PsychoPharmacology: Make It Up As You Go, & Damn the Patient!

You want agitation? You got it!

I want to prove this lady WRONG.

WHY do I keep getting psychiatrists who won't LISTEN?

Even worse, being dismissive of my concerns, is rude, hurtful, potentially medically harmful, and insulting, besides being destructive towards the therapeutic relationship, if it can be said that my psychiatrist and I have much of one.

You don't have to DO what I say, but HEAR me, please! Give me the respect of listening; I thought that was part of your job. When it becomes SO obvious that you AREN'T LISTENING, I just want to tear my hair out!

Okay, so I go in today, and say that I feel less stable since she's had me lower my topirimate (generic for Topamax) dose from 150 to 100mg. She wasn't the original prescriber of this; my last psychiatrist was. I talk about why I feel less stable, and this she listens to.

I tel her I don't seem to be feeling any effect from the Seroquel, which had been upped from 300 to 400mg last time, other than the usual bedtime sleepiness; it is decided that the Seroquel isn't working.

She decides to prescribe Geodon, which is especially good for the manic side of bipolar, I'm not sure if it handles both sides . . . . she lists some of the effects, and side effects, noting that "it helps stop cravings for carbs.". She happens to sub-specialize in nutrional issues, not that I've ever mentioned a carb problem, but I respond with the fact that I have PCOS (Poly-cystic Ovarian Syndrome), which tends to cause its sufferers to crave carbs, and she seems delighted that this little aspect of the medication will be so suited to counter something I have.

Like carbs are a major issue, here. DEFINITELY not a priority, although since we're poor, pasta and rice are often on the menu.

Besides, this medication has the potential to raise my blood sugar, with the potential in some cases for diabetes, I think, as well as it has the potential to cause weight gain (the literature I got listed this weight gain for 7% of the schizophrenic patients and didn't mention anything about it for the bipolar patients, but I doubt the weight gain would discriminate between the two). Now, I may have recently lost some weight, but I weigh enough (around 240, right now) that putting me on a medication with these two potential side effects (which, as a difficulty for the psychiatrist, so many of the bipolar medications seem to have these, which is why I think I've been prescribed such non-traditional mood stabilizers, as a way to avoid those, esp when I was in the 280's and 290's) is a questionable thing to do, in my mind.

Still, I'm not the doctor, and as I mention above, the choices are limited for mood stabilizers that don't have at least one or both of those types of side effects, at least as far as the on-label approved for use goes. The Gabapentin, and then, the topirimate after it, were being used "off-label", ie, the FDA doesn't recognize them for use as mood stabilizers, and, in fact, in Gabapentin's case, I believe had come down on it's manufacturer for trying to promote it as such. I did feel some effect from it though, but topirimate has worked better, I believe.

So, my new psychiatrist prescribes Geodon, and some lorazepam in case I develop agitation on the early, low doses of Geodon, which happens sometime, to counter it.

She told me to stop taking my clonazepam, which makes sense considering she'd just prescribed what I'm guessing is another benzodiazepine, given the "-pam" extension, but it's just a mild sedative, it's not meant for countering the stuff I do when I'm asleep at night.

I asked her, what do I do about THAT? The stuff I do when I'm asleep, like yelling, hitting, etc.?

She said, very dismissively, and in a manner that felt like it was pulled out of thin air, "Up your dose of topirimate to counter that, it will act like the clonazepam did to stop that stuff", or something like that.

I'm assuming she means to up my dose, all at night, right before bed - she wasn't very specific.

I was stunned, though; in my years of taking topirimate, my previous psychiatrist had never mentioned this property, and most psychiatrists don't prescribe clonazepam or any other benzodiazepine casually; of course, he may have been prescribing it additioally for it's anti-anxiety effects, as I was to take a tiny portion in the morning, to help keep a constant level in the blood, and then of course my nighttime dose, but . . . you'd think he would have mentioned that the mood stabilizer I was taking would have substituted for the clonazepam to take care of all the night stuff, if indeed that was one of it's properties.

I absolutely frickin' don't believe it. It's a painkiller, that some people I know take, or took, for migraines; some take as a mood stabilizer, like me, and now it's got an additional property I'd never heard of??

I was just disbelievingly stunned, that she would dismiss my concerns so quickly, with something that sounded like fiction to me. It also sounded like she didn't give a fig what night symptoms I had, either.

Later, it occurred to me, that if I up my dose back to it's mood-stabilizing effective dose of 150, to counter the night stuff (even if it doesn't work for that), then why the hell would I be taking an additional medication to stabilize me? How would I know what effect would be coming from which medication, then? It would be two medications where only one was needed.

This is why I said, at the beginning of the post, you want agitation, you got it! How am I then supposed to tell, as I start taking this medication Geodon, if the agitation is because of IT, or because I'm pissed off at my psychiatrist for being so . . . . . idiotic.

I'm going to take extra topirimate before bed tonight, and hope I have yelling, screaming, kicking nightmares, so I can call her in the morning and tell her how wrong the hell she was, and what now does she recommend?

Cause I'm PISSED, and I can't risk endless nights of possibly punching my recently operated leg (ow), or waking up to it jerking and convulsing, like I did a week after I got out of the hospital (OW), or waking up to me yelling HELP! as if I'm being raped and murdered, liked I believed I was in the nightmare, and then hearing the people in the apartment above wake up and turn over and go deathly still, listening for further signs of attack, me holding my breath against them waking and coming downstairs to pound on the front door, relaxing when they finally relax and turn over back to sleep. I'm hoping I don't throw any left or right hooks though; that behavior seems to be fairly rare, thank goodness, but then I've been on clonazepam for quite some time so who knows how rare it is . . . . . . .

Here's hoping I prove that WOMAN wrong TONIGHT, despite it meaning nasty nightmares for me.

Now, if anyone knows if that med is supposed to have this effect, I'd appreciate a comment, but . . . . yeah, I know it's the internet, grain of salt, not my doctors.