How do we,who need to take medications daily,stay compliant,(take them as prescribed) and why do we go off them, knowing the results if we do.

I for one, remember the times when I went off, even for a few weeks, knowing the outcome might not be to my liking,but justified it saying the side effects are too much and I deserve to live better.

Ken, this is a good thread, and I may make it a sticky for the medications board.

Staying compliant is very hard for the individual as well as the health care worker. This pertains to all medications, not just those that deal with mental health aspects.

You see, the meds, whether it be for high blood pressure, hypo/hyperthyroidism, bipolar, schizophrenia, etc... make people feel better than their pre-medicated state. So, once a patient feels better many think they are "cured" and this is just not so.

To remain compliant on medications it is up to the health care provider, whether it be the doctor, but usually the nurse, to educate the patient on their particular malady so that they understand that the medications need to be taken EXACTLY as prescribed.

Many people who have an infection, for instance, take their medications until the symptoms are gone... so they think that they are healthy again, even if they only took the antibiotic for 3 days instead of the prescribed 10 days. This is one reason we have developed superbugs like MRSA. The bacteria becomes dormant rather than killed completely and then they mutate and become resistant to drugs.

People with schizophrenia, as another instance, begin to feel better symptoms seem to disappear, so they think they are "better" when in fact it is the medication balancing out the neurotransmitters that are not working correctly in the brain. When they quit their meds the psychosis comes back full force, and many times worse than in the beginning. When this happens there is no way to turn back the hands of time, the schizophrenia has gotten worse and will not regress, so different meds are needed.

Again, it is all about education of the particular illness involved. I, as a health care worker, am responsible for educating patients regarding their illness... what to expect regarding side-effects of medications... how long to take the meds, etc.

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KBC agrees: You mean I get my first 'sticky'?? Thanks J-9

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Yes, you have your own personal sticky and I think it is very well warranted.

Good thought here Ken, this was much needed. I am all about education and medicine... Well, here we go. I hope the thread grows and grows.

As J_9 said
Again, it is all about education of the particular illness involved. What to expect regarding side-effects of medications... how long to take the meds, etc.


There are things you can do but it depends on what you are taking what medicines for and
So forth. Many people try alternative herbs, vitamins and minerals but you have to know what ones work with your meds and what ones work against them and what ones accelerate the effect. So you should ask your doc to work with you if you want to go the alternative route.

For example, some people can take chromium picolinate for diabetes but they need to keep their levels monitored all the more cause you usually need less insolin.

When you take statin drugs for cholestrol you should take omega and Q 10.
If you look that up on the internet you will see that many doctors are saying it is important.

Also as J_9 said you have to take the whole script for antibiotics, but once you are through with it it is important to take probiotics or eat yogurt to replace healthy bacteria that your body needs.

I have been doing the alternative supplements and nutrition for preventative measures. Many people my age are already getting put on so many meds they look like a walking pharmacy. I spent the past 10 years teaching myself the alternative stuff and I am healthier than I was in my 20's (30 years ago!)

I am currently on prescribed Depakote and Celexa.

The medications are only effective for a short time,outside stimulus has been eliminated to a few needful things,stresses are very low.

For the past month, I have been going through many multi-cycling episodes,manic to the point of sleep losses,often up for 14 hours,sleeping for 2-3 and up for another 14 or so.

No depression as of yet.

My mind is cloudy, but I can still function,just not at full capacity when I get too tired.(cabinet making requires some clearheadedness to operate the power tools)

My appointments with a psychiatrist is every 3 months, due to the lack of Dr's in the remote area I live in.(closest clinic is 50 miles round trip) closest private Dr is 80 miles round trip.

I am lacking sleep, serenity falls off during these times also. My cravings for food, especially sweet foods, rises by 5 fold, impulsiveness is erratic,sometimes overwhelming, I fall prey to them, going on spending sprees and excessive activities( don't need sleep, can do just about anything, got a lot of time on my hands)

Working in the shop becomes second in line to far fetched ideas, useless pursuits ending in some shame, because I didn't get anything done (at least what I thought I should do that day)

Focus can be done through concentration,although it brings headaches on if I do it for too long.

Does this sound familiar to anyone? It is the first signs of bi-polar relapse. My signal flairs are going off, and I am clearly needing help.

My post here will hopefully help others as to what to do when this kind of thing happens to you. All answers are appreciated.

Ken

Ken, this sounds very familiar. It is rapid cycling bipolar, if my memory serves me correctly (I'm not where I can get a hold of my textbook at the moment).

Let me ask how long you have been on the Depakote and Celexa and what the dosage is. Many people with bipolar disorder learn to adjust the dosage of their medications according to the symptoms. What other meds have you tried?

Now, the drive that you mention (50 miles round trip and 80 miles round trip) is nothing really, especially when you are in need of some help. I drive 95 miles round trip 3 or 4 days a week. LOL

How long have you been going through this current manic phase?

Been on these meds for over 6 months.

DepakoteER 1500 mg daily.

Celexa 20 mg daily, just got lowered for manic behavior 2 weeks ago)

I have been on almost every medication on the market today,

Paxil
Prozac
Zoloft
Trileptal
Lamictal

Probably a few I can't remember right now also.

