Category Archives: Lamictal

Insidious Black Box

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I apologize for the length of this post. Please consider reading the entire post. It’s very important. Your life could depend upon it. (Robin)

Emotionmasks insane faces

I take two medications that I considered to have a Black Box warning. They both depress breathing. Together they can stop my breathing altogether… There are other dangers.

I have chronic pain with Bipolar Disorder and Generalized Anxiety. I am prescribed both Oxycodone and Clonazepam by two different providers. They both know that I take both medications.

I see a pain management specialist for my pain. I have for some time now. To be treated there, I have had to sign a contract that governs my behavior with regards to taking pain medications, I have to take a pee test every time I go in and they count my pills every time as well.

My med provider handles my Clonazepam prescription for anxiety. I suffer from extreme anxiety. Sometimes I feel like my brain is going to explode. Recently, this woman, who is the 4th or 5th provider I’ve had since I started going to this clinic, told me that I’m more likely to kill myself because of anxiety rather than depression. I was always told that a depressed person was more likely to commit suicide when they started to feel better. When they started feeling better, they finally would have the energy to follow through with their suicidal inclinations. Apparently, there is more to it than that.

My counselor and every med provider I’ve had is intimately aware of my massive anxiety and my inability to get it under control. We’ve tried all the counseling type of solutions including Cognitive Behavioral Therapy (talk therapy), mindfulness and other techniques. I’ve not had success with any of them.

My med provider is content for me to only take Lamotrigine, which is primarily to treat my Bipolar Disorder depression symptoms, and not to take anything other than Clonazepam for anxiety. From talking to her, it appears that this is primarily to treat the depressive symptoms that I experience. I have not been able to get any of the med providers who have treated me to give me anything for anxiety other than Clonazepam.

She, my med provider, told me at our second meeting, that people with anxiety are more likely to commit suicide than people with depression. Since I suffer primarily from anxiety, you would think someone would have warned me of this. I understand now why I feel so self-destructive while I’m exploding with anxiety.

She has told me that her goal is to get me off the Clonazepam completely. Now that I’m taking my runaway anxiety and the real chance I will kill myself because of it more seriously, I’m also taking the mix of these two medications seriously. I always have, but my frantic response to my anxiety has created a situation where I’m so afraid of what might happen if I stop taking the drug for anxiety.

I’ve always felt like I’m most insane when my anxiety is at its peak.

I understand that long-term opioid use for chronic pain is not the most effective way to treat it. I’ve wanted to find a different solution for a long time. My pain management provider doesn’t offer other alternatives than pain medications.

I normally don’t want to die. I’ve always had urges that are normally short in duration towards it, but I haven’t had times when I sit there with my bottle of Oxycodone ready to take it all. But, I could.

I’ve never told any of my mental health caregivers that I have suicidal thoughts. I know that my community does not have good facilities to treat acute mental health emergencies. I don’t want to become one of those people who is shuffled into a hospital emergency room with a guard sitting outside my little room. That’s what they do. I have first-hand knowledge of this.

So what’s the answer? Do I chance dying in my sleep? Or do I chance ending my life while I’m awake? Both are real dangers.

I’ve decided to deal with my feelings of self-destruction now. With the danger of the two medications and my new understanding the relationship between anxiety and suicide, I have promised my family that I will talk to my counselor on Wednesday when I see him. I will admit that I think about suicide. That’s a huge step for me.

I’m afraid. Admitting how I’ve been feeling for years is like admitting that I can’t control the one area of dealing with my mental health that I always felt I could say I didn’t have a problem with. I’ll finally be admitting I have no control over my depression or my anxiety in relationship to staying alive.

As I say, I don’t want to die. When my anxiety runs away I cannot always control myself. I can become violent and destructive. I break down and cannot function. I become paralyzed yet also hysterical.

Yesterday I talked to my mother and all three of my kids and admitted the truth to them. My youngest who is a psych major at the same university that I attend (so is her partner) said she had been wondering if that was a problem for me. They all agree that they would rather I call them than I call a suicide line. I’ll talk to my therapist about that.

