On the maplessness of medication...

I had someone ask me a few questions offline about meds. Of course, I can only address this question as someone who is currently a guinea pig, not as a medical professional. I'm addressing this in a post because I think others are often wondering the same things about trying meds...I know I do. Know too that I am writing as someone who is still searching for a good combo...I have only been on this road for about 6 months. Anyway, here goes:

Meds can hit everyone differently. Some people try meds and nothing happens. Some people, like me, try meds and EVERYTHING happens/the side effects kick me in the ass, and everything in between can happen too. This fact can make it a little hard to feel like you really know if they are "doing something" or "doing what they're suppposed to do".

When you are a really busy person, it makes it even harder to tell, because you might have so many things coming at you at once that it's hard to know if you're coming or going, nevermind if your meds are "working".

Also consider that if you are taking meds, but not doing therapy, you may be slapping a band-aid on a broken leg. You could be so used to hobbling around on the leg that you don't really see that the band-aid is not changing your relationship with that leg. Once you heal the leg the band-aid might be helpful for more cosmetic issues...which is what it is meant for, but band-aids don't fix broken legs. You can't use something for a purpose that it was not intended for, and them blame "it".

All of that said, in my experience, it seems like the stimulants are pretty straightforward drugs. Overall...it seems to me that based on my own experience and what I've read of others' experiences, IF you are having an effect from a stimulant medication, you will KNOW it. Either a particular drug will "work" for you or it won't. And for me that means I get an intense and pleasant state of focus where my brain just chills out, and my thoughts slow down a bit, and I can just keep working away without the distraction of "thoughtsplosions". There is nothing subtle about it, it is absolutely obvious that the focus is occurring. The other effect I seem to have with a stimulant (currently, for me, that means Vyvanse) is a very particular feeling of calm. Clear, light calm. It does not make me feel heavy, or speedy, in fact it's like a breeze blowing across my brain, making my energy focus a bit, and allowing me to just "do" whatever it is that I'm doing. It also puts me in a really good, light mood. Sometimes this can make me just a tiny bit oblivious about things going on around me while I'm working, but it does make me more productive so I consider this a good thing, and I can switch to focusing on something new without feeling grumpy. Again...there is nothing unmistakeable about this sensation.

Within these sensations, I still have to choose to make better decisions about how I spend my time, and what I blow all that focus on, and sometimes my choices are better than others. If you are taking a stimulant and truly do not notice any difference, I would go back to your prescriber, give them this information, and see what they say. The good news about stimulants is that there are several of them these days...so you can try others if the first ones you try don't seem to "do" anything.

The only other drugs I have experience with are anti-anxiety/anti-depressant meds. I get the sense from reading other people's experiences that working with these drugs (mostly SSRI's, SNRI's and the like) tends to be a much more subtle experience. Allegedly, it takes a little longer to see a result, during which time some interesting side-effects might pop up. In other words, you're not likely to take one dose of one of these types of drugs and magically feel like a whole new better you. It could be more like 4-6 weeks before you settle on a good dose. If you're like me, that could be a totally different experience...I have been "hit" by these drugs within an hour, and not in a good way, lol, BUT, most people, thankfully, are not that med-sensitive, so I would hardly report my experience as representative.

I have taken Strattera (an SNRI), Citalopram (generic for Celexa, an SSRI) and Mirtazapine (generic for Remeron, a tetracyclic antidepressant). Other than Strattera, they are not really intended for improving focus...I take them for generalized anxiety. Strattera gave me some cool focus, but was a little heavy for me otherwise...in that it actually made my mood feel a little "heavy". The focus was also not very consistent. This was a much wishy-washier experience than the stimulant. It did calm me down, and that, I liked, but overall, I tried it for a looong time, and it just didn't pan out.

Citalopram was another barrel of monkeys entirely...I've already blogged about that, but I will say this...whatever it was doing, for me, was not good for a lot of reasons, and it was REALLY OBVIOUS.

Remeron, now that I'm on a smaller dose, seems to be adjusting to me quickly, and this is giving me hope that I will be able to find a dosage of it in the next couple of week that will give me some real benefit.

When a med isn't working (or is "doing" something lame!) there are a lot of things that could be wrong. Wrong dosage, wrong drug for you, wrong diagnosis. The best way to address it is always by giving a prescriber and a therapist, if you have one, as much honest information about how things are going for you as possible, so they can help you figure it out.

