Abilify, Not I : Adventures in Antipsychotics

Lately, I have written a series of posts over the last two months describing certain troublesome symptoms I associated with the worsening of Bipolar Disorder, or the potential for comorbid disorders.

In my last post, When Medications Go Wrong, I briefly wrote about my recent discontiuation of the pharmocological treatment using Abilify as part of my medication regimen:

Recently, I stopped my Abilify.  Admittedly, it was because I noticed an interaction between the Abilify and my weekend consumption of alcohol.  I started to find that I would fall asleep soon after taking it on Friday’s while we drank.  I decided that I would just stop over the weekend, and continue during the weekdays as normal.  But, eventually, I just forgot to take it at all.  And soon, I started to notice an improvement in my worsening condition.

I went on to describe some of the awful side effects I was experiencing as a result.  However, the list was truncated for the sake of keeping word count down.  The description is rather limited in terms of accurately depicting exactly what I was subject to.

• Cognition Disturbances and Memory Fragmenting.  Originally, I wrongfully blamed Lamictal in Vitamin L : Medication Adventures for my aphasia-like symptoms.  The disturbances felt like aphasia.  At first, it was almost indescernable.  I started word dropping again, meaning I would be reaching for a word, but was unable to grasp it.  Instead, I would be able to get to every synonym around it, however, those words did not fit the exact context.  Eventually, it became a more severe form of word dropping, and I found myself dropping sentences entirely at the loss of any word or synonyms around it.  It progressed into entirely dropping conversations at the loss of a sentence.  Then, I found myself

  I started forgetting things again.  These were simple things, like losing my purse or shoes in the house.  It seemed like just a simple case of forgetfulness, maybe stress related.

• Emotional Blunting and Partial Flattening.  I had never had too much trouble with emotional blunting in the past.  While I’ve found myself in times where it was difficult to express my emotions, this didn’t indicate a lack of emotional response.  I describe it as a partial emotional flattening, because it wasn’t an entire lack of reactivity.  It felt like my spectrum of emotions had been significantly reduced, although not completely removed.  There was a certain inaccessibility to certain strong emotions.  Rather than completely removing extreme emotions, it threw a wet blanket on top of them, leaving them to bubble under the surface.  So, the emotions still existed, but were muted and unable to be adequately expressed.

  At it’s worst, I began to lose most feeling entirely, with the exception of irritation and the sensation of boredom and fatigue.  I began to lose love and my attachments to meaningful people and my relationships with them.

• Dissociation.  I touched on a summary of the dissociative symptoms that Abilify had brought on.  I have been writing articles on the experience throughout the last few months on the subject, describing the feeling in great detail, but remained unable to exactly identify is appropriately.  The dissociation probably occurred as a response to the prior bullet points.

  The dissociation cited was experienced as a removal of self and removal from my own life.  I had felt as if I had been separated from myself and my world.  It was a feeling of something being stolen from me, or something fundamentally inaccessible.  Like, I was being locked out of my own life, or becoming transparent and just fading away.

• Worsening of Depressive States.   This is probably a direct result of the first three bullet points.  I started to disengage from my life.  I lost interest in just about everything.  Most things were considered to be either boring or tedious.  Important things started to lose meaning.  This was experienced as a part of the emotional flattening, but it caused a concerning and distressful reaction.
• Exacerbation of Social Anxiety.  Since I had lost the ability to carry on a conversation and found myself completely disinterested in socialization, my social anxiety went through the roof.  I simply didn’t care about anything anymore, especially trivial things I used to find interest in.  Therefore, I found it difficult to carry on a conversation.  This caused extreme distress in social situations, and encouraged further isolation.
• Disturbed Sugar Levels.  While I have no concrete proof in terms of tests, certain symptoms have come to my attention.  They are notated below in the next two bullet points as thirst and weight gain.
• Loss of Sensation of Bodily Hunger, Thirst, and Fullness.  Within the last few years, I started to become more in tune with my body.  I was able to feel the sensations of hunger through my sugar level, which probably caused the loss of bodily hunger.  The disturbed sugar levels probably also caused an extreme thirst that could not be quenched.  At first, I craved water.  Eventually, I started to put the soda back down, which probably caused part of the weight gain mentioned below.  And I felt an extreme pressure in my stomach, which was also exacerbated by the influx of so much fluid.
• Extreme Weight Gain.  Truthfully, I don’t dare get on a scale at the moment, so I am unable to notate at this time exactly how much weight I’ve gained.  By the fit of my clothing, I will estimate that I have gained somewhere between ten and fifteen pounds in the last three months.  That is a substantial gain for me, especially since I was losing weight prior to the start of this medication.
• Exacerbation of Eating Related Problems.  By all definitions, it’s completely possible that I am living with an undiagnosed eating disorder.  However, I am not entirely convinced, since it isn’t an ongoing and prevalent problem.  Therefore, I define it as eating related problems and difficulties.

