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Unread 08-26-2009, 05:38 PM   #1
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Trig How do you know if you are being overmedicated?

My biggest mental health issue as I see it has been PTSD following assaults by a violent boyfriend that ended in tragedy. I have dealt with this about as well as anyone could, I think, and want to move on with my life.

I am also diagnosed with ADHD and bipolar. As I have reached mental-pause age I have had wider swings in mood and increased fatigue and insomnia. Not manic though because I have no energy as in real mania. I think I probably had PMDD but was never diagnosed with that.

I suspect that I have had the ADHD and bipolar at least since college if not before. I remember one week during my freshman year that I only got five hours sleep total from Monday until Friday. I have always been happier when busy with tons to do.

Despite these mental health issues I was high functioning until the day that my BF came to the hospital where I worked and threatened to kill me there and I no longer had a safe haven. After my BF's death my doctor told me he was going to "shut down my brain" and hospitalized me for five weeks and put me on some heavy duty psychotropes. I was hospitalized perhaps ten times since then (mostly early after BFs death due to my guilt before I accepted that he had made the choice to use meth and that I had done what a reasonable prudent person would have done); last year for nonstop flashbacks after reading a news article I wish I hadn't read and then this year for what appears to be neurological (episodic aphasia with lower body weakness and difficultly holding my head steady) rather than psychiatric although my symptoms could be side effects of meds.

Earlier this month my doc stopped my xanax and temazepam (both hypnotics for sleep) while in the hospital but restarted the temazepam at lower dose so I can sleep. He reduced my clozapine (antipyschotic and mood stabilizer) from 250 mg to 150 mg. Kept selegiline (MAOI) at 10 mg, strattera (ADHD) 18 mg. Increased dilantin (mood stabilizer) from 12.5 mg to 25 mg twice daily. Added mirtazapine 15 mg to aid sleep and added zonisamide (mood stabilizer) 50 mg each day.

My mood fluctuates a bit but I have not been severely depressed or manic for a couple of years or more. For quite awhile I have been experiencing dizziness which is a side effect of several of my drugs. Prescribing drugs is what psychiatrists do so naturally my doctor would want to keep mixing the drugs to finetune me but I wonder if I really need these drugs or am I taking so many psych meds to keep him in practice.

I have some doubts about my doc. I was itching all over while hospitalized recently and he said he had not added anything new. I corrected him and said the cogentin was new. He said, well if I wasn't taking it before then I didn't need it. I had given a photocopy of my current drugs to be attached to my chart to help him recall my meds so in my mind that was unexcusable.

I have an appt tomorrow and would like to see my meds reduced. As a patient how do you know when you don't need a ton of meds?
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Last edited by January; 08-26-2009 at 10:14 PM. Reason: clarity
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Unread 08-26-2009, 09:33 PM   #2
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Default Re: How do you know if you are being overmedicated?

IMO, it's something you first need to bring up with your doc. (If s/he doesn't care about your concerns, that's not a good sign.)

Sometimes the only way to examine the question is to reduce or stop a med that you suspect may not be helping. But a doc should absolutely supervise, and care must be taken. My doc recently gave me the OK to try stopping Abilify. It was a disaster!

I'm not medically trained at all, but based on the substantial trauma you have experienced plus your diagnoses, it wouldn't surprise me if taking several medications will really help you. (I currently take 7, and I don't think I have been through what you have!) But it is a very good question to ask, I think.
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Unread 08-28-2009, 01:26 AM   #3
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Default Re: How do you know if you are being overmedicated?

I think it's a good discussion to have with your doctor. Maybe you don't need all those. You are on 3 different mood stabilizers. Are all 3 necessary? Have you seen any benefit from strattera? Many people with ADHD are not helped by Strattera (but some are). If you have never seen a benefit from Strattera with your ADHD symptoms, then that is one that might be eliminated. You are on 2 different meds to help with sleep. Are both necessary? I'm not saying they aren't, just that drugs with a similar function might be among the first that could be reduced or eliminated. One thing to worry about when taking many different drugs is that strain it puts on your liver to detoxify them.

