Medications Part 4 – Atypical Antipsychotics Aren’t Just for Schizophrenia

A lot of people hear the word “antipsychotic” and shy away from the medication, or think they’re doomed. But in fact, atypical antipsychotics are quite useful in the treatment of bipolar disorder and depression.

 A few are even FDA approved for the use of either augmenting an antidepressant for someone with clinical or major depressive disorder, or as a mood stabilizer for bipolar disorder. I’ve been on atypical antipsychotics since I was 18, and must say, they have less side effects than the first generation ones, and they’re much more helpful. One, called Symbyax, is a pill of Zyprexa and Prozac paired for use in major depression and approved for bipolar depression as well.

 The main atypical antipsychotics are Abilify, Saphris, Fanapt, Latuda, Zyprexa, Symbyax, Invega, Seroquel, Risperdal, Geodon/Zeldox and Clozapine*.

 Antipsychotics, unfortunately, have the risk of major weight gain. I gained 40 pounds while on Zyprexa, it seemed to even out when I switched to Abilify. This can be off-putting for many of those prescribed these medications. Geodon, Clozapine and Abilify are considered “weight-neutral”, meaning they do not cause weight gain or loss(1) but your mileage may vary. I lose weight on Geodon.

 I found Risperdal to be a little sedating for a bit. But the big problem with many atypical antipsychotics (or AAP’s, for short) can cause your prolactin (a hormone) to go up. This, in females, can stop your period and cause “leaky breasts”. It’s not as much fun as it sounds, it’s downright gross and embarrassing to try to explain to your 70 year old shrink that your tits are leaking! Before I took Risperdal, I actually had to take medications to increase my prolactin levels, and I was taken off them before starting Risperdal.

 I find Risperdal to be a good “once in a while” medication. It doesn’t have the mood stabilizing effects that a lot of the others do. It helped with my irritability, but I’ve never been on it long enough to see it’s full effects. But my boobs went from a C to a DD. It is also available in a long acting injection. I don’t like long acting injections because once its in your system, it stays there, and until its completely out, you get the side effects.

 Saphris is a newer AAP and is not available in Canada, to my knowledge, and when swallowed, is only 10% effective, so, like Zyprexa Zydis, it has to be dissolved under the tongue. Reports say that it’s horribly disgusting tasting but it works. You also get a numb mouth for a little bit, which is always heaps of fun. Zyprexa Zydis doesn’t cause as much weight gain as Zyprexa itself, for some reason, and is good at knocking you right out, but there’s always that chalky feeling in your mouth the next day. Ick.

 Seroquel is one of the most well known AAP’s out there and is also known for causing a lot of weight gain. I never really gained on Seroquel, to be honest, and it made me stop smoking so much for some strange reason. Unfortunately I had weird side effects from it (heart arrythmia’s and trouble swallowing) so I had to stop taking it. At one point I was taking 900mg a day, enough to sedate a horse. No wonder I kept falling asleep in class! The dose I’ve noticed most people take is 300-600mg a day, usually at bedtime. It’s good in tiny doses (12.5mg, 25mg) for anxiety or a PRN (as needed) medication. It is also approved to be used with an antidepressant in bipolar and unipolar depression. Some people call it Slurrrroquel because of its sedating effects. It can be used as a mood stabilizer without a combination of an anti-convulsant.

 Geodon is one of my favourites, I honestly shouldn’t have switched to Abilify. Some people find Geodon (called Zeldox in most of the world, I’m using the USA name) very sedating, but I found it not-so-much. I often have trouble sleeping or staying asleep on it. It works as a mood stabilizer as well. It’s weight neutral but can cause akithasia, inner restlessness, something I’m feeling now due to Abilify. Abilify is considered a third generation antipsychotic, while the rest are second generations.

 Okay, this isn’t a review on AAP’s, so I’ll continue on with how they work, how they differ from “typical” antipsychotics and side effects.

 How do they work?

Like most psychiatric medication, they don’t really know how or why they work.(2) The theory is that they act on dopamine (a neurotransmitter) and block other neuroreceptors. Rispderal is said to block the creation of serotonin and dopamine, so the symptoms don’t show up, and Invega works the same way. Zyprexa, Seroquel and Clozapine block several receptors and try to fix the chemical imbalance in the brain, but unfortunately, do to this specific mechanism, type 2 diabetes is a possible side effect, as is weight gain. Abilify is unknown and Geodon is completely different, helping with positive and negative symptoms of schizophrenia, making it a good mood stabilizer.

 Side Effects

They say side effects only occur in 10% of those taking these meds(3) but honestly, I think its much more than that. Common side effects are: weight gain, tachycardia, insomnia, akathisia, agitation, anxiety, headache. It’s kind of funny because some of those side effects are what those medications treat.