  The concern for weight gain and the sensation of fullness caused a very terrible reaction of binging and purging.  I was unable to control my eating, as notated above, therefore the sensation of extreme fullness would cause me to perceive the overeating as worse than it actually was.  Unfortunately, this led to a very vicious cycle and encouraged further weight gain.

• Disturbed REM Sleep.  I was waking up tired, and noticed that it felt like I had stopped dreaming.  This caused my mental state to take a considerable dive.  It caused extreme fatigue and excessive, unproductive sleeping.

While I am cleared of most dissociative symptoms, emotional flattening, and my depressive state is lifting a little, some side effects have remained.

• Cognitive Disturbances.   The aphasia-like symptoms remain, but to a lesser degree.  I am back to just being a little forgetful, and have some minor word dropping.
• Memory Fragmenting.   Some of my memories remain dull, but seem to be returning.  However, most of the last three months remains inaccessible.  It may never become accessible, due to the disruption in the formation of short-term memory.
• Disturbed Sugar Levels.   I am still thirsty, but I am no longer engaging in carbohydrate seeking consumption behavior.  I figure it will take awhile before my sugar is regulated properly again.
• Weight.   Thankfully, my weight does seem to be coming down.  I have only been completely off of the medication for less than a week, and my clothes are already fitting better.  I’m going to assume that in addition to the weight gain, I was retaining water and constipation.  My regularity has come back, and I don’t feel as puffy as I did

Unfortunately, I am experiencing a return of some of my milder psychotic symptoms.  In Imaginary Enemies, I described a cognitive disturbance I described as “The Voice”.  “The Voice” can be characterized as a singular persona, as I wrote about in Conscious, Subconscious, and Extraconscious, where I described a theory of a third consciousness that exists between the subconscious and the conscious mind.

The Extraconscious is postulated as where the persona(s) reside, laying in semi-dormant waiting, perfectly aware of the current reality that is being experienced.  “The Voice”, in more severe psychotic states, can be experienced as a separate entity entirely, detached from the consciousness.  That is the defining line between a cognitive distortion and an auditory hallucination, when a persona detaches itself from the extraconscious as an external sensation.

As an extraconscious persona, “The Voice” can best be defined as a quasipersona, lying somewhere between Dissociative Identity Disorder and psychosis.  It is experienced as a semi-active part of the conscious mind, as the dominant persona is well aware of it’s existence and there is a certain interaction that occurs between the dominant persona and “The Voice”.

That is the best theory I can offer as to the existence and function of the quasipersona, known to me as “The Voice”.

The mild auditory hallucinations and visual hallucinations have returned, probably defined better as a sensory disturbance, rather than a symptom of psychosis.  When experiencing a sensory disturbance, it’s not full on hallucinations as described in the definition of psychosis.  There are not entities separate from the body.  They are recognized as a disturbance in the current reality, distorting shapes, colors, and contrast in the vision.  In the hearing, it is experienced as a distortion in sound, causing sounds to be sharper, duller, muffled, or louder than they actually are.  It can only be sensed by a sudden shift in perception.

