Medication Monday: Melatonin

What is Melatonin?
Melatonin is a natural hormone your body makes that helps you fall asleep. In some people, this is not produced enough or, due to insomnia, they need some help to go to sleep. Sometimes it is used for a sleep condition called ‘delayed sleep-phase disorder’ whereby someone has later sleep patterns than others e.g naturally going to sleep and waking up much later than is typical. Melatonin (in the UK) is licensed for use in children and those over 55. It can be hard, therefore, for young adults to be prescribed it but it is sometimes used “off-label” for sleep.

My experience with Melatonin
I was initially give melatonin as a a child, so it being prescribed wasn’t an issue. I was under the child and adolescent mental health service in my county at the time and the psychiatrist there thought it would be useful in tackling my long-standing sleep issues. It is relevant to note here that I have ASD and autistic people often have trouble sleeping! So did it work? Eh, a bit. I can’t say it worked really well but it might have been somewhat useful in getting me to fall asleep quicker. It’s come in more helpful when prescribed as an adult. I don’t actually remember who gave me it, which suggests I was in hospital? I also don’t remember when they doubled the dose, but I find it much more helpful for sleep at this age and this dose, although it’s hard to tell as I always take a benzodiazepine at night also. I still take it nightly and haven’t be tempted to skip a dose so hopefully it’s doing some good, I’d certainly prefer it to other medications used for sleep that are less natural and have more side effects, such as antipsychotics, (more) benzodiazepines and hypnotics.

I’m quite happy to take my Melatonin at night and drs have never issued any warning against it so I feel comfortable doing so! Has anyone else been on Melatonin? Was it helpful? I’d like to know because I’m not 100% sure myself!

Medication Monday: Lamotrigine

Lamotrigine (Lamictal) is from a class of drugs know as ‘anti-convulsants” or anti-epileptics. They are also used regularly as mood stabilisers for conditions such as bipolar and schizoaffective disorder. No one quite know how they work for mood but they are considered first-line treatments along with lithium. Lamotrigine needs to be prescribed by a specialist, such as a neurologist or a psychiatrist.

I’ve been on lamotrigine for a loooong time, far before I had a manic episode. The main reason for this is that I have epilepsy. I remember being in the neurologist’s office, I’d just been diagnosed with temporal lobe epilepsy and the appointment passed in a shocked blur, I’d only began having seizures in my very early 20s. He handed me over the medication with a big warning to titrate up slowly and watch out for rashes. Most people on lamotrigine have heard about the dreaded rash. Although it is known for causing benign rashes, some people develop what is known as Steven-Johnson syndrome, which is characterised by “flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters”, and can be fatal. I started small and inched up over time.

I noticed some side effects pretty much straight away, some itchiness (but no rashes), some major dizziness and double vision but they settled pretty quickly. What seemed to linger though, and was the most problematic, was brain fog. I started to forget how to spell things, I couldn’t talk fluidly, my memory was shocking and my concentration suffered. Although I don’t know how I’d be without lamotrigine now, it does seem to have settled over the years (though I still sometimes get stuck on words!).

Originally put on a high dose of lamotrigine for seizures, these settled at 300mg. What was apparent though, was that it wasn’t stopping my mania. Lamotrigine is a good mood stabiliser but it’s more effective in treating depression than it is mania (whereas lithium is the other way round). I was put on abilify for its antipsychotic but also mood stabilising effects and put up to 350mgs. I haven’t had mania since being at these doses so I suspect they’re working, though I don’t know which one more!

Oh, and just a side note; these are the most vile tasting tablets I have ever taken in my life, and they get stuck in your throat.

Does anyone else take lamotrigine? How do you find it affects you?

Medication Monday: Equasym XL

On to the second medication I was ever prescribed! Equasym XL.

Equasym belongs to a class of drugs called Stimulants, and a specific group of stimulants known as methylphenidate, the most commonly known of which is Ritalin. Methylphenidate is one type of medication used to treat those with ADHD, and the ‘XL’ part of the name in Equasym refers to extended released, meaning that the treatment works for longer throughout the day. No one is quite sure how or why stimulants work for ADHD but they are very effective. There is a potential to abuse methylphenidate and so it is a controlled substance. They cannot be prescribed (in the UK) by a GP and need to be given to you directly from a psychiatrist. I once lost a packet of mine and was instructed to inform the police as they are also sold as street drugs.

