Clozapine Prescriptions

My psychiatrist mailed me two months worth of prescriptions. These scripts, for Clozapine, will get me from my 200mg dose up to my target 400mg dose. Each script is for one week worth of medications (because I still have to do the weekly blood work). He sent me everything that I would need to get through the next two months. The scripts are pre-dated, so I can’t fill them until Wednesday of each week.

I will be starting the increase soon, either Wednesday or Thursday of this week. I’m a little concerned about the possible side effects, but I mostly think it will all work out.I’m increasing my dose slowly to hopefully avoid side effects. I guess only time will tell.

I can still contact my psychiatrist any time I need, but hopefully everything with the dosage increase will go smoothly and I won’t have to. My next appointment with him is on August 25th. Until then, I can contact him via email or text if necessary. He will still get my weekly blood work results. If he sees a problem with my blood tests, then he will contact me.

Clozapine Blood Work Change

Since the beginning of April, I have been getting my weekly Clozapine blood work done on Fridays. A couple of weeks ago, somehow the day that I pick up my prescription changed. Instead of picking up my filled prescription on Sundays or Mondays, I’m picking it up on Thursdays.

Since I now pick up the script on Thursdays, it seems a bit ridiculous to get my blood work done on Friday. I’m going to start by changing my blood work days to Mondays. Depending on how things go, I will either stay with Mondays or change to Tuesdays.

All I know is that my psychiatrist and pharmacist should be getting current blood test results. Right now, by getting blood work done on Fridays and prescriptions filled on Thursdays, none of my results are technically current. I’ll see how Mondays go for a while; I have an appointment right now for Monday at 2pm.

Another Week Of Clozapine

It’s time to refill my Clozapine again. I really hate having to do this every week. I spend so much time making sure the pharmacy can find my blood work results (they usually can figure out where they put the paperwork) and making sure my prescription is refilled or called in as necessary. After I’ve been on this medication for six months, I will be able to do this entire process every other week. Then, once I’ve been on it for a year, I get to do this once a month. So there is something to look forward to, it’s just going to take some time to get there. I started taking Clozapine in the beginning of April, so I still have to do this weekly ordeal until the beginning of October. That time can’t come quick enough.

Even though dealing with this charade is very stressful and difficult, the medication has been helpful. I do believe that Clozapine has helped to improve my depression when nothing else was helping. The reason the blood work and weekly scripts have to be completed is to protect me, and anyone taking the medication, from serious side effects that could occur. So far, I’m doing okay, and I hope that the Clozapine will eventually help me, and maybe even help me become stable. Anything is possible.

UPDATE: I received an email from Walgreens letting me know that my Clozapine prescription has been filled and is ready to be picked up. I’m going to go get it tomorrow afternoon. I’m so surprised. I didn’t even have to make sure they found my blood work or explain that I get the prescription every week. This is the first time that they did it all on their own, and I’ve been doing this every week for over two months. This is wonderful news; maybe it will be this easy to get my weekly Clozapine prescription.

Insomnia…

I’ve probably mentioned before that I’m an insomniac. However, the Clozapine I take at night helps me fall asleep with 20 minutes, I just don’t stay asleep. I wake up at least twice every night. It would be nice to sleep through the night, but I don’t know if that will ever happen. My mind is always running extremely fast. It goes from one thought, to the next, and so on. I never catch a break; I never get a moment of peace from my own brain. This happens when I’m manic, depressed, and even when I’m not experiencing an episode.

There are many aspects in life that affect my ability to sleep. These aspects include keeping a routine, medications, my anxiety level, and my honesty. Keeping a routine is important, but it’s something that I’m not very good at. I almost never go to bed at the same time every night. I pretty much go to sleep whenever I feel like it, so that isn’t very helpful. Several of my medications, including Lithium and Tegretol XR, can cause insomnia in patients. I’m sure this worsens my ability to sleep. My anxiety level is high quite often. Even when it’s not high, I deal with anxiety on a regular basis, especially when I’m outside of my home. For me, it’s important to remain honesty. I have a hard time living with myself if I’m not honest. I truly believe that honesty is the best policy; it’s important that when we interact with others, you should treat them the way you want to be treated.

There are many reasons why I could struggle with insomnia. I wonder if this is something I’ll have to deal with for the rest of my life. When I was a young child, I would fall asleep anywhere. Now, I have to force myself to fall asleep. And to make matters even worse, I tend to have nightmares when I finally do fall asleep. My husband says that he can tell when I’m having a bad dream because I talk very loudly in my sleep and I’m constantly tossing and turning. When I wake up, I don’t always remember my dream/nightmare, but I do remember feeling terrified. I wonder if there’s anything I can do to help get rid of these nightmares.

IV Ketamine Scares Me

The other day I made the decision to stop my ECT treatments and to increase by Clozapine dosage. I’m currently at 200mg and will be increasing my dose by 25mg each week until I reach 400mg. This was one of the options my psychiatrist gave me. Another option was to go back to doing ECT three times a week, but I’m not willing to do that at this point. The third option my psychiatrist gave me was to do IV Ketamine. He has been offering this as an option for many months now, but it’s not something I want to do.

IV Ketamine scares me for a couple of reasons. I used to get high off of Ketamine when I was using. That was a long time ago, and I know that abusing Ketamine and using IV Ketamine are two completely different things; the side effects of IV Ketamine are nothing like the effects of getting high off of it. My biggest fear of trying IV Ketamine is the possibility of dissociation. When I would use Ketamine to get high, I would take so much that I would slip into what’s called a ‘k-hole’, which is pretty much a dissociative state. I couldn’t move or speak, but I could still feel everything that was going on around me. The possibility of dissociating scares me, it triggers my PTSD. I always need to be able to protect myself, and dissociation would take that away from me. Plus, the treatments are especially expensive.

