About a year ago, I made the mistake of reducing the dose of my Lamictal - the one medication I can tolerate for bipolar disorder. I remember thinking, “This med isn’t helping my depression much. Maybe it’s not working at all!” I talked with my coauthor about this and let my therapist know what I was doing. Then I reduced it until I was taking half. I thought I was making the right decision. I originally started the medication to help with my constant depression- and though it helped reduce the depression by about 25%, I didn’t think it worked enough. The normal dose of Lamictal is 200 mg and I was on 500. I started to worry what it was doing to my body- was the high dose causing problems I couldn’t see? Did I really need that high of a dose? It doesn’t seem to be doing much anyway! I think I’ll reduce it and see how much I really need.  Looking back, this reasoning is not very sound. I went with my emotions instead of looking at the facts. Medications are always tricky- we know we need them, but we don’t really want to take them. This is when we start making excuses and often convince ourselves that they aren’t really working well enough or that we don’t really need them. That is what happened to me.  

Within one month of reducing my dose, I was so ill I could hardly function- all of my energy went into staying well- I used my treatment plan all day long just to get my work done. I thought my trouble was due to holiday stress or the result of a relationship problem I was having at the time. My depression wasn’t much worse, so I didn’t connect the problems to reducing my meds. I started to get very anxious, my OCD symptoms got out of control, my psychosis got worse and my rapid cycling just went into overdrive. And yet I still thought, “Lamictal is a drug for depression and my depression is about the same, so the drug wasn’t needed.”  I was so blind! Then one day my therapist said to me, “Julie, you seem a lot more ill than normal. You’re having a lot of psychotic thoughts and you seem really unhappy. You’re not as creative as you used to be and you don’t seem to be excited about any project.”  Then it hit me, the Lamictal may not have reduced my depression as much as I wanted it to, but it was an amazing drug for all of my other bipolar disorder symptoms- and it certainly helped enough with the depression to keep taking it. I couldn’t see the reality of things. It was working- just not the way I thought it should. I got my dose back to 500 mg – it took some time as I had to be really careful about side effects, but within a month I was functioning more normally. I am thankful for this drug. I still have to use my treatment plan everyday to manage this illness- but I know that I have the medication to help me in so many areas and it makes it a lot easier to use my plan! I’m 44. I’ve been managing my bipolar disorder for 13 years now- and I’m still learning every day. I learned a lesson I’ll never forget. It’s often when we think the meds aren’t working that they work the most.  

How are you doing with your meds? Are you playing with doses? Or are you unhappy with the results of your meds? This is serious stuff isn’t it? Talk with your doctor- find out what works. Don’t give up. Medications are the foundation of any treatment plan. When you find the right medication, it’s a miracle!  Also, if you love someone with the illness, is that person taking their meds as needed? Maybe they can read this and not make the mistakes I’ve made. I want to help in any way I can.  Julie

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 A friend of mine just had to up her Zyprexa due to paranoia. She was really trying to make it on a lower dose, but had to face the reality of her psychosis. I am so proud of her for being able to take care of herself.  Another friend went off her meds and called me crying on Saturday- she said,  “I was doing so much better! I thought I didn’t need them.” The interesting thing is that she’s a doctor! No matter how educated we are or how smart we are, bipolar disorder can still trick us regarding medications.    

When the meds are working long term , it’s hard to feel them working.  My mind often says, “You’re doing well today Julie. It won’t matter if you just skip a dose. Opening all of those pill bottles is such a bother.” This is not the voice of reason! The voice of reason reminds me of what life was like before I had my Lamictal- or before my friend had her Zyprexa.  It reminds me that it’s not normal for my doctor friend to cry when she calls me.   Meds work.  They don’t take away all of my symptoms- but they help. I managed bipolar disorder on my own for over 10 years- it’s possible to do, but extremely difficult. When I found a medication that worked, I still had to manage the illness daily – but it’s a lot easier now. If you’re struggling with your meds, don’t give up. It took me a long time to find the right one for myself, but I’m so glad I kept trying.  I now use the med as part of my overall treatment plan. I’m doing a lot better these days, that’s for sure. Julie  

 Julie appeared on KATU’s AM Northwest in Portland, Oregon on January 17, 2008.  You can see the interview by pressing the arrow in the screen above.

I’m on a cortisone awareness crusade. There is so much ignorance surrounding its use and how it can affect bipolar disorder symptoms.  I’ve had two cortisone shots in the past few years and both times they caused profound depression and a spike in hypomanic episodes. On both occasions my doctors assured me that the dose was very small and localized- thus it should not affect my moods. This was unfortunately not true.  

Here is some information on the drug:  

Cortisone is a corticosteroid hormone (glucocorticoid). It decreases your body’s natural defensive response and reduces symptoms such as swelling and allergic-type reactions. This medication is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, and certain cancers. 

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I used the cortisone for a serious hand injury I couldn’t get to heal. I talked about the side effects pretty thoroughly with my doctor- he was understanding, but still felt it would stay localized in my hand. It was my choice to give it a try and I regret that I did.  

After three months of mood swings, including one that included a lot of aggression, I know that I don’t want to take cortisone again- no matter how small the dose. Not everyone responds in this way of course, but all people with bipolar disorder need to be educated on its use. If you or someone you care about is faced with a decision to use cortisone, think carefully about how it may affect moods.  I tend to be very reactive to medications, so people like myself have to be extra careful.  

It’s also up to us to educate doctors on how to use it correctly with people who have mood disorders.  No matter how small the dose or how localized, it can and often does cause mood swings.   

Join my cortisone awareness crusade!  

Julie

I’ve kept a chart of my mood swings for the past year. It’s amazing to see what triggers most of my downswings. Without question, it’s difficult relationships. I knew that this was a problem, but seeing the reality on a piece of paper forced me to make some serious behavioral changes. I have to limit contact with certain people, no matter how much I care for them. I wish I were the type who could have exciting, but difficult people in my life, but as my chart clearly pointed out. I can’t. There is a mood swing chart and an example of one of my charts at the back of my book Take Charge of Bipolar Disorder. The Health Cards can provide you a lot of information as well. I faithfully chart my mood every night. It’s depressing to see how this illness controls my life, but I at least know I am doing what I can to stay stable by seeing the reality of what causes many of my mood swings. Interestingly, the chart has shown me that my hypomanic episodes are usually not triggered by anything I do. Truly interesting.  Julie