(Previous in my therapy thread: Session 3)
The Friday after my 3rd psychologist session was my appointment with the psychiatrist. My wife had called ahead and had them fax us the paperwork so I could fill it out before hand. Along with the normal contact, insurance and medical forms, I had to fill-out 3 or 4 different mental health questionnaires. One was more focused on Bipolar, another was for schizophrenia, and the others were for depression and general mental health. Filling those things out was slightly confusing, because I was filling them out after the actual reasons that I went into therapy had passed. I did my best to answer them by my current state, and slightly bumping them into the direction I have known I go to in the past.
We were lost on our way to the office, and eventually made it there a little bit late after calling them on the phone and getting better directions. Apparently, maps.google.com always gets it wrong for their office. They are in a newly developed area, so I’m sure Google is just behind on getting it’s information up to date. I was a bit stressed out by the time we finally pulled up and headed inside. The doctor was a little late getting back from lunch so it ended up being just fine that we were 5 minutes late.
After checking in with the front desk, they handed me one more paper to fill out. I let my wife do most of the writing since her handwriting is much clearer than my own. I had to fill out one more series of questions, and then waited a couple more minutes for the doctor to be ready for me. I was called back into his office and I took a seat on the couch. He looked like a nice guy and gave a chuckle at what I had written for one of my answers. The question was regarding the reason for seeing him, and I answered "to be normal." He said that it is a hard task that I ask of him.
He starts in asking some of the exact same questions I had already filled out. I’m guessing he has us fill those things out so we have already thought through the questions and have some type of answer already prepared. Also, I’m sure he is looking to see what we wrote down for a self appraisal versus what we say out-loud and his appraisal. I don’t know exactly, but those reasons seem likely to me. He goes down the questions relating to specific disorders, and starts honing in on a couple of areas and asking for more details on certain responses. For a good majority of the questions I answer that I don’t suffer from the problems, but have family members that have, and I explain to the degree they suffered.
I tell him about some of my past history in northern Idaho, and how extreme the conditions were growing up. I explain to him that it is impossible for me to turn my thoughts off. They are always going. It takes me 3-6 hours every night to get to sleep. I have panic attacks every couple of weeks. Have flash backs to previous events in my life. I don’t hear voices, or anything like that, but it feels like I always have 6-8 different conversations or thought processes going on in my head all the time. They are all me, nothing that I feel is “external.” After a while of talking to me, he asks if he can bring in my wife. I don’t have any problem with that, it will be good for him to get her point of view on me and my actions.
My wife comes in and takes a seat next to me and the psychiatrist asks her questions related to those that I answered. She does really well answering most of the questions. Some of them I could tell she wasn’t quite sure what he was asking, but he always clarified and had answers to what he was looking for. He is a very nice guy, well spoken and I felt very comfortable around him.
Finally, he says he thinks he knows what he wants to suggest we do for treatment. He starts by saying that I’m not psychotic, and that is not too surprising to me. He does say that there is probably a underlying genetic predisposition considering all my family members that have been diagnosed and from what I have explain about my parents. He tells me he is suggesting putting me on a very low dosage of an anti-psychotic. If there is anything genetically there this should help correct it. Not only is it used as an anti-psychotic at a higher dose, but at a lower dose it is prescribed for major depression. He explained that because of genetics, your brain is pre-disposed to function more a certain way, and then with childhood your brain develops even more differently depending on your experiences. It was as I had always thought was the case and talked with my wife about that exact thing in the past. I’ve been hit with both whammies.
I’m very happy about this, and everything he is telling me makes perfect sense. I wouldn’t be surprised at all, if there are some things there in my brain from genetics. I’ve worked so hard all my life to keep everything in check, not to be like my sister, parents and other family. Inside my head it’s a full day’s effort just to keep everything under control, but worth it, as it is the only way to survive and be functional. I can be a mess inside, but no one would ever know from the outside. I spend so much time and energy making sure that externally I’m calm, collected, responsible, etc. I’m at the point now where I’m just tired, I can’t do it every day all the time anymore. I’m not getting sleep, and I feel like I’m wasting 60-80% of my time and energy every day, and I’m still working my butt off so no one can tell.
