Insidious Black Box

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

 

I Am . . . Afraid

I’m still depressed. My Lamictal dosage is rising steadily and is currently at 350 mg daily. Maybe it’s starting to work because I already was taking 200 mg daily. Maybe I realized how afraid I really am. Oh sure, I go to see my med provider every two weeks again (back up from once monthly) and my counselor weekly, but somehow I “feel” worse off. It’s almost as if having my mental/emotional needs addressed again with such intensity tripped me up really hard. I’m at a place in life where I am so afraid… it’s the kind of fear that sucks your brain out and leaves you stunned and unable to think straight. The depression, anxiety and anger seem like they are swarming about me. They suck at my soul. They lap at the fallen corner stone of my very being…

I’ve lost my purpose and I’m so afraid.

I was trying to think of an image that would demonstrate how I feel. It’s pretty hard to Google “afraid, depressed, anxious, without purpose” and expect anything helpful to pop up. I thought of Leonardo de Vinci  and some of they dramatic faces he drew. I looked at a few and this one seems to come kind of near to what I want you to see… my fear. The man is shouting. The setting is the Battle of Anghiari.

 

da_vinci_shouting_man

da Vinci’s “Shouting Man”

Let me try to explain to you my friend, what I mean. During some of my very dark periods I was able to hold on to one thing, one certainty, that kept me going and gave me purpose… a reason to live. That purpose was to be the best mom that I could be and raise my kids to be the best people they could be. Growth them strong.

Now, they are old enough to not need me to keep my hand locked firmly on the tiller of their lives. They steer themselves. They are moving on and I am lost. From the time my eldest was born in 1992 my passion, my calling, my purpose, was to be “Mom”. I’ve thought that I have had other purposes along the trail of my life, but somehow being “Mom” over shadowed them all and now I am fighting myself just to remember what I believed I needed and wanted passionately to do… to be.

I am afraid that I’m a failure. No one needs me any longer. I keep to myself mostly. My family and I are not particularly close. I don’t work or volunteer. Putting it short: I don’t feel that I have anything to contribute to the world.

My fear has driven me off my path. I allowed bushes and hedges to crowd my chosen path and completely obscure it from my vision. I know, well, I think I knew what my “vocation”, that is what my passion was. I feel empty and bruised. I don’t want life to touch me. I seem to think it will injure me by exposing my worthlessness to me.

I’m trying to pull together my wits and engage in the monumental fight with myself to reclaim who I am and what I’m about, my purpose.

And, my pain meds for chronic back pain (degenerating disks all up/down my spine have kicked my butt and I just nodded off. Tomorrow I’ll attempt to pull myself together enough to begin discussing with myself how to deal with myself this time. I’ve already worked it out in advanced, but this lack of purpose, this is new and frighting.

I’m letting the drug induced sleep take me away from the fear for a time. Starting physical therapy this last week had kicked up my pain, as I knew it would. It makes the whole of me even more difficult to deal with. At this particular moment I feel like in the morning I can begin to pull my will back together. That is, unless I conveniently forget what I intend on doing with myself, again.

Time to sleep.