Depakote
Lithium

Again a few I can't remember.

Zyprexa

Adivan(sp?) during hospital visits,that one really helps.

Many for the shakes, all low dosages.

Length of time in this phase,1 month or so.

And I need to amend that 'drive' thing (clear thought prevailing after the fact)

It's not the drive so much(that just makes me feel better,to see someone face to face)its the contacting of the doctor for changes.The 'system' is falling short of thorough help,lack of funds play a huge part in this.

These came on suddenly and are very upsetting( you saw some of my harsh statements on here lately)

1500mg Depakote? Can I ask how much you weigh? The dosage is dependent on your weight. This may be too little or too much, which, either way could be causing this episode.

Are you involved with NAMI?

Had a meeting yesterday with them, yes.

Good, I found one in your area, I was going to give you the #, but if you met with them, then you are on the right track.

Now, your weight? I would like to calculate your dosage to see if you are in the correct therapeutic range.

Just had my valporic acid level tested 2 weeks ago, I am within the therapeutic range(don't remember the actual numbers, but it was somewhere in the middle of the scale.)

Any way, I am 6'1" 230 lbs

Thanks. You are indeed on the max dosage. Are you taking it all at once or twice a day? You should be taking 750mg twice a day.

You say the Celexa was decreased due to mania. Has your mania gotten better or worse since the decrease?

Actually the mania is close to the same, maybe a little less.

The depakote is once nightly,being ER tabs, it does take time to disburse and testing was 12 hours after last dosage.

Sorry, I forgot it was the ER. Although my text says that Divalproex sodium (depakote, Depakote ER, Epival) should be given by mouth 750 mg in divided doses.

It may do you good to call your pharmacy and have a consultation with the pharmacist to get his opinion on your particular symptoms and dosage.

Pharmacist,not the psyche?

Ok, I have never done that.

Thanks J :)

The pharmacist is a GREAT resource for drug information. It was the pharmacist who taught my father how to recognize his symptoms, whether being manic or depressed, and how to alter his medication dosage and times of day in which it was to be taken.

While the psych docs are pretty good with meds, meds are the ONLY things the pharmacists do.

Cool thanks, I'll look into it today when I go into town,, that's only 14 miles away... LOL:)

Well they increased my Depakote 500 mg in the Am, and 1500 at night, Have to see how it will help for the weekend, if no results are in, a hospital visit might be in order, I am not very stable tonight.

Ken, I hope it works out for you. But remember that it will most likely take longer than just the weekend to see the true effects of the meds. I am sorry to hear you are having a hard time right now. Just remember it will pass.

It will or it won't, If I need to go inpatient I can always do it... Truthfully I am looking to get some adivan, I need to settle down... But self medication is not an answer.

I am glad you are looking at this realistically, as you know, most people who suffer with Bipolar in the manic phase are NOT realistic thinkers.

You most likely will get Ativan in-patient. I am surprised you don't have a script for it already so that you can use it when you are feeling as you are right now.

I know it's tough Ken, but you will get through this.

Another night of little( but at least some) sleep, getting a cold and feel yucky!! :(

Head is SWIMMING with thoughts, eyes are heavy too, but the sleep is a fleeting thing, OH WELL, that's life.

If I can just stay on board with this fit I might bypass the hospital visit, ( fingers crossed, just like my eyes... lol)

God knows I hope this online journal helps someone else, If anyone else goes through this, look for the help, there are good people out there,like J-9, with sound advice and a clear mind to ask questions to, don't do this alone.

Ken

Ken, I am hoping you got at least a little sleep last night.

Keep coming here hun, you know if I am not online at the moment I will eventually respond. Just be patient with me and my hectic schedule.

Does it help you to talk about what thoughts you mind is swimming with? Does it help release some of the penned up energy?

Yes, to talk about things is like an online journal.

But to release pent-up energy, I can't think of any constructive ways to do that.It is what it is, uncontrolled energy,I shake, rattle and roll,its just a passing phase,although I wish it was over before I make a fool of myself.

I did spend some time in the shop today,no intricate cuts,want to keep my fingers on.It wasn't bad to get artistic,and productive,but when a distraction shows its face I just want to go with it,focus isn't there,ended up playing poker with old friends for 6 hours,till I got cranky and had to leave,1/2 hour drive plus dusk and deer on the road are a bad mixture.

Anyway, Thanks to excon for the comment, I need those every once in a while.

Ken

Ken, I hope you got some rest last night. Glad you made it through the weekend. I am off to school today, but I will check in later this afternoon to see how you are doing.

Thank you J-9,

I am losing reality,, Giddy now,, but its all good, I have family here,visiting from out of town, they have offered to take me to the unit if necessary.

I'll let you all know what's up later.

Ken

Dr. Prescribed ATARAX today,I haven't found any real changes yet, but I think it needs to build up,Not sure,even the med nurse said the PDR wasn't clear,all I found out was the med is an antihistamine( like that's going to help,, sheesh, who do they think they are dealing with,JUNIOR... ) I am getting really pissed with the band-aid treatment from the mental health officials!