So final summary, in my experience...seems like if a stimulant is "doing" something you will feel it. If you don't, might mean you need more of it, might mean you need to try something different.

Anti-depressants are more subtle and take their time. Again, if you feel no effect after a few weeks, tell your prescriber. If bad things are happening, then tell them that too, and right away so they can help you if there's a problem.

After you try a few, you will start to develop your own "map" in your head about "if" something is happening. And definitely ask your prescriber lots and lots of questions about each drug.

Lastly...if you're like me and your life is way too busy, do yourself a favor and take a few things off your plate so that you don't have a ton of stuff adding to your stress and making it harder for you to be able to "see" if anything is happening. Seriously...I am a terrible role model for that, but I'm trying...I really am, and I swear it's worth it.

Gonna go work on that one right now...

What Wouldn't I Give for a Beer, Right Now...

I would love a nice cold beer in a bottle, right now. There's about 24 of them in my fridge. But I'm in the middle of TESTING OUT NEW PSYCH MEDS HELL right now so I really would actually have to be nuts to try a beer at the moment.

I am not only in psych meds hell, I am also in "exceptionally bad time finding the right psych meds" hell.

It all started with Strattera. Not enough consistency, and the weighty feeling was a little unnerving.

Next...Vyvanse...wow, great stuff. For a few days...then not anymore...then a higher dose...same thing, great for a few days and then...not so much...then a higher dose and nope, doesn't seem to--oh wait...is it that the Vyvanse isn't working or is it just that I feel COMPLETELY NUTS because this new antidepressant has made me into a HOT MESS?!

Hmm. Not sure. Hard to tell. Hard to tell anything really, when you are alternating between so doped off your ass you feel like you just smoked about 3 joints by yourself...and so drugged that you are slurring and can't walk straight and can't hold up your own head...and so irritable that if you didn't really love the cat you'd sort of like to throw it out the window because you can't stand the sounds it's making (no actual cat throwing has occurred, or will occur! I am simply using figurative language to achieve a literary goal!)...and so nervous you can't think straight...and so paranoid that every time you talk to someone (because until you left the house you didn't realize how socially inappropriate you were) you worry that they think you are crazy, because you know you seem kinda crazy, and you have to stop yourself from explaining your self and then actually, in fact, acting crazy. Just really hard to tell ANYTHING about your very straightforward stimulant when the anti-depressant is making your anxiety 18 times worse than anything you're even in treatment for. And that's just the last 24 hours! And, might I add...only 15 mg of anti-depressant. Did I mention that I'm med sensitive? Well I WAS NOT JOKING. Sheesh. And did I mention that I can't drive, at all, like this? I shouldn't be operating a toothbrush, nevermind driving a piece of machinery.

And this is after the great citalopram experiment...where 10 mg was okay...so we moved up to 20mg...and I had horrifying anxiety, which I waded through because I knew that I needed to get past that side-effect to see if there would be any benefit for me from the drug. At about week four things were GREAT. Wow. That's how I know the Vyvanse wasn't screwing with me. I was taking both, and I felt focused, CALM, and for the first time in my entire life, FREE of anxiety. It was amazing. Then of course I refilled the prescription from another pharmacy whose supply came from a different manufacturer...the debilitating anxiety came back. My prescriber and I discussed whether or not I wanted to try to get back to that good point, by reducing the dosage, or trying to get the drug from the original manufacturer again...until I showed him the huge, disgusting bruises all over my legs, that had appeared during the time I was taking the citalopram. That put my prescriber over the edge (and also meant he had to ask me some questions that would have been really embarrassing to have to answer if I wasn't me, and didn't have the boring, normal life that I have). I believe the quote was "give me back the prescriptions, now". He wrote me a new one.

So here I am in the throes of the great Remeron experiment. And all I can really say, 15mg and 24 hours later is: HOLY SHIT. No...seriously...if you've read this blog for five minutes, you know I'm an articulate person but...HOLY SHIT. I described the effect above, and it is no exaggeration. Within ONE hour I was a slurring, stumbling, giggling, hungry, passing-out disaster. Some people would pay big money for this payoff, me, I just want to escape from it. In addition to the above described wackness, I also spent my entire day completely unable to stop myself from fidgeting...tapping, moving constantly, worryworryworrying, making a ton of unnecessary phone calls, totally OCD-ing out...I felt like a prisoner in my own mind. Misery.