I was given medication for my ADHD when I was around 14/15. It was intended to help with extreme inattentiveness and some impulsivity I was showing around that age. I was diagnosed with the “inattentive” subtype of ADHD. At first the starting dose (10mg) seemed to be working a bit, but not much, and so we increased the dose under guidance from my psychiatrist to 20mg. This changed my whole life. I could suddenly concentrate at school and was more motivated to do so, my parents remarked that I could focus better one conversations and not drift off in the middle of them, I stopped getting in trouble for “not listening/paying attention”. It was like a miracle drug! Except for the downsides…

Methylphenidate makes you focus, but doesn’t decide what to let you focus on. That meant if I took it and then focused on something other than my homework, I would get that thing done at my homework’s expense. I was also a very anxious child and when I focused on that, it led to lots of overthinking and rumination. It also made my heart beat considerably faster and at times would give me palpitations, which weren’t fun.

I kept taking methylphenidate on and off for years. Finally it was time to transition out of child and adolescent mental health services and into the adult mental health team. It was not a smooth transition. I went off to university and used up the last of my meds to good effect. Now I had to wait months to be seen by a new psychiatrist to get a new prescription. The consultation was a nightmare, the new psychiatrist was extremely eccentric and anti-drug. He informed me that he would not prescribe without being reassessed for ADHD at the local ADHD clinic, despite having ample evidence of my diagnosis, and compared me to a drug addict. I gritted my teeth and went, with my diagnosis being confirmed. The psychiatrist now lamented to me about how experiments had been done on rats and their ventricles had shrank so as he ‘reluctantly’ handed me my prescription, he told me “I’ll see you in a few years when you have psychosis”. I want to make one thing really clear, yes I did end up having psychosis (MANY years later) but it was in no way linked to a drug I took sparingly as a child, a drug that thousands of people take with no problems. I have a family history.

After my first episode of mania and psychosis, I tried to go back to university and found my concentration issues really pronounced. Some of this may have been due to recovery after the trauma my brain had experienced, but I had a feeling some of it was ADHD related. My new (very nice) psychiatrist explained to me that she didn’t want to prescribe it currently because it is contra-indicated in people with mania and/or psychosis but it wasn’t a closed conversation. Unfortunately my mental health continued to be unstable for the next year and my new, new psychiatrist, after telling me she would look into it, will not prescribe it for the same reasons. So I’m left a little stuck. I understand the rationale behind these decisions but I also would like, if I could, to start on a low dose and just see if I could handle it. I am, after all, on an antipsychotic and mood stabiliser. For now, all I can do is wait for my health to be stable and see if anyone will revisit it with me in the future.

Medication Monday: Sertraline (Zoloft)

So I realised that over the years, I’ve been on a TONNE of different medications, so I decided to write a series of blogs about my experiences taking each one. I’m starting with Sertraline because it’s the first psychiatric drug I was ever prescribed.

Sertraline is an antidepressant belonging to a class of drugs known as Selective Serotonin Re-uptake inhibitors or SSRIs. They can be used to treat depression, and at higher doses, anxiety, OCD and panic attacks.

I was 13 and had been referred to the child and adolescent mental health service (CAMHS) in my hometown where I was diagnosed with reoccurring depression, OCD and anxiety. We tried therapy first but it did little to help and so my psychiatrist prescribed me my first pack of Sertraline tablets. I started taking them the same week at a fairly low dose and found myself having headaches and being extremely nauseous. On one occasion, I took my tablet at the wrong time, meaning my doses were too close together and vomited as a result. We also found that although it had some effect on my mood, it wasn’t touching my anxiety, and so my Dr started to increase the dose. For a few years it kept increasing and after every higher increment: headaches and nausea so bad I was in bed for days. Same thing happened if I missed my dose. I would first get the typical antidepressant ‘brain zaps’, and then feel unwell again.

My mood plummeted several times whilst I was on Sertraline, even at a high dose, but because I was at uni and therefore moving between GPs in different areas, it wasn’t until my 20s when it was determined; okay, this isn’t working for me. I was switched to another antidepressant (which I will cover in another post!) and found much more success with it. I am not sorry to never have to go back on the sickness inducing heck that was my life on Sertraline!

