Medication

Insidious Black Box

/ Robin / Leave a comment

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 – Latuda

/ Robin / Leave a comment

I usually check carefully over the side effects and warnings on my new medications. I’ve been taking Latuda long enough that I assumed that I’d do okay with it. But, I guess I didn’t do it because if I had, I’d have noticed right off that the source of my ticks and twitches was probably right in front of me.

From the Latuda.com website: Tardive dyskinesia (TD) is a serious and sometimes permanent side effect reported with LATUDA and similar medicines. Tell your doctor about any movements you cannot control in your face, tongue, or other body parts, as they may be signs of TD. TD may not go away, even if you stop taking LATUDA. TD may also start after you stop taking LATUDA.

I have Tardive Dyskinesia. It is sever and interrupts my communicating with others. It is especially a problem in my classes at the university. This morning I actually had to stop talking. I felt that I had to explain my difficulty because they were trying to listen to me and I couldn’t talk. It was maddening.

This condition may be permanent. I’m not taking it at all now. I stopped two days ago. I hope that as the drug passes out of my system the tic will subside. God I hope so. I’m trying to relax. I’ve noticed that when I get nervous it gets worse. Talk about motivation to learn to chill out.

Bipolar – Anxiety Rising

/ Robin / Leave a comment

(Sept. 04) I’ve been sitting here trying to think of how to begin writing this and I’ve been getting nowhere. School is coming and I’m stressed out about that.

I have tremendous back pain and I go to a pain management doctor for my pain medication. The doctor that I’ve been seeing for like two years has stopped working in pain management and has opened a family practice. She was great. She really worked with me and worked to manage my pain knowing that I have Bipolar Disorder, PTSD, GAD, ADHD and so on. She was the one who prescribed my chill pill (medication anxiety) that I started taking during the school year last year when I had an anxiety meltdown.

The new pain management doctor started out by accusing me of selling my oxycodone and refused to refill my chill pill. I had a prescription of Oxycodone at the pharmacy to pick up which she didn’t take into account. I didn’t do anything wrong. I don’t like her. I don’t trust her with my health. My next visit to her she accused me of breaking my pain management contract by not bringing in the second pain medication I’m on. I was never told to bring the bottle in with me. Oxycodone yes, the other stuff, no.

My back has been bothering me.

My facial tick is back. It comes with anxiety like snow falls in the mountains… when the cold and precipitation is sufficient, the snow comes. Actually the vicious tick came with my beginning to take Gabapentin gain instead of Lyrica (Gabapentin can also be used for anxiety as well as for FM, which is why I tried taking it again).

FAST FORWARD TO TODAY Sept 28

I’ve been taking my chill pill daily. I survived my first day of classes because of the pill. I usually wake up in a cold sweat whenever anything remotely stressful is going to happen during the day. Like, for instance, going back to school.

Anxiety is such a huge part of my being right now that although I’ve lived in my new house for about two months I haven’t been to the grocery store by myself even once. I needed to buy some poetry books from the bookstore about 20 minutes from my house and instead of just going and getting them I called my eldest daughter and bribed her (I’d buy her a book if she’d come with me) to come with me. I just find it stressful to do things alone. I do not have a rational reason. I’ve done all the thinking and reasoning about my anxiety that my counselor and I have come up with and the anxiety does nothing but get worse.

I stopped taking the Gabapentin and the facial tick immediately started going away. When I’m stressed it comes back. I hope it isn’t permanent.

I see my med. Provider (the gal who manages my mental health medications) Sara in the morning. I’m asking her for something to treat the sever anxiety on a long term basis. The chill pill is great but it’s for a crisis and not meant for long-term consumption.

I get so wigged out about things that earlier tonight I already mapped out in my head the route that I would take to get to see Sara and then called my daughter to make sure that I could get to the grocery store from where I was coming from. I’m planning on going to get some milk on my way home in the morning. I need to do it on my own. I think if I have the chill pill I can.

