Thursday, May 15, 2008

Bipolar Medication: My First Experience

Caveat: I am a layperson with no medical training. This series on medication is based on research and personal opinion. If you plan on making any changes to your medication, consult your doctor.

After I was diagnosed as atypical bipolar II in 1993, the psychiatrist whom I've long since thought of as Ice Maiden (given her lack of empathy), prescribed Zoloft. Despite how horribly depressed I felt, she told me the medication would take two weeks to "kick in" if it worked at all.

When I asked her for information on Zoloft, she said she was out of the pharmaceutical brochures. When I asked her to recommend books about bipolar disorder, she said all her books were too technical, and she had no suggestions.

The next two weeks were the longest ones in my life. Perhaps William Styron describes it best in his book, Darkness Visible: A Memoir of Madness, when he writes:
"In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come--not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul."
It was truly a miracle when the Zoloft kicked in. You have to have undergone this yourself to know what it's like to feel alive again after feeling so melancholic that it was not only difficult to get up each day, and to pretend to feel "normal" so I could be with my husband and son, but even to physically "speak."

The Zoloft continued to work. While my doctor wanted me to remain on it all the time, I chose to go off it after each six-week semiannual depressive episode ended. My reasoning made sense to me. I wasn't comfortable taking psychiatric medication. And even with Zoloft, I could feel the depression beneath the surface, and thus I knew when it was over.

In 1994, in addition to having a depressive episode in April and another in October--which had been my pattern for 25 years--I had a third depressive episode in December. This time I agreed to remain on Zoloft for six months, but in February it pushed me into my first and only full-fledged mania. Stay tuned!

A Word of Explanation: Many of you probably know that ordinarily psychiatrists are supposed to prescribe mood stabilizers before antidepressants because the latter, by itself, can and usually does lead to manias or hypomanias. In retrospect, it was fine for Ice Maiden to have prescribed the Zoloft first because I was so terribly depressed, but she certainly should have known that after the depression ended, she should have prescribed a mood stabilizer. It was bad medicine not to have done that, and it had frightening consequences.

* * *
What was the first medication(s) your doctors prescribed for you? Did it (they) work? How did you feel?

27 comments:

Tony C. said...

Hi Susan,
It all started with amitriptyline way back about 10 years ago. That was when the medics thought I was depressed. Then they tried me on diazepam for a time. Next came seroxat (paxil) - which caused me so many problems; I was left with tinitus from that stuff. Getting off it was an absolute nightmare. I tried st. Johns wort - no good at all. Next it was prozac, which sometimes works. December 2006 I was diagnosed with rapid cycle bipolar, and the drugs party really started!! First up came respiridone, which would have knocked out a bear! I didnt know where I was, and was taken off it quickly. Depakote came next, and made me paranoid. for a while the medics scratched their heads and upped the prozac. The next thing on thier shopping list was Carbomazipine which seemed ok till my liver was tested and I had to come off that. After a whole load of tests the most recent brain tinkering came in the form of lithium, after six days of the most awful side effects I was taken off. So its just prozac, omega3, and vitimin B complex now. Next week I go and see the psyciatrist again; lets see what he has left in his chemical toolbox to offer me now.
stay well everyone.
Tony C.

Tony C. said...

Hi Susan,
as a postscript to my other comment about meds. Now that my employer has found out I am med-less I seem to have become a human time bomb, and my competancy to the do my job is being questioned. Why should I be pressurised by who I work for into being chemically "defused"?

NurseExec said...

My first med was Prozac, way back in the day. I was in the deep dark, and I remember feeling human again. Unfortunately, it pooped out fairly quickly. After that, it was "try and find something that doesn't send me into a mania". Ugggg. It took the advent of Lamictal to really get my depression under control without mania hell.

GirlBlue said...

I was first diagnosed with dysthymia and prescribed PaxilCR which then changed to regular Paxil when CR was no longer available in my country.

Going on was rough to begin with the nausea, dizziness, orgasm issues etc etc but it did help for all of a year or two. The withdrawal symptoms when I neglected to take them for a few days was always fun as well, especially the electric zaps in the lips, oh yesh fun stuff indeed

Naturalgal said...

The very first medication prescribed to me was Imprimine. The first time I took it I was in college. It made me incredibly sleepy. I could barely keep my head up.

I went back to the doc and told him I wasn't going to take it. This was 1986.

Ironically I had gone to the local mental health facility for help and they said, "We don't do medicines." So I went to the psychiatrist on my own. I didn't have insurance and he was private, so I couldn't continue to see him. He was NOT medicine happy. (But I was in college I had read how this was biochemical and I begged him for something.)

In 1988 I was again prescribed Imprimine, this time by a different doc. I was also prescribed Klonipin.

I believe that these medicines started my roller-coaster ride into my first manic episode a couple years later.

Less than 10 years later this same mental health facility I first went to was now a big pusher of "medication management" and had several psychdocs (MDs) on staff or on contract.

Meredith said...

