Latuda

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I've been taking Latuda for almost two months. I started out taking 40 mg. for 10 days and then my psychiatrist gave me 80 mg. to take. 40 mg. wasn't hard to take, but 80 mg. is more challenging. I think it's a good medication, as far as antipsychotics go, but learning the best time to take it was tricky for me. It makes me feel good during the day if I take it at night.  I tried to take it during the day at least 8 times, and each time I felt terrible. A couple of hours after taking it, it became hard to focus, concentrate, and do work. It also made me feel anxious.

The reason that I struggled with what time to take it is that it is supposed to be taken with 350 calories in order to be absorbed properly. That is a small meal, and I'm trying to lose weight. I tried taking it with breakfast, lunch, and dinner, and that bad feeling came on after a few hours and I knew I couldn't tolerate it at those times. The only other time left is later at night, close to my bedtime. If I take it at night I feel good the next day. It doesn't help with sleep, so I'm taking 200 mg of Seroquel  for that purpose, with the goal of slowly cutting that dose down. My psychiatrist believes that I need an antipsychotic along with my mood stabilizers, and I have found that if I take Latuda at night, I feel energetic during the day and tend to ruminate less and I also feel less anxious. But, if I take it any time before bedtime I have a very negative experience. So, I've been taking it at night with a peanut butter and jelly sandwich after dinner, and I'm trying to eat less during the day to make up for what feels like an indulgence, although it's necessary.

The most challenging part of my treatment for bipolar disorder has been deciding which antipsychotic to take. The closest second to Latuda that I have tried is Seroquel. Seroquel helped me to sleep at night, and made me feel calm, but it is very sedating when taken during the day, and also caused quite a bit of weight gain when taken at higher doses. So, for now, my regimen is 200 mg. Lamictal, 1200 mg. Trileptal, 80 mg. Latuda, and 200 mg. Seroquel.

Latuda is very expensive, and that makes me nervous. If I ever lost my Extra Help with Medicare, I would not be able to afford it and would have to take something else, and I think that would be Seroquel. It would definitely be an adjustment.

Weight Loss

From the beginning of my treatment for bipolar disorder, I've struggled with weight gain. Gaining weight has been my most bothersome side effect, with excessive thirst coming in second. I was diagnosed with bipolar disorder when I was an active, thin nineteen year old. I had been playing soccer since the age of five, as well as doing other sports off and on, and I was always fit. When I started taking lithium, the only medication that was prescribed to me at the onset of my illness, I gained 40 pounds in three months. Because of that, I quit taking lithium and promptly lost the weight. I had gone from 130 pounds to 170 pounds and I could barely run. I couldn't imagine living without running, although now I can.

I wouldn't take medication again until I was twenty four and realized that medication would probably help me move forward in my life, which it did, because about a year after that decision, I graduated from college and got a job. When I decided to take medication again, I knew I would probably gain weight. I fought hard against my appetite, and I always exercised as much as I could, and even participated in sports, but I still gained weight. I was considered to be a compliant patient. Gaining weight was really hard. Not only did I feel different and apart because of my diagnosis, I also felt that I had lost control of the body that I had taken good care of for my entire life, and that had always served me well. I became plus sized and had no idea how I should dress anymore. I also worried about my health. I lost my lifelong identity of being a fit athlete. It was depressing.

I quit taking my medication a few more times over the years, always to relapse and end up in the hospital. Every time I quit taking my medication, it was because I could no longer stand the weight gain, and I always lost weight when I quit taking my medication. When I was thirty two, and hospitalized because of mania, I told myself I would never quit taking my medication again because of gaining weight. That year I had quit taking my medication when I weighed 220. I was off of my medication for about nine months before I became manic, and I got down to 160 in that time, but then I ended up in the hospital.

Even though I quit taking my medication several times over the years because of weight gain, I took it long enough and consistently enough that I was always told that I was a compliant patient. I really hated the idea of being compliant. I felt like it was killing me, but I didn't know what else to do. I had the same psychiatrist from the age of nineteen to the age of forty, and he always asked me what was more important, my weight, or my mental health. He treated my concern about my weight like it was an issue of vanity. I was scared of what my weight was doing to my health, and the weight gain was also terrible for my self esteem.

