Hospital + Current Medications

So here I am once again, back in a hospital. This will be my eighth hospitalization since the age of 17 so I’m pretty used to the routine that occurs in places like this. I’ve never been to this hospital before, which is a mental health institution here in my city, and so far I’m really pleased with the service I’ve been getting.

During my first week here, the psychiatrist suggested that I consider undergoing ECT (Electro-Convulsive Treatment) for my chronic depression. I was shocked that he suggested that but I did some research, asked around, and was actually surprised by the way attitudes surrounding ECT have changed over the years. I met a few people who are currently doing ECT, and a few who had had it in the past, and although not everyone saw positive results, they didn’t regret having it, and they all said that the problems with memory were temporary, which was one of my main concerns. Anyway, after probing the issue for a few days, my psychiatrist told me he’d rather focus on my anxiety and that he would contact a hospital psychologist on my behalf.

Med changes… During the first few weeks here, they tried me out on two different medications to combat my anxiety, but I had no success with either of them:

Ativan (Lorazepam): 2mg as needed – for anxiety
Loxapac (Loxapine): 25mg as needed – for anxiety and agitation

Whenever I took the Loxapine, I developed a nasty tremor – much worse than the usual tremor I have that never goes away. This was less of a trembling and more of a full-on twisting of the wrists and flapping movement of the lower arms. To treat that, they gave me 2mg Cogentin (Benzatropine) as needed. I stopped taking the Lorazepam and Loxapine because they had no effect on me (probably due to the fact that I have a huge natural tolerance to most pharmaceuticals; I probably require a dose that they wouldn’t be willing to prescribe), but I am still exploring whether the Cogentin might be of use to me with regard to my tremor. I’m going to take an experimental dose today and see whether it has any effect on the constant tremor I’ve been experiencing for at least the past year. I’m not sure if this tremor is medication-induced, but it most likely is – I’d attribute it to the Risperidone I take for my Tourrette Syndrome.

My psychiatrist also threw in a steadily increasing dose of BuSpar (Buspirone) for anxiety. We’re up to 50mg as of the 24th but I haven’t noticed any change to my anxiety yet, which is pretty much on par because it takes at least two to four weeks to see any change in most cases.

You may notice that some of my vitamins, supplements and herbal remedies are missing from the following list. They’re pretty strict here about what they will and won’t let me take, so I’ve had to give Valerian Root and “Relaxing Night” Herbal Tea a miss for now. I’ll probably resume taking them when I get out of the hospital.

Lastly, they have been decreasing my sleep medication. The first night I came here, the duty doctor looked over my meds and decided I was on too much Chloral Hydrate, so he reduced my dose by 25%. About a week later, and after much debate on how to do the taper, I finally reduced my Imovane to 26.25mg, and we have another decrease planned for tonight or tomorrow night. I’m not experiencing any horrendous withdrawal symptoms but I have this general feeling of malaise that won’t really go away.

Psychiatric Meds
Imovane/Immovane (Rhovane) (Zopiclone): 26.25mg nightly – for Insomnia
Risperidal (Risperidone): 2.5mg nightly – for Tourrette Syndrome
L-Tryptophan: 2000mg nightly – for Insomnia
Chloral Hydrate: 7.5mL nightly – for Insomnia
BuSpar (Buspirone): 20mg in the morning and 30mg at dinnertime – for anxiety
Cymbalta (Duloxetine): 90mg nightly – for Depression

Non-Psychiatric Meds
Clindoxyl (Clindamycin and Benzoyl Peroxide): apply topically at night – for acne
Delatestryl (Testosterone Enanthate): 60mg intramuscular once weekly (Friday) – for low testosterone
Erythromycin: 333mg in the morning and at dinnertime – for acne
Losec (Omeprazole): 20mg in the morning (before eating) – for acid reflux
Fucidin (Fusidic Acid): apply topically once daily – for bacterial skin rash

Vitamins, Supplements, and Herbal Remedies
Melatonin: 3mg nightly – for Insomnia
Multivitamin: 1 in the morning – for overall health
Salmon Oil: 1 in the morning, at dinnertime and at night – for high cholesterol
Calcium + Vitamin D: 500mg Calcium and 125IU Vitamin D (1 tablet) in the morning and at night – for bone health

Cymbalta Withdrawal Forums + Bruxism

While I was doing research for my latest medication profile, I stumbled upon cymbaltawithdrawal.com, a website started by someone who presumably went through the trials of Cymbalta withdrawal and the associated SSRI/SNRI discontinuation syndrome. It’s an open forum for other people who are going through the same experience, and people are free to discuss what’s going on for them during the withdrawal period. This website is a bit of a grim view into the future for me; if Cymbalta turns out to be just like all the other drugs I’ve tried (failures), then one day I’ll have to stop taking it and will probably suffer from the discontinuation syndrome. However, my pharmacist told me that Cymbalta withdrawal is apparently not as bad as Effexor (Venlafaxine) withdrawal, which I have also been through. If she’s right, then I think I should be able to manage.