I was, as you probably know, mistaken for unipolar depression (the doctor asked, "I don't think you have, but have you ever been manic?" and I, not knowing what that was, said, "Noooo....?") and prescribed Zoloft, which flipped me manic and put me in the psych ward. Yay for overworked and underpaid campus psychiatrists. :(

Jazz said...

Hi, Susan. Great post, as usual! You asked about the first medication...the first psych med I took was zyprexa, which was given to me by my GP when she realized I was in a manic episode. She knew it would be a number of weeks before I could get in to see a psychiatrist, and wanted to give me something to help bring me down. She was right--I called that very day, and the first available appointment was six weeks away.

At first, the Zyprexa didn't do much except make me a little sleepy--but she had me on a very low dose--2.5 mg for a few days, and then 5 mg. It took about a week before the agitation and irritability and high-energy calmed down. And it made me pretty sleepy. Hard to be agitated and irritable when you're half asleep!

When I finally saw the psychiatrist, the first thing he did was take me off the Zyprexa ("We don't like Zyprexa," he said, though he didn't explain why. This was in 2003...I'm not sure where that fits with the black box warnings that came out concerning diabetes).

Bipolar Wellness Writer said...

Dear Tony,
Before I comment, I'm going to let people know the trade names (where you don't use them) of the drugs you've taken so they understand. Amitryptiline is Elavil.Diazepam is Valium. Carbamazepine is Tegretol.

It sounds like your medication merry-go-round has been as bad as mine, although ultimately I was given so many more drugs). So sorry to hear it. St. Johns Wort didn't work for me either. Depakote didn't help, but it made me physically ill. Prozac made me feel like I wasn't myself.

I'm so sorry to hear about the effect of Tegretol on your liver. I, too, never could adjust to lithium although I tried it three different times over 15 years.

I'm so sorry that your employer is adding to all your suffering and stress! I'm not sure if the laws in the United Kingdom are different than in the United States, but it sounds like an overt case of job discrimination.

Thanks for participating in this series. Just know my thoughts are with you!

Susan

Bipolar Wellness Writer said...

Dear Nurse Exec,
Welcome to my blog! Thanks for your comment. I'm sorry for your suffering, but you bring up a good point about drugs "pooping out." Ultimately, that happened with Zoloft although in those days I didn't know that drugs that worked could "poop out." Glad to hear that Lamictal is working for you.

Susan

Bipolar Wellness Writer said...

Dear Girlblue,
Thanks for your comment. It's kind of amazing for those of us who live in the United States to think that medication would be available and then "not available." So sorry to hear that! In yesterday's post, you mentioned you've just started Depakote, and I will talk about it in a future post.

Susan

Bipolar Wellness Writer said...

Dear Naturalgal,
Your story brings up some difficult but important issues...I'm surprised that Imprimine (Tofranil) was the first medication they prescribed unless the diagnosis was ADHD.

But it also brings up the question of mental health services in college, the difficulty of getting any real help when you don't have health insurance, and the cost of medication.

I'll try and deal with some of these issues in future posts. Thanks for letting us know. And I wish you the very best on your quest for a "natural cure."

Susan

Bipolar Wellness Writer said...

Dear Meredith,
It's always interesting to be asked if you've ever been manic without knowing the symptoms. As you undoubtedly know, there is an increasing need for mental health services on college campuses. The question is whether colleges are adding staff to accommodate the demand.

I've written about this topic before, but will revisit it in future posts. Thanks for letting us know.

Susan

Bipolar Wellness Writer said...

Dear Jazz,
I don't know where you live but a six week wait to see a psychiatrist during a manic episode is extraordinary to me. I thought it was terrible that I had to wait four days to see Ice Maiden, but then I live in Los Angeles where there are probably more psychiatrists per capita than Starbucks stores in Seattle!

Your story brings up a critical issue about "access" to care in a "crisis." From what I've read, it's easy to see someone if you're willing to be hospitalized, but difficult as an outpatient, which makes no sense to me at all!

Thanks for your comment. Sounds scary to be in that situation!

Susan

P.J. said...

After my son was born in 2003, I went on Paxil for depression. It helped for the 6 months I was on it - we thought it was just post partum depression I was having.

My first bipolar med was Topamax, just diagnosed in Dec 07. It worked great for three months - I was stable, I was myself, etc. I hated the side effects - acne like I was a teenager again on my face and back (yes, my back!), carbonated beverages were impossible to drink due to weird, gross sensation/taste it did to my tongue, and my left arm and face was tingly from time to time. The first time that happened I thought I was going to have a stroke! But, it did aid in weight loss, which was a bonus. :)

I'm now on Valporic Acid and Celexa. I've been on it since April 17th, and so far so good! (Although coffee tastes a little off, but I will drink it regardless!!)

Bipolar Wellness Writer said...

Dear P.J.,
Glad to hear that your current medication is helping. So sorry to hear about the Topamax. I had some problems with that medication, but I'll need to check my six-year mood charts to remember!

