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About larkspur

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  • Birthday July 8

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    being a productive member of society... hard as it may be

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  1. Stimulants have been prescribed for depression since the 1960's... It's definitely a less popular strategy today, but stimulants can definitely help with depression. I know that, for me, taking a stimulant helps with social anxiety by making me more outgoing, helps with my motivation and reward feelings, and suppresses my desire to binge-eat. Maybe stimulant augmentation for depression isn't for everyone, but if there's still a motivation deficit after trying SNRI's, a history of binge eating, etc then it can be a good choice. I wasn't diagnosed with ADHD as a kid because I wasn't ever disruptive or hyperactive, I just wouldn't do the work that I deemed boring or uninteresting. I would ace tests, or churn out a good paper in an hour or two of work, and get by with a C. Once I got to college, and I was no longer mandated to have my butt in the chair, I really started to have worse issues with attention span. I never thought ADHD would apply to me, but my doctor's assessment plus my academic and family history resulted in an eventual diagnosis of adult ADHD-I...but that came after I was prescribed stimulants to augment my antidepressant. My doctor at the time was about 90 years old, so he was practicing medicine in the 60's when stimulants were used for depression, so he didn't see it as odd at all.
  2. I will say, I have strong feelings surrounding how aggressively stimulant medications are pushed on little kids. My brother, when he was about 9, was pretty hyperactive, and his teacher flat-out demanded that he be put on Ritalin. He lost tons of weight and looked like a skeleton. Switched to Adderall and he just kept losing weight. At the same time, my other brother, who was 11 or so at the time, was stealing his pills and taking them for fun (both brothers were later addicted to illegal drug starting at ages 15 and 17, respectively). I think you really have to be careful about pushing medication on small children, and I feel the same about any psych medication - hearing about the high numbers of foster kids who are sedated to the gills by Seroquel or other antipsychotics, just because drug therapy is covered by Medicaid and talk therapy isn't...that type of stuff really makes me mad. That said, I think that there is a huge amount of misinformation out there about stimulants and the role they play in mental health. For those of us with ADHD that impacts their occupational functioning, stimulants are a godsend. If I were to ever encounter someone with such a hard-line view (that stimulants have no therapeutic purpose), I would really press them on why they think that way. There are tons of people in the world addicted to opiate painkillers, but would we ever say that those drugs have no therapeutic purpose? Benzodiazepines, which save the lives of tons of people with epilepsy or anxiety disorders, are abused sometimes...but they definitely have an important role to play in medicine.The mere fact that one may become addicted to a substance doesn't necessitate that each person will become addicted. I think the mental health community is often singled out for its medications being "bad" or "addictive", just because people have mythical ideas that mental illness isn't "real" or is somehow "not as bad" as physical illness. It reminds me of when Tom Cruise and the Church of Scientology tried to advocate that women with postpartum depression just needed vitamins, not drug therapy. Why did they think that? Because they didn't see it as a physical illness. Opinions that are based on assumptions like the above (MI is not real, MI is not as bad as physical illness, MI is a result of personal weakness, etc.) are just wrong, and those people who hold those beliefs need to be educated about the correct use of ANY medication, whether it's muscle relaxers, painkillers, benzos, stimulants... Funnily enough, those same people who think that stimulants are terrible drugs that cause a 180 degree swing from normal to meth-head, will usually readily agree that caffeine makes them feel more alert and better able to focus on their work. Do energy drinks make people into meth-heads? Hardly. But that's really what they're doing, is equating normal usage of a stimulant (let's say caffeine) to abuse of a stimulant (meth abuse, illegal drug, snorting adderall, etc.). Forgive my rambling. I have lithium brain, ADHD, and no stimulants at all right now... so there may well be a more concise and focused way of saying what I've said above. Which is, to point, that equating normal use to abuse is a logical fallacy.
