Polly Pharmacy? Who’s she?

Today I’m reflecting on a comment. A few days ago a relative asked if I wanted a glass of wine with dinner; I declined, explaining it didn’t mix well with my meds. Someone else, overhearing this, expressed irritation that my partner Tom and I “go on” about our meds. I keep pondering this. Do I (we?) talk about meds too much? And are others right to be annoyed? I know I mention them a lot, especially around mealtimes – some have to be taken with food, others before meals, and if I mistime a does it’s a challenge not to fall asleep with my face in my plate. I guess the simple fact is that I do talk about them a lot, because that reflects their massive impact on my life. Trying to manage them takes up almost as much mental space as managing the bipolar itself.

My meds have long affected whether I can go out – to choir, say, or an evening class – and get myself safely home again. They have impacted for years on my ability to get up early for work or travel. They affect whether and when I can drink alcohol; whether I can stay awake until the end of favourite programme; what my energy levels will be like for the day. My life revolves around repeat prescriptions and making sure I don’t run out, particularly around Bank Holidays or trips away from home. I am constantly aware of the need to make sure I’m well hydrated and book in for regular blood tests (lithium), and to take care when it’s hot so I don’t get sunburn or sunstroke (quetiapine). I have for some time now also taken drugs for the side effects of the bipolar medications. I cannot tell you how I resent the fact that I must take unpalatable laxatives daily, without fail, or endure severe bowel problems. Since the summer I have also been on a daily blood pressure drug (both quetiapine again).

But as I say, it’s not just me. Tom takes meds for two conditions, again in different combinations at different times of day. To some extent our daily life is dominated by the drugs we need. Before we leave the house we ask each other, “Have you got your meds?” and at mealtimes, “Have you taken your meds?” If we go out we pop just enough for the evening into my handbag. Perhaps my medication use has become normalised by this, and by association with others who take prescribed drugs. After all, most – not all, but most – people I know with a mental health condition take medication.

In accordance with suggestions from the National Mood Disorder Service, I have recently started thyroid augmentation and I’m also titrating upwards towards a therapeutic dose of lamotrigene. The addition of lamotrigine means I now have to stay vigilant for nasty rashes, although hopefully by this point in treatment I have escaped the one that’s potentially fatal (joy!). I was also recommended pregabilin for anxiety. I am glad of this, as just as my moods have stopped swinging back and forth, acute anxiety has started to rear its head. It’s really quite debilitating and I‘ve become slightly worried about just how much diazepam I am using to cope; it’s just not a viable longer-term option, so as of today, pregabilin is in the mix too.

The idea is that once I am sufficiently stabilised on the lamotrigine, we can begin slowly withdrawing the quetiapine (the lithium will stay). But we’re not at that point yet, and as a result I now take fourteen different pills and one sachet of medication every single day:

  • levothyroxine for mood
  • lamotrigine for mood/rapid cycling
  • quetiapine for mood stabilisation/anti-manic
  • lithium for mood stabilisation
  • pregablin for anxiety
  • losartan to tackle the high blood pressure caused by the quetiapine
  • senna to tackle the bowel problems caused by the quetiapine
  • Movicol, again for the bowel problems

In other words, I am well into the realm of polypharmacy. Health think tank The King’s Fund defines the term as “the concurrent use of multiple medications by one individual” and notes that in the context of an ageing population it is increasingly common. Traditionally, polypharmacy has been seen as something as something rather negative and as something “done to” patients, particularly vulnerable or older adults, without due care for the overall impact of multiple medications. Indeed I am fully expecting this post to generate horror from the anti-psychiatry brigade and concerned comments from friendly clinicians worrying that I’m on far too many drugs. The King’s Fund however notes that it can be beneficial in some contexts, and suggests it may be more appropriate to distinguish between “appropriate” and “problematic” polypharmacy.

Is polypharmcy appropriate in my case? Yes, I think it is. I’ve gone from unmanageable rapid cycling to mood stability in a couple of months, although as I say the anxiety really needs some work. But of course there are downsides. Without pre-payment, all my drugs plus additional diazepam would set me back just over £70 a month. I do worry about the cost to the NHS – although I have to remind myself they are this remains a cheaper option than Home Treatment or inpatient care. The main consequence for me is that I now have to manage a significantly increased number of pills, taken at three different points throughout the day (formerly two), something I would fail woefully at without a huge dossette box and a pill reminder app. I find it harder and harder to remember exactly how much of each drug I am on. Away from home recently and faced with the possibility having to ask a local doctor for an interim prescription, I realised that for the first time in my life I was not entirely sure of all the doses of all my meds.