Disclaimer: Although it didn’t work for me, everyone’s different and Sertraline may be just the drug for someone else! Don’t be put off by my experiences, most people who have nausea only do so mildly and it disappears within days.

Weight gain on Abilify

I have officially gained 10lbs since upping my Abilify dose from 300mg to 400mg monthly. I am not happy about this. For one of the first times in my life (the other time was when I was on Risperidone), I am officially classed as ‘overweight’ according to my BMI. As someone who is used to being in the bottom half of the ‘healthy’ range, this has hit hard. I want desperately to have my dosage decreased back down to 300mg but no one I know; drs, CPN, family, will support me in this decision since I became psychotic on that dosage. I understand their hesitance but I with I felt like I had more autonomy over what goes in my body.

Antipsychotic depot injections

So what’s a depot?
A depot shot is an injectable form of (in this instance) an antipsychotic medication. It’s slow-release, which means instead of having to take oral medication every day, you only need the shot once every few weeks. My oral medication currently is Aripirazole (Abilify) and the depot version is called ‘Maintena’, which is fun because it’s clearly a play on maintenance of or maintaining mental health. My shot will be done by IM every 4 weeks at home by my nurse and after that at a depot clinic at my local mental health centre

Why go on a depot?
There are a few reasons why people might be on a depot. They might struggle with oral medication, need monitoring of taking their medication – something that’s much easier at a clinic every few weeks as opposed to at home every day – they may not like thinking about medication everyday or forget to take it. My doctors and my decision was based on a couple factors:

1. I have relapsed more than once from stopping my medication when I start to get unwell. Once I’ve stopped, I get much sicker quickly and it can be hard to get me back ON the medication to treat the episode.
2. I’ve already been in a position where a team has been sent to my house daily to ensure I take my medication as prescribed, which was a hassle for everyone.
3. I do not like taking my antipsychotics so I have an internal conflict every day that I take it, we feel it’s unlikely I will be long-term compliant with medication, even thought I know logically that is in my best interests.
4. When I stop taking my medication, I don’t tell anyone and so people are unaware of the risks and the fact I may be becoming unwell. My CPN (community psychiatric nurse – my care coordinator) gives me my depot so if I was not taking my medication, someone would be aware.
5. When I was first put on it, I was in hospital under a section (involuntary hold) and was backed into a corner as they could forcibly medicate me and the way they do that is by injection.

The main positive for me about being put on the depot is that it helps me instil some trust back in myself not to mess up with my medications, but also trust between me and my family/friends/mental health team, who won’t always be wondering ‘is he taking his meds?’. It also helps that I don’t have to think about it every day and there is some evidence to suggest that the side effects of my medication will be less on a depot due to the more steady level of it in my blood. I have found this to be the case in terms of akathisia (restlessness),

However, the thing with depots is, once they’re in, they’re in and you can’t get them out. So I was initially worried that if I had side effects from this new form or a dose adjustment, I can’t just stop because i felt it was all too much…which I suppose is the point. It still makes me uncomfortable though!

Overall I think it was probably the right thing to do at this point. I’d like to give myself at least 6 months – a year of stability and this is probably my best bet. So far I’ve need to up the dose due to breakthrough symptoms but otherwise have been a lot more stable.

Appointment with the Head Pharmacist

There were a lot of options thrown up: Extra PRN antipsychotics, Carbamazapine instead of Lamotrigine (although my pdoc piped up at that and said she’s not had a great experience with using it as a mood stabiliser?), Lithium was finally mentioned and shot down (by me). Antidepressants were mentioned and shot down (by them). SO I still have no good plan for if I get really low again. 

I feel tired as heck, what are everyone’s BP, SZ and SZA working drug cocktails?

Switching up my Abilify Depot

I’m currently on a depot shot for my antipsychotic Abilify/Aripiprazole. I was initially on 300mg every month but started to become unwell again so my Dr and CPN recommended that I up the dose the the max available on the depot (400mg). This has been much better for me and bought be out of an episode that was getting very close to hospitalisation but unfortunately, I’m still getting breakthrough symptoms, especially in the week before my shot is due. My CPN had proposed that we change the dates slightly so that I get my shot every 26 days instead of monthly.

Here’s hoping that works! Is anyone else on an antipsychotic depot but experiences breakthrough symptoms when their next one is due?