  3. The title really says it all. I'm in a relationship of four and a half years, and if we could get married we would. I love her so much and can't see my life without her. I have been on disability leave from work since the beginning of January, due to mania/hypomania and agitated depression. I had just added Remeron to my cocktail for sleep, but soon I wasn't sleeping at all, and my anxiety was off the charts. I was paranoid and afraid of every little sound, and filled with rage when I wasn't cowering. It wasn't good. I later learned that it was probably what they call "dysphoric hypomania." My psychiatrist diagnosed me as bipolar after years of treatments for just plain ol' depression, and then I started playing drug roulette. First it was Abilify, then Zyprexa, then Seroquel. The antipsychotics sometimes helped with my mood and anxiety, sometimes exacerbated other symptoms (Abilify is not a good mix for someone with OCD!), but always made me sluggish, tired, and, for lack of a better term, a vegetable. Suicidal ideation has been constant, ever since the hypomania started in that first week of January. I started to have cognitive side effects when I swapped Zyprexa for Seroquel, which got worse when the doctor added lithium 600mg/day to my regimen. My short term memory is shot. My word recall is awful. I can't follow conversations. When I talk to people, I end up rambling for five minutes to express what should have been a five word sentence. But I can't think of the right words! This is only going to get WORSE because I'm probably going to have to take at least 900mg/day of lithium for it to have positive effects on my symptoms. I had preexisting comorbid ADHD-inattentive type, so that probably exaggerates the extent to which I am a total space-case on these drugs. The doctor will consider adding a stimulant back in once it's clear whether I've stopped cycling and leveled out. In any event, I haven't been working for 6 weeks. I get 80% of my normal pay thanks to being on short-term disability. It doesn't matter to me, but my 80% is still more than her 100% pay. My partner is getting increasingly frustrated with how little I'm able to do - she'll give me orders, like demanding that I cook dinner, or do laundry, and I'll forget them five minutes later or be too lethargic (thanks Seroquel!) to follow through. I am able to take care of our dogs (feeding/potty time/etc) and get myself a shower every couple of days, but to be honest, not much else. Cooking is dangerous, I space out and leave burners or the oven on (twice so far!). If I do laundry, I'll forget to put soap or fabric softener in, or leave wet clothes in the washer for days and end up having to redo the load. Nevertheless, my partner is constantly accusing me of "not doing anything", being lazy, like she thinks I'm playing sick in order to get a free vacation from work. I can tell that she resents that 20% cut in my pay, because she is constantly in my face about how if I'm not working, I shouldn't be spending money. And our finances aren't good, but then again, I'm not well. These comments from her, which grow increasingly regular, only make my thoughts of the s-word worse, because I have a 20K life insurance policy through my employer, of which she is the full beneficiary. I have tried to tell her how much it bothers me when she makes these comments about me not doing anything or being lazy, and I've tried to explain the cognitive impact that antipsychotics (and especially lithium!) can have...but she doesn't want to hear or acknowledge it, I guess, because her comments just keep on coming. This morning, as we were getting up, she started in on me again about how I never get out of bed, don't do anything productive, etc. I had it, so I told her off, saying I didn't appreciate her starting my day like that, and asking her to apologize for being rude to me. She didn't. So I got up, and I started doing what I could - hanging up clothes, letting the dogs out - and she stayed in bed. While I was hanging up a sweater, the seams didn't look right to me, so I turned it inside out, only to see tags. She criticized me for doing it wrong, and I explained that the seam didn't look right to me. She claimed I was being mean to her for explaining why I turned the sweater inside out instead of, I guess, just yes ma'am-ing and acknowledging that, once again, I'm acting like an ***** because of these D*** drugs. I apologized for whatever rudeness she thought was coming from me, and tried to change the subject to what else we would do today. She ignored me, and, 2 hours later, is still in the bedroom avoiding me. So, from the living room, I sent her the following text message: "I am upset with you for how rude you've been over the last couple weeks. You lash out at me constantly and act like I'm not working just because I enjoy sitting around being useless. I don't. I want to go back to work, but you clearly can't see or understand what I'm struggling with. I have wanted to **** myself every single day for 6 weeks now. The only reason I haven't tried is because I love you and don't want you to have to deal with it. I am suffering, and these meds make me f***ing stupid, and I just don't think you understand at all what I'm dealing with. It gives me a short fuse, so I'm sorry about that, but I really need your help and support to get through this rough patch in my treatment." No reply. I don't know what else to do. She gets personally offended when I forget things that she's told me, and she keeps making me out to be this useless dead weight that she's sick of having around. I am so hurt by all of this, and have trouble verbalizing it in the moment because my word recall is s*** thanks to lithium et al. How can I handle this? How can I explain why I can't do the things she expects of me? When I tell her the drugs make me stupid she acts like I'm making it up. I'm so mad and sad at this whole situation, because I feel like I need support and nobody is around to give it to me. I ALMOST want to call up my recovering alcoholic, formerly abusive mother and tell her everything just so I can have someone care about me and support me through this. I really have nobody - even my friends whom I know have struggled with mental illness in the past don't want to so much as follow the blog I keep about all this. I have my first appointment with a new therapist on Tuesday, so I know that will help somewhat...but I want to feel like I have someone on my team whom I don't have to pay by the hour.
  4. Trileptal never happened, and Abilify was kicked to the curb. However, I did leave the doc today with a sample pack of Nuvigil. I'm hoping it will help with the sedation from being on Seroquel. Seroquel, Depakote, and what have you all seem to give me fuzzy cognitive side effects where I can't focus to read a chapter of a book or watch a tv show. So nuvigil will hopefully fix that!