The use of IV Ketamine is highly effective, and it works very quickly. It is known to show improvements by the end of the infusion. Maybe my reasons for not trying it are ridiculous, but they are my reasons. I’m not saying that I’ll never try IV Ketamine; I would just prefer to leave it as an absolute last resort.

IBPF: Honesty Between Patients And Psychiatrists

Today, I had my biography and my first blog posted on the International Bipolar Foundation (IBPF). My first blog talks about the importance of honesty between patients and psychiatrists. It explains how I have learned over time what a big role honesty and respect play in the relationships between patient and doctor.

You can find my first post on the IBPF website here.

You can find my biography on the IBPF website here.

How Much Medication Is Too Much?

I take a lot of medication, and I really mean a lot. I take medication for both my mental health and my physical health. I already take Lithium, Tegretol XR, Deplin, Clozapine, Mirapex, Cytomel, Valium, and Inositol all for my mental health. I also take Zofran, Percocet, Depo-Estradiol, and Depo-Testosterone for my physical health. This doesn’t even include my multiple inhalers and breathing treatments. I’m hoping that I can decrease the meds over time. The first medication I want to go off of is the Deplin. It’s really expensive and I don’t think it’s been doing me any good. I have to wait until I’ve been off of ECT for a while before making any changes to my mental health medications.

A doctor told me this past week that a certain medication may help my bladder condition, but it would be a lifelong medication. I laughed, sarcastically, and told her that wouldn’t be a problem for me. I’m already on a lot of other meds that are lifelong ventures, adding one more to that list is no big deal. Plus, it would be awesome if I could eventually stop getting bladder installations done every week. The new medication is called Elmiron, and the problem is that it’s very expensive. The cheapest I found it was $224 a month. Luckily, my aunt found a patient assistance program that I’m qualified for. I have already filled out my portion of the paper work. I will have my doctor fill out the rest of the documents (which isn’t much) and then I can send it in. I’m excited to find out how much this program will help me.

I often wonder how much is too much. It’s hard to get off medications once you start them because everything has to be done slowly in order to know what medication is causing or helping each issue. Most of my medications are for my mental health, but there are still many that I take because of my physical health. Also, a couple of my meds from both physical and mental health are taken only as needed, so I don’t take them every day. For example, I only take the Zofran when I’m nauseous, the Percocet for pain, and Valium for anxiety attacks. I try to take these meds as little as possible; I don’t want to become dependent on them. I’m sure that I’ll always be on medication, but maybe one day I won’t have to take as much as I do right now. I wonder how many other people take as much medication as I do.

Managing My Health

Sometimes I feel like all I do is go to doctor appointments, pick up my prescriptions, and manage my prescription refills. This week, I have two doctor appointments and another appointment for blood work. That’s about how many appointments I have each week. I feel pathetic. Most of my life is spent attempting to manage my health, especially my mental health.

My current meds are: Lithium 450mg twice a day, Tegretol 200mg one in the am and two at night, Cytomel 37.5mcg in the am, Clozapine 200mg at night, Deplin 15mg at night, Mirapex 1mg three times a day, Inositol 500mg in the am, Depo Estradiol injection weekly, Depo Testosterone injection monthly, Valium 10mg twice daily as needed, Percocet 10mg as needed up to four times a day, and Zofran 4mg once daily as needed. It’s difficult to manage this many medications, but I do it pretty well. I’ve gotten used to it; I’ve developed a system so I get all my meds filled on time without missing a day.

I have an appointment with my psychiatrist on Thursday to discuss my Clozapine dosage. I’ll probably end up with more than one medication change. I’m hoping to get off the Deplin. It’s really expensive and it doesn’t appear to be making a difference. We’ll see what happens on Thursday.

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.

Clozapine Side Effects

Today marks 6 weeks that I have been on Clozapine. My psychiatrist has been increasing the dose slowly. I have only been at my current dose of 200 mg a night for 2 weeks. This is the dose that my psychiatrist wants me on until we get the results of my Clozapine level from this upcoming blood work. Things were going just fine, until the past several days. There’s always some sort of problem with me and medications, it can never simply work.

One thing I noticed is that I’m starting to slur my words and sometimes I just have a hard time saying certain words, usually words that have several ‘s’ sounds strung together in a row. It doesn’t happen often, but when it does, it’s very frustrating. I feel like a little kid again with the speech impediment I had until I reached 3rd grade. I first noticed it happening about 3 or 4 days after increasing my dose to 200 mg. My initial thought was that it could be due to the Valium or Percocet. I paid close attention making sure that the slurred speech was still occurring even when I had not taken any Valium or Percocet.

Over the past few days, I noticed another side effect, drooling. It only happens when I’m sleeping, but it gets so bad that my pillow is soaked. Sorry, I know it’s gross, but it’s been happening for about 4 days now. I tend to wake up in the middle of the night and then I have nowhere to lay my head down when I try to go back to sleep. I did some research, and it turns out that drooling is a regular side effect of Clozapine. The slurred speech is also a known side effect, but it’s not very common. I wish I could fix the fact that I tend to get so many side effects from medications. I wonder if it’s because of my Ashkenazi genes.

I told my psychiatrist about these side effects. He said that we can discuss options regarding the drooling the next time I see him, which is on Wednesday. That sounds promising, at least there are options. However, he said that if the slurred speech continues or increases, then I would most likely have to reduce or get off the Clozapine. I’m not happy with that option. There’s nothing I can do about it now. If I do end up having to get off the Clozapine, then I’m sure there is a very good reason for it. Now, I just wait and see…

My Side of the Pole

Bipolar – Mental Health

Tag: Med Management