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?

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.

Down the Rabbit Hole

I’m feeling pretty low. That’s why my last few posts have been about things I have learned either through experience or reading. I think it’s important for you to either learn something new or feel uplifted after reading a post here. I’ve gotten to the point where my brain isn’t working well enough to come up with something. I’m falling down the rabbit hole, but unlike Alice, I’m not going to land in Wonderland. There is nothing wondrous about the place I’m going. It’s dark, lonely, hopeless and usually doesn’t make much sense. Well, maybe Alice and I have that latter part in common.

I can usually tell when I’m falling. I start getting really tired for no particular reason. Then I start to lose what little motivation I have. That’s how this spell started, but there were a few added perks. I changed the dosage on my medication and I’m having a hard time adjusting. The first few days I was really nauseous and shaky. The nausea went away, but the tremors stayed. It makes it extremely hard to draw which seems to be the only thing I can do without having to jump over the giant hurdle of dread. These symptoms, along with the lack of motivation have kept me from going to work. I think I feel guilty about not doing any work, or maybe I just think I should feel guilty, I don’t know. I don’t care enough to figure it out.

Yesterday was particularly wretched. I haven’t been sleeping very well and the night before last I pretty much didn’t. My lack of sleep has accumulated into that nauseating, photosensitive, headache-y feeling that leaves you stranded in bed or on the couch in the dark. So that’s where I’ve been for most of the day….and night.

While I was rotting on the couch, I got confirmation that my husband will definitely be out of a job for the next school year. There are no full-time science contracts in the school board he is tenured with. All these questions are swirling through my brain. What are we going to do?! Will he find something else? Will I have to leave my Ph.D.? Will we have to move? This would normally start a panic which I would talk myself down from, except I don’t have the energy to panic. So instead I curled up into a ball and prayed that I’d just disappear. Since it was not likely that my prayers would be answered, I needed a new strategy.

I’ve been told that when I start to fall apart I should try living life 10 minutes at a time so I don’t get overwhelmed and can stop thinking about the future. There was nothing I could do about my meds, my work or his job at the moment anyway. What could I do right now? Try to feel better. How? I have a list of things that usually cheer me up. I have it written down for times like this when I’m not rational. Starting at the top of my list is my husband, who is not currently home, next… Find Ewok (my cat). Check. Sweatpants. Check. Cup of coffee. Check. Put on the Phantom of the Opera. Check. Watch until I feel better.

The Phantom played through five times. I still feel the same. At least I haven’t completely lost hope yet.

Road Trip and Withdrawal

Road Trip!!

I was actually looking forward to the change in scenery. I got up early enough to get in a workout before hitting the road at 8am. The drive from Montreal to Toronto isn’t that exciting. You go straight…for about 5 hours. At least there is no chance of getting lost. The major highlight making this trip as a kid was the giant apple on the side of the highway just outside of Toronto. They call it The Big Apple and sell all sorts of apple items, pies in particular. I’ve never stopped there, but who knows, maybe I will this time.

So I was enjoying my road trip with the husband until we got to Cornwall. Cornwall is about half an hour outside Montreal. I realized I had forgotten all my medication. When you are on anti-depressants and they tell you not to go cold turkey, it’s not something to be taken lightly. So much for my little getaway. I’ll be okay today and tomorrow, but after that the flood gates will open, my negative feelings and self-loathing will return. My brain just wont work right anymore. The way I think and what makes sense completely changes when I’m off medication. I’ve left my meds behind often enough to know that this is what happens. I know my thoughts are distorted and I shouldn’t take them seriously, but its still no comfort, I still have to fight the demons. It gets harder to concentrate on things, to smile, to make conversation and normal routine tasks like brushing my teeth or taking a shower suddenly become insurmountable. Forget going to work or out with friends. That’s what I was planning to do on Saturday, go out with friends from elementary school. I hope I’ll still be able to handle that by Saturday.

Going cold turkey on some meds is easier than on others. It also depends on your brain chemistry. What I’ll be going through in the next few days will be rough, but I’ll manage. I wont be wishing I could slam my car into a tree or anything. It is like that sometimes when you suddenly stop. When I was on Effexor and I ran out it, was scary! I couldn’t stop crying, I couldn’t leave the house and I was wishing that I could go to sleep and never wake up. I also got a really strange withdrawal symptom…..shocks. You know when you shut the car door in the summer, sometimes you get shocked. It was like that, but happening in my head. It was really disruptive and uncomfortable. It’s hard to carry on a conversation with that going on in your head. So weird.

I ran out of medication a few times while I was on Effexor. I didn’t have a regular doctor and prescription refills aren’t exactly top priority at the walk-ins. Because of the horrible withdrawal and all the other uncomfortable side effects (stomach upsets, dry mouth, loss of libido, tremors and excessive sweating) I ended up switching medications. Effexor was both the best and the worst medication I have been on. It gave me a lot more energy, I even lost weight, but the side effects and withdrawal were too steep a price to pay.