ECT? Ketamine infusions??

I saw my psychiatrist this morning, and it turned out to be quite an…interesting…half an hour.

She realised the lithium dilemma without me having to explain it, and the upshot is that we’re reducing my dose from 800mg to 600mg nightly in order to reduce the side effects I’m experiencing. This means we definitely won’t be hitting our original target of a lithium level between 0.55-0.7, but she says that target is more relevant to bipolar patients than patients with depression. Hopefully 600mg will still be useful to me.

We’re also adding in another antidepressant to try and boost my serotonin levels: welcome back mirtazapine (/Remeron). I have to admit, I’m a bit nervous about this – I’ve taken it before to help me sleep (which is another reason my psychiatrist wants me to take it now), and in December I wrote myself a warning before discontinuing this med for being too strong. I’ve been told to cut the pills in half and see if a lower dose is tolerable, and then increase in a fortnight. 

The whole medication vs insomnia battle really sucks; the meds are either so strong that I’m barely conscious in the daylight hours, or so weak I might as well be swallowing chalk pills. The only med that hit the right spot in the middle was zopiclone (/Imovane/Zimovane), but I’m not trusted with it in case I overdose. Grrr.

With this all established, my psychiatrist sat back and said we should think about what the next step is. When I see her in two months time, if the mirtazapine hasn’t helped much she wants to add in aripriprazole (/Abilify), an antipsychotic. After my bad experiences of olanzapine (/Zyprexa), quetiapine (/Seroquel) and risperidone (Risperdal) I had sworn I never wanted to touch an antipsychotic again, so we’ll see how I feel if it is decided this med is necessary.

And then my psychiatrist said she wanted to say something that might horrify me…that I should consider ECT. I’ve read enough blogs on WordPress to know that for all the scary assumptions we hold about it, it can have it’s good points, and my doc was quite encouraged when I didn’t immediately say no. She reckons it’s really underused, especially with patients like me who are managing to function, but are having a miserable time of it. 

Apparently I should also consider ketamine infusion therapy, because a UK trial has just finished and found some patients respond really well, so it’s opening up to referrals. And yes, that’s ketamine as in the horse tranquilliser/Class B drug, but used at a much smaller dose. 

I was a bit shocked by these suggestions – I’d thought that ECT especially was for very severe cases of depression, but now I know that’s not true (..and I’ve been reminded that my diagnosis is ‘severe depression’). I’m not exactly shut against the suggestion of having ECT, but the memory loss bothers me. I’d also have to have it as an outpatient because the hospital is really short on beds, but I’d need to have someone to care for me for 24 hours, and that’s not an option. 

With the ketamine infusion idea, I was pretty skeptical, but having looked up the details of the study etc I’m actually kind of intrigued. But, hopefully none of this will be necessary because the mirtazapine will help. Or the aripriprazole if it comes to that.

All in all, it wasn’t a bad meeting. I really like this psychiatrist (and yes, I realise that means she’ll be next on the list to disappear off somewhere else), because she is nice, but not too nice, and she clearly knows her stuff (not surprising given she’s a consultant psychiatrist). The loss of Nurse L was mentioned in passing – as I suspected there will be no replacement, and I have no interest in asking for one. My GP won’t be happy because she specifically told me to ask about it because she thinks it makes me safer (true), but letting someone else in is also dangerous in it’s own way.

We’re already rocking the med boat, so lets leave the rest alone, at least for now.

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Enter: lithium

I start taking lithium tonight (400mg), and I’m nervous about it. The Crazy Meds site is my medication Bible, and the lithium page isn’t exactly encouraging in terms of side effects. Those aside, I know it can do great things for bipolar disorders, but there seems to be less info about lithium and treatment-resistant depression. I would say ‘I guess I’m about to find out…’, but my psychiatrist said lithium can take up to SIX MONTHS for it to take effect.  Ouch. I’m worried about how it’s going to affect my GI tract, and I already have issues with drinking enough water which I’m told will be exacerbated.

But I will try it. I don’t like being dependent on meds, but I think the time has come to hold my hands up and admit I need their help. As of today I’m also back up to 60mg fluoxetine (Prozac). Let’s hope there aren’t any interactions.

There’s not much to say about how this weekend went; weekends are just two days of ‘dead time’. Nothing really useful done, nothing very exciting achieved. To be honest that’s mostly true of the weekdays too at the moment, med-appointments aside, but given the state of my mental health recently I think that’s acceptable if it means I don’t rock the boat and risk my safety. I did decide though that half-watching TV is not occupying enough, so I’ve reinstalled a computer game I used to enjoy. I don’t really want to be that person who sits around playing a game, but it’s more absorbing than TV if I can’t concentrate well enough to read or sketch.

I think overall my mood has improved since my last CBT ‘reasons not to Check out Early’ session at the hospital on Friday. I’m not miserable anymore. I’m not happy, but I’m not on the verge of tears either. I’m functional. There’s been a bit of a dip today following my GP appointment this morning; I think it’s because as I got up to leave my GP asked me if I’m ‘safe’, and looked anxious about it. The guilt I carry from worrying him has found it’s way to the surface again, and leaves me feeling sad. But at least I can recognise and understand this mood, and I suppose that’s what therapy has been teaching me to do. If I’m not in touch with my feelings, they tend to fester and grow into much darker forms of the emotions they started out as.

I’m not sure

Today I just want to air a quick thought that’s been bugging me – is my recent low mood connected to being off meds? I don’t mean withdrawals, because I’m pretty sure those were over at least a week ago. I’m wondering if generally, despite me claiming the opposite, the meds were doing something useful, and that it isn’t all that safe for me to be off them.