 Rare side effects include: Dystonia(4), Parkinsonism(5), tardive dyskenesia and neuroleptic malignant syndrome, and sometimes type 2 diabetes.

 Atypical vs. Typical

Typical antipsychotics are sometimes called neurloeptics because it means “seize the neuron”(6) They tend to control symptoms such as mania, delusions and hallucinations, also called “positive symptoms”. (Do remember, that schizophrenia and bipolar work similarly in the brain) Side effects are similar, but worse, and can cause tardive dyskenesia (7), sometimes they are paired with medications like Cogentin to stop this.

 Though typical’s can treat positive symptoms, the negative symptoms are still there. In the 1980’s, researchers found a way to treat both sides of the spectrum, called atypical antipsychotics, that work on more receptors and have less severe side effects.

 “Researchers speculate that traditional antipsychotic medications completely block one kind of dopamine receptor, leaving other types of dopamine receptors unaffected. Atypical antipsychotics appear to block many kinds of dopamine receptors less completely.”

 

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Doctors and mental illness discrimination

This isn’t really an educational article. This is going to replay the last few weeks of my fight to get help.

My psychiatrist retired immediately after changing my meds and leaving me with nobody, except my GP to refill the prescriptions. My GP has referred me to every psychiatrist in the area, I have done my own research, and be damned if I can get in with a new shrink.

I like to have things set out and planned. I like knowing what’s going to come next. This lack-of-psychiatrist while going through bad restlessness from the Abilify (it works great, but I am restless as hell) just doesn’t work for me. My GP seemed fine at the beginning, like he’d prescribe everything for me, he took care of the diabetes insipidus, he’s been great. Except, he will not change any of my psychiatric medications.

He told me to take Cogentin for side effects, but Cogentin has worse side effects than the medication causing the side effects you’re trying to get rid of. So I was prescribed Artane, same deal, then Mirapex, which seemed good, until I read the PI sheet. “May cause you to fall asleep at random”. No. I eventually settled on generic Benadryl, and it takes the edge off. (Many people take beta-blockers for the restlessness, but my blood pressure is low, even lower with the HCTZ, so there is a chance I’d pass out)

I got in with a psychiatrist, all my problems were solved! No, she does a one time consult, reports back to your GP and makes a suggestion. She had no suggestions for me, really, except to swap antipsychotics, which was my idea, too. But my GP doesn’t feel comfortable doing this. I was referred to Telemedicine. They do a one time consult, I’m not even wasting my time, and their time, either.

So after I saw the first consult psychiatrist I decided to go to the ER of W-town, the city I was in at the time. It wasn’t busy and I was immediately put into Seclusion, where my boyfriend kept me occupied with his Nintendo DS, and I texted my friend to see if we could bump lunch up a little later, I was in W-town and to get back to S-town it would take extra time.

A doctor came in. i explained my problem, I needed a psychiatrist, I need a medication change. So he orders blood work and an EKG, which I refused (BIG mistake) because I just wanted to leave. By this time I knew I wasn’t going to get anything sorted out. I sat and waited for them to discharge me, and a nurse came in and we got into an argument over the blood tests. I said, I just had them done 2 weeks ago at a physical, they test everything, call my GP. She bitched at me, I finally asked “How long for the results?”

“An hour”

Okay, I can live with that. I let her take my blood, which she did really fucking badly, I’m not sure if it was because she’s incompetent (I very rarely, if ever have had anyone screw up drawing my blood that I can remember and I get blood work done very frequently, at one point, it was twice a week) She leaves, the doctor (it was his first day) comes in holding a piece of paper.

It was a form 42. 72 Hour Hold. Involuntary. I hadn’t been hospitalized since 2008 and this jackass, on his first day had just committed me. I demanded to speak to a patients advocate (that’s my right as a patient) and he refused. I called my mom to get her to call her lawyer, they took away my phone. So I ended up in the psych ward for 24 hours, left with a “Call Dr. P and take more Xanax”

Need I say that they refused to give me Xanax while I was under their care? I went into withdrawal, I was shaking, and they blamed it on recreational drugs, even though I tested clean.

I got out, gave up. I tried talking to my GP about all the bullshit, he can’t really do anything.

Nobody will do anything. Psychiatrist 1 sends me to another, to another, back to GP, to another. Etc. It’s a circle.

There is a huge amount of discrimination via doctors with mental health. Especially since I’ve been in the system for so long. 14 years. I was told before being discharged that I would not get a psychiatrist to see on a regular basis and “well, life’s not fair”.

My old psychiatrist always told me, “you’ll never be 100%, so why don’t you settle on 70 or 80% and live like that?”