So anyway, they say... call back Wed. pm, or Thurs. am if this doesn't help... meanwhile I just wasted $50.00 on pills to clear my cold up? I could have taken Vicks for much less than that.

Sorry, just venting...

I am past giddy, now the anger is creeping in, my poor friends, much less family... I haven't been this volatile in a long time, I guess I am more aware of my actions today.

Thank you for letting me vent, I am going to think more about this episode and try to find an outlet other than anger.

Ken

Oh, Ken, you need to go to your local college and get a Nursing Drug Reference Book.

Atarak is not only a antihistamine, but is also an antianxiety/sedative-hypnotic, and antiemetic (means it's good for upset tummies).

Many of these meds cross over to help more than one condition and may be prescribed for several different things. So, you haven't wasted your money yet. This one takes about 2 days to begin to see a difference.

Sorry it took me so long to get back to you, but school happens and life goes on. Tomorrow I may not be reachable at all as I have clinicals from 6:30 - 6:30 which means I will be gone from 5:15 - 7:30, but I will check in if I get a chance.

Thank you, I knew I could get a knowledgeable response from you about this medication.

Taking it 3 times a day, till next week Mon. when the doc. Is available.

And yes, I got a full 8 hours sleep last night, first of many, I hope!! :)


Ken

I am just checking in before I head off to clinicals to deliver babies today. Good to hear you got some sleep finally.

CHECK+++

Have a good day delivering the newborns...

Ken

I got some good support from Ken this morning and wanted to thank him again and also express my sympathy for his situation. Also, I agree that staying on medications can be a problem for anybody.

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Originally Posted by J_9

Staying compliant is very hard for the individual as well as the health care worker. This pertains to all medications, not just those that deal with mental health aspects.

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I want to give my experience as an example of why this is true. I have chronic pain and I am on a fentanyl patch and a low dose of methadone to control the pain. I need to change the patch every two days and I can only take a shower right before I put on a patch. If I wash my hair at the wrong time, it washes the drug out of the patch and I go into withdrawal early. I resent having to be on these drugs and having people tell me I am an addict (and not being able to take a bath whenever I want).

When I am feeling good or I am busy, I sometimes forget to take the methadone or forget to change the patch until I am in withdrawal. Even when the withdrawal is mild, I'm labile and tend to get more upset about things than I normally do. I cry easily. I too have experienced the shame of having said something or written something to a list that I later regretted. I tend to obsess and perseverate when I am in this state. Physically, I get very hot and sweat or have chills and can't regulate my temperature. Eventually, my pain gets worse and I feel like I have the flu.

And all this because I had a broken back and have chronic lower back pain. The drugs help me to function-- take care of my family and work, to have a life. But I don't know sometimes whether my feelings are me or the (lack of) drug. I don't trust my instincts anymore. If I have a disagreement with my boyfriend, he tells me it's the drugs not me, and I'm not sure.

I try really hard to stay on my schedule, and mostly I do, but sometimes even when I've been completey punctual, I go into withdrawal anyway, for reasons I don't understand. I don't know if there's poor quality control on the patches or if something like lack of sleep can make me go into withdrawal early. But I'm constantly trying to adjust my dose while NOT increasing the methadone so that I become dependent on higher and higher doses. I feel trapped by this stuff. The other day, I was expecting 30 people for a potluck I was hosting and I was in withdrawal. I hastily took some methadone so I wouldn't go curl up in a cormer and sleep (or worse, cry) in the middle of the party. But then I feel like I have to pay for that later, because I have taken "extra." I'm so tired of trying to remember what I took when and what I need to take when.

I never take anything to get high. I am ruthless with myself and defensive about this. But I'm not sure people believe me. Several people have asked me what the high from fentanyl is like and I tell them I don't know because I have never felt high from it.

Anyway, I feel a lot of sympathy for Ken's challenges, which are so much worse than my own. I think I have an inkling of what it must be like because I too have to deal with cycling moods and drugs. I don't know much more about bipolar than what I've learned from reading this thread or about the drugs he's on. But I do know what it's like to be so dependent on powerful drugs that make you feel better and yet not want to take them.
Good luck,
Asking

Medication compliance is hard no matter what med you are on, whether it be pain, mental health, antibiotics, etc... It's just really hard and up to basically the nurse (me) to teach why it is so important.

So,I had a few days of rest, but its back to the no sleep, some sleep, no sleep thing.

Seems too quick, but that's bi-polar for you.

This medication is different than Seraquil, I don't wake up hungover,groggy,or moody.

I do wake up with a headache though,although that might be from the lack of rest.

Only six days till I see the med doc. Can't wait.

The seroquel is good, it just takes so darn long to work. At least you got a little rest, that is something.

I'm sure the headache is from lack of rest as I didn't see it as a side-effect of the Atarak.

I bet you can't wait to see the med doc. I can't wait to hear what he says.

He is a listening doctor,asks what I want for meds, not what HE wants to give me.

The last one was a domineering psyche, and we had little to no relations.

AND BTW, weren't you going to lay down for a while... LOL