The Rest of the Quentiapine Story

At the beginning of September, I was at an all-time low. Psych had recommended changing my Fluoxetine (Prozac) and Bupropion (Welbutrin) to Quentiapine (Seroquel or Q) and Bupropion instead. Q was supposed to treat depression as well as the sleep problems I was having. I wrote a post about it here and then abruptly left you guys hanging for several months.

So what happened with Q? At the last post, I had been on a nightly dose of 50mg of Q for a few days. I decided that I had to keep going with it. It is important to give medication time to work before ruling it out all together. I lasted a few more days before I swore it off. You see, I blame Q for my most recent embarrassing moment!

I cringe just thinking about it. I was on the bus on my way home from work. I was uncomfortable because adjusting to Q had been making me nauseous and the bus only amplified it. I had been dealing with it for about a week and I was handling it. I’m no stranger to nausea. I normally get motion sickness riding buses or in the back seat of a car. I’m never actually sick though, thankfully. I threw up a lot as a kid. I think it was an anxiety thing. Anyway, the benefit to this is that I know my body pretty well and I know the difference between “I’m going to throw-up” nausea and just plain motion sickness.

So, here I am sitting on the bus in rush hour traffic. The bus is packed and I’m nauseous as usual. Whatever, this is my life. But, suddenly, I start getting a different feeling in my throat. It’s like the lining of my throat is being pulled downward into my stomach. That’s it. That’s my signal. I know I’m going to throw up! I know I have 30 seconds at the very most. This is what was going through my head….

“OMG I’m really going to be sick. It’s actually going to happen this time! It can’t. I have to get off the bus!”

*Turns head to see where we are and signal stop*

“Noooo!! We just got on the highway! The bus can’t stop and I’m not going to make it to the next stop! What am I going to do?!” The window! I’m sitting next to the window, I’ll open it.”

*Grabs the handle and pushes the window open all the way…….it opens about 2 inches.*

“Aaaagh!! What am I going to do now?! Press my mouth into the opening and projectile vomit onto the car next to me?! It’s going to splash back all over me. What else can I do??? A bag!!”

*Frantically searches through tote bag for a plastic bag, a tupperware, kleenex, anything…but there’s nothing*

“OMG! Running out of time!”

*Looks around for somewhere to be sick*

“I’m out of options! I’m stuck, there are so many people. The seat beside me is occupied, the window is on my other side, there is someone directly in front of me, seated at the end of my knees. There is just enough room on the floor for my feet and the person’s next to me…..”

Time is up. I convulsed. Everyone looked. It wasn’t pretty.

To Q Or Not To Q

My psychiatrist has prescribed Quentiapine (Q) to help me sleep. I’m not sure if this is a good idea for me. I have body image issues and am really nervous about the associated weight gain. Psych has never been too concerned with my body-hatred. He keeps recommending I try Remeron, which I’ve been told is a death trap for weight gain. I have been having problems sleeping though and I do need help with that. He decided to replace the Abilify I was on with Q to help with depression and sleep.

So far, I’ve been taking 50mg of Q at night. I go to bed when I start to feel woozy. I do sleep, but I wake up a lot during the night. In the morning, it’s really hard to get up and I want to eat everything! I have also experienced a strange foggy feeling in my head and some blurred vision. No change in mood so far. I know there is an adjustment period for Q, but I’m not sure it is worth it, especially if it’s not going to work wonders with my mood and sleep.

I have gained some weight in the last year and a half that I am trying to get rid of. I’ve found that the best time for me to exercise is early in the AM. I’m afraid I wont be able to do that with Q. I’m also wondering if Abilify had anything to do with my weight gain. I know it is supposed to be one of the more weight neutral anti-psychotics, but I have bad luck with side effects on most medications, so it is possible.

I’m starting to think it might be a good idea to just stay away from anti-psychotics all together. Abilify didn’t really make a big difference when I started it anyway. I can’t remember how long it has been, two years maybe? That would leave me with 300mg Welbutrin and 60mg Prozac. Psych also mentioned upping Prozac to 80mg and adding Imovane to sleep. Imovane is habit forming, so that’s not so great either. I don’t know if any of this stuff really helps anymore.

So the question is, do I keep going with Q and see if things get better? Or, do I stop now and drop the anti-psychotics all together?

Self-esteem challenge: Day 12

This blog challenge was developed by betterthandarkchocolate.tumblr.com. If you missed the introduction or want to see a summary of all the questions, go here.

Day 12:
If you could change something about your personality, what would it be and why?
What’s the last thing you did that made you feel proud of yourself? Why did it make you feel this way?