It’s amazing. I wish I could take it all the time. I’ve been having to use it to go to sleep at night. When I don’t take it I’m awake until after 2 or 3 in the morning. Then I wake up sweating. I’ve even resorted to listening to relaxing meditative music/waves on YouTube all night. I found a channel on my TV provider to listen to that works as well called Soundscapes.

The struggle I’m having with anxiety is so severe that I’ve not been willing to blog and that makes me sad. My counselor has put forth the idea that perhaps my mania is manifesting as anxiety and that It’s really part of my Bipolar Disorder. I sort of hope that’s the case. If it is, I’m confident we can deal with it.

Why haven’t I been in to see my med. Provider sooner? She’s been booked. It’s been over a month since I last saw her. I’ve talked to her on the phone and my counselor talked to her on my behalf too.

Hopefully tomorrow I can communicate clearly how absolutely painful this anxiety is. My counselor is supposed to go to that meeting with me. I hope she can actually make it. It would give Sara a clearer picture of what’s going on with me.

Now, I’m going to listen to Rachel Platten’s “Fight Song” then I’m going to go to bed. I might read for a few minutes. Maybe one or two. Seriously, that’s as long as I’ll read.

I have high expectations for my visit with Sara and Rebecca (my counselor) in the morning. We got this. I have to believe, we got this.

Bipolar – Preparing for Potential Fears

/ Robin / Leave a comment

I’m leaving early tomorrow morning to fly from Seattle, WA to Tampa, FL where I will meet up with my eldest daughter who is leaving the military and coming home to us. She, her two cats, and I will begin our journey on Monday or Tuesday to cross this great nation of ours. While I’m gone my other kids will take care of my new house, and my dog and cat.

I have GAD (Generalized Anxiety Disorder) in addition to my Bipolar Type 1 and am currently cruising along in a hypomanic state according to one of my doctors. Being the mixed bipolar that I am I’m dancing with a little bit of depression too. I’m taking my chill pills as allowed.

I’m afraid I suppose. If you cornered me and asked me how I feel I’d say I’m afraid of all the unknowns ahead of me and of what will happen at my home while I’m gone and it’s all out of my control.

These are normal fears for the most part. Some of their intensity isn’t. If you have Bipolar Disorder you understand that.

I’ve tried to be as prepared as I can be so I can sit and relax this afternoon and not rush around looking for things that should already be packed. I finally got enough Lamactical to last me the whole trip. That was a panic for a few days waiting for the pharmacy to do its thing and have them ready for me.

Probably my greatest fear is of losing my medications.

My family will come together and take care of things here. My daughter and I travel well together so I’m not worried about that. Well, I’m not sure about the cats. They don’t travel well. It may very well be noisy and smelly. But if I lose my meds or the pill boxes get opened I’ll be stuck. I take some controlled substances that just can’t be replaced.

I’ve talked about fear in the past. I’m experiencing fear right now. I’m not afraid of the flight this time so much as I am about the drive from the freeway into the parking garage. I’ve never seen such dangerous driving conditions. Last time it took us an hour or more to go half a mile. Forget about getting to the airport two hours early for the security check in… it might take us an hour to get from the freeway to the parking garage. I’m afraid of the drive and being late because of it.

After that I’ll have the potential of being afraid of the flight, after I consider being afraid of not finding my flight on time.

Lots of potential fears are in my near future. This will be a good opportunity to test myself and see if what I say to do actually works.

I choose today to believe in myself. I choose to believe that we’ll get to the airport safely and all the way to Tampa without a hitch. I choose to believe that all will be well at home and our journey will be a grand adventure. (I’m glad some hotels allow animals.)

I choose to believe in myself and that I’m sane and a terrific person. I believe I can cope with the situations ahead of me and I will do the things that I have learned to do to make that happen.

The truth will out.

Bipolar and Clear Thinking

/ Robin / Leave a comment

(I want to hide in the cupboard until this is all over.)

Success! We’ve found a house we like. The big issue is storage. I realize that all houses this small have very limited storage, but I’ll have to get rid of pretty much all that I own to make this happen even if I have a storage shed to help with the overflow. I’m preparing to have a panic attack. I’m going to schedule it.

