Wednesday, September 25, 2013

Another blah day, and question about meds

I survived another day, and generally am feeling better. I did start getting that anxious feeling again in the afternoon- and I realized that I had an extra cup of coffee in the morning. It was only half-caf, and normally I can drink a lot more coffee with no anxiety, but perhaps not now. Or, perhaps it had nothing to do with the coffee. I took a quarter milligram of klonopin, and felt a lot better.

I am wondering about lowering my Zyprexa again. When I was doing so well, I thought well, I made my deal with the devil. I am actually functioning and doing things. I'll take the higher dose of this drug I don't want to even be on if it keeps me good. That was in July that I increased the dose. But if this quickly I have felt bad again- maybe the dose increase is no longer working, and there is no point in being on it. Maybe my brain has adapted. Or maybe it was never the Zyprexa- the lithium was raised at the same time.

I hate this trial and error system of psychiatry. There is no one who can tell me what my dose of Zyprexa should be. And whether I should go back down- so that I can increase it again in time of need- or stay on the higher dose to try to prevent future episodes, etc. I certainly don't trust clinical trials sponsored by drug companies to answer these questions.

1 comment:

Just Me said...

The thing is that the clinical trials don't show much that is relevant to us really. A trial of Zyprexa is meaningless when you are on Zyprexa and lithium. Dr. Calabrese at Case Western at least used to do multi-drug trials; I was in one with 3 drugs when I was newly diagnosed. First it was done with lithium and depakote and then I was in it when Lamictal was added. They were pretty stringent about who would benefit from triple therapy.

I've been discovering this anew as my tiny dose (25 mg) of Topamax is working incredibly well. Oh shoot I did not take that. Oops. But really, I'm on a subtherapeutic dose of gabapentin and now a subtherapeutic dose of topamax and really my lithium level is kept just below therapeutic when we are achieving our goal (it's been higher lately, I'd guess more like .8) and then a huge dose of Seroquel and that's what is working for me--a combination nobody would ever have rationally given me.

The studies just aren't real world and I don't think they can be, no matter who sponsers them, because cocktails are so different. Even the clinical trial I was in, which really was designed well, didn't require all other meds to be stopped (or I couldn't have done it). So I was on ativan throughout it and then propanolol because I had such tremors from lithium (I was maintaining at 1.1 as a goal back then. I did not like it).