Sometimes the cure is worse than the illness...

I'm sitting here fighting off waves of nausea and anxiety which, I think, is due to stopping Lamictal abruptly. Lamictal is one of the two meds I've been taking to treat bipolar disorder. I was up to taking 300 mg of Lamictal when I went to see my psychiatric nurse, Erin, yesterday afternoon.

I had an itchy rash all over my arms that started to spread to my legs and back. Erin also noticed that my legs were red. She's not the first one that noticed...the pain management doctor noticed it and I brought it up to my internist who said it could be caused by any number of things, including all the meds that I take. Suddenly Erin was very serious. She wanted to know if I noticed any differences in my mouth, tongue swelling, something like that? And I said no, starting to worry already.

Well, surprise, folks, there are a bunch of medications out there--including our favorite pain NSAIDs--that can cause a potentially serious or fatal condition called Stevens Johnson Syndrome. I read the web page and I don't think that's going on here but I most definitely have reddened skin and itchy blisters caused by something. Nothing in my mouth and no skin sloughing off--knock on wood. :P

Erin told me to stop taking the Lamictal altogether. I imagine there must be some side effects from going right down to 0 from 300 mg and maybe that's why I have the anxiety and shakiness. To treat that, I'm supposed to take an Ativan, a tranquilizer.

To treat the itchiness and rash--the internist thought I might have a poison ivy or something like that--I'm taking a medication pack with a variation of prednisone. That's raising my blood sugar to high levels and they were already high this month to begin with. I've been trying to figure out why. I'm not eating the kind of food to deserve these numbers doggone it, it's not fair!

I just looked up this information about Abilify:

Abilify may cause you to have high blood sugar (hyperglycemia). Talk to your doctor if you have any signs of hyperglycemia such as increased thirst or urination, excessive hunger, or weakness. If you are diabetic, check your blood sugar levels on a regular basis while you are taking Abilify.

Great. And the thing is, I knew it because Erin told me about it way back when I began to take it...and I forgot it! I forgot it because of all the other crazy stuff that's been going on around here.

Would I be better off not taking anything at all? I don't know...I've been on some kind of medication now for years because of chronic depression. But are the meds worse than the disease? Do I have the courage to find out?

I wanted to go around reading other blogs and commenting on them but I'm so jittery I can barely sit still.

Other stuff: I had an MRI today for the maybe-cyst on my right kidney. I wasn't supposed to eat for five hours before the test but oooops! I forgot and ate breakfast. I wonder if that will affect the test?

The hearing in Tennessee has been postponed until July...the hearing to determine residential custody for Little T is coming up at the end of this month. TB's legs still hurt but seem better. We still can't pay any bills with little to no income coming in. And yet, we're living and breathing, so that's something.

Not too long ago, I wrote a post about the way my medications might interact with each other. What triggered that post was that I was supposed to start taking seroquel for my mood swings and I was horrified to read that I shouldn't take it if I have diabetes, high blood pressure, high cholesterol and am overweight...well, I am all four!

I wish I'd researched things like metabolic disorder and pre-diabetes while I still had the chance to reverse what was going on. I wish I'd listened to my midwife 20 years ago when she told me, "If you don't get the weight off now, you'll have trouble losing it later." I wish I'd been stricter with myself.

Okay, enough self-pity. Now I am more careful about what I take. I wish I could say the same about what I eat but I'm getting there. Recently, I got this article in my mailbox from About.com:

Bipolar Disorder Meds Increase Risk of Metabolic Syndrome and Type 2 Diabetes
From Debra Manzella, R.N.,


Metabolic syndrome is a collection of conditions, including insulin resistance, that can often lead to a diagnosis of type 2 diabetes if it is not reversed with diet and exercise. But sometimes factors beyond our control may cause metabolic syndrome.

Bipolar disorder is a medical condition with symptoms that include extremes of mood known as depression and mania. Many of the medications prescribed for bipolar disorder can place people at risk for developing metabolic syndrome.

According to the online journal, Bipolar Disorders:

"The prevalence of the metabolic syndrome in patients with bipolar disorder is alarmingly high, as it is for the general population.

The prevalence of obesity is even higher than the already very high prevalence that has been estimated for the US general population."

Many of the medications used to manage bipolar disorder are thought to contribute to the risk of developing metabolic syndrome and type 2 diabetes. Not all medications used for bipolar disorder cause metabolic symptoms but the medications listed here are more prone to causing weight gain, insulin resistance, hyperglycemia (high blood glucose levels) and other signs associated with metabolic syndrome.

* Olanzapine (Zyprexa) - weight gain, hyperglycemia
* Sodium valproate and valproic acid (Depakote) - weight gain
* Clozapine (clozaril) - weight gain, hyperglycemia
* Quetiapine (Seroquel) - weight gain, hyperglycemia
* Risperidone (Risperdal) - weight gain, hyperglycemia
* Lithium - transient hyperglycemia

Many physicians have become aware of the implications of bipolar disorder and the accompanying medications on the development of metabolic syndrome and diabetes. According to the online journal, Psychiatric Times, of January 2007:

"Considering the emerging recognition of the true enormity of the metabolic consequences of bipolar disorder, drugs with an advantageous metabolic profile should be considered as first-line therapy in the long-term management of this condition."

