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.