Now then...in addition to my prescriptions, my prescriber said to me...because I SUCK at asking for help or identifying when to ask for help, even when I'm having something bad happen...said "YOU MUST CALL ME IF ANYTHING HAPPENS that is bothering you". Okay. I considered this an additional prescription because I am so lame about admitting that I need help. Usually when I call to tell him something I am unable to say "I feel bad and need help"...I say "oh that's okay, I'm okay, I'll just talk to him later" and other such stupid, self-effacing things. And they always say "we can have one of the other prescribers give you a call back, are you sure?" and I always refuse. And then he gets upset with me because I didn't tell him how bad things were. Well NOT ANYMORE I said.

So tonight, terrified (bordering on hysterical) to take another full 15 mg of this insanity I called the mental health center...and they said "he's not here, he can call you tomorrow or someone else can call you back today" and I said "okay, let's do both because I'm feeling pretty bad". Good job Miss K! Good job! Waited...no call back...me=panicking because I am an overwrought mess because of the meds and I'm terrified. Waited longer. Agonized. Finally called again...and got a person who apparently forgot to screw their own head on this morning before they went to work to answer a phone at a mental health center. Here's an approximate transcript of our phonecall:

"Hello, XYZ Mental Health Center, how can I (not) help you?"
"Hi...I called earlier and really needed someone to call me back but didn't get a call."
"Oh. Who are you trying to reach?"
"Mr. Potatohead, but he won't be in until morning."
"OH! Cool, you can talk to him then!". Clearly she thought this was a sufficient response.
Me says "Right...and I will...but I'm having a problem now...and it's really hard for me to admit when I might be having a problem and call, so...can you just tell me, is there anyone in who is legally authorized to prescribe meds because I really need to talk to someone."
"Oh...hold on. (LONG PAUSE) Nope, sorry, Dr. Soandso isn't in."
"Right...I'm not even a patient of Dr. Soandso...look, is anyone there that can answer a meds question?"
"No. Just call your pharmacy." (Picture me taking phone away from ear and staring at it.)
"Right. Okay...here's the deal. I'm taking psychiatric medication and I'm afraid because it's doing really bad things to me, and I'm actually SO afraid of my medication, that I am simply not going to take my medication if I can't talk to a medical professional--is there no other number I can call?".

Wait for it...wait for it...what do you suppose the genius...that just told a psych meds patient threatening non-compliance to just get over it and wait until morning...what do you suppose this genius said?

(PAUSE)

"No."

What you should know reader is that I was sitting there in front of my computer screen LOOKING AT THEIR EMERGENCY HOTLINE NUMBER. Why didn't I just call it? Because...as I said...I am the WORST at being able to tell when I'm having an emergency and I will put up with far too much before I will ask for help...and hello...my thinking processes were so scrambled a few hours ago, when I had this conversation, that I could barely think, nevermind exercise decent judgement. I was in no position to help myself...and clearly, neither was this idiot, who didn't bother to mention the emergency number...and who incidentally, I hope is fired after I talk to my prescriber tomorrow. I'm not so annoyed about how she treated ME per se...I'm terrified that if I had been actually psychotic, or suicidal, or harmful to myself or other people...all possibilities when someone is calling a freaking mental health center...that she would have done exactly what she did to me. This woman had no idea what it took for me to even call in the first place...no idea what a struggle it is for me to ask for help...and none of that matters, because no matter what, if you are answering the phone at a mental health center, at any time of day, you should NEVER say to someone what she said to me. (To be totally, totally clear...this is not normal when you call this center...they are usually much more professional.)

I cried hysterically for a while...then called a pharmacist to ask some questions. He assured me that this is apparently TOTALLY NORMAL when you first start this drug. And that typically this drug is prescribed to people who have sleep issues in addition to anxiety (which I don't have) or could stand to gain some weight (and I could definitely stand to add some pounds to my 105...in fact I would LOVE to). This shit gives you the munchies like none other. I've been eating Doritos and nacho cheese all day... at least I wasn't hungry while I was feeling awful in every other way.

So I asked the pharmacist "sir...I know you're not a prescriber...and you're not my prescriber...but honestly, I don't want to take the full dose of this medication, it freaks me out. Will I turn into a pumpkin if I split the dose in half tonight before I get to talk to my prescriber?". He said "Sounds like a plan. Then talk to your guy in the morning.".

Ahhhhhhhhhhhhhhhhhhhhhhhhhh.

So...if only I could wash that half a tablet down with a beer. But I can't. And I won't. But the ice cold beer in my imagination right now tastes soooooo goooooood.