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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.