Lost It, Again

I lost it in the office at the psych's. Completely, utterly broke down. Shaking, sobbing. I think I used half his tissue box. I couldn't stop. And he just sat there and let me cry, which made me feel stupid and dumb and broken. I admitted I hadn't been med compliant and that I couldn't keep up with the hydration on the Lithium to offset the side effects. And when he suggested Abilify, I had to shoot that down because I'd been on it and gained 50lbs. And that's when my last psychiatrist suggested bariatric surgery rather than meds. What the fuck?

So I'm out in the parking lot outside the office, calling Jb, because I suddenly realize what day it is and that he's not getting paid 'til next Friday, and I blew all our foodstamps on food for, like, 4-5 days and a bunch of crap, and we've a whole other week we need groceries for. So I fucked up. And I'm bawling on the phone to him about that. And I can't stop. I can't stop crying. Up and down, up and down, up and down. Fucking roller coaster, and I want off. But no, the psych says, "That seems to be symptomatic of your illness." So it's official: I'm a rapid cycler.

Anway, prescription changes: off the Lithium. Still on the Lamictal and Klonopin. Wellbutrin is now gone. Zoloft has been up from 50 to 100MG.

You Are What You Eat

So, now that I've a cocktail of five drugs, I'm interested about what, exactly, I'm putting in my body. I mean, what's the difference between the three sets of anti-depressants I'm on?

According to Crazy Meds, Wellbutrin XL is a multiple reuptake inhibitor, which means:

These drugs affect more than one neurotransmitter, usually serotonin and norepinephrine. Serotonin, norepinephrine and dopamine are the big three neurotransmitters responsible for a lot of depression issues. My wild-ass guess / rule of thumb is that imbalances of one or more of these three are responsible for 80% of the depression issues people suffer from. It's all just a matter of figuring out exactly the extent of the tweaking and what neurotransmitters you exactly need to tweak.

As for Remeron, it's a tricyclic anti-depressant. According to McMan, that means:

They work by preventing two neurotransmitters - norepinephrine and serotonin - from being absorbed by the brain cell's receptors, and can be a life-saver where other medications have failed. Some experts contend that because these meds have strong action on two neurotransmitters, they may be more effective than the newer generation of antidepressants, which largely zero in on only one. But owing to the fact that tricyclics are imprecise weapons that take out unintended targets such as opioid receptors and histamine receptors, patients are at risk for a range of unwanted side effects. Overdoses can be fatal.

Yay for fatal overdoses.

So, now, what's the Zoloft for? Apparently, it's an SSRI, or a selective serotonin reuptake inhibitor. Nice to know that the three are at least three different kinds of anti-depressant. Still, here's what Crazy Meds says:

These drugs don't make you produce more serotonin, rather they make your neurons soak for a longer period of time in the serotonin you already produce.

But is that the same thing?

That depends on the person and the sensitivity of your 5HT receptors. Sometimes it's the same effect, sometimes not. When not it could be sub-par (to the point of being useless) or too much.

These days serotonin is the first line of attack in conquering depression, and the most likely neurotransmitter to really mess you up if your problem is actually bipolar and not unipolar depression. While these are not happy pills, for unipolar depression they are often quite effective at keeping depression at bay. In addition to depression, SSRIs are frequently good for panic/anxiety disorders and some are good for OCD as well. SSRIs are sometimes good for the more common forms of premenstrual dysphoric disorder (PMDD).

Basically, the psych nurse is trying to cover all bases, it seems. I don't know how I feel about that. Wellbutrin and Remeron are in my system and have been for a while now. The Zoloft is the one that'll take nearly a month before I can possibly see any benefit.

I'm not even ready to touch the debate about anti-depressants and bipolar disorder. Maybe it means I don't have it. Maybe the fact I'm not having an adverse reaction means I've something else: major depression, unipolar depression, what have you. Sometimes, I think I'm drug resistant. Because I've been on Zoloft, on Effexor, Prozac, Cymalta, Trazadone, and one or two more I can't remember because it was long ago. They either seemed to help, then pooped out, or didn't help at all, or made me suicidal. Now I'm on nearly every type of anti-depressant, except an MAO inhibitor, which no one uses anymore, and a mood stabilizer.

It makes you think: if this doesn't work, what the hell will?

Psych Check-In

I haven't felt like writing here much. I had a good bout of depression going last week. Slept until 2:30 one day, got up for a few, then went back to sleep until Jb came home. Couple fights put me so low that I was thinking about the hospital and suicide again. It passed, though, which is good. I did make up an excuse to not see my therapist last Friday. Jb'll have a fit when he reads this, as I told him I was sick, which I was, just not in a way he could understand. Or so I felt.