I have tried to learn to practice mindfulness several times in the past. I never fully committed to it. Mindfulness was just part of the learning experience in one of my classes I just finished. It’s time for me to review the materials I have about it, I have lots. I need to try to learn how to harness it’s potential in earnest this time. My life depends upon it.

I have a particular fear: I’m terrified of my anxiety. I know what it does to me. I sometimes feel the insidious devil of insanity creeping through my mind trying to take over, and it literally shreds my mind.

If you have any Black Box warnings for medication yourself, please take it seriously. Now that I am self-aware of my true situation I’m ready to find a way to deal with my symptoms.

 

My main medications:

Chronic Pain – Oxycodone / Nucynta

Anxiety / PTSD – Clonazepam / Benzodiazepines

Bipolar Disorder / Depression – Lamotrigine

 

Oxycodone – Warnings

“To make sure this medicine is safe for you, tell your doctor if you have:

  • a history of drug abuse, alcohol addiction, or mental illness
  • if you use a sedative like Valium (diazepam, alprazolam, lorazepam, Ativan, Klonopin, Restoril, Tranxene, Versed, Xanax, and others)”

https://www.drugs.com/oxycodone.html

Clonazepam – Warnings

Risks from Concomitant Use with Opioids
Use of benzodiazepines, including Clonazepam, and opioids may result in profound sedation, respiratory depression, coma, and death. Because of these risks, reserve concomitant prescribing of benzodiazepines and opioids for use in patients for whom alternative treatment options are inadequate.

Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. If a decision is made to prescribe Clonazepam concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation.
(The above Warning is taken from: https://www.drugs.com/pro/clonazepam.html)
Concomitant: (synonyms: attendant, accompanying, associated, related, connected)

Lamotrigine – Warnings

To make sure lamotrigine is safe for you, tell your doctor if you have:

  • A history of depression or suicidal thoughts or actions
  • Some people have thoughts about suicide while taking this medicine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

https://www.drugs.com/mtm/lamotrigine.html

Nucynta – Side Effects for Health Care Professionals

Psychiatric – Common (1% to 10%): Insomnia, confusion, abnormal dreams, anxiety, depression, irritability, nervousness, drug withdrawal syndrome, restlessness, sleep disorder, hallucination, depressed mood.
https://www.drugs.com/sfx/nucynta-side-effects.html

 

Benzodiazepines

Benzodiazepines may be used in the treatment of anxiety, panic disorder, seizures, or sleep disorders.
https://www.drugs.com/drug-class/benzodiazepines.html

 

Bipolar – Changing Meds Again

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My title “Changing Meds Again” isn’t meant to be a negative statement. It is a part and a way of life for some people. People like myself.

I have many, many issues in the weave that is ME so please do not take what I say about myself and my plans (treatment and such) and assume they will work, or not, for you. They may, but that’s between your med provider and you.

Anyway. I’m at the point where my med provider (this time we’ll call her Toni) Toni, has put me on a “don’t argue, come see me every two weeks until this is straightened out.” schedule. Actually she told me something about my nerves and getting them to calm down. ;0)

Today I started Lyrica for FM. I’ve been waiting for 6 months for this to make it through insurance. (There’s that word again.) Speaking of nerves, it should help quiet a great many of mine I look forward to the possibilities.

Also, in the morning I start back on Wellbutrin. I was on it years ago and it seems like a good thing to try again.

Toni: “Are you depressed?”
Me: “When? Like right now?”
Toni: “All the time. Over all the things, would you say you are mostly happy or mostly sad?”
Me: Hemming an hawing… “Like all the time?”
Toni: gives me a look of ‘honestly, you silently scream depression creating irritation’
Me: regretfully admitting “Okay, yes, depressed. I didn’t want to admit that.”
Toni: “Because it confuses you being a mixed Bipolar?”
Me: “Yes!”
Toni: “Because you’re a manic depressive.”
Me: “Yes!!”