Fuck. That.

Still jumping through hoops. I can’t afford a therapist, though they can’t do shit about my meds, they do help. My GP won’t alter my meds, nobody will see me more than once.

They have no clue whatsoever. I have been chewed up and spit out by this system and I really can’t take much more. I was put on a 72 hour hold because I attempted suicide 11 years ago. I was calm and fairly collected (I didn’t run around yelling and screaming) during the intake process. I didn’t rip the Form 42 up and kick Dr. First Day in the balls. I complied, because I know what happens when you don’t comply. It’s not pretty.

On the other hand, I broke my shoulder last year and there’s a 9 month waiting list for physio. My insurance doesn’t cover most physio and at $150/hr, yeah, right. My shoulder is, in medical terms, “very messed up”. So I suppose the mental health system is no better than the entire system itself.

Also, they wrongly diagnosed me with borderline personality disorder (something that has been discussed since I’ve been in treatment) by asking me only borderline personality disorder questions. Then they’d ask “why do you THINK you’re bipolar?” Because, um, well, 9 psychiatrists and 4 psychologists have assessed me (once was over a period of 6 months inpatient) and they TOLD me I was bipolar. I don’t want a disorder!

I tried to speak up. I tried to ask for help. It was denied. I was put in a locked ward and denied a medication I need. I’m more irritable. I’m afraid of telling the truth so they won’t lock me up again.

Something has to be done.

Danger! Lithium Orotate

If you do a basic Google search for this supplement, it will bring up things like:

  • Lithium orotate works!
  • Lithium orotate is NOT a prescription drug!
  • It is NOT toxic like lithium carbonate! (1)

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Well, what do you think when something sounds too good to be true?
It probably is.

Over the counter supplements can be extremely dangerous when put in the wrong hands. Diet pills are a good example. So many diet pills are put up and pulled down from the market in any given month, and serious side effects are later reported: heart failure, anxiety, liver or kidney problems. Sure, people abuse over the counter supplements because they think they are safe, but some over the counter supplements can do far worse than a prescription medication.

This article is probably going to piss some people off because I’m fairly anti-over-the-counter-supplement, unless I need something for my cough or flu. Vitamins are always a good idea, but you should still make sure you need them. Sometimes more is too much. This is my side, and many medical professionals, sides of lithium orotate. I’m not saying it’s going to immediately kill you, it may work, but tell your doctor, as with any supplement you may be taking because they can interact with other medications and dietary supplements too. I can’t stress that enough. Also, it isn’t allowed in Canada.

Let’s get started.

What is lithium orotate?
Another way of delivering lithium. Lithium carbonate is generally used in bipolar disorder in doses of 300mg and up. They claim that lithium orotate goes “straight to the brain”(2) but this is untrue because medications have to be processed by the body, mainly liver and kidneys, and the blood-brain barrier has it’s own defence system, which basically means, drugs don’t go directly to the brain. The barrier is needed to keep the brain and central nervous system healthy. It treats medications as an enemy, not allowing them through. (3)

Okay, so lithium orotate is just another method of delivering lithium to the body in hopes of it helping bipolar disorder, depression, anxiety, and whatever else.

Lithium orotate is a salt of lithium and orotic acid. There are no systematic reviews of the efficiency of lithium orotate for any condition. In 1979, it was found that lithium orotate was more dangerous to the kidneys than lithium carbonate.(4) Don’t forget about the thyroid! Lithium effects that, too.

Lithium attacks the kidneys. I know this because I have diabetes insipidus. People complain of symptoms such as urinating too much and being constantly thirsty on lithium orotate. I am not saying its causing diabetes insipidus in all the users, but that’s not necessarily good for you. Ok, I’ll stop giving you my opinion and give you some facts.

Lithium Toxicity from Internet Dietary Supplement (5)
The internet has made it easier to get supplements, and easier to overdose on them. An 18 year old woman presented in the emergency room after taking 18 tablets of a lithium orotate based product, each containing 120mg of lithium. She had a low lithium level, was vomitting, and given IV fluids. 90 minutes later, her lithium level was higher, and she was transferred to a psychiatric ward with stable vital signs, but also lithium toxicity.

Lithium orotate is not FDA approved. (6)
There is no research of it being used on humans, but it is available online to anybody.

Lithium orotate releases more lithium into the body than lithium carbonate, bringing us back to kidney issues. Kidney disease, kidney failure, and death. Talk to your doctor. Don’t believe everything you read, take caution, and read the bottle. Unlike a prescription bottle, whose to say if the information is accurate?

