Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Saturday, January 12, 2008

Today was my psychiatrist visit. As has been the common experience lately she thought I was doing really well. She said after seeing such extremes this last year in both directions it was nice to see no mania. I agree 100%.

She had ordered an imipramine level to see how I process that, as part of trying to monitor how all of my meds are processed since poor processing seems to be part of my issue. That's what has finally worked, figuring out that I process them even more poorly than we knew and going for high doses and in the case of depakote we've changed things around until my level stayed at 120. As expected my level was low, but I get manic if much of that is added. Still, if I get depressed we know I can go up further, which I've tolerated in the past. My thyroid is still not great and she thinks my family doctor will give me more thyroid meds. This is good because I truly think my thyroid is the reason behind my feeling exhausted. Some of it is my meds, but it doesn't have that sleepy med feeling to it. I am not sure I know the difference but I think I do.

The kind of bothersome thing is that I've had a lot of tremors and some jerky movements of my hands and mouth. Not anything like the EPS I've had before, but she made a "gotta watch that" face and now I'm trying really hard to not think about it. If it happens it happens. I'm going to probably start an older med for it since I can't take the typical tremor remedy (inderal) because Seroquel has dropped my blood pressure pretty low. She wants to avoid Cogentin as much as possible. So do I. I'm so tired of strong and scary meds.

Once again, here's an example of HOW PSYCHIASTRISTS AND PSYCHOLOGISTS OUGHT TO BE: My psychologist says my anxiety issues are very severe. I've not done well learning the things he's tried to teach me, or at least not all of them, and not the ones that might make a bigger difference. Some time ago he asked me to have the doctor change my anxiety med or increase it. At that time I was taking ativan and had difficulty tolerating a morning dose because it made me sleepy. So I switched to atarax (same family as benadryl), but it is tricky because I have to remember to take it in the morning and mid-afternoon. I do take one AM med but I take it before I'm fully awake, often at 5 AM, and if I took anxiety meds then I would not wake for work. So that means remembering two extra med times and as responsible as I am with meds I have never succeeded with that. We've moved meds and changed to long-acting versions of things over the years to try to help that by putting all meds possible at night. (Thyroid meds have to be taken in the morning). So that worked ok as long as I took both doses but I stink at that. And now I am really too tired still to handle the late dose so I've moved the AM one to noon. Anyway, I was asking about what I knew was the next option in the anxiety line to see if I would get away with one dose. No luck, but the psychiatrist is going to call the psychologist again to talk about this and they can decide together how to treat it. That leaves me out of trying to figure out how bad it is when I know it only as how life has always felt.

I'm too tired to remember more. But it is 2 months without med changes (although the tremor med may happen and the other doctor may change my thyroid meds), and that's a very, very big deal.


Anonymous said...

Glad to hear it. The tremor is no joke. Even my minor tremor, comparatively, is a pain in the ass and occasionally obvious. I hope they can hit on the right anxiety med combo for you, that allows you to not live your life by the alarm clock.

Just Me said...

It's funny, the one thing I don't care about anymore is the obviousness. In fact your comment kind of reminded me that's another argument for asking for meds, that I'm not fond of people noticing. That used to be the worst part when I was on high dose lithium. That and breaking things. I am safe from that because I use disposble dishes. Bad for the environment but good for my cleaning disabilities.

I suspect the right anxiety med will actually reduce the tremors. But I'm honestly sort of in denial about the anxiety and how bad it is. Plus I've always had it and I don't know what it feels like to relax. The psychologist tells me I'm worrying when I think I'm fairly relaxed so I apparently am clueless here.

Emilija said...

I'm surprised that you take a TCA for depression. I have always heard that they are the class most likely to induce cycling. But sometimes you just have to take what works.

Just Me said...

Imipramine working was a shock to everyone. I'd been off all ADs for several years, then I was on Remeron for quite a while. Remeron works similarly to some of the atypicals (except at a lower strength) and after I had a terrible reaction to risperdal with very high BP we couldn't control my BP unless I went off Remeron (which required trying me off and then back on different drugs and which was not pleasant at all). Finally we gave up on Remeron. Then I tried Effexor because I had liked it when I took it without stabilizers and apparently it has a good history of doing well with stabilizers. I had no response to it whatsoever. It may also have messed with my BP; I don't remember. Regardless, that left us hanging as we knew SSRIs make me very, very manic, Wellbutrin made me extremely sick and unable to eat without vomiting, and of course MAOIs are the absolute last resort.

So we tried imipramine and after years of avoiding tricylics it was this incredible feeling like "wow, AD working". I take a small dose and we adjust it very carefully so that I'm often taking some bizarre dose nobody has heard of. I'm allowed to increase or decrease at will within a range, and that seems to work well.

I came off it for a bit this fall but got very depressed until I'd been on it a few days then felt really good again.

One of those whatever works in a storm stories...