I’m starting to feel like I’ve answered some of these questions already…. Anyway, I have always wished I were a more passionate person. Sometimes I feel like there is something standing in the way of me really enjoying something or really caring about something. My husband is a very passionate person, I admire that about him. Within the first few conversations, anyone who meets my husband will know that he loves Batman, wildlife, Coca Cola and Aerosmith. These are his favourite things, but there’s more to it than that. There’s an enthusiasm behind it. I don’t really know how to describe it. It’s like he is inspired by them, maybe. He knows all about them and can spend hours getting to know more or experiencing more. I don’t have anything like this. Sure, I have favourite things, but there is no drive behind them like there is with hubby. Everyone knows I have a sweet tooth and like cake, but there’s no passion to it. It’s not like I bake or decorate them or try exotic flavours. I pretty much eat the same type of cake every time I want a treat. I enjoy drawing, the blogging world knows that, but it’s something I often have to force myself to do. Eventually I get going, but there is no enthusiasm to it. I don’t know if this is a personality trait or if my medication has numbed all the passion out of me.

The last thing I did that made me feel proud of myself was comps. This was late last fall. Comps, or comprehensive exams, are a must for Ph.D. students. Basically you have to prove that you have what it takes to do a Ph.D. dissertation. My comps consisted of four questions from four experts in fields that were similar to mine, but not the same. My field is low vision and I was asked questions on certain vision research technology, age-related hearing loss, molecular biology of macular degeneration and genetics of retinitis pigmentosa (tunnel vision). I had to write 10 page papers on three of them, answer the fourth in a power point presentation and then do a presentation defending my research proposal. I opted to do my genetics question as a presentation. There was no way the answer to that question would have fit in 10 pages! The question itself was almost a page long! Anyway, the presentations went well. I got a sneaky thumbs up from my supervisor when the rest of the panel wasn’t looking. The molecular paper was ok, but it was the other two papers I was really proud of. I felt I had taken topics that I knew little about and told a cohesive story. My supervisor even mentioned publishing them! I actually felt like maybe I did deserve to be where I was. I knew what I was doing and didn’t feel like an imposter. Part of comps is finding out if you can find information, but you can’t just regurgitate what others have already said. You have to put it together and tell your own story, offer an opinion and insight for future research. I felt I did a really good job of that on those two papers.

R is for Recent Research

Researchers are always looking for new antidepressants since current methods are not putting all individuals with depression in remission. Approximately one third of patients with depression are resistant to current treatments. A recent proposal has been Ketamine aka Special K. Its mood altering properties are often enjoyed by club goers. Yes, it’s most commonly known as a street drug, but before you rule it out, note that is has been used in medicine safely for over 40 years! Veterinarians use Ketamine as a tranquilizer for cats and horses. Doctors use it in anesthesia during surgery. In fact, even dentists use it because it doesn’t have cardiac or respiratory effects. This is why dentists are able to put you under, without having all the equipment that a hospital has. Ketamine is commonly used in third world countries where medical monitoring equipment is in short supply. Something else that makes Ketamine safe is it’s half-life. This is how long the drug stays active in the body. Ketamine has a half-life of 3 hours, which is not long enough to cause any neurotoxicity. This is great, but it also means that the antidepressant effects will wear off as well.

A recent study showed that 71% of treatment-resistant bipolar sufferers responded to Ketamine. The primary side effects were mild dissociative symptoms, but this was only reported during infusion (first 40min.). A UK study found that participants who responded to Ketamine found relief within days after infusion. Days?! Can you imagine a treatment where you didn’t have wait a month or more just to find out if it works!? The same study reported the beneficial effects of Ketamine to last anywhere between 25 days and 8 months. A third study found Ketamine in the form of a nasal spray to be just as potent as intravenous administration. Researchers are also hoping that Ketamine could be a substitute for electroconvulsive therapy (ECT) which is usually used for those with treatment resistant depression. ECT has had some positive results, but memory loss has been reported as a side effect. This doesn’t happen with Ketamine.

Much of what we currently know about Ketamine is from its use in anesthesia. So we know a one-time dose has no detrimental effects, but what about long-term usage? It may be that the ability of the brain to process the drug decreases over time. Studies on Ketamine-dependent individuals show changes in white matter in the brain.

Ketamine has potential. I think it would be great if it were available as a medical rescue for people who come to the ER in crisis, but it has a long way to go before it’s ready for the market.

R is for Red Rose too!

