Medication? Who me?

Lithium Capsules...truly a lifesaver for me.

Yeah, I'm still on my bipolar thought process roll. It doesn't usually last so long, but here we go again.

I am a terrible patient/former RN when it comes to my own medication compliance/adherence (adherence is the new "feel good" terminology since it doesn't make a accusation regarding the patient). I am one of those nurses who unfortunately lives by the "Do as I say, not as I do" motto. I've been on and off meds for my bipolar disorder since 1997. When I'm on the, most of the time I'm pretty stable or "normal" by some people's definition. Like I've said before I don't believe in "normal" anymore, I much more prefer "stable."

Anyway, there are times that I stop my meds on my own...and I mean abruptly stop them, something that should not be done with psychotropic meds...just because I'm feeling really good AKA in a hypomanic episode. I don't recommend stopping meds without talking to your psychiatrist, but if you do do so taper them down over a couple of weeks do not ever just suddenly stop them! Like I said I really recommend talking to your doc first...I'm a little dangerous because I have that extra knowledge that lay people don't typically have. During these episodes I really feel more like my old self than ever...except that I tend to overspend, have issues with lack of sleep or not sleeping at all, racing thoughts, etc. but I've never gone into a full blown manic episode that becomes possibly life threatening because there's a lot more risk taking involved. It's not uncommon for those with bipolar disorder to think that they feel good so they don't need their meds when the reverse is actually true. Mood stabilizers will help quell down the overly active/risk taking behaviors and in extreme cases an anti-psychotic may be needed in addition to the mood stabilizers to maintain the moods in check. Typically both these medications will be taken long term.

For depression of course antidepressants are prescribed. The problem is that antidepressants can actually trigger a  hypomania or mania. So it's not uncommon (or it shouldn't be) to only use antidepressants for short term...what I mean by that it 6-12 months. Please remember I was studying and two semesters shy (2 clinical courses and 2 theoretical courses from graduating as a prepared Pysch/Mental Health advance practice nurse or qualified to certify as a PMH-NP) of graduating so that's where a lot of my statements are built from...my educational background. After the prescribed use a trial off the antidepressant should be attempted and if all goes well the patient may be taken off the med...if it doesn't go well they stay on or maybe try a different one.

I digress, so on those occasions when I do stop my meds it can just be a few days simply because I forgot, or weeks & months (I've been off my meds for about a month and a half and just restarted taking them yesterday) simply because I feel "good" and I've even gone years off of them always crashing big time into a long lasting, severe and even suicidal depression. It's stupid. I was an RN for 22+ years, I taught psych/mental health nursing for 4 years and I've been diagnosed for 15+ years. You'd think I'd have my head all together and a grasp on this, but no.

So right now in Spring through the Summer this is when I can almost guarantee that I'll drop into a severe depression. I'm actually surprised that it hasn't happened considering how long I've been off my meds, but it's enough to scare me into starting them up again. To help with this I have a 7 day pill box to set up all my twice daily meds...OK, I have it somewhere but I can't find it but that's what I usually use to keep my meds straight. I've also downloaded an app called MyMedSchedule that has charts you can print out to track your meds and mobile apps for iPhone and Android that can be set up to send you email and SMS reminders to take your meds at whatever setting you determine. Once I got this set up correctly I started getting my reminders...now if only they could send reminders to Twitter/Facebook since I'm always on those and sometimes allow my phone and tablet to die and forget to recharge them.  However, the email can also be seen on your regular email account...as long as you check it regularly or have some sort of pop-up set up for the message when it comes in. Hopefully this will be something hat really helps with my med adherence.

Yes, this is in face my actual printable med schedule/checklist from MyMedSchedule

The printable medication schedule from MyMedSchedule

I've got one and a half days of medication on board and because I am familiar with the intricacies of these meds I know which ones that I can return to a full dose and those which I need to taper up to my normal does over several days. Depending on your meds never go straight back to the dose you were on unless you talk to you psychiatrist!! It can be dangerous to do so...and please don't decide that you're going to catch up on several days of medications all in one go. I know a lady who ended up and the mental health unit with me during my first psych hospitalization because she took  a week's plus of medications when she expected her husband to come back from a business trip!!

So to anyone out there who maybe having to deal with medication adherence issues whether it be psychotripic meds or regular medical medications take a look at MyMedSchedule. It may be of assistance. Good luck to us all!

UPDATE 3/25/13 at 11:55am;
I'm gonna try something a little different in addition to a hard copy checklist. If you look on the right hand sidebar you'll see a new page "Medication Accountability Checklist." this is the same info as on the checklist above but available online. Some people may wonder why I am so public about my meds, it's because I choose to do so. I'm not violating anyone else's HIPPA rights. I choose to try this and see how it goes. Let's see if I can remember to update it daily!