Bruxism. Bruxism started becoming an issue for me about two months ago. I first started noticing jaw pain during the day, as though my mouth was constantly working throughout the night. Also when my mother came to check on me, she could hear my jaw creaking while I was asleep. Then I started to notice jaw clenching and tooth grinding during the day – first only a little bit, then more and more until I was constantly clenching unless I made a concerted effort not to. Even then, I would only last about three to five seconds before my jaw would clench again. As a result of all this clenching, I get a lot of pain in my jaw, and I assume I’m doing damage to my teeth, but I haven’t seen a dentist in years. That’s on my list of things to do. I already take the dietary supplements recommended for people with bruxism – Pantothenic Acid, Magnesium, and Calcium – but they don’t appear to be helping.

There are a number of things that could be contributing to my bruxism:

• Smoking
• Anorexia Nervosa
• Insomnia
• Consumption of caffeine
• High levels of stress and anxiety
• Cymbalta (Duloxetine)
• Dexedrine (Dextroamphetamine)
• Obsessive-Compulsive Disorder
• Generalized Anxiety Disorder

Any or all of those things could be impacting upon my bruxism, but it’s nigh impossible to tell exactly which one it is. On a hunch, my psychiatrist advised me to lower my dose of Dexedrine to see if that would affect the bruxism, but even after a week of being Dexedrine-free I was still bruxing heavily. To keep from grinding my teeth all day long, I try to bite my lip or tongue when I notice I’m bruxing, but I feel like it makes me look sort of funny. Some people, including my mother, a friend, and my psychiatrist, have mentioned that I visibly appear to be chewing or otherwise moving my jaw around constantly whenever I’m not speaking. It makes me very self-conscious about being out in public.

I’ve heard about people using benzodiazepines to relieve bruxism, but I’m not too keen on going back to those if I can help it. I don’t think my psychiatrist would be down for that either. Another totally extreme option is Botox – actually freezing the muscles that are doing the bruxing – but there’s no way I’m going to willingly allow someone to paralyze parts of my face.

Medication Profile: Cymbalta (Duloxetine)

Brand name(s): Cymbalta, Yentreve.

Generic name(s): Duloxetine.

Street name(s), if any: Unknown.

Available form(s): Oral.

Available dose(s): 30mg, 60mg.

North American availability: Available by prescription in the U.S. and Canada.

Class(es): SNRI (Serotonin-Norepinephrine Reuptake Inhibitor).

Method(s) of action: Inhibits the reuptake of serotonin and norepinephrine in the brain, making larger quantities of those chemicals available for use.

Most commonly prescribed for: Depression.

Also prescribed for: Stress Urinary Incontinence, Diabetic Peripheral Neuropathy, Generalized Anxiety Disorder, Fibromyalgia, Chronic Fatigue Syndrome.

Possible side effect(s): Palpitations, myocardial infarction, tachycardia, vertigo, ear pain, tinnitus, hypothyroidism, diplopia, visual disturbance, flatulence, eructation, gastritis, halitosis, stomatitis, gastric ulcer, hematochezia, melena, chills/rigors, feeling abnormal, feeling hot and/or cold, malaise, thirst, gait disturbance, gastroenteritis, laryngitis, weight gain, increased blood cholesterol, dehydration, hyperlipidemia, dyslipidemia, musculoskeletal pain, muscle tightness, muscle twitching, dysguesia, lethargy, parasthesia/hypoesthesia, disturbance in attention, dyskinesia, myoclonus, poor quality sleep, dysarthria, abnormal dreams, sleep disorder, apathy, bruxism, disorientation/confused state, irritability, mood swings, suicidality, dysuria, micturition urgency, nocturia, polyuria, abnormal urine odor, anorgasmia, abnormal orgasm, menopausal symptoms, sexual dysfunction, yawning, throat tightness, cold sweat, contact dermatitis, erythema, increased tendency to bruise, night sweats, photosensitivity, ecchymosis, hot flush, flushing, orthostatic hypotension, peripheral coldness.

Possibility of tolerance: Possible.

Addictive potential: Low.

Withdrawal potential: Moderate.

