Too much lithium?

All summer I drank water constantly. Suddenly, as the seasons have changed, I am no longer drinking a lot of water any more. And today I feel really weird, really out of it- and like I did when we tried going up even higher on my lithium (which I decided was too much and went back down).

Drinking a lot lowers lithium levels. Maybe I was keeping mine very low with all of the water, and now it is higher. I don't think it is toxic, as my level was only .59 when last tested- it could double and I wouldn't be toxic. But it could be enough to be making me feel not very good.

Or it could be the fact that I didn't eat breakfast this morning...

I have decided that I must be on too much Zyprexa because my mother was here for over a week and we did not fight. Well, I did yell at her once when she did something very stupid and dangerous, but otherwise no fighting. I did kind of zone out during some of her lecturing but I did so mindfully, if that makes any sense, and just let her talk without really hearing her.

Experimenting

I'm experimenting with meds over the weekend, to see if I can feel better. I'll call my doctor if I have too- but there is a part of me that feels like that is failure (as in I couldn't figure it out myself...). Plus, I really don't to bother him between sessions if I don't have to.

I have a good psychiatrist right now, I really do. I have had some unbelievably bad ones at times in the past, which has warped my thinking about psychiatry, but the guy I am seeing now is one of the good ones.

I also made sure to have my window shades up today (although I did not make it out of the house). And I did my light therapy in the morning. And I am trying to eat healthy today, but that is hard as I really don't have much food left in the apartment- I am reduced to eating backpacking food for dinner. Gone are the days when I lived in the city, and I could just call for delivery!

What constitutes an Occupational Therapy Emergency?

Sometimes getting someone occupational therapy services is urgent. I have stayed late to make a splint for a patient who has had a fracture. Or to start ROM exercises with a patient who just got out of surgery before scar tissue sets in. Or to teach a a patient who has had a hip replacement who is going home and straight to outpatient physical therapy how to dress with adaptive equipment and to order anything needed.

But sometimes there are paperwork emergencies. Today a patient needed an OT evaluation to go to a rehab hospital. The OT evaluation was just a formality, it all comes down to PT: can the patient walk? That is what the insurance company cares about. But they do require an OT eval.

And it was a Friday, and the inpatient therapist called out sick and so I had to go cover and do that evaluation just to get that done so he can go tomorrow. So that was the OT emergency that kept me late at work today.

Generally, it was a stressful day. I got some negative feedback at work. It was not unjustified, but it was also a freak event and I don't know how I could have handled the situation differently. It is not something likely to happen again.

Still, it hurt. But not as much as it might have. I am very sensitive to criticism. I think on the lower Zyprexa dose, I would have been more devastated. Instead, it just hurt, it stung, but I didn't get stuck in it.

I know that is what the meds do. And at times I complain that they make me numb- but the also give me freedom to live that I don't have when I am trapped in my negative emotions that arise from every day events. I think I am less inhibited on meds, which is generally a good thing.

Interesting thought

"Just Me" commented on my last post that maybe I might need the higher dose of zyprexa on my bad days, even if I don't need it on my good days, or every day. And that constantly playing catch up with med adjustments based on mood shifts doesn't work very well. And that is very possible.

I think my biggest fear, however, is that whatever I take my brain just eventually adjusts to- and so eventually the doses always seem to go up. And I don't want to keep going up on Zyprexa. I don't even want to be on it, but I had finally come to terms with the 5mg. And so I am just worried- if I start to get manic on 7.5mg, will it now get raised to 10mg, etc. 

Plus I feel a little spacey on the higher dose, and I really don't like that feeling. 

But for now, I am back to 7.5mg, after talking to my psychiatrist. What did I think he would advise me? What psychiatrist has ever advised me to go down on meds? Except for klonopin. That is the only drug I have had a doctor want me to decrease or go off of. 

But I do like him. He checked me for lithium tremors (none), and did a screen for involuntary movements for tardive dyskinesia (none). Most psychiatrists don't do that. Or at least the ones that I have had. But I really think that if you are prescribing antipsychotics, you should be doing regular involuntary movement screens on those patients. 