Finally, the only rational thing to do seemed to be to find a new psychiatrist. I found a young woman who I thought would understand why I wanted to lose weight. She was reluctant to take me off of lithium, but by the time she decided it would be okay to do it, my weight had gotten up to 278 and I had been diagnosed with high blood pressure and sleep apnea. This seemed to be rock bottom as far as my weight was concerned. I never thought I would weigh anywhere near 300 pounds. Lithium was interfering with my weight and my sleep. My sleep study showed that I drank six cups of water during the night. I would wake up thirsty and drink water all night long. I don't think my psychiatrist took my reports of this behavior seriously until the sleep study showed how much I was waking up and drinking water, because of the intolerable thirst caused by lithium. She agreed to take me off of lithium slowly.

I had a bout of mania when I was coming off of lithium last fall,  but I stayed out of the hospital. Last spring I was hospitalized for a suicidal depression. It was debilitating and awful, and dragged on for almost two months, but I'm glad I didn't end up taking lithium again. I've been off of lithium for about a year and I've lost 54 pounds. I now weigh 224. I'm glad to be losing weight. 54 pounds lost is significant, but I still have a long way to go. I gained 148 pounds in the time since I decided to start taking medication for bipolar disorder. I always get mad when I think of it. I complained about the weight gain the whole time I was affected by it, and not much was ever done about it until my current psychiatrist decided to take me off of lithium. I knew it was medication that was making me gain weight, but my old doctor blamed my habits for the weight gain. My appetite increased. I was always hungry and thirsty, and I was also lethargic. It's terribly hard to fight those side effects. Now that I am no longer always hungry and thirsty, and I have more energy, I'm losing weight.

I 'm doing a lot of exercise - usually the equivalent of walking five miles or riding my bike twenty miles most days, and some days walking 10 miles or riding my bike 50 miles. I'm also eating well and eating less and less. I'm focusing on eating less fat, less sugar, less sodium, more fiber, and more potassium. This kind of diet is recommended for weight loss and also for control of blood pressure. So, I've lost 54 pounds, but I want to lose 84 more because I'd like to reach my target weight of 140. I'm very happy to be losing weight, but it's hard not to be upset that my medication wasn't changed until I became very overweight and developed health problems because of it. I try really hard to focus on the positive, on the progress I've made, and I'm glad my health is improving.

I was losing weight before I met my boyfriend, but it helps a great deal that he has a mental illness and also had the experience of being an athlete who gained weight because of his medication. He understands the struggle to tame an artificially insatiable appetite. His psychiatrist has also changed his medication to something that allows him to lose weight. We exercise and eat together almost every day, and we really help each other to stay on track. He became fed up with his weight gain after he had gained about 50 pounds and his psychiatrist worked with him to change his medication. His psychiatrist told him that he wasn't going to sit back and watch him get diabetes. I asked my old psychiatrist what would happen if I got diabetes, and he said I would just have to treat it. He didn't take my concern about my health and weight gain seriously.

I'm so glad that I decided to change psychiatrists. I'm currently taking 1200 mg. Trileptal, 200 mg. Lamictal, 300 mg. Seroquel, and 2.5 mg. Saphris. I'm slowly tapering off of Seroquel, down from 400 mg., in the hope that it will decrease my metabolic side effects, and allow me to lose weight faster. My blood pressure is lower, but my LDL cholesterol and triglycerides are still high. I will continue to eat well and exercise, and work to reduce stress, and hope for medication that works without negatively affecting my health. It might take me another year and a half to reach my goal.

Sleep Study

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I've been having trouble sleeping for years. I'm 42 now and my insomnia started when I was about 14. The diagnosis of bipolar disorder at 19 explained my sleeplessness at the time. About 10 years ago, I started having sleep problems again. I had gained a lot of weight because of bipolar medications, and my psychiatrist suspected that I had sleep apnea. He referred me to a sleep specialist and I had a sleep study. It was determined that I had mild sleep apnea (too mild to treat) and I was told that I would get better sleep if I slept on my side, so that is what I did.

This past summer, I started to suspect that my sleep apnea had gotten worse. I was waking up about 6 or 7 times each night, that I remembered, and I didn't feel rested. Part of the problem was that I was taking lithium, and it was causing extreme thirst, which was compelling me to drink huge amounts of water, and I was in the bathroom all day and all night. I was so thirsty that I would drink more water each time I woke up at night. Whether because of my extreme thirst, or suspected sleep apnea, I wasn't getting good sleep, so I asked my general practitioner to refer me to a sleep specialist, and I let my psychiatrist know about it. My psychiatrist was very interested in learning the results of my sleep study.

