Clozapine Refill Frustrations

I started my Clozapine rechallenge on April 3rd; I have now been taking it for close to 8 weeks. My doses have increased slowing over that time. I’ve had some side effects, but nothing that can’t be managed or dealt with. Some of the side effects have gone away over time and others I’ve learned to deal with to the best of my ability.

I just had my Clozapine level taken and the results finally came back yesterday. My level came back at 80, which is very low. I’m assuming that my doctor is going to be increasing my dose, but I’m not sure. I don’t really know where he wants my Clozapine level. A low level is between 50 to 150 ng/mL, 200 to 300 ng/mL is a medium level, and 350 to 450 ng/mL is a high level. I’m pretty sure that the therapeutic level begins 100, which I haven’t reached yet.

Every week I seem to have problems with my blood work and filling my prescription. People at the pharmacy tend to lose track of my blood test results, which they need in order to fill my prescription. I have finally learned that if and when the pharmacy says they haven’t received my weekly blood work, I just need to tell them to look in my file. I thought getting my script filled would be easier now that I’ve figured out that part. However, this week’s prescription has been difficult for another reason. First, my doctor wanted to wait for the Clozapine level results so he knew how much to prescribe. I normally get my script filled on a Sunday or Monday. It’s now Thursday, so I can’t last much longer without a refill. My doctor has called the prescription in twice to the pharmacy. He said that he was on hold for 10 minutes just to leave a message. I’ve called the pharmacy 3 times today regarding this script, and it still isn’t filled.

I don’t know why it’s so difficult to get this prescription. It seems to add a great deal of anxiety to my life every week. I’m actually taking Valium just to deal with this situation. I wonder if it does more good than harm.

Knowing Your Diagnosis

Understanding your own mental health is extremely important. Even though most of us have some type of support system, knowing your own illness is the best way to take care of ourselves. I know that I am diagnosed with Bipolar 1. I have manic, depressive, and mixed episodes. While others may be able to see some of my symptoms, I try to be the first person that can see them. I am aware of the symptoms I exhibit for each type of episode. Knowing my symptoms helps me to catch my episodes before they get too far. Those that I’m close with, such as my husband, family, and best friend are also able to see my symptoms when they start to appear. I can ask these individuals for help to better maintain my mental health.

Hopefully, by paying attention, I will be the first to notice when I’m not sleeping, if I become obsessive, if I have racing thoughts, if I spend too much money, or become overly talkative. These are all signs that I’m becoming manic. I also hope to be the first to notice if I’m sleeping too much, if I feel pathetic or empty, if I cannot find pleasure in activities, if I gain weight, or if I start planning a suicide. These are all signs that a depression is coming. A mixture of these symptoms can mean a mixed episode is starting. I want to be the first to notice my symptoms so that I can get a jump-start on treating the symptoms and episode.

It’s not easy to know and understand your own mental health. Every person’s bipolar disorder is different. Each person has different symptoms occur, and each person has different ways they have found that treat their symptoms. Knowing your symptoms also allows the individual to contact their doctor so he/she can alter medication as necessary. Some of our episodes come from medication changes, from stressful events, from medical changes, or even from out of the blue. The sooner we begin to treat our episodes, and allow our doctors to treat us, the better off we will be. Success comes from knowledge of our own diagnoses.

Vivid Dreams

Insomnia and other sleeping disorders are common among patients with bipolar disorder. I personally have suffered from insomnia. I have taken Ambien, Lunesta, Seroquel, Trazodone, and other medications over the years to get me to sleep. Right now, the Clozapine I take gets me to sleep and keeps me asleep. It is also common for individuals with bipolar disorder to have very vivid dreams, especially nightmares.

Patients diagnosed with bipolar disorder often have strange and scary dreams. Many of these patients have anxiety in their dreams. Their type of dreams may also change depending on their status, whether they are manic or depressed. My husband tells me that I am very active at night. I tend to talk a lot in my sleep and I also move around a lot. I’m not sure, but I think that this is related to the type of dream I am having.

