Medications are a major part of managing many mental illnesses, but something the general population has a hard time understanding. I’m not even talking about the issues of stigma, accepting “meds for life”, or side effects. I’m just talking about the process of finding the right cocktail to function as normally as possible. It’s hard to grasp without a good example, so here’s the history of my meds over the last two years (keeping in mind that I’ve been on psych meds for over 20 years!)
NB: The numerous links to my blog aren’t intended as flagrant self-promotion, just further background for the full context of each med change.
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In November 2010, I realized something was very wrong. When I reluctantly started seeing Psych #1 in February, I was taking 150mg of Wellbutrin XL per day plus instant release Adderall. I’d been taking that combo for ten years for Major Depressive Disorder and ADHD without any problems. Or so I had convinced myself, in my ignorance.
Wellbutrin XL, 150mg. There was Adderall too.
The first change was to double the dose of Wellbutrin to 300 mg (1). Psych #1 also had me discontinue the Adderall (2), basically to test the hypothesis that stimulants were causing hypomanic episodes and I didn’t truly have ADHD.
Wellbutrin XL, 300mg.
That would have been convenient, but with unmedicated ADHD and depression that persisted despite upping the Wellbutrin, I really struggled. When I went to 450mg of Wellbutrin in March 2011 (3), I had migraines for a month and became even more nonfunctional, bordering on disabled.
Psych #1 kept me on that for 5 months before I gave up at the end of July 2011. So I started seeing Psych #2 in November 2011. They immediately diagnosed bipolar disorder and added Lamictal to the mix (3). As usual, I started at 25mg of Lamictal, and worked up to 50mg (4) and then 75mg (5). After complaining about worsening anxiety for months, Psych #2 finally prescribed Hydroxyzine HCl (6), but it was not effective enough to offset the side effects and I stopped using it after only 2 doses (7).
Wellbutrin XL & Lamictal 25mg tabs for titration.
In December 2011, I had computerized ADHD testing that verified what several doctors had already diagnosed, so I started 18mg Concerta (8). Psych #2 refused to offer any other anxiolytics, however, leaving me no better off with respect to panic attacks. I also started researching vitamins and supplements that can help with bipolar disorder, and started taking fish oil, Vitamin B Complex, and Vitamin C.
Starting to experiment with vitamins & supplements.
The Concerta wasn’t cutting it, so in just two weeks I switched to 15mg Adderall ER (9) when I went up to 100mg of Lamictal in late December 2011 (10). Holy crap, did that help! But only for about half the day, so the dosage increased to 20mg in January 2012 (11), and that worked like a charm. The Lamictal prescription was also raised to 150mg (12), and my moods finally stabilized for the first time in years.
I travel a lot and by that point, instead of carrying two pill bottles in my carry-on, I had a virtual maraca of meds in my bag by February 2012. It took some to get used to.
Stick this in your carry on luggage!
Things were going quite well, but after a negative drug test for amphetamines in February 2012, Psych #2 refused to prescribe stimulants and forced Strattera (13). It was a nightmare. The side effects were simply intolerable.
Strattera was bad. Very bad.
I discontinued Strattera in under 2 weeks (14) and in March 2012, after Psych #2 didn’t return my distress call for 3 weeks, I decided I had to change providers again. It took months to find and get in to Psych #3, and in the meantime, I used up my stash of stimulants and then a friend supplied me with Concerta 54mg to see me through my dissertation end game (15). I also added more supplements: Vitamin D-3, more fish oil, and Folic acid.
When I started seeing Psych #3 in May 2012, the immediate changes were to reduce Wellbutrin back to 300mg (16) and resume 20mg Adderall ER (17). I stopped taking Vitamin C as I had discovered that it increases the rate of clearance of amphetamines, and also started taking Biotin to support metabolism and brain function.
Another adjustment to Lamictal and Adderall.
Toward the end of June 2012, I was prescribed Ativan as needed for anxiety (18), which actually works. I was still taking the fish oil, Biotin, Vitamin B Complex, Vitamin D-3, and Folic acid. Even when I went backpacking for a week, I had to take a handful of pills every morning on the trail.
Meds go with you even on vacation.
Things stabilized enough to identify severe depressive episodes that were clearly hormonally triggered – probably Premenstrual Dysphoric Disorder. During a particularly harsh downswing in June 2012, I pretty much abandoned all the vitamins and supplements except D-3 and the addition of Chromium Picolinate to try to support metabolism. Then I added in 50mg Zoloft (19), and things improved somewhat. In July 2012, the Lamictal dose went up to 200mg (20), and everything evened out again.
