Archive for the 'Mental Illness' Category
Clozapine is a powerful antipsychotic drug. I was prescribed clozapine to contain my psychotic delusions when I was in hospital.
Clozapine is generally prescribed after other antipsychotic drugs have failed. This could be because of side-effects, or because it’s not working, etc. In my case I started on olanzapine, then I was put on risperidone, and finally I was put on clozapine which I’ve been on since (at the time of writing).
The clozapine had an almost immediate effect; say two weeks and getting stronger from there). For me it meant that I was bumped out of my euphoric bubble and was forced to face reality again. I clearly remember thinking “something isn’t right”, but it still took me a long time (years) to figure out what was real and what wasn’t. That was without doubt the hardest part.
The thing is that everything seems to make perfect sense when you’re delusional (courtesy of the chemicals in your brain who start), and even after all the treatment I still sometimes wonder what the hell happened.
It raises a lot of questions that’s for sure. For example:
- What’s real?
- What thoughts are mine?
- What thoughts can I trust?
- What’s my purpose?
- Why am I here?
- Does God exist?
If you find yourself stuck with those questions, ask yourself this one instead: “What can I do to turn this around?“. That’s a far more powerful question to ask yourself, and it will help you through. Also a good idea is to answer those questions while you’re feeling good, so that when you don’t feel so good you have some answers ready. Otherwise you’ll just end up running around in circles for a long time like me. 
History
Clozapine was created in 1971, but wasn’t always the wonderdrug that it is now. In 1975 the manufacturer withdrew it from the market because of the severe side-effects. In 1989, after studies showed clozapine was the best antipsychotic drug around, the FDA approved it again.
Blood tests
Users of clozapine also have to take regular (every four weeks in my case) blood tests to make sure that the white blood cell level is still okay (a possible side-effect of clozapine is the reduction of white bloodcells). White blood cells are very important of course so it’s important not to miss any tests.
I’ve come to know the staff of the medlabs quite well over the years.
Side-effects
There are several possible side-effects with clozapine; here are the ones I experienced:
- Drooling while sleeping (there are special pillow covers for this – no longer an issue)
- Weight gain (always feeling hungry and gained 20 kgs in no time – the fast food restaurant within walking distance from the hospital didn’t help of course – hmmm comfy food)
- Thirty minutes after taking clozapine I fall asleep
- Initially I slept for 10-11 hours, then gradually back to 10, and now down to 9 1/2 (any less and I don’t feel too good the next day – this also requires a bit of planning for waking up at the right time)
- Sleep really deeply (I don’t wake up for anything)
- Wake up groggy (used to take 30 minutes to properly wake up, now I’m much more alert)
- No dreams for years (except for the odd one)
- Brain fog during the day (hard to focus/concentrate – now much better)
There is also medication to treat some of the side-effects (like drooling), but that medication can then have side-effects of its own. Doh! Strange concept really. For me the drooling stopped when the dosage was reduced far enough.
Tip:
Don’t drink heaps of water before going to bed (say 2 hours). I’ve had to be rescued from being stuck inside the wardrobe several times by my wife in the middle of the night as I had absolutely no idea where I was (and more importantly where the toilet was).
Whether you like clozapine or not, I think it’s absolutely incredible that it works at all. I simply can not imagine what my life would have been like without it, and I think it’s something to be thankful for (side-effects or not). In other words; it does the job – eventually.
Dosage
Clozapine is generally reduced in small steps, so it may take a while to get back off it.
I started out on 300 mg, and I’m now on 87.5 mg (at the time of writing).
The dosage itself can have a big effect on how you feel and function. Every time my dosage was reduced I felt clearer in my mind, or was able to get up earlier, and even write clearer articles (starting earlier this year). So in many ways your thinking changes.
There are no hard guidelines for when to reduce clozapine, so the doctors generally try and get an idea of the state of your mind. When the more logical thinking returns and your handling it well, they might reduce it further, etc. If you’re thoughts are still chaotic then you’re likely to stay on your current dosage a bit longer. This has happened to me several times, and it’s no big deal. Good things take time, and there’s no need to rush these things.
