I suck. And I’ll start updating more, too.

August 1 2008 I had been discharged from my longest hospitalization.

form1

October 7th, 2013 I was hospitalized until October 24th because the stress of life, the universe and everything kicked in and I broke down. Of course, no beds on my Dr’s unit, so he loopholed me through PERT – Psychiatric Emergency Resource Team. They had an emergency room physician come in and put me on a Form 1. 72 hour involuntary hold. Dr N, my pdoc, was not impressed. He took me off it when I was transferred to Unit B, the ward he works on. I was a danger to myself. What crap.

I had a panic attack when they handed me the Form 42 (copy of the Form 1). PERT is just seclusion rooms. Luckily, I wasn’t locked in. They nurse gave me some Ativan and a heated blanket. I slept. BF showed up. He brought McDonalds. My friends took my car back to the apartment. The next day I was transferred to Unit B, where my pdoc works. I had a private room. It was BF’s birthday. He saw me anyways. I owed him big for that!  They tried to give me Ritalin at 10pm, night meds. I refused it. They charted I was “refusing meds”.  My pdoc laughed the next day, thankfully, saying it was good I knew to refuse Ritalin at 10pm! He then told them to NEVER give it to me after 4pm.

Pdoc was good to me. Saw me daily. I had a pass for Canadian Thanksgiving. It sucked, my dad was drunk and being an ass. It was a short pass, thankfully, I had BF with me. “Oh, back so soon.” Oh, yes. BF went for his MRI results: No change in the tumor since his diagnosis a year ago!! MRI’s are yearly, now. At the best cancer centre in Canada, only 45 min away from us. He had a seizure last night. His neurologist is still working on the meds. Less bad, shorter seizures, but still minor seizures. No unconsciousness, no disorientation, but still.

So, we had a lot of groups. I met a couple cool people. I had a day pass, I went to the barn, went riding.

sparkle

That’s me on Sparkle. She’s a five year old, gigantic Thoroughbred filly. Her registered name is “Sparkle Tangerine”. I did some walk, trot, canter and a small jump. She was very good. Look how tiny I am on her!  I was exhausted when I got back.

I did all the groups. I got so sick of the religious crap from a lot of patients. There wasn’t a lot of super craziness like I’ve seen. No restraints used, no chemical restraints used. A few “code whites” (unmanageable or violent patient) called. I was going to go long term, but the beds weren’t available. Dr N saw staying on the ward was getting hard on me, and we agreed on discharge for the 24th. I start outpatient therapy next Tuesday for anxiety, stress. CBT, that sort of thing. One on one. The only cost is parking.

I now take Geodon (aka Zedox), Lexapro (Cipralex), Ritalin, Topamax, Clonazepam, mostly at lower doses, managing. and my normal meds for my health. I was diagnosed with endometriosis yesterday. BLAH. I start birth control (I’ve had a tubal ligation!!) after my period to try to ease the pain. If not, we do more drastic things. It’s not the worst thing in the world. The ultrasound could have shown a million WORSE things. (Endo is not detected on most ultrasounds) I’ve decided on rotator cuff surgery. Dr N was great to me in the hospital. I thanked him before I left, for his patients. The rec therapists were great. One I’ve known since 2002. We even had a ball pit!

That’s my life for now.

Advertisements

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.”

 

Scary Side Effects Part 2 – Neuroleptic Malignant Syndrome

I’m not writing this because I’m anti-medications or anything. I’m a big fan of being on my medications or I wouldn’t be functional at all. But when you introduce different chemicals into the body, it can affect more than what it’s meant to do. I took Seroquel for many, many years, and eventually switched to Zeldox (Geodon). I switched back to Seroquel, and at 400mg, I could hardly get out of bed to go to the washroom after I took my night dose. The highest dose I had been on was 900mg. 300Mg’s 3 times a day.

Then I noticed some weird side effects. I couldn’t swallow. Then I would start to panic, get up, drugged out, drink water, try to sleep, have to pee, wash rinse repeat. I also noticed fluttering in my chest, my heart kept beating “wrong”. Too fast, too slow. I would panic until I was eventually knocked out by the ‘quel but it took a while since I’m quite the insomniac. Upon hearing my symptoms, the Seroquel was discontinued and I heard of something called neuroleptic malignant syndrome, and it fit. I mostly had symptoms of dysautonomia.

 What is Neuroleptic Malignant Syndrome?

NMS is a neurological disorder generally caused by some (not all, and very rarely) antipsychotics.(1) It is potentially deadly and starts in the first two or three weeks of antipsychotic use. It is a bit more common in the original antipsychotics (for example, Thorazine), and happens on the occasional atypical antispychotic, which is the new treatment for psychosis and mood stabilization.(2)

 What are the symptoms of NMS?

  • high fever, sweating, unstable blood pressure, stupor, muscle rigidity and dysautonomia(3).

  • Dysautonomia is a disease in itself. It is a medical term used for a group of conditions caused by the autonomic nervous system (ANS). Symptoms include:

  • — tachycardia (extremely fast heart rate)
    — bradycardia (slow heart rate), palpitations
    — chest pain
    — dangerously low blood pressure
    — wide swings/sudden drops in blood pressure
    — orthostatic intolerance (the inability to remain upright)
    — excessive  fatigue exercise intolerance
    — dizziness, fainting/near fainting
    — gastrointestinal problems
    — nausea, insomnia
    — shortness of breath
    –anxiety tremulousness
    — frequent urination
    — convulsions
    — cognitive impairment
    — visual blurring or tunneling
    — migraines

What causes NMS?

An adverse reaction to an antipsychotic or neuroleptic drug.

What is the treatment?

Immediate discontinuation of the medication, the symptoms are treated (mostly the fever) and a dopamine agonist can be useful. There is no diagnostic test.

What happens if it goes untreated?

It can be fatal.

  1. http://www.ninds.nih.gov/disorders/neuroleptic_syndrome/neuroleptic_syndrome.htm

  2. http://emedicine.medscape.com/article/288482-overview

  3. http://www.uptodate.com/contents/neuroleptic-malignant-syndrome

  4. http://www.medicalnewstoday.com/releases/76785.php