It sounds like you have been through a lot and have really benefited from pharmaceutical help. How do you know when you may not need all the meds you are on? Great question. I think when you are feeling well, it could be that you don't need everything. Or when you are feeling worse on the meds than off the meds, that is another good sign to reduce.

What is the cogentin for?

Good luck.
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Unread 08-28-2009, 10:54 AM   #4
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Default Re: How do you know if you are being overmedicated?

I had a good discussion with my doc yesterday. We talked for over an hour. I left feeling supported. He agreed to DC the dilantin and zonisamide. I wanted to stop the clozapine but he felt I needed that one so it stayed. I like what I have been reading about the selegiline so wanted to keep that one. He agreed to increase my Strattera from 18 mg that I was taking in the hospital back up to 40 mg because I had been taking 40 mg at home because that is the dose of my samples. He agreed to add some xanax back prn since my sleep has been interrupted since DCing it; will trial temazepam awhile longer at 30 mg and if no sleep improvement will email and discuss bumping back up to 60 mg where it had been for two years. He said to play with the mirtazapine and see if 7.5 mg works as well or better than 15 mg.

The previous day I had met with my therapist and she said he might not allow me to return to work as a RN on so many meds. He and I talked about that and he said he had no problem with me returning to work now per diem and he also said that he thought returning to grad school for a doctorate in management and nurse anesthesia was within my grasp. That was a big atta girl I needed to hear.

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What is the cogentin for?
Cogentin is to reduce side effects from psych meds. I thought it logical to prescribe that because on admission to the hospital he said he thought I might be toxic on some psychotropes. But when he didn't remember adding it after I mentioned it he then DCd it.
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Unread 08-28-2009, 11:18 AM   #5
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Thumbs up Re: How do you know if you are being overmedicated?

I think you have a keeper as a doctor! He sounds like he's caring about, and listening to you.

Small steps.... it's easier to add on slowly than to heap on and then feel like a failure when you can't succeed.

Per diem work sounds wonderful! That is a positive in so many ways!


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Unread 08-28-2009, 11:47 AM   #6
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Default Re: How do you know if you are being overmedicated?

Quote:
Originally Posted by _Sky View Post
I think you have a keeper as a doctor! He sounds like he's caring about, and listening to you.
Actually I started off the meeting by confronting him with some things he had said that I thought rude and asked him if he was burned out. He has his moments where he can be a real ****. I told him that but said I put up with his **** because he is so damn bright. We got into a discussion of personalities and he said I was a C. There was only one word that came to mind starting with c and I can't post that here. He did say that he loved me. We get along pretty well and it is great that we are both comfortable to confront the other when we have our moments. I think we both share an odd sense of humor which really helps. I was mentioning that I recently got a three month ban from an internet community for posting ****tard and he said I seem to get banned everywhere. I was like "huh"? He reminded me of the partial care program I attended and raised hell about an incompetent therapist and filed a written complaint against their psychiatrist for very valid reasons. The program was not used to seeing people with good self esteem who acted in such a manner and they didn't know how to deal with me so they banned me from their program. Ah yes, Yoda, the rebel. LOL.
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Last edited by Christina86; 08-28-2009 at 10:15 PM. Reason: swearing
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Unread 08-28-2009, 03:30 PM   #7
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Default Re: How do you know if you are being overmedicated?

Quote:
Originally Posted by Yoda View Post
Actually I started off the meeting by confronting him with some things he had said that I thought rude and asked him if he was burned out. He has his moments where he can be a real ****. I told him that but said I put up with his **** because he is so damn bright. We got into a discussion of personalities and he said I was a C. There was only one word that came to mind starting with c and I can't post that here. He did say that he loved me. We get along pretty well and it is great that we are both comfortable to confront the other when we have our moments. I think we both share an odd sense of humor which really helps. I was mentioning that I recently got a three month ban from an internet community for posting ****tard and he said I seem to get banned everywhere. I was like "huh"? He reminded me of the partial care program I attended and raised hell about an incompetent therapist and filed a written complaint against their psychiatrist for very valid reasons. The program was not used to seeing people with good self esteem who acted in such a manner and they didn't know how to deal with me so they banned me from their program. Ah yes, Yoda, the rebel. LOL.
YOU GO, GIRL!!!