The Zyprexa issue is still not resolved

I was feeling very bad yesterday- after a string of bad days, and I realize that I had been making a lot of excuses for feeling bad. Really good excuses, but still. I was feeling bad. And I thought that yesterday I would take a little extra Zyprexa just to get me through the day. And then go back down to the lesser dose. And I felt so much better. Plus, I started to get things done- something I had given up on being able to do until Monday came.

So then last night I took the higher dose. I don't know. I do feel a little out of it at times- but not that much. And I was able to go grocery shopping, something I have not been able to do in the longest time. And I filled my prescriptions too. I got all my notes done at work- although I had a lot of time do do it (a light day).

I see my psychiatrist tomorrow. Do I want him to give me a script for 7.5mg? 5mg? Both? I don't know. I guess I go with the 7.5mg- and I can always cut them. Or I'll take both if he will give me scripts for both. But I really don't want both. I want this to be settled. I want to know what I need.

I went down to 5mg because I felt depressed again on 7.5mg for a couple of weeks. But really, that may have been triggered by going out of town and forgetting to bring some of my meds. Maybe I would have been doing fine otherwise. And it wasn't the Zyprexa that let me down. Obviously I'd like to be on less- if for no other reason than the risk of tardive dyskinesia. But I have been functional at the higher dose- but then, I think I am also sometimes a little spacy on it too.

I guess that is what my psychiatrist is for, to talk about these things. And see if he has any answers. But unfortunately, psychiatry is more art than science. And everything about these meds is a quality of life issue- which ultimately can only be determined only by the person taking them.

Stayed home today

I didn't leave my apartment today except to take out the garbage. It was raining anyway. But I skipped yoga. I just needed to veg out, have a nothing day. Thru hikers talk about taking "zero days," in which there is no mileage accomplished (usually a stop over at a town). I really need a zero day every week or so or my mood starts to go. But too many zero's, and my mood is pretty bad too. So this means I have to get my act together for tomorrow. I plan on hiking and then going to a meetup group for a hay ride and corn maze in the evening.

I read and watched TV, I cleaned a little and did a lot of unpacking. I am living on backpacking food, because I haven't made it to the grocery store. What I really want right now are fresh veggies. That is what I miss the most when I backpack.

I spent the morning looking at gear on line, and thinking about how I could further cut my pack weight. I know I could get my pack weight down at least another 5 pounds if I get a couple of new new pieces of gear and get rid of a couple of things. I'm not planning another long trip until the spring, so I don't have to buy anything now. I'm just looking. And maybe by then I won't be so broke.

I found myself thinking about meds again. I have sucessfully decreased my Zyprexa and Effexor this past month- and I'm almost weaned off of the klonopin I needed to lower the Zyprexa. Should I try for lower?

Of course I have yet to tell my psychiatrist I am on these lower doses. This is not a function of me trying to hide it- rather the fact that I see him every couple of months. But I don't think he will want me to go any lower on the Zyprexa- not that this would stop me- I don't know what he thinks about the Effexor. I am interested to hear what he thinks.

If I thought I could take all of these meds and never have another serious depression again in my life, I'd take the deal. I really would. But thoose bad couple of weeks I had even on the increased zyprexa made me realize, there is no deal to be had. Our brain is plastic, it adapts to whatever we throw at it. Higher is not always better, it is just higher. Maybe it takes a little longer for the brain to catch up, but it does. It I could feel that bad on 7.5mg of Zyprexa, there was no need to be on that high a dose. Lower doses have been shown to be useful as antidepressant augmenters, and that is really want I think I'm going for.

A lazy Sunday morning

I think I am adjusting to the Zyprexa decrease and no longer need the whole milligram of klonopin at night. I overslept, and I'm really sleepy this morning. Tonight I'll take less.This is good. I also don't have too much pain this morning from where my tooth was pulled- it is just a little sore- so I don't have to take any naproxen. I'll just take a little tylenol later if I need to. I'm still eating soft foods- I think I would be in a world of pain if anything hard hit that area.

Sunday mornings I watch a lot of the morning news shows- either that, or BookTV on C-SPAN2. I can't watch the news this morning, it gets me too upset. I am having one of those mornings when I think that Lincoln was wrong- that our country is too large and diverse to be governable, and that we might as well splint up.