Nightmares tend to occur more often for those diagnosed with bipolar disorder. Personally, I tend to have very vivid and scary dreams, but if I don’t talk or write about them right away, I will easily forget the dreams. For the past couple of weeks, my dreams have been extremely vivid. Everything seems so real. The dreams I’m having are mostly everyday situations. I’ve actually had a few times when I’ve confused my dreams with real life. The dreams are common occurrences such as disagreements with my husband or family members, difficulties with doctor appointments for my physical health, or problems with pets.

One of the things that suck is that I have been feeling physical pain in my dreams, specifically bladder pain like I feel from my bladder disorder. I wish I could get rid of these dreams. Isn’t it enough that I have to deal with this crap during the day? Why do I have to deal with it again in my dreams? I had a conversation with my husband in one of my dreams. I ended up using that conversation from my dreams in a real life situation. My husband had no clue what I was talking about. It took me a while to realize that what I was talking about actually came from a dream.

I think I should start keeping track of my dreams. Maybe I’ll keep a journal next to my bed. This way I can write down what my dream was about as soon as I wake up. If I wait too long, then I completely forget what it was about. I’m interested to find out how my dreams change based on what episode I’m in.

Family Dinner

My husband and I decided that we want to see our granddaughter; it’s been about a week since we’ve seen her, and so we invited his daughter and boyfriend over for dinner. This all happened last night, and the dinner is tonight. That’s a lot for me to handle. I have to clean the entire house and cook a meal. Then, my husband decided he would invite his mother over because she doesn’t get to see the baby very often. It’s a very sweet thought, but it doesn’t mean more work for him, just more for me. Then I realized I can make lasagna! I made some lasagna with my mom when she was out here last time. I don’t have to do anything, just heat it up from frozen!

Okay, so now all I need to do is clean the house, do laundry, and make garlic bread. That’s not that bad. However, cleaning the house will take a while; there’s dog hair everywhere, even though I cleaned the whole house just a couple of days ago. I also have to figure out where people can eat. There’s not enough room in our house for our dining room table, at least not the way I want it. A couple of people can eat at the counter, there are bar stools there. And then there’s the couch and the desk. I can make that work.

Why is it so stressful having people come over your house? Is it just me, or are other people like this as well? I feel like my house needs to be sparkling clean and organized if I’m having any company over. At least all I need to do is clean the house; I have more time to do it since I don’t have to cook. I don’t think I’ve ever had this many people at my house at one time, so I’m a bit anxious. I’m sure it will all work out, but I will probably worry about it all day.

Bipolar Risk Factors

I suppose that I’ve been in my head a lot lately. I’m trying to figure out the answers to some questions that probably can’t be answered. However, I’m going to try to find some sort of answer because that’s the kind of mood that I’m in right now. I want to know the answer to the question, “why me?” I think about this a lot, but I’ve never actually tried to really figure it all out. Bipolar disorder is not caused by any one single thing; it is instead caused by multiple factors.

The following is general information regarding bipolar causes and risk factors. The information below is not advice, and should not be treated that way.

Family History and Genetics: Individuals that have bipolar disorder in their families are more likely to develop bipolar disorder themselves. This is especially true for individuals with a parent or sibling with bipolar. This doesn’t mean that people with a family history of bipolar will develop the disorder themselves. Also, individuals with certain genetics are also more likely to develop bipolar disorder.

I know that personally, there are mental health issues on my father’s side of the family. His sister and one of his brothers have known mental health diagnoses, but I’m not sure what they are. There is also someone on my mother’s side that struggles with depression. I know that there is no one diagnosed with bipolar disorder on my mother’s side. Neither of my parents has/had mental health issues.

Brain Structure: Individuals that are diagnosed with bipolar disorder often have physical changes to the structure of their brains. There is often a natural imbalance in the neurotransmitters in the brain of an individual who has bipolar disorder. I’m not sure if it would ever be possible, but it would be great if doctors could eventually find out which individuals are more prone to developing bipolar disorder. Maybe it’s already possible, I’m not exactly sure.

Common Issues: There are many types of issues that are known to trigger the first bipolar episode in individuals. These factors include but are not limited to high stress periods, drug and alcohol abuse, major life changes, and traumatic experiences.

I experienced all of these situations. My father was diagnosed with cancer; he lived for several years with the illness before dying. I used drugs and alcohol so I wouldn’t have to feel my emotions. Because of my drug abuse, I met a guy that ended up being very abusive towards me for about 18 months. They may have triggered an episode, but they didn’t cause my bipolar disorder. My bipolar was there to begin with, and these situations probably just helped it come out.