Reduced supplements, added Zoloft, & increased Lamictal.
In August 2012, I also added in D-Chiro-Inosulate, which is another metabolism booster that can help with insulin resistance, and returned to taking Biotin and a super-high concentrate fish oil capsule. The evidence for a diagnosis of Polycystic Ovary Syndrome was stacking up, so after consulting with both Psych #3 and a gynecologist, this week I added in Lo Loestrin Fe (21), a very low dose hormonal birth control pill.
Starting the pill & adding supplements back in.
And that brings us to today, after 21 changes to my meds in just 21 months. It’s a bit disheartening to be popping 10 pills every morning, half of which are prescriptions. But no amount of therapy is going to offset the hormonal and neurochemical weirdness in my body. I’ve been doing pretty well for about a month now. Although more changes will doubtless arise, if a few pills are the tradeoff for (relative) stability and functionality, I feel pretty fortunate.
© DeeDee and A Canvas Of The Minds 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to DeeDee and A Canvas Of The Minds with appropriate and specific direction to the original content.
A Canvas Of The Minds 
I’ve been taking supplements for years and take a handful morning and night. Luckily I’ve only had 3 meds…Tegretol, prescribed by my GP to start in Nov 2009, quit working after 3 months. It took 4 months to get into a psychiatrist when my GP recommended that. I HATED him. Didn’t listen to me at all and prescribed Seroquel which I refused. It took another 2 months to get into a different psychiatrist. In the meantime I went from suicidal ideation to ultra rapid cycling while my therapist helped me hang on. Psych #2 tapered me off Tegretol while adding Lamictal (now at 400 mg 1/2 in am, 1/2 in pm). It took 6 months for the switch over. At the end of the 6 months I was still having trouble with middle insomnia so started on Trazodone (50 mg) and Melatonin (10 mg). I’m fortunate as my psychiatrist tells me that I’m only on 2 drugs. I’d love to be on none but I won’t chance it. I pray that this combination keeps working as it has for almost 18 months.
I thought three months to get to the right dose on Lamictal was difficult, but 6 months to switch meds? Sheesh! I’m glad the current combo is working for you.
My pdoc wanted to take it really slow to avoid triggering seizures. After the Tegretol was out of my system, it took a bit to get the Lamictal up to the proper level. I think I handled it pretty well although every change brought a day or two of ‘weird brain’. I did the transitioning over a weekend to avoid it at work.
That’s great to hear s final success story! Gives us hope! Glad you are in a better place than before. 😉
Thanks – of course, it’s hard to know how long this stage will last. I kept hoping I had “gotten there” at each prior change, but so it goes.
DeeDee,
Wow… Again, I have read some of this on your own blog… And I am all for your shameless “involuntary” links back to your site… I won’t tell anyone…
Le Clown
Cher Le Bouffon,
Wow in what way?
It does add up to a lot more changes than even I had expected. The hell of it being that some months there were three or four changes, and at times, two or three at once. That makes it really hard to figure out exactly what part of the combination is causing side effects or benefits!
DeeDee
When I got back from Florida at the end of January, the psych upped my Wellbutrin to 300mg. That gave me the worst shitfest ever (sorry if I made you have a mental image). Really though, it gave me terrible constipation followed by diarrhea. I quickly got it back down to 150mg again, then out of nowhere I decided to stop taking it because I couldn’t get rid of the obsessive thought that it was going to make me go deaf faster. (I’d read about the tinnitus side effect and had noticed increased tinnitus for months.)
Now I’m on week 3 of Lamictal, 75mg. I do feel a tad bit calmer as in I’m still waking up at 4am every morning but at least I’m not waking up having panic attacks. Not much. Here’s to hoping…
p.s. The little guy at the end it cute though! heheh
I hear you on the tinnitus – it was a daily thing when I was at 450mg and that kinda freaked me out too, but it’s much less noticeable at 300mg. I’m still holding out hope to reduce Wellbutrin back to 150mg some day. It makes me sweat a lot more and that just gets really unpleasant.
I found that Lamictal really reduced my anxiety levels overall, though it didn’t completely eliminate the anxiety. It also made it easier for me to wake up in the mornings and stop binge eating, which was a huge relief. Even if I do get a PCOS diagnosis, I kinda doubt they’ll rescind the bipolar dx because of that exact sort of thing – if I didn’t actually need the Lamictal, I don’t think I’d have seen such benefits that have no apparent link to mood stability.
I meant, week 5! lol
Wow, what a journey!
I didn’t record my med history but it spans 2 years and going on (to max dosage) and off (quickly, because I’m in hospital) of them. I’ve been through a dozen or so meds.
