Prescription Meds Can Be Part of Good Self-Care #AtoZChallenge

Posted on by Astrid

Welcome to my rather late letter P post in the #AtoZChallenge. Today I want to talk about the role prescription meds, particularly psych meds, can play in good self-care. Because you know, there is still a lot of stigma attached to taking psychiatric medications or certain medications for physical health, such as opioids. Of course, medication isn’t for everyone and that’s normal. If you do experience serious mental health issues or physical ailments, it’s not weak to ask for meds.

You know, I didn’t take care of myself with respect to my medications until I was 31. Before that, I had subconsciously assumed I wasn’t taking meds for self-care, but rather to please others. That’s how psych meds had been used on me for years in mental health, since irritability (ie. being a pain in other people’s necks) was supposedly my main symptom. Well, it isn’t and even if it were, my irritability is a worse experience for me than it is for others. I mean, I’ve known people, such as those diagnosed with antisocial personality disorder, say they have a problem but don’t suffer. That’s okay, but it is rarer than to suffer in silence.

In early 2018, I finally decided I needed help for my depression. As those who read my blog regularly know, I was already on a low dose of an antidepressant, but had no idea why. I didn’t feel comfortable asking directly for a med increase. Let me tell you, however, suggesting specific med adjustments to your doctor doesn’t make you a drug seeker. They may know meds best, but you know you best.

Also, while meds won’t make you happy, you don’t have to settle for mediocre health if there are still options out there. And if you want to lessen a medication dose or stop it altogether, that’s okay to discuss with your doctor too.

Once you do get on the right meds, it’s your responsibility to make sure you take them as prescribed. Certain meds need to be taken right on time or they’ll not work as effectively. I’ve heard this is the case for antidepressants, so I really need to get back on track with taking my morning dose on time. Other meds cannot be taken together or should or shouldn’t be taken with certain foods. For example, when I took iron supplements, I didn’t know at first that it’s recommended you not consume them with dairy products. You don’t need to read everything that’s in the information on a medication you’ve been prescribed, particularly if you’re hypervigilant about side effects. However, you do need to take your medication as directed.

My Medication Musings: Risperdal

Posted on by Astrid

I started this should-have-been-series a long time ago, but never got beyond the first post. Today I’m not very inspired to write, but I want to write something anyway, so I am deciding to continue with my medication musings. The medication I’m covering today, is the first daily medication I was evver prescribed.

Risperdal, which is now sold under its generic name risperidone, is an atypical antipsychotic. It was approved by the U.S. FDA for use against irritability in autistic children in 2006. I was not a child when I was prescribed Risperdal in 2007, but I was definitely irritable and autistic.

I remember very clearly when I saw a psychiatrist I’d never met before and who may or may not have read up on my psychiatric history on July 25, 2007. She had a strong Flanders accent. My CPN had referred me to her after my staff at the independence training home called her because I had been very irritable of late. Looking back, it’s no wonder, since I was due to move out of the home and into independent living the next week. But my staff were desperate and so was I.

My CPN had suggested a sleeping medicationor tranquilizer, as I was also sleeping very poorly. Not that the psychiatrist agreed, since when I reported how many hours of sleep I got at a later phone consultation, she said that wasn’t worrysome. The psychiatrist listend to my symptoms and suggested Risperdal.

I agreed without much further questioning. That evening, I wrote a blog post saying antipsychotics in autistics are a matter of really well-informed consent. The post was a response to the general consensus at the time among vocal autistics that antipsychotics should never be considered.

Looking back, while I don’t feel that antipsychotics are completely off limits for autistics – I still take one -, I do agree with another notion from said vocal autistics: psychiatric medication is no substitute for proper support. And yet, at the time, there was no convincing my staff that I shouldn’t move into independent living, so I felt I had no other option if I wanted to have somewhat of a life worth living.

And yet, I was scared. When, after two days, I started experiencing palpitations, I was extremely anxious. It happened on a Friday night when my staff were already gone. Don’t ask me how I got through that night. The next morning, I rang the out-of-hours GP, who recommended I stop taking the medication for a few days and consult my psychiatrist on Monday. Said psychiatrist didn’t believe that this could be a Risperdal side effect or I’d have experienced the palpitations right from the start. So back I was on Risperdal.

I was on a low dose of 0.5mg twice a day. My psychiatrist was in the training home’s city, so when I moved the next week, I had no psychiatrist nearby. My GP ended up prescribing my medication. When I complained to both the training home city psychiatrist and my new GP about continuing palpitations, both dismissed me. The psychiatrist even suggested I up my dose. I refused.