Co-Occurring Conditions: Many individuals that are diagnosed with bipolar disorder often have other conditions such as PTSD, ADHD, various anxiety disorders, drug and/or alcohol abuse, and physical health issues. Individuals diagnosed with bipolar disorder are more likely to have both physical and mental health conditions.

I’m also diagnosed with PTSD, I’m 12 years sober from drugs and alcohol, and I have a variety of physical health issues.

There are many factors that contribute to individuals being diagnosed with bipolar disorder. However, just because some has one or even several of these causes/risk factors, doesn’t mean they have or will end up having bipolar disorder.

Waiting Is The Hardest Thing To Do

Right now, I’m waiting, and I’ve been waiting for days. I’m waiting for the results to my Clozapine level blood work. The results to this test will tell my doctor whether or not he wants to increase the dosage of my Clozapine. I’m currently at 200 mg every night. I did the blood work on Friday. My normal weekly blood work was completed on Friday, but the Clozapine level takes longer to come back. I just don’t know how long; I even tried to figure out how long it would take by researching it online, but I came up empty-handed. I told my psychiatrist that I’m in a depression. I informed him that I’m sleeping too much, I’m overeating, I feel worthless and empty, and I’m easily irritable. He told me to hang in there; we are waiting for the results of the Clozapine level. Once we have the results, then we can figure out our next step.

So now I’m just waiting. I’m waiting for my blood test results, I’m waiting to find out what change my psychiatrist wants to make, and I’m waiting to start feeling better. When you’re waiting for something, every moment seems to drag on and on. I’m just trying to get through this, one moment at a time, but how much longer do I have to wait? Even if my psychiatrist decides to add a new anti-depressant, we all know that it takes 4 to 6 weeks for the medication to start working, if it’s going to work at all. So that’s more waiting. No one should have to wait this long to feel better.

I’m compliant with anything I’m told to do by my doctors. However, I am getting sick and tired of it all. I wouldn’t mind the waiting, if I knew that there were going to be positive results. I also wouldn’t mind the waiting if I knew that the positive results that I was going to get would be more than just temporary. We all know that no medication to treat bipolar disorder is permanent. Every time we try a medication, our bodies react differently; we almost never react the same way twice. How a medication works varies depending on our current mental state, the medications we’re currently taking, and any treatments we’re currently undergoing.

I just wish there was an easy answer to treating bipolar depression and mania. There should be an answer, an easy way to help us, where we don’t have to spend most of our time waiting. My bipolar disorder is very gray, nothing is absolute, and everything is questionable. I wish my bipolar disorder was more black and white, I wish it had easier, faster, and more accurate answers.

Think Before Reacting

It is vital, but not easy, in life to think before reacting. People tend to react to situations automatically, at least I know that I do. I usually react by being overly polite, I almost always say yes to whatever anyone asks me, and I let people walk all over me. I have a very hard time standing up for myself. Some others have the opposite problem. Both situations are difficult to handle. This is why people could benefit from thinking before reacting. I’ve been trying to do this in my daily life, but I struggle to do it on my own. Some of the techniques I use are:

Take a moment to respond. Don’t force yourself to react immediately.
Think about what you would tell someone else to do/say if they were in your position.
Practice your response with another person if possible, or just practice with yourself.

I usually respond immediately, telling people I will do what they want and I insist that it’s no problem, even though it is an issue. I almost always put other people before myself. It’s important to stand up for yourself; I guess that’s something I’ll have to continue to work on.

When you stand up for yourself, you don’t necessarily have to explain your response to anyone. Your answer to someone’s question is enough. If you can’t do something for another person, then that should be enough. We are not children, we don’t need to justify everything we say. Speak up and clearly when you are standing up for yourself, and remember it’s okay to say “no”. Being assertive is a good thing; it’s not being mean or rude. Practice standing up for yourself. I ask my husband and my mom for help all the time. There’s nothing wrong with asking for help. I think it actually makes you stronger.

