It was the drugs, your honor
May. 22nd, 2003 10:24 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
lydyThen again, sometimes, the problem is too many drugs.
I used to think that titrate was something that was done in laboratories, a mysterious process involving bunsen burners and liquids changing colors, alchemic processes revealing the secrets of the universe, or at least synthesizing cool drugs. Boy, was I surprised when I found out that they were titrating my drugs in me. It's every bit as mysterious a process as what I had imagined, but far less entertaining. I am subjected to every overdose, every underdose, every weird, synergistic effect. For years, 37.5 mg. of Effexor was the difference between an adequate but not complete treatment for depression and mania. I dread the day I will have to change meds. Anti-depressants are notorious for just petering out. If that should happen, and it has happened before with Prozac and Serzone, I will have to taper off the one drug, and then taper onto the other drug. Figure six weeks each way. That's three months of freefall, three months of hanging on by fingernails and willpower, praying that by the time the new drug is up to effective levels in my system that it does what it's supposed to, because if it doesn't, then I have to taper off it, then taper onto another drug, another three month process. I could lose a year of my life to this kind of hell, if the psychiatrist doesn't guess right. (Anti-depressants are largely prescribed based on their side effects. Nobody really knows how they work, so prescribing them is a dice roll, anyway.)
I will say this for Provigil: it keeps me awake. The normal dose of Provigil is 200 mg a day. It comes in 100 mg caplets. (Caplets? Tablets shaped like capsules, and coated.) I have a hyper-skitzy system (I started experiencing drug effects two hours after my first dose of Prozac), so my psychiatrist suggested that I start with 50 mg, if I could break the caplet in half. I took a half-pill Monday morning. I had been up much too late the night before, and was definitely dragging on Monday. At 10:00 a.m., I was still hurting, afraid I was going to fall asleep at my desk, so I took the other half. I perked right up, made it through the rest of the day with no problem. So, Tuesday, I just 100 mg. off the bat. Ah, drugs.
Tuesday became hell. I know a drug reaction when I feel it. Well, that's not precisely true. Drug reactions (bar cool visual effects or synesthesia) feel just like "real" emotional upset; the difference is that the reactions are out of proportion to the here-and-now. One of the things talk therapy is good for is learning to identify the difference between here-and-now craziness and accumulated pain. I was anxious, and felt jagged. I couldn't concentrate, and didn't like interacting with people. I wanted to hide under my desk. When I got home, I holed up in my room with my laptop and played the solitaire game Spider. I even asked for a tray for dinner. I almost never do that. I like eating with my housemates. I think that I've asked for a tray twice before in all the time I've been there.
Fortunately, I live with nice and smart people. Pamela brought me a plate of wonderful stir-fry (her stir-frys are almost universally wonderful) and didn't ask any silly questions or try to cheer me up. After dinner, DDB asked if it would be companionable for him to lie on the bed and read, or if I would prefer he went to his own room. I allowed as how it sounded companionable. I knew that he wouldn't try to talk to me. I continued to obsess on my solitaire game and he lay on my bed reading a Ngiao Marsh mystery. We didn't talk, but it was a comforting reminder that I'm loved and cared for.
I only took 50 mgs on Wednesday. Titration ahoy! Ah, the joys of using oneself as a crucible, the pleasures of being one's own experimental animal. Yesterday wasn't as bad as Tuesday -- just as well. I was just short of suicidal depression on Tuesday. Today, I've only taken 50 mg again. I'm feeling tired, that kind of tired where it feels like you're carrying a heavy weight on your back. I'm not falling asleep, though, and I'm not jagged and miserable.
The problem is the drugs, your honor. They haven't invented the right drugs.
I used to think that titrate was something that was done in laboratories, a mysterious process involving bunsen burners and liquids changing colors, alchemic processes revealing the secrets of the universe, or at least synthesizing cool drugs. Boy, was I surprised when I found out that they were titrating my drugs in me. It's every bit as mysterious a process as what I had imagined, but far less entertaining. I am subjected to every overdose, every underdose, every weird, synergistic effect. For years, 37.5 mg. of Effexor was the difference between an adequate but not complete treatment for depression and mania. I dread the day I will have to change meds. Anti-depressants are notorious for just petering out. If that should happen, and it has happened before with Prozac and Serzone, I will have to taper off the one drug, and then taper onto the other drug. Figure six weeks each way. That's three months of freefall, three months of hanging on by fingernails and willpower, praying that by the time the new drug is up to effective levels in my system that it does what it's supposed to, because if it doesn't, then I have to taper off it, then taper onto another drug, another three month process. I could lose a year of my life to this kind of hell, if the psychiatrist doesn't guess right. (Anti-depressants are largely prescribed based on their side effects. Nobody really knows how they work, so prescribing them is a dice roll, anyway.)