Withdrawal symptoms: Irregular heartbeat, “brain zaps”, speech impairment, emotional lability, dizziness, dysphoric mood, agitation, sensory disturbances, anxiety, confusion, headache, lethargy, insomnia, hypomania, tinnitus, seizures.

Potential for abuse/misuse: Low.

Drug interaction(s): Fluvoxamine, Cimetidine, Ciprofloxacin, Enoxacin: Increases the effect of Cymbalta.
Paroxetine, Fluoxetine, Quinidine: Increases the concentration of Cymbalta.
NSAIDs, Warfarin, and Aspirin: Altered anticoagulant effects, including increased bleeding.
Desipramine: Increases the concentration of Desipramine.
MAOIs (Monoamine Oxidase Inhibitors): May cause hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, agitation, delirium, and coma.
SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): May cause serotonin syndrome.
St. John’s Wort: May cause serotonin syndrome.
Triptans: May cause serotonin syndrome.
Linezolid: May cause serotonin syndrome.
Lithium: May cause serotonin syndrome.
Tramadol: May cause serotonin syndrome.
Tryptophan: May cause serotonin syndrome.

Contraindication(s): Hypersensitivity to Duloxetine or any of the ingredients in Cymbalta or Yentreve, concomitant use of MAOIs, uncontrolled narrow-angle glaucoma, simultaneous use of CNS-active (Central Nervous System) drugs, simultaneous use of Thioridizine.

Overdose threshold: Unknown.

Symptoms of overdose: Somnolence, coma, serotonin syndrome, seizures, syncope, tachycardia, hypotension, hypertension, vomiting.

Note: I am not a doctor, and the information I state on my blog is gathered from internet sources and physician’s handbooks. Therefore, it is important to speak to your doctor if you are unclear about something or if you have more questions that I am not qualified to answer.

And So Begins the Cymbalta Trial…

As I had discussed previously with my psychiatrist, we decided on Wednesday to put me on Cymbalta (Duloxetine). I took my first dose Wednesday night so that means I’m on my second full day of being on it. As with other SSRI/SNRI medications, it takes at least a week, but usually 2 – 4 weeks, to see any change. I think I’ve said this before but it bears repeating: I have little faith that Cymbalta is going to do anything for me. I think I just have a general tolerance to medications that work with serotonin, and perhaps norepinephrine. Maybe not norepinephrine, though; I did see a small (barely discernible, but apparent to the trained observer) change in my mood while I was on Effexor (Venlafaxine), which is an SNRI, so maybe I do respond a bit to norepinephrine inhibitors. Anyway the current plan is to take 30mg at night for two weeks, and then raise the dose to 60mg. My psychiatrist is prepared to go to 90mg if we don’t see any results after 3 weeks on 60mg.

Another thing we discussed on Wednesday was adjunct treatments; I’d been doing my usual research and had come across the name Abilify (Aripiprazole), an atypical antipsychotic that is also approved for treatment of Bipolar II and has recently been approved as an adjunct treatment for depression when used with another antidepressant. Abilify is specifically for people like me who haven’t seen any (or enough) effects from taking only one antidepressant. I’m not sure exactly how it works, but it sounds tempting. Another possible plus of Abilify would be that, as an antipsychotic, it may act like Risperidal (Risperidone) and control my verbal and motor tics, which would enable me to cut that medication out of my schedule. Cons of Abilify are:

– I would be taking yet another medication.
– It can cause insomnia, which would worsen an already horrible situation.
– It can cause shaking/tremors, which would make me even shakier.
– It can cause high blood sugar, and some people have developed diabetes while taking it (note that this was after long-time use – several years).
– It can cause speech disorders, which would complicate things because I already talk strangely because of my bruxism.
– It can cause permanent tardive dyskinesia. However, I’ve already been on Risperidone for about a year and a half and I haven’t developed this symptom. That said, though, I’m not sure what the risk factor is for Abilify in relation to Risperidone.

So there are, in fact, quite a few reasons why I shouldn’t go on Abilify. It seems, just from the readings I’ve done, to be more risky and potentially side effect-y than Risperidone. But it might be a valuable tool as an adjunct treatment – a lot of people are reporting great successes with it. I really wouldn’t want to miss out if there was a chance that this medication could help me.