I don’t know, and it’s never going to be a straight answer because there’s a lot of stress around my daily life at the moment (although I think if you went back in time and stopped me at any point over the last couple of years I’d say I was stressed). All I do know is that I haven’t been so obsessed with suicide and self harm in a while.

I really hope meds aren’t playing a role in this. I’d hate to have to admit I need them.

I’m not sure I can be trusted with meds

Last night wasn’t brilliant, but it could have been worse. It turns out Nytol and trazodone (Desyrel) don’t make for a great combo; some internet research warned me that the two would interact, but it wasn’t the way I expected. I was hoping to be knocked out, but actually that didn’t happen at all. It took hours to get to sleep, which is unusual when I OD on Nytol.

Now I don’t know what to do. I want the Nytol to work, and for that to happen I would have to skip the trazodone. But at the same time I know I’m really meant to be giving the trazodone a proper try, so my doctor would say to skip the Nytol instead. My head is going ‘no. no, no...’ because the less sleep I get, the stronger the destructive urges get. And I guess also because I’m sick of insomnia, and when Nytol works it’s a nice change. If I’m being honest there’s a part of my brain telling me to take all the trazodone in one go and see what that does, but since that’s a promise-breaker I’m doing a good job of ignoring it.

You know what makes me feel pretty sad at the moment? I don’t think I can be trusted with meds. I was so pleased to be allowed weekly prescriptions again this week, but perhaps my GP was right to hesitate. I haven’t abused the trazodone so far, but it’s come pretty close. And now I think that even if we dropped back to twice-weekly prescriptions, the urges would be there all the same.

I don’t know what the answer to any of this is, but part of me wonders if I shouldn’t be given meds at all. That wouldn’t improve the Nytol-related problems, but it would make me safer in one sense at least.

I don’t know

 

Trazodone (Desyrel) at 0.00001 miles per hour

I saw my GP today to ask for my first trazodone prescription, and when he pulled up the instruction letter from the psychiatrist I thought I must be mis-reading it. ‘Begin at 50mg nightly, and titrate upwards by 50mg each fortnight as needed up to a maximum of 500mg’.

What?? When the psychiatrist rang me about starting trazodone, she told me I’d need a high dose to get an antidepressant effect. And when I actually got the box from the pharmacy, the instruction leaflet inside said depression patients should start at 350mg nightly.

…if I start at 50mg and go up by another 50mg each fortnight, it’s going to take THREE MONTHS just to get to the STARTING DOSE of this med…

Please tell me someone else thinks this is as ridiculous as I think it is. I shared my concerns with my GP and he brushed them off, apparently quite happy to have a plan that stretches out for months (rather than the usual 3/4 month cycle of trying a med, upping it, discarding it and searching for the next one). When I see him next week I will make my point again.

Tonight I took my first tablet, and I’m pleased to say that only 30 minutes later I’m quite drowsy. I won’t be needing the Nytol tonight!

New med time: we welcome trazodone (Desyrel) to the party

After a lot of head scratching/talking to her consultant, my new psychiatrist has decided I should come off the sertraline (Zoloft) and try out trazodone (Desyrel), a SARI med. According to her it isn’t widely used these days, but it should help with my insomnia as well as giving me a bit of a mood boost.

That sounds promising, although the Crazy Meds trazodone page has me worried that I’m going to be over sedated. I don’t think that’s me being paranoid: quetiapine (Seroquel) knocked me right out, and even mirtazapine (Remeron) was too strong in that sense. But I will give it a go and hope for the best. If it is too sedating, I can just imagine the eye-rolling that’s going to go on behind those medical doors. I really don’t mean to be a ‘difficult’ patient!

Asides from that…I keep finding myself buzzing with anger. Anger at pretty much everyone, sometimes for no real reason at all. I’m already in a hostile state of mind about therapy tomorrow, despite repeatedly reminding myself that I’m overreacting to his response to my request for an earlier session (‘write your feelings down’ – excuse me, if I felt able to handle it like that I wouldn’t be contacting you…). But I think that’s only part of the apprehension; there’s also a sense of determination, like I’m only managing to survive right now by shutting down parts of my brain and soldiering on. Dr T completely undoes that.

I have to say though, I’m not in as dark a place as I was a day or two ago, and a couple of people here deserve some credit for that. Thank you x

So I HATE colds…but I have a new sleep aid!

As the title suggests, I have a cold. Let me take a moment to moan: my eyelids are swollen, my nose is disgusting, and despite some lemsip stuff I still feel like crap. Ugh. Okay moan over – a cold is really nothing in the world of illness and disease, but I hate colds anyway.Image

Asides from that, I’m pleased to report I’ve found a herbal sleep aid that really helped me out last night: Kalms Sleep. I’ve always been very sceptical of anything with the word ‘herbal’ and automatically assumed it’s a placebo, but I realized yesterday that that was stupid – I use natural products that affect my body in various ways all the time, e.g. tea or coffee containing caffeine that gives me an energy boost. So when I had a wander around Superdrug yesterday I spotted the box of Kalms Sleep tablets containing a blend of things like valerian, and decided to give it a try. It works! I’m not sure it sped up the getting-to-sleep process because a cold/runny nose makes that difficult anyway, but I slept incredibly well, didn’t wake up in the night once, and this morning I was quite bright and ready to go. Hopefully this can be a solution to my Nytol-abuse problem.

My plan to do some work is not happening, but maybe that’s not surprising given how yuck I feel. I have been pretty efficient though in terms of chores, and have done plenty of laundry and cleaning…okay so that’s not exactly impressive, but at least I’ve done something today… I have some babysitting this evening, and then I’m going to collapse in bed before dealing with therapy tomorrow.