I’ve been meaning to write an update for this blog for a couple weeks now, but I only seem to think of it when I’m climbing into bed for the night. Today was lucky in that I thought of it a few hours before bed, so here we go.
Last post, I was doing pretty well. I expect to make another addition to my CPTSD posts next within a timely manner, but first there are some more updates to address in my personal life/mental health journey.
I’ve probably said in at least one previous post that, according to my psychiatrist and all research I’ve done too, bipolar people tend to need more mood stabilization in the summertime and more depression control in the winter. Bipolars tend to be influenced by the weather, length of days, that sort of thing. So, with that, our winter in Missoula is drawing to a close (though it was a pretty mild winter, all things considered). Even though it was mild, the days were short and dark, so the depression side of my bipolar needed more support, so I was on antidepressants. Venlafaxine (brand name Effexor). Just a low dose, because antidepressants make bipolars cycle more often than not, and mood stabilization is always the priority in a case like mine. We found a pretty good balance at a low 37.5mg venlafaxine ER, along with my 300mg lithium carbonate (mood stabilizer – my miracle drug, shame I can’t be on a higher dose due to CKD, as mentioned), 160mg lurasidone (antipsychotic/mood stabilizer, max dose), and an additional 8mg haloperidol (additional antipsychotic/mood stabilizer, relatively small dose as an “average” dose is 10+mg), as well as senna to manage constipation side effects from haloperidol and vitamins D3/K2 (the K2 helps with absorption? metabolization? something like that? of the D3). So that’s where we’ve been sitting at for the last couple months. And I had been doing fairly well until spring started.
Now that spring’s started, my mood started cycling. I’ve been feeling pretty low off and on with some mild depression taking hold, but it hasn’t been a flat depression. In the past with past psychiatrist nurse practitioners, this is where my doctor would have upped my haloperidol for the mood stabilization. However, this leads to an endless cycle of upping mood stabilizers, then antidepressants, then mood stabilizers, and back and forth over and over. It wasn’t until my current doctor that I realized how significant the seasons and sleep schedules are for bipolar people. So with my mood cycling due to the weather, he took me off my antidepressants, since I was already at such a low dose anyway.
So far, so good. I’m experiencing some Antidepressant Discontinuation Syndrome (ADS) symptoms, such as sweating, chills, insomnia, and sensory disturbances, but not so far as brain zaps (see Episode 27 – Antidepressant Discontinuation Syndrome for more on ADS). I suspect my body is very sensitive to changes in medications, and an antidepressant like venlafaxine would be expected to have effects anyway, even though it was such a small dose. My psychiatrist almost wants to change me back to duloxetine (Cymbalta) because he believes the ADS symptoms would be better, and it’s expected I’ll need to be on and off antidepressants based on seasons regularly, but I believe venlafaxine is more effective for me and maybe the ADS symptoms in between seasons are worth it.
I stopped venlafaxine last Tuesday, so I’ve been off of it for about four days now. No brain zaps so far, which is nice, but I definitely feel… off, in the familiar way I always am when stopping antidepressants. It’s almost like I’m under the influence in that my brain feels a little… sharper yet sluggish, slow somehow, like I can feel the precursors of brain zaps but I haven’t had any of them yet. And the last two nights I struggled to fall asleep for any meaningful amount of time. Last night I got around three broken hours of sleep around 6-9am, and the night before I don’t believe I got more than two. I don’t know what else would be causing the sleep disturbances other than stopping venlafaxine. Tonight I plan on taking some melatonin to maybe help with that part, though typically that doesn’t help me fall asleep. It just makes me uncomfortably tired.
Anyway, I don’t expect the ADS symptoms will last more than a week, since I’m coming off such a low dose. In the past, my ADS has lasted sometimes up to a month. But that was when I was coming off a high dose of antidepressants, and I would have been feeling brain zaps by now for sure. So it’s promising that I’m not experiencing those.
My last blood work for my nephrologist came back at 1.45 creatinine and a GFR of 51, as opposed to the last 1.58 and 46, when she was insistent that I stop lithium. Upon further review of past records, and with the inclusion of these latest results and a discussion with my psychiatrist, she has settled for me staying on lithium with the tentative idea that my kidney results are not directly tied to my lithium use. After all, a few years ago I was up to 900mg lithium and my kidney results were no worse at the time, and they didn’t improve upon my going down a few doses, so my psychiatrist is fairly certain that my problems aren’t lithium-related. I suspect my nephrologist is jumping her guns for the easy answer when maybe it’s an even easier answer – my NSAID use as a kid, and the resulting damage from it. As for now, I still have an appointment and lab work with her next month, but she’s entertaining the idea that my problems aren’t due to lithium, since I’ve had somewhat stable creatinine and GFR results since early 2022, when I started lithium.
I had another nerve block for my occipital neuralgia again back at the end of March. By the beginning of March, I was back up to 3-5 headaches per week, ranging on the pain scale from 2’s to 8’s. They largely responded to Tylenol, but after seeing what ibuprofen use did to my kidneys, I’m hesitant to rely on even OTC pain relief for extended periods of time. I had breakthrough headaches for about a week after my shots, but they seem under control again. I suspect I should aim to get the shots every 3 months or so, as that should overlap the breakthrough symptoms a little bit. That’s not too bad a price to pay for the pain relief.
Other than that… I’ve been feeling extraordinarily unmotivated most days. I think it’s related to the mood cycling, as I tend to slip into a lot of depression even when cycling, and it’s just too much to do too much on any given day. Hopefully as these ADS symptoms wear off and I recover again it gets easier to get back into streaming and pursuing things I like to do.
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