I read all your posts with much interest. I like reading posts when there is a lot of info on prescribing meds cuz I learn a lot from them.

Same thing happened to me when I was put into a rehab hospital after breaking my femur into four pieces. All the other patients there were over 70 and the nursing staff were horrible! I felt so sorry for the patients. They kept giving me the wrong meds, and kept lying to me about what the meds were that they were giving me. I threw a hissy fit one evening which resulted in them calling a supervising RN in from her baseball game to negotiate with me. She struck a deal with me that they would give me the pain meds on time if I would simply calm down. I said, that's all I want and I want them to give me the right ones and not lie to me. They were glad to see me go.
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Unread 08-28-2009, 04:12 PM   #8
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Default Re: How do you know if you are being overmedicated?

Quote:
Originally Posted by Vickie in Phoenix View Post
YOU GO, GIRL!!!

I read all your posts with much interest. I like reading posts when there is a lot of info on prescribing meds cuz I learn a lot from them.

Same thing happened to me when I was put into a rehab hospital after breaking my femur into four pieces. All the other patients there were over 70 and the nursing staff were horrible! I felt so sorry for the patients. They kept giving me the wrong meds, and kept lying to me about what the meds were that they were giving me. I threw a hissy fit one evening which resulted in them calling a supervising RN in from her baseball game to negotiate with me. She struck a deal with me that they would give me the pain meds on time if I would simply calm down. I said, that's all I want and I want them to give me the right ones and not lie to me. They were glad to see me go.
Right on!!!! Sometimes a hissy fit is just the right thing to do.

Once I was in the psych hospital and I asked the RN to call my doctor because I needed X. She lied to me and said she had called but didn't. The next day I asked my doc why she had refused to give me X and she said nobody called. I was pissed. My doc was pissed. Both my doc and I complained to the unit manager about that RN. A few years later I was in a different hospital and my BP was running very very high. I asked for them to recheck it later and they refused. I was dizzy and wanted to know what it was. It seemed simple to me but she was adamant in refusing to recheck it and I said fine, if you don't recheck it I am signing out AMA and going to the emergency dept. She then said, "you don't remember me, do you? You always have been a troublemaker". That was when I realized she was the RN I had reported at the other hospital. Way below the standard of care and unethical too. I was so mad.

Normally I am a very patient, easygoing person and go with the flow. Yeah I am a rebel and strong willed but I avoid conflict. But there are times you have to respectfully stand up for yourself. I don't usually tell folks that they are acting like a d*** but I have known my pdoc for fifteen years and I know he is cool enough to joke with.
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Unread 08-28-2009, 05:35 PM   #9
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Default Re: How do you know if you are being overmedicated?

Hmmm I used to instruct others in determining personality types and strengths...way back when.... used A B C... C being a "Carol" outgoing, gregarious, wanting to know everything now so as to fully determine the whole situation... (can't recall the other two names, A, B... but one was quiet and needing to be shown how to do everything, step by step...)

Most doctors I know, including myself, can be rather difficult at times. Most people I know are that way too.
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Unread 08-29-2009, 07:38 AM   #10
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Default Re: How do you know if you are being overmedicated?

Quote:
Originally Posted by Yoda View Post
He and I talked about that and he said he had no problem with me returning to work now per diem and he also said that he thought returning to grad school for a doctorate in management and nurse anesthesia was within my grasp. That was a big atta girl I needed to hear.
This is great - what a supportive doc! Even if he said you are a "C"

It's great that you are open about how things are going with you, that's so important. (If anything I tend to underreport my symptoms.)

And being a rebel in the face of incompetence is always good...
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