He tells me he just wants to start me off on Abilify right away, low dosage, half a 5mg pill a day. I agree, it sounds like a great plan to me. I’ve read the series over at Corpus Callosum (Part I, Part 2, Part 3), regarding prescription and dosage selection process. I’m aware there is going to be a trial and error period involved and I’m fully looking forward to it. I get to be my own little science experiment. That is all he wants to do right now. He explains that I should take it right before bed because it can cause nausea and drowsiness. He also thinks it might help with the insomnia, but if it doesn’t we’ll get that figured out a little later on. He wants to see where this takes us for now and wants to see us in 10 days. He asks if I want his notes sent over to my psychologist to let them know what he has suggested and planned. I think it is a great idea and I fill out the release forms while scheduling my next appointment.
That night I decide I’m not going to read too in depth into the side effects because I don’t want to “taint” the results. I know that can be risky and everyone should be fully aware of what they are taking. I decide I don’t know, perhaps there is always a possibility that I could be a hypochondriac in some minor way and I don’t want to have any effect on this working. I’m going to watch it very closely and if I any strange symptoms start to develop, I’ll go read up on the side effects in detail. I do read all the major warnings and other documentation. I take my first half pill that night and head off to bed.
That first night was horrible, absolutely terrible. I always go to bed between 9 and 10 pm. If I don’t, I don’t get sleep. This night was not any different; I head to bed at 9pm and lay there. 6 hours pass by and I’m still just laying there not able to get to sleep at all, total insomnia. Finally, I dose off but wake up 20 minutes later from a really nasty nightmare. The rest of the night is more of the same. 20 minutes of sleep, not restful in anyway, delirious dreams (I’ve had heatstroke before and high fevers, and the dreams were of that sort) that turn into nightmares and I wake up. That morning I just feel awful, worse than as if I hadn’t had any sleep at all. I mope around all day, and I start to feel like I have the flu. My body starts to ache, I get a fever, slightly runny nose, light headed, dizzy, overall feel like I’m in a fog.
Considering I was feeling just fine the day before, and I usually start to notice the day before if I’m coming down with something, I decide to jump online and check the minor side effects. After a quick search and read through, my mind is put to ease about the flu symptoms. A few other people have suffered from the same thing and their effects went away after a while. I’ll pay close attention to make sure I don’t get worse. I read some good additional information about Abilify on epocrates.com, drugs.com, PDSHealth.com and emedtv.com.
The drug is pretty spiffy, lots of people like it because it affects 3 things at once. Many people were able to remove 3 medications and replace it with Abilify. It has a partial agonist activity at the D2 receptor; which means that it binds to the D2 receptor and makes it a partially more happy. D2 is a subtype of the dopamine receptor, schizophrenia can be caused by malfunction here, along with lots of other things. It is also a partial agonist at the 5-HT1A receptor; same as the effect on the D2 receptor, it binds to the 5-HT1a receptor and makes it partially more happy. 5-HT1A is a serotonin receptor and induces neuronal inhibition and controls behavior, such as sleep, feeding, thermoregulation, aggression, anxiety. Here is where I think it is hosing my sleep (insomnia) and my thermoregulation (fever). It is also is an antagonist on the 5-HT2A receptor; which means that it partially blocks the receptor and makes it less active. 5-HT2A is another serotonin type receptor and when excited by things like LSD cause visual hallucinations and other weird things, but Abilify makes it less exited. I’m guessing this is good for those that see people or hear external voices. Of course, all three of these receptors are seriously complex, and I’m no way trained to really know what the heck they do.
I suffer through the weekend feeling just miserable with flu like symptoms, insomnia, restless sleep, and nightmares. Monday rolls around and I head off to work. I feel sick all day long on Monday, and luckily the day was full of interviews since we were looking to hire another person for our team. I helped run through the interviews and then came home. We put a call into the Psychiatrist to see what we should do concerning the side effects I was experiences. Unfortunately, we missed his call back. Monday night was still bad, insomnia and nightmares, but Tuesday most of the flu like symptoms started to leave. I was still suffering from a fever, but the muscle aches, slightly running nose, and overall fog went away. I was still light headed and dizzy 5-6 times that day, followed by feeling nauseous. I also noticed something else; things seemed much quieter inside my head.