  5. Hey, listen, it may be long since pertinent, but I'm an insurance agent and I had to study all this stuff! I've also had personal experience filing disability for mental health. What you need to do in this circumstance is call human resources to get the number to file a claim for FMLA (family and medical leave act), where, if you've worked there a year, you should get job protection for up to (I think) 16 weeks of unpaid medical leave. FMLA protects your job, meaning you shouldn't be written up or fired if you qualify for FMLA and miss work with valid medical documentation. It does not replace your income. Short term disability claims are usually separate, and they are usually filed to the insurance company that works the plan for your employer - for me, my employer IS the insurance company, but for you the benefits may be through Unum, the Hartford, etc. Your disability claims IN ADDITION TO FMLA job protection, and require more than just a doctor's note - they require documents like the APS (attending physician statement) and it's a lot more hassle for your doc. If you get short term disability, you will get income replacement, usually at a fixed percentage (like 80% for the first 16 weeks, then 60%...this may depend on your years of service to the company or on the policy purchased by your company). You will continue to have to fill out forms for the duration of your disability, if it's short term, or, you may need to at some point in time convert to a long term disability claim where you'll get something like 50% of your income indefinitely or until you go on SSDI. SSI and SSDI are social insurance programs that you have paid into by taxes, just like you and your employer pay into private disability insurance. If you file for disability, which you can do online, they will determine if your condition qualifies you and if you have worked enough credits to earn social security disability (and if so, how much your benefit is). If that happens, you'll get the monthly check from Uncle Sam and after 24 consecutive months of benefits, you will be able to go on Medicare. (YAY Medicare. Everyone in the world should be jealous of Medicare, and every American should have access to buy in regardless of age or disability...but I digress.) Keep in mind, most people are denied for SSDI benefits the first time they apply, and it takes a while sometimes to get what you've earned. Now, since I understand that your situation didn't go down like I described above, with filing for FMLA protections or STD claims, you may still want to speak with HR and see if you can retroactively file. It absolutely may not be too late, because it has been LESS THAN 60 DAYS! There are so many times in laws where the guidelines are 90 days or greater, so do be optimistic. If you are fired and you truly believe that you will not recover sufficiently to reenter the workforce, you can start the SSDI process. Better to start early, since you may be denied lots of times before getting benefits. If you are fired and you think you can make it elsewhere on unemployment - good luck! :) I mean that sincerely, the job market is what it is, but there is work to be found.
  6. Thanks everyone for the replies. While XR is fine, I think IR will work better for what I need, based on this feedback. After getting used to it, the Seroquel helps me sleep quite well, but I have to take it around 6pm. Mornings are actually now my most productive part of the day - I wake up, and I'm UP! But I get sedation mostly in the afternoons once my initial energy after waking up has worn off. If it all hits me at once, and I can sleep it off and then get up and around my day, I think that will be ideal. One dosing question - going from XR to IR, is it just straight dosing, 300mg XR = 300mg IR, or would the IR dosage need to be higher to maintain blood plasma levels and etc.
  7. So there's a big difference in the drowsiness between the XR and IR? I ask because, of course, quetiapine IR will be available generic in a few months and if I could get a little MORE sedation out of it, that would be great! I barely feel the XR.
  8. Thanks! I'm starting with CBT again soon, next week sometime! I'm finally feeling on the right track.
  9. Gotta agree with the above - dry mouth is gonna happen on almost any med, and TD isn't particularly linked to Seroquel moreso than any other drug in the class. You should be totally fine.
  10. Thanks nocturneangel, I'm glad I'm not alone in this! My doc absolutely refuses to give me an antidepressant until I'm stable, so hopefully after a few weeks on just Seroquel and Lamictal I can talk him into an SSRI for the OCD. Funny you mention thyroid though - my thyroid tests are always fine, I'm euthyroid. However, I am an obese woman with PCOS, my limbs are always freezing and I have huge patches of rough, flaky, dry skin... so I'm going to be retested and even if I'm in the normal range I'm thinking a little l-thyroxine can't hurt, and will maybe decrease my future need for a stimulant.
  11. TAJ, could you please give me some examples of drugs for OCD that don't produce mania? Because from what I can find, OCD is treated (as it was in myself) with an SSRI, usually either citalopram or fluoxetine, or with a tricyclic antidepressant, which produces mania at about the same rates. What drugs are you thinking of when you say there are OCD drugs that won't trigger mania?