Because of the abrupt change in my living situation soon after starting Risperdal, I had no idea whether it was working. I was still experiencing a lot of meltdowns.

After two months, I took myself off of the medication. I more or less informed my GP, because she was really against me going off of it. I probably lowered my dose way too quickly, going from 1mg a day to 0.5mg for a week and then stopping altogether.

We will never be sure whether Risperdal worked for me, as I never went back on it. However, three weeks after stopping the medication, I started to spiral down into crisis and had to be hospitalized four days later. The crisis service psychiatrist didn’t say a thing about me having discontinued Risperdal.

An interesting thing I need to note, is the fact that Risperdal is notorious for increased appetite and weight gain. However, I experienced the opposite if anything. This could’ve been due to stress though.

My Medication Musings: Celexa

Posted on by Astrid

Like I said last week when participating in Working On Us, I wanted to write a series of posts on the medications I’ve been on. I won’t promise this will be anything like a regular feature. However, today I saw that Medication Monday over at The Dark Tales Project is about a medication I currently take: Celexa. I already wrote several posts on this medication in the past, so may be repeating myself. Let me share though.

I was first prescribed Celexa in September of 2010. At the time, I had just finished a book whose title translates to Prozac Monologues, which was about the positives and mostly negatives of antidepressants. I didn’t really care. One comment I remember, by one of the pro-Prozac people, was that she’d become nicer on antidepressants. That comment was on my mind when my psychiatrist suggested Celexa and boy did I hope it’d do this for me. I was a definite bitch! The saying that depression makes you feel as though you’re not okay and neither is anyone else, definitely related to me.

The thing is though, I wasn’t sure I was depressed. No proper assessment of my mental state preceded my being prescribed Celexa. Yes, I was irritable and no amount of tranquilizers or antipsychotics could help that. But is that depression? Would Celexa help?

As it turned out, it helped a little with that. I felt a little calmer, a little nicer on the medication. I never asked my husband to comment on the level of my irritability and can’t remember for sure whether he ever made any positive comment on it. If at all, that must’ve been in 2018, when my dosage got increased.

I actually wasn’t diagnosed with depression till 2017. At the time, my irritability was one symptom that prompted the psychologist to diagnose me with major depression. I’m pretty sure I have persistent depressive disorder (formerly known as dysthymia) too though, but I don’t think I’m currently even diagnosed with any mood disorder at all.

It took another year before my Celexa dosage finally got increased to first 30mg and then my current dosage of 40mg.

I was very irritable at the time of seeking my psychiatrist’s help with my depression. I was also most definitely depressed, in that I didn’t have much energy or motivation for anything. As is known for Celexa and other SSRIs, the medication caused my energy to go up first before actually helping with my mood. My mood however did eventually lift. I am pretty sure that, had it not been for Celexa, I would’ve sank deep into depression during the long process of applying for long-term care.

But the story isn’t all positive. Aside from the side effects, Celexa (and Abilify) took only the edge off of my irritability. I’m in fact noticing it getting worse again. I’m not exactly sad, but I’m most definitely pretty negativistic lately. I’m not sure why. I mean, maybe it’s something to do with the lack of an over-the-moon sense of relief at going into long-term care. Or maybe it’s the other way around and my negativistic state prevented that. I’m not sure.

Working On Us Prompt: Psychiatric Medication

Posted on by Astrid

I’ve been thinking of doing some posts on the medications I’ve been prescribed so far, but didn’t get down to it till now. Today, Beckie’s topic for Working On Us is psychiatric medication. Beckie asks a few interesting questions I didn’t think of.

First, she asks whether, when you were first diagnosed with a mental illness/disorder, it took you a while to get used to the medication prescribed. Well, my first diagnosis from a psychiatrist was autism, for which there are no specific medications. It took four months after that diagnosis before I first got put on a daily psychiatric medication. That was Risperdal (risperidone). I didn’t like it at all, even though it took only a few days to kick in.

I remained on Risperdal for 2 1/2 months, and then took myself off. I felt that the medication was merely used to keep me just contained enough that I didn’t qualify for more care. Well, it is my firm belief that medication is not a substitute for proper care.

Going off Risperdal was a mixed bag. I felt okay the first few weeks, but three weeks after having stopped taking the medication altogether, I spiraled into crisis.