Depression Triggers

This depressive episode has me dealing with some depression symptoms that are not normal for me. My symptoms include weight gain, hopelessness, inability to feel pleasure, lack of interest, sadness, extreme fatigue, sleeping more than normal, excessive hunger, restlessness, and suicidal ideations. I push myself to get through this every day. I make myself get out of the house because I know it’s good for me. Just because it’s good for me doesn’t mean it’s easy to do.

I’m trying to figure out why this depressive episode is even happening. Normally, I can pinpoint the reason or trigger for an episode, either depressive or manic. Some of the reasons are medication induced, situational, or emotional. The problem is that I can’t find the reason for this depressive episode. I’m wondering if it’s possible that my recent ECT treatment could have caused this depression. I had already started to feel slightly depressed when I had the treatment, but I have felt so much worse ever since I woke up from it. It feels like ECT was a jumpstart into depression.

Does it even really matter what the cause is for any episode? I suppose the reason to know what triggered an episode is to help for the future. If you know what caused a depressive episode, then you can avoid that trigger in the future. I’ve been doing ECT treatment for over a year, and this is the first time I’m having problems like this. It may not be a trigger for me, but it may have been the thing that pushed me over the edge. Other things I’ve been experiencing that can cause depression are poor sleep habits, poor diet, weight gain, other health problems, and feeling home sick. I wonder, with this such as weight gain and poor diet, which was first. Did they occur first as a symptom of bipolar depression or were they triggers for the bipolar depression?

My Wellness Toolbox

A wellness toolbox is a list of any and all of the tools that an individual has found to be helpful from their own personal life experience. Everyone’s wellness toolbox is different because they are based on personal experience. A wellness toolbox can be edited as you learn new helpful tools and/or cross of ones that no longer work for you. My wellness toolbox contains the following tools:

Blog
Clean the house
Talk to or meet up with a friend
Cook (organize ingredients and make a whole meal)
Listen to Jennifer’s Rabbit by Tom Paxton (a song from my childhood)
Take the dog for a walk
Call friends from support groups
Organize anything I can find
Play the piano
Workout and eat healthy
Go to therapy or a support group
Watch old family videos
Look through old photos
Avoid caffeine
Light candles that smell good
Stay away from crowds
Watch a funny video or movie
Color in my adult coloring books

I have done several of the things in my wellness toolbox, so at least I know I’m on the right track. I’m also planning on cooking tonight, so that’s another thing I’m doing for myself. There are some things I’ve tried, but wasn’t able to do, such as coloring. I tried but couldn’t do it for some reason. I guess I’ll try it again a little later.

This is the reason I completed the Wellness Recovery Action Plan (WRAP), to help me and my loved ones when I’m struggling with either mania or depression. I’ve already found it useful. I’ve even added something to my toolbox; the coloring is a new tool. I will keep my wellness toolbox handy so I can reference it whenever necessary.

Another Day of Depression

I went to bed last night hoping that today was going to be different. When I woke up, I knew that it was going to be another day dealing with depression. The first sign was that I slept until 10am. I don’t sleep that late when I’m feeling well. Then my mom called me, which normally makes me happy, but this time I couldn’t feel anything. I’m dealing with a loss of interest in things I normally enjoy. My energy level is extremely low, everything feels like a major tasks. Even writing has become a huge task, but I force myself to do it.

Yesterday, I forced myself to get out of the house and go to my mother-in-laws when she invited me. It was extremely difficult, but I did it, and I’m glad I did it. It helped me feel a little better. Maybe today I should do the same thing. There’s a friend’s house I could go to; she understands depression and doesn’t judge me at all. I’m going to try my hardest to go over there in little while. I actually just made plans with her, that way I have someone to stay accountable to.

I’m pushing myself so hard. Sometimes I feel like I should just give in to the depression. It would be easier to just let go, but I need to put up a fight. Although, I’m wondering what the reason is why I’m fighting the depression. Am I doing this for my family or my husband? Is it possible that I’m doing this for myself? I don’t even know if the reason why matters. The most important thing is that I am fighting the depression. I’m not simply giving up. There are a lot of things that I could do to help. One thing I could do is to look at my Wellness Recovery Action Plan (WRAP) and looking through my wellness toolbox for suggestions that I know are helpful when I’m in a depression.

My Side of the Pole

Bipolar – Mental Health

Month: May 2016