I don't know how I feel about Obamacare. Ideally, healthcare should have been taken care of at the state level, it seems like a states rights issue. But, with the exception of Massachusetts, it wasn't. And something had to be done- and nothing had been done. Is this better than doing nothing? Perhaps. I don't know. What nobody says: there will be winners and losers with this law. It is not all good or all bad. The other things that people don't say: if you liked the health insurance you had, you probably couldn't have kept it for very long anyway. Costs were getting out of hand, and policies were covering less and less each year. I have patients with 50$ copay's for there occupational therapy visits, who tell me that they can only afford to come once or twice. Insurance isn't what it used to be. Like last year when I spent $3000 for my hospitalization- my in-network out of pocket maximum.

I'm doing laundry, and trying to clean the kitchen. Later I will go for a walk. Tomorrow it is back to work.

So far so good on less Zyprexa.

This year I also managed to cut down on my Effexor. Cutting down on my Zonegran did not work. I'm not even going to try with the lithium- I think I'm at the sweet spot, with a level of 0.6. Just at the very bottom of the therapeutic range. That leaves Provigil- which isn't my biggest priority of things to reduce- except for the cost (as my overseas supplier has become unreliable and the price still hasn't dropped much in America).

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.

What got me to the yoga mat?

I saw my therapist a couple of nights ago and told her that I wanted to cut down to every other week. She agreed that I was doing much better. And she said that she thought that one of the reasons I was doing so well is that I am doing yoga now.

And I think it is true, it is helping. But what got me to the yoga mat? I have been saying for years that I wanted to do it regularly. And I didn't. Every now and then I would manage to drag myself to a class, never to return. It was only after this latest round of med increases that I was able to get myself there regularly. I think that the meds helped tremendously, and I hate to admit it- because it is the two meds that I really didn't want to be on- lithium and Zyprexa.

I don't think it is only the meds. I think it is also that I have finally studied for and passed a certification exam that was hanging over me for years. It is the DBT skills that I have learned. It is having rewarding work. But I had all that in the months before the med increase, and I was still miserable and paralyzed. And then finally, I was able to get myself there. It was really hard in the beginning to get myself there in the beginning, but I could do it. And I kept going.

So I have to give the meds a little credit. As well as me, for "taking up the slack," and using the space the meds gave me to push a little further into life. Because the meds don't get you there. You still have to push.

Summer's end, I can't believe it

It is Labor Day weekend, the unofficial end of summer. I can't believe it. I am a little bit worried, because my moods are very seasonal, and I tend to get very depressed in the fall. Light therapy helps a lot, but it can still happen. Well, at least I am unlikely to get manic this time of year.

Before I figured out the light thing and started doing light therapy, I had a string of years in which every fall whatever antidepressant I was taking would stop working and by December I was in the hospital. I remember mentioning the pattern to a psychotherapist who tried to convince me that I found the holidays stressful. This was a long time ago, before everyone knew about SAD and light boxes. It was all still new.

So I have started my light therapy already. One psychiatrist told me that, as long as I am not getting manic, there is really no reason for me to stop- I should do it year round. But then this year I did get manic in the spring, so I don't know.

There are too many unknowns in psychiatry. Too many variables. I keep thinking that they should be able to design a computer program in which you enter your age, history, and symptoms, and it can tell you which antidepressant you ought to try first. Last year, when I was really depressed, and thinking of changing antidepressants, I was trying to find research on comparative effectiveness, and there is basically none (well, every little). Almost all of the guidelines and advice say that they all are basically the same, so start with an SSRI because it has fewer side effects. Really? Is that the best you can do?

We went with adding lithium, and that worked. I didn't want to do it, but as he was the second psychiatrist to suggest it I thought maybe I should really give it another try. And lithium the second time round has been a much better drug, because I am on a lower dose.

I actually have plans for a meetup group on Saturday, and Sunday I will help my dad to extract honey- if he has enough to extract. He doesn't know yet- he is going up on the weekend to his bees. Monday I am hoping to swimming in the pool in their development if the weather is nice enough. I didn't go all summer- it is my last chance.

Feeling like I need to justify myself- to who?

I take a lot of psych meds. Effexor, Zyprexa, Lithiuim, Provigil, Zonegran, and Ambien. And the occasional Klonopin, but very rarely these days. And I feel defensive about it- which is a separate concern from my concerns about medication.