I am a book hoarder. I’ve been successful in getting rid of probably 50 boxes of books. It was painful. Next weekend we’re having a big garage sale in the neighborhood that my mom lives in. It’s a huge multiple neighborhood gated community. I’ve sent over two car loads of things to sell including my Ryan Seacrest bobble head (I’m not attached to it, I just want to get more than $10 for it.)

I woke up this morning thinking about the lack of storage the little house has. I waited till about 10 a.m. to call my mom to talk about the storage problem and what we can do about it. I want to go look at it again and do some measuring. We’ve only been to view it one time. A commitment that huge we should look at again, don’t you think? The housing market here is so tight that if you find a house you like you need to put an offer on it the day you find it or someone else will. So, if I decide not to go with this house we go back to all the stress of looking for a house all over again.

I’m a worrier. I’m a bipolar worrier with anxiety issues. I keep having to calm myself down. I look around my 1800 sq. ft. house and realize I’m going to have to get rid of most all of my possessions to make this work. The new house is only 837 sq. ft. So yeah, downsizing. All my kids have moved out and I don’t need this large a house. I can’t afford anything bigger than the house we’ve put an offer in on.

My stress meter is reading high. Very high. It turns out that it really was good that I didn’t go to school this quarter because we found the house during what would be the week before finals and I wouldn’t have had the time to go look at it.

So how to deal with the stress and associated problems that come with it? I need to think clearly and NOT emotionally. I don’t know how much of my fear of no storage is being realistic or if I’m just falling in with my all too familiar states of paralyzing worrying and all the things that come with stress, like the possibility that I may not be able to handle it and have an episode.

I think I need to begin with focusing on tidying up my thinking processes and think accurately rather than emotionally. If I can do that it will help me have a positive attitude about this instead of having the attitude that we’re going to make a huge mistake. What does clear thinking tell me? Does it make sense to move into this house?

One of the problems I have to deal with constantly is making decisions based on commonsense and thoughtfulness rather than on emotion. I don’t want to pass this house up if I’m just having an anxiety attack because of all the worrying I’ve been doing. I need to settle down and think with clarity.

A really good way to start is to have people around me who I can consult with who know my situation and can make judgements based on commonsense and logic. If I’m blinded by panic they can help me see clearly. I’ve chosen to make my mom, and my three kids those people. Granted the kids think any house is good, once we start measuring and they’ve been inside the house they’ll be able to make good recommendations.

Another thing I can do is avoid, eliminate, thinking about the whole thing in such negative terms such as: never, only, nothing, every, no way, can’t and impossible. I must remember that these negative ways of thinking are going to impact my accurate thinking and that I need to hold on to the positive attitude I’ve been working on cultivating within myself.

To think clearly I have to bind it with a positive attitude. I need to remember that I’m in control of my decisions and that I can make good ones not driven by negative emotions.

I need to work hard to take control and direct my thoughts and control my emotions. Of course being bipolar I’m challenged to think clearly and not let my emotions drive my decisions all the time.

My thoughts must control my thinking, not my emotions. This is especially true right now while I’ve got an offer in on a house. I need to be sure and have a convinced positive attitude before signing the papers. I can’t move into a house that I don’t think I can live with the storage challenges forcing me to throw out all the things I’m attached to.

I need facts. I need clear thinking. I need the advice of others that I trust who know me how my emotions impact my thinking. I need to separate “facts” from imagined fictions, and important facts from unimportant ones.

Bipolar Disorder will definitely have a large role in determining whether or not we buy this house. All the small houses we’ve looked at have pretty much been dives and not had any storage. We’ve seen this house and one other that has been fixed up by a flipper (someone who buys a house, fixes it up, and sells it). Both are really great. Neither has storage. Realistically, no houses this size will have storage.

So we’ll see. Will I freak out and convince everyone that the lack of storage is a deal breaker for me? Or will I go do some measuring and creative thinking? The plan is to go next week to view it again and do a lot of measuring.

I’m going to stay on my meds, see my counselor, exercise, get enough sleep, play with my dog and eat better. These things will give me a chance to keep from falling into a bipolar tailspin.