I’m on wellbutrin. I start taking it tomorrow (Thursday) morning. We shall see.We shall see.

Heres my medication list for Bipolar and other mental alphabet soup:
Lamictal
Latuda
Wellbutrin
Diazepam
Lyrica (not directly in the list, but a major player in my new “list”)
Oxycodone  (not directly in the list, but a major player in my new “list”)

I fired my counselor. Talked to the head guy of counseling assignments. I explained the problem. She is only 4 years practicing while I need someone who can handle me. All of me. From the head to the toe… toes. From my head to my toes. Eh. From Arthritis and FM, to Bipolar and ADHD, from chronic pain to degenerative disk disease/arthritis in spine. I need someone who can help me focus and go through my day still being me but maybe being more experienced and work in biofeedback, mindfulness and neuroplasticity. With my medications I think this is the next logical step.

Medications are not going to fix me. They will hopefully allow me to function without… you know don’t you? Without the craziness running what feels like all the rest of my life.

I need to be able to manage. I must be able to succeed and what I want to do.

Bucket list? That’s for babies. Try barrel mitigated by soup.

Be well my friend. More later. I’m going to begin answering questions some people have been asking. I hope it will be helpful.

Ciao

Bipolar 1, ADHD, FM, PTSD, Anxiety, Chronic Pain, OA – Now What??

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If I’d started my blog off listing all my bits of my alphabet you might have clicked off and dismissed me as a hypochondriac. Personally, I might have too. However, the fun facts pile continuously up and I wonder if I might be much older than my drivers license says I am.

I’m 51 degrees old. Wait. 51 years old. Yes, that’s it. I think it’s time I leveled with you and give you my “medical” life. I am much more than my medical stuff. I’ve had my right knee replaced twice – in just two years. I know, that’s very young to even have it done once, but twice on the same knee… Skip that. Here’s a “brief” list. Each item is a medically real thing for me.

Bipolar 1
ADHD
FM
PTSD
Anxiety
Chronic Pain
Degenerative Disk Disorder
OA
2 Total Knee Replacements
Cataracts
Allergies – environmental, biological and food
Depression
Manic
Stress – Excessive
Obsess
Asthma
Dentures – Full

I’ve also had a ruptured appendix, broken ankle, blood clots, carpal tunnel syndrome, rage… I think you get the idea.

Over the last couple of months I’ve thought I’ve been falling asleep while driving. It freaks the freak out of me. No matter what I do I don’t seem able to prevent it. I even pull over and try to nap just so I can complete a 40 minute drive home. I’m not able to nap when I pull off the road. I try. No go. I can sleep in a parking lot when I’m too tired to drive, but it’s not working now. I sing, I scream, I pound my feet on the floor, I hit my steering wheel… Nothing helps.

It’s very scary. No, it terrifies me. Suddenly I’m about to rear end another car or find myself drifting to one side or the other. I’ve been asking my health care people what it could be. I eventually got around to my pain management specialist. I described it to her and asked if she thought it might be any of my many medications. Like my med provider, she didn’t think so. She wanted to know if I was born prematurely. Nope. Seizures? Nada.

Michelle, the pain specialist, asked if I could describe what happens as a “loss of time”. Maybe I’m not really falling asleep. Maybe I’m just losing time and tune back in just seconds later. Do I remember actually falling asleep or feeling sleepy. No. I’ve even tried coming home and trying to sleep. Not sleepy. No naps.

She sent me home charging me with looking into Absence Seizures. She knows I love to research stuff. I appreciate that she lets me learn and talk with her about my health care. I have read a bit about Absence Seizures. I think she might be right. Before I left she agreed she would get me in to see a neurologist she likes to use in a city about an hour from here. I’m going to have an EEG to see what’s going on.

New bipolar med on Wednesday… Friday a possible new diagnosis to add to my alphabet soup. Know what I keep thinking?

… Well shit.