After taking myself off of the Risperdal, I was without daily medication for nearly 2 1/2 years. I was in a psych hospital, so I can tell you right away that the crisis service nurse was wrong to say hospitalization would mean being put straight back on meds. Apparently my psychiatrist agreed medication is no substitute for proper care. That was until, despite mostly adequate care, my irritability got so bad I just needed something. I was put on Abilify (aripiprazole) and remain on that ever since.

Beckie also asks about withdrawal. I have been on the same antipsychotic and antidepressant ever since 2010 and never lowered my dosage yet. However, I did for a while take Ativan (lorazepam) at a relatively high daily dosage. Then when I wanted to quit, my psychiatrist said he’d prescribe it as a PRN med. Well, I didn’t need it for the first few days, so I didn’t take it. That was until I started experiencing tremors a few days into withdrawal. I am lucky I got only those and didn’t get seizures or the like. Thankfully, I got put back on lorazepam and tapered safely.

Beckie’s last question is whether you work closely with your doctor in managing your meds. Well, I just had a meeting with the intellectual disability physician for my facility last Monday. She is making sure I get my medications and will also order yearly bloodwork to check for metabolic issues etc. I haven’t seen a psychiatrist with my new mental health team yet, but will soon enough. I want to eventually try to lower my Abilify dose. The intellectual disability physician advised me to wait at least six months to get used to living here though.

Today’s Accomplishments (October 29, 2019)

Posted on by Astrid

Last December, I wrote a post in which I shared my small (but important!) accomplishments for the day. I wanted to make this a regular feature, but didn’t. I am not promising it will be this time around, as pressure to do something every day or week with regards to my blog, usually overwhelms me to the point where I quit prematurely. Such was the case with the 31-day writing challenge this October and it’s been the case before. I’m however definitely hoping I can do these more often. Anyway, here are my accomplishments for today.

1. Took good care of my personal hygiene. It’s Tuesday, which means I start my morning routine all by myself and don’t get any help with my personal care. I usually take a quick shower then and often forget to put on deodorant, brush my teeth and hair. I not only took a more thorough shower than usual, but did use deodorant and brushed my teeth. I don’t think I brushed my hair.

2. Took my morning and evening meds, including multivitamin. I got the multivitamin added to my meds recently as I am deficient in folic acid (one of the possible reasons for my fatigue). I often have to remember to ask the staff for this one myself, as it isn’t in the med management system yet.

3. Had three relatively healthy meals. I had two slices of bread with chocolate spread on it for breakfast. That isn’t the healthiest possible choice, but it’s okay. I had two slices of bread again for lunch, plus a banana and a pear. For dinner, we had boiled potatoes, a hamburger and kohlrabi.

4. Walked twice today. Well, three times really, as I also took a short walk in the morning with the day activities staff and two other clients. I took a longer (about 20 minutes) walk in the afternoon with just the staff and took another walk with the living facility staff and one other client in the evening. I don’t have my Fitbit anymore, as its battery is dead and I can’t find its charger, but I’m confident I met my goal for active minutes for the day.

5. Did a short mindfulness meditation. Okay, it took only three or four minutes, but the act of starting a guided meditation in itself is already an accomplishment.

What have you accomplished today?

Working On Us Prompt: Sleep Disorders

Posted on by Astrid

The past few days have been pretty busy, so even though I did want to blog, I hardly found the time. Now it’s already latish evening too.

Today I’m once again joining in with Working On Us, for which the prompt this week is sleep, insomnia and other sleep disorders.

As a child and teen, I suffered from insomnia a lot. I would often be awake for the whole night or hardly sleep at all. On week-ends, I sometimes made up for it by sleeping in, but I was definitely chronically sleep deprived. Though my parents sometimes suggested, and I don’t know whether they were joking, that I take valerian or melatonin, I wanted nothing of it. In fact, when I was going in for eye surgery at age seven or eight, I refused the tranquilizer they offered us before the operation. I also constantly fought the anesthesia.

When I was 20, I sought treatment for my insomnia for the first time. My GP prescribed temazepam, the most commonly-used sleep medication here in the Netherlands at least at the time. I was very scared when first using it, being that I’d not taken any medication in years, not even paracetamol.

I think that what lay underneath both my insomnia and my refusal to take medication for it, was an intense fear of losing control. I was, after all, pretty compulsive particularly as an older child and teen.