The only way I can explain it is like this, before I was on Abilify, it felt like I had 6-8 different conversations or thought processes going on inside my head. If I tried really hard, meditated or listened to some good ambient or techno music, I could get all of those processes working on one task at once. It was great for work, I could do the thought work of 2-3 people; it was very wonderful. The down side was it took so much effort and work to get them all going on the same task. Most of the time when I didn’t have to focus so hard, a couple of the processes would be off wandering, a couple more criticizing myself, others were thinking about the future and all the things that might happen next, lastly were some thinking about the past, or what I was currently working on. It was a real mess in my head, but I kept it together and thought nothing of it for many years. I’m not saying they were external, or not me in anyway. It was just like I had an 8 core processor going inside my head and I was always wearing myself out keeping them in check. Having 7 distorted thoughts (CBT) all at once is not fun, nor is it great when you get one shut down only to find 3 more waiting in the wings.
Now, on Abilify I noticed something different for the first time. A good majority of them were quiet. Wow! It felt like I had 2-3 and at most 4 thought processes if it was absolutely necessary. I’ve always had great hearing and sense of smell. I always hear things others don’t at first, or I am the first one to smell something. Those senses though, were always like triggers. I wouldn’t notice anything unless something was out of the ordinary. On Abilify, I can hear everything around me, the world, without having to concentrate, or be in “panic” mode that something is out of place. It is really quite different from what I’m used to. So, there are the upsides, less “noise” inside my head and I’m more aware of my senses all the time.
Here are the downsides I have noticed. Sometimes when I’m talking, I stop mid sentence, I quickly pick up what I was saying and finish the sentence, but there is a pause there. What is happening is, I’ve always thought through what I’m going to say completely before I say it. I used to be able to think that through, put that sentence on a back thought process, let it control my speaking while I’m paying attention to the other person’s body language, or thinking about what to say next, or thinking of the exact word to better modify the sentence I just thought of. Now, I still think the entire sentence through like I used to, but now I actually have to pay attention to what I’m saying as I’m saying it. If I let my mind wander, I stop speaking. I find it really quite funny. It is not a very big deal, and I think I’ll get used to how my brain works now, but it will take a little bit more time.
It is also a little harder to stay on task now. I used to be able to do all the grunt programming work, the boring task of just typing after all the design has been done, and think about other things at the same time. I used to be able to just put things on the back burner and they’d be done. Now I have to be “there,” and attentive of the task I’m working on. So I get more easily bored than I used to. I think I can deal with that too, given time to get used to it.
It truly is a compromise. I can choose to have lots of thought process available to me when I need them, have a more “noisy” head and not be on Abilify. Or I can choose to have it a little quieter, have to pay more attention and be on Abilify. Currently I’m choosing Abilify. I like it being a bit less noisy. I can still think just as deep as before. I’m still just as creative, and still can be random. It is just less noisy and less work to keep all those horses reined in and on task. It’s not foggy or slower or faster, I’m the same in all those regards.
That Tuesday my wife finally talked to the psychiatrist and told him about my side effects over the weekend. He advised me to stop taking Abilify for a couple of days to see if I started to feel better and then call him again on Thursday. I decided I was going to give it one more night, it would be 96 hours if I took it one more night. I had read that 96 hours was the point when some people had steady blood levels of the drug, I wanted to see how I would feel after 96 hours. That night I took my half a pill, and still had insomnia and nightmares. Wednesday I had a migraine and had to stay home from work. I worked from home off and on through-out the day and didn’t take Abilify that night. Thursday I was feeling better after finally getting some sleep. No nightmares and I was staying asleep for 1.5 hours at a time. By Thursday evening, I started to notice my head getting noisier as the drug was working out of my system.
Thursday nights are my psychologist therapy session nights, so I think I’ll stop here for now.
(Next up - Session 4)
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