My sleep study in October was disastrous. I got out of bed 7 times to go to the bathroom and drank 6 cups of water throughout the night. I only slept for 1 hour, although it seemed like I didn't sleep at all. During that hour, I stopped breathing 16 times because of sleep apnea. That qualifies as moderate sleep apnea and is considered serious enough to treat. I went back for another sleep study in November, and this time I wore a CPAP, a device that blows a gentle stream of air into the nose during sleep to keep the airway open so that you can breathe properly. I slept 7.5 hours and was getting at least 90% oxygen all night, which is in the healthy range of oxygen. It was determined that I would get my own CPAP, and I did.

In December, I met with a respiratory therapist and was fitted with a mask and learned how to use and care for the CPAP. At first, I was given a full face mask. After three weeks of sleeping with it, I decided that it was too uncomfortable, so I went back for another mask. This time I got nasal pillows and they are proving to be much more comfortable.

I was not really excited about using the CPAP at first, but now, at the end of January, I feel so much healthier and more energetic since I've been using it, that I believe it is worth the expense and awkwardness. Also, it is thought that if you have sleep apnea and bipolar disorder, using a CPAP can lessen your experiences of both mania and depression. As an added bonus, I even look better. My eyes look much more rested and my skin looks radiant. Now, in addition to considering it necessary for good mental and physical health, I consider it to be a beauty treatment, and that makes me feel more excited about wearing it.

Unfortunately, many people with bipolar disorder gain weight from the medications, and that causes other health problems, like sleep apnea. There is a possibility that if I lose weight, I will be able to sleep well without the CPAP. Getting to my ideal weight is my next quest. When you get good sleep, you have fewer stress hormones in your body, so it is easier to lose weight.

Since I've been using the CPAP, I've lost 23 pounds. This is probably also the result of a medication change. When my psychiatrist learned, from the sleep study, that I was waking up and drinking water all night, she substituted Trileptal for lithium. I've been asking psychiatrists to take me off of lithium for years, but this was the straw that finally broke the camel's back. I'm also taking Lamictal and Saphris to control my bipolar disorder and I'm doing very well. I'm stable and alert and feeling much more optimistic about the future than I've felt in years.

Stress

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Tonight, while attending my biweekly support group, one of two support groups I attend, everyone spoke of stress more than usual. We all experience relationship stress, work stress, and the stress of having bipolar disorder itself. It's stressful to think about whether or not to disclose the illness to friends, families, and coworkers, and the mania and sleeplessness that occur at times with the illness, along with the with the seemingly endless depressions, are stressful states to be in.

At many times in my life, stress has sent me over the edge into mania and depression, and has caused me to be hospitalized more times than I can remember. As people with bipolar disorder, it is essential that we try to get a handle on our stress levels. For me, medication, diet, exercise, meditation, lifestyle changes, and therapy, have helped me to manage my stress. When stress seems to be getting out of control, I know I need to do something about it. If I can't handle the stress on my own, it's definitely time to call both my psychiatrist and my therapist. Spending time in a serious state of stress often leads to unpleasant outcomes for me: mania and depression. Hospitalization always seems like a huge setback, plus it's time consuming, often at the worst times, and expensive.

The biggest lifestyle change I've made is going on disability. At the time I went on disability, I was mired in a serious depression that I spiraled into after becoming so inert that I couldn't continue to teach. I had chosen to become a special education teacher because I thought that, as a person who had experienced many years of stability, I was ready to handle the stress, and my diagnosis of bipolar disorder would give me the insight and compassion to help students who were struggling with learning and behavior disorders. I did a good job for almost five years. In fact, I earned several awards and a lot of positive feedback from students, parents, and my principal. But the stress eventually got to me and I became almost immobile and was no longer able to gather the energy to teach. In fact, waking up was hard, as was attending to daily tasks such cooking and cleaning, and even getting dressed. I got to the point where I was barely able to care for myself, and I applied for, and was granted disability.

The period before I went on disability was the lowest part of my life. After I received disability, a lot of the stress I had felt was removed. Ironically, I saw disability as a time to focus on my health. I gradually regained my mental and physical strength. For anyone who has experienced long periods of depression, it's obvious that it's physically unhealthy. Too much time spent in bed or sitting causes muscular weakness, and many people who are depressed don't eat enough, or eat the wrong foods, and the poor nutrition causes a deterioration in health.

After a year on disability, I was able to begin working at a part time job, and now I've been working part time for slightly over three years. I'm feeling much better about myself, and people are beginning to wonder why I'm still on disability. The answer is stress. It has been a breaking point for me in the past and I need enough experience with my stable self to prevent stress from harming me again. I feel that I need a longer period of stability behind me before I go off of disability. My therapist and psychiatrist have shared their opinions that I am not ready to go off of disability yet, if at all.