So, instead of hearing things at a normal sound level, the sound volume may increase to deafening levels or may become muted and difficult to discern from nonexistent static that occurs in the mind.  My visual disturbances may be perceived as viewing the world in high contrast, extremely bright colors, and / or extra high definition resolution.  Or, they may be seen as duller than usual, muting colors, distorting shapes, and / or clouding the vision with that appearance of a veil or foggy goggles.

Intrusive thoughts have returned, but not with the same extreme nature as experienced several months ago.  In truth, they were never completely removed by the Abilify, and at some points were made worse by the drug.  Instead of experiencing them as a truth in reality, I am now able to separate them using logic.  I can talk myself off of the ledge and separate them from the reality of a situation using DBT techniques of mindfulness and distress tolerance.  Prior to the cessation of Abilify, I was unable to utilize those techniques.

I don’t mean to put anybody off of treatment with psychiatric medications, but I felt this was important to document and have as a resource on the internet for anyone who is thinking about taking the drug.  Some of these side effects aren’t listed in the pamphlet, as they are probably isolated to a condition.  But, I feel they are still a distinct possibility for anyone who is being treated for similar conditions.  It is vital that this information be notated and readily available for medication education purposes.  This information probably should not be generalized to all psychiatric medications, especially in the class of antipsychotics.

 

When Medications Go Wrong

For years, I’ve pretty much been medicating myself.  I take my scripts home and medicate how I see fit for my situation.  I realize that makes me medication non-compliant.  The trouble I come to is my trust in doctors.  I have been burned so badly before that I find I have a lack of faith in them to know how they are really treating me.

When I was in my teens, and being treated for Major Depressive Disorder (misdiagnosis – strike one), I was put on high doses over a slew of medications for years with little result (overmedication – strike two).  I suffered extreme side effects, with little done to relieve them.  I took Zoloft in increasing doses over a three year period.  I continued to complain of extreme fatigue, anxiety, motion sickness, and periods of flu-like symptoms.

The doctor’s answer?  More medication.  It came to a head when I found that if I sat still for too long, I would drift off to sleep.  Sitting in school became impossible, and I was sleeping fourteen to sixteen hours a day.  Eventually, I was put on 300 mg of Zoloft with Provigil to combat narcoleptic symptoms.

It was at the doctor’s suggestion that I continue to exceed maximum dose and go to 350 mg that my mother finally put her foot down.  “Put her on something else.  We’ve put three years into this, and it clearly isn’t working.”  And much to my doctor’s chagrin, I was switched to Lexapro.

Wrong answer.

Immediately, I started to have dissociative symptoms.  I recall laying in my room, laying on the floor, and staring at my ceiling in the dark.  My mother stood in my doorway, just observing me.

“What are you doing?” she asked.

“Nothing,” I answered blankly.

Yes, I was finally awake.  But, every moment was torturous.  I lost my sense of self, and started to drift away.  My memory began to fragment, and I sunk into a deep, desperate depression.  I was frantic and crazed, while feeling numb and blank at the same time.  I became paranoid, and started to assert that everyone was doing things against me.  They were intending to harm me, and I started to give meaning to harmless comments and phrases.

I attempted suicide several times in the first month.  The cutting became so bad that I was doing it in rather public places.  I was caught one time at my boyfriend’s house, and I had a dull exacto set ripped off of me and immediately chucked into the local creek.

We were unaware of all of the side effects at the time, because all of the medications I was placed on were brand new.  When a pharmaceutical representative left her office prior to my visit one day, it became clear that I had become an experiment to brand new medications.  I was taking expensive, largely untested medications for her financial benefit.  Strike three.

I had gained thirty-five pounds over a six month period.  I was 4’11” and 165lbs.  That put me at a BMI of 33.3, and in the obese range.  And despite all of my best, and even worst, and unhealthy efforts, I still couldn’t manage to get my weight below 145lbs.  I was starving myself on 900 calories a day, and I still hovered around obesity.

I couldn’t afford my medication once I was kicked off of my parent’s insurance, and I just decided that since it failed to ease my symptoms, I would stop taking the medication entirely.  They failed to mention that if I attempted to stop the medication cold, then I would be stricken with the worst withdrawal I had ever known.  It was a good thing my parents had been through this before with my father, because they knew how to ween me off.

