Tag Archives: bipolar disorder

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 – Danger Signs

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solar-flare-1Now that I’m taking 120mg of Latuda again I can consider the signs I was having that I was going into a crisis. I believe it’s important for me, for everyone, to know what happens before we reach a full-blown disaster so we can take precautions and get help early. That said, I recognize that it is often difficult if not impossible to tell when we’re slipping. It’s like standing on a beach when the tide is out. You’re talking to a friend or looking at the beautiful water or a sunset. You’re not paying any attention to your feet, which is unfortunate, because your feet have been slowly sinking into the sand. Now, when you try to move, your feet stick and you fall on your face because you didn’t realize what had been happening while you weren’t paying attention.

The biggest sign that I’m crashing is that I lose my temper violently and in an instant. Most of my life I have been consumed with anger and ill temper. It has kept me from getting to know my family. My father, who is gone now, was as bad tempered and mean with me as I was with him. We reacted to each other like lighter fluid on a bonfire. I believe that he also suffered from Bipolar Disorder.

In addition to a catastrophically hellish temper I was angry all the time. I don’t mean mad. I mean angry like I wanted to hurt someone. My adrenaline was (and is) on all the time. To this day my muscles are hard as rock, cocked as if to lunge into flight or fight. Even after a massage my musculature remains as solid as steel. I never relax.

Over the years I’ve taken medications that cause my face, my jaw in particular, to violently jerk and I can’t talk. I look like I’ve got a massive tick in my face and I sound like I’m hiccupping. Now, when I’m stressed, the tick comes back. As a matter of fact, I’ve been having it happen daily now even during Christmas vacation when I don’t have the pressures of school work. It really frustrates me. It’s so remarkable that people stop talking and stare at my face. It stops conversation dead.

So this time, when my temper soared uncontrollably and I saw my family react to my words as though they’d been slapped, I realized I was in trouble. I thought I was just feeling my temper returning. I felt like I was keeping it under control. I didn’t realize others noticed it until we were celebrating Christmas Day at my brother’s house and I was talking to my daughter and her fiancée when suddenly Sydney stopped short and looked at me as though I’d just stabbed her. I shut my mouth fast. I knew I was in trouble. I had to stop myself from talking the rest of the day unless I was paying attention to what I was saying and how I was saying it.

My med provider and I had a backup plan in place incase reducing my Latuda to 80mg didn’t work. I was to return to the 120mg dosage immediately. So that’s what I did. I couldn’t wait until I was able to get back in to see her in three more weeks. I’m feeling much less volatile now.

I know it is rarely as easy a fix as returning to a medication that I already know works for me. It’s never that easy. This time was an exception for which I am grateful.

We, you and I, impact those around us. Our behavior doesn’t happen in a vacuum. We have a responsibility to control our behavior for our own health and for our family and friends. It’s funny that I say we need to control ourselves because that’s exactly what I’ve never been able to do. Not till I got well medicated.

The take away – be vigilant for signs of crashing. Then take action swiftly.

Bipolar – Run Away Mind, Rather Than Matter

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running-meredith-fritzI was supposed to see my counselor yesterday. I was glad. The timing couldn’t have been better considering how I’ve been feeling. And then reality hit. I’d convinced myself that my appointment was an hour after it really was. I was convinced that I was there at the right time. Nope.

I do this to myself every once in a while. I convince myself that something is one way and it’s really another. It usually has to do with interactions with other people, but sometimes it’s more like this. I was really upset about it. Now I will be seeing her January tenth. January tenth. This sucks. We have more people who need mental health care in this state than we have mental healthcare workers. So, we are forever not getting the counseling we need. I average an appointment with my counselor about once in about every six weeks. Okay, it’s somewhere around eight times a year if I’m lucky.

My youngest daughter was over here last week and we did her FAFSA for college next autumn at UWT. She’s had trouble getting it done again this year. I was irritated and I guess I must have let that show. I remember feeling like she was being rude to me. In fact, my eldest daughter remembers me telling her how rude I thought her sister had been. I’ve asked my family to keep an eye on my behavior and tell me if I start to slide back into hell’s mouth. The youngest apparently though I was mean to her.

I was what?

I don’t remember it that way. Was my daughter was being hyper-vigilant and looking for me to act in the least not perfect? Seeing something small and making it really big in her efforts to help me? Was her mind running away with her? Or was mine?

I don’t know.

I do know is that my memory is impaired, I admit that, it has been for years. But, I don’t think I’ve become mean. I don’t want to be mean. I don’t want to treat my family badly.

One of the things I suffer most from when I’m afflicted with my illness is extreme irritability. I blow my stack over the slightest of things. Sometimes I go nuts over imaginary things, thinking things are different than they really are. This is one of the things I’m most afraid of becoming again.

I was reading today that extreme irritability is evident in both the depths of despair and the fury of mania. I agree with this. I think it shows how although the illness is called “Bipolar Disorder”, there are symptoms that cross the boundaries between the two poles. I know that this can sometimes be confusing and even misleading. Some may ask, “How can you be irritable and angry and say you’re depressed?” For me, it’s easy. It’s part of the way things have always been for me. I’ve always been severely irritable no matter what my mood.

Lesson learned: When I ask my family members to watch me I need to be more specific. I can also use these times to teach them more about the illness so they understand me better and I’m not just their “sick” mom.

I hope that I can show each of my children how much I love them every day, regardless of what state I’m in. But, I know that isn’t always as easy as it may seem.