Although I've been on disability for several years, and have reduced my stress, I've still become manic and have had to be hospitalized twice in the past three years. And I've experienced one serious depression where I was unable to work as many hours as usual for a couple of months. I'm hoping that my medication changes and lifestyle changes will continue to work, and I'll improve in my ability to handle stress to the point where I'll be able to handle the stress of working full time. I want nothing more than to deal with my bipolar disorder in a healthy way and to live the most productive life that I possibly can.

Picking up the Pieces

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For me, the hardest part of recovering from a depression or a mania is the time after the episode, when I know I'm doing better, and able to move forward, but also realize how far behind I am in things like cleaning, going through my mail, and paying bills - the routine things that are important but go out the window when I'm not in my right mind.

My mania started in March, and was followed by a depression that started in June and ended in July - thanks to a medication change my psychiatrist made. So, I've been feeling better since July. August was a month of recovery. I started going out with friends again, started my exercise routine back up, started cooking more often, and made great strides in organizing and cleaning my apartment - my cleaning routine is always the last routine to recover after a serious mood episode. So now it's September and I'm pretty much back on track. I finally feel that I have recovered seven months after my symptoms of mania first began. That's a very large chunk of time!

It's hard for friends and family to understand the recovery that needs to take place after a mood episode. It seems like once I start acting normal again, everyone assumes that I'm back on track, but that's far from the reality because I always have a lot of catching up to do.

The process of surviving mood episodes and then picking up the pieces is exhausting. It's why I take my medication, try to stick to my routines, keep regular appointments with my psychiatrist and therapist, attend support group meetings, and aim for stability. It's disappointing when I have to pick up the pieces again, but at least I have enough experience with it to know what to expect and also see it as a good incentive to stick to my treatment plan.

Financial Assistance

I had a good, unexpected thing happen this week. I am on SSDI (Social Security Disability), and I work part time. My finances are tight, but I have enough money to pay my monthly bills. However, it's hard to save money, and I've had to ask my parents for help with things such as unexpected dental and medical bills and car repairs.

My father encouraged me to apply for food stamps and I got them. I really didn't think I would. I don't think of myself as that poor. The state worker, who determined that I qualified for food stamps, also told me that I may qualify for help with my Medicare premium, and housing assistance, so now I'm in the process of applying for those programs.

If you're on SSDI , or are just living on a low income, I would encourage you to go to the agencies in your state that help with food, medical treatment, housing, etc., and apply for the various programs. You might get some benefits that could help you live more comfortably, and maybe save a little money each month.

I've been on SSDI for four years, and nobody told me that I might qualify for this type of help. When I first received SSDI, I may have been embarrassed to write about this, but after living on a very restrictive budget for the past four years, I am not ashamed. I will accept the help. I am grateful for it.

The Right Dose

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"All substances are poisons: there is none which is not a poison. The right dose differentiates a poison and a remedy." Paracelsus (1493-1541)

I was depressed for the month between my last appointment with my psychiatrist and my most recent one. I didn't reach the lowest depths of depression, but it was interfering with my daily activities. I was the happiest when I was at work, but I wasn't socializing as much as usual, and I was having trouble unpacking after closing a storage space I had rented when my boyfriend (now my ex-boyfriend) moved in with me.

When I was describing my depression to my psychiatrist, I didn't use the word depression, I told her that I thought I had a more realistic view of life after switching out Seroquel for Saphris in my bipolar cocktail. I am now taking Saphris, lithium, Lamictal, and temazepam as needed. There were problems I hadn't noticed, when I was taking Seroquel, that were worrying me, but I thought I would be able to keep moving forward.

About a week later, I called my psychiatrist and asked for another appointment. I told her that I don't like to use the word depression because it is the last state I like to be in, but I was worried that Saphris was causing me to be depressed, and I wanted to quit taking it. I had quit taking it many months before, because I felt like it had caused depression.

My psychiatrist said that she thinks Saphris is probably the best antipsychotic for me because it is less likely to cause weight gain than other atypical antipsychotics. She said, "I was probably blocking too much dopamine," and changed my dose from 5 mg., morning and night, to 5mg. at night only. I was skeptical that this change would help, but it did.

I felt good the next day and have felt good ever since. I really wanted to quit taking Saphris, but during the discussion with my psychiatrist, about the dose, I was reminded of the quote above, something I was exposed to in a college biology class, and it gave me the will to try a new dose. I'm really glad I did. Maybe Saphris will turn out to be the wonder drug for me that it has been for some others. I'm going to keep giving it a try.