Taking Psych Meds as Prescribed

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I don’t think I’ve ever really taken medicine from the pharmacy the way it was intended. I know I never read the package inserts. Or I rarely do so, I should say. Recently I had a chance to attend the Maryland DUR (drug utilization review) board meeting held virtually in my area. It was eye opening re: pharmacy procedures and protocols, and also alerted me to what I didn’t notice about my own pharmaceutical issues.

When you get a prescription filled, there’s typically a ton of paperwork involved. You may have a paper script from your dr., you’ll need to fill out intake forms at the pharmacy when it’s your first time there, and you have to wade through lengthy insurance processes to get certain medications authorized. The last thing you want to do is read anymore papers or research how to take your meds properly.

When I’m given my medication bottles, I tend to throw away the package inserts and only handle the physical bottles. What I didn’t realize is that by doing this, I was missing vital information about how to take my pills. Additionally, without a regular consult from my prescribing physicians or the pharmacist, it’s been hard for me to recognize the importance of label reading/following the directions.

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Lately I’d been noticing a recurrence in my bipolar symptoms. And I also saw an increase in other negative behaviors associated with my chronic health conditions. It was concerning to me and my support team. Then I realized that part of the problem is how I’m taking my medicine, and my adherence, or lack thereof, to the strict guidelines given with each medication.

So, I pulled out all my pill bottles and decided to read the labels. Boy was it enlightening. Take, for example, Ritalin or methylphenidate. On the back of my bottle it reads, “take this medicine 1/2 to 1 hour before meals.” And, “Check with your doctor or pharmacist to make sure it is safe for you to take this drug with all of your other drugs.” I never knew I was supposed to do this.

With my buspirone, the front of the bottle says, “take 1 tablet by mouth 2 times per day.” And on the side of the bottle there’s a table that indicates I should take one tablet in the morning and one in the evening. Until this morning, I’d never seen that part of the medication label. I’d never put together what two times per day meant. After reviewing all of my medicines, I knew that my symptom issues largely had to do with incomplete compliance with directions.

Part of me is annoyed that it took this long for me to figure this out. And part of me knows that this is a better late than never situation. Had I not attended the DUR meeting, I wouldn’t have thought about reviewing my medication history and going through my supplies. Sometimes it takes an event outside of your control to help get you back on track. In my case, it was an educational event I attended for the purposes of my advocacy work. So this turned out to be a blessing in disguise.

Bipolar and Menopause, UPDATE

I’m on my millionth night of little to no sleep, and I just started singing to myself, “this manic moment…” to the tune of Ben E King and The Drifters’ iconic song. It’s the middle of summer, and my mania seems everlasting. What began as hypomania in the middle of the spring, has turned into full blown mania that won’t quit.

Usually, I can get a handle on things and the hypomania dies down long before this point. But this time its spinning out of control and I can’t seem to get my meds in synch with my moods. It’s frustrating.

Adding to the confusion is the onset of menopause and my thyroid disorder. I have a nodule which is wreaking havoc with my mental and physical health. The thyroid nodule is increasing my night sweats, anxiety, irritation and hyperactivity. And so is the change of life. It’s like a double dose of hormones and agitation thrown at me all at once. I feel like I can’t cope.

My brain is going haywire. Sometimes I’m not sure which emotion to use for a scenario or which facial expression. I notice myself singing a lot more, loudly, and laughing at inappropriate times. This is all troubling.

So what to do about this dilemma? Well, I’ve made an appointment with a new therapist and I have a new sleep doctor and neurologist as well. I will be discussing these issues with those specialists and asking for their guidance. I also need to work on my sleep hygiene and diet. But for that, I need to the help of a nutritionist or dietitian. My eating disorder has also been affected by these illnesses.

I’m not daunted by everything that’s happening but I am appropriately concerned. But as long as I keep in touch with my doctors and have a solid support system, things should work out just fine.

Learning to Accept Mania

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“Sakinah, can I ask why you got another tattoo? I just want to understand.” Someone said this after I had gotten my latest ink during a bout of mania. A simple “I don’t know”, had been my answer then. Regretful, and filled with shame, I thought I owed this person an explanation. But I didn’t have one. I mean, hey, I was manic. It seemed like a good idea at the time. Everything seems like a good idea when you’re in that mode. But I couldn’t say that. Nobody I know would understand what that means. Considering I’m a pretty ‘by the book’ Muslim, how could it seem like a good idea to do any of the things people do during mania? Those things are forbidden to me. But what people don’t get is that brain disorders like bipolar don’t discriminate. Mental illness is an equal opportunity disease. It can strike anyone, anywhere, and at any time.

I remember having an interesting conversation with an intake nurse at NIH a few years ago. She was screening me for a clinical trial with bipolar patients. I really wanted to participate in this trial because I wanted one on one care from NIH specialists. I also thought it would be good to see if a new treatment regimen would work for me. The nurse started asking about my episodes and how my behavior changed. “Do you binge on alcohol/drugs? Do you spend a lot of money? Are you impulsive? How long do typically you stay awake? Have you gotten tattoos? Do you dress differently?”…

The questions got more and more embarrassing and hit too close to home. I firmly told her that I was a Muslim and so some of those things couldn’t apply to me. I was wrong of course, I was just too ashamed to admit what I had done to a stranger. I couldn’t admit it to myself really. She corrected me saying, “That’s what mania is. If you haven’t done these things, not only is your diagnosis wrong, but you also don’t qualify for the study. Bipolar doesn’t care what religion you are.”

Needless to say I felt a bit sheepish after that. It bothered me that I had tried to mask my illness with my faith practice. I’m not sure why I did that. I knew what she was saying was true, I just hadn’t wanted to acknowledge the toll bipolar disorder had taken on my life. After talking with the nurse, I started looking at my diagnosis differently. I no longer wanted to shy away from what happened to me during an episode, because I knew I was sick. I’ve since decided to forgive myself for my past, and hopefully over time, the people around me will forgive me too.


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