In other words, medications that don't cause the symptoms of metabolic syndrome should be prescribed first. Only if those drugs are ineffective in treating bipolar disorder, then should the drugs that are likely to cause metabolic syndrome be prescribed. Also if patients are on those drugs, they should be monitored for weight gain, high cholesterol and insulin resistance and glucose intolerance.

Yup, there it is again--seroquel. I know that my nurse practitioner says it causes complications only in higher doses but I'm glad not to be taking it. I'd rather stick with the "drugs with an advantageous metabolic profile."

Thursday Thirteen #131: My Prescription Interactions

When TB and I went to see that snotty pain management doctor who wouldn't administer the spinal epidural last October because he said he was afraid TB would break his table (yes, he said that), he also said something else that scared us then. He looked at the list of meds that TB and said something to the effect--with your size and sleep apnea I'm surprised you haven't passed away in your sleep. When TB said he uses a C-PAP machine, the doctor said well, that's probably what saved you this far.

That was a shocker. And then there is what happened to Heath Ledger--this seemingly healthy young man died from a combination of legally prescribed medications. It hasn't been that long since Anna Nicole Smith and her young adult son also died of an accidental overdose, a combination of medications.

I had to go online and look. My Thursday Thirteen this week is:

13 Scary Interactions My Prescriptions Can Cause

1. Cymbalta and Zoloft can have a major drug interaction, causing a rare but potentially fatal serotonin syndrome. I later learned that this syndrome killed an 18 year old college student--it can happen to young healthy people as well as folks like me within hours of taking too many meds that overstimulate brainstem receptors.

2. Lamictal and Zoloft have a moderate drug interaction, working together to repress the respiratory system.

3. Cardizem and Lorazepam also have moderate drug interaction. They can work together to cause low blood pressure and depress the central nervous system.

4. Lisinopril and Lorazepam, moderate drug interaction, also can work together to cause low blood pressure and depress the central nervous system.

5. Lorazepam and Zoloft, moderate drug interaction, can combine to repress the respiratory system.

6. Lisinipril and Zolpidem, moderate drug interaction, can cause low blood pressure and depress the central nervous system.

7. Lisinipril and Zoloft, same as #6

8. Zoloft and zolpidem, moderate drug interaction, can cause central nervous and respiratory depression--especially in elderly or debilitated patients, non-ambulatory, I'm assuming

9. Zolpidem and Lamical, same as #8

10. Cardizem and Zoloft, moderate drug interaction, can combine together to form higher levels of the drugs that have to be metabolized by the liver.

11. Cardizem and Prevacid, same as #10

12. There are up to 2,354 other medications that interact with the ones I'm prescribed

13. There are lots of moderate food interactions with drugs I wasn't aware of. Grapefruit is a big no-no and I eat that all the time!

Heath Ledger was taking six medications with moderate drug interactions that combined to overwhelm his respiratory system. I'm thinking he stopped breathing while he was sleeping and didn't wake up again. When his breathing stopped long enough, his heart arrested.

I think that's what that snotty doctor meant when he said the C-PAPs probably saved us. A C-PAP provides continuous forced air even if you stop breathing, as happens with sleep apnea.

Do the benefits of my meds outweigh the risks? I take Cardizem and lisinopril because of high blood pressure. I take Prevacid because I have gastric reflux and also because of the pain meds I take. Cymbalta treats depression and fibromyalgic pain. Zoloft is an antidepressant and zolpidem is a sleep aid--Ativan. Lorazepam treats anxiety/panic attacks. Lamictal is a new kid on the block, prescribed because it seems I am bipolar. I am thinking that with the bipolar diagnosis, I want to get off the Zoloft and stop the Ativan.

I already have an appointment to talk to the doctor.

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Wake up, this is scary!

Like others, I was totally shocked when Heath Ledger died. He was so young, only 28 years old, and seemingly in good health. When the initial autopsy reports came back inconclusive, I had the horrible sinking feeling that he died from an accidental overdose of medications prescribed by his doctors. Today's report from the New York medical examiner confirms it. It's so sad that such a talented young man died but what is truly scary is that he wasn't abusing his medications--he wasn't necessarily even taking high doses of them. His father said,

"While no medications were taken in excess, we learned today the combination of doctor-prescribed drugs proved lethal for our boy. Heath's accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage."

Hidden dangers is right! I went to a website that will check drug interactions of prescribed medications and all the stuff Ledger took warned of "moderate" drug interactions--all of them depressed his respiratory system. Then I plugged in all the medications that I take and almost totally freaked out!

What are doctors thinking when they prescribe this stuff? All of them ask you for a list of meds when you go see them. None of them has ever told me about the possibilities of some of these interactions--I probably wouldn't be taking the stuff I am now had I known. Two of the meds I take for depression can cause a major interaction called serotonin syndrome. It says doctors should monitor patients "closely"--well, what does that mean? I don't particularly feel like I'm being closely monitored by any of my doctors except for the internist--for diabetes.

It's not just the depression and anxiety medications interacting with each other. They also apparently interact with the blood pressure and thyroid medications too, and all of those interact with each other. It's really scary! I'm sure that in many cases the benefits outweigh the risks but still! I printed out my report and will be showing them to my doctors. This is why patients have to question the doctors carefully when they're prescribed something.

I bet Heath Ledger never thought something his doctors would prescribe for him would work together to kill him!