There's other little things. I haven't cooked in a week or so. Haven't made a grocery list yet for this two weeks. Haven't done dishes in a week. Let the apartment go to hell. Jb helped me clean up this weekend (i.e. Jb mostly cleaned up. I've yet to do the dishes). On a side note, I did apply for unemployment today, and we'll see how that goes given the obnoxiously ridiculous situation that was my work's request for a voluntary resignation and then an unpaid LOA without any documentation whatsoever. I finally just quit, and I'll probably have to explain that.

Did see the psych, or rather, the nurse practitioner, who I like better anyway. She still considers me unstable and has put me on yet another medication, Zoloft. So that's what? Five psych drugs. You've got to be kidding me. I'm really unhappy with this. I'm almost to the point where I'm ready to throw up my hands, throw out all the fucking meds, and just try to work through things with this therapist, who I'm liking quite a bit. I mean, seriously, five fucking meds:

Remeron 30 MG 1x a day (Sedative/Anti-depressant)
Lamictal 150 MG 2x a day (300 MG total) (Mood Stabilizer)
Klonopin 1MG 3x a day (Anti-Anxiety)
Wellbutrin XL 300 MG 1x a day (Anti-depressant)
Zoloft 50 MG 1x a day (Anti-depressant)

Plus the Benicar, the Levsin, and the Protonix that I'm always on for hypertension and IBS. I honestly need a pill organizer at this point. A quarter of the time, I forget to take my meds. Maybe not so much. But I'm not daily compliant. I don't remember until too late in the morning, or I totally forget at night. Maybe an organizer would help. I don't know.

Feeling increasingly frustrated.

Groggy

Forgot my meds again last night. Waking up groggy as hell. Having problems falling asleep and sleeping through the night. Up a couple times a night, sleeping until 10ish. My whole sleep schedule is screwed. Can't blame it on the Wellbutrin, as this had started before they upped my dose, and from what I understand, Wellbutrin acts as more of stimulant than a depressant.

Also, might have forgotten a psych appointment today, which, to be honest, is fine. I haven't even been on the higher dose of Wellbutrin for a week now. Can't imagine why they'd want me back so soon, except that, yes, they think I'm still unstable. Haven't heard back from the therapist I called. Should call another one. Everything is such a hassle, truly.

Back to sleeping, dreams are vivid, very vivid, but gone almost completely on waking. Struggle to focus on waking, as if I'd rather stay in the dream world.

Ha-ha!

Today, I am uber productive. I have called the unemployment, um, place and been told it's best to wait for my job to dismiss me, which I doubt they'll do. I see myself forever trailing on in this unpaid leave of absence state, arm thrown across my eyes like a melodramatic actress

On a yay note, my medical assistance determination went through, and I'm eligible for Healthchoice, which provides free doctor, dentist, ophthalmologist, psychiatrist and therapist visits, as well as cheap pharmacy costs. Jackpot! Whew. I can waive my right to insurance through JHU now and feel safe in knowing that I can get the help I need.

On an anxiety-producing note, I'm under review for food stamps, and other county programs, no doubt, on the 14th. Jb's making more money than he was, but we're still so strapped for cash. I don't know how this is going to affect their decisions. Also, I'm not sure how getting into Medicaid will affect the money I'm getting for Temporary Disability Assistance.

Both my PCP and my psych is in the managed care organization I enrolled in as well, which makes it easy to continue treatment without having to start over with someone new. I've even left a voice mail with a therapist. Now I just have to wait for her to call me back. As always, the waiting is the hardest part, to quote Tom Petty. But it's also anxiety-producing. I worry about this or that, going through every scenario in my mind, obsessing about worse-case scenarios.

Regardless, I went through all my bills, got all my medical bills sorted and ready to show my case worker. Everything else should already be on file, except for Jb's pay stubs, the new rent, and a bank statement. I'll have to talk Jb into going to get that, which he won't like. And I have to remember to tell the guy that what Jb makes annually includes a 2 1/2 - 3 month lay off period due to seasonal work. Because that makes a huge difference in whether we qualify or not.

Lot of time spent on the phone. Now, it's the waiting. And despite it all, I feel good. I have that stupid assurance that I'm fine, everything's fine, and all this medical stuff is useless. I feel like I'm fine, I don't need my meds, that going to my psych isn't necessary, that I've nothing to talk to a therapist about. Truly, I feel ... good. But put me in a situation where I'm required to do something, put me in a doctor's office, and I'm a blubbering mess of emotions. I still can't sleep at night, and I even woke up several times last night: 1am, 3am, 4:45am. I'm restless. Maybe it's the increase in the Wellbutrin. I have this "do something right now" energy and restlessness, but my eyes are so tired, my brain is tired. It feels very strange. Like part of me is sedated and part of me can't stop thinking, doing, planning, worrying, typing, on and on and on.

