically, you cannot generalize medication side effect likelihood from one population to the others.
If you look way down to the bottom, below all the lists of Lamictal side effects with a greater than 5% occurrence, you get the medication side effects with a less than 5% occurrence. These are defined by:
- 1% – 5% is considered frequent
- 0.1% – 1% is considered infrequent
- 0.01% – 0.1% is considered rare
- (Not sure what > 5% called. Common?)
Precise guys, these mathy types.
Side Effects with a Less Than 5% Likelihood Aren’t a Big Concern
I can tell you once you get down to this part, i.e., side effects with a less than 5% chance, no one really thinks about it. Mostly because psychiatrists (let alone general doctors) never see those psych med side effects.
I know, you’re thinking, but shouldn’t they see it in 1/100 cases? That seems logical, but it doesn’t seem to work that way. There are just basically, the medication side effects doctors see all the time, those they don’t see much, and then the rest of them. Clinical judgment overrules numbers simply due to the finite resource that is the human memory. (Don’t worry; psychiatrists consult computers in odd cases.)
Side Effects of Psych Med Lamictal: Special Senses – Amblyopia
And way down at the bottom of the page, under Special Senses is: Frequent: Amblyopia.
(Amblyopia – Partial or complete loss of vision in one eye caused by conditions that affect the normal development of vision. These conditions include strabismus, in which eyes are crossed inward (esotropia) or turned outward (exotropia) and anisometropia, in which there is a major difference in refractive error between the two eyes.)
So, just to review then, this means between 1% – 5% of people experience amblyopia as a (frequent) side effect of Lamictal. Peachy.
Side Effects and Psych Meds: My Eyes Hurt
[push]So of course, I only know these jolly facts because my eyes hurt. I could have happily gone through my whole life and never learned the meaning of the amblyopia. But alas.[/push]
I started noticing my eyes were having trouble focusing and my left eye hurt. I attributed it to eyestrain from copious amounts of computer time. But as it happened more and more, I started to figure something was up. I looked in the mirror and sure enough, if you look closely, you can see my left eye turning inward.
I did what all long-term psych patients with a high pain threshold do: I ignored it. (Don’t do that.) I figured it was too weird to be a psych med side effect.
I did not look up the drug side effects (probably because I didn’t want to know), but I did go to my doctor and tell her. She told me she thought it was odd as neurological effect should be bilateral (affect both eyes) not unilateral. Makes sense.
But then she looked it up, and there, in black and white, was the psych med side effect. Frequent even.
Side Effects and Psych Meds: Pain and Hopelessness
I won’t bother waxing on endlessly about what happened in my mind at the time. I’ll just shortcut it for you:
For the first time in three years I had hope for treatment, due to an increase in Lamictal. I actually thought I was on the way to feeling better. When I learned about this site effect I knew what it meant. I knew it meant I would have to decrease the Lamictal. I was destroyed. I told my doctor, through streaming tears, that she had broken my heart; I proceeded to sob loudly.
[pull]There is a special kind of pain in having hope taken from you. Sick people know this pain. Choking, destroying, slicing pain. The thread holding the weight of the world, destroyed.[/pull]
I won’t bother getting into why this is so devastating to a depressed girl, just believe me when I tell you, it is. Stay of execution denied. Pain rattling through my bones and hopelessness replacing blood plasma.
There will be doctors and ophthalmologists (as a psychiatrist can’t diagnose amblyopia or its cause) but in the end it will be simple: eyes or treatment. And like most people, I kind of need my eyes.
But, until someone with another fancy medical specialty confirms the issue, I’m going back to playing at ignorance. In spite of the fact that the sand always messes up my hair.
(Sorry about all the blog footnotes but I was trying to make the actual blog post shorter for you.)
If you’re looking for places to find out about your medications, try my Mental Illness Resources page.
 Note if a rare side effect is dangerous (like the rash associate with Lamictal) doctors are all over it. Also, I should mention here that drug companies are, by law, required to report every side effect, no matter how remote, if it is numerically greater than the placebo group. So if 1 person in the placebo group had chills, but 2 people from the Lamictal group got chills, they would have to report it. It doesn’t actually mean the drug caused it but they have to report it just in case.
 Of course, if you walk into a psychiatrist’s office and tell them you think your psych med is causing chills, they would just look on Mr. Computer and see that, yes, chills are an infrequent side effect of Lamictal.
 FYI, it never would have occurred to me that such things are possible, but as it turns out, many medications can affect your eyes. One very well known erection medication can cause you to see a blue tint permanently. The brain’s a weird and wacky place.
 Another aside. I actually had this disorder when I was a kid and had surgery to fix it. I’ve never had biopic depth perception because of it, but I’m basically fine. I figured this was a reemergence of some kind of issue.
I am very medication-reactive. Not so much with the positive effects, but I can almost guarantee you I’ll get all the side effects.I get every side effect for antidepressants, every side effect for antipsychotics and every side effect for pretty much anything else.
And sometimes, just for good measure, I’ll get side effects that doctors say “aren’t possible”. They are my favorite. And those overractions are often on the lowest known effective dose of the medication.
But if you add a low dose, lower than thought effective, of an antipsychotic, can this be helpful?
I have written thousands and thousands of words in this blog and elsewhere about how much I hate medication.
I hate it in the car, I hate it on a train, I hate on a boat, I hate it in the rain.
I hate it in the snow, I hate it in the sun, I hate it standing still, I hate it on the run.
I hate it before breakfast, I hate it after lunch, I hate it in the morning, I hate it during brunch.
And while I could fill an entire blog with all the ways I hate psych meds, I still, take them, everyday.
Weird you say?
(Well, yes. But no more so than the disease it treats.)
Because no matter how much I might hate psych meds, medication non-compliance kills.
It Doesn’t Matter that I Hate Meds, I Am Medication Compliant Anyway
Someone said to me that I have such conviction for a method that has been proven fruitless again and again. Well, yes, but there has been the odd pomegranate here and there. Moreover, I can’t think of anything better with which to convict, so I have to go with what has the greatest (however small) possibility of working. [push]Psych meds are backed by science and doctors and experience; not to mention my personal experience with medication where it has definitely been useful from time to time.[/push]
But I completely understand people who want off their meds. Now. Like. Now. No more medications. No more antidepressants. No more antipsychotics. No more mood stabilizers. No more tranquilizers. No more medications. Medication non-compliance. Now.
Bipolar Medication is Horrible
I get it. Psych meds are horrible. My list of psych med side effects is terrifying, even to me. Some I wouldn’t go through again no matter what. So I totally get it. Bipolar medications and side effects can all but ruin a life.
But Bipolar Medication Saves Lives
But psychiatric medication saves lives too. In fact, it may be saving your life right now, without you even knowing about it. The fact that you’re not trying to kill yourself may be thanks to the little pink pill that you take in the mornings, even though it is your least favorite part of the day.
And that’s the thing. I understand the consuming desire to excise the poison of psych meds from one’s body, but doing so can be just plain dangerous and life-threatening. All sorts of nasty things happen to people when they suddenly stop their medication. This is known as medication non-compliance and is a topic I wrote about at Breaking Bipolar.