My mother thinks I should not be taking psych meds- I need nutritional healing, spiritual healing, or something else. I am not really mentally ill. My step mother, who is a clinical psychologist and used to be very pro-med, has recently become anti-med, and thinks I am taking too many meds. And when I go to a new doctor, sometimes they tell me I am taking a lot of meds. When I am doing badly, people tell me that the meds aren't working, so I shouldn't be taking them. When I am doing well, they tell me that I am not really that bipolar, I don't need all of these meds.

It is also the imagined and sometimes real disapproval of people I meet who generally disaprove of psychiatric medication. It is things I read from people in the "antipsychiatry" movement, or into natural healing.

I do believe in alternative medicine. I take more supplements than meds. But for me, it has not been enough. Before I ever took my first medication, my mother took me to a nutritional healer, and I went on a bunch of supplements- but it did not slow my slide into the deepest depression of my life at that time (there were worse to come).

I have had a lot of problems from meds. I have had incompetent doctors as well. But right now, I am in a good place. I don't need to justify my use of medication to anyone (except my insurance company).

The irony is, I do think meds are over used. I do think patients are not told the risks. I don't think that mental illness exists in the same way that, say, diabetes exists. (Although I don't think that type 2 diabetes is that clearly defined, but that is another story). And many of the drugs used in studies have pretty small effects in the research. And yet, I use meds.

Because right now, I think that this is the best shot I have at having a life. Meds don't give you a life- but hopefully they make it possible to create one. Or rediscover the one you have, if you haven't been gone for too long-  but in some ways I have been. Other than work- which is admittedly a very big deal- I have been gone for a very long time.

There is this part of me that continually wants to try getting off of Zyprexa, cutting my dosage of Effexor, etc. And I have listened to that part of me a lot in the past, and occasionally I have been successful in lowering dosages, but more often not. Now, I just have to put that on hold for a while, and try to live. It is not all about meds. I do not want to be thinking about meds all of the time.

If I won the lottery, if I didn't have to work anymore- or at least could take a year off. Would I try to get off of my meds? Maybe- just to really know what I would be without them. If maybe there was another path for me that didn't involve all these meds. Just to know. But I haven't won the lottery. I have to go to work. I have to function. I want to live.

Insight

Yesterday I had a stressful day at work, and was really concerned I had done the wrong thing. In one case I had, in the other I hadn't- I was just being overanxious. But still, it made for a very worrying day. I had to remind myself that this was a temporary thing, this was from something that happened. This was not a sign that my meds were not working, etc.

Because my meds are really working well right now, and I have to resist the urge to tinker with them. I am, most of the time, feeling better than I have in at least 5 years, and I am more functional than I have been in years as well. And if it takes all of these meds to keep me here, so be it. I have had many times in my life when I did not expect to live this long.

If I keep questioning my meds, keep trying to lower something- like I recently did with the Zonegran, with bad results- it will take over my life. Or at least a big piece of my life. I take so many meds, there will always be something to try to lower, to adjust. If things are working, I am just going to let things stay for the moment.

Yes, I worry over what all of these meds are doing to my brain and my body. But I am exercising for the first time in years- that has to count for something too. Maybe it just takes a little more Zyprexa to get me to the yoga mat!

For years, I had been blaming my inability to do anything on the Zyprexa. I thought it was taking away my motivation. But I was wrong. It was low grade depression. And it has been the increase in my lithium and Zyprexa that has helped to break me though it.

 But I am holding the line at 7.5mg of Zyprexa, I really am. I cannot believe that there are people who take 20mg of this.

Good news but no answers... maybe gluten?

I got the results of my hand x-ray, at least what the doctor's assistant told me over the phone. I have no arthritis in my hand, everything is normal. I am very relieved.

However, that leaves me no closer to the source of my joint pain. They offered to refer me to a hand surgeon, but I said no. I really think that if there is something going on, it is more likely to be systemic or rheumatological than a simple orthopedic issue. If the x-rays were fine, a hand surgeon can't help me. I just don't want this to get worse.