I will say this for Provigil: it keeps me awake. The normal dose of Provigil is 200 mg a day. It comes in 100 mg caplets. (Caplets? Tablets shaped like capsules, and coated.) I have a hyper-skitzy system (I started experiencing drug effects two hours after my first dose of Prozac), so my psychiatrist suggested that I start with 50 mg, if I could break the caplet in half. I took a half-pill Monday morning. I had been up much too late the night before, and was definitely dragging on Monday. At 10:00 a.m., I was still hurting, afraid I was going to fall asleep at my desk, so I took the other half. I perked right up, made it through the rest of the day with no problem. So, Tuesday, I just 100 mg. off the bat. Ah, drugs.
Tuesday became hell. I know a drug reaction when I feel it. Well, that's not precisely true. Drug reactions (bar cool visual effects or synesthesia) feel just like "real" emotional upset; the difference is that the reactions are out of proportion to the here-and-now. One of the things talk therapy is good for is learning to identify the difference between here-and-now craziness and accumulated pain. I was anxious, and felt jagged. I couldn't concentrate, and didn't like interacting with people. I wanted to hide under my desk. When I got home, I holed up in my room with my laptop and played the solitaire game Spider. I even asked for a tray for dinner. I almost never do that. I like eating with my housemates. I think that I've asked for a tray twice before in all the time I've been there.
Fortunately, I live with nice and smart people. Pamela brought me a plate of wonderful stir-fry (her stir-frys are almost universally wonderful) and didn't ask any silly questions or try to cheer me up. After dinner, DDB asked if it would be companionable for him to lie on the bed and read, or if I would prefer he went to his own room. I allowed as how it sounded companionable. I knew that he wouldn't try to talk to me. I continued to obsess on my solitaire game and he lay on my bed reading a Ngiao Marsh mystery. We didn't talk, but it was a comforting reminder that I'm loved and cared for.
I only took 50 mgs on Wednesday. Titration ahoy! Ah, the joys of using oneself as a crucible, the pleasures of being one's own experimental animal. Yesterday wasn't as bad as Tuesday -- just as well. I was just short of suicidal depression on Tuesday. Today, I've only taken 50 mg again. I'm feeling tired, that kind of tired where it feels like you're carrying a heavy weight on your back. I'm not falling asleep, though, and I'm not jagged and miserable.
The problem is the drugs, your honor. They haven't invented the right drugs.
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no subject
Date: 2003-05-22 09:09 am (UTC)I've been taking 50mg elavil (easier to spell than the generic name) for almost 5 years now, to help with chronic pain and to help me get to sleep before sunrise.
It is odd indeed to take one pill that helps wake me up and then another pill that helps me get to sleep. I mean, I take a bunch of other stuff now that contributes to wakey or sleepy (testosterone, skelaxin, imitrex-as-needed, percocet-as-needed, my albuterol inhaler makes me sleepy) but the effexor and elavil (what I call my morning and night meds) are the keys right now.
Drugs are so interesting. It would be nice if I didn't spend so much time as guinea pig, though. I'm totally with ya there. Then again, if I wasn't a guinea pig I'd be unmedicated and that's just a dark and scary place for me.
I hope you find what works soon soon! And oh, it's nice to see you again. Every once in a while I wish I was back at whatever crappy job I had in Mpls where I could ask if you want to have lunch or something. Heh.
Take care and all that.
Shahn
no subject
Date: 2003-05-22 02:45 pm (UTC)no subject
Date: 2003-05-22 02:54 pm (UTC)Well, you've got quite some space to work in if you're only taking 150 mg. Counter-intuitively, not only do I have an extremly skitzy system, but it also takes massive doses of antidepressants to be effective. I'm on 375 mg at the moment, which is about the max for someone my size. We're much of a size, so probably you could go as far as doubling your dose before you have to look at a different drug. I strongly recommend upping the dose if possible, rather than switching drugs.
I've used up Prozac, Zoloft, and Serzone, so far. There are lots of other drugs we can try. It's just that 12 week free fall that's the problem. When I was going around and around about sleep problems earlier this year, the cardio-pulmonary and general practice doctors all talked blithely about reducing my dosage, or switching to a new med. Every time, I'd stare at them,aghast, and start to cry. My psychiatrist, on the other hand, completely understands the situation and has no interest in casually messing around with my meds. Thank god for that.
no subject
Date: 2003-05-22 11:45 pm (UTC)My bizarre system reacts strongly to drugs of all kinds except local anesthetics. So I need minimal dosage of almost anything, except that, to make it work. If I want to be able to sleep, I take decongestants before noon for example. And usually just half a dose at that. Ah well. I'll have to hunt around for a psychopharmacologist I guess.
Good luck to us both.
MKK
no subject
Date: 2003-05-22 03:02 pm (UTC)I don't know if you're looking for suggestions or not - feel free to skip the rest of this comment if you're not. But maybe it would work to split the dose of Provigil - take 50mg in the morning and 50mg a bit later in the day? Sometimes that helps with side effects.
no subject
Date: 2003-05-23 06:31 am (UTC)The truth is that psychiatric medicine is still at the waving feathers and rattling noisemakers stage. The big differnce is that they sterilze them, first.
no subject
Date: 2003-05-22 08:29 pm (UTC)