I generally know when I’m ready for another reduction (able to handle the current dosage, and feeling good, etc), and will then ask them for it.
More information
Your doctor should have informational pamphlets about clozapine; best to start there.
For additional information check out the Wikipedia/Clozapine page. Their research on clozapine is very extensive (albeit a little bit more technical).
If you can talk to people who are also on clozapine then try and exchange experiences with them; you might both learn something new.
July 22 2009 | Mental Illness | Comments Off
This is an update to the Holistic Approach article I wrote approximately two months ago.
Diet
By far the biggest impact on my health must be the realization that food intolerances can seriously disrupt how your body (and brain) works. As far as digestion goes, the brain is just another secondary organ; no special treatment whatsoever.
I almost immediately noticed more clarity in the first two weeks of sticking with my (rather restrictive) diet. Although I’m not always as sharp as I want to be, it’s definitely an improvement over the “eat everything you like” diet. Some of my diet changes (caffeine, sugar, and fizzy drinks) are actually common sense, and I feel somewhat silly at times for not realizing this sooner. I never thought they could worsen (or even create) my mental illness, but that’s life I suppose.
I must admit that at some point I got a bit more casual with what I was eating, venturing out into things like chips, sushi, bran-muffin (no sugar). All things I thought wouldn’t really be a problem. While I was eating these items within days I started feeling way more tired than before. When I discussed this with my wife she pointed out that a lot of those items have ingredients that were in fact not so good for me. So from that perspective the diet I’m on has been a real eye opener and at times a big learning curve (still learning every day).
We’re now also getting more food from the health stores, etc. Would you believe that I actually found Apple/Date cookies I can eat. Two months ago I wouldn’t have even looked at them, but now that my taste buds have been restored I’m starting to really enjoy all the things I never really considered before. I suspect this is because the removal of sugar from diet has reactivated my taste buds. Yummy!
Going on a rather restrictive diet like this is definitely more expensive (ingredients) and time-consuming (reading the labels, thinking about dinner for the entire family, etc). Going out for lunch/dinner is also a lot harder of course, as it’s not always clear what ingredients have been used. If you want to get better though, this is definitely the way to go! And making your own Muesli is kind of fun after all. 
I’ve also learnt more about managing my blood sugar levels more. For example, I now only eat fruit with my meals, and I’ve also added some more protein to lunch (eggs), etc. I’m also still using a glucose manager supplement as recommended by my nutritionist.
Weight loss
I finally got back in the 80s with my weight again (89′ish at the moment). This is awesome because I’ve been trying to achieve that for months. It’s interesting because initially I actually had set that as a primary goal and got nowhere with it. This time it just happened naturally because of the change in diet. I see my weight now more as a side-effect of my lifestyle.
Reduction in medication
I started feeling so good (no real depression), that I asked my doctor if I could reduce my clozapine dosage. They agreed and I’m now back down to 87.5 mg (a 12.5 mg reduction). I haven’t really noticed any differences yet though. I’ve asked for an appointment so we could reduce it by another 12.5 mg. That should definitely be noticeable.
Interestingly enough, somebody pointed out to me that doctors may not want to reduce clozapine all the way to zero because of the higher relapse possibility. This is a tough pill to swallow because I was originally planning to be clozapine free in 2010, and I now need to consider accepting a certain amount of clozapine in my life for a longer time. From a doctor’s point of view it does make sense to reduce the clozapine to an acceptable ’safe’ level where one can function ‘normally’ – an acceptable way to live so to speak. I don’t know what I’m going to do yet, but for now I’ve readjusted my goal to down to 50 mg by the end of the year. From that point I should be able to judge for myself whether it’s worth going any further with the reductions.
Health Group Meeting
I’m finding the health group meetings really enjoyable. I’m getting a lot out of it; just seeing people in similar situations makes me feel less alone, and I’ve picked up a lot of things I didn’t know as well. So far, we’ve had casual chats, deep spiritual conversations, medication discussions, etc.
I also enjoy the opportunity to simply share my own experiences, especially when somebody finds them useful.
July 14 2009 | Mental Illness | Comments Off
Managing your medication plays a vital role in your recovery from mental illness, so I thought I’d share my ’strategies’.