I have to figure out if there is a chance that this could still be related to hemochromatosis- and see if I can't get a blood test at my next doctor's appointment just to totally rule that out. In the meantime, I am going to seriously go gluten free. I keep saying I am going to try it, but I don't.

I tested negative for celiac, but it seems you can still have trouble with gluten- and I have nothing to lose.

Meanwhile, I had a good appointment with my psychiatrist. I like him. Even though things aren't perfect, he decided to do nothing with my meds (just resume light therapy). Which was the right decision. What I didn't tell him was that at my next vacation I will probably try to cut back on the Zyprexa again, but that can wait. And meanwhile he gave me a prescription for Nuvigil which is currently still cheaper than the Provigil I take (because I take 2 pills), but I am really hoping that the price for generic Provigil falls fast. Now that my international supplier has become unreliable, I am really worried about "financing my drug habit" as my insurance company has decided that this is one drug that they will not pay for. And it is a very important one for me.

Tomorrow: Pilates after work. Am I up for it? I'd better be. I'm signed up.

Sometimes it's not enough

They say that half of life is just showing up. But that is only half of it. Sometimes it is not enough. I get myself there, but I can't get myself to stay there.

I had tried to lower one of my medications last night. This morning I was depressed. But I was also determined that if nothing else I was going to visit family, as some people were in from out of town. After much inner battling, I sprayed some dry shampoo in my hair (great for when I am too depressed to shower), managed to brush my teeth, throw on some clothes, and run out the door before I could think of another reason not to go.

I am glad I went. I was glad to see them. But the gnawing in my stomach just kept growing, and finally I could ignore it no more, and I had to leave. 

There was a time when I was listening too much to the cognitive therapists, and I thought that I "should" feel better if I made myself do something positive. They would want me to rate my mood before and after... Which to me meant that if I didn't feel any better after doing something, it was a failure. It is not a good way to think about things.

Things are worth doing if they are worth doing. Yes, how it makes you feel is part of the package, but only a part of it. 

The one thing that should definitely make you feel better is your psych meds, if you choose to take them. I can't figure out what to do with mine right now- but I see my psychiatrist next week so maybe he will have some answers. 

I also have a problem which is freaking me out- it looks like the site I get my provigil from overseas is no longer reliable. And I can't afford to buy it in America, even though it is now generic- the price has still not dropped very much. And my insurance company has denied it for me. So I don't know what to do. Maybe try the amphetamines again- my doctor had once mention Vyvvanse, but I haven't always done well on the amphetamines. 

Maybe I should tell my health insurance company that I need to go to detox to get off of provigil if they won't pay for it! Maybe then they would pay!

What I don't understand is why it is so expensive, especially now, when it has been generic for a few months. I'm not asking for it for free, I'm willing to pay a couple hundred a month if I have to- but not what they are asking. 

Still liking yoga, still not sure what to do about Zyprexa

I've been going to yoga 2x/week. I am starting to look forward to it! Who would have thought! I usually have to drag myself to just about everything I do- even if I wind up liking it. I am used to that little layer of depression making me not want to do just about anything. I go because I think I should, or the hope that maybe I will enjoy it, but not really expecting it. But I am so used to the battle, and I am having fewer of those battles with myself these days. And next week I am signed up for a Barre Amped class. I want to try that out.

I still didn't get myself into work this weekend. Well, what did I expect, a miracle? I had planned on going late afternoon- but that was when the depressed/anxious feeling started kicking in. It is happening every time I try to drop my Zyprexa dose, I start feeling really bad by mid-late afternoon. And klonopin strangely doesn't fix it. And so, even though I feel more out of it on the higher Zyprexa does, I am actually more productive on it. I had tried cutting down by a quarter of a pill last night again, but I'm not feeling good again. Just like last week.

And so I have been going back and forth over the past few days. I don't know which to try to wait out: the spacey feeling from the higher dose or the bad feelings late in the day at the lower dose. Obviously I'd rather be at the lower dose, but it is getting to the point that I almost don't care which. I just want a dose to be working and feel good on it.

It is really hard to make medication changes when you are working. Really hard. Withdrawal effects that I might otherwise be willing to put up with, even if while in bed under the covers, until they went away- now they make me panic. I don't know how long they will last. How will they affect my ability to get to work on Monday, to treat my clients, do my paperwork.