“Controversial claims regarding the actual benefits and side effects of lithium orotate are widespread. Much of the debate centers around the last recorded study done on rats in 1979 by Smith and Schou. In the study, equal amounts of all three lithium derivatives were given to the rats. The results indicated that lithium orotate was not eliminated by the rats’ kidneys, unlike the other two brands.” (7)

So what am I trying to say?
Lithium orotate could help you. Or it could not. It could damage your kidneys or kill you. If you need to be on lithium, get it through your doctor or psychiatrist, not off the internet. It’s been used since the 1970’s. You need kidneys and the risk of damage is lowered when a physician is having regular levels drawn and monitoring your treatment.

(1) http://mysite.verizon.net/res003jh/lithium-orotate/
(2) http://www.marsvenus.com/p/lithium-orotate
(3) http://www.health.umn.edu/research/corridors/brain/blood-brain-barrier/index.htm
(4) http://www.ncbi.nlm.nih.gov/pubmed/34690
(5) http://www.ncbi.nlm.nih.gov/pubmed/18072162
(6) http://www.ehow.com/about_5531532_lithium-orotate-information.html
(7) http://www.ehow.com/about_4614151_side-effects-lithium-orotate.html

Break

Taking a break from blogging for a bit as I’ve fallen into depression and don’t really want to do anything. I could change my mind tomorrow, or next week. We’ll see how things go. Thanks everyone. I’ll be back eventually.

Involuntary Patient

Sorry, I had some stuff I was going to post yesterday but I had great fun going through the ER trying to find a new psychiatrist (mine retired) and ending up involuntary committed to the psych ward. I got out this morning after a 30 second “chat” with the staff psychiatrist, who referred me to someone not taking patients, back to the start.

I don’t see why I have to do all this by myself, or why I was admitted at all. I asked to speak to a psychiatrist about my medications, the doctor (it was his first day) demanded blood work and an EKG, which I had last week. I said no, I just want to talk to a psychiatrist. He asked if I ever attempted suicide.

If he saw my arms, he’d know, but I wear long sleeves. I said, once, when I was 17.

Apparently that made me a DANGER TO MYSELF and refusing the testing made me PSYCHOTIC so he served me with a Form 42 and would not let me talk to a patient’s advocate, which is illegal. 

They denied me my regular doses of Xanax and I went into withdrawal quickly.They referred me to this psych and that one, none are taking patients. I left with no med changes and with all of my patient rights violated.

I was not psychotic (I was saner than he) nor have I hurt myself in years (May 12, 2011). My last suicide attempt was in 2001.

I give up.

The Devil and God are raging inside of me

Hell on Earth: Bipolar “Mixed States”

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Bipolar I, and Bipolar II (was just updated in the DSM5), all tend to come with a symptom that isn’t quite mania nor depression. It can also be called dysphoric mania. It’s like taking the two, throwing them in the blender and see what you get. You can be depressed with a lot of energy (example: racing mind, many suicides are attempted in mixed states) or manic with depressed thoughts.(1) I find myself incredibly irritable and angry during a mixed state.

 

Sounds fun, eh?

It’s not, at all, even closely remotely to being fun.

 

The DSM-IV defines a mixed episode as a period of at least 1 week in which the criteria for both a major depressive episode (MDE) and a manic episode are met nearly every day. During a mixed episode, an individual experiences rapidly alternating periods of sadness and irritability and of euphoria accompanied by symptoms of a manic episode”(2)

 

Some symptoms include: agitation, insomnia, appetite dysregulation, psychotic features and suicidal thinking. At least 40% of those with bipolar disorder have at least one mixed state in their life. There is a greater rate of suicide, substance abuse (which definitely won’t help it!) It is literally mania littered with depression.

 

Those with mixed symptoms are generally diagnosed at an earlier age with rapid cycling, suicide attempts, more irritability and Bipolar 1. It affects more women than men.

 

Mixed episodes are difficult to treat, both states have to be identified, and works best if caught early (and can prevent future mixed episodes from occuring.) The treatment, for the most part, is medication, like Lithium or Depakote. Antidepressants can make the mixed state worse, or blow up into full mania. Mixed states have also been mistaken for ultradian cycling bipolar disorder. Mood stabilizers, antipsychotics (preferably atypicals) help with mixed episodes, and ECT(3) can also be used to zap you out of it. An antidepressant might be temporarily used, but as I said, it can do more bad than good.

 

Over the years, I’ve had a few mixed episodes. I have bipolar type 1 with rapid cycling. After ECT, my highs and lows weren’t as drastic, but I still get mixed states.

 

If you’re in a mixed state, or someone close to you thinks you are, please, go to a hospital before it gets worse.

 

 

  1. http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

  2. http://newsletter.qhc.com/CP/CP_BMS2.html

  3. http://www.webmd.com/bipolar-disorder/guide/mixed-bipolar-disorder