It’s tough going trying to find the right combo. Sometimes I questioned the whole process and if the meds are actually going to help me at all but finally I think I can say they are helping. Finally!!
All the best,
Thanks for sharing your journey with us x
Glad they’re finally helping – it’s such a test of patience to get there. When I first started Lamictal, I felt like I’d found a miracle drug and would never need to make another change. Not so much… But at least things are better, if only for now.
I was diagnosed with bipolar 2, borderline personality disorder and ptsd in 2004. Been prescribed 25mg seroquel, 150mg wellbutrin and 75mg lamictal. I was doing great until 9/27/11 when I had a seizure and was hospitalized (needlessly) for 4 days. Although a ct scan showed hydracephalus, They figured the seizure was caused by the lamictal and was forced to wean myself off. Since then, I have had 11 more seizures. They have prescribed a generic form of wellbutrin called budeprion sr (150mgs daily). Today is the 5th day I’ve refused to take it because on the info sheet I recieved when I picked up this generic form, it clearly states to discontinue use if you experience seizures and on 11/12/12, I experienced 3 seizures in a row, the last of which my b.f. witnessed my lips turn blue
My pdoc has not even responded to any of my msgs and I’m mortified I will do something drastic! My appointment isn’t til 12/11/12. I don’t even feel like myself. Can you help? Any advice would be so greatly appreciated. Thank you so much! Cindi
Hi Cindi, that sounds like a really difficult situation. I am not a medical doctor and I can’t offer medical advice. However, I would suggest that your pdoc not returning calls suggests that you might want to start looking for a new doctor ASAP.
I have never had seizures of any kind (sounds so scary!) so I can’t even give common sense advice there, except go to the hospital if you’re experiencing a medical emergency! Sorry I can’t be any more helpful.
Thanks for your reply! What sucks is that this is a new pdoc, who during our first meeting he prescribed abilify. When I picked it up and read the info, it stated that the med is for schizophrenia and bipolar 1. (which I have neither) And not to use if you have ever had a seizure, have a family history of diabetes. Which I do have. Great pdoc, huh? I’m kinda stuck between a rock and a hard place because I have no insurance.
I’m on day 6 no meds at all (except for 25mg seroquel every night for sleep). It’s been scary but, I think I might go it med free because besides a few hives on my neck and slight ringing in my ears, I feel pretty good. I’m totally hesitant to go back to this quack, ya know?
Abilify is one I’d be super skeptical about myself, but it’s also really helpful for a lot of people. It sounds like your pdoc was prescribing “off label” which means for a purpose other than what it was approved for. That’s not always a bad thing but risk factors can be very hard to evaluate, e.g. the family history thing, without genetic testing for medication sensitivity, which I highly recommend to anyone taking psychoactive drugs.
It seems odd that the medical team thought lamotrigine caused a seizure (it’s an anticonvulsant) but didn’t look at the Wellbutrin (known to increase seizure risk!) I’m sure they had a reason for that, but it sounds weird.
If you’re going off your meds without a doc’s supervision, be very careful and make sure the people around you know what symptoms to look out for in case you’re not able to see them yourself. Discontinuation on certain drugs can cause known withdrawal effects and so on, but it sounds like you’re doing OK so far. The sooner you can get into a good doctor, though, the better. I know how much easier said-than-done that is; it took me 3 months to get in to see a new pdoc when I quit a crappy one because my area is “underserved” meaning there are very few options even if you do have insurance!
If you’re without insurance, you should check into your local resources for low-income health care (go to the library – librarians can find pretty much any information you need!) And check out this awesome post from Sarah Sullivan: http://thebipolarcuriousblog.com/2012/03/07/best-kept-secrets-for-getting-affordable-treatment-for-mental-illness/
Hey Dee Dee, Thanks for the vital info. I have an evaluation on 12/4, this dr has me so frustrated though. He’s the one who prescribed abilify. I also believe these seizures began when they started using “generic” budeprion in place of Wellbutrin. They never informed me of any of this, I just noticed the tablets looked different. I really wish I had insurance so I wouldn’t have to use the health dept. But I have no choice. But, really!! 😀 12 days no meds besides a valium now and then, not too often though, and I really feel very much like me! It’s been exactly 2 weeks since the last seizures. For that I’m extremely grateful. I pray almost constantly! My drs. are health dept. drs. I cant work but 2 days a week and I think I’m ready to apply for disibility because I also suffer from severe carpal tunnel syndrome. Between that, the bp2 and seizures, maybe I’ll be approved and begin to receive the type of care I need. I will keep you posted! Thanks and bless you! Cindi
Good luck!