It took me years to get the rest of that weight off.  But, by then, the medication had already done long lasting damage far worse than just weight.  I had begun to develop a drinking problem.  I had engaged in risky sexual behavior due to hypomania.  And it sent me walking with bad eating habits.

After that, I distrusted doctors and medication entirely.  I had lost faith in mental health treatment.  I was left with a feeling that I didn’t have a disorder at all, and instead, it was just me.  I was convinced that I wasn’t treatable.

It took a lot to make me realize that I was in desperate need of treatment.  I had taken psychology courses and was suggested by several psychologists in my college to have bipolar disorder.  I knew my behavior wasn’t “normal”, just as I had always suspected.  It took the my marriage, my depleting mental health of my husband, and the birth of my son to encourage me to start treatment again.

Three years, four doctors, and a another slew of medications later, and here I am, again the victim of overmedication and bad medication choices.

Recently, I stopped my Abilify.  Admittedly, it was because I noticed an interaction between the Abilify and my weekend consumption of alcohol.  I started to find that I would fall asleep soon after taking it on Friday’s while we drank.  I decided that I would just stop over the weekend, and continue during the weekdays as normal.  But, eventually, I just forgot to take it at all.  And soon, I started to notice an improvement in my worsening condition.

Suddenly, I was able to think again.  I started to feel more like myself.  I became more aware of what I was thinking and feeling, and I finally started actually living in the world around me.  It actually felt like living again.  And that’s when I noticed the weight I had put on.  I had fell victim to Abilify’s weight gain, among other things.

I can blame the dissociative symptoms on Abilify.  It had created an emotional flattening, and I started to dissociate from myself and my world.  It had robbed me of my ability to write and care for my family appropriately.  I wasn’t feeling, so I wasn’t caring.

The anxiety?  Well, I recently started to run out of a supply of Wellbutrin I can’t really afford right now.  I started to cut back to make ends meet, and I discovered that was starting to subside.  Other than rebound depressive symptoms, I was feeling better.  It didn’t matter to me anyway.  I was still going through crying jags, whether I was taking the Wellbutrin or not.  The difference was between whether they were loaded with distressful urgency to cut or not.  I decided that I would prefer to keep my near streak of four months without cutting.

I don’t blame my doctor.  He’s an old school doctor who works off of the biological model and treats symptoms.  I have declined therapy several times, though my requests to be seen since have not been honored.  All of my symptoms point to mild psychosis in general, aggravated by extreme life stressors.

I blame myself for not listening to myself and taking action sooner.  Treatment happens on both ends, and I have not been holding up my end of the bargain.  I have not been mood charting, and I have not been notating subtle symptoms.  It has become abundantly clear to me since my extreme meltdown and psychotic break during the summer that I had been probably Bipolar 1.5 all along.

Though I don’t experience full on mania, I do experience mild psychosis, practically all of the time.  I have not been pressing the issue about invasive thoughts, paranoia, “The Voice”, or any of the mild hallucinations that I experience.  Only when I had my break did I bring it to my doctor’s full attention.  And I was met with extreme medication.

Personally, I’m at a loss as to what to do.  I’m damned if I do, and I’m damned if I don’t.  I noticed last night that “The Voice” has returned, even if it’s benign (right now).  I don’t want to be overmedicated, and I can’t risk gaining anymore weight.  The weight is worse for my mental health than anything else.

And it completely screws up my bodily function.  Now, I’m experiencing weight related problems again.  My knees and back hurt.  I have acid reflux near to the point of anorexia again.  Sexual dysfunction is destroying my sex life, my self-esteem, and hurting my marriage.  And I’m back to full on social anxiety, because I’m too self-conscious to function.

But, at the same time, I’m aware that I need some kind of medication.  While, for now, I’m better off without it, the day will come where I am asked to step up, and perform at a higher function.  My family, including Finn, has been very great about my general lower function and picking up a lot of the slack for me.  However, this won’t last forever.