Thanks for participating in this series. I'm feeling good that we're all so willing to share our experiences.

Susan

bart said...

the first medication i was prescribed was seroxat, which sucked me so dry emotionally that i ended up vaguely suicidal after a couple of months... reason enough to drop the stuff altogether after the winter and try to cope on my own...

Bipolar Wellness Writer said...

Dear Bart,
It's no wonder. I just "googled" suicide and Paxil and found that in May 2006, the Food and Drug Administration issued a report stating that Paxil causes a significantly higher rate of suicidality in depressed adults as measured in clinical studies.

Susan

Susan

Jazz said...

Susan-
I'm in Minnesota, fairly close to Minneapolis. You would think a big metro area like that would be crawling with shrinks, wouldn't you?

What's really scary about it is that six weeks was actually an amazingly short time to have to wait. She told me it would probably take 3 months...and the first place I called, it was 3 months.

I wasn't bad enough to go to the hospital...but I sure wasn't comfortable either. I don't understand why it takes so long to get in to see someone, either.

Bipolar Wellness Writer said...

Jazz,
From what I've heard, hospital stays can be awful. But, it would seem that if you were in a mania, you should have been able to have been assessed at a hospital as an outpatient, and given medication while you waited to see someone else.

To say the mental health system is "broken" doesn't even do it justice. I've read that the former Surgeon General, David Satcher, has attended meetings to discuss why mental health and physical health services aren't integrated!

Anyway, it was lucky that you survived while you waited to get care. No one in their right mind would think this kind of wait was okay for someone with a physical health problem.

Susan

perennial sam said...

Hi Susan,

My first antidepressant was Celexa, prescribed when I was diagnosed with major depressive disorder and social anxiety. It worked okay for a while, but my system got used to it very quickly and before long I was taking the maximum dose. My psychiatrist at the time went so far as to prescribe me with about twice the regular maximum dose. I have since learned this and the doctor who told me that most people don't go above 60-80mg more or less accused me of lying when I said my previous dose of Celexa had been 140mg. Thankfully there was a copy of my previous medications in my chart (probably a list of 10 or more meds), so she relented.

Currently I am not taking any medication, although I haven't been feeling that great. Most recently I took Effexor which made me really unwell physically.

Samantha

Bipolar Wellness Writer said...

Dear Samantha,
Thanks for participating. I'm sorry to hear you're not feeling well. As I remember you're in college. You should look at the program they do at Kansas State University. It's in the section, Wellness and Healing Sites, and it's called Therapeutic Lifestyle Change. If I were starting all over, this is the program I'd emulate. Hope it helps!

Susan

Coco said...

Hi Susan, my first was Zoloft for post-partum depression in 1994. When it started working and the hellish nightmare ended, I was in heaven. I remember the precise moment I started to feel better... I looked at my Mom and said 'mom? I think I'm actually beginning to feeling better'... it was the weirdest thing. And I continued to feel fabulous and on top of things for a few years.

Bipolar Wellness Writer said...

Dear Coco,
I must admit that when something finally works, it feels like a miracle. But, what happened? Did the medication "poop out" or did you stop taking it?

Susan

Coco said...

Susan What happened with the Zoloft is that I stopped taking it. Life was strange & stressful at the time, my husband and I were seperating... I thought I'd make a fresh start... just me and my 2yo son, no bad relationship, no meds. No Way. I crashed so very hard after 4 months. Back on Zoloft. It pooped out 5 years later. Onto Effexor. Now I want off the ride.

Bipolar Wellness Writer said...

Dear Coco,
Thanks for letting me know. I'm not sure how many "newbies" realize that even medications that work "poop out."

Susan

nicki said...

I experienced the same situation as you did. First one antidepressant helped, but eventually mania occurred. I eventually had to diagnose myself. I had read and read and read so much, but one day, when I hit bottom once again, I got on the internet on a mental illness website and reviewed the symptoms and decided that I would try the bipolar questionnaire and one question summed it up for me. "Do you sometimes have grandiose ideas and feel like you could do anything you put your mind to?" That was me... and when I told my doctor, who has been as supportive as she could possibly be, she said "I knew you would be the one to figure it out!" I wish I could say it has been smooth sailing since. I was put on valproic acid which took weeks to make any difference at all, depression still lurked and I had to watch my every move to make sure I didn't get too tired, or too excited. Then my psychiatrist added lamictal to the mix which seems to have picked me up a bit and I am able to be productive once again. However, I have to measure my activity and not overdo it, or I am either depressed or manic. I feel like a diabetic who has to measure their blood sugar all the time, I have to measure my moods all the time. But it is worth it to have some sort of life even if it is not the life I had imagined.
Nicki

Wellness Writer said...

Niki,
You'd have to read my most recent postings to learn this, but I'm now off all medication and I feel great! It turns out it was the medication that made me so ill, not the illness.

I probably should have been diagnosed as suffering from seasonal affective disorder rather than bipolar disorder.

I'm medication free and thriving!

Susan