The last thing I discussed with my psychiatrist was my anxiety. Due to certain environmental factors in my life at the moment and in the past few weeks, I’ve been a lot more anxious (in certain situations) than usual, but I also feel like my base level of anxiety has risen. I’m anxious about some things that are typical of people with anxiety disorders – social situations, public places, taking transit, the police/authority figures, etc., but I’m also anxious about other things, like getting out of bed. This anxiety is seriously keeping me from getting things done because it totally shuts me down and renders me unable to make effective decisions. Given all that, I decided it was time to ask my doctor about trying anxiolytic medication again. He’s really not a fan of benzodiazepines in the first place, and especially not in my situation, so he ignored them altogether and considered some other options. He ended up deciding that if the Cymbalta doesn’t have any anti-anxiety effect on me in 5 weeks, he’ll start me on a trial of Buspar (Buspirone). I’ve been on Buspar once before but the results were inconclusive. I don’t think we gave it enough time or a high enough dose to really see what it could do for me.

Anyway, here’s an idea of what my current meds look like. There’s some new additions in both the prescription and non-prescription categories.

Cymbalta (Duloxetine): 30mg nightly – for Depression
Imovane/Immovane (Rhovane) (Zopiclone): 22.5mg nightly – for Insomnia
Risperidal (Risperidone): 2.5mg nightly – for Tourrette Syndrome
L-Tryptophan: 1000mg nightly – for Insomnia
Dexedrine (Dextroamphetamine) Spansules: 40mg in the morning as needed – for Depression-related symptoms
Chloral Hydrate: 10mL nightly – for Insomnia

Clindoxyl (Clindamycin and Benzoyl Peroxide): apply topically at night – for acne
Delatestryl (Testosterone Enanthate): 60mg intramuscular once weekly (Friday) – for low testosterone
Erythromycin: 333mg in the morning and at dinnertime – for acne
Losec (Omeprazole): 20mg in the morning (before eating) – for acid reflux
Fucidin (Fusidic Acid): apply topically once daily – for Impetigo

Melatonin: 3mg nightly – for Insomnia
Multivitamin: 1 in the morning – for overall health
Salmon Oil: 1 in the morning, at dinnertime and at night – for high cholesterol
Vitamin C:  500mg in the morning – for overall health
Calcium + Vitamin D: 500mg Calcium and 125IU Vitamin D (1 tablet) in the morning and at night – for bone health
Valerian Root: 800mg (2 tablets) nightly – for Insomnia and Generalized Anxiety Disorder
“Stress Relief” B50 Complex with Sensoril: 1 capsule nightly – for anxiety
Siberian Ginseng: 250mg (1 tablet) in the morning, at dinnertime and at night – for stress and low energy
“Relaxing Night” herbal tea*: 1 bag steeped in hot water nightly – for Insomnia

* “Relaxing Night” tea contains Chinese jujube, subterranean fungus, white mulberry, lycium barbarum, and Chinese yam.

[More] Current Medication List

At my last visit with my psychiatrist we decided that the Effexor (Venlafaxine) isn’t doing anything for me; therefore we decided to start tapering me off it in preparation to go on another medication. We’re not sure yet what that new med will be, but my shrink is thinking of Cymbalta (Duloxetine). I’m not sure what I think of sticking with an SNRI (Serotonin-Norepinephrine Reuptake Inhibitor) – I already know I have a tolerance to SNRI medications, as evidenced by my experiences with Effexor. I’m more of the opinion that we should switch to a TCA (Tricyclic Antidepressant) or an MAOI (Monoamine Oxidase Inhibitor). Then again, I’m not a doctor

Effexor (Venlafaxine): 112.5mg in the morning – reducing by 37.5mg each week until discontinued – for Depression
Imovane/Immovane (Rhovane) (Zopiclone): 22.5mg nightly – for Insomnia
Risperidal (Risperidone): 2.5mg nightly – for Tourrette Syndrome
L-Tryptophan: 1000mg nightly – for Insomnia
Dexedrine (Dextroamphetamine) Spansules: 40mg in the morning as needed – for Depression-related symptoms
Chloral Hydrate: 10mL nightly – for Insomnia

Clindoxyl (Clindamycin and Benzoyl Peroxide): apply topically at night – for acne
Delatestryl (Testosterone Enanthate): 60mg intramuscular once weekly (Friday) – for low testosterone
Erythromycin: 333mg in the morning and at dinnertime – for acne
Losec (Omeprazole): 20mg in the morning (before eating) – for acid reflux

Melatonin: 3mg nightly – for Insomnia
Multivitamin: 1 in the morning – for overall health
Salmon Oil: 1000mg in the morning, at dinnertime and at night – for high cholesterol
Vitamin C:  500mg in the morning – for overall health
Calcium + Vitamin D: 500mg Calcium and 125IU Vitamin D in the morning and at night – for bone health