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.

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.”

 

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

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

More than just a lift: Off label use for Antidepressants

A brief history of antidepressants

Antidepressants were accidentally discovered by chance in the 1950’s.(1) While seeking out a medication for schizophrenia, the main diagnosis at the time, drugs were found that could “tweak” the balance of the brains neurotransmitters (even though they didn’t really know how it worked at that time) Patients that weren’t schizophrenic got worse, but other patients, depressed (“neurotic”) had bouts of euphoria.

In 1955, the miracle cure Tofranil (imipramine) was patented, and others started coming up with similar tricyclic(2) antidepressants. Relief came to 60-80% of the patients, but there were terrible side effects and tricyclics can cause heart problems, much moreso than many other psychiatric drugs. In 1987, Prozac, the first SSRI(3) was created, with the same effectiveness and less side effects.

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Wellbutrin (Buproprion)

Wellbutrin was created as an atypical antidepressant but they found it helped aid people in quitting smoking, in which it is called Zyban. (When I took it, I got so anxious, I started smoking again after 6 months smoke free!) It is a mild stimulant and is the fourth most prescribed antidepressant in the USA.(4) It is very effective and can be an add-on drug to an antidepressant without worrying about serotonin syndrome, a dangerous syndrome caused when there is too much serotonin in the brain. Often, it is prescribed because SSRI’s can effect sexual functions, and this can help get them back, as well as lose some weight while you’re at it!

Zoloft (Sertaline)

Zoloft is used to treat depression, obsessive compulsive disorder, panic disorder and social anxiety. It is the second highest selling antidepressant in the USA(5) and is approved for children and adults. It works in a similar fashion to tricyclic antidepressants and some say it helps control urges, such as binging and purging. I took it for bulimia, but it made me incredibly violent and agitated, so I was taken off it ASAP.

Off-label Uses 

Off label uses of antidepressants are on the rise. One in five doctors prescribing antidepressants are not psychiatrists(6) and aren’t being used for psychiatric purposes. They can help with: fatigue, non-specific pain, smoking cessation, headaches, abnormal sensations and premenstrual tension.

 Prozac, Zoloft and Paxil are approved for premenstrual tension. Wellbutrin for smoking cessation and Cymbalta for diabetic neuropathy, chronic musculoskeletal pain and fibromyalgia. Some antidepressants control menopause symptoms as well as hormones do, and if you switch it around, beta-blockers help anxiety. Many medications for schizophrenia were used off-label for bipolar disorder or to augment an antidepressant, and are now on the market, FDA approved for both, such as Abilify, Seroquel and Zyprexa. Many antidepressants can help with pain (migraines, for example) such as Elavil (amitriptyline).

 Hell, Viagara is even prescribed to some women to improve their sex lives too!

  1. http://www.time.com/time/health/article/0,8599,1952143,00.html

  2. Three-ring chemical structure

  3. Selective Serotonin Reuptake Inhibitor

  4. http://en.wikipedia.org/wiki/Bupropion

  5. http://en.wikipedia.org/wiki/Zoloft

  6. http://depression.about.com/b/2011/08/09/off-label-antidepressant-use-on-the-rise.htm

  7. http://www.consumerreports.org/cro/2012/05/off-label-drug-prescribing-what-does-it-mean-for-you/index.htm

  8. *Note: Off-label does not mean illegal. It is generally not FDA approved for that specific condition. Also, antidepressants don’t have the abuse potential of many other meds.

Mania slowly eats your brain (seriously)

Mania, the horrible mistress of bipolar disorder. We sometimes take it for granted in it’s early stages, hypomania, but in a full blown out manic episode, everything can go to hell. Many people accidentally kill themselves in manic episodes. But did you know, that during an episode, you’re killing your brain?

“Episodes of mania and depression may cause damage to learning and memory systems”(1)

Long term patients showed more cognitive impairment than those younger, or newly diagnosed. Bipolar disorder and time are not your friends. After 5-7 years, the newly diagnosed showed some cognitive impairment.

It can be blamed on medications, but that’s untrue. They can cause cognitive slowing but they aren’t a culprit. Some medications even repair parts of the brain, and are considered to have neuroprotective properties.

The brain breaks down as the disease goes on, and it isn’t able to process information the way it used to. (Remember, bipolar is a kindling disease, if left untreated, it just gets worse and worse, and the damage increases per episode)

“People with bipolar disorder suffer from an accelerated shrinking of the brain”(2)

Gray matter in the brain is lost during an episode, in the areas of the brain that control memory, face recognition and co-ordination.

“Evidence has been overwhelming that bipolar disorder is a disease of the brain, like Parkinson’s or MS”(3)

Those with bipolar disorder have enlarged ventricles in the brain and extra white matter, for example. Impaired awareness (50% of those with bipolar disorder are aware of their disease, diagnosed or not) is because of decreased activity in the pre-frontal area. This is similar to a stroke victim.

Results of MRI’s from the mentally interesting and people without mental illness show that those without mental illness had more gray matter in their brains.(4) Gray matter is consisted of nerve cells. An essential amino acid, called NAA, was monitored in bipolar patients and the amount decreased as the illness progressed, which indicates damage to neurons. These findings are comparable in Alzheimer’s.

In conclusion, if you’ve been diagnosed with bipolar disorder and want to make the best of your life, take your medications, live a healthy lifestyle, don’t drink or do drugs and learn some insight to get proper treatment before an episode happens.

And just remember this: What goes up, must come down.

  1. http://www.healthyplace.com/bipolar-disorder/articles/brain-damage-from-bipolar-disorder/

  2. http://www.sciencedaily.com/releases/2007/07/070720103036.htm

  3. http://www.pendulum.org/disease.htm

  4. http://www.ehow.com/about_5245785_effects-bipolar-disorder-brain.html