6:00 a.m. Med Check

Woke about 5:45 a.m. Took my meds. Ate them with some cheese and crackers--got my protein in. I now sing Kate MacLeod's "Me and My Medicine" in my head every time I have to take my meds:

"I'd rather be a pillar of salt
Then to leave my self behind"

Didn't sleep very well. Vivid dreams again. More on those in the next post. Woke up achy, probably still because of sleeping on the floor. Went to bed around 11ish last night.

8:01 a.m. Med Check

Lamictal and Wellbutrin taken. Breakfast: salmon cream cheese and bagel. I've taken my pills and eaten--like a good girl. I'm fairly miffed at having to do this and beginning to resent it.

Everybody's Comin' to Get Me

Last night, paranoia hit me hard. It's been hitting me on and off for a long while, though it gets stronger and weaker at times. But it's only last night that I think I started seeing it for what it is. Half the time it manifests itself in the usual ways: thinking people are always watching me, talking about me behind my back, thinking mean thoughts about me, conspiring about me at work. Now I'm starting to think it manifests itself heavily in my relationships. I start thinking things about my significant other like, "Oh, he doesn't really love me. I just want him to admit what I already know: he doesn't actually love me." And there's paranoia about what they're doing, thinking, mostly in regards to me or how it affects me. Are they cheating? Would they ever? Do they want to? What are they hiding on their computers? What are they hiding in their lives? Why don't they ever want to spend time with me? The computer/tv/object must be more important than I am. Maybe I'm not capable of being loved. Etc., etc.

My thoughts were on the mental downward train last night because Jb was on the computer most of the night, watched a tiny bit of tv with me, then zonked out. I immediately started in with the whole, "He never wants to spend time with me anymore. He must not love me. The computer and tv are more important than me. This is just like my last relationship. I'm losing him. What if he cheats on me? He probably doesn't love me anymore. He probably hates me and thinks I'm crazy." Which he should when I think things like that. Because, you know, he couldn't possibly be tired because he's had a long week at work in 90 degree weather, which would be enough to sap anyone. So this becomes just another symptom to bring up to my psych doctor.

Also, I willfully didn't take my meds last night. I didn't want to. I didn't want to have to be taking meds, and certainly not so damn many. Most of the time, I'm extremely faithful to the idea of being med compliant. But last night, I was so down with the paranoid thinking that I didn't see how it mattered if I took meds or not. I didn't care. I didn't care about me.

On a better note, I did take my meds this morning. Lamictal and Wellbutrin down. As far as my sleep schedule, tried to go to bed around 10:30-ish. Not sure when I actually got to sleep. Slept until about 10:30-ish this morning. 12 hours. A little too long, maybe.

8:10 a.m. Meds Check

Saw the psych doctor on Monday, the day after the move. Told the psych nurse practitioner that I had been feeling depressed, wishing I were back in the hospital, thinking bad thoughts, but not to the point of having a plan. Just the beginnings of them. I was crying more, acting out and difficult to handle, and not interested in much, despite the obvious need to pack and move. I told her that I know change is a trigger for me, and that I usually go depressed afterward. I'm still sleeping a ton. So she tweaked my meds and actually put me on an antidepressant along with the sleep aid and mood stabilizer. Why I wasn't on one before this, I've no idea. There was also talk of raising my Lamictal because of the anger and irritability, but we never settled on a dosage.

Here's my new list of psych meds:
Wellbutrin XL 150 MG 1x a day (antidepressant)
Lamictal 100 MG 2x a day (mood stabilizer)
Remeron 30 MG 1x a day (sleep aid/sort of an antidepressant; up from 15 MG)
Klonopin 1 MG 2x a day (anti-anxiety)

Other meds:
Benicar HCT 40/25 MG 1x a day (blood pressure)
Protonix 40 MG 1x a day, as needed (gastro-intestinal pain)
Levsinex .375 TIMECP 2x a day (abdominal pain/IBS symptoms)

Add to that the 2 Tylenol or Ibuprofen I've been taking for my left knee (osteo-arthritis is acting up with all the rain and change of seasons), and I'm starting to feel like I need a day-of-the week pill box with separate day and night chambers. Not to mention that you'd think someone with Bipolar, IBS, GERDS, lymphadema, and osteo-arthritis could get a response on her medical assistance application from the county. It does hurt the morale.