And I have been on disability, and I was always going on and off huge doses of meds- often in hospital- and had all of these side effects- but I didn't have to function. And I one time I got off of meds (including Zyprexa), I literally put myself into a coma to do so (not the intended purpose, that was to die).  I overdosed on my mood stabilizers, it took me 3 days to come out of the coma, and I spend another week in a regualr medical bed, getting only ativan. I was surprisingly ok. I felt very alive, very sad, but that seemed quite appropriate to me. But I couldn't sleep. Without the zyprexa, even the ativan they were gving me that week before they transferred me to the psych hospital, I didn't sleep,

Unfortunately, I was not a voluntary patient (they didn't even give me that option). And they wanted to put me back on Zyprexa. I asked if this drug could be dropped from my regimen. The doctor said that to do that, I would have to stay longer. Now, I knew I wasn't so crazy that I could be kept there forever-  but I wanted to be out before graduate school started up in a few weeks, I had a time table.   But I did talk then down to a lower dose (partially by lying). They also had wanted to put me on the exact same meds that I had been on- that I had been so depressed and agitated on that I wanted to kill myelf on! So I had to convince them that my doctor was about to change my meds (I had figured out by then that he was unlikely to ever call), and get myself at least on some new things and not on the same drugs. Except for the Zyprexa.

I did get out in time to go back to school. And my voice, which had been damaged during the intubation process, came back just a couple of days before classes, I was so scared it was damaged for life. And even the bruises on my wrists and ankles from the restraints in the ICU started to recede just about right then. I was very lucky. And I finished my degree, double lucky.

But that was the coma method for getting off of Zyprexa. There has to be an easier way.

Withdrawal effect

Last night was my second night on the lower Zyprexa. I had a hard time falling asleep due because of restless legs. I have never experienced this except when lowering antipsychotic dosages. It is really unpleasant! Fortunately, last night is was not that severe compared to a couple of times in the past. I hope it doesn't repeat tonight.

All drugs have side effect listing that you can look up, and see how common they are (or at least have been reported). There should also be a listing for these drugs for withdrawal effects! But I suppose there is no economic incentive for that- the drug companies want you to stay on these drugs forever, why would they collect data on the problems that people have going off? Not unless the FDA mandates it, they won't.

And I don't trust psychiatrists to report adverse withdrawal effects, any more than adverse effects. I have had more psychiatrist deny that I was experiencing a certain side effect, or that it was due to the medication I was taking, only for years later it to become a known side effect of the drug.

Weekends aren't long enough

I was supposed to go to my dad's today, but felt so tired I put it off until tomorrow. I did two loads of laundry today, otherwise not much else. I feel like I need today to recuperate from the week. And then it is Sunday, when I have a hundred things to do, and then it is back to work.

It is not that I don't like working- I'd just like to do less of it! That would be ideal.

I think I will have to go out to the grocery store tonight, because I have nothing left to eat. Otherwise I am being very lazy. And I am a little sore from Friday evening's yoga. My body is still not used to it. I am trying to go twice a week- I don't think there is a third beginner class that fits with my work schedule, so it will have to be twice a week.

Tomorrow at my dad's I can do some swimming, as his development has a pool. But before I go there I have to go into work to do some paperwork.

And my success- as of last night, I am back down to 5mg of Zyprexa. I did have to take klonopin to sleep, but otherwise I feel fine. I haven't decided if I am going to try to go down further. I'm sure I will- I always do, I can't help myself- but I'm not sure when.

Thursday I get a lithium level done, and I am very curious as to what it will be. My last one was .4, but that was before the increase. I don't know if levels increase linearly with dosage or not. Part of me hopes it is at least .6 this time- then I would have more confidence about trying to lower the zyprexa. Because I wouldn't need it so much as a mood stabilizer.

Too much lithium, I think

I tried going up on the lithium this weekend. Yesterday it was hard to judge- I didn't try to do anything (except go for a massage, heavenly). But today I tried to go in to do paperwork, and I could not. I felt so frozen and paralyzed, and my hands felt so tight it was hard to write. It was literally hard to write. I wasn't having tremors, but it felt like my body wanted to be shaking- and trying to write only made that feeling worse- and it was a horrible feeling.