So maybe I do “go on” about my meds. But that’s because living with polypharmacy is complex, sometimes difficult, and the consequences of getting it wrong could be huge. I guess I feel that saying that a disabled person “goes on” about any form of treatment is essentially saying that they “go on” about their disability – after all, no disability, no meds. Not having to take meds confers a level of freedom and privilege that younger and/or non-disabled people probably don’t even realise they have. When I took one or two pills daily of a single antidepressant, I had no clue. Yes, I fell into the camp of those maligned by pillshamers, but taking my single drug at the same time every night right before I went to sleep had no real negative effect on my life. Right now the ups currently outweigh the downs, and after all, the goal is to reduce the use of some drugs by the introduction of others. So for the moment, Polly is my friend. Even if she makes me rattle.

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About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
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8 Responses to Polly Pharmacy? Who’s she?

  1. LisaSaysThis says:

    I thought this was extremely useful for anyone on medication. And I suspect the people who describe someone else “going on” about something clearly so important lack what shines through in all your blogs, which is compassion for others.

    All I have to do is remember my daily dose of sertraline and to change my oestrogen patch twice a week. I’ve gone from feeling that I’m weak for needing them, through I don’t really deserve the excellent care I get, to where I am now. Which is that taking my medication as prescribed is an act of self-compassion and a reminder that I matter – to myself and to others.

    And so do you. Am so pleased that Polly is helping you. If and when you need less of her help will be a decision for you with your clinical team. And no-one else xxx

    • You are lovely (as always!). I’m not ashamed of what I take but I can see how people could be made to feel that way. I can also understand how someone who doesn’t take any drugs could simply fail to understand how life can get to revolve around what you take and when. Hopefully all this won’t be forever! xxxx

  2. tigtigs says:

    What a great article! I too am frineds with Polly and while it brings disadvantages it makes my life liveable and bearable. My partner is a diabetic and so like you we both rely on meds to keep us alive…………..

  3. luvintheprof says:

    Hi, Charlotte. I’m just curious as to how yourself and Tom dealt with the situation at the time. Did any of you say anything to the “someone else” who got a bit narked about you guys “going on” about your meds? I know you were really upset about this and I know I would’ve been to. They should just thank their lucky stars that they’re not in your shoes and have to take the amount of meds that you do on a daily basis. It sounds likes a full time job in itself! Can I just say that I was so sorry to hear of your MIL’s passing. From what I heard you say about her, she sounded like a really lovely lady. She’ll be very missed by all her family and friends, I’m sure. Sending love and hugs from “Bonnie Scotland”. xXBrendaXx

  4. TheManInWolverhampton says:

    Hi, Charlotte. Having previously spent a prolonged period on Citalopram due to an anxiety-depressive condition, I can say that the medication really did give me that ‘extra crutch’ that helped prevent my mind spiraling out of control and that it became a “vocal” part of my life in two ways. The first was because I felt that being open about it was not because I wanted to draw attention to it explicitly, but I felt that my recovery at the time was in part based on the acknowledgment and then acceptance of my mental “frailty”. The second was when I went out of town for a few days and forgot my meds and the withdrawal was … very interesting. I realised then that, for the duration I was on them, the meds were going to be an important aspect of my life. From my own observation, I think people that have the kind of attitude you speak of are those that have had the great fortune not to have been adversely affected by a mental condition and therefore just cannot understand what it is like when it manifests itself… I don’t think anyone can “appreciate” the journey of mental health unless having had to travel the path themselves. Thank you for your blog – your journey provides a great insight. x

  5. Bipolar Pharmacist says:

    I was recently diagnosed as bipolar in November; Started on lamotrigine and slowly titrated up. I’m now on 300 mg daily + 800 mg of quetiapine. I look forward to getting rid of the quetiapine one day BUT it won’t be soon as we tried to back off and things did not go well! I don’t know if you’ve ever tried it but I’ve found acidophilus helpful for the constipation with the quetiapine, 2 tablets a day (mine’s the 1 billion/million cells) and I stay regular! of course also making sure to drink plenty of water (but I know you have the lithium to watch out for) I’ve been unlucky since i hit 200 mg of lamotrigine to be plagued by sweating and now that I’ve hit 300 mg of lamotrigine sweating and drowsiness! If my mood wasn’t so great right now I would be pushing my doc to change things up! I don’t know if you have genetic testing in England but we found it really helpful in planning what my medication future looks like. 🙂 And I think it’s really rude of someone to comment on your meds! I really look forward to your posts, I loved to read them as a clinician before I was diagnosed and now to learn more about your experiences so I can be better prepared for the future! Thanks for writing this blog!!

  6. i honestly can’t see why anyone would have a problem with somebody discussing their meds!!

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