I don’t particularly enjoy doing all the refill and repeat stuff, but since it’s a big part of my life I might as well try and make it as painless as possible.
Tools of the trade
Because I need to take my medication at various times of the day I just tend to carry them all with me in what’s called a “medication organizer” (or pillbox).
Top to bottom: Supplements, Lithium, Clozapine, …
The box will hold a week’s supply of medication, and has 4 compartments for various times of the day. Each day has a vertical plastic slider so you can easily open the compartment you want and tip the box upside down (to get them out) without leaving them all over the floor. Works really well actually.
The orange bit of paper is a reminder for myself that I need to get more medication (and in my case also a blood test). When I’ve just received a new repeat I simply clip the orange reminder to the bag with the new medication. When I run out of medication I put the orange reminder in the box so I can easily see it, and know that it’s time for another repeat and blood test.
Refill when empty
One of the rules I have with regards to refilling my box is that it needs to be done when I’ve run out. If I don’t do that it’s much easier to forget them the next day.
I don’t always feel like refilling it immediately, but the alternative (grabbing what you need from the individual pill bottles) is far worse as now you effectively have to do it twice.
The fewer annoyances you have while taking your medication the better.
Repeats
I generally get about 3-4 repeats on one prescription, and my chemist will (almost always) let me know when I’m about to run out. Sometimes they even put a big orange sticker on the bag itself. Either way you can always ask them and make a note on the bag itself. I’ve found the staff of the chemist I go to very friendly and helpful.
Before I used the orange reminder I ran out of my prescription once or twice without having any pills left (oops). In that situation they can generally give you your medication for say a day at the time. This is generally long enough to sort something out. Your doctor/nurse can also fax the prescription if needs be.
Medipack
If you don’t like any of this there’s also something called a Medipack. It’s very much like having a medication organizer, but now all compartments are separate from each other and wrapped in plastic. This way you can easily tear off Monday-morning and take it to work. More discrete if you like.
Try it out once if you think that a Medipack is for you.
Taking medication in public
When I was in hospital for a mental illness everybody knew, so I decided early on not to hide my medication. I just take them to work and take them as required. I’ve been asked about them only once and I jokingly said that they were brain candy. Everybody else at work already knows I have a mental illness and they don’t even pay attention to it anymore.
The reason I don’t want to hide my medication is because I feel they are a part of me, and that there’s no reason to hide that. The worst thing that I reckon can happen is that someone asks and then you’ve just been giving an opportunity to talk about mental illness to someone. You can explain to them what mental illness is about and as a result they might develop a deeper understanding of it. That will undoubtedly also affect other people in that person’s life, so you can’t go wrong here really.
Miscellaneous
Going on a holiday or overseas can be somewhat of a logistical nightmare, especially when crossing several time zones. It doesn’t matter for me when I take my Lithium, but when I take the Clozapine I’m a zombie for 10 hours – not a good look when you’re on a plane. Definitely talk to your doctor before you go.
I’ve forgotten to take my medication once or twice (oops). Definitely discuss what to do with your doctor as your medication will almost certainly be different from mine. From my own experience; taking a double dose of Clozapine (to catch up) really is a good incentive to remember it next time.
If you get an aftertaste after taking your medication try having your medication with some food. I often eat something first, then take my Lithium and follow it with some more food. Lithium sandwich -yum!
Conclusion
It’s important to stay on top of your medication as it leads the way to recovery. I can not stress this enough.
If you think your medication is not good for you, never just stop taking it – always run it past your doctor first.
Suddenly stopping your medication may have undesired side-effects. I switched medication twice (while in hospital) and each time the old medication dosage was reduced first while (simultaneously) increasing the new medication dosage. In both cases my psychosis temporarily flared up, that’s the last thing you want.
It’s important to take your medication at regular times so your body gets used to it. Make taking your medication at fixed times a habit so that it becomes almost impossible to forget.
Make it fun. I know, I know, but let’s face it – you’re going to have to take them anyway so you might as well have some fun with it. I look forward to taking my medication at 1.30 pm every day because it is accompanied by a treat!
Hmmm… Scooby Snack!
June 26 2009 | Mental Illness | Comments Off
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