A is for Antidepressants

I am participating in the Blogging from A to Z Challenge (April 2014). For more information, click the link. Just to summarize, there are 26 letters in the alphabet and 26 days in April excluding Sundays. Each day gets a different letter (in alphabetical order) and you have to write about something that starts with that letter. Today is April 1st, so today’s letter is A. Since a lot of my posts are about my experiences with mental health, I’m going to stick to that theme.

A is for Antidepressants

Usually I post a doodle with my posts. Antidepressants were kind of boring to draw, so we’ll go with another “A”, Alice in Wonderland.

When I was prescribed antidepressant medication for the first time, I didn’t know much about depression, never mind the medications and what was right for me. I just went with whatever the doctor said because doctor knows best, right? Wrong! The doctor knows the medications, their interactions and the general biology of how they work, but only you know you best. To find the right antidepressant for you, you have to work together with your doctor. Here is what I wish I knew at the beginning of my antidepressant experience.

1. Do your research. Know the different types of medications, what they do and the associated side effects. Here is a cheat sheet for you:

• Selective Serotonin Re-uptake Inhibitors (SSRIs). These hit in the market in the 80s and are the most widely used class of antidepressants today. They are typically used to treat anxiety and depression. SSRIs increase the activity of the neurotransmitter serotonin the brain. Serotonin has been linked to feelings of well-being and happiness. The function of serotonin is inhibitory, it tends to decrease, appetite, sexual behaviour, aggression and pain perception.
• Serotonin and Norepinephrine Re-uptake Inhibitors (SNRIs). This is a newer class of anti-depressants, most often used for depression and mood disorders. They are less often used to treat anxiety and relieve symptoms of menopause. They work similarly to SSRIs in that they increase neurotransmitter activity in the brain, but they act on norepinephrine in addition to serotonin. Norepinephrine is associated with concentration and alertness.
• Tricyclic Antidepressants (TCAs). These were one of the earlier classes of antidepressants, developed in the 1950s. They have basically been replaced by the above two categories because those have more favourable side effects. There are different types of TCAs, some act on serotonin or on norepinephrine, or both.
• Monoamine Oxidase Inhibitors (MAOIs). These were the first antidepressants developed. They work well, but are not often prescribed because of the adverse reactions they have with certain food and medications.
• Atypical Antidepressants. These are all different and don’t fit into any of the previous categories. These are a few examples.
  Bupropion (Wellbutrin, Aplenzin) – Welbutrin acts on norepinephrin and dopamine. Dopamine is a neurotransmitter associated with the brain’s reward center. Side effects are usually mild.
  Mirtazapine (Remeron) – This one interacts with norepinephrine and serotonin. It is mostly used for depression and mood disorders, but is also used as an appetite stimulant. It is recommended to be taken at night.
  Trazodone (Desyrel) – This one interacts with serotonin. It is used for depression but also has anti-anxiety and sleep-inducing properties. It needs to be taken with food to decrease stomach side effects.
  Vortioxetine (Brintellix) – This one was approved only last year! It works on various neurotransmitters including serotonin, glutamate, GABA and histamine. The side effects are supposed to be minimal and it is supposed to help with the cognitive symptoms caused by depression.

2. Know your symptoms. Do you have trouble sleeping? Are you chronically low on energy? Do you have anxiety as well? If you aren’t sure about the answers to some of these questions, ask someone you see on a daily basis. They might have picked up on something you’re missing. Knowing the answers to these questions could help you and your doctor narrow down your options. You want to find a medication that will alleviate your symptoms and not exacerbate them.

3. Know your family history. If someone in your family is successful on an antidepressant, it is likely you will be too. Of course, the closer the relative, the better the chance you have. I tried three different medications before I found out my aunt had depression and was on Prozac (fluoxetine). Now I’m on it and my body tolerates it quite well. Something like this is often a good starting point.

4. Give the medication a chance to work (or not). Don’t worry if it doesn’t work right away. To notice a difference, it takes time for there to be a high enough concentration of the drug in your body. You may notice some changes right away too. They could be good or bad. This does not reflect how you will feel over the long term. Give these effects a chance to settle into something stable.

5. Watch for side effects. Some medications come with nasty side effects. These could outweigh the benefit the drug might give you. I have heard Remeron and Paxil are notorious for weight gain. Since I have body image issues, I’m not going near those. I’ve also had an interesting experience with Effexor (venlafaxin). It worked really well, but if my timing was off, I’d start to get crazy mood swing and brain zaps. It’s like the shock you sometimes get when you close a car door in the heat, except in your head. It’s not fun. Although Effexor helped me a great deal, it wasn’t worth the side effects.