This week when I went to my four-times-a-year med check, I told my psychiatrist that I thought I needed a change in medication. The previous time I saw him I had expressed concerns over assorted Life Stuff that was making me extremely anxious. Given what was going on in my life at the time, the anxiety was understandable.
Since then my anxiety has lessened somewhat, now coming out mostly as irritability and difficulty sleeping. And my depression now makes me feel like I have a low-grade fever – logy, listless, exhausted (which is not helped by the sleep problems) – plus the usual depressive numbness, lack of holiday cheer, and all the rest.
My psychiatrist listened to my symptoms, then discussed my meds with me. There were only two, both mood levelers, that he would recommend increasing. I chose the one that had had the most dramatic effect on me when I started taking it. So he increased the dosage from 200 mg. to 300 mg. We’ll see how that works out. I’m to call him before my next med check if I need to.
I’m used to changes in medications. It took a long, trying – even painful – time for my previous psychiatrist and me to work out the cocktail of drugs that would alleviate my seemingly treatment-resistant bipolar disorder. We tried various antidepressants, anti-anxiety agents, anti-seizure meds, antipsychotics, mood levelers, and I-don’t-remember-what-else. At last, when we were about to give up and try ECT, one of the drugs worked. It took some more tinkering before we got the dosages right, but for years now, I’ve been on basically the same “cocktail” of drugs.
Psychiatric Times, in an article on switching antidepressant medications (most of the literature seems to focus on antidepressants), reports that “approximately half of all patients fail to achieve an adequate response from their first antidepressant medication trial. High treatment failure rates make it critical for prescribers to know how to safely and effectively switch antidepressants to ensure patient-treatment targets are met.” Other publications put the figure at nine percent, one-third or two-thirds. Whichever is correct, it’s a substantial number.
One method of switching medication is simply called “the switch.” The patient goes off one drug and onto the other. But there are problems with that, including drug interactions between the old medication and the new one.
The technique most recommended is the one that my previous psychiatrist used with me, which is known as “cross-tapering” – tapering down on the first drug and then ramping up on the second. A “wash-out period” when no drug is given allows time for the first med to clear the body before the second is given. This is promoted as the safest method.
I can testify that it is also the slowest and most miserable. Going off one drug, being basically unmedicated while you wait for the second drug to ramp up, and then possibly going through the whole process again when the second drug doesn’t work either (or has side effects you can’t tolerate) is brutal. I went through the process more than once, and it was hell. Basically, it took me back to full-strength depression during the wash-out period and minimal to no effect as the new drug being tried ramped up.
However, eventually, we found a drug that made a huge difference and that, in conjunction with my other medications, allowed me to function almost normally. Close enough for jazz, as they say. The recent adjustment in dosage does not appear to be having much of an effect yet, but I didn’t expect it to. Pretty soon, relatively, I’ll know. And if it doesn’t help – or if it induces side effects – I still have my psychiatrist’s phone number.