So tonight I go back down to 900mg. It will have to do. I liked lithium at 900mg (I never thought I would say I liked lithium...). I don't like it at 1200mg. And I didn't like it in the past, when I was on a very high dose.

So hopefully this means I can stop thinking about meds so much for a while. The question is answered about my lithium dose. 900mg for lithium. And then I will give it a few more days on the higher Zyprexa, then try to come back down to 5mg.

Meanwhile, I have to figure out how much to give myself some slack vs how hard to push myself. I think I am feeling better enough that I can start to push myself a little- I actually did laundry this morning.

But I cried at work, when I couldn't do my notes. It is hard enough to fight my moods. When I am fighting the meds, too, it can be impossible to act. I was so frustrated, that made me depressed.

Hopefully tomorrow will be better with less lithium in me.

And hopefully tomorrow I can be present and in the moment and not going back and forth in my head about meds, etc. Which is what I have been doing too much of recently, and I hate it- although, to a certain extent it is appropriate when you are making med changes.

Doing what I don't want to do, again

I was not doing well, I even broke down and called my psychiatrist a week and a half before I was supposed to see him. He upped my lithium, which seemed to help a little. But not enough. So when I went to see him next, he upped my lithium even more, as well as increasing my Zyprexa to 7.5 from 5, although I had really been doing that off and on just to get through the day.

I do not want to be on more Zyprexa- or lithium, for that matter. But I don't want to be like this. It has really gotten unbearable. 

It is really damn hard to work and make med adjustments. One minute you can't work because your mood disorder is acting up, and the next minute you can't function because of side effects- and then you can't tell which is which at times.

I did back off the lithium after the first day because I felt too spacey the next day- but now on the weekend I am back up to 1200mg. And I am giving it one more night to see how it is. Tomorrow I have to go in and do paperwork, i'll see how it goes.

But between the lithium and the zyprexa, I do feel much better. I'm not all the way there- but I am better. I'm not going to stay on this high dose of Zyprexa, but I'll give it a week more I think. I'm hoping the lithium is okay. I feel like the Zyprexa really took care of the irritability that was so intolerable- but that the lithium has more of an impact on my depression.

Of course in my tradition of going on something and stopping something- as I raise the lithium I am trying to lower another of my meds, Zonegran. Because it also makes me a little space, and I'm not 100% sure I need it. It was the next drug to try to get off of. So now I am down from 300mg to 200mg.

I am going to reduce it ever so slowly, as it is an anticonvulsant and I do not want to have a seizure. I did once, supposedly from a medication interaction, but who really knows? It was during one of the few times in my adult life that I was not taking an anticonvulsant, only lithium.

I just want a life and to not think about my moods and my meds and all that. I just have to get through this. It is getting better. 

My trip to my shrink

I saw my psychiatrist yesterday- and it was the most uneventful appointment I'd had in a long time. I really had no complaints. We did determine, however, that I have a mild tremor in my left hand (very minor), since going on the lithium. Do I care? No.

I like this guy. He is the first person who actually looks for things like tremors and tardive dyskinesia, no other doctor has. What I really think is, if I psychiatrist can't be a doctor, then let psychologist prescribe. You have to be a doctor if you are a psychiatrist. These are powerful meds you are giving people, with often terrible side effects.

I asked him my question, which I know he doesn't know the answer to: what are the odds that I can stay on 5mg of Zyprexa the rest of my life and not get tardive dyskinesia? And he hedged. He said, a lot better than with the older drugs, but that the odds obviously increase the longer I am on the drug. He said that the important thing would be to catch it early.

I am kind of at peace with my meds right now. I don't want to think about making changes, getting off of things. Other than the Effexor, I am not on a high dose of anything. Side effects are pretty manageable, and my head feels clearer than it has in years. I can concentrate. However bad the meds can be for your mind, depression is worse. I have been wanting to blame the meds for my inability to concentrate the past couple of years- even though I was pretty continually depressed during this time. I even tried coming off of things. But what gave me my mind back was actually going on lithium.

No my life is not perfect. I still really struggle with a lot of things. More that I would like. But perhaps if I didn't, I would complain that the meds made me flat.

Meds don't fix everything. DBT doesn't fix everything. But I am glad that they have fixed some things.