My sleep issues escalated in 2007, when I lived on my own in Nijmegen. Though I didn’t sleep less than I had as a younger person, I did suffer from the effects of sleep deprivation more. When I was admitted to the psychiatric hospital, the first medication I was prescribed was again temazepam. Then followed another few benzos and even levomepromazine (Nozinan), which is normally only used for palliative sedation.

I had to take “twilight anesthesia”, which means high doses of benzos, several more times prior to procedures and chose them over the pain that would otherwise ensue. However, I still had terrible fear when I “awoke”.

Other than insomnia, I’ve had an assortment of other sleep issues. My husband said at one point that I have hypersomnia, because I slept so much. This was probably down to a combination of medication, vitamin and iron deficiencies and lack of structure.

I am a sleep talker and I snore too. The snoring got slightly better as I lost weight last year. I’m not sure whether it’s worsened again since I’ve gained weight back up again. The sleep talking comes and goes with stress.

Lastly, I suffer from vivid dreams and nightmares. They’ve gotten a little better now that the long-term care situation is more or less settled, but during times of stress, I very often awaken in a state of shock because of vivid dreams. That is, I’m not 100% sure they’re REM sleep dreams or night terrors (which happen during stage 4 sleep). I’ve never had a sleep study done either.

Working On Us Prompt: Coping With Crisis

Posted on by Astrid

Today, I’m once again joining in with Beckie’s Working On Us Prompt. This week, the topic is to write a narrative of what works for you when facing a panic or anxiety attack, manic episode or other crisis. I don’t get panic or anxiety attacks much or mania at all, so I’m going to describe what works for me when I’m in an emotionally dysregulated crisis.

Like I’ve said before, I have BPD (traits). These are also known as emotion regulation issues. I also experience complex PTSD symptoms. Both can cause me to suffer emotional outbursts. In addition, I can get severely overloaded due to my autism. This can cause me meltdowns, which in some ways are similar to BPD outbursts. In fact, I’m not 100% sure my BPD diagnosis is correct given that autistics, particularly women, are often misdiagnosed as BPD.

Anyway, I usually notice an outburst coming on when I experience an increase in sensory reactivity. I also often start to experience a decrease in my language abilities. I start to stutter or can only make humming noises and repeat the same phrases. My staff at day activities say that when in this state, my communication abilities resemble those of a toddler. It is interesting, in that we have only one toddler alter. When I can’t do something to calm down, I may progress to a full-blown state of meltdown, in which I become angry and sometimes aggressive or self-injurious.

What helps me when I’m in such a state, is to physicaly remove myself from the situation. This is hard though, as often it feels as though everything that happens around me is important. Usually, my staff help me by clarifying what’s important and what is not.

Of course, now that I still live independently, I don’t always have a staff member available to help me sort through a crisis or make suggestions on how I can cope. I, however, have a phone number of a psych hospital I can call in a state when I’m close to a crisis. They can’t do much but listen to me and try to offer advice, but it’s definitely been helpful in some situations. The mental health team that treats me also has a staff available on the phone for crisis intervention during office hours.

Sometimes, when I’m in a really bad crisis, I take my PRN lorazepam. However, I have some experience with it being overused on me in the psych hospital. Like, whenever I’d react to a sound in an irritated tone of voice, staff would tell me to take a lorazepam rather than helping me to figure out what was causing me overload. This has really gotten me weary of PRN medication.

Mental Health Ramble

Posted on by Astrid

The month of May is mental health awareness month. I’m not sure how much I can contribute to it. In fact, I only found out about it today. Since I have a cold right now, I really don’t feel like writing. Or really, I do, but my brain is too foggy I can’t come up with a coherent topic to write on. So I’m just going to ramble.

Since it’s mental health awareness month, I could share my story of how I found out I’m mentally ill. Then again, I honestly don’t know. Autism, which was my first diagnosis, isn’t a mental illness. Adjustment disorder, which I got diagnosed with upon my breakdown in 2007, isn’t really either. Thank goodness, it still qualified me for care back then. Since insurance coverage of care is diagnosis-based in the Netherlands, and adjusmtnet disorder is no longer covered, I wouldn’t have been able to get care with just that diagnosis later on. In this sense, it’s good that I was diagnosed with dissociative identity disorder and PTSD in 2010, then borderline personality disorder in 2013.

I am not even 100% sure I identify with mental illness myself. It’s really weird. If I were mentally ill, wouldn’t I need therapy? I don’t get any unless you count the meetings with my nurse practitioner every few weeks.