  12. I have just come out of a dysphoric hypomania, my first really bad spell in years. I was feeling that crawling out of your skin feeling, super high anxiety, etc. I say dysphoric hypomania because it wasn't a normal, happy, productive hypomania...it was like a ******ous rage slowly simmering beneath the surface hypomania. What my doctor did, and I trust my doctor immensely (he's not only a psychiatrist, but also certified in internal medicine) is put me on Zyprexa 10mg and Depakote 1000mg for just a week. It was almost instant, how much calmer I felt after the first dose of Zyprexa. I didn't feel sedated from the drug or anything... just slower, and more comfortable. Like life was manageable. That was last week. Zyprexa, I can't take long term, because I'm already obese with PCOS, so it's contraindicated for me. I'm now coming down on Depakote (500mg) and titrating up on Seroquel (tonight will be 100mg, up to 300mg by Tuesday). Wednesday I'll start titrating up on Lamictal, replacing Depakote, and keeping Seroquel at 300mg. It's only then, after I have been stabilized on Lamictal and Seroquel, that we're going to add Prozac or Celexa for the OCD (and, for me, the GAD and social phobia). Now, my OCD symptoms are going nuts because I haven't had my Celexa. My wonderful doctor knows this, but he is of the opinion that if you have any kind of mania, whether it's a mixed state, rapid cycling, hypomania, etc., you should treat mania first and depression second, because mania is more dangerous. He also explained that if you're having issues with suicidal ideation, he would lean more towards Lithium than Depakote. It sounds like our situations are somewhat similar, so take what I'm saying with a grain of salt, but you may want to consider a short term run of Zyprexa to get you out of those cycles, and then start from scratch on the meds, with a mood stabilizer or antipsychotic at the bottom and adding drugs on as your body acclimates. I'm sorry that you don't currently have a doctor that you have full faith in, but come to your appointment with a list of questions and options, and give him the third degree! He works for you! So if you say, for example: "Hey Dr. X., I heard that Zyprexa can really help with rapid cycling, which is what I have going on. What do you think about a short trial of Zyprexa to get my mood regulated?" If the doc says no, ask why. Be polite, and make clear you're asking because you will defer to their clinical experience rather than your cyberchondria (lol) Zyprexa might actually really, seriously be good for you. It works so well with Prozac that they combined the two and made a new drug to sell for bajillions of dollars! I'm not a doctor or even a pharmacist, but Zyprexa helped me with similar problems to what you're having.
  13. Thanks! I'm going to keep taking it in the evening with dinner until I talk to the doc next. I think it will stay there. As far as giving me something to sleep, I have refractory insomnia too...so most sleep meds have little effect on me after years of using Ativan or Benadryl to get to sleep. I still have some Sonata, and can take 20mg up until like 2 or 3 in the morning without feeling hungover the next day. I'm trying hard not to use it though, and since I'm off work for mental health disability until March 5th, there's not a lot on the line there. Thanks for your feedback on Lamictal, I think it will be a great med for me as well... my fingers are crossed that it's activating and helps keep the depression away. Thanks for your feedback. Once it did kick in, I was out like a light and down for the count for seven solid hours. It felt like the deepest sleep I've had in ages. It's good to know that it can vary in terms of timing though - I want to go to bed at around 11pm, and if your doc's four hour figure is right, then taking it at 7pm is just right for me. That gives me some sort of benchmark to go off, and I'll keep track in my journal if it kicks in too much earlier or later. :)
  14. Thanks for your reply. In my opinion, Celexa is the gold standard treatment for OCD - it was a miracle worker. Until I discontinued it recently (after almost 5 years on it), I had hardly any ruminations or intrusive thoughts of injuries, and my only compulsive "collecting" phases were when I was off my meds... So maybe adding the Celexa back in later would be okay. The reason I mention Prozac is that it has similar efficacy in the trials, from what I've seen, and I've heard Prozac is very activating and can be anoretic. I'm packing on the pounds while I run through every antipsychotic known to man, so I'm thinking Prozac may have an edge in terms of energy levels?
  15. Hi folks, I have bipolar II and OCD (amongst other things). My OCD symptoms (compulsive hoarding/collecting, intrusive thoughts of injury, etc.) are totally out of whack since I went off Celexa. Celexa was great for my OCD, I had everything on lockdown, but then I had a hypomanic episode induced by Remeron....so now I'm only taking Seroquel and Depakote. The Depakote is short-term and will be switched to Lamictal at my next appointment. Now, I know that once I am all the way up around 300mg of the Seroquel that it will start having serotonergic effects. I saw online also that there were promising studies about Lamictal helping with OCD. But by far, the best evidence seems to be for SSRI's or tricyclics. Is there anyone else out there who is bipolar II and also OCD? I think I really want to try Prozac once I'm all levelled out, or maybe back to Celexa, but my pdoc is adamant right now that I can't take antidepressants until stable, and even then maybe not ever. I feel like OCD is ruining my life. I have no motivation to walk my dogs, to clean my house, to work...but I am positively DRIVEN to expand my collection of nail polish. Any other comorbid OCD/bipolars in the house? How do you and your doc treat it?
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