This includes the life and times of a bipolar MD. The blog was started when I was in medical school- the previous title was Highs and Lows Bipolar in Medical School. I'm changing the focus of the blog but keeping old posts
So, I'm pretty good at hiding it. But, there are little things. I live in fear of forgetting my medication, so I keep it in my Coach wristlet among my credit card receipts, random change, and crumpled dollar bills. I usually keep about a day or two's supply on hand- the hospital I'm at is a ways away from my apartment so if I forget, I'm a little screwed.
Mostly, everything's fine. I go to the pharmacy, I keep my bottles full, I put pills in my purse, I take them, and I'm normal.
Except for when I'm not. For instance, on Monday, after going to bed quite early Sunday night, I found myself falling asleep during rounds. My face didn't really want to smile, and my feet were perfectly happy to remain still while waiting for the elevator. Life wasn't bad, just a little boring. That, and I felt that if I could find a couch, I'd be able to nap.
I just got a shipment of medications from Glasko Smith Kline. Whenever I get a package, I excitedly shake it like a little kid on Christmas. And when I hear the moroca-y sound of lots of tiny pills tumbling around inside their plastic bottles, I get very excited. Because this means that another month has gone by where I will NOT have to pay twelve hundred dollars for my medications.
Yes, my medications cost 1200 per month. And getting help from the drug companies was like pulling teeth. I HAVE insurance, so I didn't technically qualify for most of the programs. The fact that my insurance caps out at 2,000 dollars a year didn't seem to count when I first applied. So I appealed. And in some cases, I appealed again. Finally I'm at the point where most of my drugs are supplied for free through some of these prescription drug charity programs.
This makes me really mad about being bipolar. Most things can be fixed. Relationships can be repaired, tattoos can be lasered away (If I were to so desire), but I will always be a slave to the pharmacy. Always always always. In day to day life, it seems easy enough. I get my prescriptions, I go to the pharmacy (or as is the case right now, I get my drugs from the companies), I take my pills... everything's fine. The trouble comes when I realize I'm running out of medication and I forgot to tell my doctor I needed another prescription. Sometimes when I'm planning to go on vacation, I realize I'm set to run out of medication right smack in the middle of the week. And sometimes, if you've got your 90 day supply, you can't get another batch of pills until that 90 days are up. So if you're going on vacation at day 85, and you need 10 days worth of pills during your vacation, you may not be able to get those extra 5 pills before leaving. That means you have to carry a prescription with you, and make a visit to the pharmacy wherever you happen to be.
The inconvenience isn't a big deal in and of itself- I don't sit around thinking about it, crying over it... it's just that it's a reminder.
At the clinic where I'm rotating now, the weirdest complaints tend to be due to some medication side effect. It's like we prescribe medication so that people can get rid of their symptoms, and they end up with all new symptoms from the medications. And then they medicate that... It's like a perpetual motion machine.
For instance, it's been reported that people taking voriconazole (a fungus medication) have experienced hallucinations. So it is suggested that doctors tell patients on this drug not to worry if they see flying Christmas trees or Ewoks. "You're not crazy," the doctor should say, "It's just the medication."
I actually blame everything that goes wrong with my body on my medication. Stomach ache? Medication. Headache? Medication. Stubbed my toe? Must be related to medication... I'm on quite a cocktail.
Lamictal is technically an anti convulsant. So people use it for seizure treatment. But it's also one of the only drugs "officially" designated to treat bipolar disorder. It helps with mood stabilization, just like Lithium and Depakote. Lithium is sort of the gold standard, it's what everyone in the medical community thinks when they hear someone say "bipolar." Sometimes people are surprised when I'm not on Lithium. But, for better or for worse, I'm on Lamictal. It has its advantages- it's not famous for causing weight gain, water retention, or mental "fogginess" like some of the other drugs. It is famous for causing a rash, though. A certain percentage of people who take it do get a rash. Then, a certain percentage of those get this horrific thing called Stevens Johnson Syndrome. I've got a Stevens Johnson Syndrome flash card for Board Review. It's got this guy on the front with a disgusting, scabby face. On the back, it says, Stevens Johnson Syndrome, and then lists causes which include medication, like Lamictal. Stevens Johnson Syndrome is serious, and you do NOT want to end up like the guy on the flash card. When I first went on the drug, I called my doctor in a panic, furiously scratching my stomach and wondering if it was pink because of an itchy rash, or if it was pink because I was scratching myself and therefore creating a rash. My doctor told me to calm down and that I did NOT have Stevens Johnson Syndrome. So far, the Lamictal has worked out well. My moods are stable, and I'm not going to end up on a flash card.
Seroquel is an "atypical antipsychotic" that is being sold to treat everything from anxiety and insomnia to bipolar disorder and schizophrenia. It's also being sold on the black market as a drug of abuse in some prisons. I'm still trying to figure that one out. So, the label "Anti-Psychotic" is a bit of a misnomer, and that's one of the drugs on my regimen. It's famous for causing the "wet blanket" effect where you feel like you're under water, you can't think, you can't read, you can't concentrate. In short, it can make you feel slow and stupid. It can also make you gain weight. I take it at night and it has the immediate effect of helping me to fall asleep, as well as a more long term mood stabilizing effect. I was really careful to watch my diet when I started the drug so I didn't have the misfortune of gaining weight, although my mind was dragged under water to a place where I could no longer think or read. Luckily, this "extreme wet blanket" phase didn't last. I'm sort of in a chronic, slightly damp, blanket phase. I'm not as sharp as my sharpest hypomanic state, but I'm also not as dumb as my dumbest depressive state. The one really annoying problem that has persisted is the dry mouth. I awake in the middle of the night with no saliva. "Oh, no Emily, surely you have SOME saliva when you awaken in the middle of the night..." Nope, I'm not exaggerating. It feels like I tried to eat 10 saltines in under a minute. It's that sort of dry. Tumble weed dry. So I have to keep half- diluted Gatorade by my bed. And I have to go to the dentist quite frequently. A dry mouth is conducive to cavities.
Next, the anti depressants. Lexapro is an SSRI, in the Prozac family. It's the usual- sexual side effects, causes some people to be sleepy, causes insomnia in other people, causes overeating, undereating... All the side effects are mild. I don't think this pill gives me too much grief.
Wellbutrin works on dopamine and norepinephrine. It has the distinction of NOT giving sexual side effects. In fact it makes some people hypersexual, not that it had this particular effect on me. It also helps people pay attention, it's good for ADHD. But, it lowers the seizure threshold so it's not so good for people detoxing from alcohol. And it's not so good for people with bulimia. Those two groups are particularly prone to seizures, so when you add Wellbutrin to the mix, it doesn't always turn out so well. Actually, one positive effect that this drug has is that it makes you LOSE weight. Almost every single psychiatric drug known to man causes weight gain- except for Wellbutrin. It actually made me disgusted with food for a while. I lost about 5 pounds. But I gained it back. I stayed in equilibrium.