I don’t feel able to ask for more help on my own accord, even though I’m pretty sure I need it. I have been having a ton of weird symptoms lately and, though I’m getting by, is this really all there is to it?

I had a physical check-up at the mental health agency last February. I have a ton of issues that could be related to my mental health and/or the medication I take for it. Yes, despite the fact that I don’t even know whether I am currently diagnosed with anything other than autism, I take high doses of an antipsychotic and antidepressant. I don’t mind, but I do feel they need regular monitoring.

My psychiatrist would’ve seen me in March, at least that’s what she intended on in December. I still haven’t seen her. I do need to schedule an appt, but I’ve been taught through my years in the mental hospital that, unless you are a pain in the neck of others, there’s no need for you to see your treatment provider. I challenged this belief last year by scheduling an appot for my depression, but I”m not sure I can do it again.

Gratitude List (March 23, 2019) #TToT

Posted on by Astrid

This week was better than last week. Still, when I filled out a check-in questionnaire on an app called Pacifica, it said I scored as severely depressed. Well, apparently that’s my normal state.

Today, I am feeling pretty good. I want to share the things I’m grateful for, so I’m once again joining in with #TToT.

1. A full Monday at day activities. Like I mentioned last week, from this week on, I’ll be going to day activities three full days (Monday, Tuesday and Friday) plus Wednesday morning. I liked it on Monday afternoon.

2. Lorazepam. On Tuesday, I was pretty unquiet all day. Thankfully, I’d taken my PRN tranquilizer with me to day activities. I took it in the afternoon. At first, it just made me feel drowsy, but I eventually calmed down too.

3. Stuffed animals. I spent some time Tuesday afternoon at another group at day activities, where I tried to relax in a recliner. They have a large stuffed dog, which I was allowed to hold.

Also, last Thursday before leaving for work at 5AM, my husband covered me in stuffed animals as I went back to sleep. That’s so awesome!

4. Two long walks with my support coordinator. On both Wednesday and Thursday, we took an hour-long walk.

5. Yoga. On Thursday, I tried to do some yoga on my bed, because I couldn’t find my yoga mat. Turned out it had disintegrated and my husband had thrown it out. I ordered a new yoga mat on Thursday, which arrived at my in-laws on Friday. I picked it up today and it is great. It is not as thick as the one I used to have, but thick enough at 1.5cm. I tried some yoga again today.

6. Mindfulness apps. I tried meditating regularly using Insight Timer this week. It was good. I also, like I said, got an app called Pacifica, which helps me track my mood and health habits. I like it.

7. Beautiful weather yesterday. The temperature reached 19 degrees Celsius, which meant we could have coffee outside in the afternoon at day activities. The staff also put up the cocoon swing, which I always love.

8. Sleep. Yesterday, I was feeling exhausted and had a headache. My husband noticed an dtold me to go to bed. I slept for over twelve hours last night. Though my quality of sleep could be better, since I snore awfully, I feel okay now energy-wise.

What are you grateful for?

Celexa #SoCS

Posted on by Astrid

Today’s prompt for #SoCS is “cele”. Choose a word that starts with it and go from there. I initially chose “celebrate”, but I got stuck before I even introduced my topic. Then it hit me, I’d have to choose another word: Celexa. I bet this isn’t as common a choice as “celebrate”, which I’ve seen with at least one other blogger.

Celexa is the antidepressant I’ve taken for over eight years and counting. Its generic name is citalopram. It is a selective serotonin reuptake inhibitor (SSRI), the most commonly used type of antidepressant. It is known to help with both depression and some with obsessive and compulsive behaviors. Not that I have those a lot, but I do suffer with depression quite a bit.

That being said, I hadn’t even been diagnosed with depression when I was first put on this medication. It was used as an adjuvant to my antipsychotic, Abilify, when two increases in the dose didn’t calm my anxiety-induced irritability.

Years later, I was diagnosed with depression. This gave me the courage to finally ask for a dose increas of my Celexa. I had already had five dose increases in my Abilify and was at the highest dose, but no-one bothered to look beyond my irritability anymore. In fact, I am not sure the psychiatrist who initially put me on Celexa did.

In May of 2018, I got put on my current dose of 40mg. This is so far working quite well. I mean, even with the bad news I received this past week – and trust me, it was very bad, distressing news -, I am not falling into the pit of depression. I’m pretty sure that without my high dose of Celexa, I’d have spiraled out of control. And I don’t need that happening if I want the situation, which the bad news was about, to work out.